Workplace physical activity interventions: a systematic review

Identifying effective obesity prevention intervention components: An umbrella review mapping systematic review evidence

This overview of reviews synthesizes the effectiveness of obesity prevention interventions in children and adults on BMI/zBMI, following JBI and Cochrane Handbook guidelines. The protocol was prospectively registered in OSF in September 2020. Searches for eligible reviews were run in five databases and gray literature in May 2022. Systematic reviews published in 2010 and assessed BMI/zBMI outcomes of obesity prevention interventions were eligible. Screening, data extraction, and quality assessment were performed independently and in duplicate using standardized tools. For similar interventions, the more recent, higher-quality review was included. Thirty reviews reporting on 60 discrete interventions (i.e., a specific intervention component), mapped to 14 of 21 IOM sub-domains, were included. Nine interventions were classified as effective in improving BMI outcomes, including digital health or counseling interventions for adults in 'healthcare environments', behavioral interventions for children (broadly nutrition education), physical education curriculum modifications, and policies targeting food and beverages in 'School environments'. This review extends on previous reviews by consolidating evidence from high-quality, recent reviews to identify effective intervention components. Thus, this review provides direction for implementation efforts and highlights research gaps, where future research is warranted. However, as primary studies were not directly analyzed, gaps may reflect a lack of systematic reviews rather than primary research.

Effects of workplace interventions on sedentary behaviour and physical activity: an umbrella review with meta-analyses and narrative synthesis

BACKGROUND

Physical inactivity is rising globally, exacerbating the burden of preventable deaths and diseases. Despite extensive research on promoting physical activity in the workplace, synthesising the existing literature is challenging due to the wide variety of interventions and outcomes. This study aims to provide a comprehensive synthesis of intervention effects to inform health promotion initiatives and guide future research efforts.

METHODS

In this umbrella review, we conducted systematic searches of six databases (Cochrane, MEDLINE, Embase, CINAHL, Scopus, and Web of Science) for systematic reviews and meta-analyses published between Jan 1, 2000, and May 31, 2024, evaluating workplace interventions targeting sedentary behaviour or physical activity in working adults aged 18 years and older without specific health conditions or mobility impairments. Outcomes encompassed any behavioural changes related to sedentary behaviour or physical activity. Evidence for each relevant combination of intervention and outcome categories was summarised using either meta-analysis or narrative synthesis, with primary study data extracted as needed. This study is registered with PROSPERO, CRD42020171774.

FINDINGS

We included 36 systematic reviews and meta-analyses covering 214 unique primary studies. Despite considerable heterogeneity in the evidence, several effect trends emerged with moderate-to-high confidence. First, sit-to-stand workstations produced the largest reductions in sedentary time, decreasing it by up to 75 min per day (95% CI -109 to -41) when used alone, with reductions increasing by up to 33% when paired with psychosocial strategies. However, these interventions did not significantly increase physical activity at any intensity. Second, self-monitoring combined with psychosocial strategies yielded the largest increases in step count, with average gains of 1056 steps per day (371 to 1740). Third, no specific strategy consistently increased moderate-to-vigorous physical activity, although the available evidence remains sparse. Additional trends were observed but with lower confidence levels. Analysis of publication bias suggested an inflated effect of environmental-level interventions on occupational sedentary time. Adjusting for this bias using the trim-and-fill method only slightly reduced the effect size, but this result should be interpreted with caution due to high heterogeneity (I2=84·80%).

INTERPRETATION

Current evidence highlights the modest effect of existing workplace interventions on physical activity. Some strategies, such as sit-to-stand workstations and gamified interventions, effectively reduce sedentary behaviour and encourage lighter forms of physical activity, but none consistently improves moderate-to-vigorous physical activity, which provides the greatest health benefits. With many countries falling short of the WHO target to reduce physical inactivity prevalence by 15% from 2010 levels by 2030, intensified efforts are needed to address this gap, meet global goals, and alleviate the health burden of physical inactivity.

FUNDING

None.

The work Lifestyle-integrated Functional Exercise program for preventing functional decline in employees aged 55 years and older: development and initial evaluation

BACKGROUND

Despite the global increase in older employees, workplace physical activity interventions (WPAIs) for this target group have not yet been sufficiently developed. The major drawback of existing WPAIs is low adherence due to lack of time or limited motivation. A novel approach could be to integrate tailored neuromotor and strength exercises into everyday working tasks to prevent the functional decline of older employees at the workplace without needing much additional time for training. This approach was tested in the present study by evaluating the proof-of-concept of a novel WPAI based on the Lifestyle-integrated Functional Exercise (LiFE) program integrated into a working environment (wLiFE55 +).

METHODS

The proof-of-concept of wLiFE55 + was quantified within a 4-week pre-post exercise intervention study by measuring (1) feasibility including adherence, activity frequency, adverse events and acceptance (integrability of wLiFE55 + activities, perceived improvement and safety, satisfaction, physical demand, personal trainer session, intervention content) and (2) pre-to-post changes in neuromotor function (12-Level Balance Scale, 12-LBS; Community Balance and Mobility Scale, CBM), strength (60sec Chair Stand Test), and PA (1-week activity monitoring). For statistical analysis, the median and interquartile range (IQR) were computed. For pre-to-post changes, Wilcoxon signed-rank tests with effect size (r) were also performed.

RESULTS

Seventeen older employees (mean age 59 years, 8 female) were included of which fifteen completed the study. The intervention adherence was 100%, and the activity adherence was 58% (9 out of 12 maximum possible wLiFE55 + activities implemented). Depending on the specific activity, the frequency of practice ranged between 25-75% of the days of the intervention period, and single wLiFE55 + activities were practiced between one and three times per day. No adverse events occurred, and acceptance was high. Pre-to-post increases with medium effect sizes were found for neuromotor function (CBM, 12-LBS) and specific PA variables (total sedentary time, sedentary bouts > 30 min).

CONCLUSION

The results of the study highlight the feasibility of wLiFE55 + in a work setting with older employees. The pre-to-post increases observed in neuromotor measures and reductions in sedentary time suggest that wLiFE55 + may counteract the age-related functional decline in older employees and justifies future studies in this field. The next steps are program adjustments to boost exercise frequency and evaluating wLiFE55 + in a randomized controlled trial.

Health screening clinic to reduce absenteeism and presenteeism among NHS Staff: eTHOS a pilot RCT

Background

Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common.

Objectives

To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff.

Design

Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation.

Setting

Four United Kingdom National Health Service hospitals from two urban and one rural Trust.

Participants

Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham.

Interventions

Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines.

Main outcome measures

The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the 'amber' zone, then the trial would require modifications to proceed to full trial. If all were 'red', then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only.

Results

Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes.

Conclusions

There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities.

Trial registration

This trial is registered as ISRCTN10237475.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.

Participatory Approaches in the Context of Research Into Workplace Health Promotion to Improve Physical Activity Levels and Reduce Sedentary Behavior Among Office-Based Workers: Scoping Review

BACKGROUND

Participatory research (PR) involves engaging in cocreation with end users and relevant stakeholders throughout the research process, aiming to distribute power equitably between the end users and research team. Engagement and adherence in previous workplace health promotion (WHP) studies have been shown to be lacking. By implementing a PR approach, the insights of end users and stakeholders are sought in the co-design of feasible and acceptable intervention strategies, thereby increasing the relevance of the research.

OBJECTIVE

This scoping review aims to explore, identify, and map PR techniques and their impact when used in office-based WHP interventions designed to improve physical activity (PA) or reduce sedentary behavior (SB).

METHODS

The reporting of this scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). A systematic literature search of 5 electronic databases-Web of Science, PubMed, Scopus, Google Scholar, and OpenGrey-was conducted, searching from January 1, 1995, to February 8, 2023. In total, 2 independent reviewers first screened the retrieved articles by title and abstract, and then assessed the full texts based on the inclusion and exclusion criteria. The search strategy and eligibility criteria were developed and guided by an a priori population (office-based working adults), intervention (a PA WHP intervention that took a PR approach), comparison (no comparison required), and outcome (PA or SB) framework. Data were charted and discussed via a narrative synthesis, and a thematic analysis was conducted. The included studies were evaluated regarding the degree of end user engagement throughout the research process and power shared by the researchers, using Arnstein's ladder of citizen participation.

RESULTS

The search retrieved 376 records, of which 8 (2.1%) met the inclusion criteria. Four key strategies were identified: (1) end user focus groups, (2) management involvement, (3) researcher facilitators, and (4) workplace champions. The degree of engagement and power shared was relatively low, with 25% (2/8) of the studies determined to be nonparticipation studies, 25% (2/8) determined to be tokenistic, and 50% (4/8) determined to provide citizen power.

CONCLUSIONS

This review provides a foundation of evidence on the current practices when taking a PR approach, highlighting that previous office-based PA WHP studies have been largely tokenistic or nonparticipative, and identified that the end user is only engaged with in the conception and implementation of the WHP studies. However, a positive improvement in PA and reduction in SB were observed in the included studies, which were largely attributed to implementing a PR approach and including the end user in the design of the WHP intervention. Future studies should aim to collaborate with workplaces, building capacity and empowering the workforce by providing citizen control and letting the end users "own" the research for a sustainable WHP intervention.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2021-054402.

Physical Activity and Social Comparison: The Importance of Group Composition in an Employee Fitbit Intervention

This study examined the impact of group composition of a 6-week group-based employee Fitbit intervention on daily physical activity steps. Group composition comprised heterogenous and homogeneous groupings based on variations in baseline high, medium, and low steppers. The intervention included weekly step leaderboard information, motivational and informative messages, and the ability to participate in group step challenges. Repeated measures analysis of variance (ANOVA) examined differences in change of steps across time, step-level groups (low, medium, and high), and group composition (low/high, similar, and mixed), and replicated with a subgroup of participants who participated in group step challenges. While group and step level did not emerge as significant interactions in the overall sample, when focused within the group step challenge subsample, relationships among time, the group composition, and participant step-level categories emerged. Overall, the greatest increases in steps occurred at the mid-point time period, among lower steppers, and within the low/high comparison group. This study provides evidence of the importance of group composition in physical activity interventions as well as the fidelity of intervention design in facilitating group comparisons.

Dual processing approach to sedentary behavior and physical activity in the workplace

Regular physical activity is an important health promoting behavior. Yet, many adults live sedentary lifestyles, especially during their workday. The current study applies an extended theory of planned behavior model, incorporating affective attitudes and instrumental attitudes, along with habit, to predict limiting sedentary behavior and physical activity within an office environment. Theory of planned behavior constructs and habit were assessed with an online survey on a sample of 180 full-time office workers, with self-reported behavior assessed 1 week later (Mage = 25.97, SDage = 10.24; 44 males, 134 females, and 2 nonbinary). Model fit was indicated by BRMSEA (M = 0.057, SD = 0.023), B γ^ (M = 0.984, SD = 0.010) and BCFI (M = 0.959, SD = 0.026), accounting for 46.1% of variance in intention, 21.6% of variance in sedentary behavior, and 17.4% of variance in physical activity behavior. A Bayesian structural equation model revealed direct effects of instrumental attitudes and perceived behavioral control on intention to limit sedentary behavior, direct effects of intention and perceived behavioral control on limiting sedentary behavior, and direct effects of perceived behavioral control and habit on engaging in physical activity. The current study indicates intentions to be active in the office are primarily driven by beliefs about the benefits of activity and individuals' perceived level of control, rather than normative or affective beliefs. As behavior was predicted by both intention and habit, findings also indicate office-based activity is likely not always a consciously driven decision. These findings may have implications for improving activity levels in this highly sedentary population.

A Systematic Review of Workplace Physical Activity Coaching

Aim Studies show that about 60 min of moderate physical activity (PA) per day compensate for sitting all day at work. However, the workplace offers an ideal setting for health-promoting interventions such as PA coaching as a person-centered intervention aimed at achieving lasting health behavior changes. Given a good evidence base of health coaching studies in general, this systematic review aims to provide an overview of workplace PA coaching interventions. Methods This review was conducted according to PRISMA guidelines. Studies published up to July 2021 were considered based on the following inclusion criteria: (1) longitudinal intervention studies, (2) analysis of PA at work, (3) sedentary employees, (4) PA coaching in the workplace as intervention, (5) increasing workplace PA. Results Of 4323 studies found, 14 studies with 17 interventions met inclusion criteria. All 17 interventions indicated an increase in at least one PA outcome. Twelve interventions indicated significant improvements in at least one workplace or total PA outcome. There is a high variation within the different coaching parameters, such as behavior change techniques and communication channels. The study quality showed a moderate to high risk of bias. Conclusions The majority of interventions provided evidence for the effectiveness of workplace PA coaching. Nevertheless, the results are inconclusive with regard to the variety of coaching parameters and thus no general statement can be made about the effectiveness of individual parameters. However, this variety of parameters also leads to a high degree of individualization of workplace PA coaching interventions to increase PA for different groups of employees and different types of workplaces.

Is a combination of individual consultations, text message reminders and interaction with a Facebook page more effective than educational sessions for encouraging university students to increase their physical activity levels?

Background

Physical activity (PA) has been consistently reported as a crucial component of disease prevention and improvement of people's health. Nevertheless, data has evidenced a decline in physical activity levels among adults in Jordan. Although previous behavioral change interventions have documented efficacy in increasing physical activity among adults, the PA levels is low among adults. A new motivational intervention that focuses on changing behavior toward performing the recommended level of physical activity is on need.

Objective

This two-arm single-center randomized controlled trial aimed to measure the efficacy of a multi-component behavioral intervention (including goal setting, self-monitoring, and feed-back) for increasing physical activity levels and self-efficacy for exercise and decreasing body mass index and blood pressure among students at a Jordanian University.

Setting

Philadelphia University in Jordan.

Methods

A behavioral intervention based on individualized consultations, text messages reminders and interaction with a Facebook page was compared with educational sessions in terms of efficacy for increasing physical activity levels among students at Philadelphia University.

Results

The intervention and control groups were comparable at baseline. At 6 months a significant increase was seen in the moderate physical activity and walking levels of the intervention group compared with the control group. The mean change (SD) in total METs of moderate physical activity and walking was 503 (325.20) METs/week in the intervention group and 6 (271.20) METs/week in the control group. The mean change (SD) in steps/day was 3,000 (1,217) steps/day in the intervention group and 876 (1120.23) steps/day in the control group. The difference between mean change of the two groups was very significant at 2,124 (-820 to -563). Self-efficacy for exercise scale significantly increased among the intervention group compared with the control group. In addition, body mass index (BMI) declined from the baseline (Mean: 28.23, SD: 4.82) to 6 months (Mean: 25.36, SD: 5.23) for the intervention group.

Conclusion

Behavioral intervention through multicomponent strategies, alongside the implementation of an advanced communication strategy via phone and social media, is effective for motivating adult students to increase their physical activity levels.

Clinical trial registration

ISRCTN54100536.

Twelve Weeks of Web-Based Low to Moderate Physical Activity Breaks with Coordinative Exercises at the Workplace Increase Motor Skills but Not Motor Abilities in Office Workers-A Randomised Controlled Pilot Study

Integrating physical activity interventions at the workplace can have positive effects on the employees' health. This study aimed to evaluate a physical activity break with coordinative exercises (PAB) including juggling and balance tasks and to assess its effects on motor abilities. Thirty-two university employees were randomly allocated to an intervention (IG:20) or a control (CG:12) group. The IG participated two times per week for 12 weeks in a PAB with a duration of 15 to 20 min. We measured the unimanual, bimanual finger, and hand dexterity with the Purdue Pegboard Test, the reaction time with the Fall Stick Test, and the dynamic balance with the Y Balance Test. Juggling performance was assessed by measuring the time(s) of performing a three-ball-cascade. Furthermore, an evaluation of the PAB was executed. Participants in the IG improved their juggling performance after six and twelve weeks. These increases were significantly different compared to the CG. However, no other parameters changed significantly. The evaluation showed that the PAB was enjoyable and led to subjective improvements in the participants health and working routine. To conclude, PAB can lead to improvements in juggling performance, subjective health, and the working routine.

Physical activity in the workplace: a cost or a benefit for organizations? A systematic review

Purpose

Most adults do not follow the minimum requirements for physical activity despite the benefits such activity can provide toward improving quality of life. On average, an adult spends 60% of daily hours in the workplace, making it essential to create working environments that are favorable to avoiding harmful effects on the health of workers. Toward this end, the application of physical activity programs in a work context is one of the possible interventions. This study aims to carry out a systematic review of the literature to identify the impact of physical activity programs applied in the workplace, on employee wellness and organizational productivity.

Design/methodology/approach

The search for reports was carried out in two databases, namely, Thomson Reuters Web of Science and Scopus, according to several inclusion and exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was applied to ensure the quality of the study. Microsoft Excel 2016 was used to organize the database to support the data analysis.

Findings

The sample comprised 64 reports published in international journals between 1986 and 2019. From these studies, six thematic clusters were formed: Workplace Physical Activity Interventions, Workplace Wellness, Physical Activity and Organizational Performance, Barriers to Developing Physical Activity Programs in the Workplace, Physical Activity and Sedentary Occupations and Workplace Physical Activity Incentives. The analysis of these clusters confirmed that the implementation of physical activity programs in this context could represent beneficial effects for workers and the organizational system by contributing to a reduction in the rates of absenteeism and presenteeism. However, there are still many organizations that do not implement such programs.

Originality/value

The results of this study are essential for managers of organizations to be able to implement physical activity programs in a work context, similarly to the application of a strategy of corporate social responsibility in an intra-organizational environment. This research may also be useful for professionals in the areas of sports and physical exercise, who want to build their business around physical exercise programs applied to a work context.

Evaluation of a Workplace Active Rest Program in Office Workers With Comparison of a Prospective and Retrospective Survey

Physical activity-related workplace interventions can be counterstrategies for physical inactivity due to office work. Newly introduced programs should be evaluated for success. This study aimed to evaluate the intervention of a workplace active rest program and to compare a prospective and retrospective design of evaluation. A Germany-wide multicenter evaluation of a 3-month workplace active rest program (30 min, once a week) was carried out at 14 locations with a longitudinal pre/post design by means of an anonymous questionnaire (npre = 405, npost = 369). The participants' program-related changes in targeted characteristics regarding posture, function, complaints and physical awareness were collected with a questionnaire in a prospective design and afterward retrospectively. The prospective evaluation showed a significant improvement in the target characteristic "postural muscles in the neck area". In the retrospective survey, all target characteristics improved significantly. There were no differences between locations. The workplace active rest program in this study had positive effects on the perception of postural neck muscle status regardless of prospective or retrospective approach. Selection of survey mode should depend on desired outcome and consecutive influencing factors. In this specific case, retrospective survey could give more indirect information about overall satisfaction with the program and job although being influenced by response bias. Recall bias should be relatively small for shorter time periods assessed. Future studies should account for corresponding bias and specifics of target characteristics regardless of the chosen approach to survey.

Physical Movement Habit Formation in Sedentary Office Workers: Protocol Paper

Engaging in physical movement has a number of mental and physical health benefits, and yet 45% of Australia's population do not meet the recommended guidelines for physical activity. The current study aims to develop an online habit-based intervention designed to reduce sedentary behavior within the workplace, using environmental cues to instigate simple behavioral changes. Participants in this study will include full time office workers who self-report as having a highly sedentary job and work from either a commercial office, home office, or a mixture of both. Participants will complete a habit-based intervention over a four-week period designed to reduce sedentary behavior by increasing habitual responses to simple physical movement behaviors cued by their environment. Analysis will involve mixed methods ANOVAs to test the efficacy of the intervention. A successful intervention will show a reduction in sedentary behavior as a response to habitual simple physical movement behaviors.

Enhancing the health of NHS staff: eTHOS - protocol for a randomised controlled pilot trial of an employee health screening clinic for NHS staff to reduce absenteeism and presenteeism, compared with usual care

BACKGROUND

Staff absenteeism and presenteeism incur high costs to the NHS and are associated with adverse health outcomes. The main causes are musculoskeletal complaints and mental ill-health, which are potentially modifiable, and cardiovascular risk factors are also common. We will test the feasibility of an RCT to evaluate the clinical and cost-effectiveness of an employee health screening clinic on reducing sickness absenteeism and presenteeism.

METHODS

This is an individually randomised controlled pilot trial aiming to recruit 480 participants. All previously unscreened employees from four hospitals within three UK NHS hospital Trusts will be eligible. Those randomised to the intervention arm will be invited to attend an employee health screening clinic consisting of a screening assessment for musculoskeletal (STarT MSK and STarT Back), mental (PHQ-9 and GAD-7) and cardiovascular (NHS Health Check if aged ≥ 40, lifestyle check if < 40 years) health. Screen positives will be given advice and/or referral to recommended services. Those randomised to the control arm will receive usual care. Participants will complete a questionnaire at baseline and 26 weeks; anonymised absenteeism and staff demographics will also be collected from personnel records. The co-primary outcomes are as follows: recruitment, referrals and uptake of recommended services in the intervention arm. Secondary outcomes include the following: results of screening assessments, uptake of individual referrals, reported changes in health behaviours, acceptability and feasibility of intervention, indication of contamination and costs. Outcomes related to the definitive trial include self-reported and employee records of absenteeism with reasons. Process evaluation to inform a future trial includes interviews with participants, intervention delivery staff and service providers receiving referrals. Analyses will include presentation of descriptive statistics, framework analysis for qualitative data and costs and consequences presented for health economics.

DISCUSSION

The study will provide data to inform the design of a definitive RCT which aims to find an effective and cost-effective method of reducing absenteeism and presenteeism amongst NHS staff. The feasibility study will test trial procedures, and process outcomes, including the success of strategies for including underserved groups, and provide information and data to help inform the design and sample size for a definitive trial.

TRIAL REGISTRATION

ISRCTN reference number 10237475 .

The economic impact of workplace physical activity interventions in Europe: a systematic review of available evidence

Purpose

There is growing interest in the economic impact of workplace physical activity interventions, but the evidence is still lacking — especially in Europe. Although, some evidence on the return on investment (ROI) is found in literature, the included studies may not be applicable to the Europe situation. Therefore, the objective of this study was to review current evidence on the economic impact of workplace physical activity interventions in European countries.

Design/methodology/approach

A systematic review on the economic impact of worksite health promotion programs aiming at increasing physical activity was conducted. Five electronic databases (MEDLINE (Ovid), MEDLINE (PubMed), EMBASE, NHS-EED and Emerald Insights) were searched for relevant studies published between 2000 and 2020.

Findings

A total of 953 abstracts were screened, and 28 were reviewed, 11 of which met all inclusion criteria. The studies varied substantially in sample size, intervention type, duration and frequency of follow-up measurements, valuation methods and assessed economic outcomes. There is inconclusive evidence for decreasing absenteeism, positive net benefit (NB) and positive ROI. No evidence was found to indicate an effect on self-assessed productivity or job satisfaction.

Originality/value

This study is the first try to take the different working conditions from Europe into consideration. The authors found that working conditions could have some impact on the valuation of absenteeism costs and thereof on the ROI. Further, this study provides insight into how to deploy effective and efficient workplace physical activity interventions, based on a standardized and validated methodology and program scope.

Increasing workplace physical activity through motivational and volitional coaching – a randomized controlled trial with truck drivers

Purpose

Although the health hazards of truck drivers are well known, only few studies address the health status of this occupational group. The purpose of this empirical research paper is to evaluate the effects of motivational and volitional coaching on workplace physical activity (WPA) with the provision of a vehicle-integrated fitness device.

Design/methodology/approach

Intervention group 1 and intervention group 2 received motivational coaching to improve behavioral internalization. Intervention group 2 received additional volitional coaching to increase physical activity (PA)-related self-efficacy. The control group received only the vehicle-integrated fitness device to perform WPA, as did both intervention groups. Internalization and PA-related self-efficacy were collected four times. WPA was assessed weekly.

Findings

All 140 participating truck drivers were consistently physically active for an average of 85 min (SD = 85.2 min) during motivational coaching, 76 min (SD = 65.0 min) during volitional coaching and 71.0 min (SD = 63.5 min) during follow-up, with no differences found between groups. Variance analyses for repeated measures revealed no intervention effects on WPA, internalization and self-efficacy, and internalization and self-efficacy did not prove to be mediators of increased WPA.

Originality/value

The primary goal of increasing WPA of all participants was achieved, but the present form of coaching cannot be confirmed as a successful strategy. Nevertheless, the results are valuable and could be an impetus for further research on WPA promotion in truck drivers as the creation of an opportunity with the vehicle-integrated fitness device alone led to an increased WPA.

Workplace interventions for increasing physical activity in employees: A systematic review

Background

There is scattered evidence of the impact of workplace interventions in improving employees' physical activity. This systematic review was performed to evaluate the strategies of workplace interventions and their effectiveness, as reported in primary studies.

Method

Primary experimental trials, both randomized controlled trials (RCTs) and non‐RCTs, which examined interventions to increase healthy adult employees' physical activity were included in this review. Studies in English or Persian published between 2009 and 2019 with access to full text of resources were considered. Google Scholar, PubMed, Web of Science, Scopus and Cochrane Library, ProQuest (Thesis) and World Health Organization Clinical Trial Registration Databases and Persian databases such as SID, Magiran, IranMedex, Irandoc were searched. All the stages of review were conducted based on PRISMA. RoB and ROBINS‐I were used to assess the risk of bias of the primary studies.

Results

Thirty‐nine studies, with a total of 18 494 participants, met the inclusion criteria. Of these, 22 were RCTs, 17 were non‐RCTs. Effective interventions were reported in 15 RCTs and 14 non‐RCTs. Four main strategies of interventions were identified, consisting of motivation and support; monitoring and feedback; information and education; and activity. Thirteen different behavior change techniques (BCT) were identified with self‐determination theory (SDT) being the most frequent behavior change theory used.

Conclusion

It seems that a multi‐strategy intervention that one of the strategies of which is physical activity in the workplace (Activity), the use of behavioral change theories, especially SDT, may be indicative of a more effective intervention. It is recommended that BCTs be considered when designing physical activity interventions.

Activity space, office space: Measuring the spatial movement of office workers

A key to the development of more effective interventions to promote movement and reduce physical inactivity in office workplaces may be to measure and locate individual's spatial movement. Using an activity space estimation method, high resolution location data collected from 15 office workers over 12 days were used to estimate and analyse the location and extent of their daily spatial movement whilst in an office work-based setting. The results indicated that the method, kernel density estimation, combined with location data offers significant opportunities to not only measure and compare spatial movement behaviours but also simultaneously identify the locations where the behaviours occur. Combined with other data streams, this method will allow researchers to further investigate the influence of different environmental characteristics on these behaviours, potentially leading the development of more effective, longer lasting interventions to promote movement and reduce stationary behaviour, ultimately improving the health of office workers.

Cardioprotective effects of resistance training add to those of total activity in Americans

BACKGROUND

Resistance training is cardioprotective independent of total activity in experimental research and is prescribed to clinical populations, but is often largely neglected at population scale. Here we determine whether these benefits are relevant to general practice.

METHODS

A total of 6947 Americans over 20 years old (51% male) from NHANES 2003-2006 reported resistance training and objectively tracked 1-week total activity. Activity measures were modeled as five-level predictors of objectively measured binary heart-disease risks (hypertension, dyslipidemia, overweight, and diabetes) corrected for age, ethnicity, gender, and smoking. Significance was defined as Pfor trend less than .10 that the lowest activity category differed from the average of all others. If both activity measures predicted the same risk, mutually corrected models were run.

RESULTS

Average total activity was 20 minutes/day (SD 24). About 30% of subjects had resistance trained in the past month, reporting up to 7 sessions/day. Prevalences of hypertension, dyslipidemia, overweight, and diabetes were 32%, 46%, 68%, and 7.2%, respectively. All significant associations for resistance training (but not total activity) exhibited a threshold in dose-response curve, with comparable benefits from any dose above "none." Resistance trainers had significantly lower odds of hypertension (ORs, 0.55-0.85), overweight (ORs, 0.55-0.74), and diabetes (ORs, 0.51-0.80), but not dyslipidemia (ORs, 0.55-0.74). For total activity there was no significant trend in risk of either hypertension or dyslipidemia, but there were for overweight (ORs for each quintile above the lowest 1.04, 0.89, 0.78, and 0.49) and diabetes (ORs, 0.83, 0.68, 0.50, and 0.23; all Pfor trend <.01). Associations of resistance training with diabetes and obesity attenuated only slightly after correction for total activity, and vice versa.

CONCLUSIONS

Cardioprotective associations of resistance training were comparable to those of total activity and clinically relevant at low doses. Largest benefits accrued to those who combined any dose of resistance training with high total activity.

Effects of cycling workstation to get tertiary employee moving on their overall health: study protocol for a REMOVE trial

BACKGROUND

Sedentary behaviour (SB) and low levels of physical activity (PA) are predictors of morbidity and mortality. Tertiary employees spend a considerable amount of their daily time seated and new efficient strategies to both reduce sedentary time and increase physical activity are needed. In that context, the REMOVE study aims at evaluating the health effects of a 24-week cycling desk intervention among office workers.

METHODS

A prospective, open-label, multicentre, two-arm parallel, randomized controlled trial (RCT) will be conducted in office-sitting desk workers. Office workers (N = 80) who have 0.8 full time equivalent hours (FTE) and 75% of this time in a sitting position will be recruited from tertiary worksites in Clermont-Ferrand, France. Subjects will be randomly assigned to one of the two following interventions: (i) PPM6: performance of two 30 min of cycling desk (using portable pedal exercise machine-PPM) per working day for 6 months or (ii) CTL_PPM3: 3 months with no intervention (control) followed by 3 months during which workers will be asked to complete two 30 min of PPM per working day. At baseline (T0), at 3 months (T1) and at 6 months (T2) after the start of the interventions, primary outcomes; 7-day PA and SB (3D-accelerometers), secondary outcomes; body composition (bioelectrical impedance), physical fitness (aerobic fitness, upper and lower limb strength), metabolic outcomes (fasting blood samples), self-perceived stress, anxiety, quality of life at work and job strain (questionnaires), tertiary outcomes; resting metabolic rate and cycling energy expenditure (indirect calorimetry) and eating behaviours (questionnaires) will be measured. An ergonomic approach based on observations and individual interviews will be used to identify parameters that could determine adherence.

DISCUSSION

The REMOVE study will be the first RCT to assess the effects of cycling workstations on objectively measured PA and SB during working and non-working hours and on key physiological and psychological health outcomes. This study will provide important information regarding the implementation of such cycling workstations in office workers and on the associated potential health benefits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04153214 . Registered on November 2019, version 1.

Interventions to promote work ability by increasing physical activity among workers with physically strenuous jobs: A scoping review

Aims: The potential benefits of workplace physical activity (PA) interventions are in improving both health and important workplace outcomes. Despite the differences in PA level between physically strenuous and inactive work, the literature reporting the effectiveness of the interventions does not usually differentiate physically active and inactive jobs. The aim of the current study was therefore to collect and synthesise research evidence on workplace PA interventions to promote work ability specifically among workers in physically strenuous jobs by means of a scoping review. Methods: The databases Medline, Cochrane Central and Scopus were used to identify interventions to promote work ability by increasing PA among workers in physically strenuous jobs. An iterative method was used to obtain an overview of the study elements and to extract details on the study design, sample, intervention, outcomes and effectiveness. Results: A total of 47 studies evaluating eight categories of interventions were found. Out of these, 18 reported significant effects on work ability. Positive results came from a range of different interventions, including aerobic exercise, strength training, combined aerobic exercise and strength training, stretching, yoga, consultation and tailored physical exercise programmes. Conclusions: Few interventions were effective in promoting work ability by increasing PA among workers in physically strenuous jobs. In particular, trials based on the demands of work, multimodal interventions and applying wearable technology are needed.

Organizational and Individual Outcomes of Health Promotion Strategies-A Review of Empirical Research

The main purpose of the paper is to identify the outcomes for employers and employees indicated in research related to workplace health promotion interventions (WHPIs). We investigated what methods are used and what types of organization this type of research is most often carried out in. In addition, the authors attempted to assess to what extent the methods used in the previous research prove the effectiveness of the implemented WHPIs. A systematic review of English-language papers (2000–2020) focused on types of health-promoting interventions in the workplace, and outcomes for employers and employees were conducted using the SCOPUS database (n = 260). As a result, 29 texts qualified for a final qualitative synthesis of the results. The analyses were most frequently conducted in small and medium-sized enterprises (SMEs) based on both quantitative and qualitative methods. In order to draw conclusions, analyses were made by classifying the research presented in the texts according to the type of intervention implemented, classifying the outcomes identified, and indicating the type of evaluation made by the researcher. The analysis showed that most of the outcomes presented refer to changes in the strategy and organizational culture, as well as the behavior of employees. In 18 studies, the indication of outcomes resulted directly from the evaluation outcomes. In other cases, the outcomes were identified by an evaluation of the process or structure of WHPI. The conducted analysis showed significant diversity in terms of the outcomes measured and the research methods used. The quasi-experimental methods, randomly controlled cluster trials, or cross-sectorial studies used in the study to confirm the effectiveness of WHPI were used only in every third study. In these studies, measurements were usually performed twice: at baseline and after intervention. The majority of studies confirmed that WHPIs led to a positive change in the healthy behavior of employees and effected an organizational change, and more rarely led to savings or a reduction in costs resulting from sickness absenteeism, presentism, turnover, etc., and return on investment (ROI). The article shows the need to conduct further research towards the development of guidelines for the evaluation of the effectiveness of implemented programs.

Resemblance in accelerometer-assessed physical activity in families with children: the Lolland-Falster Health Study

Background

Evidence of intra-family resemblance in physical activity (PA) is lacking. The association between parent and child PA appears weak, the influence of age and gender on this association is uncertain, and no studies have investigated the degree of resemblance in family members’ PA behaviours such as walking, sitting/lying, and biking. Thus, the aims of the study were to examine the degree of resemblance in PA within families, specifically between parents and children, and to explore the size of resemblance across age of children, gender of parents and children, and intensity and type of PA.

Method

The study is a cross-sectional analysis of a subsample (902 parents and 935 children nested within 605 families) of the Danish population study Lolland-Falster Health Study. PA was measured using a dual-accelerometer system (Axivity AX3) with subsequent processing of time spent in light PA (LPA), moderate-to-vigorous PA (MVPA), and vigorous PA and classification of PA behaviour types. Families with at least one son/daughter aged 0–22 years and one parent providing minimum 4 days of valid accelerometer data were included in the analysis. A linear mixed model regression analysis was used to determine the intraclass correlation coefficient (ICC) of clustering among family members for PA intensities and PA behaviours, adjusted for sex, age, parental education, and the interaction between sex and age.

Results

In the analysis of within-family variation in PA, the ICCs across PA intensities and PA behaviours ranged from 0.06 to 0.34. We found stronger clustering in family members’ PA for LPA and behaviours requiring low energy expenditure (LPA: ICC 0.22 (95% confidence interval (CI) 0.17; 0.28), sitting/lying: ICC 0.34 (95% CI 0.28; 0.40)), and walking: ICC 0.24 (95% CI 0.19; 0.30) than for higher intensities (e.g. MVPA: ICC 0.07 (95% CI 0.03; 0.14)). The ICC for biking was 0.23 (95% CI 0.18; 0.29). Analyses on parent-child dyads gave similar results. No interaction effects for gender and age (except for biking) were found.

Conclusion

Parents and children’s time spent in PA behaviours requiring low energy expenditure had moderate resemblance within families, whereas engagement in PA with higher intensities showed small or close-to-zero resemblance.

Feasibility and Process Evaluation of a Need-Supportive Physical Activity Program in Aged Care Workers: The Activity for Well-Being Project

The need to undertake pilot testing and evaluation of novel health promotion programs has become increasingly apparent for the purpose of understanding the true effects of complex interventions and for testing and refining behavioral theories that these interventions are informed by. A mixed-methods process evaluation and feasibility study was undertaken for a need-supportive physical activity program that was piloted in a single-group pre–post study. The piloted program was designed to support participant needs of autonomy, competence, and relatedness through evidence-based and theory-informed behavior change strategies including a motivational interviewing style appointment, education on self-management tools (i.e., pedometers, goal setting, action and coping planning, a customized website for goal setting and self-monitoring), and self-determined methods of regulating physical activity intensity [affect, rating of perceived exertion (RPE), and self-pacing]. The program aimed to positively impact physical activity behavior, psychological well-being, and associated motivational processes. Reach, adoption, fidelity, context, change and performance objectives, and feasibility of the program were evaluated using information from survey respondents from the target population (n = 118) and implementing staff (n = 6); questionnaires from pilot study participants (n = 21); and individual semi-structured interviews with a combination of pilot study participants, non-participants, and implementing staff (n = 19). Process evaluation of the Activity for Well-Being program found that the reach of the program was moderate but adoption was low. The use of self-management tools and self-determined methods of regulating physical activity intensity appeared to be feasible. The website had mixed responses and low engagement. The element of having a support person elicited a strong positive response in the program participant interviews. Involving local implementing staff more directly into the delivery of the intervention could have potentially improved reach, adoption, and feasibility of the program.

Effects of Workplace-Based Physical Activity Interventions on Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis of Controlled Trials

BACKGROUND

Cardiorespiratory fitness is a strong predictor of all-cause mortality. Physical activity of at least moderate intensity can improve cardiorespiratory fitness. Workplaces may provide a relatively controlled setting in which to improve cardiorespiratory fitness through physical activity. Limited work has been conducted to quantify the impact of delivering physical activity in the workplace on cardiorespiratory fitness.

OBJECTIVE

The objective of this systematic review was to quantify the effects of workplace physical activity interventions on peak oxygen consumption (VO_2peak) and explore study and participant characteristics as putative moderators.

METHODS

Seven databases were searched up to September 2018. Search terms included "workplace", "physical activity" and "intervention". Inclusion criteria were controlled trials where physical activity of at least moderate intensity was delivered in the workplace and compared to controls or non-active comparators; and cardiorespiratory fitness measured by actual or predicted VO_2peak. Risk of bias was assessed using the PEDro scale. A random-effects meta-analysis was conducted with between-study variation quantified and then explored for putative predictors with a meta-regression. Pooled estimate uncertainty was expressed as 90% confidence intervals (CIs) and assessed against our threshold value for clinical relevance of 1 mL·kg^-1·min^-1.

RESULTS

The final dataset consisted of 25 estimates of VO_2peak from 12 trials. The pooled mean differences between intervention and control arms was a beneficial improvement of 2.7 mL·kg^-1·min^-1 (90% CI 1.6-3.8). The 95% prediction interval ranged from a reduction in VO_2peak of - 1.1 to an improvement of 6.5 mL·kg^-1·min^-1. Between-study heterogeneity (τau) was ± 1.6 mL·kg^-1·min^-1. The meta-regression showed longer interventions (3.2 mL·kg^-1·min^-1; 90% CI 1.6-3.8) to have an additive effect and studies with a low risk of bias (- 2.5 mL·kg^-1·min^-1; 90% CI - 4.0 to - 1.0), and participants of greater baseline VO_2peak (- 1.6 mL·kg^-1·min^-1; 90% CI - 3.6 to 0.4), and age (- 1.4 mL·kg^-1·min^-1; 90% CI - 3.2 to 0.3) having a lesser effect. Participant sex (percentage female) had an additive effect on VO_2peak (0.4 mL·kg^-1·min^-1; 90% CI - 1.6 to 2.4).

CONCLUSIONS

Workplace-based physical activity interventions consisting of at least moderate-intensity activity improve cardiorespiratory fitness. At the present time, we surmise that no single group of employees (e.g. older employees or less fit individuals) can be definitively identified as standing to benefit more from workplace physical activity interventions than others. This demonstrates the potential utility of workplace physical activity interventions for improving cardiorespiratory fitness in a broad range of healthy employees. Protocol registration: PROSPERO (registration number: 42017057498).

Efficacy of theory-informed workplace physical activity interventions: a systematic literature review with meta-analyses

This review aimed to assess the efficacy of workplace physical activity interventions; compare the efficacy of those that were and were not informed by behaviour change theory, and outline the effectiveness of different intervention components. A search was undertaken in Medline, Embase, PsycINFO, Ovid Emcare (previously CINAHL) and SportDiscus. Randomised, non-randomised and cluster-controlled trials with objectively measured physical activity and/or measured or predicted maximal oxygen uptake (VO_2max) as outcomes were included in the review (83 papers from 79 trials). Random-effects meta-analyses of mean differences were undertaken. Workplace physical activity programmes demonstrated positive overall intervention effects for daily step counts (814.01 steps/day; CI: 446.36, 1181.67; p < 0.01; i² = 88%) and measured VO_2max (2.53 ml kg^-1 min^-1; CI: 1.69, 3.36; p < 0.01; i² = 0%) with no sub-group differences between theory- and non-theory informed interventions. Significant sub-group differences were present for predicted VO_2max (p < 0.01), with a positive intervention effect for non-theory informed studies (2.11 ml.kg^-1 min^-1; CI: 1.20, 3.02; p < 0.01; i² = 78%) but not theory-informed studies (-0.63 ml kg^-1 min^-1; CI: -1.55, 0.30; p = 0.18; i² = 0%). Longer-term follow-ups ranged from 24 weeks to 13 years, with significant positive effects for measured VO_2max (2.84 ml kg^-1 min^-1; CI: 1.41, 4.27; p < 0.01; i² = 0%). Effective intervention components included the combination of self-monitoring with a goal, and exercise sessions onsite or nearby. The findings of this review were limited by the number and quality of theory-informed studies presenting some outcomes, and confounding issues in complex interventions. Future researchers should consider rigorous testing of outcomes of theory-informed workplace physical activity interventions and incorporate longer follow-ups.

Health and Fitness Benefits But Low Adherence Rate: Effect of a 10-Month Onsite Physical Activity Program Among Tertiary Employees

OBJECTIVE

The aim of this study was to assess the effects of a 10-month structured physical activity intervention implemented within the workplace on overall health indicators among tertiary (office workers) employees.

METHODS

In this quasi-experimental study, 224 employees followed a 10-month worksite physical activity program. Overall health was assessed at baseline, after 5 months, and by the end of the intervention.

RESULTS

Fat mass percentage decreased significantly. There was a time effect favoring push-ups, abdominal strength, flexibility, heart rate postexercise, heart rate +30 seconds, and heart rate +60 seconds postexercise. Anxiety, depression, and eating habits also improved. In total, 45% of participants completed the whole intervention.

CONCLUSION

Although a structured on-site physical activity program supports improved health indicators, adherence remains a concern and requires specialists to develop new strategies.

A loyalty scheme to encourage physical activity in office workers: a cluster RCT

Background

Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions.

Objectives

To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day.

Design

A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.

Setting

Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland.

Participants

A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group.

Intervention

The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.

Main outcome measures

The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources.

Results

The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008).

Limitations

Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.

Conclusions

Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.

Trial registration

Current Controlled Trials ISRCTN17975376.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.

A workplace-based intervention to increase levels of daily physical activity: the Travel to Work cluster RCT

Background

There may be opportunities for working adults to accumulate recommended physical activity levels (≥ 150 minutes of moderate-intensity physical activity in bouts of ≥ 10 minutes throughout the week) during the commute to work. Systematic reviews of interventions to increase active transport indicate that studies are predominantly of poor quality, rely on self-report and lack robust statistical analyses.

Objectives

To assess the effectiveness, cost and consequences of a behavioural intervention to increase walking during the commute to work.

Design

A multicentre, parallel-arm, cluster randomised controlled trial incorporating economic and process evaluations. Physical activity outcomes were measured using accelerometers and GPS (Global Positioning System) receivers at baseline and the 12-month follow-up.

Setting

Workplaces in seven urban areas in south-west England and south Wales.

Participants

Employees (n = 654) in 87 workplaces.

Interventions

Workplace-based Walk to Work promoters were trained to implement a 10-week intervention incorporating key behaviour change techniques.

Main outcome measures

The primary outcome was the daily number of minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes included MVPA during the commute, overall levels of physical activity and modal shift (from private car to walking). Cost–consequences analysis included employer, employee and health service costs and consequences. Process outcomes included barriers to, and facilitators of, walking during the daily commute.

Results

There was no evidence of an intervention effect on MVPA at the 12-month follow-up [adjusted difference in means 0.3 minutes, 95% confidence interval (CI) –5.3 to 5.9 minutes]. The intervention cost was on average, £181.97 per workplace and £24.19 per participating employee. In comparison with car users [mean 7.3 minutes, standard deviation (SD) 7.6 minutes], walkers (mean 34.3 minutes, SD 18.6 minutes) and public transport users (mean 25.7 minutes, SD 14.0 minutes) accrued substantially higher levels of daily MVPA during the commute. Participants who walked for ≥ 10 minutes during their commute were more likely to have a shorter commute distance (p < 0.001). No access to a car (p < 0.001) and absence of free workplace car parking (p < 0.01) were independently related to walking to work and using public transport. Higher quality-of-life scores were observed for the intervention group in a repeated-measures analysis (mean 0.018, 95% CI 0.000 to 0.036; scores anchored at 0 indicated ‘no capability’ and scores anchored at 1 indicated ‘full capability’).

Conclusions

Although this research showed that walking to work and using public transport are important contributors to physical activity levels in a working population, the behavioural intervention was insufficient to change travel behaviour. Broader contextual factors, such as length of journey, commuting options and availability of car parking, may influence the effectiveness of behavioural interventions to change travel behaviour. Further analyses of statistical and qualitative data could focus on physical activity and travel mode and the wider determinants of workplace travel behaviour.

Trial registration

Current Controlled Trials ISRCTN15009100.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 11. See the NIHR Journals Library website for further project information. Living Streets, a UK charity promoting everyday walking, provided funding for the intervention booklets and free pedometers for distribution to participants in the intervention group.

Evaluation of an intervention to promote walking during the commute to work: a cluster randomised controlled trial

Background

Opportunities for working adults to accumulate recommended physical activity levels (at least 150 min of moderate intensity physical activity in bouts of at least 10 min throughout the week) may include the commute to work. Systematic reviews of interventions to increase active transport suggest studies have tended to be of poor quality, relying on self-report and lacking robust statistical analyses.

Methods

We conducted a multi-centre parallel-arm cluster randomised controlled trial, in workplaces in south-west England and south Wales, to assess the effectiveness of a behavioural intervention to increase walking during the commute. Workplace-based Walk to Work promoters were trained to implement a 10-week intervention incorporating key behavioural change techniques: providing information; encouraging intention formation; identifying barriers and solutions; goal setting; self-monitoring; providing general encouragement; identifying social support; reviewing goals, and; relapse prevention. Physical activity outcomes were objectively measured using accelerometers and GPS receivers at baseline and 12-month follow-up. The primary outcome was daily minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes included overall levels of physical activity and modal shift (from private car to walking). Cost-consequences analysis included employer, employee and health service costs and outcomes.

Results

Six hundred fifty-four participants were recruited across 87 workplaces: 10 micro (5–9 employees); 35 small (10–49); 22 medium (50–250); 20 large (250+). The majority of participants lived more than two kilometres from their place of work (89%) and travelled to work by car (65%). At 12-month follow-up, 84 workplaces (41 intervention, 43 control) and 477 employees (73% of those originally recruited) took part in data collection activities. There was no evidence of an intervention effect on MVPA or overall physical activity at 12-month follow-up. The intervention cost on average £181.97 per workplace and £24.19 per participating employee.

Conclusions

The intervention, focusing primarily on individual behaviour change, was insufficient to change travel behaviour. Our findings contribute to the argument that attention should be directed towards a whole systems approach, focusing on interactions between the correlates of travel behaviour.

Trial registration

ISRCTN15009100. Prospectively registered. (Date assigned: 10/12/2014).

Increasing Employees' Health by Workplace Physical Activity Counseling: The Mediating Role of Step-Based Physical Activity Behavior Change

BACKGROUND

This study evaluated the effects of a 3-month workplace physical activity (PA) intervention on employees' health-related fitness and well-being. Moreover, mediational pathways were examined.

METHODS

A longitudinal, quasi-experimental trial was evaluated in Belgian employees. The intervention group (IG: n = 246) received 3-months individualized, tailored PA counseling, consisting of face-to-face counseling and follow-up e-mail and telephone contacts. The reference group (n = 54) received no PA counseling. Outcome measures (assessed at baseline, 3 mo [short term], and 9 mo [long term]) included body composition, cardiorespiratory fitness, well-being, and step-based PA.

RESULTS

With no changes in the reference group, the IG showed short-term improvements in body mass index (-0.24 kg/m², P < .001), body fat (-0.88%, P < .001), waist circumference (-1.47 cm, P < .001), and muscle percentage (+0.47%, P < .001). Moreover, with respect to cardiorespiratory fitness, IG participants improved on perceived exertion, both in the short term (-0.91, P < .001) and long term (-0.83, P < .001). Furthermore, perceived physical well-being increased in the IG, both in the short term (+0.57, P < .001) and long term (+0.57, P < .001). The observed intervention effects on body composition, perceived exertion, and well-being were mediated by (increases in) step-based PA.

CONCLUSIONS

Workplace PA counseling programs have the potential to enhance employees' health-related fitness and well-being. Importantly, step-based PA behavior change was found to contribute to the postintervention improvements.

Effect of Work-Related Sedentary Time on Overall Health Profile in Active vs. Inactive Office Workers

Objective: While public health strategies are developed to fight sedentary behaviors and promote physical activity, some professional activities, and especially tertiary ones, have been pointed out for their highly sedentary nature. Although workplace physical activity programs are increasingly proposed by companies to their employees in order to increase their physical activity levels, sitting and screen time remain extremely high. The main aim of this work was to compare health indicators between active and inactive tertiary employees with similar high levels of sedentariness. Secondly, we questioned the effects of a 5-month workplace physical activity program on overall health indicators among initially active and inactive tertiary employees.

Methods: Anthropometric measurements, body composition (bio-impedance), physical fitness (cardiorespiratory and musculoskeletal fitness) and health-related quality of life and perception of health status (self-reported questionnaires) were assessed among 193 active and inactive tertiary employees before (T0) and after a 5-month workplace physical activity intervention (T1), composed of 2 physical sessions per week.

Results: Significant improvements were found in performance of push-ups (p < 0.001), back muscle strength (p < 0.001) fat mass (p < 0.01) and waist circumference (p < 0.05) in active compared with inactive employees both at baseline and at the end of the program. Health perception (p < 0.001) was significantly different between groups at T0 but not at T1. However, no significant difference was observed for fat-free mass, BMI, workplace well-being and lower and upper limbs muscle strength. The variations between T0 and T1 demonstrate that, while all the studied parameters progressed positively during the 5-month program, health perception (p < 0.001), back muscle strength (p < 0.05) and BMI (tendency) showed a significantly higher progression in the inactive compared with the active group.

Conclusion: Health indicators might not be improved among active tertiary employees compared with inactive ones, which might be due to the high level of sedentariness characterizing their occupational task.Structured on-site physical activity programs can improve health in both initially active and inactive employees.

Employees' adherence to worksite physical activity programs: Profiles of compliers versus non-compliers

While worldwide public health policies have emphasized the necessity to create a culture that favors regular physical activity, stakeholders and health institutions keep looking for new strategies and opportune settings. Workplaces have been identified since employees spent a considerable part of their time at work and several worksite interventions have been developed lately. While the actual scientific literature clearly points out the beneficial effects of physical activity programs implemented within companies on employees overall health, available evidences however seem to question their adherence to such interventions. Based on previously published results and new observations, this paper discusses the adherence rate during workplace physical activity programs and suggests new strategies to favor increased physical activity among employees, considering their dropouters or finishers' profiles.

Changes in Physical Activity Behaviour and Health Risk Factors Following a Randomised Controlled Pilot Workplace Exercise Intervention

Background

Declining physical activity (PA) and associated health risk factors are well established. Workplace strategies to increase PA may be beneficial to ameliorate extensive sedentary behavior. This study assessed the effectiveness of two PA interventions in workplace settings.

Methods

Interventions were conducted over 40 days targeting insufficiently active (<150 min/wk PA) and/or obese (BMI ≥ 30 kg/m²) adults; participants were randomly allocated to instructor-led exercise sessions either after-work (n = 25) or in-work (n = 23) with a 60 minPA/day common goal, or a wait-listed control group (n = 23). The programme commenced with low-moderate physical activities and progressed to high intensity game style activities by week six. Adherence and compliance were determined using both objective measures of daily PA time from HR monitors and self-report responses to PA questionnaires. Cardiovascular and metabolic risk factors were measured pre- and post-intervention. Changes across the study were analysed using Chi square and repeat-measures ANOVA.

Results

Adherence rates (completed pre and post-testing) were not different between groups (76.0 vs 65.2%). Compliance for the instructor-led sessions was higher for the after-work group (70.4% vs 26.4%, respectively). Increased total PA and aerobic fitness, and decreased weight in both intervention groups were found relative to controls. The after-work group undertook more vigorous PA, and had greater weight loss and fasting blood glucose improvement, relative to in-work participants and controls.

Conclusions

These workplace interventions resulted in rapid and dramatic increases in PA behaviour and important health benefits. Short, in-work PA sessions were less efficacious than longer after-work sessions.

Effect of a 5-Month Worksite Physical Activity Program on Tertiary Employees Overall Health and Fitness

OBJECTIVE

This pilot study questions the effects of a worksite physical activity program on health and fitness in tertiary employees.

METHODS

Ninety-five employees were randomly assigned to Control (CON); Novice (NOV); Experienced group (EXP). The NOV and EXP groups followed a 5-month worksite physical activity program (at least two sessions/week). Body composition, physical activity level and physical fitness, eating habits, health perception, sleep quality, pain, and quality of life were assessed.

RESULTS

Fat mass decreased in NOV and EXP; the distance covered during the 6-minute walking test, push-ups, squat jump increased for NOV and EXP group. Physical activity level, health perception, quality of sleep, and eating habits were improved in NOV.

CONCLUSION

This study underlines for the first time the beneficial effects of such worksite programs among tertiary employees on overall health and the feasibility of its design.

The Effect of a Leisure Time Physical Activity Intervention Delivered via a Workplace: 15-Month Follow-Up Study

In line with recommendations from both the World Health Organization and the European Union some employers encourage workplace health promotion through physical activity (PA) facilities and leisure time PA-initiatives. The current study describes a 15-month follow-up after an 8-week workplace delivered PA-initiative, investigates if improvements in cardiovascular risk status are sustainable, and elucidates differences according to educational level. One hundred and twenty one employees (43 women) were examined before and after the 8-week PA-initiative and 94 at the 15-month follow-up. PA-levels, blood pressure, resting heart rate, lipids, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and selected markers of inflammation were registered at baseline, immediately after the 8-week PA-initiative, and 15 months after baseline. At the end of follow-up (15-month), PA-levels—increased during the 8-week intervention—had returned to baseline values. None of the five improvements in cardiovascular markers (total cholesterol, low density lipoprotein (LDL), P-selectin, CD40Ligand (CD40L) and Monocyte chemoattractant protein-1 (MCP-1)) seen at the 8-week follow-up were sustained. At the 15-month follow-up as compared to baseline HbA1c, CRP (log) and interleukin-6 (IL-6) were reduced by 0.06 mmol/L (95% CI −0.11,−0.01), 0.25 mg/L (95% CI −0.46,−0.04) and 0.39 pg/mL (95% CI −0.75, −0.04), respectively. At baseline, there were differences in cardiovascular risk factors comparing men with low versus high levels of education. No differences in changes in outcomes between these groups of men were found during follow-up. In this study highly educated men generally have lower levels of cardiovascular risk factors, but the effect of PA on such markers in this group do not differ from the effects seen in less educated men.

Development, Implementation, and Evaluation of Active Lions: A Campaign to Promote Active Travel to a University Campus

PURPOSE

To outline the development, implementation, and evaluation of a multistrategy intervention to promote active transportation, on a large university campus.

DESIGN

Single group pilot study.

SETTING

A large university in the Northeastern United States.

PARTICIPANTS

University students (n = 563), faculty and staff (employees, n = 999) were included in the study.

INTERVENTION

The Active Lions campaign aimed to increase active transportation to campus for all students and employees. The campaign targeted active transport participation through the development of a smartphone application and the implementation of supporting social marketing and social media components.

MEASURES

Component-specific measures included app user statistics, social media engagement, and reach of social marketing strategies. Overall evaluation included cross-sectional online surveys preintervention and postintervention of student and employee travel patterns and campaign awareness.

ANALYSIS

Number of active trips to campus were summed, and the percentage of trips as active was calculated. T tests compared the differences in outcomes from preintervention to postintervention.

RESULTS

Students had a higher percentage of active trips postintervention (64.2%) than preintervention (49.2%; t = 3.32, P = .001), although there were no differences for employees (7.9% and 8.91%). Greater awareness of Active Lions was associated with greater active travel.

CONCLUSION

This multistrategy approach to increase active transportation on a college campus provided insight on the process of developing and implementing a campaign with the potential for impacting health behaviors among campus members.

Dietary interventions to prevent and manage diabetes in worksite settings: a meta-analysis

OBJECTIVES

The translation of lifestyle intervention to improve glucose tolerance into the workplace has been rare. The objective of this meta-analysis is to summarize the evidence for the effectiveness of dietary interventions in worksite settings on lowering blood sugar levels.

METHODS

We searched for studies in PubMed, Embase, Econlit, Ovid, Cochrane, Web of Science, and Cumulative Index to Nursing and Allied Health Literature. Search terms were as follows: (1) Exposure-based: nutrition/diet/dietary intervention/health promotion/primary prevention/health behavior/health education/food /program evaluation; (2) Outcome-based: diabetes/hyperglycemia/glucose/HbA1c/glycated hemoglobin; and (3) Setting-based: workplace/worksite/occupational/industry/job/employee. We manually searched review articles and reference lists of articles identified from 1969 to December 2016. We tested for between-studies heterogeneity and calculated the pooled effect sizes for changes in HbA1c (%) and fasting glucose (mg/dl) using random effect models for meta-analysis in 2016.

RESULTS

A total of 17 articles out of 1663 initially selected articles were included in the meta-analysis. With a random-effects model, worksite dietary interventions led to a pooled -0.18% (95% CI, -0.29 to -0.06; P<0.001) difference in HbA1c. With the random-effects model, the interventions resulted in 2.60 mg/dl lower fasting glucose with borderline significance (95% CI: -5.27 to 0.08, P=0.06). In the multivariate meta-regression model, the interventions with high percent of female participants and that used the intervention directly delivered to individuals, rather the environment changes, were associated with more effective interventions.

CONCLUSION

Workplace dietary interventions can improve HbA1c. The effects were larger for the interventions with greater number of female participants and with individual-level interventions.

Evaluation of the implementation of a whole-workplace walking programme using the RE-AIM framework

BACKGROUND

Promoting walking for the journey to/from work and during the working day is one potential approach to increase physical activity in adults. Walking Works was a practice-led, whole-workplace walking programme delivered by employees (walking champions). This study aimed to evaluate the implementation of Walking Works using the RE-AIM framework and provide recommendations for future delivery of whole-workplace walking programmes.

METHODS

Two cross sectional surveys were conducted; 1544 (28%) employees completed the baseline survey and 918 employees (21%) completed the follow-up survey. Effectiveness was assessed using baseline and follow-up data; reach, implementation and maintenance were assessed using follow-up data only. For categorical data, Chi square tests were conducted to assess differences between surveys or groups. Continuous data were analysed to test for significant differences using a Mann-Whitney U test. Telephone interviews were conducted with the lead organisation co-ordinator, eight walking champions and three business representatives at follow-up. Interviews were transcribed verbatim and analysed to identify key themes related to adoption, implementation and maintenance.

RESULTS

Adoption: Five workplaces participated in Walking Works. Reach: 480 (52.3%) employees were aware of activities and 221 (24.1%) participated.

IMPLEMENTATION

A variety of walking activities were delivered. Some programme components were not delivered as planned which was partly due to barriers in using walking champions to deliver activities. These included the walking champions' capacity, skills, support needs, ability to engage senior management, and the number and type of activities they could deliver. Other barriers included lack of management support, difficulties communicating information about activities and challenges embedding the programme into normal business activities. Effectiveness: No significant changes in walking to/from work or walking during the working day were observed. Maintenance: Plans to continue activities were mainly dependent on identifying continued funding.

CONCLUSIONS

RE-AIM provided a useful framework for evaluating Walking Works. No changes in walking behaviour were observed. This may have been due to barriers in using walking champions to deliver activities, programme components not being delivered as intended, the types of activities delivered, or lack of awareness and participation by employees. Recommendations are provided for researchers and practitioners implementing future whole-workplace walking programmes.

Green exercise as a workplace intervention to reduce job stress. Results from a pilot study

BACKGROUND

Stress and mental fatigue are major health threats to employees in office-based occupations. Physical activity is widely used as a stress-management intervention for employees. Moreover, experiences in contact with nature have been shown to provide stress-reduction and restoration from mental fatigue.

OBJECTIVES

In a pilot study designed as a randomized controlled trial we investigated the impact of a green-exercise intervention on psychological and physiological indicators of stress in municipality employees.

METHODS

Fourteen employees (7 females and 7 males, 49±8 yrs) volunteered in an exercise-based intervention in workplace either outdoors in a green/nature area or in an indoor exercise-setting. The intervention consisted of an information meeting and two exercise sessions, each including a biking bout and a circuit-strength sequence using elastic rubber bands (45-minutes, at about 55% of HR reserve, overall). Main outcomes were perceived environmental potential for restoration, affective state, blood pressure (BP) and cortisol awakening response (CAR AUC(G) and CAR AUC(I)) and cortisol levels in serum. Measurements were taken at baseline and in concomitance with the exercise sessions. Furthermore, affective state and self-reported physical activity levels were measured over a 10-weeks follow-up period.

RESULTS

Compared with the indoor group, the nature group reported higher environmental potential for restoration (p <  0.001) and Positive Affect (p <  0.01), along with improved CAR AUC(I) (p = 0.04) and, marginally, diastolic BP (p = 0.05). The nature group also reported higher ratings of Positive Affect at follow-up (p = 0.02). Differences at post-exercise were not found for any of the other components of affective state, systolic BP, CAR AUC(G) and cortisol levels measured in serum.

CONCLUSIONS

Green-exercise at the workplace could be a profitable way to manage stress and induce restoration among employees. Further studies on larger samples are needed in order to improve the generalizability of the results.

A Systematic Review of Interventions to Increase Stair Use

CONTEXT

Stair climbing is an accessible activity that can be incorporated into one's daily lifestyle to increase physical activity levels and provide health benefits. This review summarizes the effectiveness of stair interventions and explores key differences that may influence intervention effectiveness.

EVIDENCE ACQUISITION

Interventions to increase stair use published from January 1990 to July 2015 were identified in PubMed, Sport Discus, Web of Science, Environment Complete, CINAHL, Trial Register of Promoting Health Interventions, Embase, Scopus, and PsycINFO. Eligibility criteria included original studies, published in peer-reviewed journals, targeting adult samples, and clearly describing intervention design and results. Studies were also required to measure the use of stairs compared with an elevator, escalator, or moving stairway at baseline and during at least one timepoint when the intervention was in effect. Studies were required to provide data to determine if the intervention resulted in significant changes in stair use/climbing.

EVIDENCE SYNTHESIS

The search results yielded 2,136 articles in total; 54 articles met the criteria, which resulted in a final sample of 67 studies included in the analyses. Interventions settings included public sites (75%), worksites (21%), or a combination of both (4%). For Phase 1 results, 72% of studies reported significant improvements in stair use (n=10 of 14) and stair climbing (n=38 of 53).

CONCLUSIONS

Evidence from the review demonstrates support for the effectiveness of interventions to increase stair use and stair climbing. Although evidence supports the effectiveness of stair interventions in public settings, less support is provided for worksites.

A workplace intervention designed to interrupt prolonged occupational sitting

Purpose

– The purpose of this paper is to investigate the effectiveness of a workplace intervention designed to interrupt prolonged occupational sitting time (POST) and its impact on the self-reported health of a cohort of desk-based employees.

Design/methodology/approach

– In total, 43 participants received an interactive computer-based software intervention for 26 weeks. For the first 13 weeks the intervention passively prompted the participants to interrupt POST and perform brief bouts of non-purposeful movement. The second 13 weeks involved the passivity of the intervention being removed, with the intervention only accessible voluntarily by the participant. This approach was adopted to determine the sustainability of the intervention to change workplace health behaviour.

Findings

– ANOVA results revealed a significant interaction between group and test occasion, F(2, 42)=2.79, p < 0.05, such that the experimental group increased their total health from pre-test to post-test (13 weeks), and to second post-test (26 weeks) with a medium effect size of Cohen’s d=0.37.

Research limitations/implications

– An action research approach was implemented for this study, and hence the participants were organised into one group. Based on a communitarian model, the intervention aimed to monitor how desk-based employees adapted to specific health behaviours, and therefore a control group was not included.

Practical implications

– Passively prompting desk-based employees to interrupt POST and perform non-purposeful movement at work improved self-reported health. Participant perceptions of health were maintained following the removal of the passive feature of the intervention.

Social implications

– Interventions predicated on a social ecological model that modify how employees interact with the workplace environment might provide a framework for health behaviour change in populations where sitting is customary.

Originality/value

– The passive approach used in this study removed the individual decision-making process to engage in health behaviour change, and established a sustainable effect on participant health.

Organizational-Level Strategies With or Without an Activity Tracker to Reduce Office Workers' Sitting Time: Rationale and Study Design of a Pilot Cluster-Randomized Trial

Background

The office workplace is a key setting in which to address excessive sitting time and inadequate physical activity. One major influence on workplace sitting is the organizational environment. However, the impact of organizational-level strategies on individual level activity change is unknown. Further, the emergence of sophisticated, consumer-targeted wearable activity trackers that facilitate real-time self-monitoring of activity, may be a useful adjunct to support organizational-level strategies, but to date have received little evaluation in this workplace setting.

Objective

The aim of this study is to evaluate the feasibility, acceptability, and effectiveness of organizational-level strategies with or without an activity tracker on sitting, standing, and stepping in office workers in the short (3 months, primary aim) and long-term (12 months, secondary aim).

Methods

This study is a pilot, cluster-randomized trial (with work teams as the unit of clustering) of two interventions in office workers: organizational-level support strategies (eg, visible management support, emails) or organizational-level strategies plus the use of a waist-worn activity tracker (the LUMOback) that enables self-monitoring of sitting, standing, and stepping time and enables users to set sitting and posture alerts. The key intervention message is to ‘Stand Up, Sit Less, and Move More.’ Intervention elements will be implemented from within the organization by the Head of Workplace Wellbeing. Participants will be recruited via email and enrolled face-to-face. Assessments will occur at baseline, 3, and 12 months. Time spent sitting, sitting in prolonged (≥30 minute) bouts, standing, and stepping during work hours and across the day will be measured with activPAL3 activity monitors (7 days, 24 hours/day protocol), with total sitting time and sitting time during work hours the primary outcomes. Web-based questionnaires, LUMOback recorded data, telephone interviews, and focus groups will measure the feasibility and acceptability of both interventions and potential predictors of behavior change.

Results

Baseline and follow-up data collection has finished. Results are expected in 2016.

Conclusions

This pilot, cluster-randomized trial will evaluate the feasibility, acceptability, and effectiveness of two interventions targeting reductions in sitting and increases in standing and stepping in office workers. Few studies have evaluated these intervention strategies and this study has the potential to contribute both short and long-term findings.

Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial

Background

Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both.

Objective

To test the efficacy of these interventions.

Design

A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment.

Participants

Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals.

Results

For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.6–23.7%) relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 26.4% (95% CI 9.9–34.3%).

Conclusions

Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment.

Trial registration

IRSCTN38001825.

Validation of an integrated pedal desk and electronic behavior tracking platform

Background

This study tested the validity of revolutions per minute (RPM) measurements from the Pennington Pedal Desk™. Forty-four participants (73 % female; 39 ± 11.4 years-old; BMI 25.8 ± 5.5 kg/m² [mean ± SD]) completed a standardized trial consisting of guided computer tasks while using a pedal desk for approximately 20 min. Measures of RPM were concurrently collected by the pedal desk and the Garmin Vector power meter. After establishing the validity of RPM measurements with the Garmin Vector, we performed equivalence tests, quantified mean absolute percent error (MAPE), and constructed Bland–Altman plots to assess agreement between RPM measures from the pedal desk and the Garmin Vector (criterion) at the minute-by-minute and trial level (i.e., over the approximate 20 min trial period).

Results

The average (mean ± SD) duration of the pedal desk trial was 20.5 ± 2.5 min. Measures of RPM (mean ± SE) at the minute-by-minute (Garmin Vector: 54.8 ± 0.4 RPM; pedal desk: 55.8 ± 0.4 RPM) and trial level (Garmin Vector: 55.0 ± 1.7 RPM; pedal desk: 56.0 ± 1.7 RPM) were deemed equivalent. MAPE values for RPM measured by the pedal desk were small (minute-by-minute: 2.1 ± 0.1 %; trial: 1.8 ± 0.1 %) and no systematic relationships in error variance were evident by Bland–Altman plots.

Conclusion

The Pennington Pedal Desk™ provides a valid count of RPM, providing an accurate metric to promote usage.

The role of peer physical activity champions in the workplace: a qualitative study

Aims:

Peer health champions have been suggested as an important component of multilevel workplace interventions to promote healthy behaviours such as physical activity (PA). There is accumulating quantitative evidence of their effectiveness but as yet little exploration of why and how champions influence peer behaviour. The current study explores the role of peer physical activity champions (PPACs) in influencing colleagues’ PA behaviour from the perspectives of both champions and colleagues.

Methods:

Seven months after the introduction of a workplace PA programme in 17 small- and medium-sized enterprises (SMEs), two focus groups were held with PPACs and four with programme participants. Data were analysed using inductive thematic analysis.

Results:

Three overarching themes were developed: how PPACs encourage PA, valuable PPAC characteristics and sustaining motivation for the PPAC role. Both direct encouragement from PPACs and facilitation of wider PA supportive social networks within the workplace encouraged behaviour change. PA behaviour change is a delicate subject and it was important that PPACs provided enthusiastic and persistent encouragement without seeming judgemental. Being a PA role model was also a valuable characteristic. The PPACs found it satisfying to see positive changes in their colleagues who had become more active. However, colleagues often did not engage in suggested activities and PPACs required resilience to maintain personal motivation for the role despite this.

Conclusion:

Incorporating PPACs into SME-based PA interventions is acceptable to employees. It is recommended that PPAC training includes suggestions for facilitating social connections between colleagues. Sensitivity is required when initiating and engaging in conversations with colleagues about increasing their PA. Programmes should ensure PPACs themselves are provided with social support, especially from others in the same role, to help sustain motivation for their role. These findings will be useful to health-promotion professionals developing workplace health programmes.

Employee health codes of conduct: what would they look like and who wants to accept them?

Purpose

– Most workplace health promotion efforts have failed to consistently and sustainably encourage employees to take responsibility for their health. The purpose of this paper is to explore a potentially high-impact solution – Health Codes of Conduct – for engaging and motivating employees to assume responsibility for their health.

Design/methodology/approach

– This mixed methods study draws on interview and survey methodology with a sample of 149 working adults to examine the feasibility of Health Codes of Conduct. Descriptive and inferential statistics are calculated to understand reactions, characteristics of the companies likely to support the idea, and components of a Health Code of Conduct.

Findings

– Nearly all employees offered moderate to high support for Health Codes of Conduct; this included overweight but not obese employees. Additionally, all demographic groups either moderately or strongly supported the policy when they included either monetary incentives (such as prescription discounts) or often overlooked non-monetary incentives (such as employee recognition). Some of the more popular features of Health Codes of Conduct included annual physical exams, exercise routines, and simply being encouraged to stay home when ill.

Research limitations/implications

– Health Codes of Conduct offer a surprisingly well-supported potential solution. Favorable reactions were observed across all examined segments of workers, even overweight (but not obese) employees. Using the specific features of Health Codes identified here, visionary companies can tailor their company’s Health Code of Conduct with the appropriate monetary and non-monetary incentives and disincentives.

Social implications

– What if the workplace could be a positive source of health and empowerment for valued employees? The authors show employee Health Codes of Conduct could be this empowering, engaging solution that has been missing.

Originality/value

– This paper is the first to propose the concept Health Codes of Conduct and solicit feedback from employees on this novel idea. Furthermore, the authors identify both the monetary and non-monetary incentives and disincentives that employees believe would be most compelling.