By: Aislinn Braun – although now graduated, Aislinn was a physiotherapy at McMaster University when she wrote this review
Canada is an often sedentary society. We sit on sofas, surfing and streaming on laptops, ipads, tablets, and cell phones. We sit watching TV, sit down for breakfast lunch and dinner, sit in cars and buses to commute to jobs where we often sit, or to school where we usually sit. You’re probably sitting, or lying down, or standing still and static as a statue as you’re reading this right now. And you wouldn’t be alone. A 2011 Canadian Health Measures Survey by Statistics Canada found that, on average, Canadian adults are sedentary for 9.5 hours per day (Colley et al 2011).
All of this sitting isn’t great for us. A recent meta-analysis estimated a whopping 34% increase in mortality risk for adults who sit 10 hours per day (Chau 2013). Studies have also shown sedentary time may be associated with increased cardiovascular and all-cause mortality, and an increased risk of type two diabetes (Proper 2011).
What about musculoskeletal issues? And occupational sitting? As any office worker has experienced, a fair amount of daily sitting can happen at work. While occupational sitting has previously been linked to a variety of musculoskeletal issues (Kryger et al 2003, Lassen et al 2004, Marcus et al 2002, Palmer et al 2001), this relationship is currently being reexamined through the lens of systematic reviews, which have thus far found that, contrary to popular belief, occupational sitting is likely not associated with low back pain (Hartvigsen et al, 2000, Kwon et al, 2011), may or may not be associated with neck pain (Côté et al 2008) and, for computer users, may or may not be associated with wrist tendinopathy and forearm disorders (Wærsted et al 2010).
While occupational sitting may not be as bad for the musculoskeletal system as previously believed, simple strategies like micro movement breaks may still have a positive effect on worker pain and productivity (Balci 2003, Balci 2004, Kennedy et al 2010, Osama 2015, Davis 2014). In fact, studies show that a 30 second break every 15 to 20 minutes or a five-minute break every hour may improve neck, upper extremity and/or low back discomfort without reducing productivity (Balci 2003, Balci 2004, Kennedy et al 2010). Taking a five minute break for every hour of computer work has also been endorsed by the Ontario Ministry of Labour https://www.labour.gov.on.ca/english/hs/pubs/gl_restbreaks.php.
While micro breaks are a promising and simple strategy, just advising your clients on their potential benefits likely won’t have any effect. This is because studies have shown that workers provided with education and advice only, did not take sufficiently frequent breaks to change discomfort levels (Karwowski, 1994, Mclean 2001, Cooley et al 2013). However, workers provided with active prompts in the form of software such as ExerTimeTM or ErgobreakTM took a significantly greater number of breaks, were up to five times as likely to comply with recommended FITTS (Cooley et al 2013, Mclean et al 2001), and experienced significantly lower levels of musculoskeletal discomfort (Mclean
et al 2001).
What are some of those software options?
One option nearly guaranteed to force workers to take scheduled breaks is ExerTimeTM. ExerTimeTM has an optional setting that, when active, forces users to take a certain number of micro breaks within a predetermined amount of time, or be locked out of their computer. When this option is active, users are only allowed to unlock their screen after they have entered a break activity (see image below – this user will be locked out of their computer if they do not take a rest break then enter their activity, within 14 minutes). Further information about ExerTimeTM can be found at http://www.exertime.com/.
A number of other rest break and movement encouraging programs and apps are also available, such as WorkRave for windows, PC WorkBreak, EyeLeo, StretchClock, Stand Up! The Work Break Timer, and BreakTime.
Workrave provides pop-up break reminders with a friendly message encouraging you to move. It can be downloaded for free from http://www.workrave.org/ and is compatible with GNU/Linux and Microsoft Windows operating systems. The prompt below states: “This is your rest break. Make sure you stand up and walk away from the computer on a regular basis. Just walk around for a few minutes, stretch, and relax”
PC WorkBreak provides reminders for micro breaks, stretch breaks, eye exercise breaks, and/or walk breaks, as well as providing statistics on your break patterns. It is compatible with Windows 2000, XP, Vista 7 and 8, and can be downloaded for 30$ for one PC, 40$ for three PCs, or 50$ for 10 PCs from http://www.trisunsoft.com/pc-work-break/.
EyeLeo prompts you to give your eyes a break. EyeLeo sets up micro eye breaks, during which the screen dims and a cute cartoon leopard guides you through eye exercises. There is also a long break option, during which the computer screen is temporarily disabled. It can be downloaded for free from http://eyeleo.com/ .
StretchClock provides break reminders, as well as videos of stretching exercises that can be performed at a desk. It’s compatible with Mac and Windows systems or can be activated to run on a web browser with no download required. StretchClock can be downloaded or activated for free from: https://www.stretchclock.com/download/.
BreakTime is a break reminder app, which can be set at variable modes of strictness (from allowing you to skip break reminders … to locking your screen for the specified break duration). BreakTime is compatible with iphones/ipads/macs, and can be downloaded for 4.99$ from the app store (for iOS devices) or from http://breaktimeapp.com/ .
Stand Up! The Work Break Timer
Stand Up! Is an iphone/ipad compatible app that reminds you to take standing breaks with a friendly pop up reminder, and a wide variety of customizable sounds – from ‘duck typing’ to ‘bubble gum’ to the more classic ‘chime’. Stand Up! Can be downloaded free from the app store (for iOS devices) with a free intro sound, and the option of unlocking additional sounds for 99 cents.
While microbreaks are not always effective at decreasing musculoskeletal discomfort in office workers (Kennedy et al 2010), and may not be a magic fix, they’re a promising low to no cost intervention that just might help you and your clients feel better, break sedentary sitting habits, downsize office discomfort, and decrease inactivity associated health risks.
Balci R, Aghazadeh F. The effect of work-rest schedules and type of task on the discomfort and performance of VDT users. Ergonomics. 2003; 46: 455 – 465.
Balci R, Aghazadeh F. Effects of exercise breaks on performance, muscular load, and perceived discomfort in data entry and cognitive tasks. Comput Ind Eng. 2004; 46: 399–411.
Chau JY, Grunseit AC, Chey T, Stamatakis E, Brown WJ, Matthews CE, Bauman AE, van der Ploeg HP. Daily Sitting Time and All-Cause Mortality: A Meta-Analysis. PLoS ONE. 2013; 8(11): e80000.
Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian adults: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, Statistics Canada. 2011; 22 (1): 7-14.
Cooley D, Pedersen S. A Pilot Study of Increasing Non-purposeful Movement Breaks at Work as a Means of Reducing Prolonged Sitting. Journal of Environmental and Public Health. 2013; Volume 2013: 1-8.
Côté P, van der Velde G, Cassidy DJ, Carroll LJ, Hogg-Johnson S, Holm LW, Carragee EJ, Haldeman S, Nordin M, Hurwitz EL, Guzman J, Peloso PM. The Burden and Determinants of Neck Pain in Workers. Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. European Spine Journal. 2008; 17 S1: 60–74.
Davis KG, Kotowski SE. Postural variability: an effective way to reduce musculoskeletal discomfort in office work. Hum Factors. 2014; 56(7):1249-61
Hartvigsen J, Leboeuf-Yde C, Lings S, Corder EH. Is sitting-while-at-work associated with low back pain? A systematic, critical literature review. Scand J Public Health. 2000 Sep; 28(3):230-9.
Karwowski, W., Eberts, R., Salvendy, G., & Noland, S. The effects of computer interface design on human postural dynamics. 1994. Ergonomics; 37(4): 703–724.
Kennedy CA, Amick III BC, Dennerlein JT, Brewer S, Catli S, Williams R, Serra C, Gerr F, Irvin E, Mahood Q, Franzblau A, Van Eerd D, Evanoff B, Rempel D. Systematic Review of the Role of Occupational Health and Safety Interventions in the Prevention of Upper Extremity Musculoskeletal Symptoms, Signs, Disorders, Injuries, Claims and Lost Time. J Occup Rehabil. 2010; 20:127–162
Kryger AI, Andersen JH, Lassen CF. Does computer use pose an occupational hazard for forearm pain; from the NUDATA study. Occup Environ Med. 2003; 60: el4.
Kwon BK, Roffey DM, Bishop PB, Dagenais S, Wai EK. Systematic review: occupational physical activity and low back pain. Occupational Medicine. 2011; 61: 541–548.
Lassen CF, Mikkelsen S, Kryger AI, Brandt L, Overgaard E, Thomsen JF, Vilstrup I, Andersen JH. Elbow and wrist/hand symptoms among 6943 computer operators: a 1-year follow-up study (the NUDATA study). Am J Ind Med. 2004; 46: 521–33.
Marcus M, Gerr F, Monteilh C. A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders. Am J Ind Med. 2002; 41: 236–49
Mclean L, Tingley M, Scott RN, Rickards J. Computer terminal work and the benefit of microbreaks. Appl Ergon. 2001; 32(3): 225–37.
Ontario Ministry of Labor. Rest Breaks for Computer Operators: Health and Safety Guideline. Ministry of Labour [internet]. Labour.gov.on.ca. 2017 [cited September 19th 2017]. Available from: https://www.labour.gov.on.ca/english/hs/pubs/gl_restbreaks.php.
Osama M, Jan MBA, Darain H. A randomized controlled trial comparing the effects of rest breaks and exercise breaks in reducing musculoskeletal discomfort in static workstation office workers. Ann Allied Health Sci. 2015; 1(2):44-48
Palmer KT, Cooper C, Walker-Bone K, Syddall H, Coggon D. Use of keyboards and symptoms in the neck and arm: evidence from a national survey. Occup Med 2001; 51:392–5,
Proper KI, Singh AS, van Mechelen W, Chinapaw MJ. Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med. 2011; 40(2):174-82.
Wærsted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review. BMC Musculoskeletal Disorders. 2010; 11:79. doi:10.1186/1471-2474-11-79.