Promoting work ability through exercise programmes
Authors: Alex Burdorf, Suzan Robroek
Journal: The Lancet Public Health (2019)

There is a clear need to improve or at least maintain employees' abilities to meet the physical and mental requirements of their jobs. Unhealthy behaviours and obesity are important risk factors for reduced work ability1Van den Berg TI Elders LA de Zwart BC Burdorf A The effects of work-related and individual factors on the Work Ability Index: a systematic review.Occup Environ Med. 2009; 66: 211-220Crossref PubMed Scopus (459) Google Scholar and subsequent sickness absence2Virtanen M Ervasti J Head J et al.Lifestyle factors and risk of sickness absence from work: a multicohort study.Lancet Public Health. 2018; 3: e545-e554Summary Full Text Full Text PDF PubMed Scopus (62) Google Scholar and loss of paid employment.3Robroek SJW Reeuwijk KG Hillier FC et al.The contribution of overweight, obesity, and lack of physical activity to exit from paid employment: a meta-analysis.Scand J Work Environ Health. 2013; 39: 233-240Crossref PubMed Scopus (96) Google Scholar Hence, it is unsurprising that many workplace programmes have been developed that aim to increase work ability through improvements in health behaviours, most notably through promoting a physically active lifestyle. Exercise programmes have long been popular, but their effectiveness is far from established. A systematic review4Oakman J Neupane S Proper KI Kinsman N Nygård CH Workplace interventions to improve work ability: a systematic review and meta-analysis of their effectiveness.Scand J Work Environ Health. 2018; 44: 134-146PubMed Google Scholar reported that only two out of six randomised controlled studies on the effects of exercise programmes on work ability showed improved work ability, but with small effect sizes. Furthermore, the generally small proportion of invited participants who enrol to receive these interventions and low compliance with the exercise regime are barriers to the successful implementation of workplace exercise programmes.5Vuillemin A Rostami C Maes L et al.Worksite physical activity interventions and obesity: a review of European studies (the HOPE project).Obes Facts. 2011; 4: 479-488Crossref PubMed Scopus (48) Google Scholar In The Lancet Public Health, Sven Haufe and colleagues6Haufe S Kerling A Protte G et al.Telemonitoring-supported exercise training, metabolic syndrome severity, and work ability in company employees: a randomised controlled trial.Lancet Public Health. 2019; published online June 13. http://dx.doi.org/10.1016/S2468-2667(19)30075-1Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar report on a randomised controlled trial that compares health benefits in employees assigned to a 6-month exercise programme (n=160) with those in a waiting-list control group (n=154). Using their data on outcome measures, we calculated the effect sizes of their outcomes as a common measure of the effectiveness of the intervention (appendix). The intervention improved total physical activity with an effect size of 0·25, showing that participants in the intervention group indeed became more physically active than those in the control group. The intervention was effective in reducing bodyweight by 3·5 kg (ES=0·18), body fat percentage by 1·9% (ES=0·23), and by increasing work ability by 4% (ES=0·29). Since increased duration of physical activity per week was associated with increased improvement in work ability over 6 months, the exercise component of the intervention clearly contributed to the improvements in work ability and participant health. Considering the negative results of several studies on the effect of exercise programmes,4Oakman J Neupane S Proper KI Kinsman N Nygård CH Workplace interventions to improve work ability: a systematic review and meta-analysis of their effectiveness.Scand J Work Environ Health. 2018; 44: 134-146PubMed Google Scholar, 5Vuillemin A Rostami C Maes L et al.Worksite physical activity interventions and obesity: a review of European studies (the HOPE project).Obes Facts. 2011; 4: 479-488Crossref PubMed Scopus (48) Google Scholar the differences between their methodology and that of Haufe and colleagues should be examined. Several important features of their trial6Haufe S Kerling A Protte G et al.Telemonitoring-supported exercise training, metabolic syndrome severity, and work ability in company employees: a randomised controlled trial.Lancet Public Health. 2019; published online June 13. http://dx.doi.org/10.1016/S2468-2667(19)30075-1Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar must be discussed before advising on the most appropriate type of intervention for successful outcomes in workplace programmes that promote health. First, the investigators adopted a selective intervention strategy, whereby workers with metabolic syndrome only were recruited, rather than the whole workforce. The trial started with a general health examination that is an effective way to attract potential participants into a study and to select those who are at increased risk of cardiovascular disease and type 2 diabetes. This approach might have disproportionately included participants who are highly motivated to increase their daily physical activity and to sustain a newly adopted health behaviour. Alternatively, it could have been much easier for those with a high risk for type 2 diabetes and cardiovascular diseases to change their behaviour. In the study by Haufe and colleagues, the mean bodyweight of participants was well above 105 kg, indicating that most participants were obese. Second, the participants in the intervention group were supported through telemonitoring with a wrist-worn device that recorded steps, activity times, and heart rate. A linked mobile application provided continuous feedback on individual achievements and compliance with training goals. The use of mHealth (here an exercise application) is a potentially powerful strategy to improve health behaviours, specifically when combined with regular face-to-face meetings with a health coach,7Bonn SE Löf M Östenson CG Lagerros YT App-technology to improve lifestyle behaviors among working adults – the Health Integrator study, a randomized controlled trial.BMC Public Health. 2019; 19: 273Crossref PubMed Scopus (19) Google Scholar and such monthly meetings were ensured in the study by Haufe and colleagues. This additional support would have contributed to the good adherence to the exercise regime in the intervention group. Third, the use of different communication strategies with participants through information meetings, in-application messaging, and face-to-face consultations was crucial for good adherence to the intervention, which was equally effective in manual and office workers and in shift workers and non-shift workers. A systematic review8Rongen A Robroek SJ van Lenthe FJ Burdorf A Workplace health promotion: a meta-analysis of effectiveness.Am J Prev Med. 2013; 44: 406-415Summary Full Text Full Text PDF PubMed Scopus (283) Google Scholar has shown that workplace health promotion programmes are generally more effective in white-collar and younger workers, thereby introducing intervention-generated health inequalities. However, new evidence9Lorenc T Petticrew M Welch V Tugwell P What types of interventions generate inequalities? Evidence from systematic reviews.J Epidemiol Community Health. 2013; 67: 190-193Crossref PubMed Scopus (504) Google Scholar suggests that workplace interventions could reduce health inequalities, specifically when the intervention combines different components tailored to the needs and preferences of different groups. The health promotion programme by Haufe and colleagues is promising for the development of effective interventions that prevent unhealthy behaviours. Given the intervention's moderate benefits after 6 months, it is not an all-purpose solution to address health-related loss of work ability. Further improvements in health behaviours and outcome measures are required to create a healthy workforce. Favourable methods are multicomponent interventions that address several unhealthy behaviours simultaneously and interventions that ensure that strenuous working conditions and unhealthy behaviours are equally targeted.10Feltner C Peterson K Palmieri Weber R et al.The effectiveness of total worker health interventions: a systematic review for a national institutes of health pathways to prevention workshop.Ann Intern Med. 2016; 165: 262-269Crossref PubMed Scopus (61) Google Scholar The use of wearable fitness devices and applications will provide excellent opportunities for dynamic intervention programmes that overcome the traditional barriers of insufficient scope, uptake, and sustainability of large-scale health promotion programmes. We declare no competing interests. Download .pdf (.15 MB) Help with pdf files Supplementary appendix Telemonitoring-supported exercise training, metabolic syndrome severity, and work ability in company employees: a randomised controlled trialA 6-month exercise-focused intervention using telemonitoring systems reduced metabolic syndrome severity. This form of intervention shows significant potential to reduce disease risk, while also improving mental health, work ability, and productivity-related outcomes for employees at high risk for cardiovascular and metabolic disease. Full-Text PDF Open Access