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Akram M, Cerin E, Lamb KE, White SR. Modelling count, bounded and skewed continuous outcomes in physical activity research: beyond linear regression models. Int J Behav Nutr Phys Act 2023; 20:57. [PMID: 37147664 PMCID: PMC10163772 DOI: 10.1186/s12966-023-01460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 04/29/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Inference using standard linear regression models (LMs) relies on assumptions that are rarely satisfied in practice. Substantial departures, if not addressed, have serious impacts on any inference and conclusions; potentially rendering them invalid and misleading. Count, bounded and skewed outcomes, common in physical activity research, can substantially violate LM assumptions. A common approach to handle these is to transform the outcome and apply a LM. However, a transformation may not suffice. METHODS In this paper, we introduce the generalized linear model (GLM), a generalization of the LM, as an approach for the appropriate modelling of count and non-normally distributed (i.e., bounded and skewed) outcomes. Using data from a study of physical activity among older adults, we demonstrate appropriate methods to analyse count, bounded and skewed outcomes. RESULTS We show how fitting an LM when inappropriate, especially for the type of outcomes commonly encountered in physical activity research, substantially impacts the analysis, inference, and conclusions compared to a GLM. CONCLUSIONS GLMs which more appropriately model non-normally distributed response variables should be considered as more suitable approaches for managing count, bounded and skewed outcomes rather than simply relying on transformations. We recommend that physical activity researchers add the GLM to their statistical toolboxes and become aware of situations when GLMs are a better method than traditional approaches for modeling count, bounded and skewed outcomes.
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Affiliation(s)
- Muhammad Akram
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Simon R White
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Kim HJ, Choo J. Socioecological Factors Associated With Physical Activity and Sedentary Behavior Among Workers: Using the PRECEDE-PROCEED Model. Workplace Health Saf 2023; 71:22-33. [PMID: 35369827 DOI: 10.1177/21650799221079388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Physical inactivity is a major global health problem. Industrial automation has led to an increased number of workers who are sedentary at work. We examined whether three socioecological factors (i.e., predisposing, reinforcing, and enabling factors) derived from the PRECEDE-PROCEED model would be significantly associated with the physical activity and sedentary behavior among workers. METHODS A cross-sectional study was conducted among 539 employees at an electronic manufacturing plant in Gumi, South Korea. Physical activity variables of energy expenditure (MET-min/week) and sitting time at work (minutes/day) were measured by the International Physical Activity Questionnaire and the Workforce Sitting Questionnaire, respectively. Of the socioecological factors, a predisposing factor defined as self-determined motivation was measured by the Exercise Self-Regulation Questionnaire; a reinforcing factor defined as autonomy support was measured by the Work Climate Questionnaire; and an enabling factor defined as supportive workplace environment was measured by the Perceived Workplace Environment Scale. FINDINGS Self-determined motivation (i.e., autonomous and controlled forms of motivation), autonomy support, and a supportive workplace environment were all significantly associated with increased physical activity energy expenditure during leisure-time. However, they were not significantly associated with sitting time on working and non-working days. CONCLUSION/APPLICATIONS TO PRACTICE Three socioecological factors of the PRECEDE-PROCEED model were significantly associated with leisure-time physical activity among workers. Our findings may help occupational health nurses use a socioecological approach for designing effective workplace strategies to increase leisure-time physical activity among workers.
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Affiliation(s)
- Hye-Jin Kim
- Catholic Kwandong University.,Korea University
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d'Arripe-Longueville F, Hayotte M, Planchard JH, Steiner DD, Corrion K. Development and Validation of the Workplace Decisional Balance Scale for Exercise (WDBex) in a French Sample. J Occup Environ Med 2021; 63:e715-e723. [PMID: 34387284 DOI: 10.1097/jom.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite positive effects of physical activity programs in the workplace, an appropriate measurement instrument to capture employees' decisional balance to exercise is lacking. This study sought to develop and validate a decisional balance scale for exercise adapted to the workplace. METHODS Four complementary studies were carried out, with a total sample of 2398 French volunteer employees, to develop a preliminary version and examine its dimensionality, temporal stability, and construct validity. RESULTS The Workplace Decisional Balance scale for Exercise (WDBex) consists of 21 items with two subfactors, respectively composed of 12 items (facilitators) and nine items (barriers); for each subfactor, three dimensions (ie, physical, psychological, and logistic) were distinguished and presented satisfactory psychometric properties. CONCLUSIONS This instrument constitutes a reliable and valid instrument for studying the psychosocial determinants of physical activity engagement in the workplace and for developing health promotion strategies.
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Affiliation(s)
- Fabienne d'Arripe-Longueville
- Laboraboire Motricité Humaine Expertise Sport Santé (laboratory human motricity, expertise, sport and health), Université Côte d'Azur (University Côte d'azur) (Dr d'Arripe-Longueville, Ms Hayotte, Dr Corrion); Département Médecine du Travail, Centre Hospitalier Universitaire de Nice (Dr Planchard); Laboratoire d'Anthropologie et de Psychologie Cognitive et Sociale (laboratory of Anthropology and Cognitive and Social Psychology), Université Côte d'Azur (University Côte d'azur) (Dr Steiner), Nice, France
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Biber DD, Rice K, Ellis R. Self-compassion training within a workplace physical activity program: A pilot study. Work 2021; 68:1059-1067. [PMID: 33867372 DOI: 10.3233/wor-213436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Desire2Move (D2M) is an 8-week team-based, workplace program that incorporates competition and self-monitoring to encourage physical activity (PA). OBJECTIVE The purpose of this pilot study was to evaluate the effectiveness of a self-compassion (SC) intervention within the existing workplace PA program. METHODS University employees (n = 20) were assigned to a SC treatment group or an attention control group. Participants logged their PA minutes using MapMyRun. Treatment group. participants received a 7-week, SC podcast intervention. Participants self-reported PA, SC, and demographic information at pre- and post-intervention. Separate ANOVAs were used to determine group differences. RESULTS There was not a statistically significant group x time interaction for SC, F(1, 18) = 0.02, p = 0.90, or main effects for time, F(1, 18) = 0.28, p = 0.61, or group, F(1, 18) = 1.70, p = 0.21, g = -0.42 [95%CI = -3.13, 2.29]. There were not significant differences between groups for total PA minutes during D2M, F(1, 18) = 2.15, p = 0.16, g = -0.63 [-1.53,0.27]. Overall, participants engaged in more than the recommended levels of PA each week. CONCLUSIONS This pilot study provided feedback and guidance for future online SC training within a workplace PA intervention.
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Affiliation(s)
- Duke D Biber
- Department of Sport Management, Wellness, and Physical Education, College of Education, University of West Georgia, Carrollton, GA, USA
| | - Ken Rice
- Department of Counseling and Psychological Services, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Rebecca Ellis
- Department of Kinesiology and Health, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
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The Mediating Role of Self-Regulation and Self-Efficacy on Physical Activity Change in Community-Dwelling Older Adults (≥65 Years): An Experimental Cross-Lagged Analysis Using Data From SITLESS. J Aging Phys Act 2021; 29:931-940. [PMID: 34135127 DOI: 10.1123/japa.2020-0322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/22/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022]
Abstract
Improving the capacity for physical activity interventions to maintain behavior change is a key public health concern and an important strategy for the health and independence of older adults. Ways of ensuring effective maintenance of physical activity levels in older adults are unclear. This study includes the objective measure of moderate-to-vigorous physical activity (MVPA); self-reported self-efficacy; and self-regulation at four timepoints (baseline, intervention completion at 4 months, 12-, and 18-month follow-up) from the SITLESS study, a clinical trial conducted with a cohort of community-dwelling older adults (≥65 years) from Denmark, Germany, Spain, and the United Kingdom. A cross-lagged analysis found that self-regulation and self-efficacy may be key determinants of MVPA behavior in community-dwelling older adults. More specifically, the use of behavioral support strategies represents an important correlate of MVPA behavior, and its association with MVPA may be mediated by self-regulation and self-efficacy in older adults in the short and long term.
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The Influence of Occupational Categories on Overall and Domain-Specific Physical Activity and the Association with Chronic Diseases. An Analysis Using the Austrian Health Interview Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042148. [PMID: 33671784 PMCID: PMC7926308 DOI: 10.3390/ijerph18042148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022]
Abstract
Background: The performance of physical activity (PA) in different domains varies between different occupational groups and they contribute differently to the prevention and management of chronic diseases. This study aimed to give a fuller picture of the potential influence occupational categories have on the different domains of PA among the Austrian population of working age. Methods: A total of 8251 gainfully employed persons in 9 major and 39 sub-major occupational groups from the Austrian Health Interview Survey 2014 were analyzed. PA was measured with the Physical Activity Questionnaire of the European Health Interview Survey (EHIS-PAQ) and the prevalence of 17 chronic diseases was obtained. Results: A total of 48.2% were mostly active when working, 18.4% reported transport-related PA in the upper quintile, 50.4% performed at least 150 min per week of moderate PA or cycling, 32.7% performed muscle-strengthening PA at least twice a week, and 76.3% were either mostly physically active when working or complied with the aerobic PA guidelines. As a general rule, people in physically active occupational groups tended to perform less PA in their leisure time and vice versa. Occupational groups with especially low amount of PA were Information Technology workers, directors, and secretarial staff. People with a chronic disease tended to perform less PA, but there was an interaction between occupation and chronic disease on PA. Conclusions: Domain-specific programs to promote PA should be developed for various occupational categories.
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Risk Factors for Non-Communicable Diseases at Baseline and Their Short-Term Changes in a Workplace Cohort in Singapore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224551. [PMID: 31752089 PMCID: PMC6888317 DOI: 10.3390/ijerph16224551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
We aimed to examine the behavioural and clinical risk factors for non-communicable diseases (NCDs) at baseline and their changes over 12 months in a workplace cohort in Singapore. A total of 464 full-time employees (age ≥ 21 years) were recruited from a variety of occupational settings, including offices, control rooms, and workshops. Of these, 424 (91.4%) were followed-up at three months and 334 (72.0%) were followed up at 12 months. Standardized questionnaires were used to collect data on health behaviours and clinical measurements were performed by trained staff using standard instruments and protocols. Age-adjusted changes in risk factors over time were examined using generalized estimating equations or linear mixed-effects models where appropriate. The mean age of the participants at baseline was 39.0 (SD: 11.4) years and 79.5% were men. Nearly a quarter (24.4%) were current smokers, slightly more than half (53.5%) were alcohol drinkers, two-thirds (66%) were consuming <5 servings of fruit and vegetables per day, and 23.1% were physically inactive. More than two-thirds (67%) were overweight or obese and 34.5% had central obesity. The mean follow-up was 8.6 months. After adjusting for age, over 12 months, there was a significant increase in the proportion consuming <5 servings of fruit and vegetables per day by 33% (p = 0.030), who were physically inactive by 64% (p < 0.001), and of overweight or obese people by 15% (p = 0.018). The burden of several key NCD risk factors at baseline was high and some worsened within a short period of time in this working population. There is a need for more targeted strategies for behaviour change towards a healthy lifestyle as part of the ongoing health and wellness programs at workplaces in Singapore.
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Adlakha D. Burned Out: Workplace Policies and Practices Can Tackle Occupational Burnout. Workplace Health Saf 2019; 67:531-532. [PMID: 31535598 DOI: 10.1177/2165079919873352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Burnout has been included as an occupational phenomenon in the International Classification of Diseases. Health promotion through workplace physical activity policies, incentives, and supports has the potential to prevent burnout.
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Dunleavy G, Sathish T, Nazeha N, Soljak M, Visvalingam N, Bajpai R, Yap HS, Roberts AC, Thach TQ, Tonon AC, Soh CK, Christopoulos G, Cheung KL, de Vries H, Car J. Health Effects of Underground Workspaces cohort: study design and baseline characteristics. Epidemiol Health 2019; 41:e2019025. [PMID: 31623427 PMCID: PMC6815877 DOI: 10.4178/epih.e2019025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
The development of underground workspaces is a strategic effort towards healthy urban growth in cities with ever-increasing land scarcity. Despite the growth in underground workspaces, there is limited information regarding the impact of this environment on workers' health. The Health Effects of Underground Workspaces (HEUW) study is a cohort study that was set up to examine the health effects of working in underground workspaces. In this paper, we describe the rationale for the study, study design, data collection, and baseline characteristics of participants. The HEUW study recruited 464 participants at baseline, of whom 424 (91.4%) were followed-up at 3 months and 334 (72.0%) at 12 months from baseline. We used standardized and validated questionnaires to collect information on socio-demographic and lifestyle characteristics, medical history, family history of chronic diseases, sleep quality, health-related quality of life, chronotype, psychological distress, occupational factors, and comfort levels with indoor environmental quality parameters. Clinical and anthropometric parameters including blood pressure, spirometry, height, weight, and waist and hip circumference were also measured. Biochemical tests of participants' blood and urine samples were conducted to measure levels of glucose, lipids, and melatonin. We also conducted objective measurements of individuals' workplace environment, assessing air quality, light intensity, temperature, thermal comfort, and bacterial and fungal counts. The findings this study will help to identify modifiable lifestyle and environmental parameters that are negatively affecting workers' health. The findings may be used to guide the development of more health-promoting workspaces that attempt to negate any potential deleterious health effects from working in underground workspaces.
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Affiliation(s)
- Gerard Dunleavy
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Thirunavukkarasu Sathish
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Nuraini Nazeha
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Michael Soljak
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Nanthini Visvalingam
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Research institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Hui Shan Yap
- School of Civil and Environmental Engineering, College of Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Adam C. Roberts
- School of Civil and Environmental Engineering, College of Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Thuan Quoc Thach
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - André Comiran Tonon
- Laboratório de Cronobiologia e Sono, Porto Alegre Clínicas Hospital (HCPA), Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Chee Kiong Soh
- School of Civil and Environmental Engineering, College of Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Georgios Christopoulos
- Division of Leadership, Management and Organisation, Nanyang Business School, College of Business, Nanyang Technological University Singapore, Singapore, Singapore
| | - Kei Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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