Title: A cluster randomised controlled trial to investigate the effectiveness and cost-effectiveness of a Structured Health Intervention For Truckers (The SHIFT Study)
Funder: Department of Health and Social Care

Abstract: Background: Long distance lorry drivers are exposed to a multitude of risk factors associated with their occupation, including long and variable working hours, prolonged periods of sedentary behaviour, and tight schedules which contribute to psychological stress and sleep deprivation. Their working environment provides limited opportunities for a healthy lifestyle and unhealthy lifestyle behaviours are extremely prevalent in this occupational group. As a consequence, lorry drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and have a significantly reduced life expectancy in comparison to other occupational groups. Pilot research: In partnership with a large transport company in the East Midlands, we have developed a Structured Health Intervention For Truckers (the SHIFT programme), a multicomponent, theory driven, health behaviour intervention promoting positive changes in physical activity (PA), diet, and sitting in lorry drivers. Pilot testing (using a pre-post study design) revealed favourable increases in PA (steps/day), reductions in fasting blood glucose, LDL-cholesterol, total cholesterol and waist-hip ratio. The next logical step is to formally evaluate the effectiveness and cost-effectiveness of the intervention. Aims: To evaluate the effectiveness and cost-effectiveness of the SHIFT programme using a cluster randomised controlled trial. Research Plan: A powered sample of 336 heavy goods vehicle (HGV), long distance drivers will be recruited from our partner companies. Upon completion of baseline measurements, depots (clusters) will be randomised to either the SHIFT intervention or usual care control arm (12 clusters in each). An internal pilot will be conducted on the first 6 clusters, involving approximately 84 participants (25% of the total sample). The 6-month SHIFT intervention includes a group-based interactive 6-hour education programme delivered by trained educators. The education session is supported by specially developed resources and participant support materials including a wearable PA tracker and equipment (e.g. resistance bands and balls) to facilitate a ‘cab workout’. Throughout the intervention participants will be supported by a trained worksite champion who will facilitate periodic step count challenges. Baseline, 6-month and 12-month measures will be taken to evaluate effectiveness. Objectively measured total daily PA, expressed as steps/day, will be the primary outcome. Secondary outcomes will include: objectively measured time in light PA and MVPA, sitting time, sleep duration, markers of adiposity, blood pressure, reaction time, and sickness absence data (from organisational records). Capillary blood samples will be collected and analysed for levels of HBA1c, total cholesterol, HDL and LDL-cholesterol. Self-report measures will assess fruit and vegetable intake, mental health and a range of psychosocial outcomes, including health related quality of life. We will undertake a full cost-effectiveness analysis and process evaluation. Impact: The Chartered Institute of Logistics and Transport (CILT) fully support our work given the absence of health promotion resources available to tackle health inequalities within the transport sector. If successful, CILT foresee the SHIFT programme being embedded within drivers’ compulsory Continued Professional Competence, and utilized across the transport sector, nationally and internationally.

Lay abstract: Long distance lorry drivers have higher levels of overweight and obesity than those working in other occupations. This increases their risk of diseases linked to obesity, including heart disease, diabetes, and sleep disturbances. Due to the nature of their jobs, lorry drivers are faced with many barriers when it comes to leading a healthy lifestyle. For example: the very nature of their job means they spend long periods of time sitting, their opportunities to be physically active while at work are limited, the food available at rest stops tends to be unhealthy, and working shifts tends to mean they get insufficient amounts of sleep. Lorry drivers in the UK are an ageing workforce, with an average age of 53 years. As a consequence of these working conditions and unhealthy lifestyle choices, lorry drivers have a lower life expectancy than the average working person. They are currently an ‘at-risk’ and underserved group in terms of health promotion efforts. Given the well-being of lorry drivers can directly affect the safety of other road users, strategies are needed to improve the health of this working group. In partnership with lorry drivers and Health and Safety personnel from a UK transport company, we have developed a programme designed to increase physical activity, improve diet and reduce sitting (during breaks and non-work time) in long distance lorry drivers. The programme involves a 6-hour interactive education session, use of a pedometer to monitor steps and set goals to increase steps, equipment to carry out stretching exercises whilst in the cab, individual and group based step count competitions, and access to free fruit. In a small study, we found this programme was effective in encouraging drivers to become more active; however we now want to test how effective this programme is in a larger sample with a comparison group. We also want to test whether this programme provides value for money. We will recruit long distance lorry drivers from a large transport company who have agreed to work with us on this project. Overall, we will recruit 336 drivers from 24 depots. All drivers within the chosen depots will be eligible to take part. Drivers from 12 depots will receive our health promotion programme for 6 months. The drivers in the remaining 12 depots will continue with their usual routine. We will measure how active all participating drivers are using a small device worn on the thigh for 7 days. This device provides an accurate measure of daily step counts, time spent sitting and standing, and time being active. We will measure drivers sleep duration using a monitor placed on the wrist, also worn for 7 days. We will take a number of measures of health including weight, percentage body fat, waist and hip circumferences, blood pressure and a blood sample, analysed for levels of blood sugar and cholesterol. Participating drivers will also be requested to complete some questionnaires about their health. These measurements will be taken from all drivers before the health promotion programme begins, immediately after the programme finishes at 6 months, and again at 12 months after the first set of measurements. If our programme is successful in increasing activity levels, and improving driver’s health, this programme could be made available to all professional drivers through continuing professional development programmes which could lead to improvements in health and well-being of all occupational drivers.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE