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Principal Investigator: Jacquelyn P Kulinski
Organization: MEDICAL COLLEGE OF WISCONSIN
Fiscal Year: 2024
Award: $551,977
Funding agency: National Heart Lung and Blood Institute
Abstract: Sedentary behavior is becoming increasingly prevalent with the expansion of a ‘work from home’
culture, most recently driven by the COVID-19 pandemic. We now spend more time sitting than in all other
activities combined. This increased chair dependency, including a reduction in occupational energy expenditure
over the past 5 decades, has contributed to the epidemic of chronic disease, including metabolic syndrome,
cardiovascular disease, and type 2 diabetes mellitus (T2DM). Several studies, including a large meta-analysis
of 18 studies totaling 794,577 subjects, concluded that sedentary behavior mediates T2DM. The CDC predicts
that if current trends continue, as many as 1 in 3 U.S. adults could have diabetes by 2050. At present, 9% and
34% of U.S. adults have T2DM and prediabetes, respectively. Although we excluded diabetics in our pilot study,
11 of the 15 overweight or obese subjects were found to have some insulin resistance by HOMA-IR at baseline
(BMI positively correlates with the incidence of T2DM). In our pilot study of 15 subjects with sedentary office
jobs, 6 months of sit-stand desk use resulted in a 23% improvement in insulin resistance, most substantial in
those who decreased daily sitting by over 90 minutes/day. Additional improvements in vascular endothelial
function and triglyceride levels were seen without any change in exercise activity, step counts, or body weight.
These findings not only corroborate epidemiologic findings on this topic but suggest causality and warrant a
randomized control trial. This strategy of replacing sitting desks with a sit-stand desk has significant potential to
reduce cardiometabolic risk in the 70% of adults categorized as overweight or obese, the majority of whom have
insulin resistance. This intervention could have substantially strong impact, amplified by the COVID-19
pandemic, given nearly 80% of U.S. jobs are sedentary. We hypothesize that adult subjects at-risk for
diabetes will improve insulin sensitivity, metabolic and vascular (endothelial) health with a sit-stand desk
intervention at work (whether in the office or at home), in the context of a randomized, controlled trial.
We will randomize 198 sedentary office workers with a BMI≥25 at risk for T2DM in a 1:1:1 ratio of three groups:
(a) sit-stand desk intervention targeting 2 hours standing per day; (b) sit-stand desk intervention targeting 3 hours
standing per day; or (c) control arm over 6 months. Objective quantification of sitting and standing times will be
performed with sophisticated activity monitors and smartphone activity logs. We will ascertain if the sit-stand
desk improves insulin sensitivity and metabolic health and whether there is a dose-dependent relationship with
changes in sedentary time (Aim 1). We will determine if the intervention improves vascular endothelial function
locally (superficial femoral artery FMD) and/or systemically (assessing brachial artery FMD resilience) (Aim 2).
Sub-aims will assess changes in circulating triglycerides and free fatty acid levels and correlate with changes in
endothelial function. Affirmative findings would move the field forward by demonstrating that a readily adoptable
workplace intervention focused only on reducing sitting time alone, reduces cardiometabolic risk.
Terms: <21+ years old><Address><Adopted><Adult><Adult Human><Adult-Onset Diabetes Mellitus><American Heart Association><BMI><BMI percentile><BMI z-score><Bed rest><Bedrest><Biological><Blood Vessels><Body Weight><Body mass index><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cardiometabolic Disease><Cardiometabolic Disorder><Cardiovascular><Cardiovascular Body System><Cardiovascular Diseases><Cardiovascular Organ System><Cardiovascular system><Categories><Causality><Cell Phone><Cellular Phone><Cellular Telephone><Chronic Disease><Chronic Illness><Coronary Disease><Coronary heart disease><Data><Data Reporting><Dependence><Diabetes Mellitus><Disease><Disorder><Dose><Endothelium><Energy Expenditure><Energy Metabolism><Epidemic><Epidemiologic Research><Epidemiologic Studies><Epidemiological Studies><Epidemiological data><Epidemiology><Epidemiology Research><Epidemiology data><Etiology><Event><Exclusion><Exercise><Expenditure><Free Fatty Acids><Future><Generalized Growth><Goals><Grant><Growth><Guidelines><Health><Health Expenditures><Heart Vascular><Home><Hour><Human><Hydrolysis><Hyperglyceridemia><Hypertriglyceridemia><Impairment><Incidence><Insulin Resistance><Intervention><Intervention Strategies><Intervention Studies><Job Location><Job Place><Job Setting><Job Site><Jobs><Ketosis-Resistant Diabetes Mellitus><Knowledge><Link><Lipoproteins><Maturity-Onset Diabetes Mellitus><Measurement><Measures><Mediating><Mendelian randomization><Meta-Analysis><Metabolic><Metabolic syndrome><Mobile Phones><Modern Man><Monitor><NIDDM><Non-Insulin Dependent Diabetes><Non-Insulin-Dependent Diabetes Mellitus><Nonesterified Fatty Acids><Noninsulin Dependent Diabetes><Noninsulin Dependent Diabetes Mellitus><Obesity><Occupational><Occupations><Over weight><Overweight><Persons><Physical activity><Pilot Projects><Prediabetes><Prediabetes syndrome><Prediabetic State><Professional Positions><Quetelet index><Raised TG><Raised triglycerides><Randomization trial><Randomized><Randomized Controlled Clinical Trials><Randomized, Controlled Trials><Recommendation><Research><Risk><Risk Factors><Risk Reduction><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sedentary behavior><Sedentary life-style><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Slow-Onset Diabetes Mellitus><Stable Diabetes Mellitus><Superficial Femoral Artery><T2 DM><T2D><T2DM><Therapeutic><Time><Tissue Growth><Treatment Efficacy><Triacylglycerol><Triglyceride Metabolism><Triglycerides><Type 2 Diabetes Mellitus><Type 2 diabetes><Type II Diabetes Mellitus><Type II diabetes><Vascular Endothelium><Weight><Work><Work Location><Work Place><Work-Site><Workplace><Worksite><adiposity><adult onset diabetes><adulthood><arm><atherosclerotic heart disease><biologic><brachial artery><cardiometabolic><cardiometabolic risk><cardiometabolism><cardiovascular disorder><causation><chronic disorder><circulatory system><clinical efficacy><coronary disorder><coronary plaque><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><corpulence><data representation><data representations><design><designing><diabetes><diabetes risk><diabetic><disease causation><disease risk><disorder risk><elevated tg><elevated triglyceride><epidemiologic><epidemiologic data><epidemiologic investigation><epidemiological><epidemiology study><health care expenditure><healthcare expenditure><high triglycerides><homes><iPhone><improved><in vivo><increased triglycerides><insight><insulin resistant><insulin sensitivity><insulin tolerance><interest><intervention efficacy><intervention research><interventional research><interventional strategy><interventional study><interventions research><ketosis resistant diabetes><lack of physical activity><maturity onset diabetes><medical expenditure><novel><obese individuals><obese people><obese person><obese population><obese subjects><ontogeny><physical inactivity><pilot study><pre-diabetes><pre-diabetic><prediabetic><primary outcome><public health intervention><randomisation><randomization><randomized control clinical trial><randomized control trial><randomized trial><randomly assigned><reduce risk><reduce risks><reduce that risk><reduce the risk><reduce these risks><reduces risk><reduces the risk><reducing risk><reducing the risk><resilience><resilient><response><risk-reducing><sedentary><sedentary lifestyle><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><smart phone><smartphone><therapeutic efficacy><therapy efficacy><trend><type 2 DM><type II DM><type two diabetes><vascular><weights><work setting>