Development and feasibility of a conceptual model for planning individualised physical exercise training (IPET) for older adults: a cross-sectional study

OBJECTIVE

Older adults constitute a heterogeneous group, and the focus of the individual physical exercise is often subject to the reasoning and experience of health professionals or exercise physiologists who prescribe them. Thus, this is the first effort to explicitly conceptualise the planning of individualised physical exercise training (IPET) for older adults in an outpatient setting and investigate individual exercise preferences.

DESIGN

The concept of IPET was developed by researchers, exercise physiologists and health professionals from a real-life outpatient setting using an iterative approach. Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites form the basis of physical exercise recommendations. A cross-sectional study was conducted to assess the basis of implementing IPET.

SETTING

Outpatient setting.

PARTICIPANTS

We included 115 older adults (70 females) from an outpatient setting with a median age of 74 years.

OUTCOME MEASURES

Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites were collected and informed the concept of IPET that structures exercise programmes based on the individual citizen's needs and physical exercise preferences. Exceeding a health indicator cut-point results in exercise content mitigating the risk associated with the health indicator.

RESULTS

We included 115 older adults (70 females) from an outpatient setting median age of 74 years. Approximately two-thirds of participants exceeded at least one health indicator cut-point for aerobic training. One-third of the participants exceeded the cut-point for upper extremity strength, and almost all participants >99% exceeded the cut-point for lower extremity strength. Approximately two-thirds of the participants exceeded the cut-point for functional/balance training. The most prevalent site of musculoskeletal pain was the lower extremities. Eight of 20 training combinations were used, clustering the 115 participants primarily in three main training combinations.

DISCUSSION

This study shows that older adults vary in physical functioning, indicating that exercise preferences and rehabilitation needs are individual.

TRIAL REGISTRATION NUMBER

NCT04862481.

Internal consistency and construct validity of the Short Musculoskeletal Function Assessment (SMFA) in older adults

OBJECTIVE

The primary objectives of this study were to 1) investigate the internal consistency 2) and construct validity of the Short Musculoskeletal Function Assessment Questionnaire (SMFA) in older adults commencing physical rehabilitation in an outpatient setting.

METHODS

This cross-sectional study recruited older adults who had commenced physical rehabilitation in an outpatient setting. The SMFA consists of two indices: 1) dysfunction capturing the impact of musculoskeletal disorders on physical limitations, and 2) bothering capturing how the individual is emotionally affected by their disorder. SMFA holds four categories: 'mobility', 'daily activities', 'emotional status', and 'function of the arm and hand'. Participants answered the SMFA alongside other patient-reported questionnaires (such as the 36-Item Short Form Survey, SF-36) and similar) and objectively measured muscle strength for the upper and lower body and functional capacity.

RESULTS

We included 115 older adults with a median age of 74 years (IQR 9). Adequate internal consistency was seen with Cronbach's alpha values of 0.90-0.94 for the SMFA indices and 0.77-0.91 for the SMFA categories. The strongest correlations between the SMFA indices were observed with the SF-36 physical component summary (SMFA-Dysfunction r = 0.74, p < 0.05, SMFA-Bother r = 0.72, p < 0.05). Only fair correlations were found between SMFA index scores and clinical outcome measures.

DISCUSSION

This study demonstrated that the SMFA has adequate internal consistency and construct validity for self-reported health status in older adults, especially when considering components covering physical health status. However, we only observed fair correlations between SMFA and clinical outcome measures, indicating that SMFA does not adequately capture muscle strength and functional capacity.

Long Term Cardiovascular Health Effects of Intelligent Physical Exercise Training Among Office Workers-A 2 Year Follow up of a Randomized Controlled Trial

OBJECTIVE

The aim of the study is to assess long-term effects of intelligent physical exercise training (IPET) on cardiorespiratory fitness (VO 2max ) and cardiometabolic measures.

METHODS

Office workers were randomized to a control group (CG, n = 194) or a training group (TG, n = 193). The TG received 1-hour weekly IPET during paid working hours for 2 years and recommendations to perform 30-minute leisure time physical activity 6 d/wk (LPA).

RESULTS

Training group compared with CG demonstrated a significantly larger increase in VO 2max of 0.13 ± 0.06 L/min and improved cardiometabolic measures at 1-year follow-up that were maintained at 2-year follow-up, with larger increases in VO 2max among high-adherence participants.

CONCLUSIONS

Intelligent physical exercise training and LPA showed the potential for long-term improved VO 2max and cardiometabolic measures. These findings emphasize the effectiveness of integrating IPET during paid working hours, and the significance of adherence to training was underlined.

A Multi-component Intervention (NEXpro) Reduces Neck Pain-Related Work Productivity Loss: A Randomized Controlled Trial Among Swiss Office Workers

Purpose Neck pain is common among office workers and leads to work productivity loss. This study aimed to investigate the effect of a multi-component intervention on neck pain-related work productivity loss among Swiss office workers. Methods Office workers, aged 18-65 years, and without serious neck-related health problems were recruited from two organisations for our stepped-wedge cluster randomized controlled trial. The 12-week multi-component intervention included neck exercises, health-promotion information, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. In addition, we reported the weekly monetary value of neck pain-related work productivity loss. Data was analysed on an intention-to-treat basis using a generalized linear mixed-effects model. Results Data from 120 participants were analysed with 517 observations. At baseline, the mean age was 43.7 years (SD 9.8 years), 71.7% of participants were female (N = 86), about 80% (N = 95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (b = -0.27; 95% CI: -0.54 to -0.001, p = 0.049). Weekly saved costs were Swiss Francs 27.40 per participant. Conclusions: Our study provides evidence for the effectiveness of a multi-component intervention to reduce neck pain-related work productivity loss with implications for employers, employees, and policy makers.Trial Registration ClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646 .

Exercise Prescription for the Work-Life Population and Beyond

The background for this paper concerns a high frequency of work-related disorders that may result from physical exposure at work being highly sedentary, repetitive-monotonous, or physically demanding. This may result in levels of physical inactivity or strenuous activity impairing health. The aim is to present an evidence-based exercise prescription for the work-life population and beyond. The exercise program is designed to be feasible for use at the workplace and/or during leisure time and to improve health, workability, productivity, sickness absence, etc. The specific concept of Intelligent Physical Exercise Training, IPET, includes the assessment of several health-related variables, including musculoskeletal disorders, physical capacity, and physical exposure at work and/or daily life activity. An algorithm with cut-points for prescribing specific exercises is provided. Exercise programs in praxis are addressed through descriptions of precise executions of various prescribed exercises and possible alternatives to optimize variation and adherence. Finally, perspectives on the significance of introducing IPET and the ongoing, as well as future lines of development, are discussed.

Inter-rater reliability, discriminatory and predictive validity of neck movement control tests in office workers with headache and/or neck pain

BACKGROUND

Movement control tests (MCTs) are clinical tests to evaluate impairment of movement and associated neuromuscular control and are commonly used to evaluate people with neck pain or headache conditions. The aim of this study was to establish inter-rater reliability as well as discriminatory and predictive validity for seven MCTs of the upper (UCS) and lower cervical spine (LCS) in office workers with headache or neck pain.

METHODS

Seven MCTs of the UCS (3) and LCS (4) were performed at baseline on 140 office workers which were included in a cluster randomized controlled trial. The occurrences of headache and neck pain were established at baseline (discriminatory validity) and at a 15-month follow-up (predictive validity). Inter-rater-reliability was established in a separate cross-sectional study.

RESULTS

MCTs showed slight to almost perfect inter-rater reliability but limited discriminatory (baseline) and limited to small predictive validity (15-month follow up) for different subgroups of office workers with headache and/or neck pain. MCTs of the UCS showed limited discriminatory validity, especially for rotation in participants with headache and neck pain compared to those with headache only (Negative Likelihood-ratio: 0.82, 95% CI: 0.69-0.98). Participants with neck pain only and ≥1/4 positive MCTs for the sagittal plane had an increased risk for future neck pain (Relative risk: 3.33, 95% CI: 1.05-10.56).

DISCUSSION

MCTs of the UCS and LCS are reliable but have only limited to small validity to predict future headache events in office workers. Insufficient sagittal plane movement control may predict neck pain relapses in the future.

Evaluation of an exercise and ergonomics intervention for the prevention of neck pain in office workers: exploratory analysis of a cluster randomised trial

OBJECTIVES

To determine the impact of a 12-week ergonomic/exercise programme compared with an ergonomic/health education programme on the development of neck pain in office workers over 12 months.

METHODS

This cluster-randomised trial prospectively recruited office workers from public and private organisations. Only non-neck pain cases at baseline were included (n=484). All participants received an ergonomic workstation review then randomly allocated to receive a neck/shoulder progressive exercise programme (20 min, 3 ×/week; intervention group) or health education sessions (60 min, 1 ×/week; active control) for 12 weeks. Generalised estimating equations evaluated group differences in the point prevalence of neck pain cases (defined as those with a neck pain score of ≥3 on a 0 (no pain) to 9 (worst pain) scale) over time (3, 6, 9 and 12 months) with cumulative incidence of neck pain cases evaluated descriptively.

RESULTS

While no significant group × time interaction was evident, the 12-month point prevalence of neck pain cases in the intervention group (10%) was half that of the active control group (20%) (adjusted OR 0.46, 95% CI 0.21 to 1.01, p=0.05). Lower cumulative incidence of neck pain cases was observed in the intervention (17%) compared with active control group (30%) over the 12 months.

CONCLUSIONS

A combined ergonomics and exercise intervention may have more benefits in preventing neck pain cases in office workers than an ergonomic and health education intervention. Group differences were modest and should be interpreted with caution when considering strategies for primary prevention of neck pain in the office worker population.

TRIAL REGISTRATION

ACTRN12612001154897.

No evidence for an effect of the first COVID-19 lockdown on work stress conditions in office workers

Background

The COVID-19 pandemic has forced around 50 % of employees of Switzerland into a working from home setting during March and April 2020. Working from home appears to change the work experience of office workers considerably. The aim of this analysis was to investigate the effect of the first COVID-19 lockdown on work stress conditions.

Methods

We based this longitudinal analysis on control group data from an ongoing stepped-wedge cluster randomized controlled trial. Office workers from two Swiss organizations, aged 18-65 years, were included. Baseline data from January 2020 (before the COVID-19 pandemic) were compared with follow-up data collected during the fourth and fifth week of the first lockdown (April 2020). Work stress conditions were measured using the Job-Stress-Index (JSI). The JSI indicates the ratio of work-related resources (e.g., appreciation at work) and stressors (e.g., work organisation) on a scale from 0 (stressors < resources) to 100 (stressors > resources). Paired sample t-tests were performed for statistical analysis.

Results

Data from 75 participants were analysed. Fifty-three participants were female (70.7 %). The mean age was 42.8 years (range from 21.8 to 62.7) at baseline. At baseline, the mean JSI was 47.6 (SD = 5.0), with 77.7 (SD = 12.4) for resources and 22.3 (SD = 10.1) for stressors. At follow-up, the mean JSI was 47.4 SD = 4.5), with 77.5 (SD = 11.7) for resources and 21.4 (SD = 9.6) for stressors. We found no evidence for a difference in JSI (estimate = 0.67, 95 % CI: -0.33 to 0.66, p-value = 0.50), its index of resources (estimate = 0.23, 95 % CI: -1.32 to 1.69, p-value = 0.82) or the index of work stressors (estimate = 1.4, 95 % CI: -0.32 to 2.02, p-value = 0.15) between measurement time points.

Conclusions

The first COVID-19 lockdown did not result in a difference of work stress conditions among our sample of Swiss office workers. Improved working times and work-life balance may have contributed to this finding.

Key messages

Improved working times and work-life balance may have contributed to stable task-related stressors and resources in the early phase of the lockdown.

Other, non-work-related environmental stressors should be investigated to explain COVID-19-related changes in mental and physical health.

Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain-Related Disability: A selfBACK Randomized Clinical Trial

IMPORTANCE

Lower back pain (LBP) is a prevalent and challenging condition in primary care. The effectiveness of an individually tailored self-management support tool delivered via a smartphone app has not been rigorously tested.

OBJECTIVE

To investigate the effectiveness of selfBACK, an evidence-based, individually tailored self-management support system delivered through an app as an adjunct to usual care for adults with LBP-related disability.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial with an intention-to-treat data analysis enrolled eligible individuals who sought care for LBP in a primary care or an outpatient spine clinic in Denmark and Norway from March 8 to December 14, 2019. Participants were 18 years or older, had nonspecific LBP, scored 6 points or higher on the Roland-Morris Disability Questionnaire (RMDQ), and had a smartphone and access to email.

INTERVENTIONS

The selfBACK app provided weekly recommendations for physical activity, strength and flexibility exercises, and daily educational messages. Self-management recommendations were tailored to participant characteristics and symptoms. Usual care included advice or treatment offered to participants by their clinician.

MAIN OUTCOMES AND MEASURES

Primary outcome was the mean difference in RMDQ scores between the intervention group and control group at 3 months. Secondary outcomes included average and worst LBP intensity levels in the preceding week as measured on the numerical rating scale, ability to cope as assessed with the Pain Self-Efficacy Questionnaire, fear-avoidance belief as assessed by the Fear-Avoidance Beliefs Questionnaire, cognitive and emotional representations of illness as assessed by the Brief Illness Perception Questionnaire, health-related quality of life as assessed by the EuroQol-5 Dimension questionnaire, physical activity level as assessed by the Saltin-Grimby Physical Activity Level Scale, and overall improvement as assessed by the Global Perceived Effect scale. Outcomes were measured at baseline, 6 weeks, 3 months, 6 months, and 9 months.

RESULTS

A total of 461 participants were included in the analysis; the population had a mean [SD] age of 47.5 [14.7] years and included 255 women (55%). Of these participants, 232 were randomized to the intervention group and 229 to the control group. By the 3-month follow-up, 399 participants (87%) had completed the trial. The adjusted mean difference in RMDQ score between the 2 groups at 3 months was 0.79 (95% CI, 0.06-1.51; P = .03), favoring the selfBACK intervention. The percentage of participants who reported a score improvement of at least 4 points on the RMDQ was 52% in the intervention group vs 39% in the control group (adjusted odds ratio, 1.76; 95% CI, 1.15-2.70; P = .01).

CONCLUSIONS AND RELEVANCE

Among adults who sought care for LBP in a primary care or an outpatient spine clinic, those who used the selfBACK system as an adjunct to usual care had reduced pain-related disability at 3 months. The improvement in pain-related disability was small and of uncertain clinical significance. Process evaluation may provide insights into refining the selfBACK app to increase its effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03798288.

No Evidence for a Decrease in Physical Activity Among Swiss Office Workers During COVID-19: A Longitudinal Study

PURPOSE

The COVID-19 lockdown interrupted normal daily activities, which may have led to an increase in sedentary behavior (Castelnuovo et al., 2020). The aim of this study was to investigate the effect of the COVID-19 pandemic on the level of physical activity among Swiss office workers.

METHODS

Office workers from two Swiss organizations, aged 18-65 years, were included. Baseline data from January 2020 before the COVID-19 pandemic became effective in Switzerland were compared with follow-up data during the lockdown phase in April 2020. Levels of physical activity were assessed using the International Physical Activity Questionnaire. Paired sample t-tests or Wilcoxon signed-rank test were performed for statistical analysis.

RESULTS

Data from 76 participants were analyzed. Fifty-four participants were female (71.1%). The mean age was 42.7 years (range from 21.8 to 62.7) at baseline. About 75% of the participants met the recommendations on minimal physical activity, both before the COVID-19 pandemic and during the lockdown. Weak statistical evidence for a decline in total physical activity in metabolic equivalent of task minutes per week (MET min/week) was found (estimate = -292, 95% CI from - ∞ to 74, p-value = 0.09), with no evidence for a decrease in the three types of activity: walking (estimate = -189, 95% CI from - ∞ to 100, p-value = 0.28), moderate-intensity activity (estimate = -200, 95% CI from - ∞ to 30, p-value = 0.22) and vigorous-intensity activity (estimate = 80, 95% CI from - ∞ to 460, p-value = 0.74). Across the three categories "high," "moderate," and "low" physical activity, 17% of the participants became less active during the lockdown while 29% became more active.

CONCLUSION

The COVID-19 pandemic did not result in a reduction in total physical activity levels among a sample of Swiss office workers during the first weeks of lockdown. Improved work-life balance and working times may have contributed to this finding.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, NCT04169646. Registered 15 November 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646.

A cluster-randomized trial of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion for office workers to manage neck pain - a secondary outcome analysis

Background

Neck pain is prevalent among office workers. This study evaluated the impact of an ergonomic and exercise training (EET) intervention and an ergonomic and health promotion (EHP) intervention on neck pain intensity among the All Workers and a subgroup of Neck Pain cases at baseline.

Methods

A 12-month cluster-randomized trial was conducted in 14 public and private organisations. Office workers aged ≥18 years working ≥30 h per week (n = 740) received an individualised workstation ergonomic intervention, followed by 1:1 allocation to the EET group (neck-specific exercise training), or the EHP group (health promotion) for 12 weeks. Neck pain intensity (scale: 0–9) was recorded at baseline, 12 weeks, and 12 months. Participants with data at these three time points were included for analysis (n = 367). Intervention group differences were analysed using generalized estimating equation models on an intention-to-treat basis and adjusted for potential confounders. Subgroup analysis was performed on neck cases reporting pain ≥3 at baseline (n = 96).

Results

The EET group demonstrated significantly greater reductions in neck pain intensity at 12 weeks compared to the EHP group for All Workers (EET: β = − 0.53 points 95% CI: − 0.84– − 0.22 [36%] and EHP: β = − 0.17 points 95% CI: − 0.47–0.13 [10.5%], p-value = 0.02) and the Neck Cases (EET: β = − 2.32 points 95% CI: − 3.09– − 1.56 [53%] and EHP: β = − 1.75 points 95% CI: − 2.35– − 1.16 [36%], p = 0.04). Reductions in pain intensity were not maintained at 12 months with no between-group differences observed in All Workers (EET: β = − 0.18, 95% CI: − 0.53–0.16 and EHP: β = − 0.14 points 95% CI: − 0.49–0.21, p = 0.53) or Neck Cases, although in both groups an overall reduction was found (EET: β = − 1.61 points 95% CI: − 2.36– − 0.89 and EHP: β = − 1.9 points 95% CI: − 2.59– − 1.20, p = 0.26).

Conclusion

EET was more effective than EHP in reducing neck pain intensity in All Workers and Neck Cases immediately following the intervention period (12 weeks) but not at 12 months, with changes at 12 weeks reaching clinically meaningful thresholds for the Neck Cases. Findings suggest the need for continuation of exercise to maintain benefits in the longer term.

Clinical trial registration

hACTRN12612001154897 Date of Registration: 31/10/2012.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-03945-y.

Individualised physical exercise training and enhanced protein intake in older citizens during municipality-based rehabilitation: protocol for a randomised controlled trial

INTRODUCTION

Successful rehabilitation of the growing number of older citizens receiving healthcare services can lead to preservation of functional independence and improvement in quality of life. Adequate intake of dietary protein and physical training are key factors in counteracting the age-related decline in strength performance and physical function. However, during rehabilitation, many older people/persons have insufficient protein intake, and difficulties in performing exercise training with sufficient intensity and volume. The primary aim of this trial is to investigate if individualised physical exercise training programmes combined with increased protein intake (IPET+P) can improve measures on all International Classification of Functioning, Disability and Health levels, such as strength, gait speed and health-related quality of life, when compared with care as usual in municipality-based rehabilitation alone (usual care, UC) or care as usual in combination with increased protein intake (UC+P). Further, the trial investigates whether UC+P will potentiate more significant improvements in outcome measures than UC.

METHODS AND ANALYSIS

The trial is a three-armed multicentre, block-randomised controlled trial consisting of a 12-week intervention period with a 1-year follow-up. Citizens above 65 years referred to rehabilitation in the municipality without restricting comorbidities are eligible. Participants are randomised to either a UC group, a UC group with protein supplementation receiving 27.5 g protein/day (UC+P), or an IPET+P supplementation of 27.5 g protein/day. The Short Musculoskeletal Function Assessment questionnaire is the primary outcome.

ETHICS AND DISSEMINATION

Approvals from The Ethics Committee in Region Zealand, Denmark (SJ-758), and the General Data Protection Regulation at the University of Southern Denmark, Odense (10.330) have been obtained.

TRIAL REGISTRATION NUMBER

NCT04091308.

Effect of non-sedation on physical function in survivors of critical illness - A substudy of the NONSEDA randomized trial

PURPOSE

Critical illness impairs physical function. The NONSEDA trial was a multicenter randomized trial, assessing non-sedation versus sedation during mechanical ventilation. The aim of this sub-study was to assess the effect of non-sedation on physical function.

METHODS

All patients from one NONSEDA trial site were included. At ICU discharge and three months thereafter, survivors were assessed for physical function.

RESULTS

205 patients were included, 118 survived to follow-up, 116 participated (98%).

PRIMARY OUTCOME

Three months after ICU-discharge, health-related quality of life (SF-36, physical component score) was similar (non-sedated 38.3 vs sedated 36.6, mean difference 1.7, 95% CI -1.7 to 5.1), as was function in activities of daily living (Barthel Index, non-sedated 19.5 vs sedated 18, median difference 1.5, 95% CI -0.2 to 3.2).

SECONDARY OUTCOMES

Non-sedated patients had a better Barthel Index at ICU-discharge (median 9 vs 4, median difference 5, 95% CI 2.5 to 7.5). At three months post-ICU discharge, the two groups did not differ regarding handgrip strength, walking distance, muscle size or biomechanical data.

CONCLUSION

Non-sedation did not lead to improved quality of life regarding physical function or better function in activities of everyday living. Non-sedated patients had a better physical recovery at ICU discharge.

TRIAL REGISTRATION

Clinicaltrials.govNCT02034942, registered January 14., 2014.

The Effect of Physical Exercise Training on Neck and Shoulder Muscle Function Among Military Helicopter Pilots and Crew: A Secondary Analysis of a Randomized Controlled Trial

Introduction: This study presents secondary outcome analyses, in terms of muscle function [i.e., maximal voluntary contraction (MVC) and rate of torque development (RTD)] from a parallel group, single blinded, randomized controlled trial introducing a physical exercise training intervention aiming to reduce neck pain among military helicopter pilots and crew-members. Methods: Participants (50 pilots, 58 crew-members) were recruited from the Royal Danish Air Force and randomized to either an exercise-training-group (ETG; n = 35) or a reference-group (REF; n = 34). Participants in ETG received 20 weeks of self-administered exercise training specifically tailored to target the neck and shoulder muscles. REF received no training. Outcome: (1) MVC was measured for cervical extension and flexion as well as shoulder elevation and abduction, (2) RTD was measured for cervical extension and flexion. Adherence to training was self-reported and categorized as regular if performed at least once a week. Results: MVC for cervical extension was significantly increased at follow-up in ETG (37.5 ± 11.2 Nm at baseline, change: 2.1 ± 8.3 Nm) compared to REF (38.1 ± 10.7 Nm at baseline, change: -2.4 ± 6.8 Nm) according to intension-to-treat analysis (p = 0.018). Likewise, RTD was significantly increased in ETG for cervical extension (149.6 ± 63.3 Nm/s at baseline, change: 14.7 ± 49.0 Nm/s) compared to REF (165.4 ± 84.7 Nm/s at baseline, change: -16.9±70.9 Nm/s) (p = 0.034). The cervical extension/flexion MVC-ratio was significantly different at follow-up (p = 0.039) between ETG (1.5 ± 0.5 at baseline, change: -0.0 ± 0.3) compared to REF (1.5 ± 0.5 at baseline, change: -0.2 ± 0.4). Per-protocol analysis of MVC, including only participants in ETG with regular training adherence (n = 10), showed a significant increase for cervical extension (33.2 ± 7.3 Nm at baseline, change: 6.0 ± 5.4 Nm) and shoulder elevation right side (143.0 ± 25.8 Nm at baseline, change: 15.8 ± 18.1 Nm). Conclusion: Physical exercise training significantly improved MVC and RTD in the upper neck extensors. Only approximately 1/3 of participants in ETG adhered to training regularly, which likely attenuated the effectiveness of the training intervention on neck and shoulder muscle function. Future studies should focus on the practical implementation of self-administered exercise training to improve adherence.

Process evaluation of a workplace-based health promotion and exercise cluster-randomised trial to increase productivity and reduce neck pain in office workers: a RE-AIM approach

BACKGROUND

This study uses the RE-AIM framework to provide a process evaluation of a workplace-based cluster randomised trial comparing an ergonomic plus exercise intervention to an ergonomic plus health promotion intervention; and to highlight variations across organisations; and consider the implications of the findings for intervention translation.

METHOD

This study applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) methodology to examine the interventions' implementation and to explore the extent to which differences between participating organisations contributed to the variations in findings. Qualitative and quantitative data collected from individual participants, research team observations and organisations were interrogated to report on the five RE-AIM domains.

RESULTS

Overall reach was 22.7% but varied across organisations (range 9 to 83%). Participants were generally representative of the recruitment pool though more females (n = 452 or 59%) were recruited than were in the pool (49%). Effectiveness measures (health-related productivity loss and neck pain) varied across all organisations, with no clear pattern emerging to indicate the source of the variation. Organisation-level adoption (66%) and staffing level adoption (91%) were high. The interventions were implemented with minimal protocol variations and high staffing consistency, but organisations varied in their provision of resources (e.g. training space, seniority of liaisons). Mean adherence of participants to the EET intervention was 56% during the intervention period, but varied from 41 to 71% across organisations. At 12 months, 15% of participants reported regular EET adherence. Overall mean (SD) adherence to EHP was 56% (29%) across organisations during the intervention period (range 28 to 77%), with 62% of participants reporting regular adherence at 12 months. No organisations continued the interventions after the follow-up period.

CONCLUSION

Although the study protocol was implemented with high consistency and fidelity, variations in four domains (reach, effectiveness, adoption and implementation) arose between the 14 participating organisations. These variations may be the source of mixed effectiveness across organisations. Factors known to increase the success of workplace interventions, such as strong management support, a visible commitment to employee wellbeing and participant engagement in intervention design should be considered and adequately measured for future interventions.

TRIAL REGISTRATION

ACTRN12612001154897; 29 October 2012.

An App-Delivered Self-Management Program for People With Low Back Pain: Protocol for the selfBACK Randomized Controlled Trial

Background

Low back pain (LBP) is prevalent across all social classes, in all age groups, and across industrialized and developing countries. From a global perspective, LBP is considered the leading cause of disability and negatively impacts everyday life and well-being. Self-management is a recommended first-line treatment, and mobile apps are a promising platform to support self-management of conditions like LBP. In the selfBACK project, we have developed a digital decision support system made available for the user via an app intended to support tailored self-management of nonspecific LBP.

Objective

The trial aims to evaluate the effectiveness of using the selfBACK app to support self-management in addition to usual care (intervention group) versus usual care only (control group) in people with nonspecific LBP.

Methods

This is a single-blinded, randomized controlled trial (RCT) with two parallel arms. The selfBACK app provides tailored self-management plans consisting of advice on physical activity, physical exercises, and educational content. Tailoring of plans is achieved by using case-based reasoning (CBR) methodology, which is a branch of artificial intelligence. The core of the CBR methodology is to use data about the current case (participant) along with knowledge about previous and similar cases to tailor the self-management plan to the current case. This enables a person-centered intervention based on what has and has not been successful in previous cases. Participants in the RCT are people with LBP who consulted a health care professional in primary care within the preceding 8 weeks. Participants are randomized to using the selfBACK app in addition to usual care versus usual care only. We aim to include a total of 350 participants (175 participants in each arm). Outcomes are collected at baseline, 6 weeks, and 3, 6, and 9 months. The primary end point is difference in pain-related disability between the intervention group and the control group assessed by the Roland-Morris Disability Questionnaire at 3 months.

Results

The trial opened for recruitment in February 2019. Data collection is expected to be complete by fall 2020, and the results for the primary outcome are expected to be published in fall 2020.

Conclusions

This RCT will provide insights regarding the benefits of supporting tailored self-management of LBP through an app available at times convenient for the user. If successful, the intervention has the potential to become a model for the provision of tailored self-management support to people with nonspecific LBP and inform future interventions for other painful musculoskeletal conditions.

Trial Registration

ClinicalTrial.gov NCT03798288; https://clinicaltrials.gov/ct2/show/NCT03798288

International Registered Report Identifier (IRRID)

DERR1-10.2196/14720

Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis

Background

At present, there is no consolidated evidence for workplace-based interventions for the prevention and reduction of neck pain in office workers.

Purpose

The purpose of this review was to investigate the effectiveness of workplace-based interventions for neck pain in office workers.

Data Sources

MEDLINE, PEDro, CINAHL, and CENTRAL were searched for trials published since inception and before May 31, 2016.

Study Selection

Randomized controlled trials (RCTs) were considered when they met the following criteria: population consisted of office workers, intervention(s) was performed at the workplace, outcome measures included neck and/or neck/shoulder pain intensity and incidence/prevalence, and comparator groups included no/other intervention.

Data Extraction

Data were extracted by 1 reviewer using predefined data fields and checked by a second reviewer. Risk of bias was assessed by 2 independent reviewers using the 2015 Cochrane Back and Neck Group guidelines. Evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system.

Data Synthesis

Twenty-seven RCTs were included. There was moderate-quality evidence that neck/shoulder strengthening exercises and general fitness training were effective in reducing neck pain in office workers who were symptomatic, although the effect size was larger for strengthening exercises. Greater effects were observed with greater participation in exercise. Ergonomic interventions were supported by low-quality evidence.

Limitations

Data could not be obtained from some studies for meta-analysis and assessment of risk of bias. Reporting bias might have been present because only studies in the English language were included.

Conclusions

Workplace-based strengthening exercises were effective in reducing neck pain in office workers who were symptomatic, and the effect size was larger when the exercises were targeted to the neck/shoulder. Future RCTs of ergonomic interventions targeted at office workers who are symptomatic are required. More research on neck pain prevention is warranted.

Effect of resistance training on headache symptoms in adults: Secondary analysis of a RCT

BACKGROUND

While strength training for the neck and shoulder muscles may be effective in reducing headache, the optimal combination of exercise frequency and duration is unknown. This study investigates the effect of different time-wise combinations of one weekly hour of strength training for the neck and shoulder muscles on headache frequency, intensity, and use of analgesics.

METHODS

A total of 573 office workers were randomly allocated at the cluster-level to five groups; 3 × 20 min a week of minimally supervised (3MS), 1 × 60 (1WS), 3 × 20 (3WS) or 9 × 7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without training (REF). Headache frequency, intensity, and use of analgesics in relation to headache were determined by questionnaire at baseline and follow-up.

RESULTS

The intention-to-treat analysis showed reduced headache frequency and intensity of approximately 50% in all training groups compared with REF at 20-week follow-up (P < 0.001). Use of analgesics was lower in the supervised training groups (1WS, 3WS and 9WS), but not in the group with minimal training supervision (3MS), compared with REF at follow-up.

CONCLUSION

One hour of specific strength training - regardless of the distribution during the week - effectively reduced both headache frequency and intensity in office workers. Thus, a large time-wise flexibility exists when implementing specific strength training at the workplace. However, only supervised training led to a reduction in use of analgesics for headache.

Physical Activity as Cause and Cure of Muscular Pain: Evidence of Underlying Mechanisms

Work-related physical activity (PA), in terms of peak loads and sustained and/or repetitive contractions, presents risk factors for the development of muscular pain and disorders. However, PA as a training tailored to the employee's work exposure, health, and physical capacity offers prevention and rehabilitation. We suggest the concept of "Intelligent Physical Exercise Training" relying on evidence-based sports science training principles.

Self-administered physical exercise training as treatment of neck and shoulder pain among military helicopter pilots and crew: a randomized controlled trial

Background

Neck pain is frequent among military helicopter pilots and crew-members, and pain may influence individual health and work performance. The aim of this study was to examine if an exercise intervention could reduce neck pain among helicopter pilots and crew-members.

Methods

Thirty-one pilots and thirty-eight crew-members were randomized to either an exercise-training-group (n = 35) or a reference-group (n = 34). The exercise-training-group received 20-weeks of specific neck/shoulder training. The reference-group received no training. Primary outcome: Intensity of neck pain previous 3-months (scale 0-10). Secondary outcomes: additional neck/shoulder pain intensity variables and pressure-pain-threshold in the trapezius muscle (TRA) and upper-neck-extensor muscles (UNE). Regular training adherence was defined as ≥1 training session a week. Statistical analyses performed were intention-to-treat and per-protocol. Students t-test was performed (p < 0.05).

Results

Intensity of neck pain previous 3-months at baseline was: 2.2 ± 1.8 and previous 7-days: 1.0 ± 1.5, and pressure-pain-threshold in TRA and UNE (right/left) was in kPa: 424 ± 187 / 434 ± 188 and 345 ± 157 / 371 ± 170 in the exercise-training-group, and 416 ± 177 / 405 ± 163 and 334 ± 147 / 335 ± 163 in the reference-group, with no differences between groups. Intention-to-treat-analysis revealed no significant between-group-differences in neck pain intensity and pressure-pain-threshold. Between-group-differences, including participants who trained regularly (n = 10) were also non-significant. Within-group-changes were significant among participants with regular training adherence in the exercise-training-group regarding intensity of neck pain previous 3-months (from 2.2 ± 0.6 to 1.3 ± 1.3, p = 0.019). Likewise, within the whole exercise-training-group, neck pain previous 7-days decreased (from 1.0 ± 1.4 to 0.6 ± 1.1, p = 0.024). Additional within-group-changes regarding pressure-pain-threshold in kPa were for the reference-group a reduction in TRA and UNE (right/left) to: 342 ± 143 / 332 ± 154 and 295 ± 116 / 292 ± 121 implying increased pain sensitivity, while for the exercise-training-group only a reduction in left TRA was seen: 311 ± 113.

Conclusions

The exercise intervention did not reduce neck pain among helicopter pilots and crew-members as no significant between-group-differences were found. However, some trends were demonstrated as some neck pain intensity and sensitivity improved more within the exercise-training-group but not within the reference-group. The lack of effect may be due to low adherence since only ~ 1/3 of subjects in the exercise-training-group engaged in regular training which may be due to the self-administration of the training.

Trial registrations

Ethical committee of Southern Denmark (S-20120121) 29 August, 2012. Clinical Trail Registration (NCT01926262) 16 August, 2013.

Neurocognitive performance and physical function do not change with physical-cognitive-mindfulness training in female laboratory technicians with chronic musculoskeletal pain: Randomized controlled trial

BACKGROUND

Cognitive and physical performance can be negatively affected by chronic pain. This study evaluates the effect of combined physical-, cognitive-, and mindfulness training (PCMT) on cognitive and physical performance.

METHODS

From a large pharmaceutical company in Denmark we randomly allocated 112 female laboratory technicians with chronic upper limb pain to group-based PCMT at the worksite or a reference group for 10 weeks. Neurocognitive performance was measured by the computerized central nervous system vital signs neurocognitive assessment battery. Physical function was assessed in terms of shoulder external rotation strength and rate of force development in a custom-made dynamometer setup.

RESULTS

No between-group differences (least square means [95% confidence interval]) from baseline to follow-up could be detected in any of the neurocognitive domains as measured by the central nervous system vital signs neurocognitive assessment battery, for example, Psychomotoer Speed 1.9 (-1.0 to 4.7), Reaction Time -4.0 (-19.5 to 11.6), Complex Attention -0.3 (-1.9 to 1.4), and Executive Function -0.2 (-3.5 to 3.0). Similarly, we found no change in maximal voluntary isometric strength -0.63 (-4.8 to 3.6), or rate of force development 14.8 (-12.6 to 42.2) of the shoulder external rotators. Finally, test-retest reliability of maximal voluntary contraction and rate of force development shoulder external rotation showed high reliability at 0 to 30 ms, 0 to 50 ms, 0 to 100 ms, and 0 to 200 ms with ICCs at 0.95, 0.92, 0.93, 0.92, and 0.91, respectively.

CONCLUSION

Ten weeks of PCMT did not improve neurocognitive or physical performance.

Background, design and conceptual model of the cluster randomized multiple-component workplace study: FRamed Intervention to Decrease Occupational Muscle pain - "FRIDOM"

Background

Several RCT studies have aimed to reduce either musculoskeletal disorders, sickness presenteeism, sickness absenteeism or a combination of these among females with high physical work demands. These studies have provided evidence that workplace health promotion (WHP) interventions are effective, but long-term effects are still uncertain. These studies either lack to succeed in maintaining intervention effects or lack to document if effects are maintained past a one-year period. This paper describes the background, design and conceptual model of the FRIDOM (FRamed Intervention to Decrease Occupational Muscle pain) WHP program among health care workers. A job group characterized by having high physical work demands, musculoskeletal disorders, high sickness presenteeism - and absenteeism.

Methods

FRIDOM aimed to reduce neck and shoulder pain. Secondary aims were to decrease sickness presenteeism, sickness absenteeism and lifestyle-diseases such as other musculoskeletal disorders as well as metabolic-, and cardiovascular disorders – and to maintain participation to regular physical exercise training, after a one year intervention period. The entire concept was tailored to a population of female health care workers. This was done through a multi-component intervention including 1) intelligent physical exercise training (IPET), dietary advice and weight loss (DAW) and cognitive behavioural training (CBT).

Discussion

The FRIDOM program has the potential to provide evidence-based knowledge of the pain reducing effect of a multi component WHP among a female group of employees with a high prevalence of musculoskeletal disorders and in a long term perspective evaluate the effects on sickness presenteeism and absenteeism as well as risk of life-style diseases.

Trial registration

NCT02843269, 06.27.2016 - retrospectively registered.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3758-6) contains supplementary material, which is available to authorized users.

Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial

People with chronic musculoskeletal pain often experience pain-related fear of movement and avoidance behavior. The Fear-Avoidance model proposes a possible mechanism at least partly explaining the development and maintenance of chronic pain. People who interpret pain during movement as being potentially harmful to the organism may initiate a vicious behavioral cycle by generating pain-related fear of movement accompanied by avoidance behavior and hyper-vigilance.This study investigates whether an individually adapted multifactorial approach comprised of biopsychosocial elements, with a focus on physical exercise, mindfulness, and education on pain and behavior, can decrease work-related fear-avoidance beliefs.As part of a large scale 10-week worksite randomized controlled intervention trial focusing on company initiatives to combat work-related musculoskeletal pain and stress, we evaluated fear-avoidance behavior in 112 female laboratory technicians with chronic neck, shoulder, upper back, lower back, elbow, and hand/wrist pain using the Fear-Avoidance Beliefs Questionnaire at baseline, before group allocation, and again at the post intervention follow-up 10 weeks later.A significant group by time interaction was observed (P < 0.05) for work-related fear-avoidance beliefs. The between-group difference at follow-up was -2.2 (-4.0 to -0.5), corresponding to a small to medium effect size (Cohen's d = 0.30).Our study shows that work-related, but not leisure time activity-related, fear-avoidance beliefs, as assessed by the Fear-avoidance Beliefs Questionnaire, can be significantly reduced by 10 weeks of physical-cognitive-mindfulness training in female laboratory technicians with chronic pain.

Exercise is more than medicine: The working age population's well-being and productivity

BACKGROUND

Physical activity (PA) includes muscle activity during exercise, manual work, and leisure time activities including sport. Conflicting results exist regarding health effects of PA that may deteriorate with manual work and elite sports, but improve when performed in moderation in accordance with international guidelines and may additionally enhance well-being and productivity.

METHODS

In Denmark 15 randomized controlled trials have been conducted, introducing exercise at the workplace enrolling >3500 workers. The interventions lasted from 10 to 52 weeks and offered ~1 h weekly supervised exercise during working hours according to the concept of intelligent physical exercise training (IPET) that is based on evidenced sports sciences training principles and tailored to work exposure, employee health status, and physical capacity. Questionnaire surveys and health checks including blood and muscle sampling were performed at baseline and follow-up. The job groups included: office and computer workers, dentists, industrial technicians, cleaning personnel, health care workers, construction workers, and fighter/helicopter pilots.

RESULTS

In all job groups significant improvements were documented regarding health outcomes. These were job group specific: neck pain was reduced among office and computer workers, dentists, industrial laboratory technicians, health care workers as well as fighter pilots. Cardio-respiratory fitness-a health risk indicator for cardio-metabolic diseases-was improved among office and computer workers, health care workers, and construction workers. Additionally, other improvements were evidenced such as increased muscle strength and balance control. Importantly, productivity increased with improved muscle strength and decreased body mass index.

CONCLUSION

IPET does enhance health if an exercise program with evidenced efficacy is implemented by expert trainees with support of the employer. Accordingly, in every study group outcomes of improved health were documented and the effect sizes were of clinical relevance. Cost effectiveness estimates indicate acceptable cost relative to savings on health expenses and lost productivity.

Occupational and leisure-time physical activity and workload among construction workers - a randomized control study

BACKGROUND

There is a lack of quantification of occupational physical activity (OPA) and leisure time physical activity (LTPA) among construction workers.

OBJECTIVES

To describe physical activity energy expenditure (PAEE), physical workload, and the effect of a PA-intervention among construction workers.

METHODS

Sixty-seven Construction workers self-reported their physical activity (PA), had PA assessed directly (PAEE), and observed OPA using the tool "Posture, Activity, Tools and Handling." The PA-intervention (Intervention; n = 29, Controls; n = 24) included 3x20-min training/week for 12 weeks.

RESULTS

Baseline median OPA was 5036 MET-min/week and LTPA 2842 MET-min/week, p < 0.01. OPA directly recorded was (mean ± SE): 56.6 ± 3.2 J/kg/min and LTPA was: 35.7 ± 2.2 J/kg/min (p < 0.001). Manual material handling was performed for ≥ 25% of working time by more than 50% of the participants. Post-intervention, the training group reduced overall PAEE compared to the control group but not specifically during work.

CONCLUSIONS

OPA was within the maximum recommended level of 1/3 proposed in consensus guidelines but did not decrease with PA-intervention.

Neck and shoulder muscle activity and posture among helicopter pilots and crew-members during military helicopter flight

Neck pain among helicopter pilots and crew-members is common. This study quantified the physical workload on neck and shoulder muscles using electromyography (EMG) measures during helicopter flight. Nine standardized sorties were performed, encompassing: cruising from location A to location B (AB) and performing search and rescue (SAR). SAR was performed with Night Vision Goggles (NVG), while AB was performed with (AB+NVG) and without NVG (AB-NVG). EMG was recorded for: trapezius (TRA), upper neck extensors (UNE), and sternocleido-mastoid (SCM). Maximal voluntary contractions (MVC) were performed for normalization of EMG (MVE). Neck posture of pilots and crew-members was monitored and pain intensity of neck, shoulder, and back was recorded. Mean muscle activity for UNE was ∼10% MVE and significantly higher than TRA and SCM, and SCM was significantly lower than TRA. There was no significant difference between AB-NVG and AB+NVG. Muscle activity in the UNE was significantly higher during SAR+NVG than AB-NVG. Sortie time (%) with non-neutral neck posture for SAR+NVG and AB-NVG was: 80.4%, 74.5% (flexed), 55.5%, 47.9% (rotated), 4.5%, 3.7% (lateral flexed). Neck pain intensity increased significantly from pre- (0.7±1.3) to post-sortie (1.6±1.9) for pilots (p=0.028). If sustained, UNE activity of ∼10% MVE is high, and implies a risk for neck disorders.

The Consequence of Combined Pain and Stress on Work Ability in Female Laboratory Technicians: A Cross-Sectional Study

Musculoskeletal pain and stress-related disorders are leading causes of impaired work ability, sickness absences and disability pensions. However, knowledge about the combined detrimental effect of pain and stress on work ability is lacking. This study investigates the association between pain in the neck-shoulders, perceived stress, and work ability. In a cross-sectional survey at a large pharmaceutical company in Denmark 473 female laboratory technicians replied to questions about stress (Perceived Stress Scale), musculoskeletal pain intensity (scale 0-10) of the neck and shoulders, and work ability (Work Ability Index). General linear models tested the association between variables. In the multi-adjusted model, stress (p < 0.001) and pain (p < 0.001) had independent main effects on the work ability index score, and there was no significant stress by pain interaction (p = 0.32). Work ability decreased gradually with both increased stress and pain. Workers with low stress and low pain had the highest Work Ability Index score (44.6 (95% CI 43.9-45.3)) and workers with high stress and high pain had the lowest score (32.7 (95% CI 30.6-34.9)). This cross-sectional study indicates that increased stress and musculoskeletal pain are independently associated with lower work ability in female laboratory technicians.

The August Krogh Institute: Capillaries and beyond

Bengt Saltin knew very well the history and work of the giants whose shoulders he was standing upon, such as August Krogh and Johannes Lindhard. He was basically a physiologist interested in physical activity and exercise, particularly in the cardiovascular and muscular responses. Some of his major original contributions were (a) the human muscle model in terms of the one-legged, knee extensor quantifying work by the high-precision Krogh ergometer and, using this, challenging Krogh's proposed autoregulation of capillary blood flow during exercise; (b) the electrolyte fluxes quantification on an intra- and extra-cellular level in human muscle during exercise to reveal such changes as possible fatigue mechanisms; and (c) the evidence presented that underlined the health-enhancing effect of physical exercise training from bedside to workplace.

Aerobic training alone or combined with strength training affects fitness in elderly: Randomized trial

PURPOSE

To investigate if combined strength and aerobic training can enhance aerobic capacity in the elderly to a similar extent as aerobic training alone when training duration is matched.

METHODS

Elderly men and women (age 63.2 ± 4.7) were randomized into two intervention groups: an aerobic group (AG, n = 17) and a combined group (CG, n = 16). Subjects trained 40 minutes three times a week for 12 weeks. Both groups trained 20 minutes at 65% of heart rate reserve on ergometer cycles followed by another 20 minutes on the ergometer cycles for AG and 20-minute strength training for the lower body for CG. The primary outcome was VO2max. Secondary outcomes were maximal voluntary contraction (MVC) in isometric knee extension, 1 repetition maximum in three leg exercises, body fat, waist-to-hip ratio, blood pressure and score on the Health Survey Short Form 36 (SF-36).

RESULTS

Both groups improved VO2max (p < .01) and MVC (p < .001). VO2max increased 17% confidence interval (CI) [7.4-26] in CG and 26% CI [14.1-38.2] in AG, with no significant difference between groups. MVC increased 22% CI [16.3-27.7] in CG and 9% CI [4.6-13.5] in AG with CG improving MVC more than AG (p < .01). CG's score on the general health dimension on the SF-36 health survey improved more than AG's score.

CONCLUSION

Elderly can substitute a part of their aerobic training with strength training and still improve VO2max to a clinically significant degree when strength training is performed with large muscle groups subsequently to the aerobic training. Combined training additionally improves strength and self-assessed general health more than aerobic training alone.

When Intervention Meets Organisation, a Qualitative Study of Motivation and Barriers to Physical Exercise at the Workplace

OBJECTIVE

To provide a comprehensive understanding of the motivational factors and barriers that are important for compliance with high-intensity workplace physical exercise that is aimed at reducing musculoskeletal disorders.

METHOD

The present study, which used semideductive, thematic, and structured in-depth interviews, was nested in a 20-week cluster randomised controlled trial among office workers. Interviews were conducted with 18 informants with diverse fields of sedentary office work who participated in strength training at the workplace for 20 minutes, three times per week. Organisational, implementational, and individual motives and barriers were explored.

RESULTS & DISCUSSION

The results show that attention should be given to the interaction between the management, the employees, and the intervention, as the main barrier to compliance was the internal working culture. The results emphasised the need for a clear connection between the management's implementational intentions and the actual implementation. The results emphasise the importance of ensuring the legitimacy of the intervention among managers, participants, and colleagues. Moreover, it is important to centrally organise, structure, and ensure flexibility in the working day to free time for participants to attend the intervention. Recommendations from this study suggest that a thorough intervention mapping process should be performed to analyse organisational and implementational factors before initiating workplace physical exercise training.

Specific exercise training for reducing neck and shoulder pain among military helicopter pilots and crew members: a randomized controlled trial protocol

BACKGROUND

Flight-related neck/shoulder pain is frequent among military helicopter pilots and crew members. With a lifetime prevalence of 81% for pilots and 84% for crew members, the prevalence of neck pain is considered high compared to the general population. The aim of this study was to investigate whether a specifically tailored exercise intervention would reduce the prevalence and incidence rate of neck/shoulder pain among helicopter pilots and crew members.

METHOD

This study used a prospective, parallel group, single blinded, randomized controlled design. Participants were military helicopter pilots and crew members recruited from the Royal Danish Air Force. Inclusion criteria were: 1) employed within the Royal Danish Air Force as a helicopter pilot or onboard crew member (technician, systems-operator, tactical helicopter observer and/or navigator), 2) maintaining operational flight status at enrollment, and 3) operational flying within the previous 6 months. Primary outcome was change in neck and shoulder pain assessed by 1) a modified version of the "Standardized Nordic questionnaire for the analysis of musculoskeletal symptoms" and by 2) pressure pain threshold measurements. Secondary outcomes included: postural balance, strength, stability, and rate of force development for neck and shoulder muscles. Measurements at baseline and follow-up were conducted at four air force bases in Denmark. Sixty-nine participants were individually randomized to either a training group (TG) or a reference group (RG). Participants in the TG performed 20-weeks of physical exercise training divided into sessions of 3 × 20 min per week. Training was completed within working hours and consisted of specific exercise training for the neck and shoulder muscles based on the principles of "Intelligent Physical Exercise Training". The RG received no training.

DISCUSSION

In spite of the high prevalence of flight related neck/shoulder pain among military helicopter pilots and crew members there are currently no evidence based guidelines for the prevention or clinical handling of neck pain among these occupational groups. Results from this study may therefore be beneficial for future establishment of such guidelines.

TRIAL REGISTRATION

Ethical committee of Southern Denmark (S-20120121) 29 August, 2012. Clinical Trail Registration (NCT01926262) 16 August, 2013.

Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation--effects on physical function: study protocol for a randomized controlled trial: a substudy of the NONSEDA trial

Background

Critically ill patients rapidly loose much of their muscle mass and strength. This can be attributed to prolonged admission, prolonged mechanical ventilation and increased mortality, and it can have a negative impact on the degree of independence and quality of life. In the NONSEDA trial we randomize critically ill patients to non-sedation or sedation with a daily wake-up trial during mechanical ventilation in the intensive care unit. It has never been assessed whether non-sedation affects physical function. The aim of this study is to assess the effects of non-sedation versus sedation with a daily wake-up trial on physical function after discharge from intensive care unit.

Methods/Design

Investigator-initiated, randomized, clinical, parallel-group, superiority trial, including 700 patients in total, with a substudy concerning 200 of these patients. Inclusion criteria will be intubated, mechanically ventilated patients with expected duration of mechanical ventilation >24 h. Exclusion criteria will be patients with severe head trauma, coma at admission or status epilepticus, patients treated with therapeutic hypothermia, patients with PaO₂/FiO₂<9 where sedation might be necessary to ensure sufficient oxygenation or placing the patient in a prone position. The experimental intervention will be non-sedation supplemented with pain management during mechanical ventilation. The control intervention will be sedation with a daily wake-up trial. The co-primary outcome will be quality of life regarding physical function (SF-36, physical component) and degree of independence in activities of daily living (Barthel Index), and this will be assessed for all 700 patients participating in the NONSEDA trial. The secondary outcomes, which will be assessed for the subpopulation of 200 NONSEDA patients in the trial site, Kolding, will be 6-min walking distance, handgrip strength, muscle size (ultrasonographic measurement of the rectus femoris muscle cross-sectional area) and biomechanical data on lower extremity function (maximal voluntary contraction, rate of force development and endurance).

Discussion

This study is the first to investigate the effect of no sedation during critical illness on physical function. If an effect is found, it will add important information on how to prevent muscle weakness following critical illness.

Trial registration

The study has been approved by the relevant scientific ethics committee and is registered at ClinicalTrials.gov (ID: NCT02034942, 9 January 2014).

Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain, stress and work ability among laboratory technicians: randomized controlled trial protocol

Background

Among laboratory technicians, the prevalence of neck and shoulder pain is widespread possibly due to typical daily work tasks such as pipetting, preparing vial samples for analysis, and data processing on a computer including mouse work - all tasks that require precision in motor control and may result in extended periods of time spent in static positions.

In populations characterized by intense chronic musculoskeletal pain and diagnosed conditions in conjunction with psycho-physiological symptoms such as stress-related pain and soreness and other disabling conditions, multifactorial approaches applying a combination of individually tailored physical and cognitive strategies targeting the areas most needed, may be an effective solution to the physical and mental health challenges.

The aim of this study is therefore to investigate the effect of an individually tailored biopsychosocial intervention strategy on musculoskeletal pain, stress and work disability in lab technicians with a history of musculoskeletal pain at a single worksite in Denmark.

Methods/design

In this single-blind two-armed parallel-group randomized controlled trial with allocation concealment, participants receive either an individualized multifactorial intervention or “usual care” for 10 weeks at the worksite. Inclusion criteria: 1) female laboratory technician (18-67 years of age) and 2) Pain intensity ≥ 3 (0-10 Visual Analogue Scale) lasting ≥3 months with a frequency of ≥ 3 days per week in one or more of the following regions: i) upper back i) low back iii) neck, iv) shoulder, v) elbow and/or vi) hand. Exclusion criteria: 1) life-threatening disease and 2) pregnancy. Stress, as measured by Cohen´s perceived stress questionnaire is not an inclusion criteria, thus participants can participate regardless of their stress level.

We will implement an individualized intervention addressing biopsychosocial elements of musculoskeletal pain with the following components; i) increasing physical capacity through strength- and motor control training; ii) lowering or preventing development of stress through mindfulness practice and learning de-catastrophizing pain management strategies through cognitive training.

The primary outcome at 10-week follow-up is the between-group difference in intensity of perceived musculoskeletal pain during the last week (average value of back, neck, shoulder, elbow and hand) assessed by questionnaire (modified visual analogue scale 0-10).

Discussion

This study will provide experimental evidence to guide workplace initiatives designed towards reducing chronic musculoskeletal pain and stress.

Trial registration number

ClinicalTrials.gov NCT02047669.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-444) contains supplementary material, which is available to authorized users.

A workplace exercise versus health promotion intervention to prevent and reduce the economic and personal burden of non-specific neck pain in office personnel: protocol of a cluster-randomised controlled trial

INTRODUCTION

Non-specific neck pain is a major burden to industry, yet the impact of introducing a workplace ergonomics and exercise intervention on work productivity and severity of neck pain in a population of office personnel is unknown.

RESEARCH QUESTION

Does a combined workplace-based best practice ergonomic and neck exercise program reduce productivity losses and risk of developing neck pain in asymptomatic workers, or decrease severity of neck pain in symptomatic workers, compared to a best practice ergonomic and general health promotion program?

DESIGN

Prospective cluster randomised controlled trial.

PARTICIPANTS AND SETTING

Office personnel aged over 18 years, and who work>30 hours/week.

INTERVENTION

Individualised best practice ergonomic intervention plus 3×20 minute weekly, progressive neck/shoulder girdle exercise group sessions for 12 weeks.

CONTROL

Individualised best practice ergonomic intervention plus 1-hour weekly health information sessions for 12 weeks.

MEASUREMENTS

Primary (productivity loss) and secondary (neck pain and disability, muscle performance, and quality of life) outcome measures will be collected using validated scales at baseline, immediate post-intervention and 12 months after commencement.

PROCEDURE

640 volunteering office personnel will be randomly allocated to either an intervention or control arm in work group clusters.

ANALYSIS

Analysis will be on an 'intent-to-treat' basis and per protocol. Multilevel, generalised linear models will be used to examine the effect of the intervention on reducing the productivity loss in dollar units (AUD), and severity of neck pain and disability.

DISCUSSION

The findings of this study will have a direct impact on policies that underpin the prevention and management of neck pain in office personnel.

Single motor unit firing behavior in the right trapezius muscle during rapid movement of right or left index finger

Background: Computer work is associated with low level sustained activity in the trapezius muscle that may cause development of trapezius myalgia. Such a low level activity may be attention related or alternatively, be part of a general multi joint motor program providing stabilization of the shoulder joint as a biomechanical prerequisite for precise finger manipulation. This study examines single motor unit (MU) firing pattern in the right trapezius muscle during fast movements of ipsilateral or contralateral index finger. A modulation of the MU firing rate would support the existence of a general multi joint motor program, while a generally increased and continuous firing rate would support the attention related muscle activation.

Method: Twelve healthy female subjects were seated at a computer work place with elbows and forearms supported. Ten double clicks (DC) were performed with right and left index finger on a computer mouse instrumented with a trigger. Surface electromyographic signals (EMG) was recorded from right and left trapezius muscle. Intramuscular EMG was recorded with a quadripolar wire electrode inserted into the right trapezius. Surface EMG was analyzed as RMS and presented as %MVE. The intramuscular EMG signals were decomposed into individual MU action potential trains using a computer algorithm based on signal shape recognition and manual editing. Instantaneous firing rate (IFR) was calculated as the inverse of each inter-spike interval (ISI). All ISI shorter than 20 ms were defined as doublets. For all MU IFR was spike triggered averaged across the 10 DC to show the modulation during DC as well as for calculation of the cross correlation coefficient (CCC).

Results: All subjects showed surface EMG activity in both right and left trapezius ranging from 1.8 %MVE to 2.5 %MVE. Regarding intramuscular EMG during right hand DC a total of 32 MUs were identified. Four subjects showed no MU activity. Four showed MU activity with low mean firing rate (MFR) with weak or no variations related to the timing of DC. Four subjects showed firing patterns with large modulation in IFR with a clear temporal relation to the DC. During left hand DC 15 MUs were identified in four subjects, for two of the subjects with IFR modulations clearly related to DC. During both ipsi- and contralateral DC, doublets occurred sporadically as well as related to DC

Conclusion: In conclusion, DC with ipsi- and contralateral fast movements of the index finger was found to evoke biomechanically as well as attention related activity pattern in the trapezius muscle. Doublets were for three of the subjects found as an integrated part of MU activation in the trapezius muscle and for one subject temporarily related to DC.

Algogenic substances and metabolic status in work-related Trapezius Myalgia: a multivariate explorative study

BACKGROUND

This study compares the levels of algesic substances between subjects with trapezius myalgia (TM) and healthy controls (CON) and explores the multivariate correlation pattern between these substances, pain, and metabolic status together with relative blood flow changes reported in our previous paper (Eur J Appl Physiol 108:657-669, 2010).

METHODS

43 female workers with (TM) and 19 females without (CON) trapezius myalgia were - using microdialysis - compared for differences in interstitial concentrations of interleukin-6 (IL-6), bradykinin (BKN), serotonin (5-HT), lactate dehydrogenas (LDH), substance P, and N-terminal propeptide of procollagen type I (PINP) in the trapezius muscle at rest and during repetitive/stressful work. These data were also used in multivariate analyses together with previously presented data (Eur J Appl Physiol 108:657-669, 2010): trapezius muscle blood flow, metabolite accumulation, oxygenation, and pain development and sensitivity.

RESULTS

Substance P was significantly elevated in TM (p=0.0068). No significant differences were found in the classical algesic substances (p: 0.432-0.926). The multivariate analysis showed that blood flow related variables, interstitial concentrations of metabolic (pyruvate), and algesic (BKN and K+) substances were important for the discrimination of the subjects to one of the two groups (R2: 0.19-0.31, p<0.05). Pain intensity was positively associated with levels of 5-HT and K+ and negatively associated with oxygenation indicators and IL-6 in TM (R2: 0.24, p<0.05). A negative correlation existed in TM between mechanical pain sensitivity of trapezius and BKN and IL-6 (R2: 0.26-0.39, p<0.05).

CONCLUSION

The present study increased understanding alterations in the myalgic muscle. When considering the system-wide aspects, increased concentrations of lactate, pyruvate and K+ and decreased oxygenation characterized TM compared to CON. There are three major possible explanations for this finding: the workers with pain had relatively low severity of myalgia, metabolic alterations preceded detectable alterations in levels of algesics, or peripheral sensitization and other muscle alterations existed in TM. Only SP of the investigated algesic substances was elevated in TM. Several of the algesics were of importance for the levels of pain intensity and mechanical pain sensitivity in TM. These results indicate peripheral contribution to maintenance of central nociceptive and pain mechanisms and may be important to consider when designing treatments.

Dose-response of strengthening exercise for treatment of severe neck pain in women

Specific strength training is shown to relieve neck pain in office workers. The purpose of this study is to evaluate the effectiveness of specific strength training in women with severe neck pain and to analyze the dose-response relationship between training adherence and pain reduction. One hundred eighteen untrained women with severe neck pain (>30 mm VAS pain) were included from a larger study, in which the subjects were randomized to 20-week specific strength training for the neck/shoulders or to a control group. In the intention-to-treat analysis, the training group experienced greater pain relief than the control group (p < 0.01). Participants who adhered "per protocol" decreased pain by 35 mm VAS (95% confidence interval: -26 to -44) from baseline to follow-up corresponding to a 70% reduction. In the dose-response analyses, participants with medium and high training adherence showed better pain relief than the control group and those with low adherence (p < 0.0001). The decrease from baseline in the medium and high adherence groups was 37 mm VAS (28-46 mm) and 33 mm VAS (24-43 mm), respectively. Specific strength training reduces pain intensity in women with severe neck pain, and 1-2 training sessions per week for 20 weeks (∼30 training sessions) seems sufficient for optimal pain relief.

A conceptual model for worksite intelligent physical exercise training--IPET--intervention for decreasing life style health risk indicators among employees: a randomized controlled trial

BACKGROUND

Health promotion at the work site in terms of physical activity has proven positive effects but optimization of relevant exercise training protocols and implementation for high adherence are still scanty.

METHODS/DESIGN

The aim of this paper is to present a study protocol with a conceptual model for planning the optimal individually tailored physical exercise training for each worker based on individual health check, existing guidelines and state of the art sports science training recommendations in the broad categories of cardiorespiratory fitness, muscle strength in specific body parts, and functional training including balance training. The hypotheses of this research are that individually tailored worksite-based intelligent physical exercise training, IPET, among workers with inactive job categories will: 1) Improve cardiorespiratory fitness and/or individual health risk indicators, 2) Improve muscle strength and decrease musculoskeletal disorders, 3) Succeed in regular adherence to worksite and leisure physical activity training, and 3) Reduce sickness absence and productivity losses (presenteeism) in office workers. The present RCT study enrolled almost 400 employees with sedentary jobs in the private as well as public sectors. The training interventions last 2 years with measures at baseline as well as one and two years follow-up.

DISCUSSION

If proven effective, the intelligent physical exercise training scheduled as well as the information for its practical implementation can provide meaningful scientifically based information for public health policy.

TRIAL REGISTRATION

ClinicalTrials.gov, number: NCT01366950.

Influence of self-efficacy on compliance to workplace exercise

Background

Continuous neck and shoulder pain is a common musculoskeletal complaint. Physical exercise can reduce pain symptoms, but compliance to exercise is a challenge. Exercise-specific self-efficacy has been found to be a predictor of participation in preplanned exercise. Little is known about the influence of exercise-specific self-efficacy on compliance to workplace physical exercise.

Purpose

To determine the influence of exercise-specific self-efficacy on compliance to specific strength exercises during working hours for laboratory technicians.

Methods

We performed a cluster-randomized controlled trial, including laboratory technicians from two industrial production units in Copenhagen, Denmark. The participants were randomized to supervised specific strength exercises for the neck and shoulder muscles for 20 minutes three times a week (n = 282) or to a reference group (n = 255). The participants answered baseline and follow-up questions regarding self-efficacy and registered all exercises in a diary.

Results

Overall compliance to exercises was 45 %. Compliance in company A (private sector) differed significantly between the three self-efficacy groups after 20 weeks. The odds ratio of compliance was 2.37 for moderate versus low self-efficacy, and 2.93 for high versus low self-efficacy. No significant difference was found in company B (public sector) or in the intervention group as a whole.

Conclusion

We did not find self-efficacy to be a general statistically significant predictor of compliance to exercises during 20 weeks, but found self-efficacy to be a predictor of compliance in a private sector setting. Workplace-specific differences might be present and should be taken into account.

Effect of scapular function training on chronic pain in the neck/shoulder region: a randomized controlled trial

PURPOSE

Neck and shoulder complaints are common among employees in occupations characterized by intensive computer use. Treatment has varied from passive rest to active treatments and active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach. The purpose of this study was in a randomised controlled trial to investigate if intensive scapular function training (SFT)-in terms of training of the lower trapezius and the serratus anterior muscle while minimizing direct training of the upper trapezius-is effective in reducing pain in adults with chronic non-specific pain in the neck/shoulder region.

METHODS

47 office workers with chronic non-specific pain in the neck/shoulder region were randomized to 10 weeks 3 × 20 min SFT with training supervision or to a control group. At baseline and at follow-up the participants were tested for maximum isometric shoulder strength by a blinded tester. Further, once a week participants reported pain intensity of the neck/shoulder during the previous week.

RESULTS

In intention-to-treat analysis neck- and shoulder pain decreased 2.0 (95 % CI 0.35; 3.64) in SFT compared with control group (p < 0.05). Pressure Pain Threshold (PPT) increased 129 kPa in the lower trapezius in SFT compared with the control group (p < 0.01). Shoulder elevation strength increased 7.7 kg in SFT compared with the control group (p < 0.01) with no change in shoulder protraction strength.

CONCLUSIONS

SFT reduces pain intensity and increases shoulder elevation strength in adults with chronic non-specific pain in the neck/shoulder region. The magnitude of improvement in pain intensity was clinically relevant.

Postural control and shoulder steadiness in F-16 pilots: a randomized controlled study

BACKGROUND

During maneuvering, fighter pilots experience loads of up to 50-70 kg on their necks. Neck disorders are common and have been linked to impairment in muscle control. We conducted an intervention study introducing targeted training for 24 wk that reduced neck pain. The current study reports the results of the secondary objective, which was to increase the understanding of possible mechanisms underlying such neck pain and its intervention-related relief.

METHODS

In a parallel, single-blinded, randomized controlled study, 55 F-16 pilots were evaluated at baseline and randomized to a control group (CG; N = 28) or training group (TG; N = 27). Postural control was tested in four different settings: Romberg with open and closed eyes, unilateral stance, and perturbation. Maximal voluntary contraction and force steadiness was measured for shoulder elevation.

RESULTS

At follow-up, there was a significant between-group difference in the Romberg test with closed eyes only (95% confidence ellipse area; CG: 761 +/- 311 mm2; TG: 650 +/- 405 mm2). Prior to randomization, there were no significant differences in postural control and steadiness between 30 pilots who experienced neck pain within the previous 3 mo and 25 pilots without such pain.

DISCUSSION

Impaired postural control and steadiness may only be quantifiable in individuals experiencing acute neck pain of certain intensity, and there may be a ceiling effect in the ability to improve these parameters. For individuals with highly developed physiological capacity, a battery of tests with more stringent demands should be considered, e.g., increased number of repetitions, prolonged duration of the tests, or testing with eyes closed.

Time-wise change in neck pain in response to rehabilitation with specific resistance training: implications for exercise prescription

PURPOSE

To determine the time-wise effect of specific resistance training on neck pain among industrial technicians with frequent neck pain symptoms.

METHODS

Secondary analysis of a parallel-group cluster randomized controlled trial of 20 weeks performed at two large industrial production units in Copenhagen, Denmark. Women with neck pain >30 mm VAS (N = 131) were included in the present analysis. The training group (N = 77) performed specific resistance training for the neck/shoulder muscles three times a week, and the control group (N = 54) received advice to stay active. Participants of both groups registered neck pain intensity (0-100 mm VAS) once a week.

RESULTS

Neck pain intensity was 55 mm (SD 23) at baseline. There was a significant group by time interaction for neck pain (F-value 2.61, P<0.001, DF = 19). Between-group differences in neck pain reached significance after 4 weeks (11 mm, 95% CI 2 to 20). The time-wise change in pain showed three phases; a rapid decrease in the training group compared with the control group during the initial 7 weeks, a slower decrease in pain during the following weeks (week 8-15), and a plateau during the last weeks (week 16-20). Adherence to training followed a two-phase pattern, i.e. weekly participation rate was between 70-86% during the initial 7 weeks, dropping towards 55-63% during the latter half of the training period.

CONCLUSION

Four weeks of specific resistance training reduced neck pain significantly, but 15 weeks is required to achieve maximal pain reduction. The time-wise change in pain followed a three-phase pattern with a rapid effect during the initial 7 weeks followed by a slower but still positive effect, and finally a plateau from week 15 and onwards. Decreased participation rate may explain the decreased efficacy during the latter phase of the intervention.

Implementation of specific strength training among industrial laboratory technicians: long-term effects on back, neck and upper extremity pain

BACKGROUND

Previous studies have shown positive effects of physical exercise at the workplace on musculoskeletal disorders. However, long-term adherence remains a challenge. The present study evaluates long-term adherence and effects of a workplace strength training intervention on back, neck and upper extremity pain among laboratory technicians.

METHODS

Cluster-randomized controlled trial involving 537 industrial laboratory technicians. Subjects were randomized at the cluster level to one of two groups: training group 1 (TG1, n = 282) performing supervised strength training from February to June 2009 (round one) or training group 2 (TG2, n = 255) performing supervised strength training from August to December 2009 (round two). The outcome measures were changes in self-reported pain intensity (0-9) in the back, neck and upper extremity as well as Disability of the Arm, Shoulder and Hand (DASH, 0-100).

RESULTS

Regular adherence, defined as at least one training session per week, was achieved by around 85% in both groups in the supervised training periods. In the intention-to-treat analyses there were significant group by time effects for pain in the neck, right shoulder, right hand and lower back and DASH-resulting in significant reductions in pain (mean 0.3 to 0.5) and DASH (mean 3.9) in the scheduled training group compared to the reference group. For TG1 there were no significant changes in pain in round two, i.e. they maintained the pain reduction achieved in round one. Subgroup analyses among those with severe pain (> = 3 on a scale of 0-9) showed a significant group by time effect for pain in the neck, right shoulder, upper back and lower back. For these subgroups the pain reduction in response to training ranged from 1.1 to 1.8.

CONCLUSIONS

Specific strength training at the workplace can lead to significant long-term reductions in spinal and upper extremity pain and DASH. The pain reductions achieved during the intensive training phase with supervision appears to be maintained a half year later.