Getting workers physically active: what works in companies?

1. Getting workers physically active: what works in companies? Lindsey Dugdill

2. Joint Health Surveys for England (DOH, 1999) estimate that two thirds of the population are not taking enough exercise to benefit their health

3. Chief Medical Officer’s Guideline for PA • Adults – • Minimum 5 x 30 minutes/week moderate PA • Walking target – 10,000 steps/day • Children - Minimum 60 minutes/day moderate PA which can be accumulated in bouts • Department of Health. (2004b) At Least Five a Week. Evidence of the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. HMSO, London.

4. Federation of European Employers • Average weekly working hours for full time workers • UK 43.2 hours • Ireland 42.5 hours • France 40.2 hours • Poland 45.4 hours “Lack of time” is cited as biggest barrier to PA • http://www.fedee.com/workinghours.shtml

5. Cultural Change • Transportation • Automation • Sedentary jobs made worse by IT technology!

6. The reality of workplace PA? The fittest tend to take up intervention opportunities – we need interventions that will impact on all workers!

7. Making PA the easy lifestyle choice • Not every employee wants to exercise during work/at work so we need to make PA integral to all parts of the working day • Have flexible working time practices/family friendly policies that allow parents to walk children to school • Encourage active commuting through green travel plans • Incentive schemes to enable staff to buy bikes etc • Maximise opportunities for PA at work, encourage walking to meetings, ensure good facilities, showers, bike racks • Consider design of buildings which can encourage PA • Endorse structured PA – sponsoring PA team activities • Raise the profile of PA – market achievements of employees

8. A REVIEW OF EFFECTIVENESS OF WORKPLACE HEALTH PROMOTION INTERVENTIONS ON PHYSICAL ACTIVITY AND WHAT WORKS IN MOTIVATING & CHANGING EMPLOYEES’ HEALTH BEHAVIOURDugdill L, Brettle A, McCluskey S, Hulme C and Long A (2007) Intervention Guidance on Workplace Health Promotion with reference to Physical Activity and what works in Motivating and Changing Employees’ Health Behaviour. Systematic Review for the National Institute of Health and Clinical Excellence, University of Salford.Dugdill L, Brettle A, Hulme C, McCluskey S and Long AT (2008) Workplace physical activity interventions: a systematic review, International Journal of Workplace Health Management, 1:1: 20-40, DOI 10.1108/17538350810865578

9. Review aims • which types of workplace PA intervention were effective in changing behaviour for different workforce sectors and types of workplace. • what aspects of design (length/intensity) and delivery (employee involvement) contributed to effective workplace PA interventions. • what the motivators, barriers and facilitators were for employers and employees (during interventions that lead to increases in PA outcomes).

10. Systematic Reviews • Dishman et al., 1998; Proper et al., 2003; Badland et al., 2004. • Proper concluded strong evidence of effectiveness but based on two RCTs only. • Our conclusion - inconclusive review level evidence that workplace PA interventions have a significant effect on PA.

11. Stair walking interventions • Evidence from 4 studies showed that the use of posters/signs can increase stair (instead of lift) usage, however in 2 studies usage had declined back to baseline at follow up/end of study period suggesting effectiveness in short term. • Only 1 study reported a significant effect for stair ascent • 1 study reported provision of written materials can increase stair use • 2 studies reported a decline in step usage/step count post intervention

12. POINT OF DECISION PROMPTS Signson stairs, lobbies and stair rises (which give information on benefits of PA) can all help to encourage stair climbing in employees however, signs can also irritate people and some studies record that signs have been taken down! Try not to preach!

13. Changing the stair environment • Painting/placing artwork in stairwells • Designing buildings with stairs in a prominent position • Make stairs an integral part of the building which encourage users to use them to move between floors (more open plan system) • Make access to lifts controlled • National Institute for Health and Clinical Excellence (2008) Physical activity and the environment: Costing Report NICE Public Health Guidance 8 http://www.nice.org.uk/nicemedia/pdf/PhysicalActivityAndTheEnvironmentCostingReportFinal.pdf

14. Walking interventions (not active travel) • Public sector workplace walking interventions (using pedometers) that focus on • Facilitated goal setting (1 study) • Diaries and Self-monitoring (3 studies) • Walking Routes (1 study) can increase daily step count of employees.

15. ACTIVE TRAVEL: Has your workplace got an active travel policy? How do you encourage walkers and cyclists to get to work? Local Travel Plans

16. Walking between bus stops or even briskly to the bus stop adds important minutes/steps to your daily total of moderate PA. Evidence suggests that employees who use public transport are more active overall than car users.

17. Active travel interventions • Evidence from 1 UK public sector workplace intervention that a walking and cycling to work campaign (written health materials distributed to employees) can increase walking to work (not cycling) in economically advantaged women. • (Mutrie et al., 2002)

18. The Walk In to Work Out pack (HEBS) • has been designed to help people to prepare and plan to start walking or cycling part or all of the way to work. It gives ideas and information on: • Why you should become more active • Why walking or cycling to work is a good option • How to start walking or cycling • How to walk or cycle safely • Useful contacts

19. Multi-component interventions • Workplace health screening has a positive impact on PA (4 studies) • Workplace counselling has a positive impact on PA (4 studies) • Employee designed interventions (including written health information) increased PA (1 study) • Health information delivered through regular workshops increased PA (1 study) (N.B. ethnic comp of sample may limit applicability to UK). • Group led exercise sessions increased PA in women but not sustained over time (over 1 year). • Inconclusive evidence regarding efficacy of health messages delivered by email on PA (2 studies)

20. Behaviour change is complex - models of behavioural change Need to understand barriers and facilitators – especially important when contemplating change

21. Barriers for employees • 7 studies reported perceived barriers to the implementation of PA during intervention studies: • negative perceptions (extent of fitness level, no time in working day) and • physical barriers (lack of safe cycle routes, shower facilities, no access to stair walking)

22. Facilitators and motivators for employees • 8 studies reported perceived facilitators to the implementation of PA during intervention studies: including improved facilities, incentive schemes (monetary/time) and flexible work practices • 1 study reported a key motivating factor to be the level of enjoyment derived by employees from the PA intervention

23. Other key issues • Workplace PA interventions are effective for sedentary workers (3 studies) – 1 study reported a greater effect in those who were overweight for example. • Delivery - Self directed interventions are effective (3 studies) – interesting as these may be relatively low cost • Intensity – moderate effect of interventions over 6 months duration (5 studies) • Involving employees in planning can have positive impact on PA (1 study) but no evidence for the impact of employee involvement in implementation and review

24. Gaps in Evidence Base • Few studies reported long term follow up (1 year or more) – little evidence of sustainable effects • No evidence for workplace type, size (SMEs), gender, ethnicity or casual workers – majority studies in large, public sector orgs • Inconclusive evidence for impact of duration/intensity of intervention in stair walking, walking and active travel interventions • No evidence of employer opinion on barriers/motivators/facilitators of workplace PA – although practice identifies management involvement as primary influence on intervention success

25. Conclusions • Stair walking interventions – limited evidence of short term effectiveness but focus needs to be on stair climbing interventions (need more rigorously designed studies) – environmental approaches such as building design would also need to be considered. 1 study only showed significant stair climbing effects – cheap to implement! • Walking interventions using pedometers – limited evidence but suggests that this approach would be worth continued focus (research and practice) in the future using facilitated goal setting and choice of walking routes – cheap to implement as infrastructure costs are low!

26. Conclusions • Active travel – need more evidence of employee endorsed schemes – 1 study showing evidence was restricted to economically advantaged women • Multi-component schemes – counselling, screening, health information, employee involvement are all components which can contribute to effective interventions but may be more costly. • Barriers/motivators/facilitators all need to be considered (considerable no of studies in this area) and are important from the employees perspective – no evidence of these from employers perspective

27. Sustained interventions needed! North West Corporate Series – series of 5km, team, running events aimed to get employee’s active - participation through organisations “Without the Corporate Cup I’d have never got my fitness up to the level it is now, which is probably the best level of fitness in my life … I’d never have been this fit without the Corporate Cup.”

28. Conclusions • Management involvement is paramount to successful implementation • Focus on the most sedentary sectors – tailor interventions • Allowing employees to self-direct their choice of PA rather than be ‘led’ in activities may be beneficial • Involve employees in planning of interventions • Set goals, keep motivating employees, e.g using pedometers is good for this • SMEs may need support to implement these ideas