Prevalence Of Work-related Musculoskeletal Disorders Research Articles

A systematic model to identify and reduce work-related musculoskeletal disorders in firefighters, and improve their function

IntroductionFirefighting is a high-risk job with a high prevalence of work-related musculoskeletal disorders (WMSDs). The aim of his study was to determine the prevalence of WMSDs, estimate the likelihood of subsequent disorders, and investigate the effect of NASM-based training protocol on firefighters function. MethodFirst, prevalence and region of WMSDs in all 524 male Isfahan firefighters were determined by Medical-history-questionnaire. Then, functional movement screen (FMS) separated firefighters to the 2-dimension FMS score (FMSCS≤14 or FMSCS>14) to show at risk firefighters. Finally, 40 Participants with both FMSCS≤14 and common WMSDs randomly assigned to either an intervention (IG) (n = 20) or control (CG) (n = 20) group. The IG received NASM-based training, while the CG engaged in daily activities. Outcomes included movement efficiency during landing error scoring system-real time, Y balance, single-leg squat, and deep squat, which were assessed in pretest and posttest. ResultsThe prevalence of disorders was 52.1%, which lower limb, back, upper limb, and neck were the highest prevalence respectively. Only lower limb and back disorders could identify individuals at disorder risk with a likelihood of 89% and 71%, sequentially. Also, movement performance significantly improved in all functional tests in IG relative to CG. ConclusionsConsidering high disorder rate in firefighters, the value of our study lies in alleging a systematic model periodically to reduce WMSDs and risk of subsequent disorders. Not only our model determined the prevalence of WMSDs, but it also identified those who are at risk. In addition, our model represents exercise therapy as a solution.

Prevalence of Work-Related Musculoskeletal Disorders and Quality of Work Life Among a Nigerian University Academic Staff

Musculoskeletal disorders are commonest work-related illnesses causing significant economic burden in terms of lost wages, treatment, and compensation. The study assessed the prevalence of work-related musculoskeletal disorders (WRMSKD) and quality of work life (QWL) among University of Medical Sciences academic staff. Fifty nine academic staff (36 males, 23 females) were purposefully recruited for the study. Questionnaire on Nordic, Quality of work life and Visual Analogue Scale were used to assess the prevalence WRMSKD, QWL and pain intensity. Questionnaires were given the respondents; they were retrieved after they due completion. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. Results showed that 51 (86.4%) reported 12-months prevalence of WRMSKD. Thirty-six respondents, (61%); reported WRMSKD in the last 7 days. The body part most affected was the neck (33 55.9%); 51(86.4%) reported that pain was caused by work. There was an inverse relationship between pain intensity and each of work experience (r = -0.289, P = 0.026), cadre (r = -0.312, P = 0.016) and extra working hours (r = -0.372, P = 0.004). This study showed that there was high prevalence of WRMSKD among academic staff and neck was most prevalent. Pain intensity was inversely related to each of the work experience, cadre, and extra-working hours.

Meta analysis of the prevalence and influencing factors of WMSDs among dentists in China

Objective: To explore the relevant factors of work-related musculoskeletal disorders (WMSDs) among dentists through Meta analysis, providing a basis for the prevention and control of WMSDs among dentists. Methods: In April 2022, cross-sectional research literatures on the prevalence correlation of WMSDs among Chinese dentists were searched in databases such as China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Web of Science, and Em Base database. The search was conducted from the establishment of the database until April 2022, literatures were selected using keywords such as musculoskeletal disorders and dentists. To extract gender, age, length of service, disease classification and other related influencing factors as indicator, and prevalence was selected as the outcome indicator. After evaluating the quality of the literatures, RevMan 5.3 software was used to calculate the combined RD (95%CI) values of the included literatures. Results: A total of 15 articles were included, with a total sample size of 3646 people. Meta analysis results showed that the prevalence of WMSDs among dentists in China was 80%, and the top three parts of the incidence rates were 65% of the waist, 58% of the neck, and 50% of the back. Gender, age, length of service, region and disease classification all increased the risk of WMSDs, and the combined effect size were 75%, 78%, 71%, 77% and 82% respectively (P<0.05) . Conclusion: The occurrence of WMSDs among dentists in China is related to multiple factors such as gender, age, length of service and disease classification. The above risk factors should be taken into account in the workplace and preventive measures should be actively implemented to prolong the working life of dentists.

Risk Assessment and Prevalence of Work-Related Musculoskeletal Disorders Among Cranial and Spinal Neurosurgeons

To assess the risk and prevalence of work-related musculoskeletal disorders (WMSDs) in spine and cranial surgeons. A cross-sectional analytic study composed of a risk assessment and a questionnaire-based survey was conducted. The risk assessment for WMSDs was performed on young volunteer neurosurgeons using the Rapid Entire Body Assessment tool. The survey-based questionnaire was distributed using the Google Forms software among the relevant official WhatsApp groups of the Egyptian Society of Neurological Surgeons and the Egyptian Spine Association. Thirteen volunteers with a median service of 8 years were assessed for the risk of WMSDs, showing moderate to very high risk of WMSDs, with a Risk Index >1 for all assessed postures. A total of 232 respondents completed the questionnaire, 74% of whom reported WMSD symptoms. Pain was experienced by most (96%), with neck pain being the most common (62.8%), followed by low back pain (56.0%), shoulder pain (44.5%), and wrist/finger pain (43.9%). Pain was experienced for 1-3 years by most respondents; however, most did not reduce their case volume, seek medical advice, or stop working when they experienced pain. The survey showed shortage in the literature studying ergonomics, calling for more ergonomic education and furnishing of working environment of neurosurgeons. WMSDs are prevalent among neurosurgeons, affecting their ability to work. Ergonomics need further awareness, education, and interventions to reduce WMSDs, especially neck and low back pain, which proved to substantially interfere with work ability.

Prevalence and impact of work-related musculoskeletal disorders among food delivery riders in Eastern Peninsular Malaysia

Work-related Musculoskeletal Disorders (WMSDs) are currently a matter of concern in the occupational world, where it is the leading cause of disability among workers. Food delivery riders were among the neglected workers even though they were highly exposed to the WMSDs. Thus, this study aims to quantify the magnitude of WMSDs among the riders and the impact on their work. This was a cross-sectional study involving 191 food delivery riders in Eastern Peninsular Malaysia. The Standardized Nordic Musculoskeletal Questionnaire (M-SNMQ), which was self-administered and validated for Malay translation, was used to quantify the prevalence of WMSDS based on various specific body regions. WMSD prevalence over a 12-month period was 74.9%. Upper back pain (UBP) (55.6%) and lower back pain (LBP) (73.3%) were the two most common body regions to experience WMSD symptoms. The least-complained body regions were thighs and feet, with a prevalence of 2.6% and 3.1%, respectively. The affected body regions that caused the highest daily life disturbance were the shoulders and knees, while those with shoulders symptom were more likely to be absent from work. Finally, LBP was the highest body region with at least a moderate pain score. In general, the findings should be a matter of concern among health authorities and others to improve the quality of life among the riders. To lower the prevalence of WMSDs among this understudied group, additional interventional research should be built on the findings of this study.

Prevalence of Work-Related Musculoskeletal Disorders and its Association of Stress among Food Delivery Personnel of Gujarat - A Cross-Sectional Analytical Study

Prevalence of Work-Related Musculoskeletal Disorders and its Association of Stress among Food Delivery Personnel of Gujarat - A Cross-Sectional Analytical Study

Prevalence of work-related musculoskeletal disorders among the Ali-Ibn Abi-Talib hospital’s staff in Rafsanjan city in 2019

One of the problems of employees in different occupations, especially employees in multiple wards of the hospital,is work-related musculoskeletal disorders. Evaluating the incidence of work-related musculoskeletal illnesses and associated variables among employees is crucial in light of the significance of this problem and staff health. Therefore, we evaluated the prevalence of work-related musculoskeletal disorders among Ali-Ibn Abi-Talib Hospital’s staff in Rafsanjan city in 2019. In this study, 220 staff members (143 females and 77 males) entered the study in 2019 with personal consent, and to collect data, the demographic information questionnaire and Nordic Musculoskeletal Questionnaire was used.The mean age of staff was 35.43 ± 8.08 including treatment staff (nurses-physicians) (46.8%,) administrative staff (33.6%), and service staff (drivers-workers) (19.6%). Additionally, 40% of all work-associated musculoskeletal diseases were connected to the neck region, 38% to the knees, 36%to the lower back, and 12% to the elbows, feet, and ankles, 16% to the thighs, and 24.1% to the back. The prevalence of disorders in some areas, such as the neck was high as in some studies. Therefore, it seems that the necessary planning should be done to prevent further occurrence of these disorders among hospital staff, which may lead to inefficiency.

Prevalence of musculoskeletal disorders in anesthesiologists in Ismailia Governorate

ABSTRACT Aim Detect the prevalence of work-related musculoskeletal disorders among anesthesiologists and their related risk factors. Methods This cross-sectional study was conducted on anesthesia and intensive care physicians in Ismailia/Egypt from June to July 2022. The questionnaire had three parts. The first part consisted of participants’ demographic data. The second focused on musculoskeletal disorders and possible risk factors. The last one questioned the impact of musculoskeletal disorders on the participants. Results The mean age of the studied population was 35.65 ± 7.734. Thirty-eight (41.8%) participants worked for 60–80 hours/week. The whole study participants reported the presence of at least one form of MSDs. Back pain was the most reported pain (78%), followed by neck pain (50.5%). Possible risk factors included the need for excessive bending and twisting, poor work ergonomics that needs improvement as reported by (81.3%) of participants and suboptimizing patient’s position before specific procedures by two thirds of the participants. The physicians reported difficulty falling asleep, feeling anxious, and needing medication to control pain; however, they did not require sick leave (79.1%). Conclusion A significant proportion of anesthetists suffer from WRMSDs. Work ergonomics need improvement.

Work-Related Musculoskeletal Disorders and Mental Health among Nursing Personnel in the Context of COVID-19 Pandemic in West Bengal, India

Introduction: COVID-19 outbreak created enormous turmoil all over the world. The health sectors were overburdened with critically ill COVID-19 patients. The load on the health sector burdened and fatigued the health care workers especially the nursing personnel as they were in direct contact with the symptomatic patients predominantly. In each wave, the patients’ number surged and overwhelmed the health sectors. In this study, the prevalence of work-related musculoskeletal disorders (WMSDs) discomfort and mental exhaustion among the nursing personnel were assessed. Methods: The duration of the study was from the end of September 2021 to March 2022. The factors that sourced the discomfort symptoms amidst and the interludes of the later waves of COVID-19 and their interrelations were also assessed here. The Modified Nordic Questionnaire and the COVID Stress Scales (CSS) were used in this study. Results: 73.9% of subjects (N=88) reported the presence of WMSDs symptoms in at least one body region in the last one-year time period with the most prevalent discomfort in the lower back region (42%), followed by discomforts in the ankles, neck, and knee. The mean value of the total score of CSS was 33.74(±19.90) with high mean values in compulsive checking, danger, and contamination subscales. This study showed significant positive correlations between the presence of WMSD symptoms with BMI (rs=0.266, p= 0.012) and CSS total scores (rs=0.216, p=0.043). Conclusion: Large percentages of reports on musculoskeletal discomforts with reports on mental enervation related to COVID-19 indicated weariness of the nursing personnel. The physical exhaustion due to overloading work and the interplay between mental stress and WMSDs revealed pivotal issues of concern.

Prevalence of Work-Related Musculoskeletal Disorders among Nurses: A Meta-Analysis.

Work-related musculoskeletal diseases (WMSDs) have a greater negative impact on nurses' physical and mental health. However, the epidemiologic characteristics of nurse WMSDs are unclear, and the reported prevalence of WMSDs varies widely. The aim of this meta-analysis was to provide a quantitative synthesis of WMSDs' prevalence in nurses and estimate the pooled prevalence of its. The PubMed, ScienceDirect, Web of Science, Cochrane Library, EMBASE, CINAHL, Ovid, WANFANG, VIP, China Knowledge Integrated, and CBM databases were searched for relevant studies. The retrieval period extended from database initiation to Mar 2022. After data extraction and quality assessment, a meta-analysis was performed using the Stata 16.0 software package. Overall, 42 articles were included, yielding a total sample size of 36,934. The annual prevalence of WMSDs among nurses was found to be 77.2% (95% confidence interval: 0.725-0.819). The three anatomical areas with the highest prevalence of WMSDs among nurses were the lower back (at 59.5%), neck (at 53.0%) and shoulder (at 46.8%). Nurses in developed countries have a higher prevalence of WMSDs than those in developing countries. There was currently moderate evidence to suggest a high prevalence of WMSDs in nurses. National policies should aim to reduce their prevalence in this population.

Prevalence and Associated Factors of Work-Related Musculoskeletal Disorders Symptoms among Construction Workers: A Cross-Sectional Study in South China

Statistics showed that work-related musculoskeletal disorders (WMSDs) are the leading cause of productivity loss in the construction industry. This study aimed to investigate the prevalence of WMSDs and associated factors among construction workers. A cross-sectional study was conducted among 380 construction workers in Guangdong Province, China. A demographic, work-related survey and the Nordic musculoskeletal questionnaire were used to collect the workers' data. Descriptive statists and logistic regression were used for the data analysis. The results showed that the overall prevalence of WMSDs symptoms among the participants in any body region during the last 12 months was 57.9%. Neck (24.7%), shoulder (22.1%), upper back (13.4%), and lower back (12.6%) showed the highest prevalence of WMSDs. Age, exercise, work experience, work position, and level of fatigue after work were significantly associated with the prevalence of WMSDs symptoms in different body regions. The findings of this study showed that the prevalence of WMSDs symptoms among construction workers in south China is still high and is associated with different body areas compared to previous studies. The prevalence of WMSDs and risk-associated factors vary by country and region. This indicates that further local investigations are needed to propose specific solutions to improve the occupational health of construction workers.

Prevalence of Work-Related Musculoskeletal Disorders and Its Effects amongst Nurses in the Selected Intellectual Disability Unit of the Limpopo Province.

The COVID-19 pandemic continuously highlights the need for occupational health and safety among healthcare professionals. Physical and mental health safety resulting from needle prick injuries, stress, infections, and chemical hazards are priority work-related musculoskeletal disorders for nurses, including those working in the intellectual disability unit. The intellectual disability unit provides basic nursing care to patients with known mental disabilities, such as learning, problem-solving, and judgment problems, which demand diverse physical activities. Nevertheless, the safety of nurses within the unit receives little attention. Thus, we adopted a quantitative cross-sectional epidemiological survey design to determine the prevalence of work-related musculoskeletal disorders amongst nurses working in the intellectual disability unit at the selected hospital in Limpopo Province, South Africa. A self-administered questionnaire collected data from 69 randomly selected nurses from the intellectual disability unit. Data were extracted, coded, and captured in MS Excel format (2016) and imported into the IBM Statistical Package for the Social Sciences (SPSS), software version 25.0, for analysis. The study reported a low (38%) prevalence of musculoskeletal disorders in the intellectual disability unit, with significant effects on nursing care and staffing. The effects of these WMSDs included missing work, interference with the daily routine, disturbance with sleeping patterns after work, and absenteeism from work. Since intellectually disabled patients depend entirely on nurses for the basic activities of daily living, this paper recommends the incorporation of physiotherapy among nurses in the intellectual disability unit to treat the incidence of lower back pain while mitigating nurses missing work or absenteeism.

Prevalence of Work-Related Musculoskeletal Disorders in CISF Staff of Delhi Metro, India (2019)

Prevalence of Work-Related Musculoskeletal Disorders in CISF Staff of Delhi Metro, India (2019)

Study of musculoskeletal health problem among bankers in Kathmandu valley

Background: Musculoskeletal disorders affect all persons regardless of age and sex and are prevalent across a wide range of industries and jobs. In Asian populations, a high annual prevalence of Work-related Musculoskeletal Disorder in at least one body region is varied from 40% to 95%. The aim of this study was to assess the prevalence and identify the factors contributing to Musculoskeletal disorders. Methods: Analytical cross-sectional and quantitative method was used. Random sampling was used to select the banks and convenience sampling was used to select the branches of those selected banks and finally, the census technique was used to collect the data from respondents. A structured questionnaire was designed and administered to study participants. Data collected from respondents were entered into Epidata 3.1 and were analysed and expressed using SPSS 26. Results: The study showed the annual prevalence of Musculoskeletal disorder was 82.5% with the highest single MSDS prevalence of neck pain and the previous one-week prevalence rate was 37.6%. Gender (OR=2.543, 95% CI=1.082-5.974), age group 30-39 (OR=2.430, 95% CI=1.060-5.572, Physical activity (OR=7.379, 95% CI=3.004-18.12), Experience (OR=5.27, 95% CI=2.490-11.185), Repetitive task (OR=22.208, 95% CI= 9.744-50.617), Posture (OR=3.834, 95% CI=1949-7.543), Working hours (OR=2.06, 95% CI=1.070-3.966) were found to be significantly associated with MSDs. Conclusions: Occupational Health and safety was one of the neglected areas in Banking industry. The concept of occupational safety and health is still new in Nepal.

Prevalence of work-related musculoskeletal disorders among health care professionals: A systematic review.

Work-related musculoskeletal disorders (WRMSDs) are one of the main causes of morbidity among healthcare professionals. It has various secondary consequences on productivity by diminishing the quantity and quality of work completed by the affected personnel, in addition to having a primary impact on the individual with pain and discomfort. The study aims to determine the overall prevalence rate of WRMSD among dentists, physiotherapists, and surgeons and also identify the commonly affected regions of the body about specific health care profession among each of the three professions, as recorded by the cross-sectional studies performed in various countries and regions of the world. A systematic searching strategy was framed following the PRISMA guidelines based on the present inclusion and exclusion criteria. A critical search of articles was conducted during June 2020 in CINAHL (DOAJ), PubMed, Google Scholar Scopus, PEDro databases and SAGE journals. Out of the 42 articles that met the eligibility criteria, there were 39 cross-sectional studies, 2 pilot cross-sectional surveys and 1 prospective cohort study with one-year follow- up. All studies included in this review used various survey tools for recording the demographic details and measuring the prevalence of WRMSDs and other outcome factors. We conclude that all three health care professionals (dentists, physiotherapists and surgeons) are highly prone to develop WRMSDs with surgeons and dentists being more vulnerable when compared to physiotherapists. The lower back and neck are identified as the two most commonly affected regions among all three professionals.

Epidemiological study of multi-site WMSDs in the footwear industry in China

Objectives. This study aimed to identify the prevalence of multi-site work-related musculoskeletal disorders (WMSDs) in Chinese footwear industry workers from 2018 to 2020 and explore the possible influencing factors of WMSDs. Methods. 7106 subjects from 26 large shoe factories in China were investigated using the epidemiological cross-sectional survey method by using the Nordic musculoskeletal questionnaire (NMQ). Results. The total prevalence of WMSDs in the study subjects was 36.8% (2616/7106). Among them, the prevalence of multi-site WMSDs was 26.1% (1858/7106). The proportion of multi-site WMSDs involving two sites was the largest (31.38%). In addition, the results showed that the risk factors of multi-site WMSDs were gender, marital status, long current job experience, poor health, poor working posture, etc. Conclusions. The prevalence of WMSDs was high in the Chinese footwear industry. Based on the results, therefore, it seems necessary to improve work posture, work organization and workenvironment to prevent WMSDs.

Ergonomics-Related and Work-Related Musculoskeletal Disorders in A High-Hazard Factory in Hatay Region

Objectives: The most common work-related diseases are musculoskeletal system disease. This study aims to determine the prevalence of work-related musculoskeletal disorders (WMSDs) in a high-hazard factory and to determine sociodemographic, occupational, and ergonomic risks. Methods: The research is cross-sectional and was conducted in a high-hazard factory, in Hatay, in 2017. The research population was all factory employees (N=190), and it was aimed to reach the whole population. Of the (97.3%), 185 employees participated in the study. Anthropometric measurements, the Cornell Musculoskeletal Discomfort Scale, the observation-based Rapid Upper Limb Assessment (RULA) Ergonomic Risk Analysis Scale, and a questionnaire developed by the researchers are used for data collection. In the statistical analyses p&amp;lt;0,05was accepted as significant. Results According to the Cornell Scale, the frequency of WMSDs was 58.9%. The most common WMSDs were in the lumbar region (34.1%). According to the RULA Scale, 31.9% of the employees had 3rd and 4th-degree ergonomic risk. There were linear relationships between the Cornell Waist Score and each of the three RULA scores (p&amp;lt;0.001). The risk factors for WMSDs in the lumbar region were the presence of chronic disease (OR=5.35), hand tool use (OR=2.63), not having had a work accident (OR=0.04) and RULA scores (OR=1.61), Conclusion: Approximately one-third of the high-hazard factory employees had a high ergonomic risk. WMSDs existed in more than half of the employees. As the ergonomic risk increases, WMSDs increase.

AIUM Practice Principles for Work-Related Musculoskeletal Disorder.

The prevalence of Work-Related Musculoskeletal Disorders (WRMSDs) among ultrasound professionals has been significant. National and international efforts to create industry standards have focused primarily on injuries in sonographers. In addition, the Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety & Health (NIOSH) have published documents related to this occupational exposure. There has also been significant attention on equipment utilization and design to help reduce the prevalence of WRMSDs. The American Institute of Ultrasound in Medicine (AIUM) developed the AIUM Practice Principles for Work-Related Musculoskeletal Disorder in collaboration with other organizations whose members use ultrasound [see Collaborating Societies and Representatives]. This document supports the "Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography" and aims to expand on these Standards to include safety practices for all health care professionals who utilize ultrasound. These professionals include members of the scientific community, a wide variety of medical professionals, and dental professionals. These ultrasound users and operators will collectively be referred to in this document as "operator(s)" except in those instances where data addressed those holding a specific job title, such as sonographer. In addition, this document will support guidance for quality improvement specific to preventing and reducing injury rates.

Investigation the contribution of process areas to lower back pain among manual assembly workers in medical device industry

Work-related musculoskeletal disorders are the leading cause of occupational health issues in manufacturing, especially for manual assembly processes. One of the primary prevalence of work-related musculoskeletal disorders among manual assembly workers in the medical device industry is low back pain. This paper investigated the risk factors associated with process areas on the low back pain cases among manual assembly workers in one multinational medical device company. This report represents the second of three stages of an investigation study; namely validation of risk factors. Interview sessions were conducted with six manual assembly workers who obtained the highest musculoskeletal disorder scores of low back pain in the earlier study. Results of the interviews were characterized into three major risk factors; lifting weights during work, chair condition and working posture. These three risk factors were then validated with a larger group of 153 female participants of the same population using Cornell Musculoskeletal Discomfort Questionnaire and an additional selfadministered questionnaire. The results show that lifting weights during work and chair conditions have the highest risk of low back pain with each 48% prevalence, while the risk due to working posture is lower at 17%. The study&apos;s outcome will be used in the third stage of the investigation study, that is, to formulate improvement actions with ergonomics specialists.

The prevalence and risk factors of work related musculoskeletal disorders among electronics manufacturing workers: a cross-sectional analytical study in China

ObjectivesTo describe the prevalence of self-reported musculoskeletal disorders among workers in the electronics manufacturing industry and to investigate the relations between work-related musculoskeletal disorders (WMSDs) and work-related variables.MethodsAn interview-based questionnaire survey was carried out in thirty electronics manufacturing factories in China in 2018. The prevalence of WMSDs was estimated using the modified Nordic Musculoskeletal Questionnaire (NMQ). A multivariate logistic regression model was applied to evaluate the effects of risk factors on WMSDs on multiple body parts.ResultsThe 12-month prevalence of WMSDs among participants was 40.6%, and the common body sites affected were the neck (26.8%), shoulder (22.8%), upper back (14.9%), and lower back (14.8%). The results of logistic regression showed that female adults, > 5 job tenure and work-related factors (including awkward posture, lifting or carrying weights, excessive repetition, prolonged sitting, monotonous work and working under conditions of cold or temperature variations) led to a higher risk of WMSDs on most body parts. Upper back, wrist/hand and elbow pain levels were significantly higher for workers with vibration. However, more frequently, physical exercise was a protective factor against WMSDs on most body parts except the upper back, leg and knee.ConclusionsThe study indicates a high prevalence of musculoskeletal pain among the electronics manufacturing industry in China. Different personal and work factors are related to the occurrence of WMSD on different body parts. Preventive measures should be implemented based on the characteristics of WMSD in the electronic manufacturing industry. Furthermore, the training and intervention guidance of ergonomic hazards in the workplace need to be strengthened by understanding the impact of bad posture, avoiding long-term sitting posture and increasing physical activities.