Vincent H. Hildebrandt

Effect of Individual Counseling on Physical activity fitness and health: A randomized controlled trial in a workplace setting

BACKGROUND Physical inactivity and obesity are major public health problems. Our objective was to investigate the effectiveness of an individual counseling intervention at the workplace on physical activity fitness and health. Counseling content derived from the Patient-centered Assessment and Counseling for Exercise and Nutrition (PACE) program. METHODS A total of 299 employees of three municipal services in the Dutch town of Enschede were randomly allocated into intervention (n =131) and control group (n =168). Over a 9-month period, intervention group subjects were offered seven counseling sessions. Counseling was based on the individuals stage of behavioral change using PACE physical activity and nutrition protocols. Subjects in both the intervention and control group received written information about several lifestyle factors. Primary outcome measures were physical activity (total energy expenditure, during sports activities, during physical activity leisure time other than sports, and meeting the moderate-intensity public health recommendations); cardiorespiratory fitness; and prevalence of musculoskeletal symptoms. Secondary outcome measures were body composition (body mass index [BMI], and percentage of body fat measured via skinfold thicknesses); blood pressure; and blood cholesterol. RESULTS There were significant positive effects on total energy expenditure, physical activity during sports, cardiorespiratory fitness, percentage of body fat, and blood cholesterol. No effects were found for the proportion of subjects meeting the public health recommendation of moderate-intensity physical activity, physical activity during leisure time other than sports, prevalence of musculoskeletal symptoms, body mass index, and blood pressure. CONCLUSIONS Individual face-to-face counseling at the workplace based on PACE protocols positively influenced physical activity levels and some components of physical fitness. The implementation of workplace counseling programs for individuals should therefore be promoted.

Effect of sporting activity on absenteeism in a working population

Objectives: To determine the effects of sporting activity on absenteeism in a working population. Methods: Data were used from a prospective cohort study in a working population with a follow up period of 3 years and were collected with yearly questionnaires or collected from company records. Complete data on absenteeism, sporting activity, and potential confounders were collected for 1228 workers. ANOVA was used to test differences in frequency and duration of absenteeism, correlations were computed to measure the association between number of sporting years (divided by age) and frequency and duration of absenteeism, and survival analysis, according to the Cox proportional hazards model, was used to test differences in relative risk at absenteeism and recovery. All analyses were adjusted for age, gender, smoking, and alcohol consumption, and were stratified for employees with sedentary and with more active jobs. Results: ANOVA showed a statistically significant higher mean duration of absenteeism among employees not practicing sports, of approximately 20 days over a period of 4 years. The survival analysis showed an increased relative risk at absenteeism (relative risk (RR) 1.09; confidence interval (CI) 1.01 to 1.18) and a decreased relative risk at recovery (RR 0.90; CI 0.85 to 0.95) for employees not practicing sports. The effect of sporting activity is larger in employees with sedentary work. No associations were found between number of sporting years and absenteeism. Conclusion: Employees practicing sports take sick leave significantly less often than their colleagues not practicing sports, while their periods of sick leave are shorter, especially when their work is sedentary.

What is actually measured in process evaluations for worksite health promotion programs: a systematic review

BackgroundNumerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle (i.e., physical activity, nutrition, smoking, alcohol use and relaxation). Research primarily focused on the effectiveness of these WHPPs. Whereas process evaluations provide essential information necessary to improve large scale implementation across other settings. Therefore, this review aims to: (1) further our understanding of the quality of process evaluations alongside effect evaluations for WHPPs, (2) identify barriers/facilitators affecting implementation, and (3) explore the relationship between effectiveness and the implementation process.MethodsPubmed, EMBASE, PsycINFO, and Cochrane (controlled trials) were searched from 2000 to July 2012 for peer-reviewed (randomized) controlled trials published in English reporting on both the effectiveness and the implementation process of a WHPP focusing on physical activity, smoking cessation, alcohol use, healthy diet and/or relaxation at work, targeting employees aged 18-65 years.ResultsOf the 307 effect evaluations identified, twenty-two (7.2%) published an additional process evaluation and were included in this review. The results showed that eight of those studies based their process evaluation on a theoretical framework. The methodological quality of nine process evaluations was good. The most frequently reported process components were dose delivered and dose received. Over 50 different implementation barriers/facilitators were identified. The most frequently reported facilitator was strong management support. Lack of resources was the most frequently reported barrier. Seven studies examined the link between implementation and effectiveness. In general a positive association was found between fidelity, dose and the primary outcome of the program.ConclusionsProcess evaluations are not systematically performed alongside effectiveness studies for WHPPs. The quality of the process evaluations is mostly poor to average, resulting in a lack of systematically measured barriers/facilitators. The narrow focus on implementation makes it difficult to explore the relationship between effectiveness and implementation. Furthermore, the operationalisation of process components varied between studies, indicating a need for consensus about defining and operationalising process components.

The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers

Abstract This study assessed the effectiveness of a single intervention targeting work style and a combined intervention targeting work style and physical activity on the recovery from neck and upper limb symptoms. Computer workers with frequent or long‐term neck and upper limb symptoms were randomised into the work style group (WS, n = 152), work style and physical activity group (WSPA, n = 156), or usual care group (n = 158). The WS and WSPA group attended six group meetings. All meetings focused on behavioural change with regard to body posture, workplace adjustment, breaks and coping with high work demands (WS and WSPA group) and physical activity (WSPA group). Pain, disability at work, days with symptoms and months without symptoms were measured at baseline and after 6 (T1) and 12 months (T2). Self‐reported recovery was assessed at T1/T2. Both interventions were ineffective in improving recovery. The work style intervention but not the combined intervention was effective in reducing all pain measures. These effects were present in the neck/shoulder, not in the arm/wrist/hand. For the neck/shoulder, the work style intervention group also showed an increased recovery‐rate. Total physical activity increased in all study groups but no differences between groups were observed. To conclude, a group‐based work style intervention focused on behavioural change was effective in improving recovery from neck/shoulder symptoms and reducing pain on the long‐term. The combined intervention was ineffective in increasing total physical activity. Therefore we cannot draw conclusions on the effect of increasing physical activity on the recovery from neck and upper limb symptoms.

Evaluation of Neural Networks to Identify Types of Activity Using Accelerometers

PURPOSE To develop and evaluate two artificial neural network (ANN) models based on single-sensor accelerometer data and an ANN model based on the data of two accelerometers for the identification of types of physical activity in adults. METHODS Forty-nine subjects (21 men and 28 women; age range = 22-62 yr) performed a controlled sequence of activities: sitting, standing, using the stairs, and walking and cycling at two self-paced speeds. All subjects wore an ActiGraph accelerometer on the hip and the ankle. In the ANN models, the following accelerometer signal characteristics were used: 10th, 25th, 75th, and 90th percentiles, absolute deviation, coefficient of variability, and lag-one autocorrelation. RESULTS The model based on the hip accelerometer data and the model based on the ankle accelerometer data correctly classified the five activities 80.4% and 77.7% of the time, respectively, whereas the model based on the data from both sensors achieved a percentage of 83.0%. The hip model produced a better classification of the activities cycling, using the stairs, and sitting, whereas the ankle model was better able to correctly classify the activities walking and standing still. All three models often misclassified using the stairs and standing still. The accuracy of the models significantly decreased when a distinction was made between regular versus brisk walking or cycling and between going up and going down the stairs. CONCLUSIONS Relatively simple ANN models perform well in identifying the type but not the speed of the activity of adults from accelerometer data.

Short and long term effects of a lifestyle intervention for construction workers at risk for cardiovascular disease: A randomized controlled trial

BackgroundThe prevalence of overweight and elevated cardiovascular disease (CVD) risk among workers in the construction industry is relatively high. Improving lifestyle lowers CVD risk and may have work-related benefits. The purpose of the study was to evaluate the effects on physical activity (PA), diet, and smoking of a lifestyle intervention consisting of individual counseling among male workers in the construction industry with an elevated risk of cardiovascular disease (CVD).MethodsIn a randomized controlled trial including 816 male blue- and white-collar workers in the construction industry with an elevated risk of CVD, usual care was compared to a 6-month lifestyle intervention. The intervention consisted of individual counseling using motivational interviewing techniques, and was delivered by an occupational physician or occupational nurse. In three face to face and four telephone contacts, the participants risk profile, personal determinants, and barriers for behavior change were discussed, and personal goals were set. Participants chose to aim at either diet and PA, or smoking. Data were collected at baseline and after six and 12 months, by means of a questionnaire. To analyse the data, linear and logistic regression analyses were performed.ResultsThe intervention had a statistically significant beneficial effect on snack intake (β-1.9, 95%CI -3.7; -0.02) and fruit intake (β 1.7, 95%CI 0.6; 2.9) at 6 months. The effect on snack intake was sustained until 12 months; 6 months after the intervention had ended (β -1.9, 95%CI -3.6; -0.2). The intervention effects on leisure time PA and metabolic equivalent-minutes were not statistically significant. The beneficial effect on smoking was statistically significant at 6 (OR smoking 0.3, 95%CI 0.1;0.7), but not at 12 months (OR 0.8, 95%CI 0.4; 1.6).ConclusionsBeneficial effects on smoking, fruit, and snack intake can be achieved by an individual-based lifestyle intervention among male construction workers with an elevated risk of CVD. Future research should be done on strategies to improve leisure time PA and on determinants of maintenance of changed behavior. Considering the rising prevalence of unhealthy lifestyle and CVD, especially in the aging population, implementation of this intervention in the occupational health care setting is recommended.Trial registrationCurrent Controlled Trials ISRCTN60545588

Overweight and Obesity as Predictors of Absenteeism in the Working Population of the Netherlands

Objective: To determine the relation between body mass index (BMI) and absenteeism. Methods: Data were collected in a prospective cohort study (n = 1284). Multilevel analyses (linear mixed model with random intercept) with two levels (employee and company) were used to test whether BMI was related to duration and frequency of absenteeism and whether this relation was influenced by sports participation. Results: Obese employees were absent 14 days a year more than normal-weight employees. Also the frequency of absenteeism of more than 7 days was significantly higher. The differences in absenteeism between obese and normal-weight employees were larger for employees who did not practice sport regularly. Conclusions: Obese employees are more often absent and are absent longer, especially when they do not practice sport regularly. An active company policy to prevent obesity is needed, both from a health and a business efficiency perspective.

The association between commuter cycling and sickness absence

OBJECTIVE To study the association between commuter cycling and all-cause sickness absence, and the possible dose-response relationship between absenteeism and the distance, frequency and speed of commuter cycling. METHOD Cross-sectional data about cycling in 1236 Dutch employees were collected using a self-report questionnaire. Company absenteeism records were checked over a one-year period (May 2007-April 2008). Propensity scores were used to make groups comparable and to adjust for confounders. Zero-inflated Poisson models were used to assess differences in absenteeism between cyclists and non-cyclists. RESULTS The mean total duration of absenteeism over the study year was more than 1 day shorter in cyclists than in non-cyclists. This can be explained by the higher proportion of people with no absenteeism in the cycling group. A dose-response relationship was observed between the speed and distance of cycling and absenteeism. Compared to people who cycle a short distance (<or=5 km) three times a week, people who cycle more often and longer distances are absent for fewer days on average. CONCLUSION Cycling to work is associated with less sickness absence. The more often people cycle to work and the longer the distance travelled, the less they report sick.

The (cost-)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers

BackgroundNeck and upper limb symptoms are frequently reported by computer workers. Work style interventions are most commonly used to reduce work-related neck and upper limb symptoms but lifestyle physical activity interventions are becoming more popular to enhance workers health and reduce work-related symptoms. A combined approach targeting work style and lifestyle physical activity seems promising, but little is known on the effectiveness of such combined interventions.Methods/designThe RSI@Work study is a randomised controlled trial that aims to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention to reduce neck and upper limb symptoms in computer workers. Computer workers from seven Dutch companies with frequent or long-term neck and upper limb symptoms in the preceding six months and/or the last two weeks are randomised into three groups: (1) work style group, (2) work style and physical activity group, or (3) control group. The work style intervention consists of six group meetings in a six month period that take place at the workplace, during work time, and under the supervision of a specially trained counsellor. The goal of this intervention is to stimulate workplace adjustment and to improve body posture, the number and quality of breaks and coping behaviour with regard to high work demands. In the combined (work style and physical activity) intervention the additional goal is to increase moderate to heavy physical activity. The control group receives usual care. Primary outcome measures are degree of recovery, pain intensity, disability, number of days with neck and upper limb symptoms, and number of months without neck and upper limb symptoms. Outcome measures will be assessed at baseline and six and 12 months after randomisation. Cost-effectiveness of the group meetings will be assessed using an employers perspective.DiscussionThis study will be one of the first to assess the added value of a lifestyle physical activity intervention in addition to a work style intervention in reducing neck and upper limb symptoms of computer workers. The results of the study are expected in 2007.

Physical activity, cardiorespiratory fitness, and body mass index in relationship to work productivity and sickness absence in computer workers with preexisting neck and upper limb symptoms

Objective: The purpose of this study was to investigate associations among three modifiable risk factors (ie, physical activity, cardiorespiratory fitness, and body mass index), work productivity, and sickness absence in computer workers. Methods: All participants were computer workers with neck and upper limb symptoms in the preceding 6 months, the last 2 weeks, or both. Productivity and sickness absence were assessed with the Health and Performance Questionnaire (HPQ). Results: Physical activity and cardiorespiratory fitness were not associated with work productivity or sickness absence. Obese male workers reported lower absolute productivity than lean workers. Lean and overweight workers reported similar productivity levels. Body mass index was not associated with sickness absence. Conclusions: In a population of white-collar workers with neck and upper limb symptoms, obese male workers showed significantly lower productivity than did lean or overweight workers.