Call Center Productivity Over 6 Months Following a Standing Desk Intervention

Abstract

Background:Many office employees are spending up to 90% of their workday seated, and employers are considering stand-capable desks as a way to increase physical activity throughout the day. When deciding on adoption of stand-capable workstations, a major concern for employers is that the benefits, over time, may not offset the initial cost of implementation. Methods: This study compared objective measures of productivity over time between a group of stand-capable desk users and a seated control group in a call center. Comparison analysis was completed for continuous six-month secondary data for 167 employees, across two job categories. Results: Users of stand-capable desks were ∼45% more productive on a daily basis compared to their seated counterparts. Further, productivity of the stand-capable desk users significantly increased over time, from ∼23% in the first month to ∼53% over the next six months. Finally, this productivity increase was similar for employees across both job categories. Conclusions: These findings suggest important benefits of employing stand-capable desks in the work force to increase productivity. Prospective studies that include employee health status, perceptions of (dis)comfort and preference over time, along with productivity metrics, are needed to test the effectiveness of stand-capable desks on employee health and performance.

Full text

Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=uehf20
Download by: [209.21.112.18] Date: 07 June 2016, At: 08:18
IIE Transactions on Occupational Ergonomics and Human
Factors
ISSN: 2157-7323 (Print) 2157-7331 (Online) Journal homepage: http://www.tandfonline.com/loi/uehf20
Call Center Productivity Over 6 Months Following a
Standing Desk Intervention
Gregory Garrett, Mark Benden, Ranjana Mehta, Adam Pickens, Camille Peres
& Hongwei Zhao
To cite this article: Gregory Garrett, Mark Benden, Ranjana Mehta, Adam Pickens, Camille
Peres & Hongwei Zhao (2016): Call Center Productivity Over 6 Months Following a Standing
Desk Intervention, IIE Transactions on Occupational Ergonomics and Human Factors, DOI:
10.1080/21577323.2016.1183534
To link to this article: http://dx.doi.org/10.1080/21577323.2016.1183534
Accepted author version posted online: 24
May 2016.
Published online: 24 May 2016.
Submit your article to this journal
Article views: 1896
View related articles
View Crossmark data

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
1
Garrett et al.
Call center productivity
Call Center Productivity Over 6 Months Following a Standing Desk Intervention
Gregory Garretta,*, Mark Bendena, Ranjana Mehtaa, Adam Pickensa, Camille Peresa, and
Hongwei Zhaob
aDepartment of Environmental & Occupational Health, Texas A&M Health Science Center
Texas A&M University, 109 SPH Administration Building, College Station, TX 77843-1266,
USA;
b Department of Epidemiology & Biostatistics, Texas A&M Health Science Center, Texas A&M
University, College Station, TX, USA
*Corresponding author. E-mail: ggarrett@sph.tamhsc.edu
Color versions of one or more of the figures in the article can be found online at
www.tandfonline.com/uehf.
Occupational Abstract Stand-capable desks have been shown to successfully reduce sedentary
behavior in the modern office, but whether their utilization improves cognitive productivity is
not known. We compared productivity between stand-capable desk users and traditional seated
desk users in a call center environment. Data were collected daily over a continuous six-month
period. We found that increased stand-capable desk use is a likely contributor to increased
productivity over traditional seated desk use. These findings indicate that use of stand-capable
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
2
desks as ergonomic interventions to improve physical health among employees may also
positively impact their work productivity.
Technical Abstract
Background: Many office employees are spending up to 90% of their workday seated, and
employers are considering stand-capable desks as a way to increase physical activity
throughout the day. When deciding on adoption of stand-capable workstations, a major
concern for employers is that the benefits, over time, may not offset the initial cost of
implementation. Methods: This study compared objective measures of productivity over time
between a group of stand-capable desk users and a seated control group in a call center.
Comparison analysis was completed for continuous six-month secondary data for 167
employees, across two job categories. Results: Users of stand-capable desks were ~45%
more productive on a daily basis compared to their seated counterparts. Further, productivity
of the stand-capable desk users significantly increased over time, from ~23% in the first
month to ~53% over the next six months. Finally, this productivity increase was similar for
employees across both job categories. Conclusions: These findings suggest important
benefits of employing stand-capable desks in the work force to increase productivity.
Prospective studies that include employee health status, perceptions of (dis)comfort and
preference over time, along with productivity metrics, are needed to test the effectiveness of
stand-capable desks on employee health and performance.
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
3
1. INTRODUCTION
It is estimated that most American adults spend 8–9 hours of their daily waking time
sedentary, with most of this sedentary time due primarily from their office environment (Straker
et al., 2013). Sedentary behavior has been linked to mortality and several negative health
outcomes including obesity, cardiovascular disease, and cancer (Katmarzyk, et al., 2009;
Tremblay et al., 2010). Research has indicated that this may be true even for those who are
meeting recommended physical activity guidelines (Hamilton et al., 2008; Katmarzyk et al.,
2009). In particular, call center operators have been observed spending ~ 90-95% of their work
shift in their seats and work long hours without breaks (Rocha, et al., 2005; Kress, 2014).
Working adults in call centers spend nearly 90% of their work time sedentary as opposed to one-
third or one-half for other office employees (Straker et al., 2013). Consequences of prolonged
sitting include lower back pain and body discomfort (Rocha, et al., 2005; Marshall, et al., 2010).
These outcomes can impact productivity; increased discomfort at daily work tasks has shown to
result in perceived productivity losses of 10% to 20% (Hagberg, et al., 2002; Wahlstrӧm, et al.,
2004).
Excess sedentary time has been linked to obesity, which in turn has been implicated in
higher risks for cardiovascular disease, diabetes, and cancer (Katzmarzyk et al., 2009, Tremblay
et al., 2010, Dunstan et al., 2012). Sit-to-stand desks, as an office ergonomics solution to this
problem, have the potential to improve caloric expenditure and reduce sedentariness in the
workplace (Alkhajah et al., 2012, Pronk et al., 2012, Grunseit et al., 2013; Commissaris et al.,
2015). However, the sustainability of sit-to-stand desk usage in maintaining physical activity and
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
4
reduction in sedentary time within occupational settings has been a challenge (Wilks et al., 2006;
Toomingas et al., 2012; Straker et al., 2013). Nonetheless, the perceived benefits of stand-
capable office environments, which include declines in musculoskeletal complaints, augment the
health benefits reported in previous studies (Alkhajah et al., 2012, Pronk et al., 2012, Grunseit et
al., 2013).
Among adults, the use of standing desks on modern office tasks in an experimental study
has been shown to reduce discomfort over time (~15 weeks), which has been argued to positively
affect task performance (Robertson et al., 2013). Thus, it is likely that stand-capable office
environments facilitate work efficiency and productivity in adults, similar to that observed in
adolescents. However, in a simulated office environment/work study, Husemann et al. (2009)
reported that stand-capable offices do not significantly impact productivity. Because that study
examined the impact of acute standing (~1 week) on efficiency of simulated work, it remains
unknown whether continued exposure to standing affects work productivity in-situ occupational
environments. It is important to examine this relationship in a naturalistic work environment,
however, as the sustainability of office ergonomics solutions relies on whether these
interventions present productivity and task interruption challenges.
The present study investigated the impact of stand-capable workstations (sit-to-stand and
stand-biased) in a call-center on employee productivity over a six-month period. Productivity
data, based on the number of successful encounters per hour, was collected by the company’s
proprietary software. It was hypothesized that employees assigned to stand-capable desks would
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
5
demonstrate higher productivity than those in the traditional seated desks, and that these
differences will be sustained over the six-month period.
2. Methods
2.1. Subjects
As part of normal business operations, data on employee’s performance were collected
daily and as a condition of employment, the company reserves the right to use that information
for research purposes. Therefore, de-identified secondary data were provided to Texas A&M
researchers for analysis without the need of informed consent from the employees. Study
participants included 167 employees in a call center (118 females and 49 males) who provided
telephonic health and clinical advising. The study participants’ workstations consisted of
traditional seated workstations, sit-to-stand workstations, and stand-biased workstations. A prior
study on this population indicated small differences in standing behavior between participants
using stand-biased and sit-to-stand workstations (Kress, 2014). Therefore, for the purposes of
this study, the stand-biased and sit-to-stand workstations were combined into one category and
are referred to as stand-capable workstations going forward. In addition, the prior study (Kress,
2014) administered online surveys that collected information as self-reported seated time,
biometrics, body discomfort, and musculoskeletal symptoms (Kress, 2014).
The intervention group consisted of 44 health advisors (Stand-HA: 23 females, 21 males)
and 30 clinical advisors (Stand-CA: 28 females, 2 males), all of whom had stand-capable desks.
The control group consisted of 58 health advisors (Sit-HA: 33 females, 25 males) and 35 clinical
advisors (Sit-CA: 34 females, 1 male), all of whom had traditional seated desks. Because the
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
6
call-center installed new desks for a new employee cohort, the Stand-CA and Stand-HA groups
were new employees, having been with the company for 3 months or less, whereas the Sit-CA
and Sit-HA employees had been employed for one year or more. To minimize confounds of
employee experience, only those employees who had been employed for a minimum of 30 days
and were working at the stand-capable or traditional seated workstations, were included in the
study. Since this study occurred in an in-situ occupational environment, rather than in a
controlled laboratory environment, attrition did occur. The retention rates were as follows:
Stand-HA 93%, Sit-HA 93%, Stand-CA 83%, and Sit-CA 89%. In all attrition cases, employees
left the company or transitioned to a different job within the 6-month period and thus had to be
excluded from the study.
2.2. Equipment
Both the sit-to-stand and stand-biased workstations used a SteelCaseTM (Grand Rapids,
Michigan) Series 5 Desk that had an electric motor allowing it to adjust from 64.77cm to
129.54cm tall. This allowed the user to press an up or down button to adjust the desk surface to
proper height for sitting (68.58-78.74 centimeters) and proper height for standing (93.95-116.84
centimeters) (ANSI/HFES 100, 2012). The sit-to-stand workstations had a standard height task
chair, The SteelCaseTM Think Chair Model 6205, which has a seat height that can be adjusted
between 40.64 centimeters and 53.34 centimeters (Figure 1).
The stand-biased workstations had a raised height or bar height task chair. The Neutral Posture
Inc. (Bryan, Texas) U4IA4692 Mesh Back Stool was used, with attached foot platform at 15.24
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
7
and 25.4 centimeters and a seat height that can be adjusted between 64.77 and 91.44 centimeters
(Figure 2).
Footrests that allow a user to prop one foot up at 20.32 or 30.48 centimeters were purchased for
stand-biased desk users. Anti-fatigue mats were purchased for sit-to-stand users. Monitor arms
for a dual monitor set-up were purchased and installed at each workstation. The seated
comparison group was seated in groups of six at a traditional desk with monitor arms for a dual
monitor set-up (Figure 3).
2.3. Data Collection
The stand-capable desks were installed in the call center late January 2013 as part of a
major addition of newly hired health and clinical advisors, and the new employees were
relocated to the new facility the beginning of February 2013. Since the new employees were
assigned to the stand-capable workstations by the company, the sample is one of convenience
rather than random assignment. Following approval by the Texas A&M Institutional Review
Board, data collected by the host company’s proprietary software was de-identified and provided
for analysis. Quantitative productivity data was collected daily over a continuous six-month
period (March 2013 through August 2013). Productivity data, based on the number of successful
encounters per hour by advisor, were collected by the company’s proprietary software. As
defined by the company, successful encounters were considered to be the completion of a call
with a member in which the advisor reviews previous goals and sets a new goal. During a call,
the advisor speaks with the member, takes notes, asks questions, and performs tasks within the
computer system which includes updating the member’s profile and goals. Specifically for health
4 4
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
8
advisors, the company generates revenue on the number of reported successful calls. The
company links calls and outcomes to the calls digitally and records related parameters such as
time on the call. Revenue for the company is directly tied to successful calls and those calls
average a value of $100 each, which is comparable to national trends. A successful encounter per
hour rate was calculated for each participant and means were obtained across each month for the
six-month period.
The control groups had been employed with the company longer than the comparison
groups and had the potential for higher accrued time off (vacation/sick leave). To address this,
total time on dialer (TOD), which is a measure of an advisors availability to make or take calls,
was calculated over the 6-month period and analyzed for group and job type differences.
2.4. Statistical Analysis
The dependent variable, mean successful encounters per hour, was visibly checked for
parametric assumptions and a follow up Shapiro-Wilk test determined that the data were
normally distributed. Two clinical advisors (one each from Sit and Stand groups) were excluded
from the study because their productivity data for four months were not available. A three-way,
mixed-factor analysis of variance (ANOVA) was performed to examine the effects of
intervention group (control vs. stand-capable desks), job category (health vs. clinical advisor),
and time period (6 months) on mean successful encounters per hour. An independent t-test was
conducted to determine group and job type differences for TOD. Statistical significance was
determined when p < 0.05. Significant interaction effects were examined using pairwise
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
9
comparisons with Bonferroni corrections as required. All statistical analyses were conducted
using SPSS 22 (IBM SPSS Statistics). Summary data are presented as means (SD).
3. RESULTS
Based on the online survey data collected in the prior study (Kress, 2014), self-reported
seated time showed that those on the stand-capable side of the call center were seated for a mean
of 72-73% of their day compared to those on the seated control side that spent 91% of their day
seated (Kress, 2014). Additionally, at 6 months, nearly 75% of those with stand-capable
workstations experienced decreased body discomfort compared to the seated controls who
experienced no statistically significant decrease in body discomfort (Kress, 2014). There was not
a statistically significant difference in TOD between stand-capable and seated groups ( t(101.18) =
.271, p = .787).
A significant group x time interaction (F(5, 111) = 5.97, p < 0.0001, partial η2 = 0.051; Fig.
4) was found. Pairwise comparisons between groups for each month revealed that the effect of
the intervention was significant from the 2nd to the 6th time period (all p < 0.005). Main effects of
group (F(1, 111) = 60.13, p < 0.0001, partial η2 = 0.351), job category (F(1, 111) = 65.52, p < 0.0001,
partial η2 = 0.375), and time (F(5, 555) = 21.1, p < 0.0001, partial η2 = 0.16) were found on
successful encounters. Productivity among employees with stand-capable desks was ~46%
higher than that among those with traditional seated desks (1.26 (0.38) successful encounters/hr).
Additionally, health advisors demonstrated ~48% increase in successful encounters/hour when
compared to clinical advisors (1.24 (0.37) successful encounters/hr; Fig. 5). In general,
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
10
productivity during the first three months was greater than during the last three months of the
six-month period.
DISCUSSION
We compared the effects of stand-capable offices (sit-to-stand and stand-biased
workstations) in a call-center on employee productivity over a six-month period. Productivity
across two job categories, health advisors and clinical advisors, were obtained using the
company’s performance metric software. The main findings were that employees assigned to the
stand-capable desks demonstrated higher productivity than those in the traditional seated desks,
particularly from the 2nd to the 6th month, and that this trend was consistent across both the health
and clinical advisors.
On average, stand-capable health advisors had 0.5 more successful calls per hour during
the 6-month period than their seated counterparts. As the company generated revenue based on
the completion of successful calls, significant additional revenue was realized. Similarly, stand-
capable clinical advisors had 0.4 more successful calls per hour per clinical advisor during the 6-
month period, compared to the traditional seated clinical advisors group. Clinical advisors do not
generate revenue on a fee per successful call rate as health advisors; rather the reduction in health
care utilization over the year determines the amount of fees paid to the company. As the stand-
capable clinical advisors had a higher successful daily call rate than the traditional seated clinical
advisors, the opportunity exists to decrease health care utilization costs at a significantly higher
rate. While health advisors had significantly higher successful calls per hour than the clinical
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
11
advisors (owing to the nature of their job), the positive impact of the intervention was similar
across both job categories.
There are several studies that suggest an inverse relationship between productivity and
body discomfort (Davis & Kotowski, 2014; Robertson, et al., 2013; Karakolis & Callaghan,
2014). Aligned with findings from these studies, Kress et al. (2014), who used the same study
participant pool and study design as the current study, found that employees assigned to the
stand-capable workstations reported significantly lower body discomfort compared to the seated
controls over the six-month period. Previous research on standing desks utilization and
associated comfort requires a habituation period of few weeks (Kress et al. 2014). It is likely that
this habituation was associated with similar productivity levels between the two groups in the
first month, with benefits beginning to show from the second month onwards. However, it can be
counter argued that decreased body discomfort alone may not be indicative of increased
productivity observed in this study. It is possible that the same productivity could have been
achieved if body discomfort had been reduced even for those in the seated workstations through
effective ergonomic improvements in the seated workstations. Moreover, it is possible that the
change in discomfort observed in Kress et al. (2014) may be attributed to time on job, or other
factors that are related to the duration of employment, rather than the experience with the stand-
biased workstations. The authors believe that the 90 days of pre baseline for the newer workers
in the treatment group (60 days of training and 30 days of break-in doing their new jobs in the
stand capable workstations) was more than adequate to minimize experience variation between
groups. The fact that at 9 months total or 6 months into the measurement period the newer
workers were still having less discomfort and more productivity points to the value of the
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
12
workstation differences in the measured outcomes. As with any field research, more work is
warranted to determine the relationship between discomfort and improved performance in real
work scenarios with longer longitudinal investigations.
Previous studies have indicated that physical activity has substantial preventable and
restorative properties for cognition and brain function (Kramer & Erickson, 2007). Specific to
standing desk applications, cognitive benefits of standing desks have been previously established
in school-based intervention studies. For example, reducing sedentariness in school children has
been linked to improved student attention and focus (Koepp et al, 2012; Dornhecker et al., 2015),
and a more recent study showed that it improves basic cognitive functioning via enhancements in
the frontal regions of the brain (Mehta et al., 2016). While the current study focused on
secondary data analyses on productivity outcomes, cognitive metrics to examine standing
behavior benefits were not available. As such, future research should focus on obtaining
potential cognitive effects of increased physical activity through the use of stand-capable
workstations in both controlled laboratory and naturalistic field studies.
It is important to note both the strengths and limitations of this study. The study was
conducted in a company whose business is in the health promotion domain; it is possible that the
employees with stand-capable desks have a higher usage than other companies that are not
focused on health (e.g., information technology). In addition, owing to constraints out of scope
of the study, employees were not randomly assigned to the conditions and as such this may have
introduced selection bias. However, because employees were assigned to their workstations, this
is a strength of the study as it reduces or eliminates volunteerism bias therefore increasing the
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
13
generalizability of the study results to other populations. One other limitation should be noted.
Since the stand-capable advisors were dealing with new clients, it is possible that the client’s
population may have been highly motivated to engage with the advisors. It is possible that some
of the variance between the stand-capable and traditional seated advisors could be attributed to
differences in the populations they were attempting to engage. Moreover, employees assigned to
the stand-capable desks had been with the company significantly less than the traditional seated
advisors. However, to address this potential confound, study participation was limited to
employees who had been working independently for a minimum of 30 days (following a 60 day
training period) thus allowing new employees to habituate to sit-stand workstations as well as
increase their familiarity with company procedures and work practices. To further address
differences between groups, this study would have been strengthened considerably if pre-existing
performance data on the control (seasoned coaches) were available. Having this information may
have better addressed associated experience differences between the groups. Ongoing future
studies that include prior performance data on the control groups will be able to address this
particular limitation. Interestingly, even though advisors assigned to stand-capable desks had
been with the company significantly less than the traditional seated advisors, they still were able
to outperform the more experienced and seasoned advisors (who had been assigned to the seated
desks).
Finally, productivity was measured using the company’s proprietary software and thus
productivity metric algorithms were not made available to the researchers. Even though the
metric used to evaluate cognitive performance is specific to this company and potentially not
generalizable to non-call center environments, previous studies have used task complexity and
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
14
critical decision making as representations of cognitive demands and have reported increases in
cognitive performance while using sit-stand desks (Robertson et al., 2013). A strength of this
approach was that all the workers were monitored continuously and objectively thru digital
software recording of the desired outcomes as opposed to more common subjective and sampling
approaches used in other studies in this field. Our findings indicate that productivity improved
with the stand-capable desks, and as such the company was provided with a very relevant,
objective metric through which they can base strategic decisions on, whilst encouraging the
physical health of their employees.
In summary, we found that individuals that have the opportunity to stand throughout the
day can operate at higher productivity levels than those that do not have the capability to stand
while working. Questions remain as to the underlying mechanism(s) that impacted the
productivity results of these groups. It is possible that reduction in body discomfort, enhanced
cognitive function due to physiological changes, or a combination of these factors played a role
in the increased productivity for those in the stand-capable condition. Further work is warranted
to examine the effects of stand-capable desks, preferably through randomized controlled trials, to
establish their non-physical benefits, both at the basic (cognition) and at macro-organizational
(productivity, employee morale, etc.) levels.
Conflict of Interest
The authors declare no conflict of interest
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
15
References
Alkhajah, T. A., Reeves, M. M., Eakin, E. G., Winkler, E. A., Owen, N., & Healy, G. N. (2012).
Stand capable workstations: A pilot intervention to reduce office sitting time. American
Journal of Preventive Medicine, 43(3), 298-303.
ANSI/HFES 100. 2012. Human factors engineering of computer workstations (ANSI/HFES 100–
2012), Santa Monica, CA: Human Factors and Ergonomics Society
Commissaris, D. A., Huysmans, M. A., Mathiassen, S. E., Srinivasan, D., Koppes, L. L., &
Hendriksen, I. J. (2015). Interventions to reduce sedentary behavior and increase physical
activity during productive work: a systematic review. Scandinavian journal of work,
environment & health.
Davis, K. G., & Kotowski, S. E. (2014). Postural Variability: An Effective Way to Reduce
Musculoskeletal Discomfort in Office Work. Human Factors: The Journal of the Human
Factors and Ergonomics Society, 0018720814528003.
Dornhecker, M.; Blake, J.J.; Benden, M.; Zhao, H.; Wendel, M. The effect of stand-biased desks
on academic engagement: An exploratory study. International Journal of health
Promotion and Education 2015, 1-10.
Dunstan, D.W., Kingwell, B.A., Larsen, R., Healy, G.N., Cerin, E., Hamilton, M.T., Shaw, J.E.,
Bertovic, D.A., Zimmet, P.Z., Salmon, J., Owen, N., 2012b. Breaking up prolonged
sitting reduces postprandial glucose and insulin responses. Diabetes Care 35, 976-983.
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
16
Evans, R.E., Fawole, H.O., Sheriff, S.A., Dall, P.M., Grant, P.M., Ryan, C.G., 2012. Point-of-
choice prompts to reduce sitting time at work: a randomized trial. Am. J. Prev. Med. 43,
293-297.
Gilson, N. D., Suppini, A., Ryde, G. C., Brown, H. E., & Brown, W. J. (2012). Does the use of
standing 'hot' desks change sedentary work time in an open plan office? Preventive
Medicine, 54(1), 65-67.
Grunseit, A.C., Chau, J.Y., van der Ploeg, H.P., Bauman, A., 2013. "Thinking on your feet": A
qualitative evaluation of stand capablestand-capable desks in an Australian workplace.
BMC Public health 13, 365.
Hagberg, M., Tornqvist, E. W., & Toomingas, A. (2002). Self-reported reduced productivity due
to musculoskeletal symptoms: associations with workplace and individual factors among
white-collar computer users. Journal of occupational rehabilitation, 12(3), 151-162.
Hamilton, M. T., Healy, G. N., Dunstan, D. W., Zderic, T. W., & Owen, N. (2008). Too little
exercise and too much sitting: Inactivity physiology and the need for new
recommendations on sedentary behavior. Current Cardiovascular Risk Reports, 2(4),
292-298.
Hjelm, E., Karlkvist, L., Hagberg, M. (2000). Working conditions and musculoskeletal disorders
amongst male and female computer operators. IEA 2000/HFES 2000 Conference.
Husemann, B., Von Mach, C. Y., Borsotto, D., Zepf, K. I., & Scharnbacher, J. (2009).
Comparisons of musculoskeletal complaints and data entry between a sitting and a stand
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
17
capablestand-capable workstation paradigm. Human Factors: The Journal of the Human
Factors and Ergonomics Society, 51(3), 310-320.
Karakolis, T., & Callaghan, J. P. (2014). The impact of sit–stand office workstations on worker
discomfort and productivity: a review. Applied ergonomics, 45(3), 799-806.
Katzmarzyk, P. T., Church, T. S., Craig, C. L., & Bouchard, C. (2009). Sitting time and mortality
from all causes, cardiovascular disease, and cancer. Medicine and Science in Sports and
Exercise, 41(5), 998-1005.
Koepp, G.A.; Snedden, B.J.; Flynn, L.; Puccinelli, D.; Huntsman, B.; Levine, J.A. Feasibility
analysis of standing desks for sixth graders. ICAN: Infant, Child, & Adolescent Nutrition
2012, 4, 89-92.
Kress, M.(2014). The Use of Stand-Capable Workstations for Reducing Sedentary Time in
Office Employees, Doctoral Dissertation.
Kuorinka, I., Jonsson, B., Kilbom, A., Vinterberg, H., Biering-Sorensen, F., Andersson, G., &
Jorgensen, K. (1987). Standardised nordic questionnaires for the analysis of
musculoskeletal symptoms.Applied Ergonomics, 18(3), 233-237.
Marshall, S., & Gyi, D. (2010). Evidence of health risks from occupational sitting: Where do we
stand? American Journal of Preventive Medicine, 39(4), 389-391.
Mehta, RK, Shortz, AE, Benden, M. Standing Up for Learning: A pilot investigation on the
neurocognitive benefits of stand-biased school desks. Int. J. Environ. Res. Public health.
In Review.
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
18
Pronk, N.P., Katz, A.S., Lowry, M., Payfer, J.R., 2012. Reducing occupational sitting time and
improving worker health: the Take-a-Stand Project, 2011. Prev. Chronic Dis. 9, E154.
Robertson, M. M., Ciriello, V. M., & Garabet, A. M. (2013). Office ergonomics training and a
sit-stand workstation: Effects on musculoskeletal and visual symptoms and performance
of office workers. Applied ergonomics, 44(1), 73-85.
Rocha, L. E., Glina, D. M. R., Marinho, M. D. F., & Nakasato, D. (2005). Risk factors for
musculoskeletal symptoms among call center operators of a bank in Sao Paulo, Brazil.
Industrial health, 43(4), 637-646.
Straker, L., Abbott, R. A., Heiden, M., Mathiassen, S. E., & Toomingas, A. (2013). Sit–stand
desks in call centres: Associations of use and ergonomics awareness with sedentary
behavior. Applied ergonomics, 44(4), 517-522.
Straker, L., Levine, J., & Campbell, A. (2009). The effects of walking and cycling computer
workstations on keyboard and mouse performance. Human Factors, 51(6), 831-844.
Toomingas, A., Forsman, M., Mathiassen, S. E., Heiden, M., & Nilsson, T. (2012). Variation
between seated and standing/walking postures among male and female call centre
operators. BMC public health, 12(1), 1.
Tremblay, M. S., Colley, R. C., Saunders, T. J., Healy, G. N., & Owen, N. (2010). Physiological
and health implications of a sedentary lifestyle. Applied Physiology, Nutrition, and
Metabolism = Physiologie Appliquee, Nutrition Et Metabolisme, 35(6), 725-740.
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
19
Wahlström, J., Hagberg, M., Toomingas, A., & Tornqvist, E. W. (2004). Perceived muscular
tension, job strain, physical exposure, and associations with neck pain among VDU users;
a prospective cohort study. Occupational and environmental medicine, 61(6), 523-528.
Wilks, S., Mortimer, M., Nylen, P., 2006. The introduction of stand capable worktables; aspects
of attitudes, compliance and satisfaction. Appl. Ergon. 37, 359-365.
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
20
Figure 1. Sit-Stand workstation
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
21
Figure 2. Stand-Biased workstation
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
22
Figure 3. Traditional seated workstation
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
23
Figure 4: Effects of intervention group and time period on mean successful
encounters/hour. * Represents significant differences between groups at each time
period. Error bars represent 95% confidence intervals.
Downloaded by [209.21.112.18] at 08:18 07 June 2016

ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
24
Figure 5: Main effects of job category and time period on mean successful
encounters/hour. Error bars represent 95% confidence intervals.
0
0.5
1
1.5
2
2.5
3
March April May June July August
Mean successful encounter/hour
Month
Health Advisors Clinical Advisors
Downloaded by [209.21.112.18] at 08:18 07 June 2016