Risk of Cardiovascular Disease and Diabetes in a Working Population With Sedentary Occupations

Prospective associations of occupational and leisure-time physical activity with risk of diabetes: a cohort study from the United States

OBJECTIVES

Leisure-time physical activity (LTPA) can reduce the risk of incident diabetes, whereas the role of occupational physical activity (OPA) in developing diabetes is still unclear due to conflicting evidence. Moreover, the joint associations of OPA and LTPA with incident diabetes among US workers have not yet been systematically examined. The objective of this study was to assess the independent and joint associations of OPA and LTPA with incident diabetes.

METHODS

This prospective cohort study included 1406 workers free from diabetes at baseline (2004-2006) from the national, population-based Mid-life in the United States (MIDUS) study. Associations of OPA and LTPA at baseline with incident diabetes during 9 years of follow-up were examined using Poisson regression models. High OPA was defined based on engagement in physical demands at work, and high LTPA was defined as participation in moderate or vigorous LTPA at least once per week.

RESULTS

High OPA was associated with an increased risk of diabetes compared to low OPA (adjusted risk ratios and 95% confidence interval = 1.52 [1.04, 2.22]), while high LTPA was associated with a decreased risk of diabetes compared to low LTPA (0.66 [0.44, 0.97]). Diabetes risk was the highest among workers with high OPA and low LTPA (2.30 [1.30, 4.07]).

CONCLUSIONS

In a national, population-based prospective cohort study of US workers, high OPA was associated with an elevated risk of diabetes, while high LTPA was associated with a decreased diabetes risk. The combination of high OPA and low LTPA exhibited the greatest risk of diabetes.

Development and piloting of a Checklist for healthy eating And Physical Activity in the Workplace (CEPAW)

To develop and pilot a tool that assesses the infrastructure and policy workplace environment characteristics that may influence employee healthy eating and physical activity behaviours. A checklist was developed with reference to prior tools and piloted at eight worksites. Piloting of the tool demonstrated that it was generally feasible to use, took 1-2 hours to complete and appeared sensitive to differences between workplace environment characteristics. Refinement of the tool occurred after piloting. The final 21-item checklist contains sub-scores capturing policy, infrastructure, healthy eating and physical activity characteristics. This new checklist overcomes some limitations of pre-existing tools as it explicitly considers policy and is short, inexpensive and can be used by workplaces for self-assessment and by health promotion professionals in evaluation studies or as an intervention tool.

Socio-Demographic Characteristics, Body Weight Status and Energy Intake among Users and Non-Users of Dietary Supplements among Government Employees in Putrajaya, Malaysia

The use of dietary supplements is prevalent among many groups worldwide. However, few studies have examined their use among government employees. The aim of this cross-sectional study was to determine the association among sociodemographic characteristics, body weight status, and energy intake with dietary supplement use among government employees in Putrajaya, Malaysia. Simple random sampling was used to select a sample of 460 government employees from six ministries in Putrajaya, Malaysia. The data used in this study were collected through anthropometric measurements (height, weight, % body fat, waist and hip circumferences), a self-administered questionnaire (sociodemographic characteristics and dietary supplements use), and an interviewer-administered questionnaire (24-hour dietary recall; fruit and vegetable intake). The results indicated that the prevalence of dietary supplement use was 55.4%, with vitamin C (38.4%) being the most popular type of dietary supplement. Health issues (80.8%) were the most common reason for usage, internet (59.2%) was the main source of information, and pharmacies (71.8%) were the most indicated places to purchase dietary supplements. A multivariate analysis showed that participants who were female, married, had better monthly income, lived within a smaller household size, had a normal body mass index, classified as having unhealthily high body fat percentage, did not skip breakfast, and consumed at least five servings of fruits and vegetables per day were significantly more likely to use dietary supplements. In conclusion, health-conscious groups were more prone to consume dietary supplements, and due to the high prevalence of dietary supplement use, dissemination of accurate scientific information regarding dietary supplements is highly recommended among government employees.

Targeting Sedentary Behavior in CKD: A Pilot and Feasibility Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

We tested the feasibility of reducing sedentary behavior common in CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We carried out a Sit Less, Interact, Move More intervention in a 24-week parallel-group, randomized controlled trial in patients with stages 2-5 CKD. In the intervention group (n=54), accelerometry performed at baseline and repeated every 4 weeks was used to develop and monitor adherence to individualized plans targeting sedentary and stepping durations. The control group (n=52) was provided national physical activity recommendations; accelerometry was performed at baseline and every 8 weeks. Between-groups changes from baseline to the average follow-up values at weeks 8, 16, and 24 of the sedentary and stepping durations were the coprimary end points.

RESULTS

The mean age was 69±13 years. Fourteen percent were on dialysis or received a kidney transplant. Eight percent of the control group and 17% of the intervention group were lost to follow-up. Sedentary and stepping durations did not change in the control group. Within the intervention group, the maximum decrease in sedentary duration (-43; 95% confidence interval, -69 to -17 min/d) and increase in stepping duration (16; 95% confidence interval, 7 to 24 min/d) and the number of steps per day (1265; 95% confidence interval, 518 to 2012) were seen at week 20. These attenuated at week 24. In mixed effects models, overall treatment effects between groups on sedentary (-17; 95% confidence interval, -43 to 8 min/d) and stepping (6; 95% confidence interval, -3 to 15 min/d) durations and the number of steps per day, a secondary end point (652; 95% confidence interval, -146 to 1449), were not significantly different. The intervention significantly reduced secondary end points of body mass index (-1.1; 95% confidence interval, -1.9 to -0.3 kg/m2) and body fat percentage (-2.1%; 95% confidence interval, -4.4% to -0.2%).

CONCLUSIONS

It is feasible to reduce sedentary duration and increase stepping duration in patients with CKD, but these were not sustained.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER

National Health and Nutrition Examination Survey (NHANES), NCT02970123.

Workplace pedometer interventions for increasing physical activity

BACKGROUND

The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.

OBJECTIVES

To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity.

MAIN RESULTS

We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions.

AUTHORS' CONCLUSIONS

Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.

Cardiovascular Disease and Type 2 Diabetes Risk Across Occupational Groups and Industry in a Statewide Study of an Australian Working Population

OBJECTIVE

The aim of this study was to investigate prevalence of type 2 diabetes (diabetes) and cardiovascular disease (CVD) risk in occupational and industry groups in a large, diverse working population.

METHODS

Five hundred thousand Victorian workers undertook health checks, including lifestyle, anthropometric, and biomedical cardiovascular risk factor assessment. Five-year diabetes (AUSDRISK) and absolute CVD risk were estimated.

RESULTS

High diabetes and CVD risk was increased in many occupational groups and industries relative to managers and Professional/Scientific/Technical Services, respectively. Significantly more blue-collar workers had high diabetes risk [males prevalence ratio (PR) 1.19 (95% confidence interval, 95% CI 1.17 to 1.20); females 1.34 (95% CI 1.30 to 1.38)], high CVD risk [males 1.45 (95% CI 1.37 to 1.53); females 1.48 (95% CI 1.17 to 1.88], and risk factors including smoking [males 2.26 (95% CI 2.22 to 2.30); females 2.20 (95% CI 2.13 to 2.27)], compared with white-collar workers.

CONCLUSION

Targeting occupational and industry groups within sustainable workplace programs could assist in reducing chronic diseases, lowering sickness absence, and improving productivity.

A Physical Health Profile of Youths Living with a "Hikikomori" Lifestyle

A cross-sectional study was designed to understand the impacts of "hikikomori" lifestyle on physical health. A total of 104 eligible hikikomori cases were recruited from the social services network of Hong Kong with a mean age of 19.02 ± 3.62 (ranged 13-31) year-old, and had completed the set of questionnaires and a series of anthropometric and physical health measurements. Despite SF36 score of 84.0 indicated good physical functioning in general, participants were lived sedentarily with high incidence of hypertension at 15.4% and prehypertension at 31.7%. Occurrence of hypertension and prehypertension in cases living as hikikomori >6 months were 3 times and 1.5 times higher than those newly onset cases, respectively. The blood pressure levels were correlated with age and all obesity index parameters measured including waist circumference and body mass index. Results also observed a shift of body weight from underweight to overweight and obesity along the hikikomori duration. Half of the hypertensive cases involved the elevation of systolic blood pressure, which suggested higher odds of cardiovascular complications. In conclusion, the hikikomori lifestyle could be a risk behavior that may harm the younger generation physically by promoting obesity and hypertension and probably other chronic illnesses.

Prevalence and risk factors associated with hypertension and prehypertension in a working population at high altitude in China: a cross-sectional study

Background

Little information is available on the epidemiology of hypertension and prehypertension at high altitude in China, the aim of this study was to determine the prevalence of hypertension, prehypertension and their risk factors among Chinese working population at high altitude regions.

Methods

A cross-sectional survey was performed in an occupational sample of 4198 employees aged 20–59 years on Qinghai-Tibet Plateau between May to July 2013. Information from a self-administered questionnaire, physical examinations and laboratory measurements were obtained from each participant. Multivariable analysis was performed to determine the association of various risk factors with hypertension and prehypertension.

Results

The total crude prevalence of hypertension and prehypertension was 28.1 and 41.5%, respectively; the overall standardized prevalence of hypertension and prehypertension was 26.7 and 41.3%, respectively. Multivariate logistic regression showed that age, sex, ethnicity, job position, overweight or obesity, frequent drinking, family history of hypertension, diabetes and hyperuricemia were risk factors for hypertension, and age, sex, education, job position, overweight or obesity, current smoking and family history of hypertension were risk factors for prehypertension. Among the hypertensives, 36.5% were aware of their condition, 19.4% were being treated and 6.2% had their blood pressure (BP) controlled; among the treated hypertensives, 31.9% had their BP under control.

Conclusions

There is a high prevalence of hypertension and prehypertension in the working population at high altitude in China, but with very low awareness, treatment and control rates. Workplace-based BP screening and intervention programs that aim to modify risk factors such as high BMI, tobacco use, alcohol consumption and inappropriate use of antihypertensive medicine are urgently needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12199-017-0634-7) contains supplementary material, which is available to authorized users.

Characterising the extent of misreporting of high blood pressure, high cholesterol, and diabetes using the Australian Health Survey

BACKGROUND

Measuring and monitoring the true prevalence of risk factors for chronic conditions is essential for evidence-based policy and health service planning. Understanding the prevalence of risk factors for cardiovascular disease (CVD) in Australia relies heavily on self-report measures from surveys, such as the triennial National Health Survey. However, international evidence suggests that self-reported data may substantially underestimate actual risk factor prevalence. This study sought to characterise the extent of misreporting in a large, nationally-representative health survey that included objective measures of clinical risk factors for CVD.

METHODS

This study employed a cross-sectional analysis of 7269 adults aged 18 years and over who provided fasting blood samples as part of the 2011-12 Australian Health Survey. Self-reported prevalence of high blood pressure, high cholesterol and diabetes was compared to measured prevalence, and univariate and multivariate logistic regression analyses identified socio-demographic characteristics associated with underreporting for each risk factor.

RESULTS

Approximately 16 % of the total sample underreported high blood pressure (measured to be at high risk but didn't report a diagnosis), 33 % underreported high cholesterol, and 1.3 % underreported diabetes. Among those measured to be at high risk, 68 % did not report a diagnosis for high blood pressure, nor did 89 % of people with high cholesterol and 29 % of people with high fasting plasma glucose. Younger age was associated with underreporting high blood pressure and high cholesterol, while lower area-level disadvantage and higher income were associated with underreporting diabetes.

CONCLUSIONS

Underreporting has important implications for CVD risk factor surveillance, policy planning and decisions, and clinical best-practice guidelines. This analysis highlights concerns about the reach of primary prevention efforts in certain groups and implications for patients who may be unaware of their disease risk status.

The Immediate and Sustained long-Term Changes in Daytime Sleepiness After Participation in a Workplace Pedometer Program: A Prospective Cohort Study

OBJECTIVE

To assess the potential benefit of a workplace physical activity program on daytime sleepiness.

METHODS

A total of 685 participants of a 4-month workplace physical activity program were assessed for daytime sleepiness (Epworth Sleepiness Scale [ESS]) at baseline, 4 months (postprogram), and 12 months. Changes in ESS were analyzed using multilevel mixed linear regression.

RESULTS

In the total population, no changes in ESS scores were observed; 0 to 4 months: -0.2 (95% CI: -0.5 to 0.0), 4 to 12 months: 0.1 (95% CI: -0.2 to 0.4). In participants with baseline excessive daytime sleepiness (ESS > 10, n = 109), ESS scores improved significantly by -2.2 (95% CI: -3.0 to -1.4) at 4 months, sustained at 12 months; and almost half no longer had excessive daytime sleepiness by end of program.

CONCLUSIONS

This study suggests that for employees with excessive daytime sleepiness, short- and long-term improvement in daytime sleepiness may be an unforeseen benefit of workplace physical activity programs.

Prevalence and Knowledge Assessment of HIV and Non-Communicable Disease Risk Factors among Formal Sector Employees in Namibia

INTRODUCTION

The burden of non-communicable diseases (NCDs) is growing in sub-Saharan Africa combined with an already high prevalence of infectious disease, like HIV. Engaging the formal employment sector may present a viable strategy for addressing both HIV and NCDs in people of working age. This study assesses the presence of three of the most significant threats to health in Namibia among employees in the formal sector: elevated blood pressure, elevated blood glucose, and HIV and assesses the knowledge and self-perceived risk of employees for these conditions.

METHODS

A health and wellness screening survey of employees working in 13 industries in the formal sector of Namibia was conducted including 11,192 participants in the Bophelo! Project in Namibia, from January 2009 to October 2010. The survey combined a medical screening for HIV, blood glucose and blood pressure with an employee-completed survey on knowledge and risk behaviors for those conditions. We estimated the prevalence of the three conditions and compared to self-reported employee knowledge and risk behaviors and possible determinants.

RESULTS

25.8% of participants had elevated blood pressure, 8.3% of participants had an elevated random blood glucose measurement, and 8.9% of participants tested positive for HIV. Most participants were not smokers (80%), reported not drinking alcohol regularly (81.2%), and had regular condom use (66%). Most participants could not correctly identify risk factors for hypertension (57.2%), diabetes (57.3%), or high-risk behaviors for HIV infection (59.5%). In multivariate analysis, having insurance (OR:1.15, 95%CI: 1.03 - 1.28) and a managerial position (OR: 1.29, 95%CI: 1.13 - 1.47) were associated with better odds of knowledge of diabetes.

CONCLUSION

The prevalence of elevated blood pressure, elevated blood glucose, and HIV among employees of the Namibian formal sector is high, while risk awareness is low. Attention must be paid to improving the knowledge of health-related risk factors as well as providing care to those with chronic conditions in the formal sector through programs such as workplace wellness.

Characteristics of men classified at high-risk for type 2 diabetes mellitus using the AUSDRISK screening tool

AIMS

The primary aim was to describe characteristics of men identified at high-risk for Type 2 diabetes mellitus (T2DM) using the Australian diabetes risk assessment (AUSDRISK) tool. Secondary aims were to determine the prevalence of pre-diabetes and metabolic syndrome in these men.

METHODS

Men (n=209) completed the AUSDRISK tool, with 165 identified as high-risk for T2DM (score ≥ 12, maximum 38). Demographic, anthropometric, physiological and behavioural outcomes were assessed for 101 men. Comparisons (one-way ANOVA) among three AUSDRISK score groups (12-15, 16-19, ≥ 20) were performed (significance level, P<0.05).

RESULTS

Common risk factors (percentages) among high-risk men were waist circumference (>90 cm; 93%), age (>44 years; 79%), physical activity level (< 150 min wk(-1); 59%), family history of diabetes (39%) and previously high blood glucose levels (32%). Men with AUSDRISK scores ≥ 20 had higher (mean ± SD) HbA1C (6.0 ± 0.4% [42 ± 4.4 mmol.mol(-1)], P<0.001), FPG (5.3 ± 0.6 mmol.L(-1), P=0.001) and waist circumference (113.2 ± 9.8 cm, P=0.026) than men with scores of 12-15. Mean FPG for the sample was 5.0 ± 0.6 mmol.L(-1), whereas mean HbA1C was 5.8 ± 0.5% [40 ± 5.5 mmol.mol(-1)]. Pre-diabetes prevalence was 70% and metabolic syndrome prevalence was 62%.

CONCLUSIONS

The AUSDRISK tool identified men who were mostly older than 44, and had large waist circumferences and elevated HbA1C. These findings provide evidence supporting the usefulness of the AUSDRISK screening tool for T2DM screening in clinical and research settings.

Socio-economic status and incident diabetes mellitus among employees in Denmark: a prospective analysis with 10-year follow-up

AIMS

To contribute to the research on diabetes and social inequality by presenting national data on incident diabetes mellitus, stratified according to socio-economic status.

METHODS

National registers were combined, linking socio-economic status with incident diabetes over a 10-year period (2001-2010). The study population comprised employees in Denmark aged 20-59 years at baseline. Poisson regression analysis was used to estimate socio-economic rate ratios. Excess fraction analysis was used to determine the proportion of cases that would not have occurred if morbidity rates in each socio-economic group had been as low as those in the reference group. Monte Carlo simulation was used to calculate 95% CIs for excess fraction estimates

RESULTS

A total of 1 005 572 men and 951 039 women were included in the analysis. The follow-up yielded 43 439 cases in 9 533 199 person-years at risk among men and 29 266 cases in 9 163 405 person-years at risk among women. Using 'professionals' as a reference group, higher levels of relative risk were observed among every other socio-occupational group. The excess fraction was, 0.342 (95% CI 0.329-0.354) among men and 0.359 (95% CI 0.349-0.369) among women.

CONCLUSIONS

Excess fraction analysis suggests that more than a third of cases of diabetes could be prevented if all employees were exposed to the same working conditions as the reference population. Acknowledging potential confounders, the observed levels of incident diabetes among the workforce highlight the potential gains to be had by better use of the workplace as an arena for prevention. Greater integration of occupational health and general healthcare is required to achieve this.

Change in well-being amongst participants in a four-month pedometer-based workplace health program

BACKGROUND

There is increasing uptake of workplace physical activity programs to prevent chronic disease. While they are frequently evaluated for improvement in biomedical risk factors there has been little evaluation of additional benefits for psychosocial health. We aimed to evaluate whether participation in a four-month, team-based, pedometer-based workplace health program known to improve biomedical risk factors is associated with an improvement in well-being, immediately after the program and eight-months after program completion.

METHODS

At baseline (2008), 762 adults (aged 40 ± 10 SD years, 42% male) employed in primarily sedentary occupations and voluntarily enrolled in a physical activity program were recruited from ten Australian worksites. Data was collected at baseline, at the completion of the four-month program and eight-months after program completion. The outcome was the WHO-Five Well-being Index (WHO-5), a self-administered five-item scale that can be dichotomised as 'poor' (less than 52%) or 'positive' (more than or equal to 52%) well-being.

RESULTS

At baseline, 75% of participants had positive well-being (mean: 60 ± 19 SD WHO-5 units). On average, well-being improved immediately after the health program (+3.5 units, p < 0.001) and was sustained eight-months later (+3.4 units from baseline, p < 0.001). In the 25% with poor well-being at baseline, 49.5% moved into the positive well-being category immediately after program completion, sustained eight-months later (p < 0.001).

CONCLUSIONS

Clinically relevant immediate and sustained improvements in well-being were observed after participation in the health program. These results suggest that participation in workplace programs, such as the one evaluated here, also has the potential to improve well-being.

Impact of personal preference and motivation on fruit and vegetable consumption of WIC-participating mothers and children in Atlanta, GA

OBJECTIVE

To determine the effect of psychosocial and sociodemographic factors on consumption of fruits and vegetables (F&V) for women and children participating in the Atlanta Special Supplemental Nutrition Program for Women, Infants, and Children.

METHODS

Participants (n = 249) were selected from 2 Atlanta Special Supplemental Nutrition Program for Women, Infants, and Children agencies. Data from this analysis were collected from in-person interviews. The dichotomous dependent variable was whether participants met recommended intakes for F&V. Independent variables were personal preference and motivation factors of F&V consumption, and sociodemographic factors. Bivariate analysis determined significant factors to include in logistic models.

RESULTS

Only 27.7% of mothers and 44.2% of their oldest child consumed > 5 servings of F&V daily. Not knowing how to prepare F&Vs and spoilage of F&V before eating them were significantly related to F&V consumption of mothers.

CONCLUSIONS AND IMPLICATIONS

Food storage and preparation resulted in significant differences in meeting criteria for F&V consumption. Future initiatives should include cooking classes and emphasize food preparation techniques.

Eight-month postprogram completion: change in risk factors for chronic disease amongst participants in a 4-month pedometer-based workplace health program

OBJECTIVE

To evaluate whether participation in a 4-month, pedometer-based, physical activity, workplace health program is associated with long-term sustained improvements in risk factors for type 2 diabetes and cardiovascular disease, 8 months after the completion of the program.

DESIGN AND METHODS

A sample size of 720 was required. 762 Australian adults employed in primarily sedentary occupations and voluntarily enrolled in a workplace program were recruited. Demographic, behavioral, anthropometric and biomedical measurements were completed at baseline, 4 and 12 months.

RESULTS

About 76% of participants returned at 12 months. Sustained improvements at 12 months were observed for self-reported vegetable intake, self-reported sitting time and independently measured blood pressure. Modest improvements from baseline in self-reported physical activity and independently measured waist circumference at 12 months indicated that the significant improvements observed immediately after the health program could not be sustained. Approximately half of those not meeting guidelines for physical activity, waist circumference and blood pressure at baseline, were meeting guidelines at 12 months.

CONCLUSIONS

Participation in this 4-month, pedometer-based, physical activity, workplace health program was associated with sustained improvements in chronic disease risk factors at 12 months. These results indicate that such programs can have a long-term benefit and thus a potential role to play in population prevention of chronic disease.

Workplace pedometer interventions for increasing physical activity

BACKGROUND

The World Health Organization and the World Economic Forum have recommended further research to strengthen current knowledge of workplace health programmes, particularly on effectiveness and using simple instruments. A pedometer is one such simple instrument that can be incorporated in workplace interventions.

OBJECTIVES

To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.

SEARCH METHODS

Electronic searches of the Cochrane Central Register of Controlled Trials (671 potential papers), MEDLINE (1001), Embase (965), CINAHL (1262), OSH UPDATE databases (75) and Web of Science (1154) from the earliest record to between 30th January and 6th February 2012 yielded 3248 unique records. Reference lists of articles yielded an additional 34 papers. Contact with individuals and organisations did not produce any further records.

SELECTION CRITERIA

We included individual and cluster-randomised controlled trials of workplace health promotion interventions with a pedometer component in employed adults. The primary outcome was physical activity and was part of the eligibility criteria. We considered subsequent health outcomes, including adverse effects, as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors undertook the screening of titles and abstracts and the full-text papers independently. Two review authors (RFP and MC) independently completed data extraction and risk of bias assessment. We contacted authors to obtain additional data and clarification.

MAIN RESULTS

We found four relevant studies providing data for 1809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study's usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting.Three studies compared the pedometer programme to a minimally active control group, but the results for physical activity could not be combined because each study used a different measure of activity. One study observed an increase in physical activity under a pedometer programme, but the other two did not find a significant difference. For secondary outcomes we found improvements in body mass index, waist circumference, fasting plasma glucose, the quality of life mental component and worksite injury associated with the pedometer programmes, but these results were based on limited data from one or two small studies. There were no differences between the pedometer programme and the control group for blood pressure, a number of biochemical outcomes and the quality of life physical component. Sedentary behaviour and disease risk scores were not measured by any of the included studies.One study compared a pedometer programme and an alternative physical activity programme, but baseline imbalances made it difficult to distinguish the true improvements associated with either programme.Overall, there was insufficient evidence to assess the effectiveness of pedometer interventions in the workplace.There is a need for more high quality randomised controlled trials to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. To improve the quality of the evidence available, future studies should be registered in an online trials register, publish a protocol, allocate time and financial support to reducing attrition, and try to blind personnel (especially those who undertake measurement). To better identify the effects of pedometer interventions, future studies should report a core set of outcomes (total physical activity in METs, total time sitting in hours and minutes, objectively measured cardiovascular disease and type II diabetes risk factors, quality of life and injury), assess outcomes in the long term and undertake subgroup analyses based upon demographic subgroups (e.g. age, gender, educational status). Future studies should also compare different types of active intervention to test specific intervention components (eligibility, duration, step goal, step diary, settings), and settings (occupation, intervention provider).

AUTHORS' CONCLUSIONS

There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.

Relationship of physical activity to cardiovascular risk factors in an urban population of Nigerian adults

BACKGROUND

The burden of chronic diseases including cardiovascular disease (CVD) is increasing rapidly in Nigeria, but fewer studies have evaluated the role of physical activity in the development of CVD in this country. We examined the relationship between health enhancing physical activity and risk factors of CVD in a working population of adults in Maiduguri, Nigeria.

METHODS

In a cross-sectional study, we assessed health enhancing moderate-to-vigorous physical activity (MVPA) among 292 government employees (age: 20-65 years, 40% female, 24% obese and 79.8% response) using the self-administered version of International Physical Activity Questionnaire (IPAQ-SF). Time spent in walking and sitting during occupational activity was assessed as well. Anthropometric measurement of height, weight and waist circumference, and blood pressure were also measured. Independent t-test and One- Way ANOVA were conducted, and the relationships between MVPA and body mass index (BMI), waist circumference, blood pressure and heart rate were explored using Pearson correlations coefficients and multiple regression analyses.

RESULTS

The mean time spent in health enhancing MVPA (116.4 ± 101.3 min/wk) was lower than the recommended guideline of 150 min/wk sufficient for health benefits. Compared with men, more women were less physically active, obese and reported more diagnoses of component of metabolic syndrome (p < 0.05). Participants whose work activities were highly sedentary tend to accumulate less minutes of MVPA compared with those who reported their work as moderately active or highly active (p < 0.001). Health enhancing MVPA was inversely related with body mass index (BMI), waist circumference, heart rate, and systolic and diastolic blood pressure (p < 0.05).

CONCLUSION

Physical activity level of the working population of Nigerian adults was low and was related with adverse risk factors for CVD. Promoting health enhancing physical activity at work places may be important for prevention and control of CVD among the working population in Maiduguri, Nigeria.

Supporting people with diabetes mellitus in applying for and participating effectively in paid work: validation of successful diabetes-related behaviors by experiential experts and professional care providers

OBJECTIVE

To validate successful diabetes-related behaviors, proposed by a group of experiential experts, and to support people with diabetes in applying for and participating effectively in work.

METHODS

In a survey among 77 experiential experts and 21 professional care providers, the behaviors were critically appraised regarding several key characteristics.

RESULTS

Experiential experts (median scores: 91%, 86%, and 86%) and professionals (median scores: 76%, 76%, and 81%) mostly agreed with these behaviors in terms of clarity, content, and relevance, respectively. Feasibility was seen as somewhat problematic, with median scores by experiential experts and professionals of 65% and 52%, respectively.

CONCLUSION

Both groups confirmed the validity of the proposed work-related behaviors that were expected to support people with diabetes. The challenge is to implement these behaviors in practice, by effective dissemination and incorporation in work-related self-management programs.

Does the use of standing 'hot' desks change sedentary work time in an open plan office?

OBJECTIVE

This study assessed the use of standing 'hot' desks in an open plan office and their impact on sedentary work time.

METHOD

Australian employees (n=11; 46.9 [9.8] years; BMI 25.9 [3.5 kg/m(2)]) wore an armband accelerometer for two consecutive working weeks (November-December 2010). In the second week, employees were encouraged to use a pod of four standing 'hot' desks to stand and work as often as possible. Desk use was recorded using time logs. The percentages of daily work time spent in sedentary (<1.6 METs), light (1.6-3.0 METs) and moderate+ (>3 METs) intensity categories were calculated for each week, relative to the total daily time at work. Paired sample t tests were used to compare weekly differences.

RESULTS

Employees spent 8:09 ± 0:31h/day at work and 'hot' desk use ranged from zero to 9:35 h for the week. There were no significant changes in mean time spent in sedentary (difference of -0.1%), light (difference of 0.8%) and moderate+ (-0.7%) intensity categories. However, individual changes in sedentary work time ranged from -5.9 to 6.4%.

CONCLUSIONS

Volitional use of standing 'hot' desks varied and while individual changes were apparent, desk use did not alter overall sedentary work time in this sample.

Participant characteristics associated with greater reductions in waist circumference during a four-month, pedometer-based, workplace health program

BACKGROUND

Workplace health programs have demonstrated improvements in a number of risk factors for chronic disease. However, there has been little investigation of participant characteristics that may be associated with change in risk factors during such programs. The aim of this paper is to identify participant characteristics associated with improved waist circumference (WC) following participation in a four-month, pedometer-based, physical activity, workplace health program.

METHODS

762 adults employed in primarily sedentary occupations and voluntarily enrolled in a four-month workplace program aimed at increasing physical activity were recruited from ten Australian worksites in 2008. Seventy-nine percent returned at the end of the health program. Data included demographic, behavioural, anthropometric and biomedical measurements. WC change (before versus after) was assessed by multivariable linear and logistic regression analyses. Seven groupings of potential associated variables from baseline were sequentially added to build progressively larger regression models.

RESULTS

Greater improvement in WC during the program was associated with having completed tertiary education, consuming two or less standard alcoholic beverages in one occasion in the twelve months prior to baseline, undertaking less baseline weekend sitting time and lower baseline total cholesterol. A greater WC at baseline was strongly associated with a greater improvement in WC. A sub-analysis in participants with a 'high-risk' baseline WC revealed that younger age, enrolling for reasons other than appearance, undertaking less weekend sitting time at baseline, eating two or more pieces of fruit per day at baseline, higher baseline physical functioning and lower baseline body mass index were associated with greater odds of moving to 'low risk' WC at the end of the program.

CONCLUSIONS

While employees with 'high-risk' WC at baseline experienced the greatest improvements in WC, the other variables associated with greater WC improvement were generally indicators of better baseline health. These results indicate that employees who started with better health, potentially due to lifestyle or recent behavioural changes, were more likely to respond positively to the program. Future health program initiators should think innovatively to encourage all enrolees along the health spectrum to achieve a successful outcome.

Impact of a pedometer-based workplace health program on cardiovascular and diabetes risk profile

OBJECTIVE

To evaluate whether participation in a four-month, pedometer-based, physical activity, workplace health programme results in an improvement in risk factors for diabetes and cardiovascular disease.

METHODS

Adults employed within Australia in primarily sedentary occupations and voluntarily enrolled in a workplace programme, the Global Corporate Challenge®, aimed at increasing physical activity were recruited. Data included demographic, behavioural, anthropometric and biomedical measurements. Measures were compared between baseline and four-months.

RESULTS

762 participants were recruited in April/May 2008 with 79% returning. Improvements between baseline and four-months amongst programme participants were observed for physical activity (an increase of 6.5% in the proportion meeting guidelines, OR(95%CI): 1.7(1.1, 2.5)), fruit intake (4%, OR: 1.7(1.0, 3.0)), vegetable intake (2%, OR: 1.3(1.0, 1.8)), sitting time (-0.6(-0.9, -0.3) hours/day), blood pressure (systolic: -1.8(-3.1, -.05) mmHg; diastolic: -1.8(-2.4, -1.3) mmHg) and waist circumference (-1.6(-2.4, -0.7) cm). In contrast, an increase was found for fasting total cholesterol (0.3(0.1, 0.4) mmol/L) and triglycerides (0.1(0.0, 0.1) mmol/L).

CONCLUSION

Completion of this four-month, pedometer-based, physical activity, workplace programme was associated with improvements in behavioural and anthropometric risk factors for diabetes and cardiovascular disease. Long-term evaluation is required to evaluate the potential of such programmes to prevent the onset of chronic disease.