Ischemic heart disease in female cleaners

Assessment of cardiovascular load among hotel room cleaners

Hotel room cleaners are a vulnerable population at risk for cardiovascular disease. To evaluate their workload heart rate (HR), % heart rate reserve (%HRR), blood pressure (BP), metabolic equivalent (MET), and energy expenditure (EE) were measured over two workdays and two off-workdays. The mean age was 45.5 (SD 8.2) years with a mean 10.4 (SD 7.8) years of work experience. Mean average and peak HR, %HRR, MET, and EE were significantly higher during a workday than an off-workday for the entire work shift, first and last hour of work. Mean average HR and %HRR saw the largest increase between the lunch and post-lunch interim. One-fourth of subjects exceeded the recommended 30% HRR threshold for 8-hour shifts. Some workers experienced a substantial increase in HR and DBP over a workday indicating physiologic fatigue and thus may be at increased risk for cardiovascular disease and premature death due to excessive physical work demands.

Occupational and Leisure Physical Activity on Cardiovascular Risk and Body Composition Among Courier Workers

OBJECTIVE

There is some controversy about the beneficial effects of occupational physical activity (OPA) on cardiovascular risk (CVR). The main aim of this study was to explore the effect of the combination of different frequencies of leisure-time physical activity (LTPA) and two types of OPA on CVR and body composition, and whether the association between physical activity (PA) and CVR was mediated by visceral adipose tissue (VAT).

METHODS

This cross-sectional study included data from 2516 couriers living in Spain, delivering either by motorbike or foot, and practicing LTPA never, occasionally, or regularly. Couriers were classified into six categories according to LTPA and OPA; body composition was assessed by Bioelectrical Impedance, and CVR by the Framingham equation. General linear models were performed to explore the association between different categories with each outcome (CVR and body composition) and the possible role of VAT as a mediator between PA and CVR.

RESULTS

Compared with the most sedentary group (motorbike couriers that never practice PA), walking couriers who practice regular PA presented the lowest CVR [β -1.58 (95% CI -2.31; -0.85)] and the lowest VAT [β -2.86 (95% CI -3.74; -1.98) followed by the motorbike couriers who practiced regular PA [β -0.51 (95% CI -1.00; -0.03) for CVR and β -2.33 (95% CI -2.91; -1.75) for VAT]. The association between PA and CVR was partially mediated by VAT.

CONCLUSION

The present results indicated that both OPA and LTPA are protective factors for CVR and play an important role on VAT accumulation.

Factors associated with musculoskeletal symptoms and heart rate variability among cleaners - cross-sectional study

BACKGROUND

The professionals who perform cleaning activity constitute a major economic sector in Brazil. Cleaners may develop health problems related to the musculoskeletal and cardiovascular systems. It is necessary to understand the working and health conditions of cleaners in Brazil. Thus, the aim of this study was to identify factors associated with musculoskeletal symptoms and heart rate variability (HRV) among cleaners.

METHODS

A cross-sectional study conducted at a public higher education institution with 45 outsourced cleaners following approval from the institutional ethics committee. The participants answered a questionnaire addressing sociodemographic, occupational and health data, the Nordic Musculoskeletal Questionnaire, the Physical Activity Questionnaire (work and leisure) and the short version of the Copenhagen Psychosocial Questionnaire. Clinical data (height, body mass, waist-to-hip ratio and blood pressure) and heart rate variability (HRV) were also collected. Logistic and linear regression models were created to identify factors associated with symptoms and HRV.

RESULTS

The sample consisted of women (100%) predominantly older than 50 years of age (44%), without a conjugal life (64%), with three or more children (59%), low educational level (58%) and who worked less than 12 months at the company (87%). Systemic arterial hypertension (23%) was the most reported health problem. The highest frequency of musculoskeletal symptoms was identified in the lower limbs (ankles/feet: 31% in the previous 12 months and 24% in the previous 7 days; knees: 31% in the previous 12 months and 20% in the previous 7 days). Moreover, the workers reported not practicing physical activity during leisure time (84%). Psychosocial aspects indicated health risks for the dimensions "influence at work" (74%), "burnout" (59%) and "stress" (52%). Associations were found between ankle/foot symptoms and body mass index, shoulder symptoms and predictability, and knee symptoms and self-rated health and burnout. HRV indices were associated with age.

CONCLUSIONS

This study outlined the profile of female cleaners and identified risk factors. The workers exhibited musculoskeletal symptoms, which were associated with the body mass index and some psychosocial factors. HRV indices were associated with age. Thus, health promotion and prevention measures should be taken to benefit this population of workers.

Acute effect on ambulatory blood pressure from aerobic exercise: a randomised cross-over study among female cleaners

Purpose

High occupational physical activity (OPA) is shown to increase the risk for elevated blood pressure, cardiovascular diseases and mortality. Conversely, aerobic exercise acutely lowers the blood pressure up to 25 h post exercise. However, it is unknown if this beneficial effect also apply for workers exposed to high levels of OPA. Cleaners constitute a relevant occupational group for this investigation because of a high prevalence of OPA and cardiovascular disease. Accordingly, the objective was to investigate the acute effects on ambulatory blood pressure from a single aerobic exercise session among female cleaners.

Methods

Twenty-two female cleaners were randomised to a cross-over study with a reference and an aerobic exercise session. Differences in 24-h, work hours, leisure time, and sleep ambulatory blood pressure (ABP) were evaluated using repeated measure 2 × 2 mixed-models.

Results

After the aerobic exercise session, the 24-h systolic ambulatory blood pressure was significantly lowered by 2.4 mmHg (p < 0.01) compared to the reference session. The 24-h diastolic ABP was unaltered. During work hours, a lowered systolic ABP of 2.2 mmHg (p = 0.02) and a higher diastolic ABP of 1.5 mmHg (p = 0.03) were found after the aerobic exercise session. During leisure time, the systolic ABP was lowered by 1.7 mmHg (p = 0.04) and the diastolic ABP was unaltered. During sleep, the systolic and diastolic ABP was unaltered.

Conclusion

A single aerobic exercise session lowered 24-h systolic ABP of 2.4 mmHg. Thus, an aerobic exercise session seems to be beneficial for lowering the risk of hypertension among cleaners.

Does Aerobic Exercise Increase 24-Hour Ambulatory Blood Pressure Among Workers With High Occupational Physical Activity?-A RCT

OBJECTIVE

High occupational physical activity (OPA) increases cardiovascular risk and aerobic exercise has been recommended for reducing this risk. This paper investigates the effects of an aerobic exercise intervention on 24-hour ambulatory blood pressure (ABP) among cleaners with high OPA.

METHODS

Hundred and sixteen cleaners between 18 and 65 years were randomized. During the 4-month intervention period, the aerobic exercise group (AE) (n = 57) performed worksite aerobic exercise (2 × 30 minutes/week), while the reference group (REF) (n = 59) attended lectures. Between-group differences in 4-month ABP changes were evaluated by intention-to-treat analysis using a repeated-measure 2 × 2 multiadjusted mixed-models design.

RESULTS

Relative to REF, 24-hour ABP significantly increased in AE: systolic 3.6 mm Hg (95% confidence interval (CI) 1.6-5.7) and diastolic 2.3 mm Hg (95% CI 0.9-3.8). Cleaners with high aerobic workload exhibited particularly high 24-hour ABP increases: systolic 6.0 mm Hg (95% CI 2.4-9.6), and diastolic 3.8 mm Hg (95% CI 1.3-6.4).

CONCLUSION

Aerobic exercise increased 24-hour ABP among cleaners. This adverse effect raises questions about the safety and intended benefits of aerobic exercise, especially among workers with high OPA and a demanding aerobic workload. http://www.controlled-trials.com/ISRCTN86682076. Unique identifier ISRCTN86682076.

CLINICAL TRIAL REGISTRATION

Trial Number ISRCTN86682076.

Long Term Effects on Risk Factors for Cardiovascular Disease after 12-Months of Aerobic Exercise Intervention - A Worksite RCT among Cleaners

Objectives

Occupational groups exposed to high occupational physical activity have an increased risk for cardiovascular disease (CVD). This may be explained by the high relative aerobic workload. Enhanced cardiorespiratory fitness reduces the relative aerobic workload. Thus, the aim was to evaluate the 12-months effects of worksite aerobic exercise on risk factors for CVD among cleaners.

Methods

One hundred and sixteen cleaners aged 18–65 years were randomized to a group performing aerobic exercise and a reference group receiving lectures. Outcomes were collected at baseline and after 12-months. A repeated measures 2×2 multi-adjusted mixed-model design was applied to compare the between-group differences using intention-to-treat analysis.

Results

Between-group differences (p<0.05) were found favouring the aerobic exercise group: cardiorespiratory fitness 2.15 (SE 1.03) mlO₂/min/kg, aerobic workload -2.15 (SE 1.06) %HRR, resting HR -5.31 (SE 1.61) beats/min, high sensitive C-reactive protein -0.65 (SE 0.24) μg/ml. The blood pressure was unaltered. Stratified analyses on relative aerobic workload at baseline revealed that those with relative aerobic workloads ≥30% of HRR seems to impose a notable adverse effect on resting and ambulatory blood pressure.

Conclusion

This long-term worksite aerobic exercise intervention among cleaners led to several beneficial effects, but also potential adverse effects among those with high relative aerobic workloads.

Trial Registration

Controlled-Trials.com ISRCTN86682076

Aerobic exercise reduces biomarkers related to cardiovascular risk among cleaners: effects of a worksite intervention RCT

Purpose

Blue-collar workers have an increased risk of cardiovascular disease. Accordingly, elevated levels of biomarkers related to risk of cardiovascular disease, such as high-sensitive C-reactive protein, have been observed among blue-collar workers. The objective was to examine whether an aerobic exercise worksite intervention changes the level of inflammation biomarkers among cleaners.

Methods

The design was a cluster-randomized controlled trial with 4-month worksite intervention. Before the 116 cleaners aged 18–65 years were randomized, they signed an informed consent form. The reference group (n = 59) received lectures, and the aerobic exercise group (n = 57) performed worksite aerobic exercise (30 min twice a week). Levels of biomarkers (high-sensitive C-reactive protein, fibrinogen, cholesterol, low- and high-density lipoprotein cholesterol and triglyceride) were collected at baseline and after 4 months. A repeated-measure, multi-adjusted, mixed-model intention-to-treat analysis was applied to compare between-group differences. The study was registered as ISRCTN86682076.

Results

Significant (p < 0.05) between-group reductions from baseline to follow-up were found for high-sensitive C-reactive protein (−0.54 ± 0.20 µg/ml; 95 % CI −0.94, −0.14), low-density lipoprotein cholesterol (−0.32 ± 0.11 mmol/L; 95 % CI −0.54, −0.10) and the ratios of LDL/HDL (−0.30 ± 0.08; 95 % CI −0.46, −0.14), and LDL/TC cholesterol (−0.04 ± 0.02; 95 % CI −0.07, −0.01).

Conclusion

This study indicates that an aerobic exercise intervention among cleaners leads to reduced levels of high-sensitive C-reactive protein and low-density lipoprotein cholesterol, and an unaltered level of fibrinogen. The aerobic exercise seems to improve inflammatory levels and lipoprotein profile among cleaners, with no signs of cardiovascular overload.

A 24-h assessment of physical activity and cardio-respiratory fitness among female hospital cleaners: a pilot study

The aim of this study was to evaluate the feasibility of methods for objective 24-h sampling of physical activity among cleaners. Twenty cleaners participated in three 24-h measurements. Amount of steps, heart rate (HR), cardio-respiratory fitness, body mass index (BMI) and blood pressure were measured. The methods were feasible for the objective 24-h sampling of physical activity and cardio-respiratory fitness among cleaners. Measurements showed that the cleaners walked 20,198 ± 4,627 steps per day. During working hours, the average cardio-respiratory load was 25 ± 6% of heart rate reserve (HRR). The cleaners had a low estimated cardio-respiratory fitness (34 mlO2/kg/min), a high BMI (50%, >25 kg/m(2)) and blood pressure (50%, >120/>80 mmHg). The high amount of steps, the relatively high cardiovascular load at work and low cardio-respiratory fitness illustrate the need for further investigation of the relationship between physical activity at work and in leisure, and cardiovascular health in this population.

PRACTITIONER SUMMARY

This study evaluated the feasibility of methods for objective 24-h sampling of physical activity among cleaners; the methods used were found to be feasible. The cleaners had a high cardiovascular load at work and low cardio-respiratory fitness, suggesting that there is a need for further investigations.

Cardiorespiratory fitness, cardiovascular workload and risk factors among cleaners; a cluster randomized worksite intervention

Background

Prevalence of cardiovascular risk factors is unevenly distributed among occupational groups. The working environment, as well as lifestyle and socioeconomic status contribute to the disparity and variation in prevalence of these risk factors. High physical work demands have been shown to increase the risk for cardiovascular disease and mortality, contrary to leisure time physical activity. High physical work demands in combination with a low cardiorespiratory fitness infer a high relative workload and an excessive risk for cardiovascular mortality. Therefore, the aim of this study is to examine whether a worksite aerobic exercise intervention will reduce the relative workload and cardiovascular risk factors by an increased cardiorespiratory fitness.

Methods/design

A cluster-randomized controlled trial is performed to evaluate the effect of the worksite aerobic exercise intervention on cardiorespiratory fitness and cardiovascular risk factors among cleaners. Cleaners are eligible if they are employed ≥ 20 hours/week, at one of the enrolled companies. In the randomization, strata are formed according to the manager the participant reports to. The clusters will be balanced on the following criteria: Geographical work location, gender, age and seniority. Cleaners are randomized to either I) a reference group, receiving lectures concerning healthy living, or II) an intervention group, performing worksite aerobic exercise “60 min per week”. Data collection will be conducted at baseline, four months and 12 months after baseline, at the worksite during working hours. The data collection will consist of a questionnaire-based interview, physiological testing of health and capacity-related measures, and objective diurnal measures of heart rate, physical activity and blood pressure. Primary outcome is cardiorespiratory fitness.

Discussion

Information is lacking about whether an improved cardiorespiratory fitness will affect the cardiovascular health, and additionally decrease the objectively measured relative workload, in a population with high physical work demands. Previous intervention studies have lacked robust objective measurements of the relative workload and physical work demands. This study will monitor the relative workload and general physical activity before, during after the intervention, and contribute to the understanding of the previously observed opposing effects on cardiovascular health and mortality from occupational and leisure time physical activity.

Trial registration

The study is registered as ISRCTN86682076.

Participation of Danish and immigrant cleaners in a 1-year worksite intervention preventing physical deterioration

Worksite health promotion is seldom offered to workers who are low-educated and multi-ethnic, possibly due to an assumption that they are more reluctant to participate. Furthermore, little has been done to promote health at female-dominated workplaces. The main aim of this study was to investigate differences in participation among immigrant and Danish cleaners throughout a 1-year randomised controlled study tailored to cleaners and carried out in predominantly female workplaces. No significant differences in ethnicity were found in consent and participation throughout the 1-year intervention. Dropout was equally distributed among Danish and immigrant cleaners. This study indicates that a worksite health promotion intervention among a female-dominated, high-risk occupation such as cleaning can be equally appealing for Danes and immigrants.

PRACTITIONER SUMMARY

This study provides insight about participation of Danish and immigrant cleaners in a worksite health promotion intervention in a predominantly female occupation. For attaining high participation and low dropout in future worksite health promotion interventions among cleaners, the intervention ought to not only target the ethnic background of the workers, but also to be specifically tailored to the job group.

Successful reach and adoption of a workplace health promotion RCT targeting a group of high-risk workers

Background

Cleaners are rarely introduced to workplace health promotion programs. The study's objective was to evaluate the reach and adoption of a workplace randomized controlled trial (RCT) among cleaners in Denmark.

Methods

Cleaning businesses with at least 30 employees, that could offer a weekly 1-hour intervention during working hours, were invited to participate. Employees working at least 20 hours/week were invited to answer a screening questionnaire and consent to participate. Analyses determined the differences in health variables between responders and non-responders, consenters and non-consenters, participants and non-participants and between participants of the RCT's three groups: physical coordination training, cognitive-behavioural theory-based training and reference group.

Results

From 16 eligible workplaces, a representative sample of 50% adopted the trial. Of 758 eligible employees, 78% responded to the screening questionnaire and 49% consented to participate. Consenters and participants differed from non-consenters and non-participants by having higher BMI, more chronic diseases and poorer musculoskeletal health.

Conclusions

This study indicates that workplace health promotion programs directed at health risk factors among cleaners enable significant adoption and reach to a high-risk subgroup of the Danish workforce.

Trial registration

Trial registration ISRCTN96241850