“Goes Together Like Peas And Carrots”*
Sitting and Standing“Goes together likePeas and Carrots”** Forrest Gump - 1994Jack P. Callaghan PhD, CCPE, FCSBCanada Research Chair in SpineBiomechanics & Injury Prevention
Time
Church et al. PLoS ONE (2011)Sit of 76% of dayStand Up Australia (2009)Images from Focal (2016)Sedentary 8-9 hours a dayMatthews et al. Am J Epidemiol 2008
PREMUS, 2016
Where is the Disconnect? Seated postures associated with: Higher loading in passive tissues andjoints Laxity changes in these structures Alteration of muscle responses
Low-back problems after standing over 50% of thework shift. Waters and Dick Rehabilitation Nursing 40(3) (2015) 5 hr of standing work induced lower extremity musclefatigue, even with regular rest breaks and persisted atleast 30 min post- work. Garcia & Martin, Human Factors, In Press (2016) 55 Minutes of standing to 5 minutes sitting
Discomfort and standing work in Europe Thomas Laeubli (presenter), Maria Gabriela Garcia Rodriguez,Maggie Graf Background. Although it is generally known that long periods of standingproduce dis- comfort, the emphasis in health promo on tends towardsrecommending people to sit less, and little attention is paid to the problem ofstanding at work. This is surprising, as standing at work is the most commonphysical risk in European workplaces according to the results of the EuropeanWorking Conditions Survey (EWCS). Methods. The data for 30,000 full-time workers in the European WorkingConditions Survey was analyzed. Results. The analysis showed that almost half of the workers in Europe standat work for more than three quarters of their working me. It revealed strongand highly Significant correlations between the amount of timespent standing at work, back pain and pain in the legs. Additionally,long periods of standing at work were found to be associated with reports ofworking in ring or painful postures. A significant interaction was foundbetween age and both backache and muscular pains in the lower limbs. Olderworkers were found to more frequently report both types of pain thanyounger workers, and this was greater in the groups that stand for longerperiods of time. Discussion. As prolonged sitting has been linked to an increased risk ofcardiovascular diseases and cancer, the ques on of an appropriate balancebetween sitting, walking and standing is essential for the work of practitionersworking on the prevention of musculo- skeletal disorders.PREMUS, 2016
Sitting and Standing LBP? When “quality” of standing is factored into theevaluation: 30 minutes OR 2.1 (Andersen et al., 2007) 2 hours Females OR 2.9 Males 1.6 (MacFarlane et al., 1997) Constrained standing Prevalence 30% vs 17% (Tissot et al.,2009) Limited evidence of “quality” of seated exposures Leisure Work combined increased LBP reporting(Nourbakhsh et al., 2001) Constrained seated driving postures 6x increase in losttime (Porter & Gyi, 2002)
Why Mix Sitting and Standing?
Ergonomic GuidelinesOHSCO’s Musculoskeletal Disorders Prevention SeriesParts 3A&B: MSD Prevention ToolboxLifts Less than 4 hoursLifts more than 4 hours
Prolonged Standing and LBP- Greater than 30 minutesof constrained standingassociated with LBPreporting (Anderson et al.2007)- 30% LBP prevalence inworkers who stand in aconstrained posture(Tissot et al. 2009)- Lab studies show at least40% report low back painNelson-Wong & Callaghan J EMG & Kin 20 (2010)Marshall et al. Hum Move Sci 30 (2011)Gallagher, Wong, Callaghan Gait and Posture (2012)Sorenson et al. Clin J Pain (2015)Sorenson et al. Man Ther (2015)Gregory & Callaghan Gait & Posture (2008)
PD had Higher Muscle CoContraction than NPDNPDPDTrunk CCI (% MVC)3200250020001500****1000500p 153045Time (minutes)6075Time 07590105Time (minutes)PD Trunk CCIPD GMed CCIPD VAS120Low Back VAS (mm)15CCI (% MVC)Gluteus Medius CCI (% MVC)3600NPDPD300090105120
Is it Important? LongitudinalPercent of Group Reporting LBP403530252015105OR 30PDNPDNelson-Wong & Callaghan, Spine (2014)*Kolb et al., Spine (2011)Population*
Changing Responses Implementing Sit-Stand
Response to Exercise Interventionp 0.00735PD-controlPD-exerciseNSLow Back Pain VAS (mm)302520151050VAS1Nelson-Wong & Callaghan J EMG & Kin 20 (2010) 1125-33VAS2
Standing & Sitting as Rotation3030Discomfort (100 mm VAS)25Pain 102010500020406080TIME (minutes)1000120102030Time (min)4050Karakolis & Callaghan, Ergonomics, 2016De Carvalho & Callaghan, Applied Ergo 2016sGallagher & Callaghan, Ergonomics 201460
20NPD18PD14123510864201530456075Time (min)90105120Visual Analogue Scale Score (mm)Total Movement Estimate(per 15 minutes)1630NPDPD2520151050Baseline015304560Time (min)Gallagher & Callaghan, Human Movement Science 20167590105120
Feet Interventions and Impact 16 subjects 7 NPD, 9 PD (56%)16PD14NPDAngle (degrees)121086420AngledGallagher & Callaghan, Applied Ergonomics, Submitted 2016Gallagher & Callaghan, Clinical Biomechanics, Submitted 2016ElevatedUpright
Foot Rest InterventionFewster, Riddell, Gallagher & Callaghan, ACE 2016
Pain ResponseMale (Control)Male (Intervention)18Female (Control)Female (Intervention)Pain Score (mm)161412108642001020304050607080Time (min) Fewster, Riddell, Gallagher & Callaghan, ACE 2016No significant difference betweenpreviously categorized pain and non-paindevelopers lumbar spine angle p 0.138
Progressive Exposure ModelSTANDINGSIT TING31621242484816McKinnon & Callaghan, In Progress 2016TIME (minutes)
Low back pain response Pain group-by-time50Low Back Percived Discomfort (mm)4540353025PDNPD20PD (Stand)1510503410121824283440465256606672Elapsed Time (minutes)78849096102 108 112 116 120 124
Methods*Training &Industry onlySit-standIndustryApproachworkstationsInitial Follow UpBaselineIndustryand ResearchBestPracticeApproachand follow up visits Current Best PracticeIndustry Example Approach Focus on chairSet-up: Sitting standingNo hands-on demo30 mins Industry Approach Behaviour change techniquesMotivational interviewingHands-on demoTips for useWeekly meetings
Sit-stand transitions/day10Transitions /dayBest hase of StudyGroup*Phase p 0.0386
Transitions /dayTransitions: Six Month Follow-upPhase3Group*Phase p 0.0001Six-month FollowPhase of Study
Pain Developers - AHABD TestNumbar or Participants1210Best Practice86420InitialStudy PhaseEndIndustry
Fitbit Steps – main effect ofPhase14000Daily Step Counts120001000080006000400020000Phase 1Phase 2Phase of StudyPhase *p 0.0001Phase 3
Take Home messages 1) Standing and Sitting? in constrainedconditions can accelerate LBP forsome individuals 50% 2) Individual (pre-existing) risk factors areimportant considerations when evaluating thepotential for LBP associated with standing :
Take Home messages 3) Not a single ratio solution for allindividuals Sit Stand alone does not reduceLBP 4 Hours could be an upper targetto balance health and MSKbenefits Or a ratio in the work day of 1:1 4) Once Pain has initiated it isresidual or cumulative
Take Home messages 5) Interventions Exercise can alter individualspredisposed to LBP from Standingexposure Driving from the feet has potential Sloped, Elevated Strategies to induce movementearly?Move Early Move Often
Peas and Carrots”* * Forrest Gump - 1994. T i m e. Images from Focal (2016) Church et al. PLoS ONE (2011) Sit of 76% of day Stand Up Australia (2009) Matthews et al. Am J Epidemiol 2008 Sedentary 8-9 hours a day. PREMUS, 2016. Where is the Disconnect? Seated postures associated with:
3. Peas can be eaten fresh (raw) or steamed. 4. Peas taste sweet and crunchy. 5. Peas can be used to make split pea soup. 6. Peas grow inside a green container called a pod. 7. Each pod contains several peas. 8. Peas can grow on bushes or vines. Other interesting facts: Some of the earliest peas were discovered in Egyptian tombs around 3600 .
1. Starches 2. Sugars 3. Fiber 1. Starchy foods include: Starchy veggies Beans, peas, and lentils Grain foods Starchy veggies include: Corn Green peas Parsnips Plantains Potatoes Winter squash Yams Beans, peas, and lentils include: Black, pinto, and kidney beans Black-eyed peas Garbanzo beans (chick peas) Red, brown, and black lentils Split peas
The tasty new peas were so different from the peasant peas that they started a new fashion craze. The French called the tiny peas petits pois, a name that remains today. Thomas Jefferson was an avid gardener, and peas were his favorite vegetable. He thought so highly of peas
peas are round. Lentils are shaped like a lens, and chickpeas look like the beak of a baby chick. . than 20,000 years. Lentils, peas and chickpeas were found in pyramids in Egypt that were built more than 4,000 years ago. Peas . Dry Peas t urtle Beans
PGRO VINING PEA GROWERS GUIDE 2016 01 1. Vining Pea area and production 2 2. Descriptive Lists of peas and their characters 3 3. Descriptive Lists 3.1 Standard size vining peas – Thornhaugh/Nocton 4 3.2 Standard size vining peas - Holbeach 6 3.3 Petit pois vining peas - Holbeach 7 4. Choice and use of seed 8 5. Crop husbandry 9 6. Weed control 11 7. 13Diseases 8. 14Pests 9. Harvesting 16 10 .
Peas: If the peas will be shelled, har-vest the pods when they are shiny green and fully developed. Overly mature peas are of poor quality. For the edible podded varieties (such as snow and Chinese peas), harvest when the pods are fully developed (about 3 i
not recommended unless you have hard water. If you need to add baking soda, limit the amount to 1/8 tsp per 2 cups (0.5 mL per 500 mL) water. Cooking Tips for all Pulses 1. Remove any shriveled peas. 2. Rinse split peas with water - no need to soak! 3. Combine split peas and
In an effort to address the World PEAS Food Hub's falling revenues, staff spent time in 2016 assessing the World PEAS Food Hub business plan. The pricing structure was identified as an area for investigation and potential change. In order to better understand how the World PEAS Food Hub prices compare to market prices in the region, New
