Abstract
Increased sedentary behavior and reduced physical activity are risk factors for morbidity and mortality. As adults spend a significant portion of their time at work where the default is to spend the majority of the day sitting, shifting workplace norms to decrease sedentary time and increase active time could have a public health impact. Workplaces offer a unique setting for multi-level interventions that can reach diverse populations. Traditional worksite wellness initiatives have produced equivocal results in terms of increasing physical activity. One reason for this may be the focus on corporate-fitness type programs and health education with little change in workplace culture. More innovative approaches combining theory-based worksite wellness components with behavioral economics approaches promoting incidental physical activity at the workplace to make activity the default may be necessary. This article discusses strategies to shift the workplace paradigm from being sedentary to more active using a range of approaches.
Introduction
Workplaces show promise for implementation of behavior change interventions focused on increasing physical activity (PA) and reducing sedentary time as they provide an existing structure for social support, behavioral incentives, policy and environmental changes. Many workplaces act as a community with their own cultural norms, values, and expectations. As many workplaces have shifted from a traditional 8-hour workday to a longer or more variable workday structure, the role of workplace interventions may be even more important. Findings regarding the efficacy of workplace wellness programs are equivocal with a some studies demonstrating no effects [1] and others showing small positive effects on PA [1, 2], body weight, cholesterol and cardiovascular disease risks [3]. However, interpretation of these findings may be limited by wide variation in study design, insufficient long-term follow-up, low recruitment and compliance numbers, and lack of well-designed, theoretically grounded interventions. Additionally, these programs tend to be more costly than usual care at time of delivery [3], adding further barriers to widespread dissemination and implementation. Despite these limitations, preliminary evidence indicates that workplace wellness programs may result in reductions in medical spending over time [4] and healthcare and absenteeism costs [5], with a reduction of approximately $3 for every $1 spent on the program [5]. Additionally, a recent systematic review suggests workplace wellness programs may also reduce presenteeism, the circumstance of being at work but limited in performance due to a health concern [6]. Thus, more rigorous research is needed to understand the benefits of worksite wellness programs and develop evidence-based recommendations for worksite wellness programs.
Despite current limitations, evidence indicates that worksite wellness programs are more likely to be successful and produce sustained behavior changes when they incorporate environmental, policy, and programmatic changes to facilitate a shift in workplace norms [7]. Workplace environments and cultural norms may be a major barrier to movement as sedentary behavior (i.e., sitting behind a desk at a computer) is the typical default [8]. Given how engrained sedentary behavior is in most workplace cultures, making a more active choice often requires effort and planning [9]. Over the course of a single workday, individuals make dozens of behavioral decisions, which are highly dependent on context. Choices and preferences in such circumstances are often determined by rapid, automatic processes that guide an individual toward the easiest or most convenient options, as opposed to eliciting thoughtful, deliberate decision-making concerning various alternatives [10]. Behavioral economics is based on the foundation that societal changes are more effective and efficient than small individual ones [10], and behavioral economic approaches highlight the pull of default options and the role of context in decision-making. PA promotion approaches consistent with behavioral economics include changing social norms which influence PA [11]; framing PA messages differently [10]; and, creating PA habits through a variety of methods, such as using incentives [10]. Thus, adding these types of approaches to more traditional ones to promote PA may substantially increase workplace PA program effectiveness [12].
Ultimately, the goal is to achieve a workplace where the easy choice and the healthy choice are one and the same. Achieving this ideal requires changes at multiple levels, innovative approaches andcollaboration and engagement of multiple stakeholders including employees, management, architects, office furniture companies, researchers, and public health professionals. In this paper, we suggest a variety of programmatic, policy and environmental modifications that could be implemented to change the sedentary default of most workplaces and establish optimal “active working” environments for employees. It is important to acknowledge that the goal of these recommendations is not for employees to meet public health guidelines for PA but rather increase daily activities in an effort to reduce sedentary time. The aim of this paper is to provide practitioners with a series of short- and long-term active alternatives to the inactive workplace default. Additionally, this paper offers researchers with potential research questions to address the efficacy of these active alternatives. Finally, this paper will provide practitioners with innovative approaches for implementing workplace physical activity programs.
Approaches for changing workplace social norms
The inactive defaults in many workplaces include spending long hours sitting in front of computers, sitting for meetings and lunches, sending emails to communicate with co-workers, using elevators as the mode of transportation to different floors, and driving to and from work. Table 1 presents ideas for modifying or replacing these default sedentary work-related activities with more active alternatives. We recognize that creating an ideal workplace in which active choices are the social norm is a long-term process; some large policy and environmental changes may be dependent upon financial resources that are not readily available. Thus, we propose both more immediate changes that may be realistic for most organizations to implement in the short term, and long-term changes that could be implemented over time to move workplaces closer to the active “default.” We propose a range of policy, environmental and programmatic ideas that have been identified in practice and research, but acknowledge that these recommendations may not be feasible for all worksites, employers, and locations. As not all of these strategies are evidence-based, we identify additional areas where more research is needed.
The ultimate goal of these recommendations is to a) make engaging in PA in the workplace less effortful and more automatic; b) increase the reach, relevance, and effectiveness of workplace PA promotion programs; and c) create sustainable programs with immediate, salient benefits for the workforce.
Policy changes
Workplace policy changes provide the opportunity to enact change on a large scale and reach entire populations, including underserved communities and individuals less likely to engage in available health programs [13]. Through subtle, yet significant, changes in policy, organizations can facilitate widespread shifts in social norms and conditions that promote employee activity and well-being. For example, workplace administration and leaders could establish workplace standards that default to active options and lead to a range of programs and structural changes (e.g., movement-friendly dress codes, breaks to facilitate interruptions of sedentary behavior across the workday). As such, activity becomes a valued part of the workplace as opposed to a distraction from productivity and professionalism. Such activities need to be flexible and forward thinking enough to accommodate a wide range of physical capacities.
Environmental changes
In many cases, modifying the workplace environment may be necessary to make the healthy choice theeasy choice. In many workplaces, elevators are found in a central, convenient location, whereas staircases are in remote corners of the building. Not surprisingly, taking the elevator becomes the norm for mostemployees [14]. When new workplaces are constructed, consideration should be given to making stairs the prominent choice. As the majority of employers are not designing new buildings, changes must be compatible with the current infrastructure. In these cases, one recommendation, when reasonable, is to limit elevator usage to authorized individuals (e.g., individuals with mobility disabilities), thus making remote staircases the more convenient option [15]. Stairwells could be painted or decorated to make them more inviting. For workplaces with limited budgets or time frames for initiating changes, posting visible signage throughout the building directing employees to available staircases may be beneficial [16].
Outdoor spaces surrounding workplaces are another potential consideration in promoting more active lifestyles Research indicates individuals will be more likely to take brief walks outside if paths and sidewalks are accessible, safe, and aesthetically pleasing [17, 18] and lead to attractive destinations (i.e. restaurants, shops). Thus, proximity to, and maintenance of, such sidewalks and paths may increase the likelihood employees will walk outside [19]. Even workplaces without a large amount of external green space could make small changes, such as developing a small employee community garden for promotion of healthful eating and incremental PA.
Finally, access to on-site resources may make it easier for employees to integrate PA into extended workdays. Examples include on-site fitness facilities with early morning/late evening hours, showers, changing rooms, and family-friendly areas at a larger scale [20] or active workstations (e.g., sit/stand workstations, treadmill desks, accessible exercise equipment such as fit balls, hand weights), and posters of exercises that can be completed in small spaces with minimal equipment [21, 22].
Programmatic changes
In addition to environmental and policy changes, workplaces may benefit from complementary programming that facilitates increased PA during working and non-working hours and supports an active workplace culture. More traditional programmatic approaches that may help to increase PA include onsite exercise classes offered before and/or after work and/or during lunchtime; employee or wellness team-led PA groups (e.g., running, walking, biking or active commuting groups); team PA challenges (e.g., steps or minutes of activity competitions) that incentivize groups of employees to compete against one another to achieve higherlevels of PA; onsite PA events (e.g., 5K run/walk, fitness exposition); and providing incentives for active transportation to/from work.
Other types of programs supporting a more active workplace culture include automated prompts to encourage employees to get up and move (e.g., screen saver or message every 60 to 90 minutes providing ideas for 5 minutes of activities) and encouraging and incentivizing walking meetings and utilization of active work stations (e.g., treadmill or bike desks). To further encourage participation in these programs, workplaces could provide activity monitors ranging from simple step-counting pedometers to more complex monitors that assess activity, sleep, biomarkers, etc. (e.g., FitBits, BodyMedia armbands) to employees for free or at reduced rates.
Success and sustainability
Table 2 details innovative approaches for implementing workplace interventions that may help increase their success and sustainability. Specifically, it is important that workplace programs a) are developed with all relevant stakeholders present including management at multiple levels, employees, and relevant human resources and wellness program staff [23]; b) include measurable components that are linked to outcomes of importance to the workplace (e.g., cost savings, work satisfaction, productivity, reduced absenteeism and presenteeism); c) are overseen by a standing committee of relevant stakeholders that regularly evaluates program success, makes necessary modifications, and generates new ideas; and d) have a presence in the physical workplace and online, particularly for workplaces with flexible work schedules where many employees may telework. Finally, participation in these programs may be further facilitated by monetary incentives or reimbursements for participation in activities that take place on- or off-site (e.g., regular use of fitness classes, active commuting) [24]. Finally, it is important for top and middle management to serve as role models and decision makers with respect to promoting worksite wellness programs.
Tables 1 and 2 provides multi-faceted solutions to shift the sedentary workplace default to a more active one. While companies may pay exorbitant fees for wellness services, it is our intention that these tables provide a range of activities that could be customized to most workplaces to help reduce sedentary behavior. In an effort to bridge the gap between research and practice and provide more rigorous evidence for worksite wellness programs, it is recommended that worksites connect with health promotion and evaluation scientists at local universities to provide technical assistance in developing, implementing, and evaluating these programs. Enhanced evaluation of these initiatives could help to identify most promising practices and provide needed data on short and long-term ROI and sustainability.
Limitations and future directions
It is important to recognize that although the negative health effects of sitting have been increasingly well documented, the evidence to support optimal ways to reduce sitting time during the workday is currently limited. Furthermore, the unintended “side effects” of prolonged standing and/or light activity have not been adequately investigated; it is possible that long bouts of standing could elicit musculoskeletal problems or other ailments for some employees. Thus, the recommendations included in this article should be considered in light of these limitations. Despite these caveats, it is not too soon for worksites to begin implementing small changes that foster a culture of activity and wellness for their employees. This article has discussed a broad range of possible solutions to assist worksites in selecting the strategies they deem most beneficial based on their current resources and priorities. Additionally, we believe one of the strengths of this article is the compilation of these innovative strategies, which have been drawn from the literature, into one paper, which can be used by practitioners and researchers alike to advance the field of worksite-based wellness.
Future research is needed to identify which strategies are most feasible and effective. Some strategies may provide a more favorable cost-to-benefit ratio, and thus prove to be the wisest investment for employers. Researchers and practitioners implementing interventions should conduct detailed evaluations of the reach and effectiveness of individual program components to accelerate the development of evidence-based guidelines.
Conclusion
Although the health benefits of PA are widely known and recognized, only about 20% of Americans meet both aerobic and muscle-strengthening PA and public health guidelines [25]. Because a majority of American adults spend a significant portion of their waking hours working, employers can play an integral role in maintaining and improving employees’ PA, health, and vitality. Through the use of behavioral economics and similar theoretical perspectives, employers have the potential to shift social norms so that active options are the default, preferred options and provide incentives to encourage PA.
Connecting research and practice may provide evidence-based recommendations that allow employers to prioritize employee health and well-being, consequently creating a culture more conducive to wellness. Although there may be significant initial costs to develop, implement, and evaluate some of these recommendations, many are relatively low-cost. Regardless, costs associated with these worksite PA program could be viewed by employers as an investment in their company.
Significant public health benefits may be achieved by starting small and trying a variety of activities to ensure opportunities are provided to all employees. Finding solutions that best fit each unique employer will take time. Continual evaluation is needed to understand which of these recommendations impact relevant important outcomes and may be most beneficial for each worksite’s specific needs and outcomes. Receiving employee feedback in planning and implementation will benefit the progress of any wellness initiative and a demonstration of long-term commitment on the part of workplace leadership is important to ensure a change in worksite culture and norms.
Work, home-life, and health are all inextricably interconnected. In an era when these boundariescontinue to blur, employers have the opportunity to play a central role in improving the health, productivity, and wellness for all employees.
Conflict of interest
The authors have no conflict of interest to report.