The Impact of a Novel Structured Health Intervention for Truckers (SHIFT) on Physical Activity and Cardiometabolic Risk Factors

Keep on truckin': how effective are health behaviour interventions on truck drivers' health? A systematic review and meta-analysis

BACKGROUND

Truck drivers are a vital workforce, but have higher rates of obesity and other chronic diseases than the general population. The occupation's sedentary nature, limited physical activity opportunities and access to healthy food, and irregular sleeping patterns contribute to poor health. This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions on health behaviours and cardiometabolic biomarkers of health in truck drivers.

METHODS

A systematic search was conducted in February 2024, and reported according to PRISMA 2020 guidelines. Experimental studies targeting physical activity, sedentary behaviour, sleep, diet, weight loss, drug/alcohol use, and/or smoking were eligible. Two reviewers independently screened and completed data extraction and risk of bias assessment. Data were combined at the study level. Pooled statistics were calculated using mean differences (MD) or standardised mean differences (SMD) for outcomes that were reported in ≥2 studies. Pre- and post-intervention means and standard deviations (SD) for the intervention and control groups were used to compute effect sizes.

RESULTS

Nineteen studies (n=2137 participants) were included. Meta-analyses found a small-to-moderate increase in fruit and vegetable consumption (SMD 0.32, p=0.03) with no other significant effects on other outcome variables.

CONCLUSIONS

Interventions are moderately effective in increasing truck drivers' fruit and vegetable consumption, but not other outcomes. There is a dearth of research in the driver population compared to other occupational groups. Future interventions should consider workplace and environmental factors to promote the health and wellbeing of truck drivers.

TRIAL REGISTRATION

The study protocol was registered on PROSPERO (CRD42021283423).

A blueprint for a new commercial driving epidemiology: An emerging paradigm grounded in integrative exposome and network epistemologies

Excess health and safety risks of commercial drivers are largely determined by, embedded in, or operate as complex, dynamic, and randomly determined systems with interacting parts. Yet, prevailing epidemiology is entrenched in narrow, deterministic, and static exposure-response frameworks along with ensuing inadequate data and limiting methods, thereby perpetuating an incomplete understanding of commercial drivers' health and safety risks. This paper is grounded in our ongoing research that conceptualizes health and safety challenges of working people as multilayered "wholes" of interacting work and nonwork factors, exemplified by complex-systems epistemologies. Building upon and expanding these assumptions, herein we: (a) discuss how insights from integrative exposome and network-science-based frameworks can enhance our understanding of commercial drivers' chronic disease and injury burden; (b) introduce the "working life exposome of commercial driving" (WLE-CD)-an array of multifactorial and interdependent work and nonwork exposures and associated biological responses that concurrently or sequentially impact commercial drivers' health and safety during and beyond their work tenure; (c) conceptualize commercial drivers' health and safety risks as multilayered networks centered on the WLE-CD and network relational patterns and topological properties-that is, arrangement, connections, and relationships among network components-that largely govern risk dynamics; and (d) elucidate how integrative exposome and network-science-based innovations can contribute to a more comprehensive understanding of commercial drivers' chronic disease and injury risk dynamics. Development, validation, and proliferation of this emerging discourse can move commercial driving epidemiology to the frontier of science with implications for policy, action, other working populations, and population health at large.

Program Evaluation of Fit to Pass®, a Remotely Accessible Health Promotion Program for Commercial Motor Vehicle Truck Drivers

BACKGROUND

Chronic health conditions are highly prevalent among truck drivers due to many unique occupational and environmental stressors. Health promotion programs are shown to be effective in improving truck driver health outcomes; however, there is no research on whether such programs can increase the length of a driver's Department of Transportation (DOT) medical certificate. The purpose of this quality improvement project was to evaluate Fit to Pass (FTP), a remotely accessible health promotion program available for truck drivers on improved health outcomes and increased DOT medical certificate length.

METHOD

Program evaluation included an evaluation of the FTP coaching guide against evidence-based practice guidelines. An analysis of a limited dataset of 22 truck driver records examined the effectiveness of the program in achieving improved health outcomes and increased medical certification length.

FINDINGS

A review of the literature revealed three major themes: (a) motivational interviewing to increase driver intention and self-efficacy; (b) mobile health care technology to connect hard-to-reach truck drivers; and (c) effectiveness of structured multicomponent health promotion programs. After participation in FTP, truck drivers experienced a mean decrease in weight and body mass index (BMI) of 4.6 lbs and 1.3 kg/m2, respectively. The lengths of initial DOT medical certificates were compared with DOT medical certificates received at the time of recertification (post-FTP). Only eight participants had the potential for improvement in certificate length. Of those, three truck drivers achieved an increased DOT medical certificate length at the time of recertification.

CONCLUSION/APPLICATIONS TO PRACTICE

FTP offers tailored and comprehensive health coaching for truck drivers using current evidence-based practice guidelines to educate and reinforce healthy lifestyle habits. Analysis of a limited dataset revealed a mean decrease in BMI and a trend of increased DOT medical certification lengths after participation in FTP; however, further research with larger sample sizes is recommended.

Describing Physical Activity Patterns of Truck Drivers Using Actigraphy

Background

Truck driving is a highly sedentary occupation that places workers at risk for chronic health conditions, such as obesity and high blood pressure. The primary purpose of this study was to objectively describe truck drivers' typical physical activity (PA) patterns.

Methods

We used ∼7-10-day baseline PA actigraphy data samples from drivers in the Safety & Health Involvement For Truckers (SHIFT) study (n = 394). Driver PA patterns (e.g., average number of ≥10 minute Freedson bouts per week, time in bouts, and common days/times for PA) were summarized with descriptive analyses. We also compared objective accelerometer data to self-reports.

Results

Drivers' weekly PA averaged 14.4 minutes (SD = 37.0), and most PA occurred between 5-6 pm on Tuesdays and Wednesdays. Drivers overestimated self-reported weekly exercise by over 60 min/week compared to accelerometer data.

Conclusion

Our results suggest that objective PA assessment may be warranted over self-report when possible, and timing may be key in future PA intervention work with truck drivers.

Exploring the Health and Economic Burden Among Truck Drivers in Australia: A Health Economic Modelling Study

Background The transport and logistics industry contributes to a significant proportion of the Australian economy. However, few studies have explored the economic and clinical burden attributed to poor truck driver health. We therefore estimated the work-related mortality burden among truck drivers over a 10-year period. Methods Dynamic life table modelling was used to simulate the follow-up of the Australian male working-age population (aged 15-65 years) over a 10-year period of follow-up (2021-2030). The model estimated the number of deaths occurring among the Australian working population, as well as deaths occurring for male truck drivers. Data from the Driving Health study and other published sources were used to inform work-related mortality and associated productivity loss, hospitalisations and medication costs, patient utilities and the value of statistical life year (VoSLY). All outcomes were discounted by 5% per annum. Results Over 10 years, poor truck driver health was associated with a loss of 21,173 years of life lived (discounted), or 18,294 QALYs (discounted). Healthcare costs amounted to AU$485 million (discounted) over this period. From a broader, societal perspective, a total cost of AU$2.6 billion (discounted) in lost productivity and AU$4.7 billion in lost years of life was estimated over a 10-year period. Scenario analyses supported the robustness of our findings. Conclusions The health and economic consequences of poor driver health are significant, and highlight the need for interventions to reduce the burden of work-related injury or disease for truck drivers and other transport workers.

A multicomponent structured health behaviour intervention to improve physical activity in long-distance HGV drivers: the SHIFT cluster RCT

Background

Long-distance heavy goods vehicle drivers are exposed to a multitude of risk factors associated with their occupation. The working environment of heavy goods vehicle drivers provides limited opportunities for a healthy lifestyle, and, consequently, heavy goods vehicle drivers exhibit higher than nationally representative rates of obesity and obesity-related comorbidities, and are underserved in terms of health promotion initiatives.

Objective

The aim of this trial was to test the effectiveness and cost-effectiveness of the multicomponent Structured Health Intervention For Truckers (SHIFT) programme, compared with usual care, at both 6 months and 16–18 months.

Design

A two-arm cluster randomised controlled trial, including a cost-effectiveness analysis and process evaluation.

Setting

Transport depots throughout the Midlands region of the UK.

Participants

Heavy goods vehicle drivers.

Intervention

The 6-month SHIFT programme included a group-based interactive 6-hour education session, health coach support and equipment provision [including a Fitbit® (Fitbit Inc., San Francisco, CA, US) and resistance bands/balls to facilitate a ‘cab workout’]. Clusters were randomised following baseline measurements to either the SHIFT arm or the control arm.

Main outcome measures

Outcome measures were assessed at baseline, with follow-up assessments occurring at both 6 months and 16–18 months. The primary outcome was device-measured physical activity, expressed as mean steps per day, at 6-month follow-up. Secondary outcomes included device-measured sitting, standing, stepping, physical activity and sleep time (on any day, workdays and non-workdays), along with adiposity, biochemical measures, diet, blood pressure, psychophysiological reactivity, cognitive function, functional fitness, mental well-being, musculoskeletal symptoms and work-related psychosocial variables. Cost-effectiveness and process evaluation data were collected.

Results

A total of 382 participants (mean ± standard deviation age: 48.4 ± 9.4 years; mean ± standard deviation body mass index: 30.4 kg/m2 ± 5.1 kg/m2; 99% male) were recruited across 25 clusters. Participants were randomised (at the cluster level) to either the SHIFT arm (12 clusters, n = 183) or the control arm (13 clusters, n = 199). At 6 months, 209 (54.7%) participants provided primary outcome data. Significant differences in mean daily steps were found between arms, with participants in the SHIFT arm accumulating 1008 more steps per day than participants in the control arm (95% confidence interval 145 to 1871 steps; p = 0.022), which was largely driven by the maintenance of physical activity levels in the SHIFT arm and a decline in physical activity levels in the control arm. Favourable differences at 6 months were also seen in the SHIFT arm, relative to the control arm, in time spent sitting, standing and stepping, and time in moderate or vigorous activity. No differences between arms were observed at 16–18 months’ follow-up. No differences were observed between arms in the other secondary outcomes at either follow-up (i.e. 6 months and 16–18 months). The process evaluation demonstrated that the intervention was well received by participants and that the intervention reportedly had a positive impact on their health behaviours. The average total cost of delivering the SHIFT programme was £369.57 per driver, and resulting quality-adjusted life-years were similar across trial arms (SHIFT arm: 1.22, 95% confidence interval 1.19 to 1.25; control arm: 1.25, 95% confidence interval 1.22 to 1.27).

Limitations

A higher (31.4%) than anticipated loss to follow-up was experienced at 6 months, with fewer (54.7%) participants providing valid primary outcome data at 6 months. The COVID-19 pandemic presents a major confounding factor, which limits our ability to draw firm conclusions regarding the sustainability of the SHIFT programme.

Conclusion

The SHIFT programme had a degree of success in positively impacting physical activity levels and reducing sitting time in heavy goods vehicle drivers at 6-months; however, these differences were not maintained at 16–18 months.

Future work

Further work involving stakeholder engagement is needed to refine the content of the programme, based on current findings, followed by the translation of the SHIFT programme into a scalable driver training resource.

Trial registration

This trial is registered as ISRCTN10483894.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 12. See the NIHR Journals Library website for further project information.

The effectiveness of the Structured Health Intervention For Truckers (SHIFT): a cluster randomised controlled trial (RCT)

BACKGROUND

Long distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent 'Structured Health Intervention For Truckers' (SHIFT), compared to usual care, at 6- and 16-18-month follow-up.

METHODS

We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16-18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit® and resistance bands/balls to facilitate a 'cab workout'). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population.

RESULTS

Three hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m², 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145-1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (- 24 mins/day, 95% CI: - 43 to - 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3-11). Differences were not maintained at 16-18 months. No differences were observed between groups in the other secondary outcomes at either follow-up.

CONCLUSIONS

The SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group.

TRIAL REGISTRATION

ISRCTN10483894 (date registered: 01/03/2017).

Not Quite Out of the Woods: Overall Health and Chronic Disease Risk Factors among Maine Logging Workers

OBJECTIVE

This research reports on the health status, including chronic disease risk factors, among Maine loggers.

METHODS

Loggers completed a survey and health screenings were held across Maine, collecting data on a variety of health endpoints.

RESULTS

Seventy-five loggers participated. The majority were men (97.1%) with a median age of 46, and a mean BMI of 30.6 kg/m2 (SD 4.9). Nearly half of those screened (45.9%) had blood pressure at the level of stage II hypertension. Loggers with at least a single joint abnormality were 38.4%. The health screening cohort was similar to the non-health screening cohort for many attributes.

CONCLUSIONS

Future research should focus on tailored interventions to improve cardiovascular and musculoskeletal risk factors among loggers.

Effectiveness of Workplace-Based Diet and Lifestyle Interventions on Risk Factors in Workers with Metabolic Syndrome: A Systematic Review, Meta-Analysis and Meta-Regression

Workplace health interventions are essential to improve the health and well-being of workers and promote healthy lifestyle behaviours. We carried out a systematic review, meta-analysis and meta-regression of articles measuring the association between workplace dietary interventions and MetS risk. We recovered potentially eligible studies by searching MEDLINE, the Cochrane Library, Embase, Scopus and Web of Science, using the terms “Metabolic syndrome” and “Occupational Health”. A total of 311 references were retrieved and 13 documents were selected after applying the inclusion and exclusion criteria. Dietary interventions were grouped into six main types: basic education/counselling; specific diet/changes in diet and food intake; behavioural change/coaching; physical exercise; stress management; and internet/social networks. Most programmes included several components. The interventions considered together are beneficial, but the clinical results reflect only a minimal impact on MetS risk. According to the metaregression, the interventions with the greatest impact were those that used coaching techniques and those that promoted physical activity, leading to increased HDL (effect size = 1.58, sig = 0.043; and 2.02, 0.015, respectively) and decreased BMI (effect size = −0.79, sig = −0.009; and −0.77, 0.034, respectively). In contrast, interventions offering information on healthy habits and lifestyle had the contrary effect, leading to increased BMI (effect size = 0.78, sig = 0.006), systolic blood pressure (effect size = 4.85, sig = 0.038) and diastolic blood pressure (effect size = 3.34, sig = 0.001). It is necessary to improve the efficiency of dietary interventions aimed at lowering MetS risk in workers.

Australian bus drivers' modifiable and contextual risk factors for chronic disease: A workplace study

INTRODUCTION

Little is known about workplace health promotion for bus drivers. Bus drivers are at-risk of chronic disease because they are exposed to the risk factor combination of poor nutrition, low levels of physical activity, high levels of sedentary time and are often overweight or obese. The purpose of this paper is to situate the quantitative baseline data collected from bus drivers within qualitative findings about the socio-cultural context of the workplace.

MATERIALS AND METHODS

Baseline data about physical activity, dietary intake and sedentary hours was collected from 58 drivers employed by a large bus company in southeast Queensland. Ten drivers and seven key workplace informants participated in interviews and discussion groups about driver health behaviours, workplace structure, culture, and resources.

RESULTS

The quantitative results of our study reveal bus drivers have a cluster of poor health behaviours-limited physical activity, lower than recommended consumption of fruit and vegetables and high levels of sitting time during working-hours-which contribute to a high prevalence of overweight and obesity and a heightened risk of chronic disease. The qualitative findings suggest there are individual and structural barriers to improving drivers' modifiable health behaviours. Individual barriers include ingrained poor habits and more pressing life concerns, while structural barriers in the context of the workplace include time constraints, shift work, long days, a lack of work amenities and a general disconnect of drivers with their workplace.

CONCLUSION

In this workplace, health promotion strategies for bus drivers should be prioritised as a means of improving drivers' health. To maximise uptake and effectiveness, these strategies should make use of existing workplace resources and consider the context of workplace health behaviour change. Further research is warranted in a broader sample of Australian bus companies to explore the context of workplace health behavior change so targeted strategies to improve bus drivers' health can be developed.

Prevalence of Diagnosed Diabetes Among Employed US Adults by Demographic Characteristics and Occupation, 36 States, 2014 to 2018

OBJECTIVE

To assess the prevalence of diagnosed diabetes among employed US adults from 36 states by occupation group using data from 2014 to 2018 Behavioral Risk Factor Surveillance System.

METHODS

Prevalence of diabetes was calculated by 22 broad and 93 detailed occupation groups among a sample of 366,633 employed respondents. Wald chi-square values were used to determine the significance of associations between diabetes and occupation groups after adjusting for sex, age, and race/ethnicity.

RESULTS

The prevalence of diabetes was 6.4% among employed US adults. The three broad occupation groups with the highest adjusted prevalence of diabetes were protective services (8.9%), farming, fishing, and forestry (8.8%), and community and social services (8.4%).

CONCLUSIONS

Prevalence of diabetes differed by occupation. Work-related factors (eg, shift work, job stress) should be further examined in relation to risk of developing diabetes.

Associations Between Musculoskeletal Conditions Risk, Sedentary Behavior, Sleep, and Markers of Mental Health: A Cross-Sectional Observational Study in Heavy Goods Vehicle Drivers. Musculoskeletal Conditions Risk in HGV Drivers

OBJECTIVE

To explore the risk of having musculoskeletal conditions (MSKs) associated with sitting and sleeping time during workdays, presenteeism, work engagement anxiety, and depression in a sample of UK heavy goods vehicle drivers.

METHODS

Eighty-eight male drivers participated in this cross-sectional study. Binary logistic regression analyses were performed to explore the associations between two-or-more MSKs and common health risk factors.

RESULTS

Possessing two or more MSKs is associated with prolonged sitting time (odds ratio [OR] 4.34) and working hours per day (OR 3.10) and per week (OR 3.12), severe sleep deprivation (OR 33.19), presenteeism (OR 4.22), and borderline or abnormal scores of depression (OR 11.69) and anxiety (OR 4.44), compared with the reference categories.

CONCLUSION

Workplace policies and health promotion interventions to improve heavy goods vehicle drivers working environment are required to minimize the risk of MSK's across this sector.

Enhancing physical activity knowledge exchange strategies for Canadian long-haul truck drivers

Purpose

Canadian long-haul truck drivers lead sedentary lives, but are receptive to receiving physical activity information to address health risks. This study examined how Canadian long-haul truck drivers would like to receive physical activity information in order to improve their overall health. The purpose of this study was twofold: 1) explore barriers Canadian long-haul truck drivers have to receiving and using physical activity information and 2) understand how physical activity information should be structured and delivered to these drivers to overcome these barriers.

Design/methodology/approach

Semi-structured interviews were conducted with 12 Canadian long-haul truck drivers. Drivers had, on average, 14.3 years of professional long-haul driving experience.

Findings

Few drivers had received any physical activity information. Drivers discussed a culture where they perceived both employers and drivers to be lacking awareness of the importance of physical activity and its impact on health. Drivers explained they were too busy, stressed or tired to be active or to learn about physical activity. Information received by some drivers on this topic was too general to be helpful in changing physical activity behaviours. Drivers mentioned that personalized and accessible physical activity information should be provided to them through multiple methods by their employers, as an aspect of occupational health and safety.

Practical implications

Future physical activity information strategies should use both passive and interactive mediums to promote physical activity to Canadian long-haul truck drivers.

Originality/value

This is the first study to assess how Canadian long-haul truck drivers would like to receive trustworthy information that can lead to healthful improvements in physical activity behaviour.

Cluster randomised controlled trial to investigate the effectiveness and cost-effectiveness of a Structured Health Intervention For Truckers (the SHIFT study): a study protocol

INTRODUCTION

Heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related comorbidities, in comparison to other occupational groups. Their working environments are not conducive to a healthy lifestyle, yet there has been limited attention to health promotion efforts. We have developed a Structured Health Intervention For Truckers (the SHIFT programme), a multicomponent, theory-driven, health-behaviour intervention targeting physical activity, diet and sitting in HGV drivers. This paper describes the protocol of a cluster randomised controlled trial designed to evaluate the effectiveness and cost-effectiveness of the SHIFT programme.

METHODS AND ANALYSIS

HGV drivers will be recruited from a logistics company in the UK. Following baseline measurements, depots (clusters) will be randomised to either the SHIFT intervention or usual-care control arm (12 clusters in each, average cluster size 14 drivers). The 6-month SHIFT intervention includes a group-based interactive 6-hour education session, worksite champion support and equipment provision (including a Fitbit and resistance bands/balls to facilitate a 'cab workout'). Objectively measured total daily physical activity (steps/day) will be the primary outcome. Secondary outcomes include: objectively measured light-intensity physical activity and moderate-to-vigorous physical activity, sitting time, sleep quality, markers of adiposity, blood pressure and capillary blood markers (glycated haemoglobin, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol). Self-report questionnaires will examine fruit and vegetable intake, psychosocial and work outcomes and mental health. Quality of life and resources used (eg, general practitioner visits) will also be assessed. Measures will be collected at baseline, 6 and 12 months and analysed according to a modified intention-to-treat principle. A full process evaluation and cost-effectiveness analysis will be conducted.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Loughborough University Ethics Approvals Sub-Committee (reference: R17-P063). Study findings will be disseminated through publications in research and professional journals, through conference presentations and to relevant regional and national stakeholders via online media and at dissemination events.

TRIAL REGISTRATION NUMBER

ISRCTN10483894.

A Structured Health Intervention for Truckers (SHIFT): A Process Evaluation of a Pilot Health Intervention in a Transport Company

OBJECTIVES

To undertake a process-evaluation of a structured health intervention for truckers (SHIFT) implemented in a sample of UK lorry drivers.

METHODS

A combination of "debrief interviews," focus groups and one-to-one interviews, in addition to observations and reflections of the two lead researchers were used to collect data on the acceptability of SHIFT from a group of 16 lorry drivers and four transport managers.

RESULTS

The SHIFT program was considered relevant and acceptable to lorry drivers. It provided them with health information tailored to their specific health needs, long-lasting tools and techniques, which helped to raise their awareness of key health issues and helped to stimulate lifestyle changes during their daily routine.

CONCLUSION

This process-evaluation suggests that the SHIFT program should now be evaluated on a larger scale and tested through fully randomized controlled trials.