The 'Goldilocks Principle': designing physical activity at work to be 'just right' for promoting health

What's Your Poison? Is Sitting Always Health Hindering and Moving Always Health Promoting?

The clear public messaging from international health authorities is that individuals should "sit less and move more." While it is acknowledged that this guidance needs to be tailored to the age of people and also to their health, and abilities, the guidance is not tailored to their current level of physical behaviors. This opinion piece aims to highlight that although people with excessive sitting and insufficient moderate-to-vigorous physical activity should sit more and move less, for other people their health would be promoted by sitting more and moving less. Thus, physical behaviors are not always "poison" or "medicine," but rather the health impact of changes in physical behaviors depends on people's initial levels. Policy, research, and practice implications of this realization are presented. Only tailoring messaging to age and health status could be far from optimal for people with very different current levels of physical behaviors. Policy, research, and practice will be enhanced when the potential for physical behaviors to be either health hindering or health promoting is adequately considered.

Effectiveness of a Goldilocks Work intervention in childcare workers - A cluster-randomized controlled trial

OBJECTIVE

Poor cardiorespiratory fitness and health is common among childcare workers. We designed the `Goldilocks-games` according to the Goldilocks Work principle to provide high-intensity physical activity for childcare workers. We investigated the effectiveness of this Goldilocks Work intervention in increasing occupational high-intensity physical activity and improving work-related health.

METHODS

In a two-arm cluster randomized trial, 16 childcare institutions with 142 workers were randomly allocated to either an 8-week Goldilocks Work intervention or a control group. The primary outcome was occupational time in high-intensity physical activity. Secondary outcomes were occupational time in active physical behaviors, heart rate during sleep, pain, physical exhaustion, energy at work, work productivity, and need for recovery.

RESULTS

The intervention was successfully delivered and received. Both groups had a low amount of occupational high-intensity physical activity at baseline, and the intervention group reported playing the games 3.1 [standard deviation (SD) 1.5] times/week for a duration of 112.2 (SD 175.0) min/week. However, the intervention did not increase high-intensity physical activity or the secondary outcomes, except for energy at work, measured on a scale from 0-10, increasing 0.65 [95% confidence interval (CI) 0.08-1.21], and need for recovery, measured on a scale from 1-5, decreasing -0.32 (95% CI, -0.54- -0.09).

CONCLUSION

The intervention was successfully delivered and received, but did not increase high-intensity physical activity. The intervention group increased their energy at work and decreased their need for recovery, but not the other health-related outcomes. Further research on how to design and implement health-promoting work environment interventions in childcare is needed.

How much advance notice do workers need? A review and theoretical framework for determining advance notice periods for unpredictable work

Regulatory guidance materials for fatigue management typically advise that employees be provided with days or weeks of advance notice of schedules/rosters. However, the scientific evidence underpinning this advice is unclear. A systematic search was performed on current peer reviewed literature addressing advance notice periods, which found three relevant studies. A subsequent search of grey literature to determine the quality of evidence for the recommendation for advance notice periods returned 37 relevant documents. This review found that fatigue management guidance materials frequently advocated advance notice for work shifts but did not provide empirical evidence to underpin the advice. Although it is logical to suggest that longer notice periods may result in increased opportunities for pre-work preparations, improved sleep, and reduced worker fatigue, the current guidance appears to be premised on this reasoning rather than empirical evidence. Paradoxically, it is possible that advance notice could be counterproductive, as too much may result in frequent alterations to the schedule, particularly where adjustments to start and end times of the work period are not uncommon (e.g., road transport, rail). To assist organisations in determining the appropriate amount of advance notice to provide, we propose a novel theoretical framework to conceptualise advance notice.

Facilitators and barriers for using outdoor areas in the primary work tasks of eldercare workers in nursing homes

BACKGROUND

Eldercare workers in nursing homes report high musculoskeletal disorders, stressful work, and sickness absence. Initiatives that can accommodate these issues are needed. Current studies point out that nature contact may offer a range of human health benefits, potentially promoting healthier work among eldercare workers. Therefore, this study aimed to investigate facilitators and barriers for using outdoor areas as part of the daily work among eldercare workers in Danish nursing homes.

METHODS

In this multiple case study, we collected data from three nursing homes, conducting three semi-structured focus group interviews with eldercare workers and three individual interviews with nursing home managers. Furthermore, we conducted observations of the daily work and mappings of the nursing homes' outdoor environments to gain in-depth knowledge of eldercare workers' and managers' perspectives on using outdoor areas in their daily work. The data was thematically analysed using 'The Behaviour Change Wheel' (BCW), more specifically the COM-B model, as a theoretical foundation for exploring facilitators and barriers for the use of outdoor areas.

RESULTS

Frequently mentioned facilitators were facilities, traditions or repetitive events, positive experiences with residents ('star moments'), and knowledge about the residents. Frequently mentioned barriers were insufficient staffing, hierarchy in the work tasks, professional identity, and lack of ideas.

CONCLUSIONS

The identified facilitators and barriers should be considered when designing initiatives for increased use of outdoor areas or activities of eldercare workers.

TRIAL REGISTRATION

According to the Danish ethics committee (Law of committee, (komitéloven) paragraph 14, Sect. 2), qualitative interviews, which do not include human biological materials, do not need neither approval by ethical and scientific committee or informed consent (The Danish National Centre for Ethics).

Can home care work be organized to promote health among the workers while maintaining productivity? An investigation into stakeholders' perspectives on organizational work redesign concepts based on the Goldilocks Work principles

BACKGROUND

Due to the aging population, the need for home care services is increasing in most Western countries, including Norway. However, the highly physical nature of this job could contribute to make recruiting and retaining qualified home care workers (HCWs) challenging. This issue may be overcome by adopting the Goldilocks Work principles, aiming at promoting workers' physical health by determining a "just right" balance between work demands and recovery periods while maintaining productivity. The aim of this study was to 1) gather suggestions from home care employees on suitable organizational (re)design concepts for promoting HCWs' physical health and 2) have researchers and managers define actionable behavioral aims for the HCWs for each proposed (re)design concept and evaluate them in the context of the Goldilocks Work principles.

METHODS

HCWs, safety representatives, and operation coordinators (n = 14) from three Norwegian home care units participated in digital workshops led by a researcher. They suggested, ranked, and discussed redesign concepts aimed at promoting HCWs' health. The redesign concepts were subsequently operationalized and evaluated by three researchers and three home care managers.

RESULTS

Workshop participants suggested five redesign concepts, namely "operation coordinators should distribute work lists with different occupational physical activity demands more evenly between HCWs", "operation coordinators should distribute transportation modes more evenly between HCWs", "Managers should facilitate correct use of ergonomic aids and techniques", "HCWs should use the stairs instead of the elevator", and "HCWs should participate in home-based exercise training with clients". Only the first two redesign concepts were considered to be aligned with the Goldilocks Work principles. A corresponding behavioral aim for a "just right" workload was defined: reduce inter-individual differences in occupational physical activity throughout a work week.

CONCLUSIONS

Operation coordinators could have a key role in health-promoting organizational work redesign based on the Goldilocks Work principles in home care. By reducing the inter-individual differences in occupational physical activity throughout a work week, HCWs' health may be improved, thus reducing absenteeism and increasing the sustainability of home care services. The two suggested redesign concepts should be considered areas for evaluation and adoption in practice by researchers and home care services in similar settings.

In silico interrogation of the miRNAome of infected hematopoietic cells to predict processes important for human cytomegalovirus latent infection

Human cytomegalovirus (HCMV) latency in CD34+ progenitor cells is the outcome of a complex and continued interaction of virus and host that is initiated during very early stages of infection and reflects pro- and anti-viral activity. We hypothesized that a key event during early infection could involve changes to host miRNAs, allowing for rapid modulation of the host proteome. Here, we identify 72 significantly upregulated miRNAs and three that were downregulated by 6hpi of infection of CD34+ cells which were then subject to multiple in silico analyses to identify potential genes and pathways important for viral infection. The analyses focused on the upregulated miRNAs and were used to predict potential gene hubs or common mRNA targets of multiple miRNAs. Constitutive deletion of one target, the transcriptional regulator JDP2, resulted in a defect in latent infection of myeloid cells; interestingly, transient knockdown in differentiated dendritic cells resulted in increased viral lytic IE gene expression, arguing for subtle differences in the role of JDP2 during latency establishment and reactivation of HCMV. Finally, in silico predictions identified clusters of genes with related functions (such as calcium signaling, ubiquitination, and chromatin modification), suggesting potential importance in latency and reactivation. Consistent with this hypothesis, we demonstrate that viral IE gene expression is sensitive to calcium channel inhibition in reactivating dendritic cells. In conclusion, we demonstrate HCMV alters the miRNAome rapidly upon infection and that in silico interrogation of these changes reveals new insight into mechanisms controlling viral gene expression during HCMV latency and, intriguingly, reactivation.

Assessing the efficacy of a job rotation for improving occupational physical and psychosocial work environment, musculoskeletal health, social equality, production quality and resilience at a commercial laundromat: protocol for a longitudinal case study

INTRODUCTION

Job rotation is a work organisation strategy used to reduce work-related exposures and musculoskeletal complaints, yet evidence for the efficacy of the approach is weak. Mismatch between job rotation and company needs, lack of full implementation, lack of exposure variation in included tasks and failure to assess variation may underlie inconclusive research findings to date. The study aims to develop a job rotation with company stakeholders, perform a process evaluation of the implementation, and determine the extent to which the intervention improves the physical and psychosocial work environment, indicators of health, gender and social equality among workers and production quality and resilience.

METHODS AND ANALYSIS

Approximately 60 production workers at a Swedish commercial laundromat will be recruited. Physical and psychosocial work environment conditions, health, productivity and gender and social equality will be assessed pre and post intervention, using surveys, accelerometers, heart rate, electromyography and focus groups. A task-based exposure matrix will be constructed, and exposure variation estimated at the level of the individual worker pre and post intervention. An implementation process evaluation will be conducted. Job rotation efficacy will be assessed in terms of improvement in work environment conditions, health, gender and social inequality, and production quality and resilience. This study will provide novel information on the effects of the job rotation on physical and psychosocial work environment conditions, production quality and rate, health and gender and social inequality among blue-collar workers in a highly multicultural workplace.

ETHICS AND DISSEMINATION

The study received approval from the Swedish Ethical Review Authority (reference number 2019-00228). The results of the project will be shared directly with the employees, managers and union representatives from the participating company, other relevant labour market stakeholders and with researchers at national and international conferences and via scientific publication.

TRIAL REGISTRATION NUMBER

The study is preregistered with the Open Science Framework (https://osf.io/zmdc8/).

Associations of activity, sedentary, and sleep behaviors with cognitive and social-emotional health in early childhood

Background

Early childhood is important for cognitive and social-emotional development, and a time in which to promote healthy movement behaviors (sedentary behavior, physical activity, and sleep). Movement behaviors may have interactive influences on cognition and social-emotional factors in young children, but most previous research has explored them independently. The purpose of this study was to determine if movement behaviors are associated with measures of cognitive and social-emotional health in young children and if so, to describe optimal compositions of movement behaviors of a daily cycle for such outcomes.

Methods

Children (n = 388, 33 to 70 months, 44.6% female) from a clinical trial (ClinicalTrials.gov ID: NCT03285880, first posted September 18, 2017) wore accelerometers on their wrists for 24-h for 9.56 ± 3.3 days. Movement behavior compositions consisted of time spent in sedentary behaviors, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sleep. Outcomes were cognitive (receptive vocabulary, declarative and procedural memory, and executive attention) and social-emotional measures (temperament and behavioral problems). Compositional linear regression models with isometric log ratios were used to investigate the relations between the movement behavior composition and the cognitive and social-emotional health measures. If a significant association was found between the composition and an outcome, we further explored the "optimal" 24-h time-use for said outcome.

Results

Movement behavior compositions were associated with receptive vocabulary. The composition associated with the predicted top five percent of vocabulary scores consisted of 12.1 h of sleep, 4.7 h of sedentary time, 5.6 h of light physical activity, and 1.7 h of MVPA.

Conclusions

While behavior compositions are related to vocabulary ability in early childhood, our findings align with the inconclusiveness of the current evidence regarding other developmental outcomes. Future research exploring activities within these four movement behaviors, that are meaningful to cognitive and social-emotional development, may be warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-023-00016-6.

Re: Cillekens B, Huysmans MA, Holtermann A, van Mechelen W, Straker L, Krause N, van der Beek AJ, Coenen P. Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants. Scand J Work Environ Health. 2022;48(2):86-98. doi:10.5271/sjweh.3993

Objectives

Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality.

Methods

A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality.

Results

We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.84–1.12] and females (HR 0.97, 95% CI 0.82–1.15). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 9% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.09, 95% CI 0.82–1.43).

Conclusions

While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.

Can occupational health professionals successfully apply the Goldilocks Work Paradigm in a simulated work redesign?

This study aimed to assess occupational health professionals' application of the Goldilocks Work Paradigm in redesigning jobs for healthier physical behaviours while maintaining productivity. During a group simulation exercise, participants (n = 16) created job descriptions for four different occupation cases (factory worker, office worker, teacher, train driver) and then redesigned the jobs using the Paradigm. Substantial changes in the time spent in sitting (9-30%), standing (8-42%), walking (6-14%), and high-intensity (0-24%) physical behaviours were achieved, which if implemented would likely result in enhanced health for workers. Overall, occupational health professionals were able to successfully redesign fictitious jobs aligned with the Goldilocks Work Paradigm. The simulation task used in this study may be useful to train professionals and assist workplaces to understand and implement the Goldilocks Work Paradigm into practice.Practitioner summary: This study assessed whether occupational health professionals could be trained in the Goldilocks Work Paradigm through a job redesign simulation task. Participants were able to redesign jobs to achieve a healthier 'just right' balance of physical behaviours. Simulations may help workplaces understand and implement a Goldilocks Work approach into practice.

Can home care work be organized to promote musculoskeletal health for workers? Study protocol for the Norwegian GoldiCare cluster randomized controlled trial

BACKGROUND

Home care workers perform physically strenuous tasks, in particular when handling patients with high care demands. Thus, musculoskeletal pain and sick leave is greater in this group than in the general population. To ease these issues, we will implement a Goldilocks Work intervention (GoldiCare), redistributing schedules between workers to achieve a "just right" weekly structure of physical work that can promote health. This protocol paper describes the content, design, implementation and evaluation of the cluster randomized controlled trial of the GoldiCare intervention in home care.

METHODS

The cluster randomized controlled trial is a 16-week workplace organizational intervention implemented through operations managers at the home care units. The operations managers will be introduced to the Goldilocks Work Principle and a GoldiCare tool, to assist the operations managers when composing a "just right" distribution of work schedules throughout the week. The GoldiCare tool provides an overview of the physical strain for each shift, based on the number of patients and their need for care. We expect to include 11 units, which will be randomized to either intervention or control at a 1:1 ratio. Home care workers assigned to the control group will continue to work as normal during the intervention period. Musculoskeletal pain in neck/shoulder and lower back will be the primary outcomes and we will also evaluate the composition of physical behaviors as well as fatigue after work as secondary outcomes. We will collect data using (1) daily questions regarding musculoskeletal pain and fatigue after work, (2) 7 days of objective measurements of physical behavior, (3) questionnaires about the participant's characteristics, health, and workplace psychosocial stressors and (4) information on the implementation of the GoldiCare tool. In addition, a process evaluation will be conducted using focus group discussions and individual interviews.

DISCUSSION

Due to the increasing aging population in need of care, measures that can improve the health of home care workers are paramount for the sustainability of this sector. This organizational intervention is based on information available nation-wide, and therefore has the potential to be scaled to all municipalities in Norway if proven effective.

TRIAL REGISTRATION

This clinical trial was registered on 08/05/2022 under NCT05487027 .

'Just Right' job design: A conceptual framework for sustainable work in rail driving using the Goldilocks Work Paradigm

Excessive physical demand at work has traditionally been connected with adverse health outcomes, but excessive sitting is now also being recognised as an occupational hazard and emerging work-related risk. Traditional preventive occupational health and ergonomics programs are useful but limited through reliance on individual behaviour change and time-diversion from productive work. A new 'Goldilocks Work Paradigm' aims to optimise health and productivity by using movements of productive tasks. Using rail driving as a specific case of a highly sedentary and inflexible working environment, we construct a conceptual framework for designing better jobs, arguing that a theoretical amalgamation of the new Goldilocks Work Paradigm with System Thinking, Participatory Ergonomics, and a Risk Management Framework, is needed, for establishing a unified, strategic approach-a 'just right' job design model. We extend this by outlining a practical process of designing better jobs with tools that can be used to achieve it.

Work/household, transport, and leisure domains account for the sex gap in physical activity in Chile

Background

Women usually have lower levels of moderate-vigorous physical activity (MVPA) than men. This sex gap can be accounted for by differences in MVPA in the work/household, transport, and/or leisure domains. Identifying where the differences lay in a context-specific manner may help close the gap. We aimed to compare MVPA by domain, and the relative contribution of each domain to total MVPA, between men and women in Chile.

Methods

We analyzed the cross-sectional National Health Survey of Chile 2016-2017 (n = 5,056, 64% women, ≥18 years old). MVPA was estimated with the Global Physical Activity Questionnaire. MVPA was expressed in MET × min/week, and the relative contribution to total MVPA by each domain was expressed as percentage. Analyses were conducted including all participants, and also including participants reporting >0 MET × min/week of MVPA (relative contributions can only be computed in the latter).

Results

Including all participants, women (vs. men) had lower MVPA (median [25-75th percentile]) for work/household (0 [0-960] vs. 0 [0-5,760] MET × min/week), for transport (360 [0-1,200] vs. 600 [0-1,680] MET × min/week), and for leisure domains (0 [0-0] vs. 0 [0-480] MET × min/week). Including only participants with >0 MET × min/week of MVPA, women (vs. men) had lower mean relative contributions to total MVPA from work/household (31.3 vs. 35.9%) and leisure domains (10.8 vs. 16.3%, respectively), but higher from the transport domain (57.9 vs. 47.8%).

Conclusion

In Chile, differences in all physical activity domains account for the sex gap in MVPA. Strategies to break job stereotypes, increase opportunities for leisure, and ease active transport are required to encourage MVPA in women.

Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants

OBJECTIVES

Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality.

METHODS

A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality.

RESULTS

We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87-1.15] and females (HR 0.95, 95% CI 0.82-1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88-1.49).

CONCLUSIONS

While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.

Designing industrial work to be 'just right' to promote health - a study protocol for a goldilocks work intervention

BACKGROUND

The Goldilocks Work Principle expresses that productive work should be designed to promote workers' health. We recently showed that it is feasible to develop and implement modifications to productive work that change physical behaviors (i.e. sitting, standing and being active) in a direction that may promote health among industrial workers. Therefore, the aim of the present study is to conduct a cluster randomised controlled trial investigating health effects of implementing the Goldilocks Work intervention among industrial workers.

METHODS

Our implementation plan consists of educating work teams, organizing implementation meetings, and providing feedback to workers. Three meetings with a preselected local workplace group will be scheduled. The first meeting educates the group to use a planning tool by which work can be planned to have 'just right' physical behaviors. The second and third meetings will focus on supporting implementation of the tool in daily work. An expected 28 clusters of work teams across two participating production sites will be randomized to either intervention or control group. Data collection will consist of 1) questionnaires regarding work and musculoskeletal health, 2) wearable sensor measurements of the physical behavior, and 3) assessment of general health indicators, including BMI, blood pressure, and fat percentage. The primary outcome is musculoskeletal health, measured by low back pain intensity, and secondary outcomes are 1) physical behaviors at work, 2) accumulated time in long bouts of sitting, standing, and being active and 3) perceived fatigue and energy during work. Furthermore, implementation and cost of the intervention will be evaluated based on questionnaires and data from the planning tool completed by the workers.

DISCUSSION

This study will evaluate the effectiveness and implementation of a 12 - weeks Goldilocks Work intervention with the aim of improving musculoskeletal health among industrial workers. The cluster randomized controlled study design and the evaluation of the implementation, results and costs of the intervention will make it capable of contributing with valuable evidence of how productive work may be designed to promote industrial workers' health.

TRIAL REGISTRATION

Clinical trial registration was assigned 10-09-2021 (ISRCTN80969503). https://doi.org/10.1186/ISRCTN80969503.

The Role of Job Control and Job Demands in Becoming Physically Active during the COVID-19 Pandemic: A Three-Wave Longitudinal Study

Organizational studies suggest that certain psychosocial working conditions are liable to foster positive health outcomes, such as engaging in leisure-time physical activities. However, the psychosocial factors contributing to this improvement remain unexplored, particularly in the workplace and in the context of the decline observed in the physical activity level of the population worldwide. The objective of the study was to examine whether exposure to different combinations of psychosocial working conditions during the COVID-19 pandemic predicts the probability of becoming physically active among Quebec workers. Job demands, job control, and physical activity were assessed three times during the first year of the pandemic via an online questionnaire among physically inactive workers (n = 440). Logistic regression analyses were conducted to examine the associations between various combinations of psychosocial risks and physical activity. A total of 117 participants became physically active during the study. After controlling for covariates, active jobs increased the odds of becoming physically active, compared to high-strain jobs (OR = 2.57 (95% CI 1.13 to 5.87)). Having a highly demanding job may not negatively impact physical activity if workers have enough job control to achieve the required tasks.

Does Childcare Work Promote Cardiorespiratory Fitness and Health? A Cross-Sectional Study of Danish Childcare Workers Based on Accelerometry and Heart Rate Measurements

Childcare workers are reported to have poor cardiorespiratory fitness and health. The Goldilocks Work Principle argues that productive work should be designed with the right composition, intensity and alternations of physical behaviors so that workers get fit and healthy. The purpose of this study was to investigate: (1) composition, (2) intensity and (3) alternations of physical behaviors during work and leisure among childcare workers. Data were collected using accelerometers and heart rate monitors over five workdays among 51 childcare workers at five Danish childcare institutions. Workers mainly spent their work time sedentary (43.0%), spent little time (0.7%) at sufficiently high cardiometabolic intensity to increase cardiorespiratory fitness and often alternated between physical behaviors (67.0% occurred in bouts of <5 min). These findings indicate that the workers have a composition of behaviors at work dominated by sedentary time, little time with high cardiometabolic intensity, and frequent alternations between behaviors. During leisure, workers spent more time sedentary (59.4%), more time at high cardiometabolic intensity (3.4%) and less time occurred in bouts <5 min (38.7%). We see a potential for promoting cardiorespiratory fitness and health of childcare workers by redesigning the way they play with the children, so that work time with high cardiometabolic intensity is increased.

Goldilocks Days: optimising children's time use for health and well-being

BACKGROUND

One size rarely fits all in population health. Differing outcomes may compete for best allocations of time. Among children aged 11-12 years, we aimed to (1) describe optimal 24-hour time use for diverse physical, cognitive/academic and well-being outcomes, (2) pinpoint the 'Goldilocks Day' that optimises all outcomes and (3) develop a tool to customise time-use recommendations.

METHODS

In 2004, the Longitudinal Study of Australian Children recruited a nationally-representative cohort of 5107 infants with biennial follow-up waves. We used data from the cross-sectional Child Health CheckPoint module (2015-2016, n=1874, 11-12 years, 51% males). Time use was from 7-day 24-hour accelerometry. Outcomes included life satisfaction, psychosocial health, depressive symptoms, emotional problems, non-verbal IQ; vocabulary, academic performance, adiposity, fitness, blood pressure, inflammatory biomarkers, bone strength. Relationships between time use and outcomes were modelled using compositional regression.

RESULTS

Optimal daily durations varied widely for different health outcomes (sleep: 8.3-11.4 hours; sedentary: 7.3-12.2 hours; light physical activity: 1.7-5.1 hours; moderate-to-vigorous physical activity (MVPA): 0.3-2.7 hours, all models p≤0.04). In general, days with highest physical activity (predominantly MVPA) and low sedentary time were optimal for physical health, while days with highest sleep and lowest sedentary time were optimal for mental health. Days with highest sedentary time and lowest physical activity were optimal for cognitive health. The overall Goldilocks Day had 10 hours 21 min sleep, 9 hours 44 min sedentary time, 2 hours 26 min light physical activity and 1 hour 29 min MVPA. Our interactive interface allows personalisation of Goldilocks Days to an individual's outcome priorities.

CONCLUSION

'Goldilocks Days' necessitate compromises based on hierarchies of priorities for health, social and economic outcomes.

Cardiorespiratory Fitness in Occupational Groups-Trends over 20 Years and Future Forecasts

BACKGROUND

Reports have indicated a negative trend in cardiorespiratory fitness (CRF) in the general population. However, trends in relation to different occupational groups are missing. Therefore, the aim of our study was to examine the trends in CRF during the last 20 years, and to provide a prognosis of future trends in CRF, in different occupational groups of Swedish workers.

METHODS

Data from 516,122 health profile assessments performed between 2001 to 2020 were included. CRF was assessed as maximal oxygen consumption and was estimated from a submaximal cycling test. Analyses include CRF as a weighted average, standardized proportions with low CRF (<32 mL/min/kg), adjusted annual change in CRF, and forecasting of future trends in CRF.

RESULTS

There was a decrease in CRF over the study period, with the largest decrease in both absolute and relative CRF seen for individuals working in administrative and customer service (-10.1% and -9.4%) and mechanical manufacturing (-6.5% and -7.8%) occupations. The greatest annual decrease was seen in transport occupations (-1.62 mL/min/kg, 95% CI -0.190 to -0.134). Men and younger individuals had in generally a more pronounced decrease in CRF. The proportion with a low CRF increased, with the greatest increase noted for blue-collar and low-skilled occupations (range: +19% to +27% relative change). The forecast analyses predicted a continuing downward trend of CRF.

CONCLUSION

CRF has declined in most occupational groups in Sweden over the last two decades, with a more pronounced decline in blue-collar and low-skilled occupational groups.

VO2peak and 24-hour sleep, sedentary behavior, and physical activity in Australian truck drivers

This study assessed cardiorespiratory fitness (CRF) and 24-h sleep, sedentary behavior (SB), and physical activity (PA) in Australian truck drivers. Participants (n = 37 men) attended clinic sessions for an exercise test to exhaustion to establish CRF and wore an accelerometer (Actigraph GT3X+) to estimate sleep, SB, and PA. Relative to normative values, CRF was "below percentile 25" in 51% of drivers (mean [SD] VO_2peak=30 .1 [7.6] mL.kg-1.min-1). Accelerometer data indicated that total vigorous-intensity (3.5-4.5 min/day) and sustained moderate- to vigorous-intensity PA (>5 min; 0.5-1.6 bouts/day) were limited. The findings show there is a need to design and test PA interventions that can improve poor levels of CRF in truck drivers.

Development and Implementation of 'Just Right' Physical Behavior in Industrial Work Based on the Goldilocks Work Principle-A Feasibility Study

The Goldilocks Work Principle expresses that productive work should be redesigned to comprise physical behaviors of different intensities in a composition promoting workers' health and fitness. This study is the first to assess the feasibility of redesigning work in an industrial setting according to the Goldilocks Work Principle. We recruited workers (n = 20) from a brewery in Denmark, and we conducted a participatory 16-week intervention including a workshop and two consultations. The workshop aimed to support the workers in modifying their work, while the consultations assisted the eventual implementation. Feasibility was evaluated as per three aspects: (1) developing modifications of work, (2) implementing these modifications, and (3) changing physical behavior and self-reported fatigue, pain and energy. The three aspects were addressed through records completed by the workers, measurements of workers' physical behavior and intensity during 'control' workdays (i.e., usual work) and 'intervention' workdays (i.e., modified work), and self-reported fatigue, pain and energy level following both types of workday. Five modifications to work were developed, and three of these five modifications were implemented. To some extent, physical behavior and intensity changed as intended during 'intervention' workdays compared to 'control' workdays. Workers were also less fatigued, had less pain, and had more energy after 'intervention' workdays. These results suggest that it is feasible to develop and implement modified work based on the Goldilocks Work Principle among industrial workers. However, we also identified several barriers to the implementation of such modifications.

Balancing time use for children's fitness and adiposity: Evidence to inform 24-hour guidelines for sleep, sedentary time and physical activity

PURPOSE

Daily time spent on one activity cannot change without compensatory changes in others, which themselves may impact on health outcomes. Optimal daily activity combinations may differ across outcomes. We estimated optimal daily activity durations for the highest fitness and lowest adiposity.

METHODS

Cross-sectional Child Health CheckPoint data (1182 11-12-year-olds; 51% boys) from the population-based Longitudinal Study of Australian Children were used. Daily activity composition (sleep, sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA]) was from 8-day, 24-hour accelerometry. We created composite outcomes for fitness (VO2max; standing long jump) and adiposity (waist-to-height ratio; body mass index; fat-to-fat-free log-ratio). Adjusted compositional models regressed activity log-ratios against each outcome. Best activity compositions (optimal time-use zones) were plotted in quaternary tetrahedrons; the overall optimal time-use composition was the center of the overlapping area.

RESULTS

Time-use composition was associated with fitness and adiposity (all measures p<0.001). Optimal time use differed for fitness and adiposity. While both maximized MVPA and minimized sedentary time, optimal fitness days had higher LPA (3.4 h) and shorter sleep (8.25 h), but optimal adiposity days had lower LPA (1.0 h) and longer sleep (10.9 h). Balancing both outcomes, the overall optimal time-use composition was (mean [range]): 10.2 [9.5; 10.5] h sleep, 9.9 [8.8; 11.2] h sedentary time, 2.4 [1.8; 3.2] h LPA and 1.5 [1.5; 1.5] h MVPA.

CONCLUSION

Optimal time use for children's fitness and adiposity involves trade-offs. To best balance both outcomes, estimated activity durations for sleep and LPA align with, but for MVPA exceed, 24-h guidelines.

Experimental Lagos bat virus infection in straw-colored fruit bats: A suitable model for bat rabies in a natural reservoir species

Rabies is a fatal neurologic disease caused by lyssavirus infection. Bats are important natural reservoir hosts of various lyssaviruses that can be transmitted to people. The epidemiology and pathogenesis of rabies in bats are poorly understood, making it difficult to prevent zoonotic transmission. To further our understanding of lyssavirus pathogenesis in a natural bat host, an experimental model using straw-colored fruit bats (Eidolon helvum) and Lagos bat virus, an endemic lyssavirus in this species, was developed. To determine the lowest viral dose resulting in 100% productive infection, bats in five groups (four bats per group) were inoculated intramuscularly with one of five doses, ranging from 100.1 to 104.1 median tissue culture infectious dose (TCID50). More bats died due to the development of rabies after the middle dose (102.1 TCID50, 4/4 bats) than after lower (101.1, 2/4; 101.1, 2/4) or higher (103.1, 2/4; 104.1, 2/4) doses of virus. In the two highest dose groups, 4/8 bats developed rabies. Of those bats that remained healthy 3/4 bats seroconverted, suggesting that high antigen loads can trigger a strong immune response that abrogates a productive infection. In contrast, in the two lowest dose groups, 3/8 bats developed rabies, 1/8 remained healthy and seroconverted and 4/8 bats remained healthy and did not seroconvert, suggesting these doses are too low to reliably induce infection. The main lesion in all clinically affected bats was meningoencephalitis associated with lyssavirus-positive neurons. Lyssavirus antigen was detected in tongue epithelium (5/11 infected bats) rather than in salivary gland epithelium (0/11), suggesting viral excretion via the tongue. Thus, intramuscular inoculation of 102.1 TCID50 of Lagos bat virus into straw-colored fruit bats is a suitable model for lyssavirus associated bat rabies in a natural reservoir host, and can help with the investigation of lyssavirus infection dynamics in bats.

Lifestyle-associated health risk indicators across a wide range of occupational groups: a cross-sectional analysis in 72,855 workers

Background

Identify and compare health risk indicators for common chronic diseases between different occupational groups.

Methods

A total of 72,855 participants (41% women) participating in an occupational health service screening in 2014–2019 were included. Occupation was defined by the Swedish Standard Classification of Occupation, and divided into nine major and additionally eight sub-major groups. These were analysed separately, as white- and blue-collar occupations and as low- and high-skilled occupations. Seven health risk indicators were self-reported: exercise, physical work situation, sitting at work and leisure, smoking, diet, and perceived health, whereas cardiorespiratory fitness, BMI and blood pressure were measured. These were further dichotomized (yes/no) and as clustering of risk indicators (≥3 vs. <3).

Results

The greatest variation in OR across sub-major and major occupational groups were seen for daily smoking (OR = 0.68 to OR = 5.12), physically demanding work (OR = 0.55 to OR = 45.74) and high sitting at work (OR = 0.04 to OR = 1.86). For clustering of health risk indicators, blue-collar workers had significantly higher clustering of health risks (OR: 1.80; 95% CI 1.71–1.90) compared to white-collar workers (reference). Compared to high-skilled white-collar workers, low-skilled white-collar workers had similar OR (2.00; 1.88–2.13) as high-skilled blue-collar workers (1.98; 1.86–2.12), with low-skilled blue-collar workers having the highest clustered risk (2.32; 2.17–2.48).

Conclusion

There were large differences in health risk indicators across occupational groups, mainly between high-skilled white-collar occupations and the other occupations, with important variations also between major and sub-major occupational groups. Future health interventions should target the occupational groups identified with the highest risk for effective disease prevention.

Can Childcare Work Be Designed to Promote High Intensity Physical Activity for Improved Fitness and Health? A Proof of Concept Study of the Goldilocks Principle

Childcare workers are reported to have high variation in physical activity during work hours, but also to sit for about half of the workday and have almost no high intensity physical activity (HIPA). No study has investigated if their work can be re-designed to introduce HIPA, thus promoting fitness and health according to the Goldilocks principle. This study investigated the feasibility of designing pedagogical games (‘Goldilocks-games’) intended to lead to more HIPA. Heart rate was measured in nineteen childcare workers during Goldilocks-games, and compared to measurements during a regular workday. Worker perceptions of feasibility, and researcher observations of contextual factors were also collected. The Goldilocks-games (33 min) elicited significantly more HIPA (18/33 min) compared to the most active period of equal length on a regular workday (0.5/33 min). Seventy-four-percent of the childcare workers reported that it was feasible to integrate the Goldilocks-games pedagogically, and seventy-two-percent could see themselves using them. Thus, we found it possible to re-design a work task in childcare according to the Goldilocks principle so that it leads to substantial time with HIPA. The sustainability of Goldilocks-games in childcare, and their effectiveness in improving fitness and health among childcare workers, needs to be tested in further studies.

The physical activity paradox revisited: a prospective study on compositional accelerometer data and long-term sickness absence

Background

The ‘physical activity paradox’ advocates that leisure physical activity (PA) promotes health while high occupational PA impairs health. However, this paradox can be explained by methodological limitations of the previous studies—self-reported PA measures, insufficient adjustment for socioeconomic confounding or not addressing the compositional nature of PA. Therefore, this study investigated if we still observe the PA paradox in relation to long-term sick absence (LTSA) after adjusting for the abovementioned limitations.

Methods

Time spent on moderate-to-vigorous physical activity (MVPA) and remaining physical behaviors (sedentary behavior, standing, light PA and time in bed) at work and in leisure was measured for 929 workers using thigh accelerometry and expressed as isometric log-ratios (ilrs). LTSA was register-based first event of ≥6 consecutive weeks of sickness absence during 4-year follow-up. The association between ilrs and LTSA was analyzed using a Cox proportional hazards model adjusted for remaining physical behaviors and potential confounders, then separately adjusting for and stratifying by education and type of work.

Results

During the follow-up, 21% of the workers experienced LTSA. In leisure, more relative MVPA time was negatively associated with LTSA (20% lower risk with 20 min more MVPA, p = 0.02). At work, more relative MVPA time was positively associated with LTSA (15% higher risk with 20 min more MVPA, p = 0.02). Results remained unchanged when further adjusted for or stratified by education and type of work.

Conclusion

These findings provide further support to the ‘PA paradox’.

Can childcare work be designed to promote moderate and vigorous physical activity, cardiorespiratory fitness and health? Study protocol for the Goldilocks-childcare randomised controlled trial

BACKGROUND

Despite extensive efforts, issues like obesity and poor physical capacity remain challenges for a healthy work life in several occupations. The Goldilocks work principle offers a new approach, encouraging design of productive work to promote physical capacity and health. This paper presents the protocol for the Goldilocks-childcare study, a randomised controlled intervention trial aiming to evaluate the effectiveness of implementing the Goldilocks work principle in childcare. The primary aim of the intervention is to increase time in moderate to vigorous physical activity (MVPA) by having the childcare workers act as active role models for children in daily playful physical activities, and thereby improve cardiorespiratory fitness and health of the workers.

METHODS

The study is a cluster-randomised trial with a usual-practice wait-list control group. The 10-week intervention consists of two phases. In the first, the childcare workers will participate in two participatory workshops aiming to a) develop playful physical activities ('Goldilocks-games') for children in which childcare workers participate as active role models at MVPA intensity, and b) develop action plans for implementation of the Goldilocks-games in daily work routines. In the second phase, childcare institutions will implement the Goldilocks-games. The primary outcome is working time spent in MVPA, and secondary outcomes are cardiorespiratory fitness, sleeping heart rate, perceived need for recovery, and productivity. Primary outcome and process evaluation will be based on direct measurements of physical activity and heart rate, determination of cardiorespiratory fitness, and questionnaires.

DISCUSSION

If proven effective, the Goldilocks work principle has a large potential for promoting sustainable health and working lives of childcare workers.

TRIAL REGISTRATION

ISRCTN, ISRCTN15644757, Registered 25th December 2019.

Sedentary and Physical Activity Behavior in "Blue-Collar" Workers: A Systematic Review of Accelerometer Studies

BACKGROUND

This systematic review assessed evidence on the accelerometer-measured sedentary and physical activity (PA) behavior of nonoffice workers in "blue-collar" industries.

METHODS

The databases CINAHL, Embase, MEDLINE, PubMed, and Scopus were searched up to April 6, 2018. Eligibility criteria were accelerometer-measured sedentary, sitting, and/or PA behaviors in "blue-collar" workers (≥10 participants; agricultural, construction, cleaning, manufacturing, mining, postal, or transport industries). Data on participants' characteristics, study protocols, and measured behaviors during work and/or nonwork time were extracted. Methodologic quality was assessed using a 12-item checklist.

RESULTS

Twenty studies (representing 11 data sets), all from developed world economies, met inclusion criteria. The mean quality score for selected studies was 9.5 (SD 0.8) out of a maximum of 12. Data were analyzed using a range of analytical techniques (eg, accelerometer counts or pattern recognition algorithms). "Blue-collar" workers were more sedentary and less active during nonwork compared with work time (eg, sitting 5.7 vs 3.2 h/d; moderate to vigorous PA 0.5 vs 0.7 h/d). Drivers were the most sedentary (work time 5.1 h/d; nonwork time 8.2 h/d).

CONCLUSIONS

High levels of sedentary time and insufficient PA to offset risk are health issues for "blue-collar" workers. To better inform interventions, research groups need to adopt common measurement and reporting methodologies.

The 2018 Physical Activity Guidelines for Americans: What's New? Implications for Clinicians and the Public

Despite the widely publicized health benefits of physical activity, a large proportion of the world's population is insufficiently active or completely inactive. The 2018 edition of the Physical Activity Guidelines for Americans (PAGA18) was a mammoth feat that took over 2 years to complete and resulted in a 779-page report in early 2018, followed by the publication of the summary guidelines in the Journal of the American Medical Association. In this Viewpoint, the authors (1) summarize the key components of the PAGA18 with respect to adults, and (2) discuss the implications for the general public and health care practitioners. J Orthop Sports Phys Ther 2019;49(7):487-490. doi:10.2519/jospt.2019.0609.

Comparison of muscle activity from upper trapezius and wrist extensors between dominant and non-dominant upper limbs during computer-based tasks

BACKGROUND

Sustained low-level muscle activity occurring during computer-based tasks is associated with the development of WMSDs (work-related musculoskeletal disorders) and this biomechanical exposure may be different between limbs.

OBJECTIVE

To compare muscle activity from dominant and non-dominant upper trapezius (UT) and wrist extensors (WE) during computer-based tasks in real work settings.

METHODS

Forty-five workers were monitored during two hours while performing their usual administrative tasks. Surface electromyography (sEMG) was recorded from UT and WE muscles in both sides. Rest and general exposure variables were calculated.

RESULTS

The 50th percentile demonstrated little muscle activity demand, for both dominant and non-dominant UT and no difference between sides was observed. The dominant WE muscles had lower measures of rest and higher muscle activity when compared with the non-dominant side.

CONCLUSIONS

Differences in sEMG between upper limbs were only found in WE muscles, probably due to the use of the mouse. The overall low-level muscle activity suggests a constant activation of the same motor units for the entire data-collection period, which can be considered harmful for musculoskeletal health.

Cardiovascular disease prevention at the workplace: assessing the prognostic value of lifestyle risk factors and job-related conditions

Objectives

The prognostic utility of lifestyle risk factors and job-related conditions (LS&JRC) for cardiovascular disease (CVD) risk stratification remains to be clarified.

Methods

We investigated discrimination and clinical utility of LS&JRC among 2532 workers, 35–64 years old, CVD-free at the time of recruitment (1989–1996) in four prospective cohorts in Northern Italy, and followed up (median 14 years) until first major coronary event or ischemic stroke, fatal or non-fatal. From a Cox model including cigarette smoking, alcohol intake, occupational and sport physical activity and job strain, we estimated 10-year discrimination as the area under the ROC curve (AUC), and clinical utility as the Net Benefit.

Results

N = 162 events occurred during follow-up (10-year risk: 4.3%). The LS&JRC model showed the same discrimination (AUC = 0.753, 95% CI 0.700–0.780) as blood lipids, blood pressure, smoking and diabetes (AUC = 0.753), consistently across occupational classes. Among workers at low CVD risk (n = 1832, 91 CVD events), 687 were at increased LS&JRC risk; of these, 1 every 15 was a case, resulting in a positive Net Benefit (1.27; 95% CI 0.68–2.16).

Conclusions

LS&JRC are as accurate as clinical risk factors in identifying future cardiovascular events among working males. Our results support initiatives to improve total health at work as strategies to prevent cardiovascular disease.