Jeanette Reffstrup Christensen

Exercise is more than medicine: The working age population's well-being and productivity

Background Physical activity (PA) includes muscle activity during exercise, manual work, and leisure time activities including sport. Conflicting results exist regarding health effects of PA that may deteriorate with manual work and elite sports, but improve when performed in moderation in accordance with international guidelines and may additionally enhance well-being and productivity. Methods In Denmark 15 randomized controlled trials have been conducted, introducing exercise at the workplace enrolling >3500 workers. The interventions lasted from 10 to 52 weeks and offered ~1 h weekly supervised exercise during working hours according to the concept of intelligent physical exercise training (IPET) that is based on evidenced sports sciences training principles and tailored to work exposure, employee health status, and physical capacity. Questionnaire surveys and health checks including blood and muscle sampling were performed at baseline and follow-up. The job groups included: office and computer workers, dentists, industrial technicians, cleaning personnel, health care workers, construction workers, and fighter/helicopter pilots. Results In all job groups significant improvements were documented regarding health outcomes. These were job group specific: neck pain was reduced among office and computer workers, dentists, industrial laboratory technicians, health care workers as well as fighter pilots. Cardio-respiratory fitness—a health risk indicator for cardio-metabolic diseases—was improved among office and computer workers, health care workers, and construction workers. Additionally, other improvements were evidenced such as increased muscle strength and balance control. Importantly, productivity increased with improved muscle strength and decreased body mass index. Conclusion IPET does enhance health if an exercise program with evidenced efficacy is implemented by expert trainees with support of the employer. Accordingly, in every study group outcomes of improved health were documented and the effect sizes were of clinical relevance. Cost effectiveness estimates indicate acceptable cost relative to savings on health expenses and lost productivity.

Sickness Presenteeism Among Health Care Workers and the Effect of BMI, Cardiorespiratory Fitness, and Muscle Strength.

Objectives: The primary objective of this study was to assess the relationship between sickness presenteeism and body mass index (BMI), cardiorespiratory fitness (CRF), and maximal voluntary contraction (MVC). Methods: Female health care workers (n = 139) were analyzed cross-sectional as well as longitudinal after 3 and 12-month follow-up. Sickness presenteeism was assessed as a summed score using validated questions from three questionnaires: Health and Work Performance Questionnaire, Work Ability Index, and Quantity and Quality Method. CRF was assessed by a maximal cycling test and MVC from four muscle groups. Results: Significant relationships were found between sickness presenteeism and BMI as well as MVC both cross-sectional and as changes over 3 months. Participants with BMI more than 30 kg/m2 had significantly higher sickness presenteeism than those with BMI less than 25 kg/m2. Conclusions: This study suggests that actions that decrease BMI and increase MVC decrease the amount of sickness presenteeism.

The effect of intelligent physical exercise training on sickness presenteeism and absenteeism among office workers

Objective: The aim of this study was to investigate the effect of individually tailored intelligent physical exercise training (IPET) on presenteeism and absenteeism among office workers. Methods: In a 1-year randomized controlled trial (RCT), employees were allocated to a training group TG (N = 193) or control group CG (N = 194). TG received 1-hour high-intensity IPET once a week within working hours, and was recommended to perform 30 minutes of moderate-intensity physical activity (PA) 6 days a week during leisure-time. Results: An intention-to-treat analysis showed no effect on absenteeism, but a significant 4% increase in workability and 9% increase in general health in TG compared with CG. A per-protocol analysis [adherence of ≥70% (N = 89)] in addition showed a significant 6% increase in productivity and a 29% reduction in absenteeism compared with CG. Conclusion: IPET combined with recommendations of leisure-time PA significantly improved presenteeism and decreased absenteeism if following the protocol.

Background, design and conceptual model of the cluster randomized multiple-component workplace study: FRamed Intervention to Decrease Occupational Muscle pain - "FRIDOM"

BackgroundSeveral RCT studies have aimed to reduce either musculoskeletal disorders, sickness presenteeism, sickness absenteeism or a combination of these among females with high physical work demands. These studies have provided evidence that workplace health promotion (WHP) interventions are effective, but long-term effects are still uncertain. These studies either lack to succeed in maintaining intervention effects or lack to document if effects are maintained past a one-year period. This paper describes the background, design and conceptual model of the FRIDOM (FRamed Intervention to Decrease Occupational Muscle pain) WHP program among health care workers. A job group characterized by having high physical work demands, musculoskeletal disorders, high sickness presenteeism - and absenteeism.MethodsFRIDOM aimed to reduce neck and shoulder pain. Secondary aims were to decrease sickness presenteeism, sickness absenteeism and lifestyle-diseases such as other musculoskeletal disorders as well as metabolic-, and cardiovascular disorders – and to maintain participation to regular physical exercise training, after a one year intervention period. The entire concept was tailored to a population of female health care workers. This was done through a multi-component intervention including 1) intelligent physical exercise training (IPET), dietary advice and weight loss (DAW) and cognitive behavioural training (CBT).DiscussionThe FRIDOM program has the potential to provide evidence-based knowledge of the pain reducing effect of a multi component WHP among a female group of employees with a high prevalence of musculoskeletal disorders and in a long term perspective evaluate the effects on sickness presenteeism and absenteeism as well as risk of life-style diseases.Trial registrationNCT02843269, 06.27.2016 - retrospectively registered.

Implementing workplace health promotion: role of middle managers

Purpose The purpose of this paper is to address a missing link between top management and employees when it comes to understanding how to successfully implement and embed workplace health promotion (WHP) as a strategy within organizations: the role of the middle managers. Design/methodology/approach A conceptual framework based on review of theory is applied within an empirical multi-case study that is part of a health intervention research project on increased physical activity among office workers. The study involves six Danish organizations. Findings Middle managers play a key role in successful implementation of WHP, but feel uncertain about their role, especially when it comes to engaging with their employees. Uncertainty about their role appears to make middle managers reluctant to take action on WHP and leave further action to top management instead. Research limitations/implications Limitations included the middle managers’ low attendance at the half-day seminar on strategic health (50 percent attendance), the fact that they were all office workers and they were all from Denmark. Practical implications Middle managers ask for more knowledge and skills if they are to work with WHP in daily business. Social implications Implementing and embedding WHP as a health strategy raises ethical issues of interfering with employees’ health, is seen as the employee’s personal responsibility. Originality/value This study adds to knowledge of the difficulties of implementing and embedding WHP activities in the workplace and suggests an explicit and detailed research design.

A survey on client-centered practice among Danish occupational therapists

Abstract Background: In Denmark, the cost of healthcare services comprise 12% of the gross domestic product. A recommended method for optimizing effectiveness of and enhance client satisfaction with healthcare is client-centred practice (CCP), a central component of occupational therapy ideology. However, Danish occupational therapists’ perceptions of CCP, including the facilitators and barriers that may contribute to CCP, have never been examined. Aim: To examine Danish occupational therapists’ perceptions of CCP. Methods: A survey was conducted using an electronic questionnaire in a small, but representative sample of Danish occupational therapists from all regions and practices. Results: Three hundred and forty-six occupational therapists (5%) responded. Of these, 98% rated CCP as important, 97% considered their work client-centred, and 92% were satisfied with their level of CCP. Having time to conduct self-directed work, using assessments to identify clients’ priorities, and CCP education, but not fixed regimes, were positively correlated with CCP. Conclusion: Danish occupational therapists perceive to practice CCP and appear to have adopted the beliefs, theory and ideals of CCP, perhaps influenced by the egalitarian Danish culture. Self-directed work, means to identify and evaluate their clients’ wishes, and education facilitated CCP. Possible absence of occupational therapists not compliant with CCP makes further research warranted.

Enhancing a Client-Centred Practice with the Canadian Occupational Performance Measure

Background The active participation of clients is an important aspect of rehabilitation quality as conceptualized in client-centred practice (CCP). A recommended outcome measure for enhancing CCP is the Canadian Occupational Performance Measure (COPM). However, the relationship between COPM use and CCP enhancement has not been documented. Aim The aim of this study was to examine whether the use of the COPM enhanced CCP. Methods We performed a scoping review in five steps: (1) identifying a search strategy with inclusion and exclusion criteria; (2) screening relevant databases for published and unpublished studies by using selected keywords and by manually scrutinizing reference lists; (3) agreeing on eligible papers between authors in terms of inclusion and exclusion criteria; (4) charting included data; and (5) analysing data using qualitative content analysis. Results Twelve studies were included in the review. The results indicated enhanced CCP in two themes when using the COPM. These themes appeared to influence each other; therefore, the first theme, Conditions for enhancing CCP when using the COPM, represented the circumstances needed for the second theme, Enhancing CCP when using the COPM, to be fulfilled. Conclusion The use of the COPM seems to enhance CCP if certain conditions are present.

“What an eye-opener” – a qualitative study of vulnerable citizens participating in a municipality-based intervention

ABSTRACT Purpose: To explore how psychologically vulnerable citizens experienced performing their everyday-life activities, identify activities experienced as particularly challenging and evaluate the significance of the Acceptance and Commitment Theory-based (ACT)-based program, Well-being in Daily Life, had on the participants everyday-life activities. Methods: Semi-structured interviews were conducted with eight participants from the Well-being in Daily Life program. Data were analysed using Systematic Text Condensation. Results and Conclusion: The participants experienced anxiety, fatigue, lack of structure, and chaos when performing their everyday-life activities; in addition to being uncertain about the limitations of their own resources. Furthermore, balancing between demands and resources was challenging, also leading to uncertainty and identity conflicts that contributed to the participants’ concerns about re-entering the workforce. The program enabled the participants to develop social skills and trust which contributed to providing the participants with confidence, individually-tailored-possibilities for developing new competencies and courage; thus, facilitating their recovery process.

Dietary Fiber Intake among Normal-Weight and Overweight Female Health Care Workers: An Exploratory Nested Case-Control Study within FINALE-Health

Socioeconomic factors affect choice of diet, that is, dietary fiber intake. Underreporting of food consumption in diet surveys has been reported higher in low-income, low-education groups compared to high-income, high-education groups. This paper examines in a socioeconomic homogenous low-income low-education group of females the relation between dietary fiber intake and overweight and scrutinizes if the level of underreporting is equally large in normal-weight and overweight groups. Thirty-four female health care workers classified as either normal-weight (N = 18) or obese (N = 16) based on BMI, fat percentage, and waist circumference participated. A detailed food-diary was used to record their dietary intake in 9 days. Average dietary fiber intake in the normal-weight group was 2.73 +/− 0.65 g/MJ, while it was 2.15 +/− 0.64 g/MJ for the women in the obese group. In both groups, the overall food intake was underreported. In spite of a significantly lower dietary fiber intake in the obese group, the present population of women working within health care all showed an overall low dietary fiber intake and a general underreporting of food intake. These results indicate a clear need for dietary advice especially on fiber intake to increase general health and decrease weight.

Degree of disability among female healthcare workers who are overweight or obese

Abstract Background: The prevalence of overweight and obesity is increasing worldwide. Research has clarified that being overweight or obese can lead to disability in everyday life. Aim: The present study explores the association between the degrees of experienced disability in Danish female healthcare workers with a Body Mass Index (BMI) classified as being overweight or obese, compared to female healthcare workers classified as being normal weight. Material and methods: 67 females with a mean age of 49.5 years and a mean BMI of 27.5 kg/m2 completed a questionnaire exploring the degree of experienced disability in their everyday lives. Results: The degree of disability in the following activities were significantly higher among females who were obese compared to females who were normal weight; Walking up/down two or more staircases, Pedicure, Dressing the lower body and Exercising outside the home. No statistical differences were found between the females that were overweight and the females that were normal weight. Conclusion: Female healthcare workers who are obese experience a higher degree of disability, than females with a normal weight. Offering an occupational therapy intervention to reduce disability and facilitate participation in everyday life could be relevant.