Encouraging stair use: stair-riser banners are better than posters

A site-specific literature review of policy and environmental interventions that promote physical activity and nutrition for cardiovascular health: what works?

OBJECTIVE

To review the literature to determine whether policy and environmental interventions can increase people's physical activity or improve their nutrition.

DATA SOURCES

The following databases were searched for relevant intervention studies: Medline, Chronic Disease Prevention File, PsychInfo, Health Star, Web of Science, ERIC, the U.S. Department of Transportation, and the U.S. Department of Agriculture.

STUDY SELECTION

To be included in the review, studies must have (1) addressed policy or environmental interventions to promote physical activity and/or good nutrition; (2) been published from 1970 to October 2003; (3) provided a description of the intervention; and (4) reported behavioral, physiological, or organizational change outcomes. Studies that had inadequate intervention descriptions or that focused on determinants research, individual-level interventions only, the built environment, or media-only campaigns were excluded.

DATA EXTRACTION

We extracted and summarized studies conducted before 1990 (n = 65) and during 1990-2003 (n = 64).

DATA SYNTHESIS

Data were synthesized by topic (i.e., physical activity or nutrition), by type of intervention (i.e., point-of-purchase), and by setting (i.e., community, health care facility, school, worksite). Current studies published during 1990-2003 are described in more detail, including setting and location, sample size and characteristics, intervention, evaluation period, findings, and research design. Findings are also categorized by type of intervention to show the strength of the study designs and the associations of policy and environmental interventions with physical activity and nutrition.

CONCLUSIONS

The results of our review suggest that policy and environmental strategies may promote physical activity and good nutrition. Based on the experimental and quasi-experimental studies in this review, the following interventions provide the strongest evidence for influencing these behaviors: prompts to increase stair use (N = 5); access to places and opportunities for physical activity (N = 6); school-based physical education (PE) with better-trained PE teachers, and increased length of time students are physically active (N = 7); comprehensive work-site approaches, including education, employee and peer support for physical activity, incentives, and access to exercise facilities (N = 5); the availability of nutritious foods (N = 33), point-of-purchase strategies (N = 29); and systematic officer reminders and training of health care providers to provide nutritional counseling (N = 4). Further research is needed to determine the long-term effectiveness of different policy and environmental interventions with various populations and to identify the steps necessary to successfully implement these types of interventions.

Changing the environment to promote health-enhancing physical activity

Supportive environments have been used to change and influence health behaviours like smoking. While psychological and ecological theories and models demonstrate the possible influences of the environment on health-enhancing physical activity (HEPA), little is known about the effectiveness of the environmental interventions. This paper presents the results of a systematic review of studies that used environmental interventions to increase health-enhancing physical activity. Two groups of studies were found, studies that changed the physical environment by creating new HEPA facilities, policies and supporting mechanisms, and studies that used the elements of the environment as an active or sedentary 'point of choice', via educational materials to promote stair use. Environmental change studies showed a small increase on HEPA behaviour, but the relative impact of environment changes was not evaluated. A number of before and after studies have observed a weak effect of a simple environmental change to stimulate stair climbing while travelling or shopping. Current national policy has embraced the environment as an option for promoting health-enhancing physical activity, especially active travel, in spite of the lack of effectiveness data. It is recommended that existing or planned public health environment and HEPA initiatives should use appropriate evaluation methods to assess their efficacy and effectiveness. Further developmental research into the nature of the relationship of the environment to particular HEPA behaviours is strongly recommended before developing new environmental interventions.

Influences of building design and site design on physical activity: research and intervention opportunities

Americans spend much of their days in buildings, yet relatively little is known about how the design of buildings or their site influences physical activity. Although some evidence suggests that using specific features of buildings and their immediate surroundings such as stairs can have a meaningful impact on health, the influences of the physical environment on physical activity at the building and site scale are not yet clear. While there is some research suggesting that people will be more active in buildings that have visible, accessible, pleasing, and supportive features, such as motivational point-of-decision prompts and well-designed stairs, there is only limited evidence to support that assertion. This paper reviews the available evidence linking design and site decisions to physical activity, and suggests a framework for connecting research and implementation strategies for creating activity-friendly buildings. In consideration of the kinds of physical activities associated with buildings and their sites, it is proposed that the form of buildings and sites affect physical activity at several spatial scales: the selection and design of sites with respect to a building's location on its site and within its immediate community and the provision and layout of site amenities; building design such as the programming, layout, and form of the building; and building element design such as the design and layout of elements such as stairs or exercise rooms. The paper concludes with an overview of opportunities for research and intervention strategies within the building industry, focusing on public buildings, which provide numerous high-leverage opportunities for linking research and implementation.

Physical workload, ergonomic problems, and incidence of low back injury: a 7.5-year prospective study of San Francisco transit operators

BACKGROUND

The etiologic role of biomechanical factors for low back injury (LBI) needs to be confirmed in prospective studies that control for psychosocial factors.

METHODS

Complete baseline information on 1,233 vehicle operators was gathered during medical examinations and by questionnaire. First LBI during 7.5 years of follow-up was ascertained from insurance records. Hazard ratios and etiologic fractions were analyzed with Cox regression models stratified by injury severity and controlling for age, sex, height, weight, ethnicity, and biomechanical and psychosocial job factors. Severe LBI was defined as medically diagnosed postlaminectomy syndrome, spinal stenosis, herniated lumbar disc, sciatica, or spinal instability.

RESULTS

An exponential dose-response relationship was found between weekly driving hours and incidence of first LBI. Indicators of physical workload were more strongly associated with more severe low back injuries compared to less severe injuries. Rates of severe LBI increased 39% for every 10-hr increase in weekly driving (hazard ratio 1.39, 95% confidence interval 1.15-1.68). Higher risks of severe LBI were also found among operators performing heavy physical labor on cable cars (hazard ratio 2.76, 95% confidence intervals 1.24-6.14) or reporting more ergonomic problems at baseline (HR for upper quartile 1.65 (95% confidence interval 1.08-2.50). Estimates of etiologic fractions suggest that reduction of ergonomic problems to the low level currently experienced by 25% of drivers would result in a 19% reduction of severe LBI among all drivers. A change from full- (more than 30 hr) to part-time driving (20-30 hr) could reduce the number of severe LBI by 59%, although this gain would be reduced to 28% at the company level if injuries expected among additional employees, hired to maintain full service are included.

CONCLUSIONS

Duration of professional driving and ergonomic problems are independent and preventable risk factors for LBI even after adjustment for psychosocial factors.

Work-Related Disability in Canadian Nurses

PURPOSE

To determine factors contributing to high registered nurse (RN) injury claim rates in Canadian hospitals.

DESIGN

Cross-sectional study of secondary 1998-99 data for RNs (N = 8,044) in Ontario, Canada, linked at the hospital level (n = 127).

METHODS

Descriptive statistics, correlations, and logistic regression analyses were conducted.

RESULTS

The odds of a high RN lost-time claim rate increased by 70% for each quartile increase in the percentage of RNs reporting more than 1 hour of overtime per week. The odds of a high RN musculoskeletal lost-time claim rate decreased by 64% for every one unit increase in the hospital-level score on the nurse-physician relationship subscale.

CONCLUSIONS

To retain and optimize scarce hospital nursing resources, strategies to address overtime, sick time, and nurse-physician relationships might provide fiscal and human benefits.

The Los Angeles Lift Off: a sociocultural environmental change intervention to integrate physical activity into the workplace

PURPOSE

To present the development and feasibility testing of a sociocultural environmental change intervention strategy aimed at integrating physical activity into workplace routine.

DESIGN

Randomized, controlled, post-test only, intervention trial. Setting. Los Angeles County Department of Health Services' worksites.

PARTICIPANTS

Four hundred forty-nine employees, predominantly sedentary, overweight, middle-aged women of color, distributed across 26 meetings.

INTERVENTION

A single 10-min exercise break during work time involving moderate intensity, low-impact aerobic dance and calisthenic movements to music.

MEASURES

Primary-level of participation, particularly among sedentary staff; secondary-self-perceived health status, satisfaction with current fitness level, and mood/affective state.

RESULTS

More than 90% of meeting attendees participated in the exercises. Among completely sedentary individuals, intervention participants' self-perceived health status ratings were significantly lower than controls' (OR = 0.17; 95% CI = 0.05, 0.60; P = 0.0003). Among all respondents not regularly physically active, intervention participants' levels of satisfaction with fitness were more highly correlated with self-ranked physical activity stage of change (r = 0.588) than the control participants' (r = 0.376, z = -2.32, p = 0.02). Among the completely sedentary, control participants reported significantly higher levels of energy than did intervention participants (P < 0.01).

CONCLUSIONS

Captive audiences may be engaged in brief bouts of exercise as a part of the workday, regardless of physical activity level or stage of change. This experience may also appropriately erode sedentary individuals' self-perception of good health and fitness, providing motivation for adoption of more active lifestyles.

The psychosocial work environment and musculoskeletal disorders: design of a comprehensive interviewer-administered questionnaire

BACKGROUND

Psychosocial working conditions are likely to contribute to work-related musculoskeletal disorders (WRMSDs), but a lack of standardized measurement tools reflects both the theoretical and methodological limitations of current research.

METHODS

An interdisciplinary team including biomedical, behavioral, and social science researchers used an iterative process to adapt existing instruments for an interviewer-administered questionnaire assessing psychosocial workplace exposure related to musculoskeletal disorders.

RESULTS

The resulting questionnaire included measures of psychosocial workplace factors based on two theoretical models (the demand-control-support and the effort-reward imbalance models), supplemented by the additional constructs of "emotional demands," and "experiences of discrimination." Other psychosocial and physical measures selected for questionnaire inclusion address physical workload, sociodemographic and anthropometric characteristics, social relations and life events, health behaviors, and physical and psychological health.

CONCLUSION

Using an interdisciplinary approach facilitated the development of a comprehensive questionnaire inclusive of key measures of psychosocial factors that may play a role in the complex mechanisms leading to WRMSDs.

Predictors of back pain in a general population cohort

STUDY DESIGN

The study used longitudinal data from the first and second cycles (1994-1995 and 1996-1997) of the Canadian National Population Health Survey.

OBJECTIVE

Our objective was to derive prediction models for back pain in the general male and female household populations.

SUMMARY OF BACKGROUND DATA

Little is known about the predictors of back pain in the general population. Most previous studies focused on specific occupational groups and used a cross-sectional or case-control design.

METHODS

The study cohort consisted of all respondents aged 18+ years who reported no back problems in the 1994-1995 National Population Health Survey cycle (N = 11,063). Potential predictors of chronic back pain were classified into nine groups and entered into stepwise logistic regression models. Bootstrap methods were used to derive the final models and assess their predictive power.

RESULTS

The overall incidence of back pain was 44.7 per 1,000 person-years and was higher in women (47.0 per 1,000 person-years) compared with men (42.2 per 1,000 person-years). In men, significant predictors of back pain were age (peak effect in 45-64 years), height, self-rated health, usual pattern of activity (especially heavy work), yard work or gardening (negative association), and general chronic stress. In women, significant factors were self-reported restrictions in activity, being diagnosed with arthritis, personal stress, and history of psychological trauma in childhood or adolescence.

CONCLUSIONS

Overall health and psychosocial factors are important predictors of back pain in both men and women. Other risk factors differ between the two sexes.

Individual and combined impacts of biomechanical and work organization factors in work-related musculoskeletal symptoms

BACKGROUND

Investigations of work-related low back (LB) and upper extremity (UE) disorders have increasingly utilized multivariable models that include biomechanical/physical and work organization factors. However, the nature of any interactive effects is not well understood.

METHODS

Using questionnaires, high and low exposure groups for biomechanical/physical factors, cognitive demands, cognitive processing, interpersonal demands, participatory management, skill discretion, and time pressure for 289 individuals (U.S. Marines) were identified. Musculoskeletal symptom status was also determined by questionnaire. Individual and biomechanical-psychosocial combinations were examined in adjusted multivariable logistic regression analyses.

RESULTS

Time pressure was associated with both LB and UE symptoms (odds ratio(s) (OR) range = 2.13-3.09), while higher biomechanical exposures were risk factors for LB symptoms (OR = 2.07; 95% confidence intervals (CI): 1.00-4.35) and concurrent LB and UE symptoms (OR = 2.80; CI: 1.35-5.83). Greater risks for concurrent LB and UE symptoms were indicated for combinations involving higher biomechanical exposure and: time pressure (OR = 2.21; CI: 1.19-4.10); cognitive demands (OR = 2.25; CI: 1.23-4.09); cognitive processing (OR = 2.08; CI: 1.16-3.75); interpersonal demands (OR = 2.44; CI: 1.35-4.41); participatory management (OR = 2.50; CI: 1.30-4.81). Results did not suggest any interaction between biomechanical and work organization factors.

CONCLUSIONS

While no synergism was indicated, the present findings emphasize the need to consider both biomechanical factors and specific work organization factors, particularly time pressure, in reducing musculoskeletal-related morbidity.

Six-month observational study of prompted stair climbing

BACKGROUND

Despite strong evidence that prompts at the point of choice between escalators and stairs encourage stair use, the long-term effects of stair prompts have not yet been investigated. Presented here are the results of a 6-month observational study of prompted stair climbing.

METHODS

Escalator and adjacent stair use were monitored in a shopping mall in the Midlands region of the United Kingdom. Participants were coded for gender, age, and ethnicity. A 2-week baseline period was followed by a 12-week intervention using motivating messages on the stair risers. Follow-up data were also collected for 2 weeks immediately after the removal of the banners and 6 weeks later.

RESULTS

A total of 45,361 escalator/stair-choice observations were made. Stair use increased significantly during the intervention period and, when the banners were removed, remained higher than at baseline. There were also significant interactions with time across the different population groups.

CONCLUSIONS

The full public health benefits of increasing physical activity levels can only be realized if the activity is sustained. These results demonstrate that stair-riser banners can elicit a sustained increase in stair use and, even when the banners were withdrawn, overall stair use remained higher than at baseline.

Determinants of duration of disability and return-to-work after work-related injury and illness: challenges for future research

BACKGROUND

The purpose of this review was to identify critical data and research needs in addressing the following question: What are the primary factors that affect the time lost from work, return-to-work (RTW), subsequent unemployment, and changes in occupation after disabling illness or injury?

METHODS

Review of the literature to identify research challenges originating from the multitude of disciplines, data sources, outcome measures, and methodological and analytical problems.

RESULTS

About 100 different determinants of RTW outcomes were identified. Their impact varies across different phases of the disablement process. Recommendations are provided for addressing five selected research challenges.

CONCLUSION

Interdisciplinary research needs to develop a comprehensive conceptual framework. Priority should be given to studies on specific domains of risk factors meeting five selection criteria: amenability to change; relevance to users of research; generalizability across health conditions, disability phases, and settings; "degree of promise" as derived from qualitative exploratory studies; and capacity to improve measurement instruments. Combining qualitative and quantitative research methods is necessary to bridge existing knowledge gaps.