Employees’ adherence to worksite physical activity programs: Profiles of compliers versus non-compliers

1 Introduction

Workplaces have been lately described as opportune settings to implement public health interventions that mainly advocate for active and healthy lifestyles. The World Health Organization and World Economic Forum have indeed defined workplaces has ideal sites to implement programs promoting health, particularly through physical activity and eating habits [1]. Employees spend a considerable part of their daily time at work and on-site physical activity facilities appear as a great way to encourage their engagement and practice while some of the main expressed barriers to physical activity are the lack of time and facilities proximity [2, 3]. Moreover, with the “tertiarisation” of our societies, most employees today spend most of their working hours seated in front of computers. In addition, according to the 2006 national nutrition and health survey (ENNS), 53% of adults aged 18 to 74 (59% of men and 48% of women) spend three hours or more per day (working days and holidays) in front of a screen (television or computer) outside of work hours [4]. Importantly, this proportion progresses with age in both men and women. This is particularly concerning since it has been clearly shown that both the total volume of sedentary time and its accrual in prolonged and uninterrupted bouts are associated with all-cause mortality [5] but also with increased risk for major non communicable diseases (type 2 diabetes, cardiovascular diseases, cancers) [6]. Employers are today encouraged to play a key role in the health and well-being of working-age adults [7], particularly since the promotion of physical activity among employees will not only generate health benefits, but also reduce health-related care costs [8] and improve productivity [9].

Many studies have been conducted, proposing in-site physical activity interventions and providing positive results on employees overall health indicators. Vivela and collaborators for instance showed that a 4-month worksite physical activity program improved body composition among employees [10]. Similarly, Genin et al. showed that a 5-month worksite physical activity intervention improved overall health parameters (sleep, pain, muscle strength, body composition, health perception…) among initially inactive tertiary workers, also underlying improvement for most of these indicators in initially already active employees [11].

2 Employees’ adhesion to physical activity programs

Although all the available evidences are in line with these two examples, collectively showing positive effects of such programs conducted within companies on employees’ health and wellbeing, the profiles and adherence rates of the employees engaged in such programs remain unconsidered. This is of particular importance since these programs have been mainly developed to favor physical practice among inactive individuals.

When considering some of the main studies in the field, dropout rates up to 50% can be observed. In a study conducted by Jakobsen et al. [12], tertiary employees exercised 5 times 10 minutes per week (high-intensity strength training using elastic bands and kettlebells during working hour) in addition to physical activity education (motivational coaching sessions) for 10 weeks, and the authors noticed 22% of dropout [12]. In 2009, Pedersen and collaborators obtained a 48% dropout rate during their 1-year study in which tertiary employees exercised 3 times a week (sessions lasting 20 minutes), alternating resistance and all-around physical exercises [13]. In a recent study from our research group in which tertiary employees were proposed to complete a 5-month on-site physical activity program (exercise facilities implemented within their companies) composed of 2 to 3 aerobic and resistance training sessions per week, 30% of the initially involved participants gave up before the end of the intervention [11]. Interestingly, our group has recently conducted two similar studies among public and private tertiary workers and our preliminary results indicate a dropout rate reaching 65% when the intervention lasts 10 months, with an intermediary dropout of 38% after the first 5 months [14]. Not only workplace exercise-based interventions suffer from a high degree of abandonment, motivation group strategies also report dropout rates up to 31% [15], 29% of dropout were observed in responses to walking and standing meetings [16] and about 25% of workers were found to give up interventions based on encouraging text messages only [17]. Unfortunately, none of these studies tried to identify the reasons beneath these high levels of abandonment. Such dropout rates are not be specific to workplace PA programs with many PA interventions also indicating high levels of abandons, this must however not be under-interpreted and underestimated as it might provide important insights to better understand potential adherence profiles (compliers vs non-compliers) and to better target workplace interventions.

3 Compliers vs non-compliers

Yet this adherence issue has been already underlined by some, studies have been so far trying to find incentives, mainly financial ones to increase their adherence rates [18] instead of identifying the core reasons responsible for the employees dropout. Indeed, while the profile of the participants who give up interventions is rarely discussed and considered, our last results seem to suggest that employees who abandon workplace physical activity programs are those who would need it the most, suggesting that such interventions might miss their primary targeted population.

From September 2016 to June 2017, our research group assessed the effect of a 10-month physical activity intervention proposed to initially physically active and inactive tertiary employees. Briefly (the protocol has been detailed elsewhere, [11]), 98 participants had to engage in 2 to 3 exercise sessions per week within their workplace, while overall health indicators (body composition, anthropometric values, physical fitness, quality of life, health perception, pain, sleep quality) were assessed before (T0), at mid-point (T1) and after (T2) the 10-month program. Our sample was composed of voluntary inactive individuals that did not reach the physical activity recommendations and active ones that were already regular members of their companies’ physical activity facilities (for at least 2 years). Taking into account the entire sample, 22% of the subjects dropped out before T1 and 47% before the end of the 10-month intervention. While these statistics seem in line with the previously cited literature, it appears interesting to give a deeper look at the profile of the non-compliant participants, to better understand their high rates of withdrawal. Our retrospective analysis showed a higher dropout rate at T1 among initially inactive individuals (27%) versus the active ones (20%). This is even more pronounced at T2 where initially inactive employees showed a dropout rate of 64% from T1 and 77% from T0 against 19% and 35% among active ones respectively.

Non-compliers were also found to have higher initial body weight, body mass index, and lower fat free mass than compliers. The percentage of fat mass was significantly higher among participants giving up prematurely (26.4±7.7%) compared with those who completed the whole program (24.2±7.5%) (p < 0.05). Other physical fitness indicators were also found higher at T0 among compliant participants compared with those who gave up. These data seem to suggest that the initial fitness profile of employees should be considered when implementing such physical activity interventions. Moreover, they also suggest that such interventions (personalized, supervised, combining endurance and strength training) might not be adapted to individuals who might need it the most, those with the lowest physicalfitness.

Importantly, we also observed that the short-term (first months) degree of success of such in-site physical activity programs might determine the rate of adherence. Indeed, our preliminary data indicate that the improvement of body composition, perceived effort induced by exercise or aerobic fitness during the first phase of the intervention might influence the adherence of tertiary employees to the remaining months of the program. For instance, we found better improvement of the heart rate response to exercise (p < 0.05), the post-exercise heart rate recovery (p < 0.01) and fat mass percentage (p < 0.05) after the first 5 months in those who did not drop out between T1 and T2 compared to those who did. This result is original and suggests that not only the initial health and fitness profile of the participants will determine their adhesion rate, but also the efficiency of the first months of an intervention to induce positive changes (Fig. 1).

Beyond these scientific statistics and considerations, the main advance reason expressed by participants for engaging in worksite-based physical activity programs is the gain of time. Indeed, most of the employees who assiduously engage in such programs admit to be already active and that these on-site facilities represent a great opportunity to gain some time outside work (by training for instance during lunch time). They most of the time confess that they would be active anyway and only few of them start being active thanks to these facilities and programs proposed within companies (on going internal survey).

Obviously these preliminary data have to be considered with caution and some larger analysis should be conducted such as systematic reviews and meta-analysis to better understand and identify the potential predictive indicators for tertiary employees’ adhesion to on-site physical activity programs. This seems particularly important since these first insights suggest that while public health policies and strategies have been advocating workplaces as opportune settings to promote higher physical activity level among employees, such interventions might not favor the adhesion of the employees needed it the most, in other words those presenting lower health-related fitness and low physical activity levels. Companies’ health and wellbeing strategies should consider adding individualized approaches based on their employees’ profiles to their classical physical activity facilities.

Conflict of interest

None to report.