Occupational factors associated with obesity and leisure-time physical activity among nurses: A cross sectional study

Analysis of multi-level barriers to physical activity among nursing students using regularized regression

Physical inactivity is a growing societal concern with significant impact on public health. Identifying barriers to engaging in physical activity (PA) is a critical step to recognize populations who disproportionately experience these barriers. Understanding barriers to PA holds significant importance within patient-facing healthcare professions like nursing. While determinants of PA have been widely studied, connecting individual and social factors to barriers to PA remains an understudied area among nurses. The objectives of this study are to categorize and model factors related to barriers to PA using the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework. The study population includes nursing students at the study institution (N = 163). Methods include a scoring system to quantify the barriers to PA, and regularized regression models that predict this score. Key findings identify intrinsic motivation, social and emotional support, education, and the use of health technologies for tracking and decision-making purposes as significant predictors. Results can help identify future nursing workforce populations at risk of experiencing barriers to PA. Encouraging the development and employment of health-informatics solutions for monitoring, data sharing, and communication is critical to prevent barriers to PA before they become a powerful hindrance to engaging in PA.

Prevalence of dyslipidaemia within Polish nurses. Cross-sectional study - single and multiple linear regression models and ROC analysis

BACKGROUND

Maintaining good health is vital not only for own well-being, but also to ensure high-quality patient care. The aim of this study was to evaluate the prevalence of dyslipidaemia and to determine the factors responsible for the development of this disorder among Polish nurses. Lipid profile disorders are the most prevalent and challenging risk factors for the development of cardiovascular disease. Nurses have significant potential and play a crucial role in providing care and treatment services.

METHODS

This cross-sectional study involved nurses and included measurements of body weight composition (Tanita MC-980), body mass index, waist circumference, blood pressure (Welch Allyn 4200B), lipid profile, and fasting blood glucose (CardioChek PA).

RESULTS

The results revealed that more than half of the nurses (60.09%) were overweight or obese, with 57.28% exhibiting elevated blood pressure, 32.25% having fasting glucose levels, and 69.14% experiencing dyslipidaemia. Multiple model evaluation using ROC curves demonstrated that multiple models accurately predicted hypercholesterolemia (AUC = 0.715), elevated LDL (AUC = 0.727), and elevated TC (AUC = 0.723) among Polish nurses.

CONCLUSION

Comprehensive education programmes should be implemented that include the latest advances in cardiovascular disease prevention. Regular check-ups, as well as the promotion and availability of healthy food in hospital canteens, are essential.

Enhancing feedback by health coaching: the effectiveness of mixed methods approach to long-term physical activity changes in nurses. An intervention study

BACKGROUND

Although knowledge of the barriers and motivators to physical activity participation among nurses is increasing, the factors influencing motivation methods' effectiveness are not completely defined. This study aimed to identify the methods that support increasing the level of daily physical activity and the factors that influence the effectiveness of motivation methods among nurses.

METHODS

This study was based on an intervention study protocol. All registered nurses in clinical settings were invited to participate in the study. The study involved 71 professionally active nurses. A self-reported questionnaire was used to collect sociodemographic and employment data. The level of physical activity was assessed using the International Physical Activity Questionnaire, and the daily number of steps was assessed using a pedometer. Body composition was measured using a bioimpedance method, and the 5-year risk of cardiovascular events was assessed using the Harvard Score. The intervention included self-monitoring daily steps using a pedometer and completing a diary daily for one month. Additionally, a few-minute speech was sent to each participant via email on the intervention's 7th, 14th, and 21st days.

RESULTS

The analysis revealed a higher value of physical activity recorded in the follow-up compared to the initial and final measurement in the Recreation domain [Met] (p < 0.001) and a higher value of daily steps in the follow-up compared to the final measurement (p = 0.005). Participants with a higher Harvard Score were more likely to increase their daily number of steps (OR = 6.025; 95% CI = 1.70-21.41), and nurses working in hospital wards were less likely to do so (OR = 0.002; 95% CI = 0.00-0.41).

CONCLUSIONS

Recommendations for physical activity in the nursing population should focus on increasing leisure time physical activity and regular risk assessment of cardiovascular events. A mixed methods approach, such as feedback enhanced by health coaching, effectively achieves long-term physical activity changes in nurses.

Investigation of obesity and its related factors among Chinese medical staff: a cross-sectional pilot study

BACKGROUND

Many studies have covered the prevalence of obesity in different populations. However, studies on the prevalence and predictors of obesity among medical staff are lacking. The aim of our study is to investigate the prevalence of obesity among medical staff and to identify the related predictors.

METHODS

Using a snowballing recruitment strategy in the form of an electronic questionnaire, a cross-sectional survey was conducted among 1201 medical staff from cooperative hospitals between January and March 2022. We designed a questionnaire to investigate the participants' demographic, lifestyle, diet, physical activity, and work status.

RESULTS

The overall prevalence of obesity was 8.5%, with males (13.7%) having a greater incidence than females (5.7%) (p < 0.001). Multiple logistic regression analyses showed that alcohol drinking (OR, 2.34; 95% CI 1.23-4.42, p = 0.01), sugar-sweetened beverages consumed > 3/week (OR, 2.50; 95% CI 1.02-6.15, p = 0.046), and working a night shift > 1/week (OR, 2.17; 95% CI 1.02-4.61, p = 0.043) were independent predictive factors for obesity in men. For women, having midnight snack having midnight snack (OR, 2.93;95% CI 1.24-6.96, p = 0.015), good sleep quality (OR, 4.47; 95% CI 1.10-21.70, p = 0.038), and working a night shift > 1/week (OR, 3.62; 95% CI 1.73-7.57, p = 0.001) were independently associated with obesity.

CONCLUSIONS

Obesity presented a low prevalence among medical staff. Alcohol drinking, drinking sugar-sweetened beverages > 3/week, and night shift > 1/week predicted a higher risk of obesity in males. In females, having midnight snack, good sleep quality, and night shift > 1/week were independently associated with obesity.

LEVEL OF EVIDENCE

V, descriptive study.

Prevalence of overweight and obesity among nurses in Bahrain: A cross-sectional study

AIM

This study aims to estimate the prevalence of overweight and obesity among nurses in Bahrain.

DESIGN

A cross-sectional design.

METHODS

A secondary data from a convenience sample of 550 nurses working in three hospitals in the Kingdom of Bahrain. The prevalence of overweight and obesity was determined by calculating the percentages of BMI using the World Health Organization classification.

RESULTS

Most participants were females (n = 488, 89.1%), ages 31 to 40 (n = 239, 43.8%). The mean BMI was 26.9 (±4.4). The prevalence of overweight and obesity was 43.2% and 21.4%, respectively. The prevalence of overweight and obesity is associated with nationality and shift work. We used BMI to estimate the prevalence of overweight and obesity. However, BMI does not consider muscle mass, bone density, body composition, and racial and sex differences. Therefore, in future studies, body fat proportion and muscle mass need to be measured to estimate the prevalence and predict risks.

The effects of a theory-informed intervention on physical activity behaviour, motivation and well-being of frontline aged care workers: A pilot study with 6-month follow-up

ISSUE ADDRESSED

Due to the nature of their jobs, frontline aged care workers may be a population at risk of poor health and lifestyle habits. Support of their well-being through the workplace is likely to be complex. The objective of this study was to assess the effectiveness of a need-supportive program for changing physical activity and psychological well-being via the motivational processes of behavioural regulations and perceived need satisfaction.

METHODS

Frontline aged care workers (n = 25) participated in a single cohort, pre-post pilot trial. The program included a Motivational Interviewing style appointment, education on goal setting and self-management, the use of affect, exertion and self-pacing for regulating physical activity intensity and practical support activities. Outcomes (7-day accelerometery, 6-min walk, K10 and AQoL-8D), and motivational processes (BREQ-3 and PNSE) were measured at baseline, 3 and 9 months, and analysed using linear mixed models for repeated measures.

RESULTS

There were significant increases in perceived autonomy at 3 months (Δ .43 ± SE: .20; p = .03) and 6-min walk distance at 9 months (Δ 29.11 m ± SE: 13.75; p = .04), which appeared to be driven by the relative autonomy index (behavioural regulations in exercise questionnaire [BREQ-3]). Amotivation increased at 3 months (Δ .23 ± SE:.12; p = .05); which may have been due to low scores at baseline. No other changes were demonstrated at any timepoint. SO WHAT?: Participants demonstrated positive changes in motivational processes and physical function, however, due to the low levels of participation in the program, the program had a negligible impact at the organisational level. Future researchers and aged care organisations should aim to address factors impacting participation in well-being initiatives.

Nurses' occupational physical activity and workload in a perioperative intensive care unit in Slovenia

The field of nursing includes heavy occupational physical demands, including walking and standing for longer periods of time, in addition to moving and lifting. As such, in the context of a typical work shift, many nurses generally achieve the World Health Organization's recommended 10,000 steps per day. This study aimed at estimating the daily physical activity and workload of nurses in a perioperative intensive care unit. The data sources for this study included data from the hospital information system on various procedures and interventions, and the Silva Ex3 Plus pedometers for measuring steps, kilometers, calories, and activity time across various shifts in a perioperative intensive care unit. Twenty nurses from Slovenia volunteered to participate in this observational study. Over 13 weeks, a nurse working an 8-hour shift walked an average of 5,938 steps (4.4 km). However, nurses who worked a 12-hour weekend day shift came very close to the World Health Organization's recommendation with an average of 9,003 steps (6.5 km). A total of 227 patients were admitted and an average of 80 nursing interventions were performed per day and there was a positive relationship between physical activity, workload, and patient admissions in the perioperative intensive care unit (p = 0.001). Results of this study could help managers better understand nurses' physical activity and workload during various shifts in the perioperative intensive care unit.

Levels of actigraphy-derived physical activity among Polish nurses: factors associated with the prevalence of selected metabolic disorders

Numerous studies demonstrate a relationship between physical activity and the development of non-communicable diseases. Nurses play a crucial role in the healthcare system, and their demanding work can have an impact on their health. The objective of this cross-sectional study was to assess physical activity in relation to factors predisposing to the occurrence of specific metabolic disorders among Polish nurses. The measurements included physical activity level using ActiGraph GT3X, body weight composition using Tanita MC-980, body mass index, waist circumference, blood pressure using Welch Allyn 4200B, lipid profile, and fasting blood glucose using CardioChek PA. The results indicate that nearly one-third (31.75%) of the total sample of studied nurses do not meet the criteria for the minimum amount of physical activity of at least moderate intensity. Furthermore, over half of the surveyed nurses (55.5%) were classified as overweight or obese based on BMI, and almost half (42.86%) had abdominal obesity. The regression model, employing linear regression, revealed that factors predisposing to selected metabolic disorders were age, engaging in multiple jobs, and the number of steps per day. There is a pressing need to implement comprehensive and supportive initiatives to improve the overall health condition of nurses in Poland through increased physical activity. Activating and supporting this professional group is an investment that benefits not only the nurses themselves but also the healthcare system and the entire nation.

The global prevalence of overweight and obesity among nurses: A systematic review and meta-analyses

BACKGROUND

Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery.

OBJECTIVE

To investigate the global prevalence of overweight and obesity among nurses.

DESIGN

Systematic review with meta-analysis.

SETTING

29 different countries across the WHO-classified geographical region.

PARTICIPANTS

Nurses.

METHODS

Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle-Ottawa Scale (NOS). Inter-rater agreement was measured using Cohen's Kappa. Meta-analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung-Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I2 statistic.

RESULTS

Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% (n = 55, 95% CI: 29%-33.5%; p < .01) and 16.3% (n = 76, 95% CI: 13.7%-19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean (n = 9, 37.2%, 95% CI: 33.1%-41.4%) and that of obesity was in South-East Asia (n = 5, 26.4%, 95% CI: 5.3%-69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators.

CONCLUSIONS

This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable as this is a systematic review.

REGISTRATION

PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785.

TWEETABLE ABSTRACT

High prevalence of overweight and obesity among nurses worldwide.

Occupational Physical Activity and Cardiometabolic Risk Factors: A Cross-Sectional Study

Contradictory data exist on the impact of occupational physical activity (OPA) on cardiovascular health. We aimed to evaluate the association between OPA and cardiometabolic risk factors. A cross-sectional study was performed in an environmental services company in 2017 (Spain). OPA was classified by work categories as being low (≤3 METs) or moderate−high (>3 METs). Multiple linear and logistic binary regression models were used to assess the associations between OPA and cardiometabolic risk factors related to obesity, blood pressure, blood lipids, and associated medical conditions, adjusted by age, sex, alcohol consumption, and global physical activity. In total, 751 employees were included (547 males and 204 females), and 55.5% (n = 417) had moderate−high OPA. Significant inverse associations were observed between OPA and weight, body mass index, waist circumference, waist−hip ratio, and total cholesterol both overall and in males. OPA was significantly inversely related to dyslipidemia overall and in both sexes, while the overweight plus obesity rate was inversely related only in the total and male populations. OPA was associated with a better cardiometabolic risk factor profile, particularly in males. The fact that our models were also adjusted by global physical activity highlights the associations obtained as being independent of leisure time physical activity effects.

Physical Activity Habits of Latvian Nursing Students: A Cross-Sectional Study

It is important to integrate knowledge about the need for physical activities (PA) in the prevention and care of human health in nursing study programs so that nurses can promote PA among their patients. This study aims to evaluate the PA habits of Latvian nursing students. Participants were students of three universities in Latvia who were enrolled in a four-year bachelor study program, "Nursing", with a total of 341 after the data cleaning (population size n = 1554). The questionnaire contained questions about sociodemographic variables derived from the survey of the Centre for Disease Prevention and Control of Latvia "Health Behaviour among Latvian Adult Population", habits of PA, and International Physical Activity Questionnaire-Short Form. The data were collected between September and November 2021. Both descriptive and inferential statistics (difference between groups, correlation, and association tests) were calculated to analyse the data. Of the study population, 39% did not reach the minimum WHO-recommended PA. Increased PA level in the later study years is related to more frequent engagement in work and fewer table activities in the curriculum study process, but the higher intensity and total PA could be related to the specifics of nurse and nurse assistant work, which could be especially intense due to the overloaded health care system during the COVID-19 pandemic.

The Effect of Shiftwork on Body Composition: A Comparative Cross-sectional Study Among Health Care Workers

OBJECTIVE

This study compared the body composition parameters between shiftworkers and nonshiftworkers in a hospital setting in Sri Lanka.

METHODS

A comparative cross-sectional study was carried out among a sample of 78 health care workers, recruited by a stratified random sampling technique. Subjects underwent anthropometric and bioimpedentiometric analysis for body composition parameters.

RESULTS

The mean (SD) body fat percentage (BF%) of shiftworking women (40.8 [SD, 6.8%]) was significantly higher than day-working women (36.7% [SD, 5.9%]) ( P < 0.05). Mean BF% between day and shift groups did not significantly differ (33.0% [SD, 6.9%] vs 32.4% [SD, 10.7%]). Body mass index and waist circumference were significantly higher among shiftworking women ( P < 0.05), whereas male workers showed the opposite trend.

CONCLUSION

Prolonged exposure to shiftwork was associated with a higher BF%. Therefore, interventions for shiftworkers must be addressed, focusing on improving body composition.

Shift Work and Obesity Risk-Are There Sex Differences?

PURPOSE OF REVIEW

Shift work is prevalent among the working population and is linked to an array of adverse health outcomes. This review summarizes current evidence on the relation between shift work and risk of obesity, with a particular emphasis on potential sex differences.

RECENT FINDINGS

Observational data strongly point towards an association between shift work and heightened risk of prevalent and incident obesity, and particularly abdominal obesity. Circadian misalignment and unhealthy lifestyle behaviors are the primary culprits mediating such association. As it pertains to sex differences in the impact of shift work on obesity, few studies have examined this aspect, and findings are conflicting. Shift work is an important risk factor for obesity, with likely multiple biological and behavioral mediators. However, whether there is a sex-dependent vulnerability to the obesogenic effects of shift work is unclear. This area presents opportunities for future research.

The Relationship between Sociodemographic, Professional, and Incentive Factors and Self-Reported Level of Physical Activity in the Nurse Population: A Cross-Sectional Study

Research indicates that while nurses are aware of the benefits of physical activity (PA), their adherence to PA is low. The results of workplace interventions that increase PA are inconsistent. The study aim was identification the sociodemographic, professional, and incentive factors influencing nurses’ PA and investigation its relationship with the level of PA that they report. This study was based on observational cross-sectional research conducted among professionally active nurses working in a clinical setting (n = 350). The self-reported questionnaire was used to collect sociodemographic and employment data and motivators and barriers of participating in PA. The level of PA was assessed using International Physical Activity Questionnaire. The analysis revealed significant differences in the Total Physical Activity Score (TPAS) depending on the variables related to professional activity (working in a management position: p = 0.015; workplace: p = 0.01; shift type: p ≤ 0.002). Cluster analysis revealed that the most important statement in the group division about motivation was fear of the pain occurring after exercise. Nurses who were more motivated to be active showed a higher level of leisure-time PA than less motivated nurses. The recommendation of PA in the nursing population should be focused on increasing the leisure time PA, ensuring the appropriate time to recovery, and compliance with the principles of work ergonomics to prevent musculoskeletal disorders.

The Influence of Doing Shift Work on the Lifestyle Habits of Primary Care Nurses

Nurses’ lifestyle habits play a key role in promoting healthy lifestyles; although, they may not always be entirely healthy and can be influenced by working conditions. This paper aims to analyze the influence of doing shift work on nurses’ lifestyle habits. Participants (n = 219) were recruited from 27 primary health care centres in Spain. Data were collected on socio-demographic characteristics, working conditions and lifestyle behaviour, assessed by use of an adhoc questionnaire including validated measures. Descriptive analysis and logistic regression models were performed. A total of 95% of the nurses reported having an adequate diet; 45.2% did not engage in any type of physical activity; and 85.8% did not smoke, especially women. A total of 60.3% did shift work, especially the younger ones (80.8%; p < 0.001), these nurses being the ones with the worst food habits (81.8%). In contrast, nurses who did shift work, exercised more days a week (69.5%; p < 0.001). The dietary habits of the nurses were adequate. Low tobacco consumption and low adherence to physical activity were observed, especially among women. Shift work harmed eating habits and obesity rates, but was a protective factor in terms of adherence to physical exercise.

Onset of Weight Gain and Health Concerns for Men: Findings from the TAP Programme

With shown reticence by men to engage with dietary interventions for weight loss, investigations that provide detail on men’s perceptions for the causes of weight gain and subsequent concerns over health and image are important. Such discoveries have potential to make a valuable contribution to male gendered programme design aimed at tackling weight gain and promoting good health. Connecting to men to health using their hobbies and interests, this study deployed semi-structured interviews of eight male participants (age > 35 years) enrolled on The Alpha Programme (TAP). TAP is a 12-week football and weight management intervention delivered in local community venues. Results captured men’s lived experiences and feelings of being overweight, their attempts at dietary modification, health and causes of weight gain. Results signify externalized attribution for weight gain, entrenched habitual intake practices, despondency related to weight stigmatization, self-objectification and low self-worth. Moreover, this study outlines the processes for capturing this information using a male friendly approach and setting. Outcomes have potential for shaping bespoke men’s weight management and health improvement interventions in the future.

Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives

Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection.

Physical activity and sedentary behaviour in shift and non-shift workers: A systematic review and meta-analysis

Research examining the prevalence, physical activity (PA) and sedentary behaviour (SB) in shift workers show mixed results. This systematic review and meta-analysis aimed to compare PA and SB in shift workers with non-shift workers following the PRISMA guidelines. Ebscohost megafile ultimate (CINHAL, E-journals, Academic search ultimate, health source consumer edition, SPORT Discus), PubMed, Scopus, Web of Science, and Science Direct databases were searched up to April 2021. Cross-sectional and baseline data from longitudinal studies reporting PA and SB in full time workers were eligible. Data on participants characteristics and time spent in PA and SB and/or prevalence of workers meeting PA guidelines were extracted and pooled with random effects model. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) 10-item checklist was adapted and used. A total of 49 studies met inclusion criteria and 21 studies included for meta-analysis. The prevalence of meeting physical activity guidelines (OR 0.84, 95% CI: 0.68, 1.03) and standardized mean difference (SMD) of time spent in moderate-to-vigorous physical activity (SMD -0.1, 95% CI: -0.4, 0.20) were similar in shift and non-shift workers. Time spent in sedentary behaviour was lower in shift workers than non-shift workers (SMD -0.2, 95% CI: 0.50, -0.001). While the differences in PA are not so evident between shift and non-shift workers, the prevalence of sufficient PA was low in both groups. These preliminary findings provide support for inclusion of physical activity and sedentary behaviour in health promotion interventions targeted at shift workers.

Start Healthy and Stay Healthy: A workplace health promotion intervention for new graduate nurses: A mixed-methods study

AIMS

This study explored the acceptability of a workplace health promotion intervention embedded into a transition to practice (TTP) programme to assist new graduate nurses in establishing healthy dietary and physical activity (PA) behaviours from career commencement.

DESIGN

A sequential mixed methods design.

METHODS

The Start Healthy and Stay Healthy (SH&SH) intervention, informed by the Behaviour Change Wheel, was conducted in an Australian Local Health District. It included face-to-face education sessions, the use of a fitness tracker and twice-weekly short answer messages. Participants completed three online surveys: at orientation, 6 weeks and 6 months. A sub-sample participated in semi-structured interviews to explore their experience of the intervention. Interview data were analysed thematically.

RESULTS

The intervention was delivered from February to December 2019. A total of 99 nurses completed the baseline survey, 62 at 6 weeks and 69 at 6 months. After 6 months, health knowledge increased as participants correctly identified recommended amounts of fruits, vegetables and PA. Fruit consumption increased at 6 months with little change to vegetable intake. Takeaway consumption decreased, but consumption of some discretionary foods increased. Across the three time points, there was a low engagement in PA during leisure time. The interviews identified three themes: (1) Support of Colleagues and Peers, (2) The Work Environment and (3) Engagement with SH&SH.

CONCLUSION

Providing a targeted intervention for new graduate nurses embedded into a TTP programme improved their health knowledge, some dietary behaviours, and participation in PA by some participants.

IMPACT

Ensuring a healthy nursing workforce is critical to retaining staff. Implementing a workplace health promotion intervention that targets new graduate nurses can help them adopt and maintain healthy lifestyle behaviours to support them in their future careers.

Health and work in Brazil: physical and psychosocial demands

This study aims to describe the prevalence and factors associated of physical and psychosocial demands among Brazilian workers. Data were obtained from the 2013 Brazilian National Health Survey. Physical demand was defined as jobs that require intense physical effort or excessive walking, whereas psychosocial demand was defined as involvement in stressful activities. Multivariate logistic regression was used to estimate the association between demands and health conditions, occupational characteristics, and work conditions. Out of 39,590 participants, 54.4% reported physical demands and 35.5% psychosocial demands at work. After adjustment for sociodemographic characteristics, health conditions, occupational characteristics, and work conditions remained significantly associated with physical or psychosocial workload. The results suggest that in Brazil the work has a high level of physical and psychosocial demands, which are associated with occupational features and health conditions. It is necessary to incorporate work activities as significant factors to investigate the causes of diseases. And the interventions and policies aimed at preventing the negative occupational exposures are urgent, and can contribute to improve physical and psychosocial health at the workplace.

Nutrition Habits of Polish Nurses: An Approach

BACKGROUND

Chronic stress, unlimited working time and the shift working system as well as sleep deficiency may lead to the occurrence of nutrition disorders among nurses.

AIM

The aim of the paper was an assessment of the nutrition habits of nurses. It was an observational study conducted from June 2017 to May 2018 among nurses (n = 1080) in Silesia in Poland. Data was obtained using a range of questionnaires.

RESULTS

Body mass index (BMI) of the analysed nurses demonstrated overweight/obesity in 490 (45.5%) of them. Nearly all the diets of the analysed nurses (n = 1021; 94.5%) required improvement. Younger nurses (<31 years old) demonstrated a greater tendency to indulge in habitual overeating, and those having additional employment demonstrated poorer nutrition habits compared to those without additional employment.

CONCLUSION

The analysed nurses made numerous dietary mistakes which, as a consequence, can lead to obesity. Emotional overeating was the dominant nutrition habit in the studied group of nurses. Nurses who were overweight/obese, nurses who had additional employment and younger nurses demonstrated tendencies toward improper nutrition choices, i.e., the tendency to overeat or restrain oneself from eating.

The Health Behaviour of German Outpatient Caregivers in Relation to Their Working Conditions: A Qualitative Study

Ongoing demographic change is leading to an increasingly older society and a rising proportion of people in need of care in the German population. Therefore, the professional group of outpatient caregivers is highly relevant. Their work is characterised not only by interacting with patients in a mobile setting but also by working in shifts. Health behaviour under these specific working conditions is crucial for ensuring long-term work ability and performance. Little is known about the health behaviour of German outpatient caregivers and its potential impact on their work. The aims of the study were (1) to examine health behavioural patterns (nutrition, exercise, smoking, regeneration) of outpatient caregivers, (2) to illuminate their personal health-promoting behaviours, and (3) to identify potential work-related factors influencing their health behaviour. Fifteen problem-centred interviews were conducted with outpatient caregivers working in Northern Germany in the period January–April 2020. Interviews were analysed by using qualitative content analysis. Outpatient caregivers reported improvable nutrition and hydration, with simultaneous high coffee consumption, low physical activity, poor regeneration (breaks and sleep quality), and good personal health-promoting behaviour (e.g., back-friendly habits), although the majority were smokers. Barriers to the implementation of health-promoting behaviours were a high perception of stress due to increased workload and time pressure, while aids to better health-promoting behaviour were described as being social support and personal resources. The respondents perceived their working conditions as potentially influencing their health behaviour. On the basis of their descriptions, various practice-relevant strategies were derived. The data explore a potential need for outpatient care services to develop interventions on behavioural and structural levels that can help create healthier working conditions for their employees so these caregivers can adopt better health behaviours.

Obesity among Health-Care Workers: Which Occupations Are at Higher Risk of Being Obese?

Obesity among health-care workers (HCWs) is an important issue as it can affect both their health condition and their professional capability. Although adult obesity is attributable to occupational factors, few reports are available on Malaysian health-care workers’ obesity and whether different health-care job categories are related to workers’ obesity. This study aimed to determine the prevalence of obesity among HCWs and the association between various HCW job categories and obesity. A cross-sectional study was conducted by analyzing secondary data from the 2019 annual cardiovascular health screening program, which included information regarding all government health-care workers in the east coast region of Peninsular Malaysia. The subject’s body mass index (BMI) was categorized according to WHO criteria. Only 43% of the subjects had a normal BMI, while 33.1% were categorized as overweight, and 21.1% were obese. Different HCWs’ job categories were shown to be significantly associated with their obesity status, with nurses apparently having a higher risk of being obese (Adj OR = 1.91, 95% CI 1.45, 2.53, p-value < 0.001). This study’s results require further exploration of HCWs’ working condition factors and for different job categories that contribute to obesity. Public health intervention programs to combat obesity should be implemented that primarily target HCW groups at the highest risk of obesity.

Life satisfaction, life quality, and leisure satisfaction in health professionals

PURPOSE

This study was aimed to determine the relationships between life satisfaction, life quality, and leisure satisfaction in health professionals.

DESIGN AND METHODS

The study was conducted with 498 health professionals working in a city of the Central Anatolia Region, Turkey. Data were collected using Socio-Demographic Form, the Satisfaction with Life Scale, the Short Form of World Health Organization Quality of Life Questionnaire, and the Leisure Satisfaction Scale.

FINDINGS

There was a positive significant relationship between life satisfaction, life quality, and leisure satisfaction. As the level of leisure satisfaction of health professionals increases, the life satisfaction, and life quality also increase.

PRACTICE IMPLICATIONS

Rise in the level of leisure satisfaction is important to increase life satisfaction and improve life quality of health professionals. Therefore, leisure patterns and behaviors that increase leisure satisfaction should be integrated into daily lives of these professionals.

Association between shift work and obesity among nurses: A systematic review and meta-analysis

BACKGROUND

The association of shiftwork and the risk of obesity in nurses has been inconsistent in the literature.

OBJECTIVES

We therefore conducted a systematic review and meta-analysis to quantitatively summarize this association in nurses.

METHODS

We systematically searched PubMed, Ovid MEDLINE, Cochrane Library, EMBASE and Web of Science from inception until April 2020 for studies that examined the relationship between shift work and obesity in nurses. Pooled odds ratio (OR) was calculated using a fixed- or random-effect model. The quality of each study was evaluated by using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Two researchers independently assessed eligibility and extracted data. The whole process followed the PRISMA statement.

RESULTS

We included 11 eligible studies with a total of 74,651 nurses in this study. All of the studies were found to be low or moderate risk of bias according to the ROBINS-I tool. The pooled estimate of the risk of obesity in shift work nurses as compared to non-shift work nurses did not achieve statistical significance (OR = 1.05, 95% CI = 0.97-1.14). However, the risk of obesity was significantly higher in the sub-analysis of night-only shift work nurses (OR = 1.12, 95% CI = 1.03-1.21). In a sub-analysis limited only to the studies of female nurses, the obesity risk was found not to be statistically significant (OR = 1.09, 95% CI = 0.84-1.35). For different regions of study population, shift work was associated with a 36% increased risk of obesity in America (OR = 1.36, 95% CI = 1.30-1.42) and 1% increased risk in Europe and Australia (OR = 1.01, 95% CI = 1.00-1.03). The BMI cut-off for obesity varied in the included studies. When using a cut-off of BMI ≥ 30 kg/m² for obesity, our subgroup analysis shows a positive relationship between obesity and nurse shift work (OR = 1.12, 95% CI = 1.03-1.20).

CONCLUSIONS

This is the first systematic review and meta-analysis confirming that shiftwork may play a significant role in the development of obesity among nurses, especially in America, Europe and Australia. This was found to be particularly true for night only shift work nurses. Implementation of health policies and a better night shift schedule are needed in the hospital's management to effectively protect nurses from obesity, and the health risks associated with it.

Level of Physical Activity and Its Associated Factors among Primary Healthcare Workers in Perak, Malaysia

Physical inactivity and sedentary lifestyle have been linked to the occurrence of non-communicable diseases. This study’s purpose was to determine physical activity levels and sedentary behaviours among primary healthcare workers in Perak, Malaysia, as well as associated factors. A cross-sectional study was conducted at 12 health clinics in Perak, Malaysia, to determine physical activity levels, sedentary behaviours and factors associated with physical inactivity among primary healthcare workers. Each respondent completed a self-administered questionnaire relating to socio-demographic characteristics, including anthropometric measurements such as body mass index, waist circumference and body fat percentage, and the English and Malay version of the Global Physical Activity Questionnaire. A total of 261 primary healthcare workers participated in this study; 45.6% were classified as physically inactive, spending a median of five hours daily engaged in sedentary behaviours. In terms of metabolic equivalent min per week, male workers had significantly higher physical activity than females. Self-reported health status and longer sitting times were significantly associated with physical inactivity. Logistic regression showed that poor health status was 1.84 times less likely to be associated with physical activity (p = 0.036, Confidence Interval = 1.04–3.24). Due to the high prevalence of physical inactivity, action is needed to increase physical activity among healthcare workers.

Analysis of Selected Body Composition Parameters and Ergonomic Safety among Professionally Active Nurses in Poland: A Preliminary Prospective Monocentric and Observational Study

Nurses consist of an occupational group that is particularly exposed to harmful work-related factors such as prolonged working hours, severe stress, fatigue, and excessive strain on the musculoskeletal system. According to nurses, the limitation of the application of ergonomic principles of work may contribute to the occurrence of numerous dangerous behaviors, improper eating habits, or deficiency of systematic physical activity. The most common consequences are nutritional disorders and musculoskeletal system dysfunctions. This prospective observational study was aimed at evaluating selected parameters of the body composition of professionally active nurses and at determining work-related risks during nursing activities. The study group consisted of 37 active nurses (38.38 ± 11.33 years). The research tool was a device for bioelectrical impedance analysis (BIA). A questionnaire designed by the authors was also implemented, which covered ergonomic principles, musculoskeletal injuries, and nutritional habits. In the present study, it was shown that all average values of the tested nurses' body composition parameters were within the normal range. The majority of respondents (97.3%) reached a high level of body water. A statistically significant correlation was found between the knowledge of the workplace ergonomic principles and body mass index. In conclusion, musculoskeletal pain and lack of implementation of ergonomic behaviors are a significant problem among nurses, which may be the cause of overweight or obesity in this occupational group.

Analyzing the Job Demands-Control-Support Model in Work-Life Balance: A Study among Nurses in the European Context

The balance of personal life with professional life is a topical issue that is increasingly worrisome due to globalization, the rapid introduction of new technologies into all areas of human life, the overlap between time between work and family, new organizational systems, and changes in the nature of work. This problem is accentuated by professions subjected to intense labor demands, as is the case of nurses. Adopting the Job Demand–Control–Support model, the main purpose of this research is to analyze how these factors lead to a greater or lesser degree of work–life balance. The research proposes a logistic regression model, which was constructed with a sample of 991 nursing professionals from the V European Working Conditions Survey. The results obtained confirm, on the one hand, that there is a significant effect of physical demands (but not psychological demands) on work–life balance. On the other hand, the moderating effects of job control are partially confirmed for psychological demands, and those of supervisor support (but not co-worker support) are partially confirmed for physical demands. In conclusion, the present research shows that effective management of nurses’ work context can decisively contribute to finding the difficult balance between personal and professional time.

Assessing the prevalence of meeting physical activity recommendations among U.S. healthcare workers: Data from the 2015 National Health Interview Survey

We examined the prevalence of U.S. healthcare workers who met the 2008 Physical Activity Guidelines for Americans (2008 Guidelines), and the relationships among meeting the 2008 Guidelines and health behaviors, musculoskeletal symptoms, and occupational- and workplace- factors. We estimated prevalence of meeting the 2008 Guidelines for aerobic and muscle-strengthening activity using data from the 2015 National Health Interview Survey. Among 1,502 U.S. healthcare workers, 56.2% met the recommended guideline for aerobic activity; 30.1% met the recommended guideline for muscle-strengthening activity; and 25.3% met both recommended guidelines. Adjusting for covariates, meeting the 2008 Guidelines was associated with no history of smoking, current alcohol consumption, type of occupation, occupational activities, and availability of a health promotion program at work. Our findings suggest multi-level approaches (combining individual and organizational level efforts) are needed.

Prevalence of Workplace Health Practices and Policies in Hospitals: Results From the Workplace Health in America Study

Purpose:

To provide a nationally representative description on the prevalences of policies, practices, programs, and supports relating to worksite wellness in US hospitals.

Design:

Cross-sectional, self-report of hospitals participating in Workplace Health in America (WHA) survey from November 2016 through September 2017.

Setting:

Hospitals across the United States.

Participants:

Random sample of 338 eligible hospitals participating in the WHA survey.

Measures:

We used previous items from the 2004 National Worksite Health Promotion survey. Key measures included presence of Worksite Health Promotion programs, evidence-based strategies, health screenings, disease management programs, incentives, work-life policies, barriers to health promotion program implementation, and occupational safety and health.

Analysis:

Independent variables included hospital characteristics (eg, size). Dependent characteristics included worksite health promotion components. Descriptive statistics and χ2 analyses were used.

Results:

Eighty-two percent of hospitals offered a wellness programs during the previous year with larger hospitals more likely than smaller hospitals to offer programs ( P < .01). Among hospitals with wellness programs, 69% offered nutrition programs, 74% offered physical activity (PA) programs, and 84% had a policy to restrict all tobacco use. Among those with cafeterias or vending machines, 40% had a policy for healthier foods. Only 47% and 25% of hospitals offered lactation support or healthy sleep programs, respectively.

Conclusion:

Most hospitals offer wellness programs. However, there remain hospitals that do not offer wellness programs. Among those that have wellness programs, most offer supports for nutrition, PA, and tobacco control. Few hospitals offered programs on healthy sleep or lactation support.

Eating Behavior (Duration, Content, and Timing) Among Workers Living under Different Levels of Urbanization

Urbanization has contributed to extended wakefulness, which may in turn be associated with eating over a longer period. Here, we present a field study conducted in four groups with different work hours and places of living in order to investigate eating behavior (duration, content, and timing). Anthropometric measures were taken from the participants (rural (n = 22); town (n = 19); city-day workers (n = 11); city-night workers (n = 14)). In addition, a sociodemographic questionnaire was self-answered and 24-h food recalls were applied for three days. The 24-h food recalls revealed that fat intake varied according to the groups, with the highest consumption by the city-day workers. By contrast, city-day workers had the lowest intake of carbohydrate, whereas the rural group had the highest. In general, all groups had some degree of inadequacy in food consumption. Eating duration was negatively correlated with total energy intake, fat, and protein consumption in the rural and town groups. There was a positive correlation between body mass index and eating duration in both city groups. The rural group had the earliest start time of eating, and this was associated with a lower body mass index. This study suggested that food content and timing, as well as eating duration, differed according to place of living, which in turn may be linked to lifestyle.

What Motivates Nurses to Exercise? Determinants of Physical Activity Among Canadian Nurses Using Self-Determination Theory

Background

Nurses’ suboptimal physical activity (PA) levels place them at high risk for cardiovascular diseases. Little is known about the motivational factors that influence their PA behavior.

Purpose

This study drew on the Self-Determination Theory (SDT) to investigate whether associations between nurses’ levels of mood disturbance, psychological need satisfaction (competence, autonomy, and relatedness), and self-determined motivation predict levels of objectively assessed PA.

Methods

A total of 363 nurses recruited from 14 hospitals in the Champlain region of Ontario, Canada, wore ActiGraph GT3X accelerometers and completed standardized questionnaires assessing sociodemographic and work characteristics, mood disturbance, and SDT variables. Levels of moderate-to-vigorous intensity PA (MVPA) were measured in minutes/week in bouts ≥10 min. Data were analyzed using path analysis and multiple mediational model.

Results

The model predicting MVPA showed good fit to the data, χ 2 (4, n = 363) = 7.82, p = .10; comparative fit index = .991; Tucker–Lewis Index = .967; root mean square error of approximation = .051. Higher mood disturbance was associated with lower perceived competence (β = −.29, p = .002), autonomy (β = −.29, p = .002), and relatedness (β = −.19, p = .002). Lower perceived competence (β = .46, p = .003) and autonomy (β = .14, p = .011), as well as higher mood disturbance (β = −.16, p = .016), were associated with less self-determined motivation for PA. Lower self-determined motivation was associated with lower levels of MVPA among nurses.

Conclusions

Interventions targeting low mood, as well as perceived competence and autonomy in exercise, may promote MVPA among nurses and reduce cardiac risk.

Women's heart health: a focus on nurses' physical activity and sedentary behaviour

PURPOSE OF REVIEW

This review focuses on recent literature examining and targeting the physical activity and sedentary behaviour of nurses. The role of physical activity and sedentary behaviour in preventing and managing cardiovascular disease (CVD) in women is also discussed.

RECENT FINDINGS

Nurses (most of whom are women) represent the largest professional group within the health care workforce and many present with risk factors for CVD (e.g. physical inactivity, sedentary behaviour, overweight/obesity, hypertension, dyslipidemia, diabetes, smoking, depression, anxiety). Several studies have measured the physical activity and sedentary behaviour of nurses and found low levels of physical activity (i.e. most do not meet physical activity guidelines) and high levels of sedentary behaviour (50-60% of the day). Nurses working rotating shifts, 12-h shifts and/or working full-time or part-time (vs. casual) may be at greater risk of physical inactivity; however, the opposite has been observed for sedentary behaviour. Few interventions targeting nurses' physical activity levels have shown promise, but those that have used activity monitors with behavioural strategies; no studies, to date, have evaluated the impact of sedentary behaviour interventions in nurses.

SUMMARY

Improving the physical activity levels and reducing the sedentary behaviour of nurses is important for nurses' cardiovascular health. There is a need for interventions to address low physical activity and high sedentary behaviour among nurses.

Excesso de peso e fatores associados entre profissionais de saúde da Estratégia Saúde da Família

Resumo Introdução Há aumento global na prevalência da obesidade, importante fator de risco para as doenças crônicas não transmissíveis. Objetivo Avaliar a prevalência de excesso de peso e os fatores associados entre profissionais de saúde da Estratégia Saúde da Família. Método Estudo transversal, com 215 profissionais de saúde de Montes Claros, MG, em 2015. Investigaram-se informações demográficas, laborais, comportamentais e de hábitos alimentares. Os profissionais foram classificados quanto à presença de um perfil de saúde - concomitância de índice de massa corporal normal, não fumar, consumir frutas e verduras diariamente, praticar atividade física e não adicionar sal às refeições. Análise estatística com modelo de regressão logística para identificar os fatores associados ao excesso de peso. Resultados Participaram agentes comunitários de saúde (58,0%), enfermeiros (27,0%), técnicos de enfermagem (9,0%) e médicos (6,0%). A maioria do sexo feminino (87%) e idade média de 35,92 (±8,98). Possuíam excesso de peso 53,5% (36,7% com sobrepeso; 16,8% com obesidade). A idade avançada, outro vínculo de trabalho, consumo de frutas e verduras irregular e ausência do perfil de saúde apresentaram associação com excesso de peso. Conclusão Houve alta prevalência de excesso de peso entre os profissionais de saúde, associado ao estilo de vida e trabalho.

Health behavior among working adults: Workload and exhaustion are associated with nutrition and physical activity behaviors that lead to weight gain

The purpose of this study was to evaluate the relationship between workload, exhaustion, and key health behaviors for weight loss-nutrition and physical activity. Structural equation modeling was used to estimate the path coefficients in a sample of 953 employed adults. The results show that workload and exhaustion were positively related to emotional eating, uncontrolled eating, and percent of calories from fat. In addition, exhaustion was negatively related to physical activity levels. Workload and exhaustion are associated with nutrition and physical activity behaviors that promote weight gain and should be considered in weight management interventions for working adults.

Clinical Staff's Motivators and Barriers to Engagement in Health-Promoting Behaviors

Clinical staff can promote patients' engagement in health-promoting behaviors to prevent/treat obesity. However, some clinical staff are overweight/obese and may not model health behaviors for their patients. This cross-sectional survey study tested the hypotheses that clinical staff's level of (1) motivators and (2) barriers to engaging in health-promoting behaviors would be significantly associated with their body mass index (BMI). Barriers were significantly correlated and motivators were not correlated with caregivers' BMI. Implications for nurses in professional development are discussed.

Associations between working environment and weight control efforts among workers with obesity in Korea

Objective The aim of this study was to investigate the relationship between working environment and weight control efforts among obese workers in Korea. Methods This study was based on the 2011 3rd Korean Working Conditions Survey, which was conducted on workers aged 15 years or older. A sample of 484 obese workers was included in the study. Multivariable logistic regression analysis was used to investigate the relationship between working environment and weight control efforts after controlling for individual variables. Adjusted odds ratios (ORs) and 95% confidence intervals were calculated. Results Of the participants, 63.4% reported that they made efforts to control their weight. After controlling for personal factors, the OR of weight control efforts for individuals working 40-49 hours per week was 2.4 times that for individuals working 60 hours or more per week. The OR of regular employment workers was 2.2 times that of non-regular workers. Conclusion We established that working hours and employment type were significantly related to weight control efforts. Therefore, we recommend that working conditions should be considered in designing effective workplace health promotion programs.

Relationships of Musculoskeletal Symptoms, Sociodemographics, and Body Mass Index With Leisure-Time Physical Activity Among Nurses

Nurses have a high prevalence of musculoskeletal symptoms from patient handling tasks such as lifting, transferring, and repositioning. Comorbidities such as musculoskeletal symptoms may negatively affect engagement in leisure-time physical activity (LTPA). However, limited data are available on the relationship between musculoskeletal symptoms and LTPA among nurses. The purpose of this study was to describe musculoskeletal symptoms and LTPA, and to examine the relationships of musculoskeletal symptoms, sociodemographics, and body mass index with LTPA among nurses. Cross-sectional data on sociodemographics, employment characteristics, musculoskeletal symptoms, body mass index, and LTPA were collected from a statewide random sample of 454 California nurses from January to July 2013. Descriptive statistics, bivariate and multiple logistic regressions were performed. We observed that non-White nurses were less likely to engage in regular aerobic physical activity than White nurses (odds ratio [OR] = 0.61; 95% confidence interval [CI] = [0.40, 0.94]). Currently working nurses were less likely to engage in regular aerobic physical activity than their counterparts (OR = 0.48; 95% CI = [0.25, 0.91]). Nurses with higher body mass index were less likely to perform regular aerobic physical activity (OR = 0.93; 95% CI = [0.89, 0.97]) or muscle-strengthening physical activity (OR = 0.92; 95% CI = [0.88, 0.96]). This study found no evidence that musculoskeletal symptoms may interfere with regular engagement in LTPA. Physical activity promotion interventions should address employment-related barriers, and particularly target racial minority nurses and those who have a high body mass index.

A systematic review of physical activity-based interventions in shift workers

Shift workers are at increased risk of a range of chronic diseases and there is evidence to suggest that these risks can be ameliorated by physical activity. Little is known however about the efficacy of physical activity interventions in shift workers. The aim was therefore to critically review the literature to improve understanding of the efficacy of physical activity promotion initiatives for this occupational group. A systematic review of randomized controlled trials of physical activity in shift workers was conducted in 2016-2017 following the Preferred Reported Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Only seven studies were found. None of the studies measured changes in physical activity behaviour or reported on the timing or setting of the intervention protocols. Instead, most focused on health-related outcomes including body composition, fitness and sleep. Almost all provided physical activity 'prescriptions' with walking or 'aerobic activity' as the primary intervention mode and most reported significant improvements in one of the outcome measures. Although the findings suggest that physical activity may mitigate intermediate risk factors associated with non-communicable diseases (NCD) in shift workers, the studies offer little insight into physical activity behaviour change in this occupational group. Future research should assess actual changes in physical activity behaviour, and its determinants, as well as the reach and uptake of intervention strategies in this challenging population group.