K.I. Proper

Meta-analyses of workplace physical activity and dietary behaviour interventions on weight outcomes

This meta‐analytic review critically examines the effectiveness of workplace interventions targeting physical activity, dietary behaviour or both on weight outcomes. Data could be extracted from 22 studies published between 1980 and November 2009 for meta‐analyses. The GRADE approach was used to determine the level of evidence for each pooled outcome measure. Results show moderate quality of evidence that workplace physical activity and dietary behaviour interventions significantly reduce body weight (nine studies; mean difference [MD]−1.19 kg [95% CI −1.64 to −0.74]), body mass index (BMI) (11 studies; MD −0.34 kg m−2[95% CI −0.46 to −0.22]) and body fat percentage calculated from sum of skin‐folds (three studies; MD −1.12% [95% CI −1.86 to −0.38]). There is low quality of evidence that workplace physical activity interventions significantly reduce body weight and BMI. Effects on percentage body fat calculated from bioelectrical impedance or hydrostatic weighing, waist circumference, sum of skin‐folds and waist–hip ratio could not be investigated properly because of a lack of studies. Subgroup analyses showed a greater reduction in body weight of physical activity and diet interventions containing an environmental component. As the clinical relevance of the pooled effects may be substantial on a population level, we recommend workplace physical activity and dietary behaviour interventions, in cluding an environment component, in order to prevent weight gain.

The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review

Ergonomic interventions (physical and organisational) are used to prevent or reduce low back pain (LBP) and neck pain among workers. We conducted a systematic review of randomised controlled trials (RCTs) on the effectiveness of ergonomic interventions. A total of 10 RCTs met the inclusion criteria. There was low to moderate quality evidence that physical and organisational ergonomic interventions were not more effective than no ergonomic intervention on short and long term LBP and neck pain incidence/prevalence, and short and long term LBP intensity. There was low quality evidence that a physical ergonomic intervention was significantly more effective for reducing neck pain intensity in the short term (ie, curved or flat seat pan chair) and the long term (ie, arm board) than no ergonomic intervention. The limited number of RCTs included make it difficult to answer our broad research question and the results should be interpreted with care. This review, however, provides a solid overview of the high quality epidemiological evidence on the (usually lack of) effectiveness of ergonomic interventions on LBP and neck pain.

The effectiveness of participatory ergonomics to prevent low-back and neck pain - results of a cluster randomized controlled trial

OBJECTIVE The aim of this randomized controlled trial (RCT) was to investigate the effectiveness of the Stay@Work participatory ergonomics (PE) program to prevent low-back and neck pain. METHODS A total of 37 departments were randomly allocated to either the intervention (PE) or control group (no PE). During a six-hour meeting, working groups followed the PE steps and composed and prioritized ergonomic measures aimed at preventing low-back and neck pain. Subsequently, working groups were requested to implement the ergonomic measures in the departments. The primary outcomes were low-back and neck pain prevalence and secondary outcomes were pain intensity and duration. Data were collected by questionnaires at baseline, and after 3-, 6-, 9-, and 12-months follow-up. Additionally, the course of low-back and neck pain (transitions from no symptoms to symptoms and from symptoms to no symptoms) was modeled. RESULTS The randomization procedure resulted in 19 intervention departments (N=1472 workers) and 18 control departments (N=1575 workers). After 12 months, the intervention was not more effective than the control group in reducing the prevalence of low-back and neck pain or reducing pain intensity and duration. PE did not increase the probability of preventing low-back pain [odds ratio (OR) 1.23, 95% confidence interval (95% CI) 0.97-1.57) or neck pain (OR 1.01, 95% CI 0.74-1.40). However, PE increased the probability of recovering from low-back pain (OR 1.41, 95% CI 1.01-1.96), but not from neck pain (OR 0.95, 95% CI 0.72-1.26). CONCLUSION PE neither reduced low-back and neck pain prevalence nor pain intensity and duration nor was it effective in the prevention of low-back and neck pain or the recovery from neck pain. However, PE was more effective in the recovery from low-back pain.

The role of work ability in the relationship between aerobic capacity and sick leave: a mediation analysis

Objectives To examine: (1) the relationships between aerobic capacity, work ability and sick leave; (2) the potential mediating effect of work ability in the relationship between aerobic capacity and sick leave; and (3) the influence of age on these relationships. Methods Information on aerobic capacity (predicted VO2max), age, gender, type of work, cardiovascular risk and body mass index was collected from 580 workers at baseline. Work ability was assessed with the Work Ability Index at first follow-up (mean 3.4±1.3 years after baseline). The second follow-up period was defined as the time between completing the Work Ability Index and the first registered sick leave episode. Mediation analyses were performed using linear and Cox regression models. Results A lower aerobic capacity was found to be significantly related to sick leave (HR=0.98; τ=−0.018; 95% CI 0.970 to 0.994). There was a significant positive relationship between aerobic capacity and work ability (α=0.165; 95% CI 0.122 to 0.208). Also, lower work ability was significantly related to sick leave after controlling for aerobic capacity (HR=0.97; β=−0.033; 95% CI 0.949 to 0.987). The mediating effect of work ability in the relationship between aerobic capacity and sick leave was −0.005 (SE=0.002), and mediated 27.8% (95% CI 10.4 to 45.2) of the total effect of aerobic capacity on sick leave. Age did not influence the relationship between aerobic capacity and sick leave. Conclusions Fit workers had better work ability, and both fit workers and workers with higher work ability were at lower risk of starting an episode of sick leave.

Challenges at work and financial rewards to stimulate longer workforce participation

BackgroundBecause of the demographic changes, appropriate measures are needed to prevent early exit from work and to encourage workers to prolong their working life. To date, few studies have been performed on the factors motivating continuing to work after the official age of retirement. In addition, most of those studies were based on quantitative data. The aims of this study were to examine, using both quantitative and qualitative data: (1) the reasons for voluntary early retirement; (2) the reasons for continuing working life after the official retirement age; and (3) the predictive value of the reasons mentioned.MethodsQuantitative data analyses were performed with a prospective cohort among persons aged 55 years and older. Moreover, qualitative data were derived from interviews with workers together with discussions from a workshop among occupational physicians and employers.ResultsResults showed that the presence of challenging work was among the most important reasons for not taking early retirement. In addition, this motive appeared to positively predict working status after three years. The financial advantages of working and the maintenance of social contacts were the reasons reported most frequently for not taking full retirement, with the financial aspect being a reasonably good predictor for working status after three years. From the interviews and the workshop, five themes were identified as important motives to prolong working life: challenges at work, social contacts, reward and appreciation, health, and competencies and skills. Further, it was brought forward that each stakeholder can and should contribute to the maintenance of a healthy and motivated ageing workforce.ConclusionBased on the findings, it was concluded that measures that promote challenges at work, together with financial stimuli, seem to be promising in order to prolong workforce participation.

Process Evaluation of a Workplace Health Promotion Intervention Aimed at Improving Work Engagement and Energy Balance

Objective: To evaluate the process of the implementation of an intervention aimed at improving work engagement and energy balance, and to explore associations between process measures and compliance. Methods: Process measures were assessed using a combination of quantitative and qualitative methods. Results: The mindfulness training was attended at least once by 81.3% of subjects, and 54.5% were highly compliant. With regard to e-coaching and homework exercises, 6.3% and 8.0%, respectively, were highly compliant. The training was appreciated with a 7.5 score and e-coaching with a 6.8 score. Appreciation of training and e-coaching, satisfaction with trainer and coach, and practical facilitation were significantly associated with compliance. Conclusion: The intervention was implemented well on the level of the mindfulness training, but poorly on the level of e-coaching and homework time investment. To increase compliance, attention should be paid to satisfaction and trainer-participant relationship.

Short term effect of feedback on fitness and health measurements on self reported appraisal of the stage of change

Background: An individual’s current status of physical activity and nutrition and readiness to change can be determined using PACE assessment forms. Practitioners have suggested that feedback on the fitness and health components can produce a change in a subject’s awareness of their behaviour and thereby lead to a beneficial change in stage of behaviour change. Objective: To evaluate the short term effect of personalised feedback on fitness and health status on self reported appraisal of the stage of change. Methods: A total of 299 civil servants were randomised to an intervention or a reference group. After having been tested for fitness and health, the intervention group received immediate feedback on their test results, whereas the reference group did not. PACE assessment forms were completed twice: before testing and after testing (reference group), or after testing and feedback (intervention group). The time interval between was one hour. The influence of feedback was determined using a x2 test and analysis of variance. Results: On the basis of the x2 test, no significant effect of feedback was found on the stage of change of physical activity, nor on the stage of change with regard to nutrition. Analysis of variance results showed no significant effect on the raw PACE score as to physical activity, intake of fruit and vegetables and dietary fat. However, a significant effect was observed on the PACE score of “calorie intake and weight management”. Subjects in the intervention group significantly more often regressed on their PACE score on this topic than the reference subjects. Conclusions: Feedback at baseline on measurements of an intervention study can influence PACE scores and can be considered as a small but relevant start of the intervention itself.

Meeting the challenges of implementing an intervention to promote work ability and health-related quality of life at construction worksites: a process evaluation.

Objective: To evaluate the process of a prevention program among construction workers. Methods: The program consisted of training sessions of a physical therapist and an empowerment trainer, and a Rest-Break Tool. Data on seven process items were collected by means of questionnaires and interviews. Results: Recruiting construction companies to participate was difficult. The therapists and trainer largely provided the training sessions as intended, but the Rest-Break Tool was poorly implemented. Construction workers (n = 171) showed high reach (84%) and moderate attendance rates (three of four sessions). Sixty-four percent of the construction workers recommended the overall program to colleagues. Company size, economic recession, engagement of the management, and intervention year influenced dose delivered and satisfaction. Conclusions: The study showed a successful reach, dose and fidelity, and moderate satisfaction. Furthermore, contextual factors played an important role during the implementation.

Barriers and Facilitators to Implementation of an Occupational Health Guideline Aimed at Preventing Weight Gain Among Employees in the Netherlands

Objective: To assess barriers and facilitators to implementation of an occupational health guideline aimed at preventing weight gain. Methods: Barriers and facilitators to implementation were assessed among 14 occupational physicians (OPs) and employers and analyzed following a systematic approach using Atlas.ti. Results: Barriers and facilitators mentioned by OPs and employers were related to the sociopolitical context, organization, OP, and guideline. Recommendations include the formation of a linkage group, collaboration with other experts, formation of peer support groups, and communicating benefits of investments, expectations, and ethical considerations. Results of this study recommend incorporating these barriers and facilitators in the guideline, including strategies about how to overcome barriers and stimulate facilitators. Conclusions: The identified barriers and facilitators can be used to increase the chance of successful implementation of the final guideline into occupational health practices throughout the Netherlands.

An exploratory study of associations of physical activity with mental health and work engagement

BackgroundPrevious studies have found moderate to vigorous physical activity (MVPA) to be associated with a decreased risk of mental disorders. Although the focus in the field of psychology has shifted towards human strengths and optimal functioning, studies examining associations between MVPA and mental health in general (MH) and between MVPA and well-being are scarce. An indicator of work-related well-being is work engagement (WE). The aim of this study was to explore the associations between MVPA and MH, and between MVPA and WE.MethodsIn this study, a total of 257 employees from two research institutes, self-reported their MVPA, MH and level of WE. In addition, a randomly chosen subgroup (n=100) wore an Actigraph accelerometer for a 1-week period to measure their MVPA objectively. Crude and adjusted associations between MVPA and both WE and MH were analyzed using linear regression analyses.ResultsThere was no statistically significant association between self-reported MVPA and mental health, resulting from both the crude (b=0.058, 95% CI -0.118 - 0.235) and adjusted analyses (b=0.026; 95% CI -0.158- 0.210), nor between objectively measured MVPA and mental health for both crude and adjusted analyses (b=-0.144; 95% CI -1.315- 1.027; b=-0.199; 95% CI 1.417- 1.018 respectively). There was also no significant association between self-reported MVPA and work engagement (crude: b=0.005; 95% CI -0.005-0.016, adjusted: b= 0.002; 95% CI -0.010- 0.013), nor between objectively measured MVPA and work engagement (crude: b= 0.012; 95% CI -0.084- 0.060, adjusted: b=0.007; 95% CI -0.083-0.069).ConclusionsAlthough the beneficial effects of MVPA on the negative side of MH (i.e. mental disorders) have been established in previous studies, this study found no evidence for the beneficial effects of MVPA on positive side of MH (i.e. well-being). The possible difference in how the physical activity-mental health relationship works for negative and positive sides of MH should be considered in future studies.