Ben Johnston’s research while affiliated with Health New Zealand and other places

Background Lifestyle behaviors including physical activity, sleep, nutrition, smoking, and alcohol consumption are independently associated with health, yet the relationship between these behaviors and mental health has not been explored among airline pilots. The aim of this study was to measure the association between health behaviors and mental health. Methods A cross‐sectional study was conducted among 502 airline pilots. The primary outcome measure was the mental component score (MCS), derived from the Short Form Health Survey 12v2. We collected information regarding age, sex, ethnicity, height, body mass, alcohol consumption, tobacco smoking status, moderate‐to‐vigorous physical activity (MVPA), fruit and vegetable intake, and sleep duration. Results After controlling for demographic and anthropometric parameters, MVPA, fruit and vegetable intake, and sleep duration were positively correlated with MCS (p ≤ 0.001), and alcohol consumption and tobacco smoking were negatively correlated with MCS (p ≤ 0.001). Multiple linear regression analyses revealed alcohol consumption was the strongest predictor of MCS (β = −0.308, p ≤ 0.001), followed by smoking (β = −0.236, p ≤ 0.001), MVPA (β = 0.233, p ≤ 0.001), sleep (β = 0.148, p ≤ 0.001), and fruit and vegetable intake (β = 0.097, p = 0.003). Conclusion The results suggest that greater physical activity, sleep duration, and fruit and vegetable intake are associated with better mental health. Meanwhile, excessive alcohol consumption and tobacco smoking undermine mental health status.

Objective Blood pressure (BP), cardiorespiratory fitness (CRF), and body composition are independently associated with health outcomes, yet the relationship between these variables has not been explored among airline pilots. The aim of this study was to evaluate the relationship between CRF and BP, and further examine whether the relationship is mediated by body composition. Methods A cross-sectional study was conducted among 356 airline pilots in New Zealand. We measured height, body mass, BP, waist circumference, skinfolds, and CRF (via a WattBike cycle ergometer submaximal VO 2max test). Partial correlation coefficients were estimated to examine the relationships between all variables while controlling for age and sex. Haye's PROCESS macro and the Sobel test were utilized for the mediation analysis. Results All body composition variables (body mass index, waist circumference and body fat percentage) were positively correlated with all BP variables (systolic pressure, diastolic pressure and mean arterial pressure) ( P < 0.001). CRF was negatively correlated with all body composition and BP variables ( P < 0.001). The Sobel test and indirect effect were significant ( P < 0.001), confirming that all body composition variables partially mediate the relationship between CRF and all blood pressure variables. Conclusion Lower CRF is associated with higher blood pressure, and body composition partially mediates the relationship between these health risk factors. These findings highlight the importance of physical fitness and healthy body composition in the management of blood pressure among this occupational group.

INTRODUCTION: The occupational demands of professional airline pilots such as shift work, sleep disruption, fatigue, physical inactivity, and psychological stress may promote adverse outcomes to cardiometabolic health. Indeed, recent studies indicate similar notable prevalence of physiological, behavioral and psychological cardiometabolic health risk factors to general population estimates globally. Obtaining adequate sleep, consuming healthy nutrition, and engaging in sufficient physical activity are three lifestyle behaviors that significantly reduce all-cause mortality and have a positive effect on short and long-term cardiometabolic health. In a series of controlled clinical trials utilizing face-to-face and digital modes of delivery, the effectiveness of a 16-week personalized healthy eating, sleep hygiene, and physical activity program was evaluated for enhancing cardiometabolic health parameters among airline pilots. METHODS: Parallel-group (intervention and control) studies were conducted among airline pilots in New Zealand. The intervention group received a personalized nutrition, sleep and physical activity program over a 16-week period. The control group received no intervention. Outcome measures of objective health (body mass index, blood pressure, resting heart rate, body composition, cardiorespiratory fitness, push-ups, plank hold) and self-reported health (weekly physical activity, sleep quality and duration, fruit and vegetable intake, self-rated physical and mental health, fatigue severity scale, and perceived stress scale) were collected at baseline and post-intervention. The control group completed the same assessments. RESULTS: Significant time x group interactions were observed for all outcome measures at post intervention (p<0.001). All outcome measures significantly improved in the intervention group when compared to the control group (p<0.001). Face-to-face consultations were associated with larger effect size improvements than the digital mode of delivery. DISCUSSION: Our findings demonstrate that a personalized 16-week healthy eating, physical activity, and sleep intervention can elicit and sustain long-term improvements in cardiometabolic health parameters in pilots and may support quality of life during an unprecedented global pandemic. These findings are of interest to professionals who may be in a position to apply preventive medicine research findings to occupational settings. Learning Objectives 1. The audience will gain insight into evidence-based strategies utilized to deliver health behavior interventions. 2. The audience will understand the efficacy of health behavior interventions delivered to airline pilots.

Background: Airline pilots experience unique occupational demands that may contribute to adverse physical and psychological health outcomes. Epidemiological reports have shown a substantial prevalence of cardiometabolic health risk factors including excessive body weight, elevated blood pressure, poor lifestyle behaviors, and psychological fatigue. Achieving health guidelines for lifestyle behavior nutrition, physical activity, and sleep are protective factors against the development of noncommunicable diseases and may mitigate the unfavorable occupational demands of airline pilots. This narrative review examines occupational characteristics for sleep, nutrition, and physical activity and outlines evidence-based strategies to inform health behavior interventions to mitigate cardiometabolic health risk factors among airline pilots. Methods: Literature sources published between 1990 and 2022 were identified through electronic searches in PubMed, MEDLINE (via OvidSP), PsychINFO, Web of Science, and Google Scholar databases, and a review of official reports and documents from regulatory authorities pertaining to aviation medicine and public health was conducted. The literature search strategy comprised key search terms relating to airline pilots, health behaviors, and cardiometabolic health. The inclusion criteria for literature sources were peer-reviewed human studies, meta-analyses, systematic reviews, and reports or documents published by regulatory bodies. Results: The results of the review show occupational factors influencing nutrition, sleep, and physical activity behaviors and delineate evident occupational disruptions to these lifestyle behaviors. Evidence from clinical trials demonstrates the efficacy of nutrition, sleep, and physical activity interventions for enhancing the cardiometabolic health of airline pilots. Conclusion: This narrative review suggests that implementing evidence-based interventions focused on nutrition, physical activity, and sleep could help mitigate cardiometabolic health risk factors among airline pilots, who are particularly susceptible to adverse health outcomes due to unique occupational demands.

Introduction: There is a need for enhanced preventive health care among airline pilots to mitigate the prevalence of cardiometabolic health risk factors. Design: A randomized, waitlist-controlled trial was utilized to evaluate the effectiveness of a smartphone-based app intervention for improving health behaviors and cardiometabolic health parameters. Setting/participants: A total of 186 airline pilots (aged 43.2±9.1 years; male, 64%) were recruited and participated in the trial during 2022. Intervention: This intervention was a personalized, 16-week smartphone-based app multicomponent physical activity, healthy eating, and sleep hygiene intervention. Main outcome measures: Outcome measures of objective health (Cooper's 12-minute exercise test, resting heart rate, push ups, plank isometric hold, body mass), subjective health (self-rated health, perceived psychological stress and fatigue), and health behaviors (weekly physical activity, sleep quality and duration, fruit and vegetable intake) were collected at baseline and after intervention. The waitlist control completed the same measures. Results: Significant interactions for time Χ group from baseline to 16 weeks were found for all outcome measures (p<0.001). Significant between-group differences for positive health changes in favor of the intervention group were found after intervention for all outcome measures (p<0.05, d=0.4-1.0) except for self-rated health, body mass, and Pittsburgh Sleep Quality Index score. Conclusions: Study findings show that an app-based health behavior intervention can elicit positive cardiometabolic health changes among airline pilots over 16 weeks, associated with trivial to large effect sizes. Trial registration: The trial protocol was prospectively registered at The Australian New Zealand Clinical Trials Registry (ACTRN12622000288729).

Cardiometabolic non-communicable diseases (NCD) and their major risk factors are associated with adverse acute and chronic health outcomes and may pose risks to flight safety and economic burden. Restorative sleep, healthy nutrition, and sufficient physical activity are powerful lifestyle behaviours that are fundamental for human health and well-being, and each are independently associated with NCD risk reduction. Although occupational preventive medicine research is increasing, airline pilots are largely underrepresented in the literature. Through a series of seven studies, this PhD thesis aimed to enhance the understanding of modifiable health risk factor status for airline pilots and to investigate evidence-based strategies for promoting positive health, wellness, and NCD risk factor mitigation among airline pilots. To identify priority health risks among airline pilots and to serve as a foundation for further studies within the thesis, Study One systematically explored the global literature pertaining to the prevalence of cardiometabolic health risk factors among airline pilots. Study Two investigated the prevalence and distribution of subjective and objective cardiometabolic health risk factors among New Zealand airline pilots and compared these with the general population. Study Three synthesised global literature and summarised evidence-based considerations regarding the health benefits of sleep hygiene, healthy eating, and physical activity for cardiometabolic health promotion in airline pilots and further discussed evidence-based considerations for enhancing health behaviours in this occupational group. Study Four evaluated the efficacy of a 17-week, three-component personalised sleep, healthy eating, and physical activity lifestyle intervention for enhancing self-report health parameters during the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, Study Five performed a 12-month follow-up investigation of the longitudinal effects of the 17-week intervention on self-report health parameters in addition to body mass and blood pressure management. Study Six further evaluated the effects of the three-component lifestyle intervention with utilisation of a wider range of objective cardiometabolic health parameters. Finally, Study Seven evaluated the efficacy of a smartphone-based app delivery of the three-component lifestyle intervention as a potentially scalable strategy for enhancing health and fitness parameters in airline pilots. In Study One, A total of 47 studies derived from 20 different countries among a total pooled sample of 36,454 airline pilots were reviewed. The systematic review revealed substantial prevalence of > 50% for overweight and obesity, insufficient physical activity, and elevated fatigue among airline pilots globally. Further, this study highlighted the heterogeneity in methodology and lacking quality and quantity among the current literature pertaining to airline pilots, identifying the need for further research to better understand health risk factors and risk factor mitigation strategies among airline pilots. In Study Two, the cross-sectional comparison of health risk factor prevalence between airline pilots (n = 504) and the general population (n = 2,033) identified notable and similar health risk factor prevalence between groups, with elevated prevalence of short sleep, physical inactivity, ‘at risk’ for hypertension, and lower positive self-rated health among airline pilots. Accordingly, findings called for further research to examine targeted, cost-effective intervention methods for promoting healthy body weight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of license, medical incapacity, and to support flight safety. In Study Three, the narrative review outlined occupational health risks in airline pilots, summarised the evidence on health benefits of sleep hygiene, healthy eating, and physical activity as preventive medicine, and discussed evidence-based considerations for promoting health behaviours in this occupational group. In Study Four, 38 airline pilots completed an acute 17-week personalised sleep hygiene, healthy eating, and physical activity intervention which elicited significant improvements in sleep quality and quantity, fruit and vegetable intake, and moderate-to-vigorous physical activity compared to the control group and suggested that achieving health guidelines for these behaviours promoted positive mental and physical health. Study Five, provides further support that the personalised three-component lifestyle intervention can elicit and sustain long-term improvements in body mass and blood pressure management, health behaviours, and perceived subjective health in overweight and obese airline pilots and may support quality of life during an unprecedented global pandemic. In Study Six, further implementation of the personalised three-component lifestyle intervention among 67 overweight airline pilots elicited significant (p = < 0.001) positive change associated with moderate to large effects sizes for objective health measures (VO2max, body mass, skinfolds, girths, blood pressure, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) at 4-months post-intervention, relative to the control group (n = 58). Lastly, Study Seven utilised a randomised control trial design to deliver a smartphone-based app three-component lifestyle intervention among 94 airline pilots, which elicited positive changes associated with trivial to large effects sizes for objective health measures (Cooper’s 12-minute exercise test, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, self-rated health, and perceived stress and fatigue) at 4-months post-intervention, relative to the control group (n = 92). In summary, the studies in this thesis provide a foundation for understanding cardiometabolic health risk factor prevalence among airline pilots. Furthermore, our series of controlled clinical trials provide preliminary evidence that a personalised three-component physical activity, healthy eating, and sleep hygiene intervention can elicit short-term improvements and may promote sustained long-term positive adaptations in objective and subjective health parameters in airline pilots. These findings are important for health care professionals and researchers to provide insight regarding the efficacy of lifestyle interventions for promoting health, and to inform practices relating to disease prevention, health promotion, and public health policy making. Furthermore, in relation to the limited literature base pertaining to health behaviour intervention research among airline pilots, our findings provide novel contributions to this field.

(1) Background: The aim of this study was to evaluate the effectiveness of a three-component nutrition, sleep, and physical activity (PA) program on cardiorespiratory fitness, body composition, and health behaviors in overweight airline pilots. (2) Methods: A parallel group study was conducted amongst 125 airline pilots. The intervention group participated in a 16-week personalized healthy eating, sleep hygiene, and PA program. Outcome measures of objective health (maximal oxygen consumption (VO2max), body mass, skinfolds, girths, blood pressure, resting heart rate, push-ups, plank hold) and self-reported health (weekly PA, sleep quality and duration, fruit and vegetable intake, and self-rated health) were collected at baseline and post-intervention. The wait-list control completed the same assessments. (3) Results: Significant group main effects in favor of the intervention group were found for all outcome measures (p < 0.001) except for weekly walking (p = 0.163). All objective health measures significantly improved in the intervention group when compared to the control group (p < 0.001, d = 0.41–1.04). Self-report measures (moderate-to-vigorous PA, sleep quality and duration, fruit and vegetable intake, and self-rated health) significantly increased in the intervention group when compared to the control group (p < 0.001, d = 1.00–2.69). (4) Conclusion: Our findings demonstrate that a personalized 16-week healthy eating, PA, and sleep hygiene intervention can elicit significant short-term improvements in physical and mental health outcomes among overweight airline pilots. Further research is required to examine whether the observed effects are maintained longitudinally.

Background: The occupational demands of professional airline pilots such as shift work, work schedule irregularities, sleep disruption, fatigue, physical inactivity, and psychological stress may promote adverse outcomes to cardiometabolic health. This review investigates the prevalence of cardiometabolic health risk factors for airline pilots. Methods: An electronic search was conducted utilizing PubMed, MEDLINE (via OvidSP), CINAHL, PsycINFO, SPORTDiscus, CENTRAL, and Web of Science for publications between 1990 and February 2022. The methodological quality of included studies was assessed using two quality assessment tools for cross-sectional and clinical trial studies. The prevalence of physiological, behavioral, and psychological risk factors was reported using descriptive analysis. Results: A total of 48 studies derived from 20 different countries, reviewing a total pooled sample of 36,958 airline pilots. Compared with general population estimates, pilots had a similar prevalence for health risk factors, yet higher sleep duration, lower smoking and obesity rates, less physical activity, and a higher overall rate of body mass index >25. Conclusions: The research reported substantial prevalence >50% for overweight and obesity, insufficient physical activity, elevated fatigue, and regular alcohol intake among pilots. However, the heterogeneity in methodology and the lack of quality and quantity in the current literature limit the strength of conclusions that can be established. Enhanced monitoring and future research are essential to inform aviation health practices and policies (Systematic Review Registration: PROSPERO CRD42022308287).

Objective: To explore the prevalence and distribution of health risk factors in airline pilots and compare these with the general population. Methods: Health risk measures: age, sex, weight, height, body mass index (BMI), blood pressure, sleep, physical activity (PA) and fruit and vegetable intake (FV) were analysed to determine the prevalence and distribution of health risk. Results: Obesity prevalence and BMI was lower in pilots (p=<0.001, −17.5%, d=−0.41, and p=<0.05, −1.8, d=−0.37, respectively), yet overall overweight and obesity prevalence did not differ between groups (p=0.20). No difference was observed between groups for hypertension (p=0.79, h=−0.01), yet a higher proportion of pilots were ‘at risk’ for hypertension (p=<0.001, h=−0.34). The general population had longer sleep duration (p=<0.001, d=0.12), achieved more total PA minutes (p=<0.001, d=0.75), and had a higher prevalence of positive self-rated health (p=<0.001, h=0.31). More pilots achieved >5 servings of FV daily (p=0.002, h=0.16). Conclusion: Pilots had lower obesity prevalence, higher FV, yet lower positive self-health ratings and total PA minutes, and shorter sleep duration overall. Implications for public health: The results indicate notable health risk factor prevalence in airline pilots and the general population. Based on present findings, aviation health researchers should further examine targeted, cost-effective intervention methods for promoting healthy bodyweight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of licence, medical incapacity, and to support flight safety.