No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
A Randomized Prospective Trial of a Worksite Intervention Program to Increase Physical Activity
Abstract
Purpose:
To evaluate the effectiveness of addressing multiple barriers to physical activity (PA) using interventions at the workplace.
Design:
The Physical Activity and Lifestyle Study used a randomized controlled trial in which 60 university departments were randomized into five groups.
Setting:
Large Southeastern university.
Subjects:
Physically inactive nonfaculty employees in the participating departments (n = 410) were interviewed five times over 9 months, with 82% completing all surveys.
Intervention:
Departments were randomly assigned to (1) control, (2) gym membership, (3) gym + PA education, (4) gym + time during the workday, and (5) gym + education + time.
Measures:
PA intensity and quantity were measured using the 7-day Physical Activity Recall instrument, with PA then classified as the number of days meeting Centers for Disease Control and Prevention guidelines.
Analysis:
The outcome was modeled with generalized linear mixed model methodology.
Results:
There was no significant improvement when a group received gym alone compared to the control (Rate Ratio [RR]) 1.22 [.90, 1.67]). However, gym + education, gym + time, and gym + education + time were significantly better than the control (RR 1.51 [1.15, 1.98], RR 1.46 [1.13, 1.88], RR 1.28 [1.01, 1.62]), with improvements sustained over the 9 months.
Conclusion:
Among sedentary adults who had access to indoor exercise facilities, addressing environmental and cognitive barriers simultaneously (i.e., time and education) did not encourage more activity than addressing either barrier alone.
... Cash only/cash combined with other non-monetary rewards was the most used incentive type (n = 28 studies) regardless of types of reinforcement schedules. Specifically, a cash reward with fixedratio schedule was administered either constantly (e.g., $20 for attending each smoking cessation session (Volpp et al., 2006)) or escalating (e.g., $5 for the initial attendance of mother-to-child HIV prevention visit and increased by $1 for each subsequent visit (Yotebieng et al., 2016)); whereas non-cash rewards were administered as vouchers for exchanging goods or services (Mitchell et al., 2016;Weaver et al., 2014;Kidorf et al., 2018), gym memberships (Gazmararian et al., 2013), or a prepaid cellular cards to offset structural barriers associated with the direct and indirect costs of coming to the health facility to receive HIV care (Elul et al., 2017). Cash lottery and raffle were the most common type of positive reinforcements with either variable-ratio only or fixed-and variable-ratio mixed scheduling among the included studies (Stitzer et al., 2010;Barnabas et al., 2020;Hennrikus et al., 2002;Pope and Harvey, 2015;Kullgren et al., 2014). ...
... Thirteen studies reported outcomes on engagement (Table 3), measured as session attendance (Stitzer et al., 2010;Yotebieng et al., 2016;Fahey et al., 2020;Desai et al., 2020), moderate to vigorous physical activity (MVPA) bouts in minutes per week (Finkelstein et al., 2016), active days per week (Gazmararian et al., 2013), logged hours per week (Finkelstein et al., 2008), meeting fitness-center attendance goals (Pope and Harvey, 2015), exercise diary submission (Mitchell et al., 2016), smoking quitline acceptance (Fraser et al., 2017), the proportion or the probability of meeting the daily goal (Shin et al., 2017;Harkins et al., 2017) and screening attendance (Frosch et al., 2010). Among eight studies implementing physical activity, lifestyle change, and weight loss programs, two reported that an incentive was not effective in increasing program engagement (Mitchell et al., 2016;Gazmararian et al., 2013), and four studies applied incentive-only strategies (Mitchell et al., 2016;Pope and Harvey, 2015;Desai et al., 2020;Finkelstein et al., 2008). ...
... Thirteen studies reported outcomes on engagement (Table 3), measured as session attendance (Stitzer et al., 2010;Yotebieng et al., 2016;Fahey et al., 2020;Desai et al., 2020), moderate to vigorous physical activity (MVPA) bouts in minutes per week (Finkelstein et al., 2016), active days per week (Gazmararian et al., 2013), logged hours per week (Finkelstein et al., 2008), meeting fitness-center attendance goals (Pope and Harvey, 2015), exercise diary submission (Mitchell et al., 2016), smoking quitline acceptance (Fraser et al., 2017), the proportion or the probability of meeting the daily goal (Shin et al., 2017;Harkins et al., 2017) and screening attendance (Frosch et al., 2010). Among eight studies implementing physical activity, lifestyle change, and weight loss programs, two reported that an incentive was not effective in increasing program engagement (Mitchell et al., 2016;Gazmararian et al., 2013), and four studies applied incentive-only strategies (Mitchell et al., 2016;Pope and Harvey, 2015;Desai et al., 2020;Finkelstein et al., 2008). The study on chronic disease management (Frosch et al., 2010) indicated a significant effect of the incentive strategy at 6 months. ...
The reach (i.e., enrollment, engagement, and retention) of health promotion evidence-based programs (EBPs) at the participant level has been challenging. Incentives based on behavioral economics may be used to improve EBP reach. We aimed to systematically review and synthesize the evidence of the effectiveness of incentives as a dissemination strategy to increase EBP reach. We conducted a literature search in PubMed, SCOPUS, EMBASE, Cochrane Review and Cochrane CENTRAL for articles published between January 2000 and March 2020 to identify incentive strategies used to increase program reach among health promotion EBPs. Inclusion criteria included studies published in English, experimental or quasi-experimental designs, comparison of incentive to non-incentive or control strategies, and reported on reach (n = 35 health promotion studies). Monetary incentives using cash and a fixed schedule of reinforcement were the most used incentive schemes (71%). Incentives alone or combined with other strategies as a multicomponent approach were effective in improving program enrollment, engagement, and retention. Specifically, incentive strategies were associated with higher odds of program enrollment (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; n = 10) and retention (OR, 2.54, 95% CI, 1.34-4.85; n = 9) with considerable heterogeneity (I2 = 94% and 91%, respectively). Incentives are a promising individual-level dissemination strategy to improve the reach of health promotion EBPs. However, understanding the optimal amount, type, frequency, and target of incentives, and how incentives fit in a multicomponent approach in different contexts requires further research.
... 26,27 Several studies have attempted to alleviate the financial barrier by providing incentives or gym memberships to participants. [28][29][30][31] Providing these benefits may alleviate some PA related barriers, specifically financial barriers and those related to unsafe or uncomfortable environments. However, interventions that provide access to PA are often expensive for the researcher, do not address all PA barriers (e.g., time constraints), and sometimes do not provide much benefit to PA or weight loss. ...
... However, interventions that provide access to PA are often expensive for the researcher, do not address all PA barriers (e.g., time constraints), and sometimes do not provide much benefit to PA or weight loss. 28,32 Thus, it is important to consider removing multiple barriers to PA participation in an attempt to increase engagement. Providing a gym membership near a person's workplace may help to not only provide access to a gym, but also convenient access to a gym. ...
Introduction:
Many barriers prevent individuals from regularly engaging in physical activity (PA), including lack of time and access to facilities. Providing free gym membership close to one's work may alleviate both time and financial barriers, increase PA, and result in greater weight loss. The purpose of this secondary analysis was to determine if gym usage, self-reported leisure PA, and weight loss differed between participants working on the University of Colorado Anschutz Medical Campus (ON) versus working off-campus (OFF) during a 6-month weight loss trial.
Methods:
117 adults (ON, n = 62; OFF, n = 55) with overweight or obesity received free gym memberships for the duration of trial. Average gym check ins/week, self-report leisure PA, weight, and fat and lean mass were compared between groups.
Results:
ON reported more check-ins than OFF (ON, 0.93 ± 0.16 times/week; OFF, 0.55 ± 0.10 times/week p = 0.038). Both groups reported increased leisure PA, with ON reporting more leisure PA than OFF at month 4. Both groups had reductions in weight and fat mass, which were similar between groups.
Conclusion:
Gym usage in both groups was low, suggesting that convenient and free gym access only marginally promoted use of provided facilities, likely having little additional impact on PA and weight change.
Clinical trial registration:
The parent trial was registered at clinicaltrials.gov: NCT02627105.
... Six studies have reported greater increases in weekly physical activity participation for a treatment versus non-active control group, 20,28-32 one of which included adults with minimal symptoms of depression 29 and two of which included inactive adults. 20,30 Four other randomized controlled trials, 19,33 -35 two of which involved overweight adults, 33,34 reported no differences in the change to physical activity participation between treatment and non-active control groups. These previous studies involved interventions of 6 weeks, 32 10 weeks, 29 12 weeks, 19,20,34 6 months, 28,35 9 months, 30 and 12 months 31,33 in duration and either aerobic 19,20,31,33 or combined aerobic and resistance [28][29][30]32,34,35 exercise. ...
... 20,30 Four other randomized controlled trials, 19,33 -35 two of which involved overweight adults, 33,34 reported no differences in the change to physical activity participation between treatment and non-active control groups. These previous studies involved interventions of 6 weeks, 32 10 weeks, 29 12 weeks, 19,20,34 6 months, 28,35 9 months, 30 and 12 months 31,33 in duration and either aerobic 19,20,31,33 or combined aerobic and resistance [28][29][30]32,34,35 exercise. All but three of these previous studies measured physical activity participation using self-report methods. ...
Objective:
To investigate the effects of exercise supervision on short- and longer-term moderate-vigorous physical activity (MVPA) participation.
Methods:
Fifty-six Australian university employees completed a 16-week moderate-to-high intensity aerobic and resistance exercise intervention and physical activity questionnaire (IPAQ) 15 months later. Participants received either personal (SUP; n = 21) or non-personal (NPS; n = 19) exercise supervision at an onsite facility or exercised offsite with no supervision (CON; n = 16).
Results:
A linear mixed model identified a significant group × time interaction effect for MVPA, with increases at 15-month follow-up for CON only. Pooled data suggested more participants completed ≥500 MET-minutes of weekly MVPA at 16 weeks (66%) and 15-month follow-up (68%) compared to baseline (54%).
Conclusions:
A comprehensive health and fitness assessment and individually tailored exercise without personal supervision may promote ongoing MVPA.
... Robroek et al. also confirmed the same in a study of 726 employees with an average age of 40 in 2010 [11]. The findings of the study by Gazmararian et al. (2013), which was performed with the participation of 410 employees with an average age of 41.2 years, were in line with the results of the present study [30]. ...
... Robroek et al. also confirmed the same in a study of 726 employees with an average age of 40 in 2010 [11]. The findings of the study by Gazmararian et al. (2013), which was performed with the participation of 410 employees with an average age of 41.2 years, were in line with the results of the present study [30]. ...
... [17] A wide variety of worksite interventions range from traditional exercise classes, [14] walking or step programs, [18] use of pedometers, [19] and cosmetic and structural enhancements to encourage physical activity including behavior and counseling techniques. [14] Depending on the program in place, some of these worksite health promotion programs have been shown to improve healthy behavior, [20,21,22,23,24] while other studies do not show a change in improvement [25,26,27] or had high attrition rates. [26,27,28] Recently, researchers demonstrated that a 12-week faculty and staff exercise program (exercising three times per week) resulted in significant improvements in measures of muscular endurance, flexibility, and balance. ...
... Prior findings have demonstrated the efficacy of workplace exercise programs for increasing physical activity and fitness and these current findings do not refute those previous. [14,20,21,22,23] However, because the Control group had similar improvements in the previously outlined variables (increased MET-min per week, increased curlups repetitions, increased self-efficacy making time, and increased competence), this suggests the Control group comprised of previously sedentary and physically active individuals maintained their physical activity behavior and achieved improvements of health-related variables without the help of the program, or that our battery of fitness testing and/or wearing a visual feedback activity monitor may have also positively affected exercise behavior resulting in changes in certain health and psychological variables. The Control group achieving improvements has been shown in other research studies. ...
... Many companies provide their employees with discounts for fitness trackers or reimbursement for gym membership to encourage employees to exercise on their own [16,24,33]. One recent US nation-wide survey reported that around 18% of companies also provide onsite exercise facilities [30]. ...
... These programs usually do not require employees to report their use or participation but also do not provide incentives for maintaining or improving healthy behavior. Some research shows that free gym membership supplemented with educational resources, coaching or incentives for participation time can better improve employee physical activities than when these measures are implemented alone [16]. ...
Workplace health and wellness programs are increasingly integrating personal health tracking technologies, such as Fitbit and Apple Watch. Many question whether these technologies truly support employees in their pursuit of better wellness levels, raising objections about workplace surveillance and further blurring of boundaries between work and personal life. We conducted a study to understand how tracking tools are adopted in wellness programs and employees’ opinions about these programs. We find that employees are generally positive about incentivized health tracking in the workplace, as it helps raise awareness of activity levels. However, there is a gap between the intentions of the programs and individual experiences and health goals. This sometimes results in confusion and creates barriers to participation. Even if this gap can be addressed, health tracking in the workplace will not be for everyone; this has implications for the design of both workplace wellness programs and tracking technologies.
... In order to design an effective training programme, one needs to consider both the available research findings and practical issues to do with the cultural and social factors impacting a given group [1][2][3]. Training programmes should be designed based on the following three stages: 1) determining the elements of the programme, 2) devising the structure of the programme, and 3) monitoring the effectiveness of the programme regularly. ...
... 10 (x -X) SD T = 50 + (1) where: ...
Introduction. If it is to be effective, health training needs to be monitored based on regular and periodic assessment. The norms that have been proposed for standardised endurance tests for the 60-plus age group, particularly for women, still require evaluation. In light of the above, we have undertaken to design quantitative and qualitative criteria for assessing the level of endurance. Such criteria are urgently needed by persons working with this age group. Material and methods. We developed a quantitative and qualitative system for evaluating endurance based on Zatsiorky’s model, and we verified it in a group of 90 women aged over 60 years. We analysed data measured directly during a 2-km walk test. Results. We developed a set of quantitative and qualitative criteria for assessing endurance in women aged over 60 years based on the results of a 2-km walk test, measured on a scale ranging from 24:18 to 15:52 min:s. Conclusion. The pilot study has proven that a scale based on Zatsiorsky’s model can be an effective tool for assessing endurance in women aged over 60 years. We can thus recommend that it be widely used in practice. It is important to compare these results with the norms for the group in question and to establish comprehensive norms that could be useful for persons who organise physical activity for older adults.
... The Physical Activity and Life Style (PALS) study was conducted at Emory University in Atlanta, Georgia, that employs over 12,000 staff and faculty [24]. The PALS study used a randomized prospective design to evaluate three interventions to increase physical activity among Emory employees. ...
... Additional details about how departments and individuals were contacted to participate in PALS are provided elsewhere [24]. If determined eligible and willing, PALS participants were scheduled to have five data collection points over 9 months. ...
Objective:
To examine costs associated with obesity in an employee population and factors associated with increased costs.
Methods:
We used data from the Physical Activity and Life Style (PALS) study, a randomized prospective design evaluating three interventions to increase physical activity among physically inactive nonfaculty university employees (n = 454). The primary exposure variable, obesity (measured by body mass index), was obtained from the in-person baseline survey. Covariates were obtained from the baseline survey and included demographic characteristics and health status. Data from the baseline survey was linked with administrative data to determine pharmaceutical, inpatient, outpatient, and total health care costs for three years. Average monthly expenditures for obese and nonobese individuals were compared using t-tests and a two-part multivariate regression model adjusted for demographic and socioeconomic characteristics and health behaviors.
Results:
Although in-patient and outpatient expenses were not associated with obesity, pharmaceutical expenditures were $408 or 87.2% higher per year ($468 versus $876) for obese individuals than for nonobese individuals, which reflected poorer health behaviors and health status of obese adults.
Conclusion:
Awareness of the costs associated with obesity among employees can stimulate employers to make the investment in providing employer-sponsored wellness and health improvement programs to address obesity.
... Whilst the evidence reviewed here suggests that interventions aimed at increasing PA levels among university staff and students are effective at increasing PA, especially amongst those that are inactive [38], research has generally produced mixed results [38,40]. The heterogeneity in results may be due to differences in the countries where these interventions were carried out; and the use of diverse study design, intervention duration, range of participants and tools used to measure PA [38]. ...
Background
Physical inactivity is one of the major risk factors for developing several chronic illnesses. However, despite strong evidence indicating the health benefits of physical activity, many university staff and students tend to be physically inactive. University settings provide a stable environment where behaviour change interventions can be implemented across multiple levels of change. The aim of this study is to examine the perceived barriers and enablers to physical activity among staff and students in a university setting, using the Theoretical Domains Framework (TDF), a precursor of COM-B behaviour model.
Methods
This was a qualitative study carried out at a Midlands University in the United Kingdom. Eight group interviews were conducted with the sample (n = 40) consisting of 6 male and 15 female university staff (mean age = 40.5 ± 10.6 years) with different job roles (e.g., academic, administrative, cleaning and catering staff), and 12 male and 7 female students (mean age = 28.6 ± 4.7 years) at different stages of study (e.g., undergraduate, postgraduate, and international students). Interviews were audio recorded, transcribed verbatim and imported into NVivo12 software, responses were mapped using the TDF where theory-driven deductive content analysis was used for data analysis.
Results
Six prominent domains were identified from the group interviews as enablers and/or barriers to physical activity among university staff and students: Environmental context and resources; intentions; social influences; knowledge; beliefs about capabilities; and social/professional role and identity. The themes emerging from the group interviews fit into all 14 domains of the TDF; however, 71% of the themes fit into the six most prominent domains.
Conclusions
These findings suggest that several enablers and barriers influence university staff and students’ capability, opportunity, and motivation to engage in physical activity. This study, therefore, provides a theoretical foundation to inform the development of bespoke interventions to increase physical activity among inactive university staff and students.
... The impact of the baseline physical activity level on adherence was assessed in 14 publications (eight assessing a physical activity incentive program, six assessing a physical activity program), with a positive correlation in eight publications (four on incentive programs (101,109,112,139) and four on physical activity programs (97,121,132,140)). Three incentive programs (99,102,104) and two physical activity programs (122,136) did not signi cantly correlated with adherence, and one intervention correlated negatively (100). ...
Introduction
The health benefits of physical activity are now widely accepted and proven. However, the physical activity of individuals has decreased over the last decades, in favor of sedentary behaviors, mainly due to changes in working patterns. Promoting physical activity in the workplace is therefore of major public health interest, but is limited by employees' adherence.
Method
A literature review was conducted to identify factors for adherence to a physical activity promotion program in the workplace. In March 2021, the terms "physical activity”, "physical exercise", "training”, "workplace", "worksite", and "employees" were searched in PubMed among scientific publications published over the 2000-2021 period.
Results
More than 900 publications were analyzed and 54 were retrieved. The main factors for adherence identified were the baseline physical activity level, health level and motivation at the individual level; the intervention individualization at the interventional level; and the work environment quality at the organizational level.
Discussion
These results are consistent with previously published studies, although their validity is limited by the high heterogeneity of the included studies. Assessing these factors for adherence now appears to be a necessary prerequisite before implementing a physical activity promotion program in the workplace.
... Regarding structural articles, continuity in the impact evaluation approach of WHWPs is observed. Gazmararian, Elon, Newsome, Schild and Jacobson (2013) evaluated the effectiveness of intervening in the framework of WHWP implementation and the multiple existing barriers to physical activity. Pronk (2015) noted that employers should identify best practices leading to the design of more effective WHWPs. ...
La implementación de Programas de Salud y Bienestar Laboral tiene como propósito mejorar las condiciones de salud y bienestar de los empleados, reducir el absentismo y a su vez impactar positivamente la productividad en las organizaciones; sin embargo, no se ha evidenciado un análisis bibliométrico que haya permitido identificar y analizar las perspectivas de investigación de los Programas de Salud y Bienestar Laboral por parte de la comunidad académica aplicando la metodología del árbol de la ciencia (en adelante ToS). Para cubrir este aspecto se revisaron los artículos publicados desde el año 2001 hasta el 2020 en la base de datos Web of Science, construyendo el árbol de la ciencia de los Programas de Salud y Bienestar Laboral, identificando y analizando las tres principales perspectivas de investigación: la promoción y prevención en salud, la intervención del estrés mental y la prevención del burnout, y la prevención de los efectos de la obesidad a través de la actividad física. Teniendo en cuenta que la literatura identificada en la presente revisión se ha generado en mayor proporción en Estados Unidos y Reino Unido, se recomienda la realización de futuras investigaciones en nuestro país que sirvan de referencia académica para que las organizaciones colombianas fortalezcan la gestión de la salud y el bienestar laboral de su talento humano.
... Behavior change theories are about altering habits and behaviors in long term. The theories that were reported in the reviewed studies included ecological approach, 18 theory of planned behavior, 19,20 social cognitive theory, 21,22 self-determination theory (SDT), [23][24][25][26] health action process approach (HAPA), 27 socialecological approach, 28,29 goal setting theory, 26 the attributes of the diffusion of innovations model, theories of self-efficacy and self-regulation, 30 BASNEF model, 31 Trans theoretical Model (TTM), 5A model, 32 health belief model, 33 self-presentation theory, 34 behavioral choice theory. 35 The behavior change theories were used in 48% (14 studies) of effective and 40% (4 studies) of non-effective studies. ...
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.
... Previous research has shown that providing participants with a gym membership alone does not improve fitness levels. 6 This study took place at the St. Boniface General Hospital in Winnipeg, Manitoba, Canada, from December 2014 until September 2015 and used a 2-group repeated measures quasiexperimental design. Study protocol was approved by the University of Manitoba Education/Nursing Research Ethics Board and the St Boniface Hospital Research Review Committee (reference numbers E2014:092 and E2014:112). ...
Objectives
Few adults participate in enough physical activity for health benefits. The workplace provides a unique environment to deliver heath interventions and can be beneficial to the employee and the employer. The purpose of the study was to explore the use of a physical activity counseling (PAC) program and a fitness-based health risk assessment (fHRA) in the hospital workplace.
Methods
A workplace-based intervention was developed utilizing a PAC program and an fHRA to improve physical activity levels of employees. Hospital employees were enrolled in a 4-month PAC program and given the option to also enroll in an fHRA program (PAC + fHRA). Physical activity was assessed by accelerometry and measured at baseline, 2 months, and 4 months. Changes in musculoskeletal fitness for those in the fHRA program were assessed at baseline and 2 months.
Results
For both groups (PAC n = 22; PAC + fHRA n = 16), total and moderate to vigorous physical activity in bouts of 10 minutes or more increased significantly by 18.8 ( P = .004) and 10.2 ( P = .048) minutes per week at each data collection point, respectively. Only participants with gym memberships demonstrated increases in light physical activity over time. Those in the fHRA group significantly increased their overall musculoskeletal fitness levels from baseline levels (18.2 vs 21.7, P < .001). There was no difference in the change in physical activity levels between the groups.
Conclusions
A PAC program in the workplace may increase physical activity levels within 4 months. The addition of an fHRA does not appear to further increase physical activity levels; however, it may improve overall employee musculoskeletal fitness levels.
... Their results showed that there was no significant improvement when a group was involved in gym activity alone compared to the control. However, with education based on physical training in the gym, improvements were sustained for over 9 months [18]. Partonen et al. reported that supervised physical exercise combined with exposure to bright light appears to be an effective intervention for improving mood and certain aspects of health-related quality of life in the winter time [19]. ...
A potential method of health promotion using the traditional wooden brass instrument the didgeridoo was examined, especially in terms of mood, stress, and autonomic nerve stabilization. Twenty Japanese healthy subjects undertook 10 lessons of the Didgeridoo Health Promotion Method (DHPM) and a moods questionnaire, blood pressure, salivary amylase (sAmy) as a stress marker, pulse rate and autonomic balance expressed by Ln[low frequency (LF)/High frequency (HF) were examined twice before the entire lessons and once before and after each lesson. The subjects had improved total mood disturbance (TMD: overall mood disorder degree) as measured by the Japanese version of the Profile of Mood States 2nd Edition (POMS2) as a result of taking the lessons. The pulse of the subjects decreased after the lessons, which correlated with a reduction in sAmy. Additionally, it was found that sAmy decreased after the lessons with increasing age of the subject, subjects with higher TMD before the lessons, or subjects with higher sAmy values before the lessons. With autonomic balance measured by Ln[LF/HF], subjects who had parasympathetic dominance as a result of the lesson were significantly more frequent. Additionally, it has been shown that Ln[LF/HF] decreased over 10 weeks, and it is also clear that the effect is sustained. Health promotion is an important concern for societies as a whole. In this study, it became clear that the DHPM affected mood, stress, and autonomic stability. Future studies should focus on monitoring the effects of continuing the lessons for a longer period of time. Additionally, physical effects such as strength of respiratory muscles should be examined. DHPM may be employed in the work place to promote the mental health of workers as well as in regional neighborhood associations/communities.
... and how internal worksite programs and facilities can increase PA while at work(Gazmararian, Elon, Newsome, Schild, & Jacobson, 2013;Mujtaba & Cavico, 2013;Sliter & Yuan, 2015;. The majority of the existing research linking the built environment around the workplace with actual PA while at work, however, has used self-reported measures of PA(Barrington, Beresford, Koepsell, Duncan, & Moudon, 2015;Cronin, 2016) or used proxies other than PA(Hoehner, Allen, Marx, Barlow, & Brownson, 2012;Moore et al., 2013). ...
The role of worksite environments in promoting physical activity (PA) remains largely unexplored. With workers in the U.S. spending half of their waking day in their work environment, the workplace could be an important venue for the promotion of health and PA. We examined associations between PA gained while at work and the built environment around the workplace. We measured PA using accelerometer devices in a sample of 119 participants of the Supports at Home and Work for Maintaining Energy Balance study, with a wear time of 1 week. Measures of built environment included perceived walkability, two different measures of objective walkability, and greenness. Working in an environment perceived as walkable was associated with more minutes of PA while at work in all models. When measured objectively, walkability was found significant in the adjusted models controlling for both home walkability and amount of PA gained in nonwork related activities. Greenness of the work environment was found nonsignificant. Findings suggest investing in walkable environments around the workplace or having worksites located in walkable areas can contribute to increased minutes of PA for employed people in the U.S. © 2019, National Environmental Health Association. All rights reserved.
... These comprehensive workplace wellness interventions, adopting best practices at multiple levels of the social ecological model, are capable of creating a culture shift necessary to make an impact [8,9]. Such multiple-level, multi-strategy interventions have demonstrated positive impact associated with implementation and increased employee physical activity [10,11]. Despite the emergence of such interventions, little is known about the extent to which worksites are currently providing interventions to address sedentary behavior among their employees. ...
The purpose of this study was to identify the extent to which sedentary behavior interventions are being implemented in Kansas worksites. The WorkWell KS Physical Activity Assessment was administered online to 111 worksites across Kansas from October 2016 through April 2018. Each worksite identified a point of contact to complete the worksite-level assessment. Four of the WorkWell KS Physical Activity Assessment’s items assessed interventions that may reduce employees’ sedentary behavior: offering point-of-decision prompts to reduce employees’ sedentary behavior, offering a program for employees to reduce their sedentary time at work, having an organizational norm that allows employees to stand, stretch, and/or move during meetings at least every 30 minutes, and offering standing desks. All 111 worksites that participated in the WorkWell KS Physical Activity Workshop completed the WorkWell KS Physical Activity Assessment, resulting in a 100% response rate. Most worksites (59%, n = 65) reported offering no information, program, policy, or environmental change interventions aimed to reduce sedentary behavior. The most commonly reported intervention offered by worksites to reduce employees’ sedentary behavior was standing desks (32%, n = 35). Overall, participating worksites reported implementing a few interventions that are designed to reduce sedentary behavior.
Keywords: sedentary behavior, worksite, workplace, physical activity, occupational health, sedentary lifestyle, exercise, Kansas
... Thus, the built and natural environment around the workplace can potentially play an important role in promoting healthy behaviors in a typically sedentary venue . This potential, however, has been largely understudied (Schwartz, Aytur, Evenson, & Rodríguez, 2009), with the majority of work-centered health promotion initiatives being focused on interventions and structured programs that take place inside the workplace (Gazmararian, Elon, Newsome, Schild, & Jacobson, 2013;Loeppke, Edington, Bender, & Reynolds, 2013;Parry, Straker, Gilson, & Smith, 2013;Quintiliani, Sattelmair, Activity, & Sorensen, 2007;Shrestha, Ijaz, Kt, Kumar, & Cp, 2015). Understanding whether worksite neighborhoods influence walking offers important benefits. ...
This article explores the role of the work environment in determining physical activity gained within and around the workplace. With most adults spending more than half of their waking day at work, the workplace is a promising venue for promoting physical activity. We used a sample of 147 employed women—median age = 53 years old; 42% meeting Centers for Disease Control and Prevention (CDC) physical activity recommendations—wearing a GPS device and accelerometer on the hip for 7 days to assess location and physical activity at minute-level epochs. We analyzed the association between geographic information systems (GIS) measures of walkability and greenness around the workplace and the amount of physical activity gained while in the work neighborhood. Our results showed that working in high walkable environments was associated with higher levels of moderate to vigorous physical activity while at work, and with higher moderate to vigorous physical activity gained within the work neighborhood. Increasing walkability levels around workplaces can contribute to increasing physical activity of employees.
... These comprehensive workplace wellness interventions, adopting best practices at multiple levels of the social ecological model, are capable of creating a culture shift necessary to make an impact [8,9]. Such multiple-level, multi-strategy interventions have demonstrated positive impact associated with implementation and increased employee physical activity [10,11]. Despite the emergence of such interventions, little is known about the extent to which worksites are currently providing interventions to address sedentary behavior among their employees. ...
The purpose of this study was to identify the extent to which sedentary behavior interventions are being implemented in Kansas worksites. The WorkWell KS Physical Activity Assessment was administered online to 111 worksites across Kansas from October 2016 through April 2018. Each worksite identified a point of contact to complete the worksite-level assessment. Four of the WorkWell KS Physical Activity Assessment's items assessed interventions that may reduce employees' sedentary behavior: offering point-of-decision prompts to reduce employees' sedentary behavior, offering a program for employees to reduce their sedentary time at work, having an organizational norm that allows employees to stand, stretch, and/or move during meetings at least every 30 minutes, and offering standing desks. All 111 worksites that participated in the WorkWell KS Physical Activity Workshop completed the WorkWell KS Physical Activity Assessment, resulting in a 100% response rate. Most worksites (59%, n = 65) reported offering no information, program, policy, or environmental change interventions aimed to reduce sedentary behavior. The most commonly reported intervention offered by worksites to reduce employees' sedentary behavior was standing desks (32%, n = 35). Overall, participating worksites reported implementing a few interventions that are designed to reduce sedentary behavior.
... Interventions providing individual or group PA behavior counseling (Atlantis, Chow, Kirby, & Fiatarone Singh, 2006;Purath, Michaels Miller, McCabe, & Wilbur, 2004;Ribeiro, Martins, & Carvalho, 2014) and/or supervised PA training (Barene, Krustrup, Jackman, Brekke, & Holtermann, 2014;Dalager, Justesen, Murray, Boyle, & Sjøgaard, 2016;Gram, Holtermann, Søgaard, & Sjøgaard, 2012) have also been effective in the workplace. Several workplace PA interventions have been found to use peers to provide informational support and to organize and/or lead PA activities (Campbell et al., 2002;Gazmararian, Elon, Newsome, Schild, & Jacobson, 2013;McEachan et al., 2011). However, the effect of peers as the central intervention strategy remains unclear. ...
A workplace physical activity (PA) study tested a novel use of peers to deliver the intervention. Peer models provided vicarious experience for living physically active lifestyles to a group of inactive women. The purpose of this study was to describe participants’ perceptions of the peer modeling intervention. Nine women from the intervention group (n = 26) participated in a 90-minute focus group. Qualitative description using thematic analysis was used to identify themes from the focus group transcript. Two themes about the intervention were “I am left wanting more” and “focus on food.” Two themes about the peer models were “real people” and “it is doable.” Focus group participants perceived the peer modeling PA intervention favorably; however, they desired more attention to healthy eating and more time with peer models. Replication of the study accounting for themes identified by focus group participants is needed to strengthen the peer modeling intervention.
To better understand the current evidence base
on workplace interventions to increase physical
activity, Nuffield Health systematically searched
the literature, narrowing down a long list of
3809 studies to 107 relevant, recent evidencebased
studies. A full list is available in the
appendix.
Out of these 107 studies, Nuffield Health
identified 12 types of intervention that
had been studied: 10 individual interventions,
as well another 51 studies that investigated
multicomponent interventions, dividing these
between those that included an online element
and those that were offline only.
Nuffield Health judged interventions to have a
strong evidence base where more than 66% of
studies found a statistically significant effect, and
a moderate evidence base where 50-65%
The assessment of these interventions, outlined
on page 7, identified four interventions with
strong evidence; four with moderate evidence
and a further four with weak evidence of efficacy.
In short, there is good evidence that employers
can make a difference to the physical activity
and sedentary behaviour of their workforce. This
review suggests that sedentary behaviour may
be easier to influence than physical activity, with
both active desks and activity prompts potentially
showing effective results.
Nevertheless, there is also good evidence that
group support and providing exercise facilities,
both on and off the worksite, can be effective.
Multicomponent interventions, particularly those
that included an online element, also had good
evidence for effectiveness.
There is weak evidence for the effectiveness of
written information when combined with any
other intervention.
There is much less specific evidence on the
impact of workplace interventions for underrepresented
groups, such as those with low
levels of education or income. Nevertheless,
the evidence that is available suggests a similar
approach to that followed for employees is likely
to work: there is reasonable evidence to suggest
that supervised exercise, group support, and
multicomponent interventions can be effective.
Employers want workers to be as healthy as possible, to reduce absenteeism and to boost productivity. The challenge is getting employees to adopt healthy behaviors, a daunting task in our obesogenic society, which promotes a sedentary lifestyle and a diet high in saturated fat, sodium, and sugar. We are seeing an epidemic of obesity and type 2 diabetes, two preventable diseases that impair quality of life and increase healthcare costs. Rogers' Diffusions of Innovations (DOI) theory explains how and why people adopt new behaviors. Rogers observed how some workers were resistant to change. He categorized people according to how long it took them to adopt an innovation. He found that certain attributes were characteristic of early adopters, the opinion leaders that organizations need to win over to facilitate acceptance of an innovation. This chapter explores how DOI theory can be applied to the workplace to promote healthy behaviors.
Introduces key concepts related to adherence
In Japan, physical therapists have usually been involved in physical therapy for patients with functional disorders associated with cerebrovascular or orthopedic diseases in hospitals. With the aging of Japanese society, the number of diseased people will progressively increase; thus, it is important to pay much more attention to disease prevention. In this regard, physical therapists are expected to play a new role in the field of preventive medicine. Metabolic syndrome or central obesity with multiple cardiometabolic risks is associated with a high risk of type 2 diabetes or cardiovascular diseases and is now a central target for early detection and intervention for disease prevention. The incidence of metabolic syndrome increases with age, and men showed a higher incidence of metabolic syndrome than women in all generations. We have been involved in the guidance of workers with metabolic syndrome for a long time, and we conducted a multicenter study to establish effective guidance for these worker. In this paper, we will use our evidence to discuss the role of physical therapists in providing guidance for preventing metabolic syndrome. We are now conducting worksite supporting exercise intervention for workers who were resistant to conventional lifestyle guidance. In addition, the unique role of physical therapists in this new trial will be introduced.
Our objectivewas to describe and evaluate an innovative approach to combining worksite wellness and ergonomics, with an emphasis on retention and absenteeism during the intervention. The study enrolled 280 employee participants in a 3-year cluster randomized, controlled trial conducted at The University of Iowa, 5 local businesses, and 1 regional business. Our results showed a 90% retention rate with lower estimated absenteeism (although not statistically significant) in the intervention group compared with the control group. This type of highly interactive and integrated short intervention has the capacity to result in high levels of participation with the potential to reduce absenteeism.
The aim was to explore levels of physical activity (PA) and mental wellbeing in university employees, as well as barriers to and incentives for workplace PA.
An electronic survey was distributed to all staff at one UK university. The survey consisted of a PA stages of change questionnaire, an international PA questionnaire (short-form), the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), questions on perceived barriers to and incentives for workplace PA, questions on methods of enhancing employee wellbeing and demographics. A self-selected sample participated in two focus groups to explore key themes arising from the survey. Descriptive statistics were reported for survey data; associations between PA and wellbeing were tested for using Kruskal-Wallis with post hoc Mann-Whitney. Descriptive, thematic analysis was performed on focus group transcripts.
A total of 502 surveys were completed (34% response rate); 13 staff participated in focus groups. In all, 42% of the sample reported PA below the recommended guideline amount. Females were less active than males (p < 0.005). The mean WEMWBS was 49.2 (95% confidence interval (CI): 48.3-49.9). Low PA levels were related to lower WEMWBS scores, with statistically significant differences in WEMWBS demonstrated between low and moderate PA (p = 0.05) and low and high PA (p = 0.001). Lack of time and perceived expense of facilities were common barriers to workplace PA. The main focus group finding was the impact of university culture on workplace PA and wellbeing.
University staff demonstrate PA levels and a relationship between PA and wellbeing similar to the general population. Carefully designed strategies aimed at enhancing PA and wellbeing in university staff are required. The specific cultural and other barriers to workplace PA that exist in this setting should be considered. These results are being used to inform PA and wellbeing interventions whose effectiveness will be evaluated in future research.
© Royal Society for Public Health 2015.
Background and purposeHeadache is a common health problem in adolescents. There are a number of risk factors for headache in adolescents that are amenable to intervention. The aim of the study was to assess the effectiveness of a low-level headache prevention programme in the classroom setting to prevent these risk factors.Methods
In all, 1674 students in 8th–10th grade at 12 grammar schools in greater Munich, Germany, were cluster randomized into intervention and control groups. A standardized 60-min prevention lesson focusing on preventable risk factors for headache (physical inactivity, coffee consumption, alcohol consumption and smoking) and providing instructions on stress management and neck and shoulder muscle relaxation exercises was given in a classroom setting. Seven months later, students were reassessed. The main outcome parameter was headache cessation. Logistic regression models with random effects for cluster and adjustment for baseline risk factors were calculated.ResultsNine hundred students (intervention group N = 450, control group N = 450) with headache at baseline and complete data for headache and confounders were included in the analysis. Headache cessation was observed in 9.78% of the control group compared with 16.22% in the intervention group (number needed to treat = 16). Accounting for cluster effects and confounders, the probability of headache cessation in the intervention group was 1.77 (95% confidence interval = [1.08; 2.90]) higher than in the control group. The effect was most pronounced in adolescents with tension-type headache: odds ratio = 2.11 (95% confidence interval = [1.15; 3.80]).Conclusion
Our study demonstrates the effectiveness of a one-time, classroom-based headache prevention programme.
Purpose:
To determine whether workload, job satisfaction, and flexible schedules are predictive of using time at work to exercise.
Design:
The study design was the quantitative analysis of the time at work to exercise intervention of a cluster-randomized controlled trial.
Setting:
The study took place at Emory University, Atlanta, Georgia.
Subjects:
Subjects comprised 188 full- and part-time faculty and staff (57% female).
Intervention:
Employees were randomized into different intervention groups, and analysis focused on employees who were provided 30 minutes of time at work to exercise.
Measures:
Time at work to exercise at was measured 9 months, and work environment characteristics were measured at baseline.
Analysis:
Logistic regression modeling using generalized estimating equation analysis was used to account for departmental clustering.
Results:
Time at work to exercise was used by 45% of participants. Participants who felt comfortable taking time off work to exercise were 2.8 times more likely to use time to exercise than those who did not feel comfortable taking time off (95% confidence interval: 1.3 to 6.1). Participants who reported too much work were .3 times less likely to exercise (95% confidence interval: 0.2 to 0.7). Job satisfaction and the ability to take time off for personal matters were not significantly associated with using time to exercise.
Conclusion:
The results support the hypothesis that individuals with a supportive work environment would be more likely to use time at work to exercise. Workload and having time during the day are more important than job satisfaction.
Current psychological theory and research affirm the positive affective and motivational consequences of having personal choice. These findings have led to the popular notion that the more choice, the better-that the human ability to manage, and the human desire for, choice is unlimited. Findings from 3 experimental studies starkly challenge this implicit assumption that having more choices is necessarily more intrinsically motivating than having fewer. These experiments, which were conducted in both field and laboratory settings, show that people are more likely to purchase gourmet jams or chocolates or to undertake optional class essay assignments when offered a limited array of 6 choices rather than a more extensive array of 24 or 30 choices. Moreover, participants actually reported greater subsequent satisfaction with their selections and wrote better essays when their original set of options had been limited. Implications for future research are discussed.
The purpose of this review is to assess the dose-response relation between physical activity and all-cause mortality. We examined these parameters of physical activity dose: volume, intensity, duration, and frequency.
We used a computer-assisted literature search to identify papers on this topic. After excluding papers examining only two levels of physical activity or fitness, papers investigating specific causes of mortality, reviews, and those not written in English, 44 papers satisfying all criteria were included in this review.
There is clear evidence of an inverse linear dose-response relation between volume of physical activity and all-cause mortality rates in men and women, and in younger and older (> or = 60 yr) persons. Minimal adherence to current physical activity guidelines, which yield an energy expenditure of about 1000 kcal x wk(-1) (4200 kJ x wk(-1)), is associated with a significant 20--30% reduction in risk of all-cause mortality. Further reductions in risk are observed at higher volumes of energy expenditure. It is unclear whether a volume of <1000 kcal x wk(-1) also may be associated with lower risk; there are some data supporting this. Due to limited data, it is also unclear whether vigorous-intensity activity confers additional benefit beyond its contribution to volume of physical activity when compared with moderate-intensity activity. No data are available on duration and frequency of physical activity in relation to all-cause mortality rates after controlling for volume of physical activity.
All studies in this review are observational studies, so conclusions are based on Evidence Category C. There is an inverse linear dose-response relation between volume of physical activity and all-cause mortality. Further research is needed to clarify the contributions of its components--intensity, duration, and frequency--to decreased all-cause mortality rates.
This article critically reviews the evidence that exercise is effective in treating depression in adults. Depression is recognised as a mood state, clinical syndrome and psychiatric condition, and traditional methods for assessing depression (e.g. standard interviews, questionnaires) are described. In order to place exercise therapy into context, more established methods for treating clinical depression are discussed. Observational (e.g. cross-sectional and correlational) and interventional studies of exercise are reviewed in healthy adults, those with comorbid medical conditions, and patients with major depression. Potential mechanisms by which exercise may reduce depression are described, and directions for future research in the area are suggested. The available evidence provides considerable support for the value of exercise in reducing depressive symptoms in both healthy and clinical populations. However, many studies have significant methodological limitations. Thus, more data from carefully conducted clinical trials are needed before exercise can be recommended as an alternative to more traditional, empirically validated pharmacological and behavioural therapies.
Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish.
We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's alpha and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to define limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument.
The final instrument, the Newest Vital Sign (NVS), is a nutrition label that is accompanied by 6 questions and requires 3 minutes for administration. It is reliable (Cronbach alpha >0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish versions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy.
NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.
Using a social marketing approach, we studied how best to adapt proven, evidence-based strategies to increase physical activity for use with underserved racial or ethnic groups.
We conducted focus groups with low-income Hispanic women in Texas, Hmong parents and their children in California, low-income African American women and men in the Mississippi Delta, and Native Hawaiian college students in Hawaii. We also interviewed key leaders of these communities. Topics of discussion were participants' perceptions about 1) the benefits of engaging in physical activity, 2) the proposed evidence-based strategies for increasing each community's level of physical activity, and 3) the benefits and barriers to following the proposed interventions for increasing physical activity. A total of 292 individuals participated in the study.
All groups considered that being physically active was part of their culture, and participants found culturally relevant suggestions for physical activities appealing. Overwhelmingly, strategies that aimed to create or improve social support and increase access to physical activity venues received the most positive feedback from all groups. Barriers to physical activity were not culturally specific; they are common to all underserved people (lack of time, transportation, access, neighborhood safety, or economic resources).
Results indicate that evidence-based strategies to increase physical activity need to be adapted for cultural relevance for each racial or ethnic group. Our research shows that members of four underserved populations are likely to respond to strategies that increase social support for physical activity and improve access to venues where they can be physically active. Further research is needed to test how to implement such strategies in ways that are embraced by community members.
In recent years, multiple imputation has emerged as a convenient and flexible paradigm for analysing data with missing values. Essential features of multiple imputation are reviewed, with answers to frequently asked questions about using the method in practice.
This chapter discusses epidemiologic studies of physical activity and cancer prevention. There is a large body of epidemiologic data on the relation between physical activity and the risk of developing cancer. Although the direct evidence on this relation comes only from observational studies, randomized clinical trials have provided indirect evidence by examining the association of physical activity with markers of cancer risk, such as body weight and hormone levels. Moreover, several plausible biological mechanisms support the hypothesis that higher levels of physical activity decrease the incidence of various cancers. The data are clearest for colon and breast cancer, with case-control and cohort studies supporting a moderate, inverse relation between physical activity and the development of these cancers.
It is estimated that 1 out of 5 American adults lacks the literacy skills needed to function effectively in todays society and as patients they present a challenge to health instruction. This book provides teaching strategies to aid in making self-help and self-management a reality for the patient with low literacy skills. The magnitude of the problem is explored and myths about illiteracy are exemplified. Two chapters deal with comprehension of written materials from theory to practical proven testing techniques including the cloze technique and the word-recognition test. Another chapter offers 2 formulas for testing the readability of written materials: the SMOG formula and the Fry index. Once a problem is identified a 4-step teaching strategy gives tips on teaching the low-literacy patient. For those pamphlets and booklets commonly given to patients suggestions for writing and rewriting to simplify the text are given along with examples of comprehension level. The use of audiotapes for teaching is explored in depth for those who learn better by listening. A chapter on the use of visuals stresses simplification to reduce the amount of text reading to emphasize instruction and to motivate and appropriate examples are given. Where written material audiotapes and visuals are drafted and produced according to the guidelines in the book the last chapter is devoted to pretesting to determine whether intended concepts are coming through. It defines the components of pretesting describes procedures discusses possible stages for production and provides examples of results. Although the book is aimed at providing teaching methods for the low-literate patient the suggestions also apply to the learning disabled.
Previous measures of physical activity for epidemiologic studies were considered Inadequate to meet the needs of a community-based health education trial. Therefore, new methods of quantifying the physical activity habits of communities were developed which are practical for large health surveys, provide Information on the distribution of activity habits in the population, can detect changes in activity over time, and can be compared with other epidemiologic studies of physical activity. Independent sell-reports of vigorous activity (at least 6 metabolic equivalents (METs)), moderate activity (3–5 METs), and total energy expenditure (kilocalories per day) are described, and the physical activity practices of samples of California cities are presented. Relationships between physical activity measures and age, education, occupation, ethnicity, marital status, and body mass index are analyzed, and the reliabilities of the three activity indices are reported. The new assessment procedure is contrasted with nine other measures of physical activity used in community surveys.
This study examined the application of constructs concerning stage of readiness to change and self-efficacy to exercise. We developed two scales to measure stages of change for exercise behavior. Prevalence information on a sample of 1,063 government employees and 429 hospital employees was then obtained. Next, the ability of a questionnaire measuring exercise self-efficacy to differentiate employees according to stage of readiness to change was tested. Results from both stages-of-change scales revealed that 34-39% of employees were regularly participating in physical activity. Scores on efficacy items significantly differentiated employees at most stages. Results indicated employees who had not yet begun to exercise, in contrast with those who exercised regularly, had little confidence in their ability to exercise. Continued work at understanding the stages of exercise behavior and exercise self-efficacy could yield important information for enhancing exercise adoption and adherence.
National objectives for public health have targeted worksite as important settings for interventions to increase physical activity. However, expert reviews reveal no scientific consensus about the effectiveness of worksite interventions for increasing physical activity or fitness.
We judged the quantity and quality of existing evidence against scientific standards for the internal and external validity of the research design and the validity of measurements. Meta-analytic methods were used to quantify the size of effects expressed as Pearson correlation coefficients (r). Variation in effect was examined in relation to several features of the studies deemed important for implementing successful worksite interventions. Pre-experimental cohort studies were excluded because they are sensitive to secular trends in physical activity.
Twenty-six studies involving nearly 9,000 subjects yielded 45 effects. The mean effect was heterogeneous and small, r = 0.11 (95% CI, -0.20 to 0.40), approximating 1/4 S.D., or an increase in binomial success rate from 50% to 56%. Although effects varied slightly according to some of the study features we examined, effects were heterogeneous within levels of these features. Hence, the moderating variables examined did not explain variation in the effects (P > 0.05). The exception was that effects were smaller in randomized studies compared with studies using quasi-experimental designs (P < 0.05).
Our results indicate that the typical worksite intervention has yet to demonstrate a statistically significant increase in physical activity or fitness. The few studies that have used an exemplary sample, research design, and outcome measure have also yielded small or no effects. The generally poor scientific quality of the literature on this topic precludes the judgment that interventions at worksites cannot increase physical activity or fitness, but such an increase remains to be demonstrated by studies using valid research designs and measures.
The purpose of this study was to identify characteristics associated with participation in worksite-based health promotion activities.
Follow-up interviews were used to identify demographic, attitudinal, and behavioral differences among three employee groups. Reasons employees chose not to participate in health promotion activities were also explored.
All respondents were employed at a large midwestern university and were eligible to participate in free onsite health fairs and health promotion programs.
A stratified random sample of 89 nonparticipants, health fair participants, and behavior change program participants was interviewed.
The interview was comprised of questions related to demographic information, personal health habits, physical activity, perceived health status, perceived self-efficacy, worksite norms, health promoting lifestyle factors, and knowledge about health promotion activities.
ANOVA and chi-squared comparisons revealed few group differences. Graduate students and employees with advanced degrees were most likely to take part in health fairs. Behavior change program participants were older, clerical-technical staff members, and women. Faculty members were least likely to participate. A lack of time was the most often cited reason for nonparticipation.
The study was retrospective and the analyses limited due to low statistical power. The results suggest that different groups of employees are attracted to different types of health promotion activities.
To summarize and provide a critical review of worksite health promotion program evaluations published between 1980 and 1995 that address nutrition and hypercholesterolemia. The article discusses and critiques both intervention methods and research methodologies to identify the most effective strategies.
Core articles are 26 original, data-based studies that report on measures of health status, behavior, attitudes, and knowledge as outcomes of worksite nutrition and cholesterol interventions. Only work published since 1980 that clearly describes nutrition or cholesterol interventions and that includes identifiable nutrition-related outcomes is reviewed. The main search method was the same one used for this special issue; supplementary sources included those found in earlier reviews or identified through backward searches or expert contact. SUMMARY OF IMPORTANT FINDINGS: Ten worksite nutrition education programs were reviewed and were categorized as group education, group education plus individual counseling/instruction, cafeteria-based programs, and group education plus cafeteria-based programs. Four of these were randomized studies, and one used the worksite as the unit of randomization and analysis. Sixteen worksite cholesterol programs were reviewed, in five categories: monitoring; individual counseling; group sessions or classes; mediated methods using print, audiovisual, telephone, and self-help kits; and combination approaches. Of these, eight were randomized controlled trials; most tested interventions for persons with elevated cholesterol levels, although four studies reported cholesterol education programs for the general employee population. Six large controlled trials of worksite nutrition and cholesterol interventions in progress are also described.
The conclusions that can be drawn from this review are limited by the study designs used, which often lacked control groups, used nonrandomized designs, or relied on self-selected high-risk or volunteer participants. Our rating for the quality of the evidence in the literature as a whole lies between suggestive and indicative. It is clear that worksite nutrition and cholesterol programs are feasible and that participants benefit in the short-term. Conclusive evidence about a causal relationship between worksite nutrition and cholesterol programs and improved behavior or health is not yet available, although studies currently underway hold promise for providing more solid evidence about the potential efficacy of these interventions.
To examine the methodology of worksite fitness and exercise programs and to assess their effect on health-related fitness, cardiac risk factors, life satisfaction and well-being, and illness and injury.
The 52 studies reviewed cover English-language literature for the period from 1972 to 1994, as identified by a search of the Cumulative Index Medicus, Medline, the Canadian Sport Documentation Centre's "Sport Discus," computerized bibliography, and my own files. Reports were divided into five controlled experimental studies, 14 quasi-experimental studies with matched controls (one reported in abstract), and 33 other interventions of varied quality.
Methodologic problems include difficulty in allowing for Hawthorne effects, substantial sample attrition, and poor definition of the intervention (exercise or broad-based health promotion). Findings are analyzed by specific fitness and health outcomes. Program participants show small but favorable changes in body mass, skinfolds, aerobic power, muscle strength and flexibility, overall risk-taking behavior, systemic blood pressure, serum cholesterol, and cigarette smoking. Claims of improved mood state are based heavily on uncontrolled studies. Quasi-experimental studies suggest reduced rates of illness and injury among participants, but seasonal and year-to-year differences in health weaken possible conclusions.
Participation in worksite fitness programs can enhance health-related fitness and reduce risk-taking behavior, but population effect is limited by low participation rates.
In recent years, multiple imputation has emerged as a convenient and flexible paradigm for analysing data with missing values. Essential features of multiple imputation are reviewed, with answers to frequently asked questions about using the method in practice.
Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.
We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.
The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.
Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
Although physical activity has been consistently inversely associated with colon cancer incidence, the association of physical activity with other diet and lifestyle factors that may influence this association is less well understood. Confounding and effect modification are examined to better understand the physical activity and colon cancer association.
Based on hypothesized biological mechanisms whereby physical activity may alter risk of colon cancer, we evaluated confounding and effect modification using data collected as part of a case-control study of colon cancer (N = 1993 cases and 2410 controls). We examined associations between total energy intake, fiber, calcium, fruit and vegetables, red meat, whole grains as well as dietary patterns along with cigarette smoking, alcohol consumption, BMI, and use of aspirin and/or NSAIDs and physical activity.
No confounding was observed for the physical activity and colon cancer association. However, differences in effects of diet and lifestyle factors were identified depending on level of physical activity. Most striking were statistically significant interactions between physical activity and high-risk dietary pattern and vegetable intake, in that the relative importance of diet was dependent on level of physical activity. The predictive model of colon cancer risk was improved by using an interaction term for physical activity and other variables, including BMI, cigarette smoking, energy intake, dietary fiber, dietary calcium, glycemic index, lutein, folate, vegetable intake, and high-risk diet rather than using models that included these variables as independent predictors with physical activity. In populations where activity levels are high, the estimate of risk associated with high vegetable intake was 0.9 (95% CI 0.6-1.3), whereas in more sedentary populations the estimate of risk associated with high vegetable intake was 0.6 (95% CI 0.5-0.9).
Physical activity plays an important role in the etiology of colon cancer. Its significance is seen by its consistent association as an independent predictor of colon cancer as well as by its impact on the odds ratios associated with other factors. Given these observations, it is most probable that physical activity operates through multiple biological mechanisms that influence the carcinogenic process.
The determinants of physical activity in adults were explored in this study. Explanatory variables included perceived benefits of and perceived barriers to physical activity, and perceived self efficacy for physical activity. Inactive participants were asked to identify barriers to activity, and active participants cited cues prompting them to adopt a physically active lifestyle. Data were collected from 137 adults obtained from work sites, an evening college program, and church groups. Overall, participants were physically active. Self efficacy was the only variable to predict physical activity. Race (i.e., being White) and body mass index (i.e., being overweight) explained perceived barriers to activity. The primary reason for inactivity was lack of time, and the most frequently cited cues to activity were dissatisfaction with one's weight or appearance. Few nursing studies have attempted to increase participants' levels of self efficacy. However, the occupational health nurse is in a unique position to increase workers' perceived self efficacy for activity and, in turn, their activity levels.
To critically review the literature with respect to the effectiveness of worksite physical activity programs on physical activity, physical fitness, and health.
A search for relevant English-written papers published between 1980 and 2000 was conducted using MEDLINE, EMBASE, Sportdiscus, CINAHL, and Psychlit. The key words used involved a combination of concepts regarding type of study, study population, intervention, and outcome measure. In addition, a search was performed in our personal databases, as well as a reference search of the studies retrieved.
The following criteria for inclusion were used: 1) randomized, controlled trial or nonrandomized, controlled trial; 2) working population; 3) worksite intervention program to promote employees' physical activity or physical fitness; and 4) physical activity, physical fitness, or health-related outcomes.
Two reviewers independently evaluated the quality of relevant studies using a predefined set of nine methodological criteria. Conclusions regarding the effectiveness of a worksite physical activity programs were based on a rating system consisting of five levels of evidence.
Fifteen randomized, controlled trials and 11 nonrandomized, controlled trials met the criteria for inclusion and were reviewed. Six randomized, controlled trials and none of the nonrandomized, controlled trials were of high methodological quality. Strong evidence was found for a positive effect of a worksite physical activity program on physical activity and musculoskeletal disorders. Limited evidence was found for a positive effect on fatigue. For physical fitness, general health, blood serum lipids, and blood pressure, inconclusive or no evidence was found for a positive effect.
To increase the level of physical activity and to reduce the risk of musculoskeletal disorders, we support implementation of worksite physical activity programs. For the other outcome measures, scientific evidence of the effectiveness of such a program is still limited or inconclusive, which is mainly the result of the small number of high-quality trials. Therefore, we recommend performing more randomized, controlled trials of high methodological quality, taking into account criteria such as randomization, blinding, and compliance.
This statement was reviewed by and has received the endorsement of the American College of Sports Medicine.
Regular physical activity using large muscle groups, such as walking, running, or swimming, produces cardiovascular adaptations that increase exercise capacity, endurance, and skeletal muscle strength. Habitual physical activity also prevents the development of coronary artery disease (CAD) and reduces symptoms in patients with established cardiovascular disease. There is also evidence that exercise reduces the risk of other chronic diseases, including type 2 diabetes,1 osteoporosis,2 obesity,3 depression,4 and cancer of the breast5 and colon.6 This American Heart Association (AHA) Scientific Statement for health professionals summarizes the evidence for the benefits of physical activity in the prevention and treatment of cardiovascular disease, provides suggestions to healthcare professionals for implementing physical activity programs for their patients, and identifies areas for future investigation. This statement focuses on aerobic physical activity and does not directly evaluate resistance exercises, such as weight lifting, because most of the research linking physical activity and cardiovascular disease has evaluated aerobic activity. Whenever possible, the writing group has cited summary articles or meta-analyses to support conclusions and recommendations. This evidence supports the recommendation from the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) that individuals should engage in 30 minutes or more of moderate-intensity physical activity on most (preferably all) days of the week.7
Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure beyond resting expenditure. Exercise is a subset of physical activity that is planned, structured, repetitive, and purposeful in the sense that improvement or maintenance of physical fitness is the objective. Physical fitness includes cardiorespiratory fitness, muscle strength, body composition, and flexibility, comprising a set of attributes that people …
Reducing morbidity and mortality related to overweight and obesity is a public health priority. Various interventions in school and worksite settings aim to maintain or achieve healthy weight. To identify effective strategies for weight control that can be implemented in these settings, the Task Force on Community Preventive Services (Task Force) has conducted systematic reviews of the evidence on nutrition, physical activity, combinations of these interventions, and other behavioral interventions (e.g., cognitive techniques such as self-awareness and cue recognition). Task Force recommendations are based on evidence of effectiveness, which is defined in this report as achieving a mean weight loss of > or =4 pounds, measured > or =6 months after initiation of the intervention program. The Task Force recommends multicomponent interventions that include nutrition and physical activity (including strategies such as providing nutrition education or dietary prescription, physical activity prescription or group activity, and behavioral skills development and training) to control overweight and obesity among adults in worksite settings. The Task Force determined that insufficient evidence existed to determine the effectiveness of combination nutrition and physical activity interventions to prevent or reduce overweight and obesity in school settings because of the limited number of qualifying studies reporting noncomparable outcomes. This report describes the methods used in these systematic reviews; provides additional information regarding these recommendations; and cites sources for full reviews containing details regarding applicability, other benefits and harms, barriers to implementation, research gaps, and economic data (when available) regarding interventions.
In this review, our first purpose is to provide an overview of existing physical activity intervention research, focusing on subpopulations and intervention modalities. Our reviews within each area are not exhaustive or quantitative, as each area has been reviewed in more depth in numerous other reports. Instead, our goal is to provide a single document that provides a qualitative overview of intervention research that emphasizes selected topics of particular importance for improving the population-wide impact of interventions. Therefore, in synthesizing this vast literature, we begin with existing reviews of physical activity research in each area and incorporate in our discussions recent reports of well-designed individual physical activity intervention studies that expand the existing research base and/or target new areas of research. Our second purpose is to offer new ideas and recommendations to improve the state of the science within each area and, where possible, to propose ideas to help bridge the gaps between these existing categories of research.
Physical activity is an important factor in chronic disease control and prevention. Yet women and rural residents consistently report lower rates of physical activity than their male and urban/suburban counterparts. The objective of this study was to assess the relationship between personal, social, and environmental barriers and meeting moderate physical activity recommendations in a sample of rural women. Data were obtained from a telephone survey of 2,510 residents of rural southeastern Missouri, Tennessee, and Arkansas. After adjusting for age and income, women who identified personal barriers, such as lack of time, no motivation, disinterest in exercise, and having no one to exercise with were less likely to meet physical activity recommendations. There was evidence of a dose-response relationship between the number of barriers identified and meeting moderate physical activity recommendations among women with higher incomes and women with lower incomes; however, this relationship was most striking among women with annual household incomes of 25,000 US Dollar or more. These findings may be used to tailor physical activity interventions to women in rural communities.
To estimate the employed population's exposure to perceived worksite policies and environments hypothesized to promote physical activity and to determine their relationship to leisure-time physical activity.
Cross-sectional, random-digit-dial telephone survey.
Community.
Employed adults (n = 987) in six North Carolina counties.
Outcomes included any leisure-time physical activity, recommended physical activity, and work-break physical activity. Perceived worksite policies and environments included on-site fitness facility at work, safe place to walk outside work, paid time for activity, subsidized health-club membership, and flexible work schedule.
Descriptive statistics were used to describe the study population and exposure to perceived worksite policies and environments. Multivariable logistic regression was used to evaluate relationships between perceived worksite policies and environments and physical activity, controlling for age, race, sex, educational status, disability, and general health status.
Various supportive worksite policies and environments were reported by 15% to 56% of employed participants. Associations between perceived worksite policies and environments and physical activity were strongest for having paid time for non-work-related physical activity, an on-site fitness facility at work, and subsidies for health clubs. Recommended activity was not associated with perceived worksite policies and environments.
Worksite policies and environments are promising factors for future study in physical activity promotion. Studies should evaluate these relationships in other populations and explore measurement error in self-reported worksite policies and environments.
To assess employees'attitudes toward potential barriers to and incentives for their likely use of worksite health promotion services.
Data from the 2004 HealthStyles Survey, a volunteer mail survey, were used to examine selected barriers to, incentives for, and potential use of worksite health promotion programs among adults employed full-time or part-time outside the home (n = 2337).
Respondents were 72.7% white and 52.1 % female; 36.5 % were college graduates, 30.7% had a body mass index of at least 30, and 35.6% were regularly active. The most common reported barriers to use of worksite services were no time during the workday (42.5 %) and no time before or after work (39.4%). More than 70% of employees responded that the following incentives would promote their interest in participating in a free worksite wellness program: convenient time, convenient location, and employer-provided paid time off during the workday. Preferred health promotion services reported by respondents were fitness centers (80.6%), weight loss programs (67.1 %), and on-site exercise classes (55.2 %). Policy practices of paid time to exercise at work and healthy vending or cafeteria food choices were preferred by almost 80% of employees.
These HealthStyles Survey data, in combination with needs data from an employer's own workforce, may help employers design wellness programs to include features that attract employees.