The effectiveness of worksite physical activity programs on physical activity, physical fitness, and health

Comparative effectiveness of lifestyle interventions on cardiovascular risk factors among a Dutch overweight working population: a randomized controlled trial

Background

Overweight (Body Mass Index [BMI] ≥ 25 kg/m²) and obesity (BMI≥ 30 kg/m²) are associated with increased cardiovascular risk, posing a considerable burden to public health. The main aim of this study was to investigate lifestyle intervention effects on cardiovascular risk factors in healthy overweight employees.

Methods

Participants were 276 healthy overweight employees (69.2% male; mean age 44.0 years [SD 9.2]; mean BMI 29.7 kg/m² [SD 3.1]). They were randomized to one of two intervention groups receiving a six month lifestyle intervention with behavior counseling by phone (phone group) or e-mail (Internet group), or to a control group receiving usual care. Body weight, height, waist circumference, sum of skinfolds, blood pressure, total cholesterol level and predicted aerobic fitness were measured at baseline, at 6 and at 24 months. Regression analyses included the 141 participants with complete data.

Results

At 6 months a significant favorable effect on total cholesterol level (-0.2 mmol/l, 95%CI -0.5 to -0.0) was observed in the phone group and a trend for improved aerobic fitness (1.9 ml/kg/min, 95%CI -0.2 to 3.9) in the Internet group. At two years, favorable trends for body weight (-2.1 kg, 95%CI -4.4 to 0.2) and aerobic fitness (2.3 ml/kg/min, 95%CI -0.2 to 4.8) were observed in the Internet group.

Conclusions

The intervention effects were independent of the used communication mode. However short-term results were in favor of the phone group and long-term results in favor of the internet group. Thus, we found limited evidence for our lifestyle intervention to be effective in reducing cardiovascular risk in a group of apparently healthy overweight workers.

Trial registration

ISRCTN04265725

Protocol for shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial

BACKGROUND

Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach.

METHODS/DESIGN

A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius.An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week.The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination. Secondary outcomes are strength and work disability.

TRIAL REGISTRATION

ClinicalTrials (NCT): NCT01205542.

Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review

This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome ("modifiers" in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.

Workplace Interventions to Reduce Obesity and Cardiometabolic Risk

The worksite is ideal for implementing interventions to reduce obesity and cardiometabolic risk factors. Although worksite health promotion is not new, employer-sponsored wellness programs have become more widespread due to the rising prevalence and high cost of obesity. Over the past two decades, employers and researchers focused efforts on individual-based programs to change employees' nutrition and exercise behaviors, but more recently, the worksite environment has been targeted. Overall, there is good evidence that individual-based worksite programs can produce modest weight loss, but the evidence for effects on other risk factors and on long-term health outcomes and costs is inconsistent. There is less evidence for the benefit of environmental-based interventions, and more data will be needed to establish conclusions about the benefits of these types of interventions. A major challenge for employers and researchers in the future will be to find the balance between effectiveness and economic viability of worksite wellness programs.

Are workplace interventions to reduce sitting effective? A systematic review

OBJECTIVE

To systematically review the effectiveness of workplace interventions for reducing sitting.

METHODS

Studies published up to April 2009 were identified by literature searches in multiple databases. Studies were included if they were interventions to increase energy expenditure (increase physical activity or decrease sitting); were conducted in a workplace setting; and specifically measured sitting as a primary or secondary outcome. Two independent reviewers assessed methodological quality of the included studies, and data on study design, sample, measures of sitting, intervention and results were extracted.

RESULTS

Six studies met the inclusion criteria (five randomised trials and one pre-post study). The primary aim of all six was to increase physical activity; all had reducing sitting as a secondary aim. All used self-report measures of sitting; one specifically assessed occupational sitting time; the others used measures of general sitting. No studies showed that sitting decreased significantly in the intervention group, compared with a control or comparison group.

CONCLUSION

Currently, there is a dearth of evidence on the effectiveness of workplace interventions for reducing sitting. In light of the growing body of evidence that prolonged sitting is negatively associated with health, this highlights a gap in the scientific literature that needs to be addressed.

"Step by Step". A feasibility study of a lunchtime walking intervention designed to increase walking, improve mental well-being and work performance in sedentary employees: Rationale and study design

BACKGROUND

Following an extensive recruitment campaign, a 16-week lunchtime intervention to increase walking was implemented with insufficiently physically active University employees to examine programme feasibility and the effects of the programme in increasing walking behaviour, and in improving well-being and work performance.

METHODS/DESIGN

A feasibility study in which participants were randomised to an immediate treatment or a delayed treatment control (to start at 10 weeks) group. For the first ten weeks of the intervention, participants took part in three facilitator-led group walks per week each of thirty minutes duration and were challenged to accumulate another sixty minutes of walking during the weekends. In the second phase of the intervention, the organised group walks ceased to be offered and participants were encouraged to self-organise their walks. Motivational principles were employed using contemporary motivational theory. Outcome measures (including self-reported walking, step counts, cardiovascular fitness, general and work-related well-being and work performance) were assessed at baseline, at the end of the 16-week intervention and (for some) four months after the end of the intervention. Process and outcome assessments were also taken throughout, and following, the intervention.

DISCUSSION

The results of the intervention will determine the feasibility of implementing a lunchtime walking programme to increase walking behaviour, well-being and performance in sedentary employees. If successful, there is scope to implement definitive trials across a range of worksites with the aim of improving both employee and organisational health.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN81504663.

The effectiveness of interventions to change six health behaviours: a review of reviews

BACKGROUND

Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e.g. for drug or alcohol dependency).

METHODS

The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis.

RESULTS

We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e.g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e.g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours.Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities.

CONCLUSIONS

Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.

Protocol for work place adjusted intelligent physical exercise reducing musculoskeletal pain in shoulder and neck (VIMS): a cluster randomized controlled trial

BACKGROUND

Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Specific strength training is a promising type of physical exercise for relieving neck and shoulder pain in office workers. However, the optimal combination of frequency and exercise duration, as well as the importance of exercise supervision, is unknown. The VIMS study investigates in a cluster randomized controlled design the effectiveness of different time wise combinations of specific strength training with identical accumulated volume, and the relevance of training supervision for safe and effective training.

METHODS/DESIGN

A cluster randomized controlled trial of 20 weeks duration where employed office workers are randomized to 1 x 60 min, 3 x 20 min, 9 x 7 min per week of specific strength training with training supervision, to 3 x 20 min per week of specific strength training with a minimal amount of training supervision, or to a reference group without training. A questionnaire will be sent to 2000 employees in jobs characterized by intensive computer work. Employees with cardiovascular disease, trauma, hypertension, or serious chronic disease will be excluded. The main outcome measure is pain in the neck and shoulders at week 20.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov, number NCT01027390.

The effect of a multi-strategy workplace physical activity intervention promoting pedometer use and step count increase

Pedometer use and step count goals have become popular in physical activity (PA) interventions in different settings. Previous pedometer-based workplace interventions were short term, uncontrolled and executed outside Europe. This European quasi-experimental study evaluated the effects of a 20-week pedometer-based PA workplace intervention. Pedometer-based and self-reported PA from one intervention worksite (68 participants at follow-up) was compared with the data of a comparison workplace (79 participants at follow-up). A downward trend in overall step counts from baseline (end of summer) to follow-up (winter) was found (F = 3.3, P = 0.071). However, the intervention effect revealed a significant smaller decrease in the intervention workplace (-618 steps/day) than in the comparison workplace (-1389 steps/day) (F = 8.8, P = 0.004). This intervention effect was only present in already active participants, reaching 10 000 steps/day at baseline (intervention participants: -1706 steps/day; comparison participants: -4006 steps/day) (F = 5.5, P = 0.023). Overall project awareness was very high (97%) and the intervention strategies were judged 'good to very good' by 57-95% of the participants. However, the proportion of intervention participants reporting that they had changed their PA behavior because of the intervention (31%) and reporting that they had used the pedometer during the intervention (48%) was limited. Future workplace projects should give extra attention to inactive employees.

Does leisure time physical activity protect against shoulder pain at work?

BACKGROUND

Shoulder pain is a common problem that can impact on work. Leisure time physical activity (LTPA) has the potential to reduce the impact of shoulder pain through its physiological, psychological and social benefits.

AIMS

To determine whether LTPA reduces the prevalence of shoulder pain in a working population.

METHODS

Participants were selected from a longitudinal population-based cohort study, the North West Adelaide Health Study. Information was gathered by questionnaire on LTPA, smoking, depression and socio-economic factors. Body mass index was measured in a clinic setting. Occupational physical activity (OPA) estimated by job title and shoulder pain was measured using the Shoulder Pain and Disability Index. Workers with and without shoulder pain were compared using logistic regression analysis.

RESULTS

Of the 1502 working participants, 16% reported having current shoulder pain. Shoulder pain was associated with older age (OR 1.98, 95% CI: 1.31-2.99) (age >50 years), smoking (OR 1.44, CI: 1.02-2.04), secondary-level educational attainment (OR 1.68, 95% CI: 1.07-2.65), high body mass index (BMI) (OR 1.54, 95% CI: 1.14-2.08) and depression (OR 2.42, 95% CI: 1.60-3.64). There was no effect of LTPA on shoulder pain.

CONCLUSIONS

In this community-based cohort, there was no statistically significant association seen between LTPA, OPA and shoulder pain. There was, however, an association between smoking, BMI, secondary-level education, depression and shoulder pain. These modifiable factors may be better targets for preventive efforts than LTPA to reduce the risk of shoulder pain.

Barriers to participation in a worksite wellness program

The purpose of this research was to determine barriers that prevent participation in an employee wellness program, Wellness Wednesdays: "Eat & Meet" About Healthy Living, conducted at East Carolina University (ECU) in Greenville, North Carolina. All ECU ARAMARK employees (n = 481) over the age of 18 were eligible to participate in the wellness program. Weekly 30 minute classes, taught by a Registered Dietitian, on various nutrition- and health-related topics were conducted for 10-weeks. Five question knowledge quizzes were administered to participants at the end of each class to determine the comprehension of material presented. Qualitative interviews (n = 19) were conducted with employees (participants and non-participants) and the program organizer after the completion of the 10-week program to identify barriers to program participation. A total of 50 (10.4% of the total number of potential participants) ECU ARAMARK employees, managers, and leadership team directors attended Wellness Wednesdays at least once during the 10-week program. Employees, on average, scored 71-100% on the weekly knowledge quizzes administered at the end of each class. The most common barriers to participation reported included (most often to least often reported): insufficient incentives, inconvenient locations, time limitations, not interested in topics presented, undefined reasons, schedule, marketing, health beliefs, and not interested in the program. Results showed that employee wellness programs can be effective in increasing knowledge of employees on nutrition- and health-related topics. However, program planning that addresses identified barriers including insufficient incentives, inconvenient locations, and time limitations may facilitate higher participation in future worksite wellness opportunities.

Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: background, design and conceptual model of FINALE

BACKGROUND

A mismatch between individual physical capacities and physical work demands enhance the risk for musculoskeletal disorders, poor work ability and sickness absence, termed physical deterioration. However, effective intervention strategies for preventing physical deterioration in job groups with high physical demands remains to be established. This paper describes the background, design and conceptual model of the FINALE programme, a framework for health promoting interventions at 4 Danish job groups (i.e. cleaners, health-care workers, construction workers and industrial workers) characterized by high physical work demands, musculoskeletal disorders, poor work ability and sickness absence.

METHODS/DESIGN

A novel approach of the FINALE programme is that the interventions, i.e. 3 randomized controlled trials (RCT) and 1 exploratory case-control study are tailored to the physical work demands, physical capacities and health profile of workers in each job-group. The RCT among cleaners, characterized by repetitive work tasks and musculoskeletal disorders, aims at making the cleaners less susceptible to musculoskeletal disorders by physical coordination training or cognitive behavioral theory based training (CBTr). Because health-care workers are reported to have high prevalence of overweight and heavy lifts, the aim of the RCT is long-term weight-loss by combined physical exercise training, CBTr and diet. Construction work, characterized by heavy lifting, pushing and pulling, the RCT aims at improving physical capacity and promoting musculoskeletal and cardiovascular health. At the industrial work-place characterized by repetitive work tasks, the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training, CBTr and participatory ergonomics. The overall aim of the FINALE programme is to improve the safety margin between individual resources (i.e. physical capacities, and cognitive and behavioral skills) and physical work demands, and thereby reduce the physical deterioration in a long term perspective by interventions tailored for each respective job-group.

DISCUSSION

The FINALE programme has the potential to provide evidence-based knowledge of significant importance for public health policy and health promotion strategies for employees at high risk for physical deterioration.

TRIAL REGISTRATIONS

ISRCTN96241850, NCT01015716 and NCT01007669.

The effectiveness of physical activity monitoring and distance counselling in an occupational health setting--a research protocol for a randomised controlled trial (CoAct)

BACKGROUND

The CoAct (Cocreating Activity) study is investigating a novel lifestyle intervention, aimed at the working population, with daily activity monitoring and distance counselling via telephone and secure web messages. The main purpose of this study is to evaluate the effectiveness of lifestyle counselling on the level of physical activity in an occupational health setting. The purposes include also analysing the potential effects of changes in physical activity on productivity at work and sickness absence, and healthcare costs. This article describes the design of the study and the participant flow until and including randomization.

METHODS/DESIGN

CoAct is a randomised controlled trial with two arms: a control group and intervention group with daily activity monitoring and distance counselling. The intervention focuses on lifestyle modification and takes 12 months. The study population consists of volunteers from 1100 eligible employees of a Finnish insurance company. The primary outcomes of this study are change in physical activity measured in MET minutes per week, work productivity and sickness absence, and healthcare utilisation. Secondary outcomes include various physiological measures. Cost-effectiveness analysis will also be performed. The outcomes will be measured by questionnaires at baseline, after 6, 12, and 24 months, and sickness absence will be obtained from the employer's registers.

DISCUSSION

No trials are yet available that have evaluated the effectiveness of daily physical activity monitoring and distance counselling in an occupational health setting over a 12 month period and no data on cost-effectiveness of such intervention are available.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00994565.

The Vital@Work Study. The systematic development of a lifestyle intervention to improve older workers' vitality and the design of a randomised controlled trial evaluating this intervention

Background

A major contributor of early exit from work is a decline in health with increasing age. As healthy lifestyle choices contribute to better health outcomes, an intervention aimed at an improved lifestyle is considered a potentially effective tool to keep older workers healthy and vital, and thereby to prolong labour participation.

Methods

Using the Intervention Mapping (IM) protocol, a lifestyle intervention was developed based on information obtained from 1) literature, 2) a short lifestyle questionnaire aimed at indentifying the lifestyle behaviours among the target group, and 3) focusgroup (FG) interviews among 36 older workers (aged 45⁺ years) aimed at identifying: a) key determinants of lifestyle behaviour, b) a definition of vitality, and c) ideas about how vitality can be improved by lifestyle.

The main lifestyle problems identified were: insufficient levels of physical activity and insufficient intake of fruit and vegetables. Using information from both literature and FG interviews, vitality consists of a mental and a physical component. The interviewees suggested to improve the mental component of vitality by means of relaxation exercises (e.g. yoga); physical vitality could be improved by aerobic endurance exercise and strength training.

The lifestyle intervention (6 months) consists of three visits to a Personal Vitality Coach (PVC) combined with a Vitality Exercise Programme (VEP). The VEP consists of: 1) once a week a guided yoga group session aimed at relaxation exercises, 2) once a week a guided aerobic workout group session aimed at improving aerobic fitness and increasing muscle strength, and 3) older workers will be asked to perform once a week for at least 45 minutes vigorous physical activity without face-to-face instructions (e.g. fitness). Moreover, free fruit will be offered at the group sessions of the VEP. The lifestyle intervention will be evaluated in a RCT among older workers of two major academic hospitals in the Netherlands. At baseline, after 6 and 12 months, measurements (primary: lifestyle and vitality, and secondary: work-engagement and productivity) will take place.

Discussion

The lifestyle programme is developed specifically tailored to the needs of the older workers and which is aimed at improving their vitality.

Trial registration

NTR1240

The effect of worksite physical activity intervention on physical capacity, health, and productivity: a 1-year randomized controlled trial

OBJECTIVE

To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention (REF) on various health outcomes.

METHODS

A 1-year randomized controlled trial was conducted with specific resistance training (SRT), all-round physical exercise (APE), and REF.

RESULTS

SRT and APE compared with REF showed significant reductions in systolic blood pressure (approximately 6 mm Hg), body fat percentage (approximately 2.2 body fat%), as well as shoulder and back pain (approximately 30% reduction in duration). Muscle strength (APE and SRT) and maximal oxygen uptake (APE) increased approximately 10%.

CONCLUSIONS

Worksite intervention with both SRT as well as APE is recommended, since these activities compared with REF resulted in clinically relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms, in combination with minor increases in physical capacity.

The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review

This report presents the results of a systematic review of the effectiveness of worksite nutrition and physical activity programs to promote healthy weight among employees. These results form the basis for the recommendation by the Task Force on Community Preventive Services on the use of these interventions. Weight-related outcomes, including weight in pounds or kilograms, BMI, and percentage body fat were used to assess effectiveness of these programs. This review found that worksite nutrition and physical activity programs achieve modest improvements in employee weight status at the 6-12-month follow-up. A pooled effect estimate of -2.8 pounds (95% CI=-4.6, -1.0) was found based on nine RCTs, and a decrease in BMI of -0.5 (95% CI=-0.8, -0.2) was found based on six RCTs. The findings appear to be applicable to both male and female employees, across a range of worksite settings. Most of the studies combined informational and behavioral strategies to influence diet and physical activity; fewer studies modified the work environment (e.g., cafeteria, exercise facilities) to promote healthy choices. Information about other effects, barriers to implementation, cost and cost effectiveness of interventions, and research gaps are also presented in this article. The findings of this systematic review can help inform decisions of employers, planners, researchers, and other public health decision makers.

Meta-analysis of workplace physical activity interventions

CONTEXT

Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research.

EVIDENCE ACQUISITION

Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008.

EVIDENCE SYNTHESIS

Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, -0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, -12.6 mg/dL on fasting glucose.

CONCLUSIONS

These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.

Physical activity and risk of metabolic syndrome in an urban Mexican cohort

Background

In the Mexican population metabolic syndrome (MS) is highly prevalent. It is well documented that regular physical activity (PA) prevents coronary diseases, type 2 diabetes and MS. Most studies of PA have focused on moderate-vigorous leisure-time activity, because it involves higher energy expenditures, increase physical fitness, and decrease the risk of MS. However, for most people it is difficult to get a significant amount of PA from only moderately-vigorous leisure activity, so workplace activity may be an option for working populations, because, although may not be as vigorous in terms of cardio-respiratory efforts, it comprises a considerable proportion of the total daily activity with important energy expenditure. Since studies have also documented that different types and intensity of daily PA, including low-intensity, seem to confer important health benefits such as prevent MS, we sought to assess the impact of different amounts of leisure-time and workplace activities, including low-intensity level on MS prevention, in a sample of urban Mexican adults.

Methods

The study population consisted of 5118 employees and their relatives, aged 20 to 70 years, who were enrolled in the baseline evaluation of a cohort study. MS was assessed according to the criteria of the National Cholesterol Education Program, ATP III and physical activity with a validated self-administered questionnaire. Associations between physical activity and MS risk were assessed with multivariate logistic regression models.

Results

The prevalence of the components of MS in the study population were: high glucose levels 14.2%, high triglycerides 40.9%, high blood pressure 20.4%, greater than healthful waist circumference 43.2% and low-high density lipoprotein 76.9%. The prevalence of MS was 24.4%; 25.3% in men and 21.8% in women. MS risk was reduced among men (OR 0.72; 95%CI 0.57–0.95) and women (OR 0.78; 95%CI 0.64–0.94) who reported an amount of ≥30 minutes/day of leisure-time activity, and among women who reported an amount of ≥3 hours/day of workplace activity (OR 0.75; 95%CI 0.59–0.96).

Conclusion

Our results indicate that both leisure-time and workplace activity at different intensity levels, including low-intensity significantly reduce the risk of MS. This finding highlights the need for more recommendations regarding the specific amount and intensity of leisure-time and workplace activity needed to prevent MS.

Determinants of participation in worksite health promotion programmes: a systematic review

Background

The workplace has been identified as a promising setting for health promotion, and many worksite health promotion programmes have been implemented in the past years. Research has mainly focused on the effectiveness of these interventions. For implementation of interventions at a large scale however, information about (determinants of) participation in these programmes is essential. This systematic review investigates initial participation in worksite health promotion programmes, the underlying determinants of participation, and programme characteristics influencing participation levels.

Methods

Studies on characteristics of participants and non-participants in worksite health promotion programmes aimed at physical activity and/or nutrition published from 1988 to 2007 were identified through a structured search in PubMed and Web of Science. Studies were included if a primary preventive worksite health promotion programme on PA and/or nutrition was described, and if quantitative information was present on determinants of participation.

Results

In total, 23 studies were included with 10 studies on educational or counselling programmes, 6 fitness centre interventions, and 7 studies examining determinants of participation in multi-component programmes. Participation levels varied from 10% to 64%, with a median of 33% (95% CI 25–42%). In general, female workers had a higher participation than men (OR = 1.67; 95% CI 1.25–2.27]), but this difference was not observed for interventions consisting of access to fitness centre programmes. For the other demographic, health- and work-related characteristics no consistent effect on participation was found. Pooling of studies showed a higher participation level when an incentive was offered, when the programme consisted of multiple components, or when the programme was aimed at multiple behaviours.

Conclusion

In this systematic review, participation levels in health promotion interventions at the workplace were typically below 50%. Few studies evaluated the influence of health, lifestyle and work-related factors on participation, which hampers the insight in the underlying determinants of initial participation in worksite health promotion. Nevertheless, the present review does provide some strategies that can be adopted in order to increase participation levels. In addition, the review highlights that further insight is essential to develop intervention programmes with the ability to reach many employees, including those who need it most and to increase the generalizability across all workers.

The effect of a resistance-training program on muscle strength, physical workload, muscle fatigue and musculoskeletal discomfort: an experiment

The aim of the study was to investigate the effectiveness of a resistance-training program on muscle strength of the back and neck/shoulder muscles, relative physical workload, muscle fatigue and musculoskeletal discomfort during a simulated assembly and lifting task. Twenty-two workers were randomized over an 8-week resistance-training group, and a control group. Isokinetic muscle strength was assessed using the Cybex dynamometer, muscle fatigue was measured using EMG, and perceived discomfort was measured using a 10-point scale. At the follow-up, we found no effect of the resistance-training program on isokinetic muscle strength of the back and shoulder muscles. Furthermore, we did not find any effect on EMG data, nor on musculoskeletal discomfort during the simulated work tasks. However, trained workers performed the lifting tasks for a longer time before reporting considerable discomfort than those in the control group.

Long-term benefits of an educational and physical program on headache, and neck and shoulder pain, in a working community

We previously published the results of a controlled trial that showed the efficacy of a workplace educational and physical program in reducing headache, and neck and shoulder pain. Participants recorded daily pain episodes in diaries; after 2 months of baseline observation, the program was administered to the intervention arm only, and comparison with the control arm was performed at month 8. The objective of the present study was to confirm the long-term (14 months from the beginning of the study) benefit of the program in the intervention arm of the study (192 office employees). Outcome measures of the present analyses were: 1) the number of days/month with headache, and neck and shoulder pain; 2) the frequency of days with analgesic drug consumption; 3) the proportion of subjects with 4 or more days/month with headache or neck and shoulder pain at baseline who achieved a > or =50% reduction in pain (responder rate). Days/month with headache decreased from 5.50 at baseline (months 1-2) to 3.11 at months 13-14 (P < .001); from 6.79 to 3.88 (P < .001) for neck and shoulder pain; and from 1.72 to 0.86 (P < .001) for analgesic consumption. Responder rates were 58.8% (95%CI = 47.1-70.5) for headache, 60.9% (49.4-72.4) for neck and shoulder pain, and 68.2 % (48.7-87.6) for drug consumption. These results confirm that the program may be effective at long term.

PERSPECTIVE

This article presents the results at long term of an educational and physical program in reducing headache, and neck and shoulder pain, in a working community. Since the benefits remained stable for a considerable period of time, a randomized trial is ongoing to confirm these results on a larger, less-selected working population.

Development of Alive! (A Lifestyle Intervention Via Email), and its effect on health-related quality of life, presenteeism, and other behavioral outcomes: randomized controlled trial

BACKGROUND

Cost-effective interventions to improve diet and physical activity are a public health priority. Alive! is an email-based intervention to increase physical activity, reduce saturated and trans fats and added sugars, and increase fruit and vegetable consumption. It was shown to improve these behaviors in a large randomized controlled trial.

OBJECTIVE

(1) To describe the components and behavioral principles underlying Alive!, and (2) to report effects of the intervention on the secondary outcomes: health-related quality of life, presenteeism, self-efficacy, and stage of change.

METHODS

The Alive! behavior change model is designed to elicit healthy behaviors and promote their maintenance. Behavioral strategies include assessments followed by individualized feedback, weekly goal-setting, individually tailored goals and tips, reminders, and promotion of social support. Alive! was tested among non-medical employees of Kaiser Permanente of Northern California, who were randomized to either the intervention group or the wait-list control group. After randomization, intervention group participants chose one topic to undertake for the intervention period: increasing physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. Pre-post questionnaires assessed changes in SF-8 health-related quality of life, presenteeism, self-efficacy, and stage of change. Mixed effects multiple linear regression and ordinal logistic regression models were used, with department as a random effect factor. Analyses were by intention to treat: the 30% (238/787) who did not respond to the follow-up questionnaires were assigned change scores of zero.

RESULTS

Participants were 19 to 65 years (mean 44.0 +/- 10.6), and 74.3% (585/787) were female. Mean SF-8 Physical quality of life score increased significantly more in the intervention group than in the control group, 1.84 (95% CI 0.96-2.72) vs 0.72 (95% CI -0.15-1.58) respectively, P = .02. SF8 Mental score also improved significantly more in the intervention group than in the control group (P = .02). The odds ratio for improvement in self-assessed health status was 1.57 (95% CI 1.21-2.04, P < .001) for the intervention group compared to the control group. The odds ratio for having a reduction in difficulty accomplishing work tasks because of physical or emotional problems, a measure of presenteeism, was 1.47 (95% CI 1.05-2.05, P = .02) for the intervention group compared to the control group. The odds of having an improvement in self-efficacy for changing diet was 2.05 (95% CI 1.44-2.93) for the intervention vs the control group (P < .001). Greater improvement in stage of change for physical activity (P = .05), fats (P = .06), and fruits/vegetables (P = .006) was seen in the intervention group compared to the control group. Significant effects on diet and physical activity behavior change are reported elsewhere.

CONCLUSIONS

Cost-effective methods that can reach large populations with science-based interventions are urgently needed. Alive! is a fully automated low-cost intervention shown to effect significant improvements in important health parameters.

TRIAL REGISTRATION

Clinicaltrials.gov NCT00607009; http://clinicaltrials.gov/ct2/show/NCT00607009 (Archived by WebCite at http://www.webcitation.org/5cLpCWcT6).

Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study

The aim of this study was to evaluate the effect of a transfer technique education programme (TT) alone or in combination with physical fitness training (TTPT) compared with a control group, who followed their usual routine. Eleven clinical hospital wards were cluster randomised to either intervention (six wards) or to control (five wards). The intervention cluster was individually randomised to TT (55 nurses) and TTPT (50 nurses), control (76 nurses). The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues. The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks. Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not, when compared to a control group, show any statistical differences according to self-reported low back pain (LBP), pain level, disability and sick leave at a 12-month follow-up. However, the individual randomised intervention subgroup (transfer technique/physical training) significantly improved the LBP-disability (p = 0.001). Although weakened by a high withdrawal rate, teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered. Other priorities such as physical training may be taken into consideration. The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP. However, physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel.

Predictors of endothelial function in employees with sedentary occupations in a worksite exercise program

A sedentary workforce may be at increased risk for future cardiovascular disease. Exercise at the work site has been advocated, but effects on endothelium as a biomarker of risk and relation to weight loss, lipid changes, or circulating endothelial progenitor cells (EPCs) have not been reported. Seventy-two office and laboratory employees (58 women; average age 45 years, range 22 to 62; 26 with body mass index values >30 kg/m(2)) completed 3 months of participation in the National Heart, Lung, and Blood Institute's Keep the Beat program, with the determination of vital signs, laboratory data, and peak oxygen consumption (VO(2)) during treadmill exercise. Brachial artery endothelium was tested by flow-mediated dilation (FMD), which at baseline was inversely associated with Framingham risk score (r = -0.3689, p <0.0001). EPCs were quantified by colony assay. With exercise averaging 98 +/- 47 minutes each workweek, there was improvement in FMD (from 7.8 +/- 3.4% to 8.5 +/- 3.0%, p = 0.0096) and peak VO(2) (+1.2 +/- 3.1 ml O(2)/kg/min, p = 0.0028), with reductions in diastolic blood pressure (-2 +/- 8 mm Hg, p = 0.0478), total cholesterol (-8 +/- 25 mg/dl, p = 0.0131), and low-density lipoprotein cholesterol (-7 +/- 19 mg/dl, p = 0.0044) but with a marginal reduction in weight (-0.5 +/- 2.1 kg, p = 0.0565). By multiple regression modeling, lower baseline FMD, greater age, reductions in total and low-density lipoprotein cholesterol and diastolic blood pressure, and increases in EPC colonies and peak VO(2) were jointly statistically significant predictors of change in FMD and accounted for 47% of the variability in FMD improvement with program participation. Results were similar when modeling was performed for women only. In contrast, neither adiposity at baseline nor change in weight was a predictor of improved endothelial function. In conclusion, daily exercise achievable at their work sites by employees with sedentary occupations improves endothelial function, even with the absence of weight loss, which may decrease cardiovascular risk, if sustained.

Evidence, theory and context: using intervention mapping to develop a worksite physical activity intervention

Background

The workplace is an ideal setting for health promotion. Helping employees to be more physically active can not only improve their physical and mental health, but can also have economic benefits such as reduced sickness absence. The current paper describes the development of a three month theory-based intervention that aims to increase levels of moderate intensity physical activity amongst employees in sedentary occupations.

Methods

The intervention was developed using an intervention mapping protocol. The intervention was also informed by previous literature, qualitative focus groups, an expert steering group, and feedback from key contacts within a range of organisations.

Results

The intervention was designed to target awareness (e.g. provision of information), motivation (e.g. goal setting, social support) and environment (e.g. management support) and to address behavioural (e.g. increasing moderate physical activity in work) and interpersonal outcomes (e.g. encourage colleagues to be more physically active). The intervention can be implemented by local facilitators without the requirement for a large investment of resources. A facilitator manual was developed which listed step by step instructions on how to implement each component along with a suggested timetable.

Conclusion

Although time consuming, intervention mapping was found to be a useful tool for developing a theory based intervention. The length of this process has implications for the way in which funding bodies allow for the development of interventions as part of their funding policy. The intervention will be evaluated in a cluster randomised trial involving 1350 employees from 5 different organisations, results available September 2009.

A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults

In the past, interventions aimed at reducing obesity have mainly targeted at weight loss treatment in obese adults, with limited long-term effects. With the increasing number of people being obese and being at risk for obesity, there has been a shift in focus towards prevention of obesity. We conducted a systematic review of the peer-reviewed literature on the efficacy of obesity prevention interventions in adults in order to identify effective interventions and intervention elements. Pubmed, OVID, and Web of Science databases were searched from January 1996 to June 2006. Interventions aimed at primary prevention of weight gain among adults achieved by focusing on dietary intake, physical activity or the combination of both were included. The outcome measure had to be difference in change in body mass index or body weight between the intervention and the control groups. Nine studies were included, five long-term studies (at least 1 year) and four short-term (3 months to 1 year). Seven studies evaluated an intervention that focused on a combination of diet and physical activity to prevent weight gain, one on diet only and one on physical activity only. One dietary intervention (long-term), and three combined dietary and physical activity interventions (one long-term and two short-term) produced significantly positive results at end of follow-up. The two long-term, effective interventions consisted of intensive and long-term intervention implementation, including groups sessions designed to promote behavioural changes. The current evidence of efficacy of obesity prevention interventions is based on a very small number of studies. Some studies showed a positive impact on body mass index or weight status, but there was too much heterogeneity in terms of study design, theoretical underpinning and target population to draw firm conclusions about which intervention approaches are more effective than others. More research is urgently needed to extend the body of evidence.

Effectiveness of an Educational and Physical Programme in Reducing Headache, Neck and Shoulder Pain: A Workplace Controlled Trial

This study was an 8-month controlled trial to evaluate the effectiveness of a workplace educational and physical programme in reducing headache and neck and shoulder pain. Central registry office employees ( n = 192; study group) and 192 peripheral registry office and central tax office employees (controls) in the city of Turin, Italy were given diaries for the daily recording of pain episodes. After 2 months, the study group only began the educational and physical programme. The primary end-point was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain, and as the proportion of subjects with a ≥50% reduction of frequency (responder rate). The number of days of analgesic drug consumption was also recorded. Diaries completed for the whole 8 months were available for 169 subjects in the study group and 175 controls. The baseline frequency of headache (days per month) was 5.87 and 6.30 in the study group and in controls; frequency of neck and shoulder pain was 7.12 and 7.79, respectively. Mean treatment effects [days per month, 95% confidence interval (CI)] on comparing the last 2 months vs. baseline were: headache frequency −2.45 (−3.48, −1.43); frequency of neck pain −2.62 (−4.09, −1.16); responder rates (odds ratio, 95% CI) 5.51 (2.75, 11) for headache, 3.10 (1.65, 5.81) for neck and shoulder pain, and 3.08 (1.06, 8.90) for days with analgesic drug consumption. The study suggests that an educational and physical programme reduces headache and neck and shoulder pain in a working community.

The effects of a graduated aerobic exercise programme on cardiovascular disease risk factors in the NHS workplace: a randomised controlled trial

Background

Sufficient levels of physical activity provide cardio-protective benefit. However within developed society sedentary work and inflexible working hours promotes physical inactivity. Consequently to ensure a healthy workforce there is a requirement for exercise strategies adaptable to occupational time constraint. This study examined the effect of a 12 week aerobic exercise training intervention programme implemented during working hours on the cardiovascular profile of a sedentary hospital workforce.

Methods

Twenty healthy, sedentary full-time staff members of the North West London Hospital Trust cytology unit were randomly assigned to an exercise (n = 12; mean ± SD age 41 ± 8 years, body mass 69 ± 12 kg) or control (n = 8; mean ± SD age 42 ± 8 years, body mass 69 ± 12 kg) group. The exercise group was prescribed a progressive aerobic exercise-training programme to be performed 4 times a week for 8 weeks (initial intensity 65% peak oxygen consumption (VO_{2 peak})) and to be conducted without further advice for another 4 weeks. The control was instructed to maintain their current physical activity level. Oxygen economy at 2 minutes (2minVO₂), 4 minutes (4minVO₂), VO_{2 peak}, systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI, C-reactive protein (CRP), fasting glucose (GLU) and total cholesterol (TC) were determined in both groups pre-intervention and at 4 week intervals. Both groups completed a weekly Leisure Time Questionnaire to quantify additional exercise load.

Results

The exercise group demonstrated an increase from baseline for VO_{2 peak} at week 4 (5.8 ± 6.3 %) and 8 (5.0 ± 8.7 %) (P < 0.05). 2minVO₂ was reduced from baseline at week 4 (-10.2 ± 10.3 %), 8 (-16.8 ± 10.6 %) and 12 (-15.1 ± 8.7 %), and 4minVO₂ at week 8 (-10.7 ± 7.9 %) and 12 (-6.8 ± 9.2) (P < 0.05). There was also a reduction from baseline in CRP at week 4 (-0.4 ± 0.6 mg·L^-1) and 8 (-0.9 ± 0.8 mg·L^-1) (P < 0.05). The control group showed no such improvements.

Conclusion

This is the first objectively monitored RCT to show that moderate exercise can be successfully incorporated into working hours, to significantly improve physical capacity and cardiovascular health.

Evaluation of an employer-sponsored pedometer-based physical activity program

This study evaluated a competition-based employer-sponsored physical activity program using pedometers. City employees (N approximately 2,600) formed teams in groups of 10 persons (N = 640). The groups competed against each other over a 12-wk. period with the goal of attaining 10,000 steps per day, per person. Only teams with complete data were included in the formal evaluation. A repeated-measures analysis of variance indicated significant differences in team steps by week of the program, with post hoc comparisons indicating significant differences from baseline step counts evident during Weeks 6-8 but not at the end of the program. These data confirm that competition-based physical activity programs using pedometers may not be an effective means of increasing the long-term physical activity of employees.

Scales to assess the quality of randomized controlled trials: a systematic review

BACKGROUND AND PURPOSE

The methodological quality of randomized controlled trials (RCTs) is commonly evaluated in order to assess the risk of biased estimates of treatment effects. The purpose of this systematic review was to identify scales used to evaluate the methodological quality of RCTs in health care research and summarize the content, construction, development, and psychometric properties of these scales.

METHODS

Extensive electronic database searches, along with a manual search, were performed.

RESULTS

One hundred five relevant studies were identified. They accounted for 21 scales and their modifications. The majority of scales had not been rigorously developed or tested for validity and reliability. The Jadad Scale presented the best validity and reliability evidence; however, its validity for physical therapy trials has not been supported.

DISCUSSION AND CONCLUSION

Many scales are used to evaluate the methodological quality of RCTs, but most of these scales have not been adequately developed and have not been adequately tested for validity and reliability. A valid and reliable scale for the assessment of the methodological quality of physical therapy trials needs to be developed.

The (cost-)effectiveness of an individually tailored long-term worksite health promotion programme on physical activity and nutrition: design of a pragmatic cluster randomised controlled trial

Background

Cardiovascular disease is the leading cause of disability and mortality in most Western countries. The prevalence of several risk factors, most notably low physical activity and poor nutrition, is very high. Therefore, lifestyle behaviour changes are of great importance. The worksite offers an efficient structure to reach large groups and to make use of a natural social network. This study investigates a worksite health promotion programme with individually tailored advice in physical activity and nutrition and individual counselling to increase compliance with lifestyle recommendations and sustainability of a healthy lifestyle.

Methods/Design

The study is a pragmatic cluster randomised controlled trial with the worksite as the unit of randomisation. All workers will receive a standard worksite health promotion program. Additionally, the intervention group will receive access to an individual Health Portal consisting of four critical features: a computer-tailored advice, a monitoring function, a personal coach, and opportunities to contact professionals at request. Participants are employees working for companies in the Netherlands, being literate enough to read and understand simple Internet-based messages in the Dutch language.

A questionnaire to assess primary outcomes (compliance with national recommendations on physical activity and on fruit and vegetable intake) will take place at baseline and after 12 and 24 months. This questionnaire also assesses secondary outcomes including fat intake, self-efficacy and self-perceived barriers on physical activity and fruit and vegetable intake. Other secondary outcomes, including a cardiovascular risk profile and physical fitness, will be measured at baseline and after 24 months.

Apart from the effect evaluation, a process evaluation will be carried out to gain insight into participation and adherence to the worksite health promotion programme. A cost-effectiveness analysis and sensitivity analysis will be carried out as well.

Discussion

The unique combination of features makes the individually tailored worksite health promotion programme a promising tool for health promotion. It is hypothesized that the Health Portal's features will counteract loss to follow-up, and will increase compliance with the lifestyle recommendations and sustainability of a healthy lifestyle.

Trial registration

Current Controlled Trials ISRCTN52854353.

Work related neck-shoulder pain: a review on magnitude, risk factors, biochemical characteristics, clinical picture and preventive interventions

The purpose of this review is to scrutinize the physiology of neck-shoulder pain and trapezius myalgia based on the most recent scientific literature. Therefore, systematic literature searches have been conducted. Occurrence of neck-shoulder pain, risk factors for development of neck-shoulder pain, and its work-relatedness are addressed. Furthermore, the latest information on the biochemical milieu within healthy and painful neck-shoulder muscles is reviewed. Finally diagnosis of and intervention for neck and shoulder pain are discussed.

Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study

BACKGROUND

Despite considerable knowledge about musculoskeletal disorders (MSD) and physical, psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD. In addition, studies of physical activity are often limited to either leisure activity or physical activity at work. Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking. This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD.

METHODS

A questionnaire about musculoskeletal disorders, physical activity and background data (employment status, age, gender, body mass index, smoking, education and physical stressors) was completed by 2265 workers (58%) 18 to 70 years old in the Royal Norwegian Navy. Multiple logistic regression with 95% confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders.

RESULTS

A total of 32% of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year. The most common musculoskeletal disorders were in the lower back (15% often or very often), shoulders (12% often or very often) and neck (11% often or very often). After adjustment for confounders, physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows, knees and feet.

CONCLUSION

The one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low. A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders among personnel in the Royal Norwegian Navy. Prospective studies are necessary to confirm the cause and effect in this association.

Strategies for prevention and management of musculoskeletal conditions. Neck pain

The aim of this article was to summarise the existing evidence concerning interventions for non-specific neck pain. Neck-and-shoulder pain is commonly experienced by both adolescents and adults. Although the prevalence appears to vary among different nations, the situation is essentially the same, at least in the industrialised nations. Explanations for the wide variation in incidence and prevalence include various methodological issues. Back and neck disorders represent one of the most common causes for both short- and long-term sick leave and disability pension. Evidenced risk factors for the onset and maintenance of non-specific neck and back pain include both individual and work-related psychosocial factors. Based on the existing evidence different forms of exercise can be strongly recommended for at-risk populations, as well as for the acute and chronic non-specific neck pain patient. Furthermore, for symptom relief this condition can be treated with transcutaneous electric nerve stimulation, low level laser therapy, pulse electromagnetic treatment or radiofrequency denervation.

Public health perspective--how to improve the musculoskeletal health of the population

Musculoskeletal disorders are the most common cause of long-term sick leave in several western countries and individuals with chronic musculoskeletal pain score very low on health status measurements. Musculoskeletal health is multidimensional and is best understood from a biopsychosocial perspective. Body structure and function interacts with personal and environmental factors, affecting the ability to perform activities and participate in society. Interventions aimed at the whole population must attend to the underlying causes of musculoskeletal disorders and promote a healthy lifestyle. Safe environments and activities could reduce the risk of traumatic events and also make participation possible for those with a disability. Public beliefs about musculoskeletal symptoms and consequences need to be changed in order to minimise fear and avoidance, which, together with other psychosocial factors, could lead to chronicity. Public awareness and identification of those at risk for the development of musculoskeletal problems could lead to early and properly timed management.

Self-paced exercise program for office workers: impact on productivity and health outcomes

The impact of a self-paced exercise program on productivity and health outcomes of 32 adult workers in a large federal office complex was investigated during 3 months. Walking was the sole form of exercise. The first month, during which no walking occurred, was the control period. The second and third months were the experimental period. Participants were divided into three levels based on initial weight and self-determined walking distance goals. Productivity (using the Endicott Work Productivity Scale), walking distance (using a pedometer), and health outcomes (blood pressure, weight, pulse rate, and body fat percentage) were measured weekly. Results from this study, based on a paired t test analysis, suggest that although the self-paced exercise program had no impact on productivity, it lowered blood pressure and promoted weight loss. Further study using a larger sample and a controlled experimental design is recommended to provide conclusive evidence.

Effects of a physical exercise intervention on subjective physical well-being, psychosocial functioning and general well-being among office workers: a cluster randomized-controlled cross-over design

The purpose of the study was to examine the effects of a workplace physical exercise intervention on subjective physical well-being, psychosocial functioning and general well-being. The study was a cluster randomized-controlled trial with the department (n=4) as the unit of randomization. The subjects (n=90) were office workers [mean age 45.7 (SD 8.5) years]. Psychosocial functioning and well-being variables were measured by descriptive visual rating scales. The cross-over design consisted of one 15-week intervention period of light resistance training and guidance and another 15-week period of no training and no guidance. The statistical analysis was based on linear mixed models. The active component of the intervention, light resistance training, resulted in a slight, but statistically significant, increase in subjective physical well-being (P=0.015). At the average training time of 5 min/working day (25 min/week) the average increase during the 15-week period was 4 units (95% confidence interval (CI) 1-7) and 5% (95% CI 1-9). The physical exercise intervention had no effect on somatic symptoms, anxiety, self-confidence, mood, mental stress at work, working atmosphere, life satisfaction or meaning of life. Daily light resistance training, conducted during the working day, had a positive direction on subjective physical well-being among office workers.

Sport oder körperliche Aktivität im Alltag?

Recent years have been marked by increased efforts of public health to pro mote physical activity. Concepts used for the promotion of physical activity range from the prescription of exercise to advice for "active living". The article compares existing evidence for the health benefits of the concepts of physical activity, health-enhancing physical activity, exercise and the German concept of "health sport". Furthermore, existing evidence for different promotion strategies for physical activity on the individual and population level are presented and discussed. Referring to the situation in Germany, the article intends to support current discussions regarding the development of health sport programs and initiatives to promote active living.

Dissemination of a community-based physical activity project: The case of 10,000 steps

This paper describes the use of a web-site for the dissemination of the community-based '10,000 steps' program which was originally developed and evaluated in Rockhampton, Queensland in 2001-2003. The website provides information and interactive activities for individuals, and promotes resources and programs for health promotion professionals. The dissemination activity was assessed in terms of program adoption and implementation. In a 2-year period (May 2004-March 2006) more than 18,000 people registered as users of the web-site (logging more than 8.5 billion steps) and almost 100 workplaces and 13 communities implemented aspects of the 10,000 steps program. These data support the use of the internet as an effective means of disseminating ideas and resources beyond the geographical borders of the original project. Following this preliminary dissemination, there remains a need for the systematic study of different dissemination strategies, so that evidence-based physical activity programs can be translated into more widespread public health practice.

Promoting physical activity with people in different places—A Dutch perspective

This paper describes five recent Dutch studies of the effectiveness of physical activity interventions carried out in diverse settings: general practice (GP), aged care facilities, and workplaces. The stage-based physical activity counselling carried out in the GP setting demonstrated a beneficial effect on the determinants of physical activity, but did not show any additional effect on physical activity behaviour, compared with standard physical activity advice. In contrast, the stage-based intervention through the workplace was effective in increasing physical activity, due mostly to an increase in vigorous-intensity activities. In the aged care setting, functional-skills training alone or in combination with resistance training showed functional improvement only in participants with high participation rates. Functional-skills training appeared to be more feasible than resistance training in this population of frail elderly. The two studies which aimed to promote earlier return-to-work among workers with sick leave due to non-specific low back pain also showed promising results. As a result, it was recommended that occupational physicians (OP) should refer workers with low back pain in the subacute phase of their sick leave to a low intensity intervention consisting of short meetings and exercises aimed at changing behaviour, and that the OPs contact other health care providers (GPs and physiotherapists) about the treatment strategy. Together, the results of these five Dutch studies suggest that it is feasible to successfully promote physical activity to groups of people in diverse places, with benefits in terms of both prevention and management of chronic disease and injury.

Offering physical activity counselling in occupational health care -- does it reach the target group?

BACKGROUND

Employees participating in worksite physical activity (PA) interventions are mostly the physically active and healthy ones. PA counselling may therefore have an important role in reaching 'at-risk' employees.

AIMS

To examine (i) how PA counselling offered by occupational health care (OHC) providers reaches the target group of physically inactive employees who have intentions to increase PA and (ii) the relations of 12 selected variables to respondents' willingness to participate in PA counselling.

METHODS

Questionnaire survey of employees of client companies of OHC providers.

RESULTS

Eight of the 19 OHC providers contacted participated and recruited a total of nine client companies to the study. A questionnaire survey was delivered to all the employees of the companies (n = 1349). Fifty-eight percent of employees (n = 784) responded to the survey and half of them (n = 380) belonged to the target group of being physically inactive and intending to increase PA. Only half of the respondents (n = 201) in the target group were willing to participate in counselling. Respondents in small companies were more interested in counselling than employees in large companies as were white-collar workers compared to blue-collar workers. Earlier PA discussions in OHC and intention to increase leisure-time PA were also positively related to willingness.

CONCLUSIONS

A counselling offer attached to a survey did not effectively reach the target group of physically inactive employees who were ready to increase their PA. More individually based approaches such as brief conversations during client contacts are needed in OHC to raise the interest in lifestyle issues.