NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Headline
This study found that the intervention and methods were feasible and acceptable to teachers, children and parents, and made recommendations for a full trial.
Abstract
Background:
Sedentary behaviour (sitting) is a highly prevalent negative health behaviour, with individuals of all ages exposed to environments that promote prolonged sitting. The school classroom represents an ideal setting for environmental change through the provision of sit–stand desks.
Objectives:
The aim of this study was to undertake a pilot cluster randomised controlled trial of the introduction of sit–stand desks in primary school classrooms, to inform a definitive trial. Objectives included providing information on school and participant recruitment and retention, acceptability of the intervention, and outcome measures. A preliminary estimate of the intervention’s effectiveness on the proposed primary outcome (change in weekday sitting time) for inclusion in a definitive trial was calculated, along with a preliminary assessment of potential cost-effectiveness. A full process evaluation was also undertaken.
Design:
A two-armed pilot cluster randomised controlled trial with economic and qualitative evaluations. Schools were randomised on a 1 : 1 basis to the intervention (n = 4) or control (n = 4) trial arms.
Setting:
Primary schools in Bradford, West Yorkshire, UK.
Participants:
Children in Year 5 (i.e. aged 9–10 years).
Intervention:
Six sit–stand desks replaced three standard desks (sitting six children) in the intervention classrooms for 4.5 months. Teachers were encouraged to ensure that all pupils were exposed to the sit–stand desks for at least 1 hour per day, on average, using a rotation system. Schools assigned to the control arm continued with their usual practice.
Main outcome measures:
Trial feasibility outcomes included school and participant recruitment and attrition, acceptability of the intervention, and acceptability of and compliance with the proposed outcome measures [including weekday sitting measured using activPAL™ (PAL Technologies Ltd, Glasgow, UK) accelerometers, physical activity, adiposity, blood pressure, cognitive function, musculoskeletal comfort, academic progress, engagement and behaviour].
Results:
Thirty-three per cent of schools approached and 75% (n = 176) of eligible children took part. At the 7-month follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63% to 97%. A preliminary estimate of intervention effectiveness, from a weighted linear regression model (adjusting for baseline sitting time and wear time) revealed a mean difference in change in sitting of –30.6 minutes per day (95% confidence interval –56.42 to –4.84 minutes per day) between the intervention and control trial arms. The process evaluation revealed that the intervention, recruitment and evaluation procedures were acceptable to teachers and children, with the exception of minor issues around activPAL attachment. A preliminary within-trial economic analysis revealed no difference between intervention and control trial arms in health and education resource use or outcomes. Long-term modelling estimated an unadjusted incremental cost-effectiveness ratio of Stand Out in Class of £78,986 per quality-adjusted life-year gained.
Conclusion:
This study has provided evidence of the acceptability and feasibility of the Stand Out in Class intervention and evaluation methods. Preliminary evidence suggests that the intervention may have a positive direction of effect on weekday sitting time, which warrants testing in a full cluster randomised controlled trial. Lessons learnt from this trial will inform the planning of a definitive trial.
Trial registration:
Current Controlled Trials ISRCTN12915848.
Funding:
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
Contents
- Plain English summary
- Scientific summary
- Chapter 1. Introduction
- Chapter 2. Study design and methods
- Study design
- Ethics approval
- Study setting
- Sample size
- School and participant recruitment and eligibility criteria
- Changes from the original protocol/grant application
- The Stand Out in Class intervention
- The usual practice control arm
- Allocation to treatment groups
- Outcome measurements
- School and participant appreciation
- Economic analysis
- Statistical analysis
- Data management and research governance
- Chapter 3. Results
- Objective 1: school and participant recruitment
- Objective 2: determine attrition in the trial (schools and children)
- Objective 3: determine completion rates for outcome measures
- Objective 4: assess whether or not there are any differences in trial recruitment, retention and acceptability between ethnic groups
- Objective 8: monitor any adverse effects, such as musculoskeletal discomfort and/or disruption to the classroom/learning, to inform the design of a full trial and minimise or eliminate any such effects
- Objective 10: derive preliminary estimates of the effect of the intervention on children’s total daily sitting time, physical activity, indicators of health (markers of adiposity and blood pressure), cognitive function, and academic performance, engagement and behaviour
- Objective 11: estimate the standard deviation of the primary outcome to inform a sample size calculation for a full randomised controlled trial
- Summary
- Chapter 4. Economic evaluation
- Chapter 5. Process evaluation
- Chapter 6. Discussion
- Trial feasibility-related outcomes (objectives 1–4)
- Lessons learnt from the process evaluation (addressing objectives 1 and 5–9)
- Preliminary estimates of intervention effectiveness and sample size calculation for a full trial
- Lessons learnt from the preliminary economic evaluation
- Strengths and limitations
- Conclusions and suggestions for further research
- Acknowledgements
- References
- Appendix 1. The Stand Out in Class intervention
- Appendix 2. Quantitative analyses
- List of abbreviations
- List of supplementary material
About the Series
Article history
The research reported in this issue of the journal was funded by the PHR programme as project number 14/231/20. The contractual start date was in October 2016. The final report began editorial review in September 2018 and was accepted for publication in June 2019. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PHR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.
Declared competing interests of authors
Stacy A Clemes, Daniel D Bingham, Natalie Pearson, Yu-Ling Chen, Charlotte Edwardson, Keith Tolfrey, Lorraine Cale, Mike Fray and Sally E Barber report non-financial support from Ergotron, Inc. (Saint Paul, MN, USA), during the conduct of the study. Keith Tolfrey reports non-financial support from Iwantastandingdesk.com (Clitheroe, UK) for EIGER™ student standing desks for other independent sedentary behaviour research in secondary schools.
Last reviewed: September 2018; Accepted: June 2019.
- NLM CatalogRelated NLM Catalog Entries
- Stand Out in Class: restructuring the classroom environment to reduce sitting time - findings from a pilot cluster randomised controlled trial.[Int J Behav Nutr Phys Act. 2020]Stand Out in Class: restructuring the classroom environment to reduce sitting time - findings from a pilot cluster randomised controlled trial.Clemes SA, Bingham DD, Pearson N, Chen YL, Edwardson CL, McEachan RRC, Tolfrey K, Cale L, Richardson G, Fray M, et al. Int J Behav Nutr Phys Act. 2020 Apr 29; 17(1):55. Epub 2020 Apr 29.
- Stand Out in Class: restructuring the classroom environment to reduce sedentary behaviour in 9-10-year-olds - study protocol for a pilot cluster randomised controlled trial.[Pilot Feasibility Stud. 2018]Stand Out in Class: restructuring the classroom environment to reduce sedentary behaviour in 9-10-year-olds - study protocol for a pilot cluster randomised controlled trial.Clemes SA, Bingham DD, Pearson N, Chen YL, Edwardson C, McEachan R, Tolfrey K, Cale L, Richardson G, Fray M, et al. Pilot Feasibility Stud. 2018; 4:103. Epub 2018 May 24.
- The West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study: a cluster randomised controlled trial testing the clinical effectiveness and cost-effectiveness of a multifaceted obesity prevention intervention programme targeted at children aged 6-7 years.[Health Technol Assess. 2018]The West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study: a cluster randomised controlled trial testing the clinical effectiveness and cost-effectiveness of a multifaceted obesity prevention intervention programme targeted at children aged 6-7 years.Adab P, Barrett T, Bhopal R, Cade JE, Canaway A, Cheng KK, Clarke J, Daley A, Deeks J, Duda J, et al. Health Technol Assess. 2018 Feb; 22(8):1-608.
- Review A revised teaching assistant-led extracurricular physical activity programme for 8- to 10-year-olds: the Action 3:30R feasibility cluster RCT[ 2019]Review A revised teaching assistant-led extracurricular physical activity programme for 8- to 10-year-olds: the Action 3:30R feasibility cluster RCTJago R, Tibbitts B, Porter A, Sanderson E, Bird E, Powell JE, Metcalfe C, Sebire SJ. 2019 Dec
- Review Peer-led physical activity intervention for girls aged 13 to 14 years: PLAN-A cluster RCT[ 2022]Review Peer-led physical activity intervention for girls aged 13 to 14 years: PLAN-A cluster RCTJago R, Tibbitts B, Willis K, Sanderson E, Kandiyali R, Reid T, MacNeill S, Kipping R, Campbell R, Sebire SJ, et al. 2022 Mar
- Sit–stand desks to reduce sedentary behaviour in 9- to 10-year-olds: the Stand O...Sit–stand desks to reduce sedentary behaviour in 9- to 10-year-olds: the Stand Out in Class pilot cluster RCT
Your browsing activity is empty.
Activity recording is turned off.
See more...