1
|
Indrayani NLD, Kao CY, Suyasa IGPD, Padmalatha KMS, Chang JH, Wang CJ. Effectiveness of exercise programs to reduce low back pain among nurses and nursing assistants: A systematic review and meta-analysis. JOURNAL OF SAFETY RESEARCH 2024; 89:312-321. [PMID: 38858055 DOI: 10.1016/j.jsr.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/02/2023] [Accepted: 01/16/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Nurses have a high prevalence of low back pain due to ergonomic hazards in healthcare workplaces. While exercise programs have been suggested as an intervention strategy, the effectiveness of low back pain programs has been inconsistent in the research literature. The purpose of study is to determine the effect of exercise programs to reduce low back pain among nursing staff. METHODS A systematic review and meta-analysis was conducted with five databases and systematically searched. Following the PRISMA guidelines, included studies evaluated low back pain relief among nurses or nursing assistants and described the exercise program. Two reviewers independently appraised, extracted, and synthesized all available studies. The study protocol was registered in PROSPERO (CRD42022359511). RESULTS A total of 296 articles with 1,355 nursing staff from nine countries were obtained. Nine randomized controlled trials with a moderate to low risk of bias quality were included. Exercise programs had a small but significant effect on low back pain of nursing staff (SMD = -0.48; 95% CI = -0.76 to -0.19; p = 0.03, I2 = 62%, p = 0.001). A subgroup analysis of nurses and nursing assistants showed moderate and small effects, respectively (I2 = 0% p < 0.0001, SMD -0.73 CI 95% [-0.97 to -0.48], p = 0.76, and I2 = 0% p = 0.002, SMD -0.23 CI 95% [-0.38 to -0.08], p < 0.88). Exercise for back and trunk exhibited a moderate effect on low back pain (SMD -0.56 CI 95% [-0.86 to -0.25], p = 0.01, I2 = 66%, p < 0.0004). A subgroup analysis comparing age, under 40 years old revealed a moderate effect size (SMD = -0.59; 95% CI = -0.83to -0.35; p = 0.06; I2 = 64%, p < 0.0001). CONCLUSIONS Exercise programs are an effective treatment to reduce low back pain in nurses and nursing assistants, especially among younger staff. PRACTICAL APPLICATION Back and trunk exercise programs should be recommended for nursing staff with low back pain.
Collapse
Affiliation(s)
- Ni Luh Dwi Indrayani
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Technology and Health, Bali, Indonesia
| | - Chi-Yin Kao
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | - Jer-Hao Chang
- Institute of Allied Health Sciences, College of Medicine, National Cheng-Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chi-Jane Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
2
|
Willeke K, Janson P, Kirchner A, Tischer C, D'Souza A, Heuschmann PU, Zapf A, Wildner M, Stupp C, Keil T. Effects of occupational health promotion interventions on health-related outcomes among employees of small businesses and self-employed individuals: A systematic review. Work 2024:WOR230441. [PMID: 38848153 DOI: 10.3233/wor-230441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Compared to workers of larger companies it is less clear what health promoting interventions might be beneficial for employees of small businesses and self-employed individuals. OBJECTIVE Our aim was to critically appraise trials investigating health promotion programs among small business workers and self-employed individuals, by means of a systematic review. METHODS We conducted a search of primary studies using MEDLINE, Web of Science, LIVIVO and the Cochrane library. Our assessment followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. RESULTS We identified six trials including 5,854 participants from Asia, North America and Australia. Most were of moderate methodological quality, only one was of low quality. Some of the supervised psycho-educational lifestyle programs focusing on individual behavior changes showed benefits in terms of stress reduction and increased physical activity levels among small enterprise employees. CONCLUSIONS There is a huge knowledge gap on evidence-based health promotion interventions for self-employed and for small business workers, especially in Europe.
Collapse
Affiliation(s)
- Kristina Willeke
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Patrick Janson
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Anna Kirchner
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Christina Tischer
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Department of Health Security, Finnish Institute of Health and Welfare, Kuopio, Finland
| | - Arun D'Souza
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Zapf
- Bavarian State Ministry of the Environment and Consumer Protection, Munich, Germany
- Pettenkofer School of Public Health, University of Munich, Munich, Germany
| | - Manfred Wildner
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Pettenkofer School of Public Health, University of Munich, Munich, Germany
| | - Carolin Stupp
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Thomas Keil
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Jeffree MS, Abdul Rahim AA, Daud DMA, Pang N, Sazali MF, Sudi S, Liau SN, Wong EEL, Peter HF, Amat SZA, Chok S, Abdelhafez MM, Lukman KA, Saad I, Hassan MR, Noordin R. Predictors of musculoskeletal disorders among special education teachers in Sabah, Malaysia. Heliyon 2024; 10:e30873. [PMID: 38826737 PMCID: PMC11141249 DOI: 10.1016/j.heliyon.2024.e30873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 06/04/2024] Open
Abstract
Special education teachers encounter considerable occupational challenges, yet there is limited information concerning musculoskeletal disorders (MSD) within this group. Therefore, this study aimed to address this gap by determining the prevalence of MSD, investigating associated factors of MSD, and identifying predictors of MSD among special education teachers. A cross-sectional study was conducted among special education teachers in Kota Kinabalu and Penampang, Sabah. Data were collected through self-administered questionnaires and musculoskeletal fitness assessments. Chi-square tests and independent t-tests were utilized to determine factors associated with MSD, while multiple logistic regression was performed to develop a comprehensive predictive model for MSD, which was then validated and tested for model fitness. A total of 122 individuals participated in the study, yielding a response rate of 95 %. The findings revealed a high prevalence of MSD (77.9 %) among special education teachers, with the lower back, shoulder, neck, knee, upper back, and foot being the most affected regions. The multivariable regression model identified several predictors of MSD, including marital status (adjusted odds ratio [aOR] = 4.78, 95 % confidence interval [CI] = 1.49-15.40), body fat percentage (aOR = 1.06, 95 % CI = 1.00-1.12), teaching in prolonged standing for few days a week (aOR = 3.20, 95 % CI = 0.99-10.29) or every day (aOR = 6.20, 95 % CI = 1.44-26.70), mindfulness (aOR = 0.47, 95 % CI = 0.22-0.98), and back extensor strength (aOR = 5.86, 95 % CI = 1.92-17.92). This study highlights the necessity of implementing interventions focusing on the ergonomic, psychological, and musculoskeletal fitness components to mitigate the prevalence of MSD and improve the overall well-being of special education teachers.
Collapse
Affiliation(s)
- Mohammad Saffree Jeffree
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Ahmad Asyraf Abdul Rahim
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Dayang Maryama Ag Daud
- HEAL Research Unit, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Nicholas Pang
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Mohd Fazeli Sazali
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Suhaini Sudi
- Faculty of Science and Natural Resources, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Shye Nee Liau
- HEAL Research Unit, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Eileen Ei Ling Wong
- HEAL Research Unit, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Hanif Fikri Peter
- HEAL Research Unit, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Siti Zuraina Ain Amat
- Development Division, Sabah State Health Department, 88590, Kota Kinabalu, Sabah, Malaysia
| | - Stephanie Chok
- HEAL Research Unit, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Mohsen M.A. Abdelhafez
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Khamisah Awang Lukman
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Ismail Saad
- Faculty of Engineering, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Raman Noordin
- Faculty of Business, Economics and Accountancy, University Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| |
Collapse
|
4
|
Pehlevan E, Şevgin Ö. Effect of exercise given to factory workers with ergonomics training on pain and functionality: A randomized controlled trial. Work 2024; 78:195-205. [PMID: 38701125 DOI: 10.3233/wor-230663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Exercise and manual therapy are used with pharmacological interventions to manage low back pain and prevent work-related musculoskeletal disorders. However, the potential benefits of incorporating exercise and ergonomics training for factory workers experiencing low back pain have not been definitively established. OBJECTIVE The objective of this study was to assess the impact of ergonomics training with exercises on pain, functionality, sleep, and fatigue among factory employees experiencing low back pain. METHODS This research was conducted as a randomized controlled trial involving workers with back pain employed in a plastic molding factory in Gebze, Kocaeli. Both groups received ergonomics training, but only the experimental group was given exercise training inclusive of stretching and core stabilization exercises. The workers in the experimental group were instructed to perform the exercises regularly for three days a week over a period of eight weeks. The McGill Pain Questionnaire (MPQ), the Visual Analogue Scale (VAS), the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the Oswestry Disability Index (ODI) were used for pre-and post-treatment assessment. RESULTS The ODI, FSS, PSQI, and MPQ scores were significantly reduced in both groups. In the intergroup comparison, the exercise group showed a significantly greater decrease in all test scores compared to the control group. CONCLUSION The exercise group showed a statistically significant decrease in ODI, FSS, MPQ, and PSQI scores compared to the control group. This study demonstrated that exercise is a more effective practice than ergonomic training for factory workers suffering from chronic low back pain.
Collapse
Affiliation(s)
- Elif Pehlevan
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Üsküdar University, Istanbul, Turkey
| | - Ömer Şevgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Üsküdar University, Istanbul, Turkey
| |
Collapse
|
5
|
Baklouti M, Ben Ayed H, Ketata N, Maamri H, Karray R, Jdidi J, Mejdoub Y, Kassis M, Yaich S, Dammak J. Low back-pain among school-teachers in Southern Tunisia: prevalence and predictors. Scand J Pain 2023; 23:687-693. [PMID: 37714848 DOI: 10.1515/sjpain-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/27/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES In the professional environment, low back pain (LBP) is a multifactorial symptomatology, despite scientific and technological advances in the design and the arrangement of increasingly ergonomic workstations. Teachers are not exempt from this risk, due to prolonged sitting or standing. In light of this, this study aimed to estimate LBP prevalence among teachers in Southern Tunisia and to identify their determinants. METHODS It was a cross-sectional study including a representative sample of teachers from secondary, middle, and primary schools in Sfax, Tunisia, conducted during the period March-April 2021. LBP intensity was assessed using a visual analog scale from 1 to 10. A severe LBP was defined as VAS≥7. RESULTS Among the participants, 292 teachers were females (55.6 %). The median age was 48 years (Interquartile Range (IQR)=[41-53] years). Overall, 377 teachers had a severe LBP, with a global prevalence of 71.8 %. Multivariate analysis showed that independent determinants of LBP among teachers were female gender (Adjusted Odds Ratio (AOR)=2.81;p<0.001), age ≥30 (AOR=5.68;p=0.009), chronic diseases (AOR=2.52;p<0.001), working at primary schools (AOR=1.75;p=0.033), working for ≥4 h per day (AOR=2.41;p=0.005), inadequate ergonomic conditions at work (AOR=1.78;p=0.008) and distance home-school ≥10 km (AOR=2.27;p=0.003). CONCLUSIONS This study demonstrated that LBP among teachers was alarmingly high. Different individual, ergonomic, and occupational factors were predictors of this symptom. Thus, development of rational strategies for LBP prevention among teachers and the improvement of working conditions are urgently needed.
Collapse
Affiliation(s)
- Mouna Baklouti
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Houda Ben Ayed
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Nouha Ketata
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Hanen Maamri
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Raouf Karray
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Jihene Jdidi
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Yosra Mejdoub
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mondher Kassis
- Preventive Medicine and Hygiene Department, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Sourour Yaich
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Jamel Dammak
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| |
Collapse
|
6
|
Abdul Rahim AA, Jeffree MS, Ag Daud DM, Pang N, Sazali MF. Factors Associated with Musculoskeletal Disorders among Regular and Special Education Teachers: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11704. [PMID: 36141974 PMCID: PMC9517555 DOI: 10.3390/ijerph191811704] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Musculoskeletal disorder (MSD) is a major health problem, which can lead to an enormous burden to the institution as well as chronic disability to the individual. Teachers are at risk of developing MSD due to the exposure to various ergonomic risk factors. Teachers of special education, for example, are expected to perform extra duty such as lifting and moving students, feeding food, changing diapers, and helping them in ambulation. Although there is an adequate amount of scientific research on MSD's prevalence and its risk factors among regular teachers, only few studies have focused on special education teachers. This review aimed to address these gaps by describing the evidence from various papers on the prevalence of MSD among regular and special education teachers and the related risk factors. The papers have been gathered using electronic databases, including PubMed, Science Direct, Google Scholar, and Springer. The prevalence of MSD among regular teachers ranges from 48.7% to 73.7%, while the prevalence ranges from 38.7% to 94% in special education teachers. Risk factors, such as individual (age, duration of teaching, working hours, and work burden), physical (teaching activities, affected body areas), and psychological factors (stress, anxiety, fear), were identified. From the review, it is recommended to implement ergonomically designed workplaces, comprehensive ergonomic training, psychological approaches, and functional training among teachers at risk.
Collapse
|
7
|
Huang R, Ning J, Chuter VH, Taylor JB, Christophe D, Meng Z, Xu Y, Jiang L. Exercise alone and exercise combined with education both prevent episodes of low back pain and related absenteeism: systematic review and network meta-analysis of randomised controlled trials (RCTs) aimed at preventing back pain. Br J Sports Med 2019; 54:766-770. [PMID: 31672696 DOI: 10.1136/bjsports-2018-100035] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We aimed to investigate which prevention strategies for low back pain (LBP) are most effective. DESIGN We completed a Bayesian network meta-analysis to summarise the comparative effectiveness of LBP prevention strategies. The primary outcomes were an episode of LBP and LBP-associated work absenteeism represented as ORs with associated 95% credibility intervals (CrIs). We ranked all prevention strategies with surface under the cumulative ranking curve (SUCRA) analysis. DATA SOURCES PubMed, EMBASE and CENTRAL databases were searched along with manual searches of retrieved articles. We only included randomised controlled trials (RCTs) that reported an episode of LBP and/or LBP-associated work absenteeism evaluating LBP prevention strategies were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Data were independently extracted by two investigators, and RCT quality was assessed using the Cochrane Risk of Bias tool. RESULTS AND SUMMARY Forty RCTs were included. Exercise combined with education (OR: 0.59, CrI: 0.41 to 0.82) and exercise alone (OR: 0.59, CrI: 0.36 to 0.92) both prevented LBP episodes; exercise combined with education and education alone both had large areas under the curve (SUCRA: 81.3 and 79.4, respectively). Additionally, exercise (OR: 0.04, CrI: 0.00 to 0.34) prevented LBP-associated work absenteeism, with exercise and the combination of exercise and education ranking highest (SUCRA: 99.0 and 60.2, respectively). CONCLUSIONS Exercise alone and exercise combined with education can prevent episodes of LBP and LBP-related absenteeism. TRIAL REGISTRATION NUMBER PROSPERO 42017056884.
Collapse
Affiliation(s)
- Rongzhong Huang
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China.,Department of Gerontology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Ning
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China
| | - Vivienne H Chuter
- School of Health Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Jeffrey Bruce Taylor
- Physical Therapy, High Point University, High Point, North Carolina, USA.,Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Demoulin Christophe
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | - Zengdong Meng
- Department of Orthopedics, First People's Hospital of YunNan Province, YunNan, China
| | - Yu Xu
- Statistical Laboratory, Chongqing Chuangxu Lifescience Institute, Chongqing, China
| | - Lihong Jiang
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China
| |
Collapse
|
8
|
Liu F, Jones AYM, Evans K, Tsang RCC, Ao L. Trunk muscle endurance in Chinese adults. J Back Musculoskelet Rehabil 2018; 31:593-602. [PMID: 30103298 DOI: 10.3233/bmr-170872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies in non-Chinese populations have found a relationship between performance on isometric trunk muscle endurance tests and low back pain (LBP). However, the relationship between trunk muscle endurance and LBP in Chinese populations has received little attention and age-referenced data have not been reported. OBJECTIVE Evaluate the relationship between age-referenced isometric trunk muscle endurance values and LBP in a Chinese cohort. METHODS One hundred and eighty-eight participants (20-59-years) performed four timed-endurance tests (Biering-Sørensen, plank, left/right side bridge) in random order. Participants with a history of LBP completed an Oswestry Disability Index (ODI) and pain scale. Holding-times for the four tests were summed and receiver operating characteristic (ROC) curve analysis was performed to differentiate participants with and without LBP. RESULTS Data were grouped by age. Analysis revealed similar endurance values to those reported in non-Chinese populations, except longer holding times were recorded in the 50-59 yr Chinese cohort. Pain scores were positively correlated with ODI scores. ROC curve analysis showed that the area under the curve was 0.723 and optimal cut-off was 288 sec (sensitivity and specificity both 0.75). CONCLUSIONS This study is the first to describe trunk muscle endurance reference data in Chinese people. Individuals with a summed endurance time of < 288 seconds appear more likely to suffer LBP.
Collapse
Affiliation(s)
- Fang Liu
- School of Rehabilitation, Kunming Medical University, Kunming, Yunnan, China
| | - Alice Y M Jones
- Faculty of Health Sciences, The University of Sydney, Sydney, Lidcombe, NSW, Australia
| | - Kerrie Evans
- Menzies Health Institute QLD, Griffith University, Gold Coast, Australia
| | - Raymond C C Tsang
- Department of Physiotherapy, MacLehose Medical Rehabilitation Centre, Hong Kong, China
| | - Lijuan Ao
- School of Rehabilitation, Kunming Medical University, Kunming, Yunnan, China
| |
Collapse
|
9
|
Maciel RRBT, Dos Santos NC, Portella DDA, Alves PGJM, Martinez BP. Effects of physical exercise at the workplace for treatment of low back pain: a systematic review with meta-analysis. Rev Bras Med Trab 2018; 16:225-235. [PMID: 32270086 DOI: 10.5327/z1679443520180133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/01/2018] [Indexed: 11/05/2022] Open
Abstract
Background The prevalence of low back pain is high among the economically active population. Low back pain reduces productivity and causes absenteeism, impaired quality of life and leaves of absence. Several measures were suggested to reduce the occurrence of this occupational condition, among which physical exercise at the workplace stands out. Aim To analyze studies which assessed physical exercise at the workplace for treatment of low back pain. Methods The present study consisted of a systematic review with meta-analysis. An electronic search was conducted on database MEDLINE using keywords "workplace," "low back pain" and "exercise," synonyms and headings located on Health Sciences Descriptors and Medical Subject Headings. We considered all the studies that included physical exercise at the workplace and defined low back pain as outcome. Results We located 499 potential studies and finally included 15 for review. The duration of treatment varied from 3 weeks to 18 months, and the main interventions were strength and stretching exercises and muscle relaxation. Conclusions The meta-analysis showed that physical exercise at the workplace did not reduce the occurrence of low back pain (difference of means=0.62, 95%CI -0.8-2.04, p<0.4). The present systematic review was registered in database PROSPERO, registration number CRD42017071563.
Collapse
Affiliation(s)
- Roberto Rodrigues Bandeira Tosta Maciel
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Natasha Cordeiro Dos Santos
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Daniel Deivson Alves Portella
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Priscila Godoy Januário Martins Alves
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Bruno Prata Martinez
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| |
Collapse
|
10
|
Shiri R, Coggon D, Falah-Hassani K. Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials. Am J Epidemiol 2018; 187:1093-1101. [PMID: 29053873 DOI: 10.1093/aje/kwx337] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/05/2017] [Indexed: 12/21/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to assess the effect of exercise in population-based interventions to prevent low back pain (LBP) and associated disability. Comprehensive literature searches were conducted in multiple databases, including PubMed, Embase, and the Cochrane Library, from their inception through June 2017. Thirteen randomized controlled trials (RCTs) and 3 nonrandomized controlled trials (NRCTs) qualified for the meta-analysis. Exercise alone reduced the risk of LBP by 33% (risk ratio = 0.67, 95% confidence interval: 0.53, 0.85; I2 = 23%, 8 RCTs, n = 1,634), and exercise combined with education reduced it by 27% (risk ratio = 0.73, 95% confidence interval: 0.59, 0.91; I2 = 6%, 6 trials, n = 1,381). The severity of LBP and disability from LBP were also lower in exercise groups than in control groups. Moreover, results were not changed by excluding the NRCTs or adjusting for publication bias. Few trials assessed health-care consultation or sick leave for LBP, and meta-analyses did not show statistically significant protective effects of exercise on those outcomes. Exercise reduces the risk of LBP and associated disability, and a combination of strengthening with either stretching or aerobic exercises performed 2-3 times per week can reasonably be recommended for prevention of LBP in the general population.
Collapse
Affiliation(s)
- Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - David Coggon
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | |
Collapse
|
11
|
Munster MM, Brismée JM, Sizer PS, Browne K, Dewan B, Litke A, Pape JL, Sobczak S. Can 5 minutes of repetitive prone press-ups and sustained prone press-ups following a period of spinal loading reverse spinal shrinkage? Physiother Theory Pract 2018; 35:259-267. [DOI: 10.1080/09593985.2018.1442539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michelle M Munster
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Phillip S Sizer
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kevin Browne
- The University of Texas at El Paso, El Paso, TX, USA
| | - Birendra Dewan
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Amber Litke
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - John L Pape
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Stéphane Sobczak
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Département d’Anatomie, Université du Québec à Trois-Rivières, Québec, Canada
| |
Collapse
|
12
|
An Updated Overview of Low Back Pain Management in Primary Care. Asian Spine J 2017; 11:653-660. [PMID: 28874985 PMCID: PMC5573861 DOI: 10.4184/asj.2017.11.4.653] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/13/2017] [Accepted: 01/26/2017] [Indexed: 12/11/2022] Open
Abstract
Currently, guidelines for lower back pain (LBP) treatment are needed. We reviewed the current guidelines and high-quality articles to confirm the LBP guidelines for the Korean Society of Spine Surgery. We searched available databases for high-quality articles in English on LBP published from 2000 to the present year. Literature searches using these guidelines included studies from MEDLINE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Embase. We analyzed a total of 132 randomized clinical trials, 116 systematic reviews, 9 meta-analyses, and 4 clinical guideline reviews. We adopted the SIGN checklist for the assessment of article quality. Data were subsequently abstracted by a reviewer and verified. Many treatment options exist for LBP, with a variety of recommendation grades. We assessed the recommendation grade for general behavior, pharmacological therapy, psychological therapy, and specific exercises. This information should be helpful to physicians in the treatment of LBP patients.
Collapse
|
13
|
Kaeding TS, Karch A, Schwarz R, Flor T, Wittke TC, Kück M, Böselt G, Tegtbur U, Stein L. Whole-body vibration training as a workplace-based sports activity for employees with chronic low-back pain. Scand J Med Sci Sports 2017; 27:2027-2039. [PMID: 28185300 DOI: 10.1111/sms.12852] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/26/2022]
Abstract
The goal of this randomized and controlled study was to examine whether whole-body vibration (WBV) training is able to reduce back pain and physical disability in seated working office employees with chronic low-back pain in a real-world setting. A total of 41 subjects (68.3% female/mean age 45.5±9.1 years/mean BMI 26.6±5.2) were randomly allocated to an intervention group (INT [n=21]) or a control group (CON [n=20]). The INT participated in WBV training 2.5 times per week for 3 months. The primary outcome was the change in the Roland and Morris disability questionnaire (RMQ) score over the study period. In addition, secondary outcomes included changes in the Oswestry Disability Index (ODI), the Work Ability Index Questionnaire, the quality of life questionnaire SF-36, the Freiburger activity questionnaire, and an isokinetic test of the musculature of the trunk. Compliance with the intervention in the INT reached a mean of 81.1%±31.2% with no long-lasting unwanted side effects. We found significant positive effects of 3 months of WBV training in the INT compared to the CON regarding the RMQ (P=.027), the ODI (P=.002), the SF-36 (P=.013), the Freiburger activity questionnaire (P=.022), the post-interventional sick-leave in the INT (P=.008), and trends regarding a positive effect of the intervention on the muscular capacity of the muscles of the trunk in flexion. WBV training seems to be an effective, safe, and suitable intervention for seated working employees with chronic low-back pain.
Collapse
Affiliation(s)
- T S Kaeding
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - A Karch
- Institute for Biostatistics, Hannover Medical School (MHH), Hannover, Germany
| | - R Schwarz
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - T Flor
- Institute for Biostatistics, Hannover Medical School (MHH), Hannover, Germany
| | - T-C Wittke
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - M Kück
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - G Böselt
- Deutsche Rentenversicherung Braunschweig-Hannover, Laatzen, Germany
| | - U Tegtbur
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - L Stein
- Institute of Sports Medicine, Hannover Medical School (MHH), Hannover, Germany
| |
Collapse
|
14
|
Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, van der Beek AJ, Dennerlein JT, Tullar J, Skivington K, Pinion C, Amick B. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med 2015; 73:62-70. [PMID: 26552695 PMCID: PMC4717459 DOI: 10.1136/oemed-2015-102992] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Abstract
The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories.
Collapse
Affiliation(s)
- D Van Eerd
- Institute for Work & Health, Toronto, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - C Munhall
- Institute for Work & Health, Toronto, Ontario, Canada
| | - E Irvin
- Institute for Work & Health, Toronto, Ontario, Canada
| | - D Rempel
- Division of Occupational and Environmental Medicine, School of Medicine, University of California, San Francisco, Richmond, California, USA
| | - S Brewer
- CB&I, Inc, The Woodlands, Texas, USA
| | - A J van der Beek
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - J T Dennerlein
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Physical Therapy, Movement & Rehabilitation Science, Northeastern University, Boston, Massachusetts, USA
| | - J Tullar
- School of Public Health, Institute for Health Policy, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - K Skivington
- Institute for Work & Health, Toronto, Ontario, Canada MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - C Pinion
- CB&I, Inc, The Woodlands, Texas, USA
| | - B Amick
- Institute for Work & Health, Toronto, Ontario, Canada Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA
| |
Collapse
|
15
|
Bertozzi L, Villafañe JH, Capra F, Reci M, Pillastrini P. Effect of an Exercise Programme for the Prevention of Back and Neck Pain in Poultry Slaughterhouse Workers. Occup Ther Int 2014; 22:36-42. [DOI: 10.1002/oti.1382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/20/2014] [Accepted: 09/23/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | | | | | - Paolo Pillastrini
- Department of Internal Medicine, Geriatrics and Nephrology; University of Bologna; Bologna Italy
| |
Collapse
|
16
|
A physiotherapy-directed occupational health programme for Austrian school teachers: a cluster randomised pilot study. Physiotherapy 2014; 100:20-6. [DOI: 10.1016/j.physio.2013.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 03/31/2013] [Indexed: 11/21/2022]
|
17
|
Chronic nonspecific low back pain: rehabilitation. Rev Assoc Med Bras (1992) 2013; 59:536-53. [PMID: 24239032 DOI: 10.1016/j.ramb.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/11/2013] [Indexed: 11/19/2022] Open
|
18
|
Erick PN, Smith DR. A systematic review of musculoskeletal disorders among school teachers. BMC Musculoskelet Disord 2011; 12:260. [PMID: 22087739 PMCID: PMC3250950 DOI: 10.1186/1471-2474-12-260] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers represent an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff. METHODS The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail. RESULTS This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers appear to be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates. CONCLUSION Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.
Collapse
Affiliation(s)
- Patience N Erick
- School of Health Sciences, University of Newcastle, 10 Chittaway Road, Ourimbah, 2258, Australia
| | | |
Collapse
|
19
|
Verbeek JH, Martimo KP, Karppinen J, Kuijer PPF, Viikari-Juntura E, Takala EP. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev 2011:CD005958. [PMID: 21678349 DOI: 10.1002/14651858.cd005958.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Training and the provision of assistive devices are considered major interventions to prevent back pain and its related disability among workers exposed to manual material handling (MMH). OBJECTIVES To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2011, issue 1), MEDLINE, EMBASE, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to February 2011. SELECTION CRITERIA We included randomised controlled trials (RCT) and cohort studies with a concurrent control group that were aimed at changing human behaviour in MMH and measured back pain, back pain-related disability or sickness absence. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group for RCTs and MINORS for the cohort studies.We based the results and conclusions on the analysis of RCTs only. We compared these with the results from cohort studies. MAIN RESULTS We included nine RCTs (20,101 employees) and nine cohort studies (1280 employees) on the prevention of back pain in this updated review. Studies compared training to no intervention (4), professional education (2), a video (3), use of a back belt (3) or exercise (2). Other studies compared training plus lifting aids to no intervention (3) and to training only (1). The intensity of training ranged from a single educational session to very extensive personal biofeedback.Six RCTs had a high risk of bias.None of the included studies showed evidence of a preventive effect of training on back pain.There was moderate quality evidence from seven RCTs (19,317 employees) that those who received training reported levels of back pain similar to those who received no intervention, with an odds ratio of 1.17 (95% confidence intervals (CI) 0.68 to 2.02) or minor advice (video), with a relative risk of 0.93 (95% CI 0.69 to 1.25). Confidence intervals around the effect estimates were still wide due to the adjustment for the design effect of clustered studies.The results of the cohort studies were similar to those of the randomised studies. AUTHORS' CONCLUSIONS There is moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain. More high quality studies could further reduce the remaining uncertainty.
Collapse
Affiliation(s)
- Jos H Verbeek
- Occupational Safety and Health Review Group, Finnish Institute of Occupational Health, PO Box 310, Kuopio, Finland, 70101
| | | | | | | | | | | |
Collapse
|
20
|
The Predictive Relationship of Physical Activity on the Incidence of Low Back Pain in an Occupational Cohort. J Occup Environ Med 2011; 53:364-71. [DOI: 10.1097/jom.0b013e31820d1633] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
21
|
Tsai HH, Peng SM, Yeh CY, Chen CJ, Chen RY. An effective physical fitness program for small and medium-sized enterprises. INDUSTRIAL HEALTH 2011; 49:311-320. [PMID: 21372441 DOI: 10.2486/indhealth.ms1152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this study is to develop a practicable worksite physical fitness program for small and medium-sized enterprises (SMEs). Community-based intervention consisting of a three-month exercise course was conducted, and its benefits evaluated. A self-administrated structured questionnaire and physical fitness examination were designed to compare the difference between pre and post intervention. A total of 133 SME workers completed the lifestyle/exercise course and filled out the questionnaire, but 16 were excluded from the exercise group due to health reasons. After the intervention, health indicators such as weight, blood pressure, resting heart rate, waistline, BMI, front and back trunk flexibility, abdominal muscle durability and back muscle strength were significantly improved, and improvements in musculoskeletal disorders were seen in reduced neck pain (18.8%), wrist pain (17.4%), and upper/lower back pain (8.7% and 21.7%, respectively). Cardiovascular risk factors (BMI and resting heart rate) showed a significant improvement related to frequent participation in the program (p=0.02), and the exercise group reported a significant difference in overall health (p=0.02). This study has demonstrated an effective approach to community-based fitness intervention through SMEs.
Collapse
Affiliation(s)
- Han Hui Tsai
- School of Public Health, Taipei Medical University, Taiwan
| | | | | | | | | |
Collapse
|