Effects of Bluetooth-Enabled Desk Ellipticals on Office Work Performance: Rationale, Design, and Protocol for a Randomized Trial With Overweight and Obese Adults

Background Workplaces that provide opportunities for physical activity without requiring extra time for activity could help counteract the obesity epidemic. Desk ellipticals can contribute to activity-supportive workplace environments; however, the feasibility of engaging employees in pedaling ellipticals during simultaneous office work has not been well evaluated. Objective We aim to present the rationale and methods from an ongoing randomized trial with overweight and obese employees that will evaluate (1) the effects of pedaling a compact desk elliptical on work performance and (2) the influence of different incentive types and schedules on desk pedaling quantity. Methods Overweight and obese medical center employees are being recruited in dyads for a 2 (gift card type: healthier food vs Amazon) by 3 (gift card schedule: immediate incentive contingent on individual pedaling quantity; immediate incentive partially contingent on dyads’ joint pedaling quantity; and delayed noncontingent pedaling incentive) cluster randomized within-subjects factorial trial. All participants receive a Bluetooth-enabled desk elliptical for 4 weeks and access to a mobile app that provides real-time pedaling feedback. The primary aims are to assess (1) change in employee work performance from pre- to postelliptical installation via employee and supervisor ratings and (2) effects of gift card type and schedule on quantity of objectively measured desk pedaling completed. Results Data collection is ongoing. We expect to complete main outcome analyses in 2020. Conclusions This trial represents one of the earliest attempts to assess the effects of desk pedaling and pedaling-incentive types in real-world offices. It could help bridge the research-to-practice gap by providing evidence on whether desk pedaling can be sustained without compromising work performance. International Registered Report Identifier (IRRID) DERR1-10.2196/16275

1 R21 HL118453-01A1 2 PRDP ROVNIAK, L 1R21HL118453-01A1 Rovniak, Liza RESUME AND SUMMARY OF DISCUSSION: This application seeks support to test the feasibility of a desk compatible elliptical device to promote exercise at the worksite. This well written resubmitted application offers very high impact to address the public health challenge of sedentary lifestyles and was highly responsive to the previous critique. Reviewers were unanimously enthusiastic about this work noting many strengths: the exceptional significance of reducing worksite sedentary behavior; the exceptional investigators and research environment; the exceptionally novel approach to increasing worksite exercise inherent in an elliptical device installed at a worker's desk; the ready and inexpensive dissemination this work could have a significant and positive impact on occupational health; and again noted the well written, compelling lab and field trial, cross over design, excellent recruitment plan and detailed assessment of work productivity. One minor weakness that could readily be addressed was noted: the qualitative interview missed an opportunity to assess acceptability that could delineate motivational factors. Overall this is an exceptional, ambitious and impressive application with very high potential to change sedentary behaviors at the worksite.

DESCRIPTION (provided by applicant):
The proposed research will investigate the feasibility of accomplishing simultaneous caloric expenditure and productive office work using a height-adapted elliptical device designed to be pedaled at a standard desk. Strategies for increasing energy expenditure without requiring extra time investment are greatly needed, as most US adults report lack of time for physical activity, and spend over half of their waking hours in sedentary behaviors. These low levels of energy expenditure contribute to an average weight gain of 1 pound per year among US adults-which raises risk for cardiovascular disease, metabolic syndrome, diabetes, and cancer. Pedaling a low-cost elliptical device while simultaneously completing office work could help reverse this trend toward weight gain-without requiring extra time investment to increase physical activity. However, there is a lack of research on the feasibility of accomplishing productive office work while using elliptical/pedaling devices. Evaluating the feasibility of simultaneous pedaling and productive office work is important for determining whether elliptical/pedaling devices should be more widely disseminated across diverse sedentary office settings. Therefore, the primary specific aims of this research are to: (1) assess the feasibility of completing simulated office work activities in a lab-based setting while pedaling the elliptical device at different intensity levels among sedentary adults varying on age, gender, and body mass index (Study 1, n = 112); and (2) assess the feasibility of completing sedentary desk work in a field-based (office) setting while pedaling the elliptical device at a self-selected intensity level, as well as social and built environment influences on elliptical device use (Study 2, n = 50). The proposed research builds upon established ecological models demonstrating the importance of proximal environmental influences on physical activity and sedentary behavior. The combination of lab-and fieldbased research will contribute to the internal and external validity of study findings, and help guide recommendations for integrating elliptical/pedaling devices in sedentary office settings. Even if used only part of the working day, elliptical devices could substantially increase daily caloric expenditure and contribute to reduced risk of obesity and chronic health conditions associated with sedentary lifestyles.

PUBLIC HEALTH RELEVANCE:
The proposed research will explore the feasibility of accomplishing simultaneous energy expenditure and productive office work while pedaling a desk-compatible elliptical device. Unlike other existing solutions for promoting simultaneous office work and energy expenditure, the desk-compatible elliptical device is low cost, space-efficient, and can be used while seated at a standard-height work desk. Widespread use of low-cost desk-compatible elliptical devices, or other similar pedaling devices, could help prevent further growth of the obesity epidemic and reduce risk of cardiovascular disease, metabolic syndrome, diabetes, and some cancers.

CRITIQUE 1:
Significance: 2 Overall Impact: This revised application is designed to assess the feasibility of completing simulated desk work activities while using a desk-compatible elliptical exercise machine in both lab and field settings. Overall, the investigators were quite responsive to the concerns raised in the initial critique. The proposed project has several notable strengths including a significant objective, novel aims, strong pilot data, and well-articulated methodology. However, some concerns that detract from the potential impact of the project also remain. One concern is that in addressing key critique issues the investigators may have made the project too ambitious for the project resources and time period. Another concern is a missed opportunity to evaluate some additional assessments that could provide important information regarding the acceptability and feasibility of the elliptical. Overall, there is considerable merit to the proposed project which addresses an important issue in promoting physical activity with a novel focus and approach.

Strengths
The investigators were quite responsive to the issues raised in the initial critique. This strengthened the application and its potential impact considerably.
If the aims are met, there is potential for meaningful public health impact through decreasing sedentary time at work during time typically spent inactive.
The opportunity to overcome common PA barriers by bring a reasonable sophisticated, yet simple, form of PA into workplace is both significant and novel.
Strong pilot data and a well-qualified investigative team heighten the likelihood of project success.

Weaknesses
A modest concern is that in addressing key critique issues the investigators may have made the project too ambitious for the project resources and time period.
The battery of feasibility measures lacks many subjective and/or perceptual measures that may help delineate keep motivational factors associated with acceptability, use, and adherence. This is a missed opportunity that can be easily addressed via inclusion of select psychosocial measures of affect, effort sense, cognition, & preference.

Investigator(s): Strengths
A strong, well-qualified investigative team with considerable prior experience has been assembled.

Weaknesses
None noted.

Innovation:
The desk compatible elliptical is quite novel and could yield meaningful impact given some apparent strengths over other similar types of work-based exercise stations.
The assessment of work productivity is also quite innovative.

Weaknesses
None noted.

Approach: Strengths
Well-qualified, experienced investigative team has been assembled.
Design is well articulated and appropriate to achieve the proposed study objectives.
Revised definition of sedentary strengthens the application.
Well justified measures for many key outcomes

Weaknesses
A modest concern is that in addressing key critique issues the investigators may have made the project too ambitious for the project resources and timeframe. Notably the 112 participants proposed for the lab assessment and 1 month field assessment, while directly responsive to concerns raised initially, may be too ambitious.
The battery of feasibility measures lacks many subjective and/or perceptual measures that may help delineate keep motivational factors associated with acceptability, use, and adherence. This is a missed opportunity that can be easily addressed via inclusion of select psychosocial measures of affect, effort sense, cognition, & preference. For example, inclusion of measures such as the feeling scale, enjoyment of using the elliptical, RPE scale, task self-efficacy would all be quite informative. Additionally, including cognitive and preference assessments tapping participants receptivity to use, plans for future use, perceived barriers to use, etc could all be very important in determining feasibility and preliminary efficacy.

Strengths
The environment is very strong and provides appropriate support and resources to ensure success of the project.

Weaknesses
None noted.

Protections for Human Subjects:
The protection procedures are sufficiently detailed and appropriate.

Data and Safety Monitoring Plan (Applicable for Clinical Trials Only):
Acceptable o The DSMP is appropriate for the proposed investigation.

Inclusion of Women, Minorities and Children:
G1A -Both Genders, Acceptable Overall Impact: The investigators aim to test the feasibility of accomplishing simultaneously caloric expenditure and productive office work using a height adapted elliptical device designed to be pedaled at a standard desk. The investigators aim to assess the feasibility in a lab based setting while pedaling at different intensity levels among a study population of sedentary adults with variation in age, gender, and BMI. In addition, the investigators have planned for a second study where the feasibility of completing desk work while pedaling the elliptical at self-selected intensity levels will be measured in office environments. The application is well written and lead by a strong investigative team. The studies are well designed and supported by previous research. If successful, the public health significance of this easy to use and economical intervention will be high in increasing physical activity within sedentary office environments.

Strengths
The investigators are addressing the current trend where work related caloric expenditure has decreased over the past several decades and many people in the work force are in sedentary office jobs.
The aim to develop desk compatible elliptical devices makes increasing daily exercise easy and affordable.
The desk compatible elliptical device is consistent with recommendations from both the CDC and American Heart Association.

Weaknesses
None noted.

Strengths
The study is led by a strong investigative team.

Strengths
The device is innovative in that it is an improvement on existing workplace exercise devices in that it: (a) has the potential to be used without leaving one's desk, increasing the convenience of use; and (b) is inexpensive and therefore feasible for employers to invest in if effective.
It is innovative to measure the effect of the device use on work productivity as that would be a concern if the device were to be used with any regularity.

Weaknesses
None noted.

Strengths
The design to conduct both a lab study where intensity levels and work performance measures can be controlled in addition to an observational study where the effect of self-selected intensity on work performance is a strength.
The work performance measures seem acceptable.
The measurement of future interest in the use of the elliptical is a strength in measuring the feasibility of this type of device use in work environments.
The use of an Actigraph for measurement of the elliptical use is a strength in the second aim.
The measurement of the social influences within real work environments is also a strength.
The analytical plans for both aims are well described.

Strengths
The environment at Pennsylvania State University is well suited for the research.

Weaknesses
None noted.

Acceptable Risks and/or Adequate Protections
Data and Safety Monitoring Plan (Applicable for Clinical Trials Only): Acceptable. No concerns.

Resubmission:
The investigators were very responsive to the previous review.

CRITIQUE 3:
Significance: 1 Investigator(s): 1 Innovation: 1 Approach: 2 Environment: 1 Overall Impact: This is a very well written and highly responsive resubmission. The proposal is both quite significant and innovative and could lead to the development of an inexpensive disseminable weight prevention intervention that could be readily incorporated into many workplace environments. The proposal is highly significant in that it targets workday sedentarism. Fifty percent of workers sit behind computers for long periods of time during the day, which has been estimated to have reduced average caloric daily expenditure by 100 calories/day since 1960. The project tests the feasibility of an elliptical device that has been ergonomically modified by the team to be used while sitting at a desk doing office work. This overcomes the most common barrier to PA, which is competing time demands. The device would have major advantages over desk treadmill devices with respect to cost ($100), space, and user physical ability requirements. The project is well conceived and has many strengths and negligible weaknesses. With respect to significance, it is estimated that if the device were used for 2 hours per day, 5 days/week for 48 weeks, it would be possible to lose 7 pounds per year, holding all else constant. If the project is successful in demonstrating that the device does not interfere with workplace productivity, the potential for uptake would be very high. It would support large scale clinical trials to test health outcomes, which could have tremendous impact on the obesity epidemic at the population level. In addition to significance of the concept, the project design is outstanding, including both a highly controlled lab experiment and a field study. The lab based study uses the superb Latin square design to test whether 4 different pedaling intensities impact tests of typing speed and cognitive performance. The team has strong and innovative pilot data having adapted a low cost elliptical device for use under a standard desk, invented a portable power output measurement system and tested caloric expenditure in 32 sedentary adults. The proposed field study has been extended to one month and includes a qualitative interview of user impressions, which should provide important usability data 1 R21 HL118453-01A1 8 PRDP ROVNIAK, L for refinement in larger trials. The team and environment are excellent. A very minor weakness is lack of direct feedback from colleagues and supervisors related to enthusiasm, workplace disruption, etc.

Protections for Human Subjects:
Acceptable Risks and/or Adequate Protections Risk are minimal in studying low intensity PA in a healthy sample Data and Safety Monitoring Plan (Applicable for Clinical Trials Only): Acceptable o There is plan for an internal DSMB. Formal criteria for coding adverse event severity and defining anticipated AES should be added

Inclusion of Women, Minorities and Children:
G1A -Both Genders, Acceptable M1A -Minority and Non-minority, Acceptable

C1A -Children and Adults, Acceptable
A minimum 25 percent minority inclusion will be sought. 20 year old children will be included. Not clear why 18 and 19 year olds will be excluded Vertebrate Animals:

Not Applicable (No Vertebrate Animals)
Biohazards:

Resubmission:
This is a resubmitted application. The investigators have operationalized their definition of feasibility. They have modified their eligibility criteria to include a more conservative definition of sedentary (<60 mins. of PA/week and engaging in sedentary office work at least 6 hours/day). They have extended the length of the field trial from 5 days to 1 month and added a qualitative assessment. They have also added considerable qualitative expertise to the team (Drs. Morse & Rothrock). This is a highly responsive resubmission. Consultants are required to absent themselves from the room during the review of any application if their presence would constitute or appear to constitute a conflict of interest.