Shaping well-being and healthy habits at work through tailored physical activity among remote and hybrid employees: study protocol for RCT

Abstract

Introduction

This study aims to create a comprehensive model for shaping well-being and healthy habits at work through tailored training in physical activity among remote or hybrid workers.

Methods and analysis

This is a three-arm randomised controlled trial designed to assess the effects of tailored and general physical activity interventions compared with a no-intervention control group. It is assumed that both types of physical activity (general and tailored) might reduce musculoskeletal problems and presenteeism and improve well-being in a short time. However, a tailored type of training, prepared to reduce pain in specific muscles associated with long-term sedentary work, along with a detailed explanation of how exercises influence the muscles, will allow the development of healthy work habits and decrease negative symptoms in a long-term period. Therefore, short-term effects on well-being, presenteeism and musculoskeletal problems will be tested immediately after training and long-term ones—3 months after the end of the training. Well-being at work, presenteeism, work habits and workstations will be measured using research questionnaires. The level of musculoskeletal complaints will also be assessed using a standardised questionnaire specifying the location and the level of pain caused by the ailments. In addition, objective assessment tools will be used—electromyography (measuring the level of fatigue of specific muscles) and myotonometry (determining the level of muscle stiffness).

Ethics and dissemination

The study was approved by the Institutional Review Board (the Rector’s Commission on Research Ethics at the Wroclaw University of Economics and Business; Ethical Committee Decision number: 10/2025) and will be conducted in accordance with the Declaration of Helsinki. The findings of this research will be disseminated in the original article.

Trial registration number

ACTRN12624001311549.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This study uses a randomised controlled trial (RCT) design with two intervention groups and a control group.

• It integrates both subjective (questionnaires) and objective (electromyography (EMG), myotonometry) outcome measures to enhance methodological rigour.

• Tailored and general physical activity programmes are delivered under the supervision of qualified physiotherapists using standardised procedures.

• Relies partly on self-reported data, which may be subject to reporting or recall bias.

• Results may be influenced by uncontrolled external factors such as changes in work environment or personal health.

• Although not based on a formal behavioural change framework, the intervention includes elements that may support habit formation, which could affect long-term adherence.

Introduction

Technological advancements over recent decades have profoundly reshaped the labour market in developed countries, leading to a marked rise in sedentary occupations, particularly in sectors such as administration, information technology and finance.¹,³ This occupational transformation has significantly increased cumulative sedentary time, with office-based employees spending approximately 77% to 82% of their workday in seated positions.⁴,⁸ Sedentary behaviour, as defined by the Sedentary Behaviour Research Network, refers to any waking activity performed in a sitting, reclining or lying posture with an energy expenditure of ≤1.5 metabolic equivalents⁹ and has been strongly associated with a range of adverse health outcomes.¹⁰

The sudden transition to remote and hybrid work after the COVID-19 pandemic has exacerbated sedentary behaviours, resulting in new challenges for physical health, mental well-being and organisational effectiveness.¹¹,¹⁹ In Poland, over 16% of employees now work remotely or in hybrid modes, often without adequate ergonomic infrastructure or structured routines.²⁰ Despite recent regulatory updates requiring employers to ensure safe and healthy working conditions in remote settings, practical enforcement is often limited. In many cases, compliance relies primarily on employee self-declarations that ergonomic and safety standards are met, while systematic oversight remains rare and difficult to implement.²¹ As a result, remote workers may receive less effective occupational health protection compared with on-site employees.²² Emerging evidence indicates that home-based employees, particularly those working without ergonomic guidance or structured routines, are more likely to develop maladaptive behavioural patterns—such as prolonged sitting, insufficient movement and increased screen exposure—which contribute to musculoskeletal overload and elevate psychosocial risks.²³

Prolonged occupational sitting has been consistently linked to musculoskeletal complaints, particularly in the lumbar spine, cervical region, gluteal muscles and lower limbs.^{24 25} Although a direct causal link between sitting duration and low back pain (LBP) remains inconclusive,²⁶,³¹ research highlights the multifactorial nature of musculoskeletal disorders, in which prolonged static posture, diminished movement variability and mechanical loading of passive tissues play crucial roles.³²,³⁶ During seated work, postural stabilisers—such as the erector spinae and deep cervical flexors—maintain low-level activation, contributing over time to muscle fatigue, postural collapse and functional decline.^{36 37} Such muscular insufficiency increases the mechanical burden on passive structures, including ligaments, intervertebral discs and fascia, thereby elevating the risk of discomfort and biomechanical overload.^{35 38} Employees who spend extended hours at desks frequently report early symptoms of discomfort—particularly in the lower back and buttocks—which are often exacerbated by poor ergonomics and insufficient movement breaks.^{28 39} These symptoms, typically experienced as tension, soreness or fatigue, may serve as precursors to more persistent musculoskeletal complaints, especially among workers with low movement variability.^{40 41} Moreover, musculoskeletal symptoms are commonly reported in the neck and upper limbs of computer users, often manifesting within the first year of screen-based work exposure.⁴²,⁴⁵ Limited cervical mobility and elevated activity of neck extensors and flexors are frequently observed in individuals with chronic neck pain, reflecting complex neuromuscular compensation patterns.^{43 46}

In addition, prolonged sitting elevates intramuscular pressure in the gluteal region and impairs venous return in the lower limbs, producing symptoms such as swelling, numbness and heaviness.⁴⁷,⁴⁹ These effects are intensified under static conditions with limited opportunities for dynamic muscular engagement. Impaired muscular perfusion and uneven pressure distribution beneath the buttocks and thighs may disrupt tissue recovery and elicit discomfort severe enough to alter posture, reduce focus or undermine task performance—especially during sustained digital work.^{39 40 47}

Taken together, this body of evidence illustrates how prolonged sitting imposes cumulative biomechanical and physiological strain, forming a pathway to musculoskeletal dysfunction in occupational settings with limited ergonomic oversight and self-directed behavioural regulation.

Beyond its musculoskeletal implications, prolonged sedentary work also generates substantial psychosocial strain, particularly in remote and hybrid work settings. The rapid shift to telecommuting, initially prompted by the COVID-19 pandemic, has exacerbated risks to employee mental well-being—particularly through increased autonomy coupled with diminished structural boundaries between work and non-work domains. Although remote arrangements can enhance flexibility, they often lack the supervisory oversight, environmental cues and peer interactions that traditionally help employees regulate effort, disengagement and emotional balance. In this context, many employees report declines in psychological well-being, characterised by elevated stress, reduced vitality and a sense of detachment or social isolation.¹¹,^{1319 50}

This contextual shift has also contributed to a significant rise in virtual sickness presenteeism, defined as continuing to work despite illness in a remote or hybrid setup.⁵¹,⁵⁴ Employees operating outside of traditional office structures appear more prone to this behaviour due to a combination of reduced visibility, heightened self-monitoring, blurred work-life boundaries and the absence of physical barriers such as commuting.⁵²,⁵⁵ Remote and hybrid work models often shift the responsibility for regulating effort, rest and recovery onto the individual. When this occurs without adequate organisational support, it can intensify internalised performance pressure and increase the likelihood of continuing to work despite illness or fatigue.^{56 57} Empirical studies also indicate that presenteeism in such settings is not only more frequent but may also have more detrimental effects than traditional forms, leading to prolonged strain, reduced recovery and impaired job performance.⁵⁵⁵⁸,⁶⁰

Despite growing awareness of the health consequences of sedentary work, a substantial proportion of employees—particularly those engaged in remote or hybrid arrangements—fail to meet the WHO-recommended thresholds for physical activity, which include 150–300 min of moderate-intensity or 75–150 min of vigorous-intensity aerobic activity weekly, along with muscle-strengthening exercises involving major muscle groups on at least 2 days per week.^{61 62} Barriers such as time constraints, low health literacy and limited organisational support are frequently cited, especially among remote workers whose routines are self-directed and physically constrained.⁶³,⁶⁶ Studies show that regular physical activity is not a standard habit of employees; working adults who spend long periods sitting at work do not necessarily compensate for this inactivity during non-work hours.⁶⁷ Moreover, awareness of the health risks associated with sedentary behaviour and physical inactivity remains limited among employees, many of whom may require supportive organisational environments and a workplace culture conducive to behavioural change.⁶⁶ In the Polish context, surveys confirm that despite general knowledge about health, a large proportion of employees report insufficient physical activity and a lack of workplace encouragement to change their sedentary lifestyle. This situation is exacerbated by limited access to employer-supported initiatives and a mismatch between declared willingness to improve health behaviours and actual organisational infrastructure.^{68 69}

Although workplace interventions based on physical activity have increasingly aimed to address inactivity and musculoskeletal complaints among desk-based employees, their effects have often been modest and difficult to sustain over time. Meta-analytic evidence suggests that many traditional interventions—often generic and undifferentiated—fail to account for specific ergonomic exposures or biomechanical risks typical of prolonged sedentary work.⁷⁰,⁷⁵ Additionally, such interventions frequently lack integrated behavioural components needed to facilitate long-term change, particularly in decentralised or digitally mediated work contexts where external structure is minimal.⁷¹ This limitation is especially salient given the escalating burden of musculoskeletal symptoms, presenteeism and emotional exhaustion reported by telecommuters and hybrid workers.^{14 54 76}

By contrast, physical activity interventions tailored to the specific neuromuscular demands and environmental constraints of home- or screen-based occupations show greater potential to improve adherence and musculoskeletal outcomes.⁷⁷,⁸⁰ These interventions are designed to target vulnerable postural muscle groups most affected by prolonged sitting—particularly the lumbar extensors, gluteal muscles, upper trapezius and deep cervical flexors.^{3643 81},⁸³ They typically integrate foundational education related to posture, proprioceptive awareness and fatigue detection, thereby enabling early correction of dysfunctional movement patterns and strengthening self-regulatory capacity.⁸⁴,⁸⁶ In addition, validated biomechanical methods such as surface electromyography (EMG) and myotonometry are increasingly employed to monitor changes in muscle fatigue, stiffness and activation patterns—particularly in spinal stabilisers and the cervical region.⁸⁷,⁸⁹

Beyond musculoskeletal outcomes, workplace physical activity interventions have increasingly demonstrated potential to support broader dimensions of employee well-being and cognitive-affective functioning. When integrated into the workday—rather than confined to leisure time—such interventions have been associated with improved affective states, enhanced energy levels and reduced emotional exhaustion, particularly among individuals experiencing digital fatigue or working under conditions of high autonomy.⁸⁴⁹⁰,⁹² Several studies underscore the capacity of structured movement breaks and posture-related training to improve emotional regulation, stress resilience and job satisfaction, especially in digitally mediated environments where recovery cues and ergonomic infrastructure are often lacking.^{79 80 93} In this regard, Pieper et al⁹⁴ highlight that increasing movement variability and embedding physical activity into work routines can enhance both productivity and psychosocial engagement—illustrating the multidimensional utility of such interventions.

While the link between physical activity and virtual presenteeism remains underexplored, some recent studies suggest that workplace-based movement interventions may indirectly reduce presenteeism-related behaviours by alleviating fatigue, enhancing recovery and improving perceived vitality—particularly in telecommuting populations where physical disengagement cues are limited.⁹⁵,⁹⁹ These effects, though preliminary, underscore the need for further investigation into the multidimensional impact of physical activity on behavioural indicators of work engagement.

Despite encouraging findings, few studies have examined the combined physiological, psychosocial and organisational effects of physical activity interventions in remote or hybrid work settings. Existing research often isolates outcomes—such as pain reduction, well-being or productivity—rather than evaluating them within a unified model.^{91 100 101} Evidence on the long-term sustainability of such interventions is also limited, particularly when it comes to programmes tailored to the specific ergonomic and behavioural demands of flexible work environments.¹⁰⁰ While general activity guidelines remain relevant, the comparative effectiveness of standardised versus individualised approaches in promoting durable healthy routines, reducing musculoskeletal strain and enhancing overall work functioning remains insufficiently explored. Furthermore, there is growing evidence that specific or tailored physical activity is more effective in reducing musculoskeletal pain and enhancing mental health outcomes. For instance, Kellett et al¹⁰² found that specific coordination exercises reduced back pain, while other studies indicated that training with guidance alleviated low back ailments.¹⁰³ In contrast, studies involving only general physical activity did not show significant improvements in mental or physical health (cf. ^{74 104}). Additionally, the broader health literature suggests that specific types of sport training can have positive effects on cardiovascular conditions¹⁰⁵ and postural strength.¹⁰⁶

Moreover, few studies integrate mixed-method approaches combining subjective self-reports with objective biomechanical assessments—such as EMG or myotonometry—which may enhance the precision and contextual relevance of intervention outcomes.^{36 87 107}

To fill the gaps and advance current understanding, the present study introduces a comprehensive model of tailored physical activity designed specifically for remote or hybrid employees. Drawing on biomechanical expertise and supported by behaviourally informed strategies, the intervention targets musculoskeletal symptoms while simultaneously enhancing well-being and mitigating virtual presenteeism. The trial evaluates short- and long-term outcomes across physiological, psychosocial and organisational domains, comparing tailored training with general exercise and a no-intervention control. By integrating validated tools such as EMG with self-reported indices of discomfort, vitality and work functioning, the project contributes to an interdisciplinary understanding of how structured movement can promote sustainable health behaviours in digitally mediated work environments

Methods and analysis

Study design

This is a three-arm randomised controlled trial (designed to assess the effects of tailored and general physical activity interventions compared with a no-intervention control group.

Patient and public involvement

Due to the specific nature of this study, patient and public involvement was not feasible. The research required specialised knowledge that limited the scope for meaningful contributions from non-experts.

Population

Participants will include professionally active adults (aged 20–65) working remotely or in hybrid mode, who spend at least 50% of their working time seated. Exclusion criteria include musculoskeletal pain >7 on Visual Analogue Scale for Pain (VAS), structured physical activity >2 h/day and participation in other employer-organised training programmes.

The study should recruit at least 90 respondents (adults, professionally active). The determination of the sample size for our study was based on careful consideration of various statistical factors, including the desired level of statistical power and the anticipated effect size. A priori power analysis using G*Power (V.3.1.9.7) indicated that a minimum of 60 participants (20 per group) is required to detect a moderate effect size (f=0.25) with 80% power at a significance level of α=0.05 using repeated measures ANOVA. To account for an anticipated attrition rate of up to 33%—based on prior pilot data—we plan to recruit 90 participants, which allows for sufficient oversampling. This ensures that even if a dropout occurs, the final analyzable sample will meet the power requirement. The estimation was also based on our experience in the pilot study and the current study. In the pilot study, we recruited 30 participants to the ‘exercise group’, and due to some work tasks, the employees were engaged, but only 22 finished all training sessions. On the basis of this experience, we presume one-third of drop-offs.

The participants will be briefed about the project and their roles.

Intervention

Tailored training consists of the following exercises:^{8182 108},¹¹¹

1. General warm-up programme—10 min using a stationary bike, treadmill or cross trainer.

2. Stretching exercises (5 min): (a) Locate mid-thoracic spinal segments on a foam roller and lie on it with the knees flexed. Fold the hands together behind the neck and slightly lift the buttocks from the floor. Then, slowly roll the foam roller up and down the mid-thoracic spine. (b) In a kneeling position, place the elbows in front of the body on the bench and sit on the heels while flexing the arms. (c) One leg kneeling position. Emphasise the stretching feeling at the front of the thigh in the back leg. Then emphasise the stretching feeling at the back of the thigh in the front leg. (d) Repeat with the opposite leg.

3. Sensorimotor exercise (10 min): (a) Lying position with a small pillow under the neck. Rotate the head slowly right and left through a full range of motion. (b) Lying position with a small pillow under the neck. Slide the back of the head on the floor up and down. (c) Four-point kneeling position. Moving the lumbar spine from the lordotic to the kyphotic position. (d) Standing position. Knees slightly flexed. Move the lumbar spine from the lordotic to the kyphotic position.

4. Strengthening exercises (15 min). 3–4 sets of exercises, without breaks in between. (a) Standing position. Knees slightly flexed. Lumbar spine in kyphotic position. Reach with the hands as high as possible for 10 s. (b) Standing position. Extend, slightly abduct and externally rotate the arms with the resistance of a rubber band. (c) Maintain the ‘plank’ position for 30 s. (d) Lying supine. Lift the head of the floor. Maintain the position for 10 s.

5. General cool-down exercise. 5 min using a stationary bike, treadmill or cross trainer.

General training will last 45 min and cover six stages of the following exercises (cf.⁸³):

1. General warm-up programme—10 min using a stationary bike, treadmill or cross trainer.

2. General warm-up exercise for the upper body in a standing position (5 min): (a) circular movement in the wrist joint with finger movement. Each hand separately and with hands folded together. (b) Circular movement of hands with flexion and extension in the elbow joint. (c) Circular movement of arms in the shoulder joint. (d) Circular movement of shoulders. (e) Circular movement of the head.

3. General warm-up exercise for the lower body in a standing position (5 min): (a) Circular foot movement with and without contact with the floor. (b) Knee bending with the knee lift to the chest or with the heel lift to the buttock. (c) Circular movement of both knees in a horizontal plane in a standing position. (d) Circular movement in the hip joint with elevated leg bent at the knee joint. (e) Circular movement of the hips in a horizontal plane in a standing position.

4. Strengthening exercises (10 min). 3–4 sets of exercises, without breaks in between. (a) Four-point kneeling position. Lift one arm and the opposite leg. (b) Push-ups. (c) Side lying with elbow support. Hip lift. (d) Sit-ups.

5. Strengthening exercises (10 min). 3–4 sets of exercises, without breaks in between. (a) Squats. (b) Rise on the toes. (c) Lunges. (d) Supine lying position. Hip lift.

6. General cool-down exercise. 5 min using a stationary bike, treadmill or cross trainer.

To ensure participant safety, all exercise sessions will be conducted under the direct supervision of qualified physiotherapists. Prior to each session, participants will complete a short safety questionnaire to report any discomfort, pain or unusual symptoms. During the sessions, physiotherapists will monitor participants in real time and adjust exercises if signs of strain or improper form are observed. Any adverse events—such as injury, sustained pain or other negative responses—will be recorded, assessed by the supervising physiotherapist and appropriately managed. In the case of serious or persistent issues, the participant will be referred for medical evaluation and may be withdrawn from the intervention if deemed necessary. Safety procedures will follow the recommendations of the American College of Sports Medicine (ACSM’s) Guidelines for Exercise Testing and Prescription.¹¹²

Comparison

The comparison group will receive general physical activity training of the same duration and frequency, focusing on global mobility and strength without specific targeting or education. The control group will not receive any intervention during the trial but will be offered feedback and recommendations post-study. Especially, the control group will be informed about the findings from the two EMG and myotonometry examinations. They will receive feedback along with physiotherapeutic recommendations for specific training aimed at reducing musculoskeletal pain and improving overall mental health. Additionally, all participants will receive sports gadgets (such as gym mats and anti-stress balls) as compensation for the time and costs associated with their participation in the project.

Research questions and hypotheses

The transition to remote and hybrid work has led to an increase in musculoskeletal disorders (physical health impact), a decline in workplace well-being (psychosomatic impact) and a rise in virtual presenteeism (health and economic impact). While physical activity is a widely recognised method to counteract these issues, research remains inconclusive—particularly under the new socio-organisational conditions shaped by the COVID-19 pandemic.

These conditions give rise to fundamental theoretical and empirical questions:

How to take care of the health and well-being of employees working remotely (or in a hybrid mode) in a sitting position?

How to conduct effective physical activity interventions under post-pandemic working conditions?

How to develop sustainable work habits that reduce negative health, psychological and economic effects?

Can methods known in physiotherapy, sports and kinesiology be applied to create effective workplace interventions?

Will such an interdisciplinary approach—both theoretical (modelling) and empirical (research and measurement)—enable the development of a comprehensive model for improving employee well-being?

The research project aims to propose a comprehensive model for promoting well-being and healthy work habits through tailored physical activity among employees performing remote or hybrid work and spending at least half of their working time in a sitting position. Although physical activity generally improves psychosomatic health, not all types of physical activity lead to lasting behavioural change. We hypothesise that specifically designed physical activity, focused on counteracting particular postural risks, will be more effective than general exercise. This, in turn, may enhance both health and productivity.

The following research questions (RQs) guide the study:

RQ1: Is the type of physical activity training (tailored vs general) important for improving workplace well-being and reducing musculoskeletal complaints in sedentary workers? (Hypotheses H1–H3)

RQ2: Does the type of training influence the development of sustainable work habits, such as continued exercise 3 months after the intervention? (Hypotheses H4–H5)

RQ3: Does tailored training lead to longer-term improvements in musculoskeletal health, well-being and reduced presenteeism compared with general training or no intervention? (Hypotheses H6–H7)

Considering the above RQs, the following hypotheses were formulated:

H1: Regardless of the type of training, physical activity will increase the level of well-being and reduce the level of presenteeism after finishing the training.

This hypothesis is based on the assumption, confirmed in some studies on health interventions, that regardless of the type of pro-health action taken, the subjects react with a change in the level of well-being. We assume that if the subjects became interested in the programme and agreed to participate in it, their level of well-being may increase and presenteeism may decrease regardless of whether they took part in the tailored or general training. This hypothesis will be verified by a comparative study of the results of the Stanford Presenteeism Scale (SPS-6) and well-being at work (WellBQ) questionnaires (described in the latter part of the paper).

H2: After finishing the training, both tailored and general training will reduce the subjective feeling of musculoskeletal ailments.

This hypothesis is based on the assumption that physical activity has a positive effect on both the circulatory system and the musculoskeletal system. Therefore, this intervention, regardless of the type of exercise, should build a better overall condition of the subjects and thus contribute to less discomfort associated with musculoskeletal ailments. This hypothesis will be verified by a comparative study of the results of the Nordic Musculoskeletal Questionnaire (NMQ) and VAS questionnaires (described in the latter part of the paper).

H3: Tailored training will reduce muscle strain and overload more than general training.

This hypothesis is based on the assumption that in tailored training (described in detail above), a direct impact on specific muscles will bring greater progress in reducing strain and overload caused by work in a sitting position. Strengthening the antagonistic muscles will result in the correction of posture and will affect the development of a better habit of correct body posture when working in a sitting position. EMG and myotonic examination will verify this hypothesis.

H4: Subjects who participated in tailored training will regularly perform physical exercises for 3 months after finishing.

This hypothesis results from the assumption that the subjects participating in tailored training learnt to perform specific exercises and know the mechanism of impact of a given movement on muscles and body positions. Therefore, they are more likely to continue exercising and have knowledge of working on correct body posture while working remotely. This hypothesis will be verified through a follow-up survey.

H5: Subjects who participated in general training will not regularly perform physical exercises for 3 months after finishing.

Due to the lack of ability to perform specific exercises related to counteracting musculoskeletal ailments when working remotely, as well as the lack of knowledge about the mechanism of impact of a given exercise on body posture, the respondents from this group will not continue regular training. They will not develop habits of proper body posture during remote work. This hypothesis will be verified through a follow-up survey.

H6: 3 months after finishing the training, musculoskeletal ailments will be lower in the group of participants of tailored training than in the other two groups (general training group and control group).

Due to the development of habits of correct body posture during sedentary work and due to regular exercise, musculoskeletal ailments will be lower in the group of people who have finished dedicated training compared with other groups. This hypothesis will be verified by a comparative study of the results of the NMQ and VAS questionnaires and EMG and myotonic examinations.

H7: 3 months after finishing training, the level of well-being will be higher in the group of participants of tailored training than in the other two groups (general training group and control group), and the level of presenteeism will be lower.

Due to the development of habits of correct body posture during sedentary work, regular exercise and sustained reduction of musculoskeletal ailments, well-being will be higher and presenteeism will be lower in the group of people who have completed tailored training compared with other groups. A comparative study of the results of the SPS-6 and WellBQ questionnaires will verify this hypothesis.

This study employs a mixed-methods approach that combines subjective self-report measures (VAS, SPS-6, NMQ, WellBQ) with objective biomechanical tools (EMG and myotonometry). This methodological integration allows for a richer understanding of how physical activity interventions influence both perceived symptoms and measurable physiological changes in muscle tone and activation. By capturing outcomes across multiple dimensions, the study enhances the reliability, precision and contextual relevance of its findings.

Although the intervention was not explicitly designed according to a behavioural change model such as the Health Action Process Approach, it incorporates several components that may support behaviour maintenance. These include guided repetition during supervised sessions, structured education about the neuromuscular mechanisms of specific exercises and follow-up monitoring to reinforce engagement.¹¹³,¹¹⁵

The training is tailored to achieve specific results by focusing on a structured physical activity programme that targets the muscles most affected by prolonged sitting in remote work. By concentrating on controlling (strengthening and relaxing) these key muscles, the exercises are designed to address postural and neuromuscular risks associated with extended sitting positions.^{116 117} Additionally, tailored training prioritises musculoskeletal specificity over cognitive-behavioural processes such as self-efficacy building or volitional planning. Thus, while behaviour change is not the primary theoretical focus, the structure of the intervention may indirectly facilitate self-regulation and habit formation. Future adaptations could benefit from the formal integration of behavioural frameworks to enhance long-term adherence and generalisability. In comparison to tailored training, general training is a standardised programme focusing on strengthening major muscle groups, applied uniformly to all participants according to general ACSM ¹¹² guidelines, without any adaptation to individual functional deficits and not specifically targeting the muscles affected by prolonged sitting.

Study procedures and expected outcomes

The study procedure includes the following steps:

Find employees working in remote (or hybrid) mode who spend at least half of their work sitting in front of a computer monitor or with a laptop. The surveyed participants will receive financial compensation for participation in the research (commuting to the research centre, participation in the EMG and a preliminary survey—including International Physical Activity Questionnaire (for evaluating physical activity levels). A professional media house will carry out the information-promotion campaign and assist in sourcing the participants; however, the project team will provide the procedure for the recruitment of participants. Potential participants will be identified through a public information campaign conducted by the media house using social media, online advertisements and industry mailing lists targeting remote and hybrid employees. Interested individuals will be directed to a secure registration platform managed by the research team. On initial contact, they will receive detailed information about the study procedures, inclusion/exclusion criteria and data protection measures. Those who meet the eligibility criteria and express interest will be invited to complete screening questionnaires and provide written informed consent prior to enrolment.

Screening the group. Participants fill in two research questionnaires: a general questionnaire containing imprint data, data on the characteristics and ergonomics of the current workplace, information on the employer’s previous activities regarding interventions/prevention activities related to well-being, daily physical activity and the scale of musculoskeletal and pain ailments (NMQ and VAS).

Screening results analysis. Establishing the final number of participants (not less than 60, according to considerations mentioned above). The following exclusion criteria will be applied:

• Individuals reporting high levels of musculoskeletal disorders (above 7 sten on the VAS scale) will be excluded due to potential risks associated with generalised training and the non-specific aetiology of their conditions.

• Individuals engaging in structured physical activity for more than 2 hours per day after work will be excluded. This threshold, while conservative, was chosen to exclude individuals whose physical activity levels significantly exceed WHO recommendations (ie, more than 300 min of moderate-intensity or 150 min of vigorous-intensity aerobic activity per week). Such individuals (g, competitive athletes, instructors, members of amateur/professional clubs) are likely to follow specific training regimens and behavioural routines, which could interfere with the goals or comparability of the intervention. Evidence shows that the greatest health benefits occur at about 3–5 times the recommended activity levels (~450 min/week), with no additional benefit and possible negative effects beyond this. ¹¹⁸ Including highly active participants may introduce bias and reduce the generalisability of results to the broader sedentary working population.

• Individuals who are already participating in more than one physical activity intervention programme organised by their employers will also be excluded (as described above).

Random selection of participants for experimental groups (tailored training/general training) and the control group. Participants will be randomly assigned (1:1:1 ratio) to the tailored training, general training or control group using computer-generated randomisation. The randomisation sequence will be created by an independent statistician using a permuted block design with variable block sizes (3 and 6) to ensure group balance. Stratification will be applied by sex (male/female) and baseline physical activity level (active/inactive), to control for known confounders. The assignment will occur only after participants complete baseline assessments and meet all eligibility criteria.

Signing contracts with participants of experimental groups about their tasks in the project, financial compensation for participation in the study and commitment to perform specific physical exercises. Signing the necessary consents for research and contracts with participants expressing willingness to participate in their tasks in the project and commitment to perform specific physical exercises. A sample of the participant consent form is provided in online supplemental file 1) (‘Participant_Consent_Form’).

Conducting questionnaire research: questionnaire of well-being at work (WellBQ, level of presenteeism (SPS-6).

Conducting biomechanical and physiotherapeutic examinations—objective examination of the state of strain and muscle weakness with the use of an EMG method by an expert. The study will focus on muscles indicated in the literature as the most exposed to overload during long-term sedentary work in a person working with a computer. These include m. trapezius descendens, m. trapezius ascendens, m. erector spinae in the lumbar part and the thoracic part (middle part).¹¹⁹ Duration 0.5 hours with the application of sensors and muscle stiffness test using a myoton, conducted by a physiotherapist.

Conducting experimental manipulation—tailored and general training for experimental groups. Duration of the intervention—4 weeks, frequency three times a week, 45 min of training with a warm-up, groups of 10–15 people, exercises in the gym (at the University of Health and Sport Science campus) with the use of simple physiotherapeutic equipment (stretching gum, ball) and under the supervision of a trainer (physiotherapist). As participants engage in various forms of physical training, or none at all, they are likely aware of which group they belong to; therefore, blinding participants is not possible.

Repeated examination—NMQ and VAS, WellBQ, SPS-6, as well as EMG and myotonometry—is conducted twice: immediately post-intervention and at a 3-month follow-up. This interval reflects a practical and commonly used timeframe for evaluating early maintenance effects in workplace interventions.¹²⁰,¹²² Previous studies show that behavioural adjustments—such as improved posture or exercise continuity—can begin to stabilise within 12 weeks when guided by structured protocols.¹²³,¹²⁷ Additionally, the sports literature suggests that 3 months without training can reverse gains in muscular, respiratory and cardiovascular function,¹²⁸,¹³⁰ reinforcing the relevance of this point for detecting sustained impact.

Participants will complete baseline assessments (t1, Week 1), post-intervention assessments (t2 and t3, both in Week 4) and follow-up assessments (t4, Week 16, which is 3 months after completion of the intervention). The schedule of the research plan based on the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines is presented in figure 1.

Figure 1. SPIRIT schedule of enrolment, interventions and assessments. Time points t1–t4 are aligned with the intervention calendar: t1=1st week of training (baseline); t2=4th week of training (end of intervention); t3=immediately post-intervention (Week 4); t4=3 months after t2 (Week 16). EMG, electromyography; NMQ, Nordic Musculoskeletal Questionnaire; SPIRIT, Standard Protocol Items: Recommendations for Interventional Trials; SPS-6, Stanford Presenteeism Scale; VAS, Visual Analogue Scale for Pain; WellBQ, well-being at work.

One of the goals of this project is to develop habits related to posture and movements during sedentary work. This assumes that the participants of tailored training will not only participate in exercise sessions but also perform these exercises at home while working. To reduce the risk of abandoning the exercise, the subjects from the dedicated training group will not only perform the exercises but also receive an explanation of why these exercises should be performed and about the mechanism of their impact on individual muscles. Hence, they will improve their skills and broaden their knowledge of why to perform such exercises. Any changes in physical activity, as well as changes in the situation and manner of work, will be monitored through a short survey before each training session. This will enable ongoing monitoring of any variables interfering with the procedure and the results of the experimental study.

In order to answer the formulated RQs, two types of training will be carried out— tailored and general. Both types were designed on the basis of literature on physiotherapy. In the case of tailored training, the selected exercises are to reduce tension and fatigue of muscles used during a long-term sitting position (trapezius, back extensor in the thoracic and lumbar region). The subjects will perform exercises under the supervision of a physiotherapist. They will also receive oral instruction on how to perform a given exercise and why it is important to perform it (how it affects a particular muscle). In general training, the subjects will also exercise under the supervision of a physiotherapist. They will also receive oral instruction on how to perform the exercise correctly; however, they will not receive information on why this type of exercise is important, that is, what is the mechanism of impact of a particular movement on the muscle. Subjects from both groups will be encouraged to continue exercising at home. Before each workout, they will fill out a short questionnaire about whether and how often they have repeated the training or part of it at home.

Research methods and tools

The following research methods and tools will be applied in the project:

1. Surface EMG is a kinesiological diagnostic method involving the collection of electrical signals (motor myopotentials) from the skin’s surface above the active skeletal muscle. Appropriately amplified and processed EMG signals carry information about the time of activation, the amount of activity (amplitude) and the type of stimulated muscle fibres (through Fast Fourier Transform (FFT) frequency analysis).^{107 131} In addition to typical diagnostic applications for neuromuscular disorders in muscle work, the EMG method characterises muscle fatigue and determines the so-called fatigue index.^{37 107} Classical tests require a constant load level at a well-defined angular position/muscle length. As a result of the recruitment of motor units, the amplitude of the EMG increases, while the mean or median frequency of the total power spectrum decreases with the duration of contraction.¹³² The reason for this decrease is, among others, a decrease in the rate of conduction of action potentials through the cell membrane, resulting in a shift of the total power spectrum towards the lower frequencies.^{132 133} The regression coefficient of the median or mean frequency inclination can be used as a non-invasive fatigue factor for the muscle under study.¹⁰⁷ The study of the effects of skeletal muscle fatigue has two important applications. First, it can be used to identify weakened muscles, for example, in patients with pain in the lumbar spine (LBP) or cervical spine. Second, they can be used to demonstrate the effectiveness of training or muscle exercises. Strength exercises affect both the increase in the amplitude of EMG and the increase in the speed of recruitment of motor units, which is manifested in the spectral image of the analysed EMG image.¹³² Based on research premises,¹³⁴,¹³⁶ for diagnostic purposes, it is planned to analyse the following muscles on the dorsal side—trapezius descendens (upper part), trapezius ascendens, erector spinae in the lumbar part and in the thoracic part (middle part). The differential EMG signal during isometric contraction lasting about 1–2 min (depending on the type of muscle) will be analysed. The initial and final fragments of the EMG signal (amplitude value and median frequency value, amplitude drop rate and frequency change) indicating the fatigue effect will be compared. The tests will be performed in a sitting position on a controlled station for measuring isometric force BIODEX System 4 PRO. The examination time of one person is about 30 min. The data captured from this examination will be analysed regarding hypothesis H1.

2. NMQ and VAS¹³⁷ for measuring types of musculoskeletal problems and the associated level of pain. The NMQ questionnaire contains nine questions about the painful areas, and then VAS includes six items related to the description of the amount of pain in the neck, upper and lower trunk, elbows, wrists, hips, knees and feet. Both instruments have high internal consistency and it is a relatively homogenous (unidimensional) measure of musculoskeletal symptom severity. Polish adaptation proceeded by Central Institute for Labour Protection - National Research Institute (CIOP-PIB). Completion of the questionnaire takes approximately 15 min. The data captured from these questionnaires will be analysed regarding hypotheses H2 and H6.

3. WellBQ is a new questionnaire developed by the National Institute of Occupational Safety and Health.¹³⁸ It measures ‘worker’ well-being as a holistic construct rather than simply ‘workplace’ or ‘work-related’ well-being. The NIOSH WellBQ is designed to collect information across the five domains of worker well-being while minimising the burden to respondents. It covers:

   • Section 1. Work Evaluation and Experience (16 items)

   • Section 2. Workplace Policies and Culture (14 items)

   • Section 3. Workplace Physical Environment and Safety Climate (10 items)

   • Section 4. Health Status (23 items)

   • Section 5. Home, Community and Society (five items)

The questionnaire is based on well-known scales that are high in internal consistency and valid. Completion of the questionnaire takes approximately 20 min. The data captured from the questionnaire will be analysed regarding hypotheses H1 and H7.

• 4 1SPS-6 identifies six key items to establish the level of presenteeism. The SPS-6 has proper psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. It covers six statements assessed on a five-point Likert scale.¹³⁹ Completion of the questionnaire takes approximately 5 min. The data captured from the questionnaire will be analysed regarding hypotheses H1 and H7
• 4 2Muscle stiffness testing with MyotonPRO equipment. The equipment is applied perpendicularly to the skin surface above the examined muscle. The probe located at the end of the apparatus exerts a slight pressure on the tested surface (0.18 N), which is indicated by the green light of the probe and the start of measurement. When the conditions for correct reading are ensured, the device generates a fivefold short mechanical impulse (with a force of 0.4 N and a duration of 15 ms). The mechanical impulse causes damped oscillations of the examined soft tissue, which are then recorded by an accelerometer placed in the device. The received feedback signal is processed to obtain an oscillation curve by which the dynamic stiffness of the muscle is determined. The muscles to be tested are those associated with the sedentary work listed above. Changes in muscle stiffness in individual examinations will inform about the possible impact of training on a given muscle. The myotonometry examination of one person will last about 10 min. The data captured from this examination will be analysed regarding hypothesis H1.
• 4 3A follow-up survey monitors the process of changes in behavioural patterns and work habits and the transfer of knowledge and skills during training. The survey consists of 10 questions assessed on a four-point scale, where 0 means no transfer and 4 means full transfer. The examples of questions are: “How often do you perform, the exercises you learned during training?”; “How often do you use the knowledge and skills from training at your workstation?” The data captured from the questionnaire will be analysed regarding hypotheses H3 and H4.

Statistical analyses will be conducted using two statistical programmes: Statistica V.13.0 and SPSS Statistics V.27, by the team members of this project. Following the Consolidated Standards of Reporting Trials (CONSORT) guidelines for non-inferiority trials, as delineated by Piaggio et al,¹⁴⁰ our assessment of non-inferiority will be confined to those participants who rigorously adhere to the study protocol. Consequently, our participant selection will only encompass individuals who have met the essential prerequisites: lack of too-high musculoskeletal disorders, lack of intensive physical activity and lack of participation in other physical activity programmes. Moreover, participants have been assigned randomly, possess complete datasets and have participated in at least two-thirds of the full training sessions. To assert non-inferiority, the upper limit of the 95% CI for the disparity in average scores on the WellBQ and SPS-6 between the experimental and control groups had to fall below the ∆ margin. We will employ linear models for the primary outcome analysis, adjusted for the initial outcome value and stratification variable. The primary outcome will encompass well-being, presenteeism and muscle stiffness and weakness.

Because empirical evidence on the comparative efficacy and utility of both training sessions under investigation is scarce, we will conduct various explorative analyses on secondary outcomes such as changes in types of musculoskeletal problems; changes in behavioural patterns, work habits and the transfer of knowledge and skills acquired during training at an individual level in both experimental groups; and changes in the level of pain.

We will analyse improvements in working habits at an individual level in both experimental groups by examining the number of participants who exhibit ‘reliable improvement’, employing the reliable change index formula.

For all other continuous outcomes, we will conduct separate linear model analyses to examine any superiority of the dedicated training group and standard training sample over the control group. Group differences will be analysed using non-parametric statistics. In addition, for all outcomes and assessment points, Cohen’s d will be calculated to quantify the size of interventional effects.

In addition, we plan to investigate various factors that could potentially influence the relative effectiveness of the training groups compared with the control groups. These factors include age, gender, prior training experiences, readiness to use technology, expectations from the training, job role, length of service, design of the workstation and job crafting. To address potential confounding, we will include several baseline variables as covariates in our regression models. We will use multivariate linear models adjusted for these covariates when analysing primary outcomes (well-being, presenteeism, musculoskeletal complaints). In addition, we will test for potential interaction effects to explore whether the impact of the intervention is moderated by any of these variables (eg, job type×intervention group). Model assumptions (normality, homoscedasticity, multicollinearity) will be checked, and sensitivity analyses will be conducted using both per-protocol and intention-to-treat approaches.

All questionnaires used in the study will be checked regarding their reliability (Cronbach’s alpha/McDonald’s omega). Due to the fact that they are already standardised and licensed by APA and other psychological societies, the validity and confirmatory factor analysis (CFA) will not need to be provided. Additionally, the use of standardised self-assessment questionnaires makes the assessors’ observations redundant. This eliminates the necessity for a blinding procedure for assessors.

The EMG examination equipment will use the Noraxon Telemyo MyoTrace 400 system using Biodex System 4 Pro to stabilise sitting posture and measure strength. The myotonic examination will be carried out using MyotonPRO. Small gymnastic and rehabilitation equipment, such as rubbers and balls, will be used during training sessions.

Dates of the study

Research is scheduled to begin in January 2027

Discussion

Expected results

It is expected that regardless of the type of training—tailored or general, physical activity will increase the level of well-being, reduce the level of presenteeism and reduce the subjective feeling of musculoskeletal ailments after finishing the training. However, adequately designed physical activity training, dedicated to reducing specific unfavourable habits, is assumed to reduce muscle strain and overload more than general training. This can ultimately impact overall well-being and increase work productivity.

Also, subjects from the tailored training group are expected to continue exercising for 3 months after finishing the training programme. Therefore, the level of well-being will be higher, the level of presenteeism will be lower and musculoskeletal ailments will be lower in the group of participants of tailored training than in the other two groups (general training group and control group). We also assume that such a training procedure will result in the development of healthy work habits related to correct posture and a positive approach to physical activity.

Our tailored training approach is designed with considerable flexibility to cater to the varying needs of remote or hybrid employees. The programme includes a broad range of exercises that target different aspects of physical well-being, but it is not rigid or prescriptive. The ultimate choice of exercises is flexible and can be adjusted based on factors such as the employee’s fitness level, physical constraints and personal preferences. Employees begin with an initial assessment that considers factors like their current level of physical activity, health status, work schedule and personal preferences. This assessment guides the recommendation of specific exercises from our comprehensive library of physical activities. The activities range from stretching exercises to mitigate the effects of prolonged sitting to more vigorous workouts for those seeking a more intensive training routine.

Additionally, we understand that employees’ circumstances may change over time. Therefore, our model includes regular check-ins and reassessments to adjust the programme as necessary. For example, if an employee develops a health issue that affects their ability to perform specific exercises, the training programme can be adapted accordingly. Moreover, we also recognise the importance of psychological well-being; hence, the flexibility extends to incorporate stress management exercises and relaxation techniques. Depending on the individual’s needs, these can be used as a standalone approach or with physical exercises. In this way, our model retains its core structure and consistency while offering flexibility to provide a personalised and adaptive physical activity regime. This flexibility enhances the likelihood of sustained engagement and promotes well-being and healthy habits in a work-from-home or hybrid work context.

Potential risks

While reviewing the individual stages of the research procedure, significant risks were analysed and ways of eliminating them were determined. Conducting research among 60 employees who meet the criteria specified in the procedure is one of the significant risks in the project. In order to ensure a high probability of finding relevant people, a professional advertising agency and a media house were contacted in order to design a web page and an information-promotion campaign using electronic media. In the general media plan, the contractor creates a pop-up window, the clicking of which redirects the potentially interested individuals to the web page that informs about the project and prompts them to fill out the contact form. According to the experience of media specialists, about 1% of people ‘clicking’ on a pop-up window will fill out the form. Therefore, the contract with the media house will be for the provision of the campaign until reaching 10 000 clicks. This level usually covers a period of about 3 months. Such an approach will minimise the risk of insufficient people being tested. It was assumed that the final selection criteria for the experiment would be met by about 60% of the candidates, that is, 60 people. Another risk occurring in the study is the problem of participation of selected subjects in the entire experimental procedure, which includes a threefold questionnaire and EMG and myotonic examinations and the presence and active participation in 12 workouts. To minimise the risk of the resignation of the respondents, the following steps were taken:

1. Attractive presentation of the benefits of participation in physical fitness and health research.

2. Signing a contract in which the subject undertakes to participate fully in the project and receives financial compensation.

3. Substantial compensation for participation in the research procedure—sports gadgets as a reimbursement of time and effort related to physical examinations as well as training sessions.

4. An assumption resulting from the analysis of the literature—participation in eight training sessions is necessary to train the appropriate movements and influence the muscular system. In case the participant cannot participate in the training, leaving less than four sessions will not eliminate him/her from the research sample.

One of the goals of this project is to develop habits related to posture and movements during sedentary work. This assumes that the participants of tailored training will not only participate in individual exercise sessions but will also perform these exercises at home while doing work. To reduce the risk of abandoning the exercise, the subjects from the dedicated training group will not only perform the exercises but will also receive an explanation of why these exercises should be performed and what is the mechanism of their impact on individual muscles. Hence, they will improve their skills and broaden their knowledge of why to perform such exercises. Any changes in physical activity, as well as changes in the situation and manner of work, will be monitored through short surveys before each training session. This will enable an ongoing monitoring of any variables interfering with the procedure and the results of the experimental study.

Conclusion

This research protocol is designed to offer a robust solution to counter the negative repercussions of remote work in the aftermath of the COVID-19 pandemic. These repercussions include an increase in musculoskeletal disorders, a decrease in workplace well-being and a rise in presenteeism. The project aims to establish a comprehensive model that fosters well-being and cultivates healthy work habits through personalised physical activity regimens for employees. These employees spend at least half their work hours seated, either remotely or following a hybrid work schedule. The study aims to bridge the existing knowledge gaps by identifying the optimal conditions for assessing the effectiveness of these physical activity regimens. It also explores the potential benefits of personalised physical activity training for sedentary workers. There is still significant uncertainty about motivating individuals to adhere to public health guidelines, reduce sedentary behaviours and decrease presenteeism.