Category Archives: wellness initiatives

Studying Sleep at Goodyear

According to Dr. Brent Pawlecki, the goal of his Thursday morning presentation here at Human Resource Executive‘s Health & Benefits Leadership Conference (held April 19 – 21 at the Aria Resort & Casino in Las Vegas) was to “make the case for why sleep is important” to employees’ health.

Making that case was also part of his plan when he took over as chief health officer at Akron, Ohio-based Goodyear Tire and Rubber Co. six years ago.

At the time, the company has begun investing more in the health of its 69,000 employees around the world. Pawlecki was brought in to “build a culture of health” at the organization. When he took the job in 2011, he was charged with helping Goodyear to better define its overall healthy strategy.

“We said, we’re a global company, with well over 20,000 U.S.-based employees,” says Pawlecki. “We need to build a strong foundation of healthy employees here in the U.S.”

Part of that building process was addressing the impact of sleep, or the lack thereof, on Goodyear employees. Why study sleep?

“I was at a conference where I attended a presentation on how sleep affects workers,” says Pawlecki. “And I thought that, if we can get our employees thinking and talking about sleep issues—which could be caused by or contributing to underlying health issues— then maybe we can get them to focus on those larger issues.”

Enter Big Health, the San Francisco-based provider of the Sleepio sleep health app.

Sharing the stage with Pawlecki was Jenna Carl, medical director at Big Health. She talked about the “hidden nature” of behavioral health problems, and how tackling sleep issues might “offer a gateway to solving mental health problems” and subsequently creating healthier and happier workers.

Those suffering from insomnia, for instance, often find themselves more easily irritated and more sensitive to stress, she says.

“Insomnia also affects the frontal cortex—the CEO of the brain—which is responsible for decision making,” continues Carl. “And, behaviorally, those with sleep problems fall into a vicious cycle. They start worrying about not sleeping, and/or might start using more caffeine or alcohol, which actually have a negative impact on the ability to sleep.”

Naturally, employees trying to work their way through such problems are going to be less than their best while on the job. Pawlecki and Goodyear were acutely aware of this reality when bringing in Big Health to help conduct a sleep awareness campaign, “designed to engage good and poor sleepers,” says Carl.

The campaign began with encouraging employees to take a sleep test, the results of which led to creating personalized plans for employees who took part.

In getting employees to participate, “it’s important to know your employee population in order to know how to reach them,” says Carl.

Goodyear, for example, has 24,000 U.S. employees spread across plants and retail locations. Roughly 60 percent of these associates have no company email address, says Pawlecki.

As such, the initial sleep awareness campaign included home mailers and in-person communications in the form of posters and animated videos geared toward these workers, as well as providing intranet articles and sending emails detailing the campaign to those with Goodyear email accounts.

Overall, the campaign netted 2,798 employees who completed the sleep test, the majority of whom suffered from poor sleep, says Carl, adding that about one third of these workers could meet the clinical criteria for insomnia, while around half were experiencing less-than-optimal sleep. Plant workers, she says, struggled the most.

These plant employees also reported that poor sleep impacted their productivity close to 28 percent of the time, with retail workers saying that sleep affects their productivity 23 percent of the time. Office workers said that inadequate rest took a toll on their work 21 percent of the time.

“This is a pretty significant impact,” says Carl, adding that Goodyear employees who used the Sleepio app and underwent cognitive therapy reported getting an additional five hours of sleep per week after using the application. Those same workers also saw their stress reduced by 54 percent, and experienced a 35 percent drop in anxiety.

“These are obviously big improvements,” says Carl, noting that these workers also reported productivity improvements in addition to improving their overall mental health.

“And that’s just from getting better sleep.”

Taking Well-being’s Pulse

If there’s a single item that runs through Aon Hewitt’s 7th Annual Consumer Health Mindset Study, released yesterday at the National Business Group on Health’s Business Health Agenda 2017 in Washington, it’s that well-being continues to be a work in progress. (You can pre-register here for the full report.)

The study of 2,503 consumers, mostly employees and their dependents, found that well-being is continuing to have a big impact, with all well-being dimensions (financial, physical, emotional and social) being viewed by employees as important.

The findings suggest that consumers are increasingly looking at well-being in a holistic way, certainly a good sign for employers as they attempt to expand their well-being footprints. In light of this, one of the recommendations offered by Aon Hewitt Partner Joann Hall Swenson at a general session on the survey’s key takeaways was for employers to build workplaces that can support well-being in its entirety.

It’s also worth noting that, according to the study, some of the more traditional elements of physical wellness experienced a decline in importance over the past year. Diet, for example, decreased in importance by 7 percent, from 65 percent to 58 percent. Exercise, meanwhile, dropped 6 percent, from 59 percent to 53 percent.

Swenson suggested that employers might want to refresh their efforts in both those areas.

Employers, of course, would like nothing more than to see a greater percentage of employees become better consumers. Right? Better consumers make better decisions, after all.

Well, if the study’s findings are correct, employers still have more work to do on this front as well.

A takeaway from the study is that savvy consumerism continues to be a challenge as far as healthcare is concerned. Among the data points shared by Swenson: 77 percent of the respondents regretted a health decision they made, and only 40 percent said they know where to go to find out what a particular health service costs, down 7 percent over the past year.

“When you look at the number of people who bring a list of questions to their doctor and the number of people who are looking at costs before having a procedure, those numbers are down,” Swenson pointed out.

Then there’s the high level of frustration and confusion patients experience navigating the healthcare system, another key finding cited by Swenson. “Patients are losing their patience,” especially in the case of emerging millennials, she said.  “Many are giving up and throwing in the towel.”

To address this, she said, employers need to use technology to simplify the health-navigation process.

The survey also took a deeper dive into the area of mental health than in past years, finding that the issue continues to reside “in the shadows.” Not surprisingly, it found that stress continues to be on the rise, with the percentage of respondents reporting high stress levels at 54 percent, up 5 percent over the past year. Of those reporting high stress, 74 percent said they were experiencing more and more obstacles that stood in the way of receiving treatments.

Consumers, Swenson said, would like to see more one-on-one assistance from their employers, greater flexibility in terms of arranging for appointments and an expanded provider network from which to choose.

Finally, Swenson said, consumers want healthcare and well-being to be a multichannel experience, one that includes email, mobile and social. Messages and information, she added, need to be delivered when they’re needed, not when it’s convenient for the employer. (The topic of personalization was addressed at several other points during the NBGH event.)

Homing in on Behavioral Health

Just over two years ago, we posted a piece on this site highlighting findings from a Disability Management Employer Coalition study on behavioral health in the workplace.

The DMEC’s research painted what HRE described at the time as a “somewhat incongruous picture.” For example, more than 60 percent of the 314 employers polled said the stigma surrounding mental health issues at work had either stayed the same or gotten worse in the past two years. On the other hand, 37 percent of those same companies said that management had “become more open” about assessing behavioral health in that time. In 2012, 25 percent of respondents said the same, according to DMEC.

Here we are in 2017, and the findings of a new Willis Towers Watson survey suggest that the picture is starting to come into focus for employers, the overwhelming majority of which say they plan to keep upping their efforts to address mental health issues among the workforce.

The firm’s 2017 Behavioral Health Study, which polled 314 U.S. employers, finds 88 percent of respondents saying behavioral health is an important priority for their organizations over the next three years.

More specifically, 63 percent count locating more timely and effective treatment of behavioral health issues as an area of primary concern in that same span. Sixty-one percent said the same about integrating behavioral health case management with medical and disability case management. In addition, 56 percent said their organizations are concentrating on providing better support for complex behavioral health conditions, and 52 percent of employers are looking to expand access to care for mental health issues between now and the year 2020.

Beyond increasing and improving the level of care received by those with behavioral health issues, the survey also found that organizations intend to address the root causes of these issues. More than one third of respondents (36 percent) say they have already addressed and taken steps to reduce stress and improve resiliency, while 47 percent are planning or considering action designed to do so over the next three years. Twenty-eight percent currently provide educational programs that touch on the warning signs of behavioral health issues or distress, and 41 percent are planning or considering such programs.

These employers are also showing more interest in mobile apps to help employees manage behavioral health needs, according to Willis Towers Watson. The survey finds the percentage of companies including mobile applications in their service offerings on the way up. For instance, 11 percent of those surveyed already offer stress reduction or resiliency apps; a number that is expected to increase to 38 percent within three years, the study finds. And, while just 7 percent provide apps designed to help curb anxiety, 31 percent of respondents said they plan to offer such applications between now and 2020.

However they plan to reach workers with mental health needs, “employers are concerned about behavioral health issues because of the impact on costs, employee health and productivity, and workplace safety,” says Julie Stone, a national healthcare practice leader at Willis Towers Watson, in a statement.

“The seriousness of the issues—both for employers and employees—has led to a deeper understanding of the problem and greater resolve to take action.”

Employers are now more committed than ever, says Stone, to “improving access to treatment, providing employees with better coordination of care across various health programs and reducing the stigma that could be associated with behavioral health through educational programs.”

Wellness Battle: AARP vs. EEOC

A federal lawsuit was just filed against the government agency that handles the rules on workplace wellness programs, according to the New York Times, which calls the suit “the first major legal challenge of the regulations, and will add fuel to one of the hottest debates in healthcare.”

The main point of contention in the suit is whether some programs that require an employee to fill out a health risk assessment or undergo biometric testing for conditions such as high blood pressure are forcing workers to hand over private medical or genetic information.

The suit was filed by AARP, the consumer advocacy group that represents older Americans, in Federal District Court in Washington. In the suit, the group argues that the programs violate anti-discrimination laws aimed at protecting workers’ medical information. It also questions whether the programs are truly voluntary when the price of not participating can be high.

The suit takes aim at the Equal Employment Opportunity Commission, the federal agency responsible for issuing the rules governing what employers can do. When the agency issued new rules on the programs in May, it said employers could set the incentive as high as 30 percent of the annual cost of a worker’s health insurance coverage.

The cost of individual coverage averages $6,435 a year, according to the Kaiser Family Foundation, which means refusing to participate could cost workers nearly $2,000.

Claiming that the commission reversed its longstanding position to protect employees’ privacy, the AARP described its members as facing “imminent harm flowing directly from the rules.” Older people would have to either incur significant financial penalties or divulge medical information that “once revealed, will never be confidential again.”

The AARP is seeking a preliminary injunction to stop the new rules, which go into effect in 2017.

James Gelfand, senior vice president for health policy for the Erisa Industry Committee, a trade group representing employers on issues like health benefits, was critical of the AARP suit. Employers, which are never told which employees have certain conditions, are not using the information to discriminate, he said.

“There’s no evidence of these things happening,” he told the Times.

The EEOC so far has declined to comment on the new lawsuit.

Beware of the ‘Food Altar’ at Work

ThinkstockPhotos-178634141Anthropologists tell us that sharing food is nearly universal in human society. And that includes the office.

Some workplaces have raised the custom to a high art. Think of Doughnut Day. Strawberries from the garden. Cookies from home. Leftovers from a lunch meeting. M&Ms in a bowl on the boss’s desk.

These rituals humanize the workplace. They break up the monotony of work. And who doesn’t like to eat?

One problem: Much of that food is unhealthy. And the cornucopia can undercut both company wellness programs and individual efforts at healthy eating. What good does it do to put bananas in the vending machines or carrots in your lunch bag when Susie in accounting brings brownies?

One recent study about this problem says there’s a term for that place in every office where food gets piled. They’re called “food altars,” according to four researchers at the University of California Davis.

Published in the June issue of the journal Food, Culture & Society, the study was by Carolyn Thomas, Jennifer Sedell, Charlotte Biltekoff and Sara Schaefer. They studied the eating habits of 25 university office workers to draw some conclusions that could apply to many workplaces.

They found that while health-conscious employees might have elaborate systems to control consumption, their efforts often were “sabotaged by food that simply materialized in the workplace.” Food altars, they wrote, are “responsible for the majority of unplanned and ‘unhealthful’ eating decisions in the workplace.”

The result: “A workplace-sanctioned system of food-choice challenges.”

Anyone who’s worked in an office will recognize the problem. Yet how can we control it? No one wants to be the Grinch who refuses to bring in bagels when it’s their turn. Or to be the boss who issues a memo declaring the office a carrot-cake-free zone.

The study authors don’t propose a solution. But at least they’ve identified a problem and given it a name. The rest, alas, is up to us.

Wait … Work Is Good for Your Health?

A compre200400993-001hensive survey of American workers this week offered some predictable findings about health and employment. But there are some happy surprises as well.

Perhaps most interesting was a finding that 28 percent of workers said their job was good for their overall health. That’s considerably more than the 16 percent who said it was bad.  (The rest, a slight majority, said their job had no effect on their overall health.)

Why the upbeat view? Researchers didn’t ask, and declined to share any thoughts about what respondents meant. But we can find some clues on our own by looking at this poll and other research. And those clues offer some encouragement for HR professionals.

How does your job affect your _____?
Good impact Bad impact No impact
Overall health 28% 16% 54%
Eating habits 15% 28% 56%
Stress level 16% 43% 39%
Sleeping habits 17% 27% 55%
Weight 19% 22% 57%
Social life 27% 17% 56%
Family life 32% 17% 50%
Source: Harvard T.H. Chan School of Public Health

Make no mistake, there are plenty of concerns raised by this survey, which was performed by the Harvard T.H. Chan School of Public Health in conjunction with National Public Radio and the Robert Wood Johnson Foundation. Researchers polled 1,601 working Americans across a range of ages, ethnicities, income levels and industries. The margin of error for the full sample was 2.9 percent at the 95 percent confidence level.

NPR stories about the survey this week have highlighted how workers with disabilities often struggle at work, how lack of sick leave can drive some families into financial crisis and why so many employees go to work while sick.

Among other troubling — if unsurprising — findings was that 43 percent of respondents said work added stress to their lives. A news release from the university quoted poll director Robert J. Blendon concluding that “The takeaway here is that job number one for U.S. employers is to reduce stress in the workplace.”

But what might workers be thinking when they say their job is good for their health?

One obvious point is that having a job means having an income and (often) having insurance. That’s definitely good for your health. But I wonder if many respondents were really thinking at that level of abstraction.

There’s also research suggesting that, in fact, work is good for your health. One frequently-cited research overview conducted in the United Kingdom concluded that meaningful, safe work generally offers physical and mental-health benefits. Being active and having a purpose is good for us.

But were many respondents thinking about arcane findings in the field of occupational health?

Perhaps a more plausible explanation is in the new poll itself — findings that suggest wellness programs really matter. More than half of respondents said their company had a formal wellness program.

Even more significant: Of those workers, a whopping 45 percent said that program was “very important” to their health. Nearly as many said it was “somewhat important.”

Wellness programs don’t offer any clues about some other surprising findings in this poll, alas. Respondents also apparently think work is good for their social life and (even more mysteriously) their family life. Let’s hope researchers some day will drill deeper to find out what’s really going on here.

A Wake-Up Call for the Sleep Deprived

Several familiar themes emerged at Virgin Pulses’ 2016 Thrive Summit in Boston this week, including some we heard at HRE’s Health & Benefits Leadership Conference earlier this spring.

Arianna Huffington’s humorous and engaging keynote Tuesday afternoon on the topic of sleep deprivation was one that personally resonated with me. Maybe it had something do with the fact I was still struggling with jet lag, having just returned from a trip from Japan the weekend before?

Of course, you don’t need to be a rocket scientist to grasp the detrimental impact sleep deprivation can have on effectiveness and productivity. Studies have repeatedly shown the huge toll it can take on businesses, including one titled “Insomnia and the Performance of U.S. Workers: Results from the American Insomnia Survey” that put lost workplace productivity at around 11 days per employee—or the equivalent of $2,280 per employee. If you’re a business leader, figures like these, you would think, could lead to a few sleepless nights of your own.

Huffington, founder, president and editor-in-chief of the Huffington Post Media Group, touched on the problem of sleep deprivation in Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, and Wonder. Most likely in the hopes of drawing more attention to this ever-important issue, she also came out with a new book last month dedicated to the subject titled The Sleep Revolution: Transforming Your Life, One Night at a Time. (As an attendee at the Thrive Summit, I received a complimentary copy, which I’m looking forward to giving a more thorough read.)

In her Thrive Summit talk, Huffington shared her own personal awakening, which involved pushing herself so hard nine years earlier that she collapsed and, in the process, broke her cheekbone. She noted that “you’re not successful when you find yourself in a pool of blood.”

After a series of doctor visits and testing, she said it was determined the cause of the fall wasn’t a brain tumor or heart condition, but was due to her not getting enough sleep.

“Sleep deprivation is the new smoking,” she said.

Despite noting that her talk would be apolitical, Huffington, a political commentary who regularly takes aim at the Republican Party, couldn’t refrain from taking a jab at the Republican Party’s “presumptive” nominee, who has, on occasion, boasted about the limited sleep he needs to get. That candidate, she said, seems to display all of the symptoms of a person who is sleep deprived: mood swings, bad judgement, etc.

Huffington said the science shows that people need seven to nine hours of sleep, not the three, four or five many are settling on—and employers and HR leaders need to do more to enable that to happen.

For starters, she said, business leaders need to end the practice of praising and rewarding those who never disconnect from their jobs. “When you congratulate people who work 24/7, it’s like congratulating them for coming to work drunk,” she said.

Huffington specifically praised the efforts of business leaders such as Amazon’s CEO and Founder Jeff Bezos and Microsoft CEO Satya Nadella, who have been ahead of the curve in talking about the value of getting eight hours of sleep a night. Other so-called “sleep evangelists” mentioned in The Sleep Revolution include Campbell Soup CEO Denise Morrison and Google Chairman Eric Schmidt.

There are a number of steps people can take to get “rekindle our romance with sleep,” Huffington said. She specifically emphasized the value of creating a ritual before going to bed. For her, that ritual includes disconnecting from all electronic devices roughly 30 minutes ahead of time and taking a hot bath in Epsom salts.

Whether it’s 30 minutes or something less, she said, “we need to wind down and put the day behind us.”

Of course, for those of us who aren’t getting enough sleep, changing our behavior is often easier said than done. So it probably wasn’t a coincidence that the program kicked off the following morning with a workshop titled “Behavior Change is a Skill,” conducted by BJ Fogg, director of the Persuasive Tech Lab at Stanford University.

The premise of his workshop was that people can learn to change their behaviors—that people can acquire skills for changing just as they can learn how to play a musical instrument or swim.

Or, I suppose for that matter, learn how to get a better night’s sleep.

What Winning at Wellness Looks Like

Curious to see what makes for a top-notch wellness program?

I’ll assume you said yes, which means you might want to take a peek at the new U.S. Chamber of Commerce Winning with Wellness report.

Released earlier this month, the new publication is designed to “demystify” health promotion initiatives, looking at some of the “fundamentals of workplace wellness programs,” including evidence-based critical components such as developing a plan and applying behavior change methodologies, for example.

The report also lays out “10 Essential Steps in Designing a Workplace Wellness Program,” urging employers to “rely on evidence-based best practice strategies and tailor interventions to their populations” when plotting out wellness initiatives.

To begin planning, for instance, the report suggests that employers assess the organization’s readiness to adopt a workplace wellness strategy, asking “crucial questions” such as: Are there business plans in place that support or impede behavior change? Is there a history of workplace wellness programs? If so, what are some lessons learned? Can the organization specify how health changes can improve the work environment?

In addition, the report cites case studies demonstrating “employee satisfaction and social or financial ROI” from wellness programs at companies such as PepsiCo Inc. and Johnson & Johnson.

An evaluation of PepsiCo’s Healthy Living wellness program, for example, studied the initiative over the course of seven years in an effort to determine the cost impact of its lifestyle and disease management programs.

As the Chamber report notes, the study revealed that Pepsi saw an average reduction of $30 in healthcare costs per member per month, after seven years of continuous participation in either the lifestyle or disease management program.

A 2011 evaluation of Johnson & Johnson, meanwhile, compared a matched cohort sample of its 31,823 employees to similar organizations with a comparable number of employees. According to the U.S. Chamber, the findings demonstrated that, from the years 2002 to 2008, “Johnson & Johnson experienced a 3.7 percent lower average annual growth in medical costs compared to the comparison group,” and J & J wellness programs produced an ROI of $3.92 for every dollar spent.

Finally, the Chamber points to a 2013 RAND Inc. report that determined “there is solid evidence to be optimistic” that healthier employee behavior will correlate directly to lower healthcare costs. More than 60 percent of respondents in that survey indicated that workplace wellness programs reduced their organizations’ healthcare costs, while also reporting an overall decrease in healthcare service utilization, which, in turn, reduced the healthcare cost burden.

While pointing out that each of these studies had limitations, “the majority show that well-designed wellness programs lead to an ROI ranging from $1.50 [for each dollar spent] to more than $3 invested over a timeframe of two to nine years,” the report notes.

Cost savings aside, the report’s authors tout the non-financial advantages of developing a winning wellness program.

“Even if one assumes for the sake of argument that any limitation of each particular study leads to an ROI of less than $1.50 to $3,” they write, “there are other benefits to these programs, such as increased job performance, overall well-being, and happy and thriving employees who contribute to business and community success.”

HR at Humana Learns by Listening

Earlier this week, I stumbled upon a press release summarizing a recent Employee Benefit Research Institute report.

In the 2015 Health and Voluntary Workplace Benefits Survey, the Washington-based organization found the percentage of workers reporting they are satisfied with the health benefits they currently receive has fallen from 74 percent to 66 percent between the years 2012 and 2015.

This is just a guess, but I have a hunch Humana Inc. employees were not among the 1,500 workers who EBRI polled for its study.

Last week, I attended a session at HRE’s Health & Benefits Leadership Conference, led by Humana’s Tim State, who serves as the Louisville, Ky.-based Medicare provider and health insurer’s vice president of human resources. Over the course of that informative hour, State discussed how HR leaders at Humana have embraced the “experience group” research methodology both to gain insight into the unmet health needs of its roughly 52,000 employees and to design a benefits program that helps them better meet those needs.

“It’s only from the associates’ point[s] of view that we can understand their health challenges,” he said. “It’s not about just having a Q&A session. It’s about having a real conversation around employees’ experience[s] with health benefits.”

Humana’s experience groups, according to State, typically consist of five to eight employees, who, along with a facilitator from the Humana HR function, convene for 60 to 90 minutes in an effort “to get across the idea that [our employees are] the experts [on their lives and health needs]. The facilitator really just kind of gets out of the way.”

Topics include obstacles that employees face on the path to better health, and, together, these experience groups and the HR team brainstorm ways to clear these hurdles.

What State and his colleagues in HR have heard from these experience groups has certainly been instructive, he said.

One employee, for instance, mentioned in a group session that work is actually “one of the biggest challenges to my health,” citing the combination of daily job-related stress and the often-sedentary lifestyle of the office employee.

Meanwhile, another female employee pointed out that the office dress code deterred her from walking more while at work, noting that going up a few flights of stairs isn’t always so easy in a pencil skirt.

State and his colleagues in HR have taken action in response to such comments, changing dress codes and introducing benefits that encourage prevention and provide more chronic-condition support, for instance.

Such adjustments—even small ones—have reaped almost immediate rewards, said State, adding that Humana’s experience groups have only been meeting for approximately 12 months.

For example, the organization has seen a 21-percent jump in employees’ use of preventive services offered by the company and has seen medication adherence increase by more than 10 percent. In addition, four out of 10 Humana employees report that they’ve improved their health by cutting down on physically risky behaviors, said State.

Making such changes has given employee engagement a boost as well, with Humana ranking in the top 10th percentile of the IBM Kenexa WorldNorms database for “world-class associate engagement” for the past four years, he added.

Such results—which have been realized in the space of one year— should be heartening for HR leaders at other large companies as well, said State.

“[Humana] is a Fortune 100, 50,000-plus employee organization,” he said. “Change can happen in an organization that size.”

Standing Desks: Fashion Over Function?

Ever since the first “standing” desks began appearing in the workplace in the mid 2000s, ergonomic experts have been debating the advantages they ostensibly bring to users.

Now, in a blow that could force even the most strident standing-desk supporter to sit down and re-evaluate his or her stand (puns clearly intended) on the issue, new meta-research finds there’s not a whole lot of science to back up the claims that using such desks are any better for you than traditional sit-down desks.

This recent analysis of 20 of the “best” studies done so far finds scant evidence that workplace interventions such as the sit-stand desk, the pedaling desk or even the treadmill desk will help you burn more calories or prevent or reverse the harm of sitting for hours on end.

“What we actually found is that most of it is, very much, just fashionable and not proven good for your health,” says Dr. Jos Verbeek, a health researcher at the Finnish Institute of Occupational Health.

“At present,” the study’s authors conclude, “there is very low to low-quality evidence that sit-stand desks may decrease workplace sitting between thirty minutes to two hours per day without having adverse effects at the short or medium term.”

The authors instead call for “cluster-randomized trials” with a sufficient sample size and long-term follow-up to determine the effectiveness of different types of interventions to reduce objectively measured sitting time at work.

Tip of the hat to NPR for posting this.