Effect of a mobile reminder app on movement breaks among desk-based software professionals: A quasi-experimental, parallel group study in Puducherry

INTRODUCTION

In recent years, accumulated sedentary behavior has become a regular habit in modern society, particularly among desk-based office employees, and is very common in the information technology (IT) sector. India had about 5.8 million IT employees during the financial year 2025.^[1] Thus, the need to develop and implement effective interventions to reduce and break up the duration of workplace sitting among IT professionals is imperative. Moreover, there are no proper guidelines for workplace sedentary behaviors; the existing recommendations are few and vary in their advice. Continuous sitting is now emerging as a significant public health concern, attributing roughly about 9% premature mortality worldwide.^[2]

Prolonged sitting habits are an independent risk factor for numerous chronic maladies, even when trying to compensate for moderate to vigorous physical activities.^[3] Recent research says acute and chronic physical inactivity leads to significant reductions in lipoprotein lipase (LPL) levels in the weight-bearing skeletal muscles that otherwise can be prevented by non-fatiguing contractions that occur during normal ambulatory activities such as walking and running. Reduced LPL activity may impair lipid metabolism.^[4] Short bouts of walking in prolonged sedentary conditions have been said to improve fasting and postprandial glucose levels.^[5,6] Hence, breaking this stasis by short movement breaks, which may include a brief walk and stretching, will help prevent metabolic syndromes. The effect of prolonged workplace sitting on mental well-being issues such as perceived job stress, depression, and fatigue is relatively less evident.^[7]

The workplace is considered an effective target of intervention as a substantial number of the population can be reached, aiming to alter multiple levels of behavior and to improve overall health.^[8] Sitting continuously for more than 30 min is considered prolonged sitting^[9] and is known to cause detrimental health hazards in the long run, especially a wide range of non-communicable diseases. Many occupations are computer-based desk jobs these days, which lead to predominantly sedentary behavior at the workplace^[10] which eventually leads to musculoskeletal^[11,12] and cardio-metabolic risks.^[7]

Although sitting continuously for more than 30 minutes is considered as prolonged and hazardous in the long run, studies conducted in Indian scenario are scarce and majority of the available studies have used objective data. Interventions have been done using accelerometers or pedometers, which are expensive devices and, hence, seem to have a smaller number of users.^[10,13-15] Other interventions, such as sit-stand workstations^[16] and reminders on computer screens,^[17] have been used. However, studies with smartphone interventions are less and rare.^[18] The use of smartphones has become universal in today’s world, most likely in this working population. Hence, this study aims to decrease prolonged sitting duration using a simple, user-friendly smartphone-based reminder application. It is also expected that, due to easy accessibility and being a relatively cheaper option, the behavior change will be long-lasting. The present study objective was to compare the change in the number of movement breaks from continuous sitting with the use of smartphone-based reminder application, along with health education, as compared only to health education among software professionals with desk-based jobs in a selected office, Puducherry. As this study was conducted as a part of a Master of Public Health Thesis, under the department of Preventive and Social Medicine, JIPMER, the scope of data collection was limited to the Puducherry region only.

MATERIAL AND METHODS

RESULTS

A total of 94 full-time, desk-based employees participated in the baseline assessment, and all participants were retained throughout the study. The mean (SD) age of the participants was similar between the intervention 28.8 (6.6), and the control group, 27.2 (4.5). Most of the participants were female, with 26 (56.5%) of females in the intervention group and 32 (66.7%) in the control group. Around 12 (26.1%) of the participants in the intervention group were current smokers, and 13 (28.3%) of the participants responded as current alcohol users. Whereas, in the control group, 15 (31.2%) of the respondents were current smokers and 12 (25%) were current alcohol users. Around one-third of the participants were overweight in both groups as per the Asia-Pacific Classification. In the intervention group, 50% of the respondents were obese, and 39.6% of the respondents were obese in the control group. The mean body mass index was found to be 24.76 (SD = 4.54) kg/m² [Table 1].

The average number of movement breaks (rounded off to the nearest whole number) during eight working hours in the office is similar between the two groups (P = 0.128). Using the washroom and attending phone calls are activities done during the movement breaks [Table 2].

Majority of the participants (93.6%) responded “workload” due to meeting deadlines as the utmost important barrier to taking movement breaks. Almost half of the respondents (45.7%) said the air-conditioned inside temperature makes them sit on their chairs and the “outside heat” acts as a barrier to taking movement breaks. Other responses for barriers were ignorance, physical tiredness, managerial supervision, lack of awareness, and laziness [Table 3].

The mean frequency of movement breaks was 9 (SD = 2) and 8 (SD = 2) in the intervention and the control group, respectively, at baseline. At the end of the 4^th week following intervention, the mean frequency of movement breaks per 8 working hour was 14 (SD = 2) and 10 (SD = 3) in the intervention and the control group, respectively [Figure 1]. The change over time is also found to be statistically significant at P < 0.001.

Close

Figure 1:

Change in movement breaks of the intervention and control group at baseline and at 1^st, 2^nd, 3^rd, and 4^th weeks of follow-up after the intervention.

Export to PPT

DISCUSSION

In our study, majority of the participants (93.6%) felt that the most common barrier for taking movement breaks is workload. A similar response was found in a study conducted by Hadgraft et al. on a qualitative study among desk-based employees in Melbourne, Australia, where study participants stated that their work needs to be done within a certain time, and 2 or 3 min in between is quite valuable. Another important barrier highlighted in our study is less priority for taking movement breaks during office hours. About 30.8% of the participants in our study said that they gave less priority to movement breaks. An employee commented that it is very easy just to get stuck, and time passes. When they realize that they have been sitting all day long, the day is gone.^[19]

Literature search revealed that to reduce sedentary behavior, a multi-pronged approach, such as desire to improve health, recently acquired awareness of sedentary behavior, an adaptable environment, use of reminders, and so on, is essential.^[20] Though smartphone reminder-based intervention has not been studied well, computer reminders based on a passive approach have been shown to improve the movement breaks among desk-based office workers during working hours.^[17] Similar findings were seen in our study. The mean frequency of movement breaks increased in both groups. However, the mean was higher in the group that received both health education and the mobile reminder application as compared to the group that received only health education. Studies have noted that exposure to an intervention not only increases movement but also improves existing health problems, such as muscular distress, eye strain, and so on.^[21]

A feasible intervention method through a commonly used device, such as a smartphone, might help with proper compliance and eventually might help in achieving the desired goal of reducing prolonged sedentary conditions by increasing the movement breaks in between. To maintain the behavior change, support from the management is required. Introduction of elevator-free hours, standing meetings, keeping the printers and other devices at a distance from the desk, and so on will indirectly help in the physical activity of the employees without loss of productivity.

Equally important are modifications at the individual level. Simple, small, repetitive activities like meeting a colleague in person for doubt clearance without discussing it over telephonic calls, walking up to the water filter to drink water, or filling water bottles, using the stairs instead of elevators if not urgently needed, etc., can be done. It increases the movement breaks from continuous sitting and, in turn, increases physical activity as well. In our study, during the intervention period, simple activities such as a casual walk, using the stairs, discussion with a colleague in person without using the intercom facility, and walking while attending a phone call were additionally adopted by the participants.

The application of health behavior theories to improve physical activity, especially sedentary workplace behavior, is in its early stages.^[22] Preventive health models like behavioral choice theory, social cognitive theory, and the health belief model have helped understand behavior change, but often focus only on initiation, not maintenance. However, sustained behavior change is crucial in public health.^[23] The TTM addresses both adoption and maintenance through stages: Pre-contemplation, contemplation, preparation, and action. If not maintained, behavior may relapse. A study done by Pronk et al. found that the benefits of an intervention disappeared within 2 weeks of its removal. Hence, it is essential to have repeated exposure and long-term strategies to prevent relapsing into sedentary habits.^[16]

Maintenance of logbooks to avoid recall and capturing adherence to utilization of the intervention using the app data were the strengths of the study. A single-center study, with convenient sampling and non-random allocation to groups, was the major limitation for the generalizability of the study.

CONCLUSION

The study concluded that the smartphone reminder application combined with health education can effectively increase the frequency of movement breaks among software professionals compared with health education alone. Since the interventions are simple, cost-effective, and well acceptable, it can be implemented in similar work settings on a larger scale. Workload pressure and a comfortable working environment were major barriers, which highlight the need for better organizational policies to encourage regular movements and to promote occupational health.