Is workplace an appropriate setting for the promotion of physical activity? A new framework for worksite interventions among employees

1. Introduction

For the last century, our civilization has clearly experienced a shift from active living and healthy eating behaviors to a sedentary lifestyle and a raise of the availability and consumption of energy dense and rich food. There is indeed a clear decline in the general population’s physical activity level that is accompanied by an impressive and exponential progression of the time devoted to sedentary behaviors [1]. Workplaces are important actors regarding the evolution of work itself that has favored both reduced physical activity needs through continuous automation of human tasks and the increased in sedentary time due to its “tertiarisation” leading to a considerable time per day spent sitting and/or in front of a screen. Some data from the US indeed showed a 20% increase of sedentary professions between 1960 and 2008 that was accompanied by a concomitant decline of more “physically active professions” [2]. French working adults have been shown to spend about 10 h a day sitting on workdays and about 7.6 hours per day on non-working days, with a clear association between the time spent sedentary at work and outside work [3].

2. Workplace: Adapted setting for physical activity intervention?

Although the evolution of human occupational tasks has then been encouraging this shift from an active lifestyle to a more sedentary way of life, workplaces have also been suggested as a new strategic opportunity to promote physical activity [4]. Worksites could indeed lift some of the barriers that have been identified to limit the engagement into physical activity, such as the lack of time and proximity [4]. Since it has been shown highly difficult to change individuals’ habits and to make people engage in physical exercise on usual settings (such as associations, gymnasiums, etc.), work-based strategies might provide a great way to incite employees to increase their activity, especially due to the time people spend on their workplace [5]. Importantly, increasing employees’ physical activity level and reducing their sedentary time will not only have beneficial impact on their individual health but will concomitantly reduce health care costs [6] and sick leaves due to diseases or wounds [7, 8] while favoring an increased productivity [9, 10].

Several studies have been conducted for the last two decades, trying to evaluate the beneficial effects of worksite interventions, from educative and informative strategies [11, 12], motivational challenges and incentives [13, 14] to onsite implemented physical activity settings and programs [15–17]. Although there is a growing body of literature, strong conclusions remain difficult to draw. Indeed, as reviewed in American Journal of Preventive Medicine by Dishman et al. and more recently by Johnson and collaborators (2018), studies that have been conducted so far in this area suffer from many scientific limitations and from an important methodological heterogeneity [18, 19]. Recently, Johnson and colleagues proposed the first scoping review synthetizing findings from both existing systematic reviews and original articles [19]. Based on their analysis, the authors pointed out the lack of high scientific quality of the available studies, the large diversity of the measured outcomes and the lack of validity or accuracy of the selected measurement tools, as well as a lack of robust statistical approaches [20, 21]. According to their conclusion, there is today a clear difficulty regarding the comparability of the available studies, a high attrition rate as well as a lack of proven sustainability [21, 22].

In line with these reviews and conclusions, some recent original studies have been conducted trying to both evaluate the efficacy of worksite physical activity interventions, not only on specific outcomes but on overall health indicators among tertiary employees, and to identify individual and environmental factors conditioning their efficacy and explaining such high attrition rates [23–25]. Mainly, these studies point out the need for more individualized approaches highlighting for instance the necessity to consider the worker’s initial profile in terms of physical fitness and physical activity level, that will determine his implication within the program and his adherence [25]. Importantly, it seems that such worksite programs might be mainly used by people that are already active as a supplementary option or alternative to maintain their physical activity level, while inactive individual do not seem to get involved into such interventions, at least in a durable way (less than three months) [25]. Similarly, personalized and regular evaluations of the worker’s progress will be of main importance since drop-outers have been identified as people experiencing low short-term benefits from the program [25]. Importantly, these recent findings also clearly point out the crucial necessity to implement physical activity interventions conjointly with strategies that will limit and reduce sedentary time. Indeed, it appears that the large amount of sedentary time (specifically sitting time and screen time) imposed by tertiary occupational tasks might limit the beneficial effect of on-site physical activity interventions on several health indicators [26]. This is clearly in line with the findings from Ekelund and collaborators showing that about 1 h and 15 minutes of moderate exercise per day would be necessary to compensate for seven hours of daily sitting, exercise duration that is increased when this sitting time is association with screen time [27]. Such exercise durations being far above recommendations for health, making it almost unrealistic for most people.

Although available evidences support the beneficial effects of worksite physical activity interventions, recent data clearly indicate that they should be better designed to reach a larger audience, especially individuals who need it the most (inactive people presenting low level of physical fitness and high time spent in sedentary behaviors), individualized, targeting overall health and not only isolated outcomes, and most of all combined with other approaches fighting sedentary time. In 2009, Anderson and colleagues proposed a first analytic model identifying the main dimensions and levers that could be used to implement worksite physical activity and nutritional interventions for workers [28] (Fig. 1). Importantly, their model was designed to target body size and body composition as the main outcome, while it is clear now that such interventions must favor overall health improvements.

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Fig.1

Analytic model for worksite physical activity and interventions to improve weight status (adapted from Anderson et al., 2009).

Based on this first model proposed by Anderson et al. and considering the recent literature, we propose here an updated framework for the implementation of worksite physical activity interventions aiming at improving overall health among tertiary employees (Fig. 2).

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Fig.2

Updated framework for the promotion and implementation of worksite physical activity on overall health in tertiary employees. HRQL: Health-related quality of life.

Mainly, this updated model underlines the need for joint interventions that combine physical activity programs and sedentary time-reduction strategies, not only based on the worksite environment but also considering the employees’ profile and the core nature of their tasks. Importantly, this new framework highlights the need for an “active culture” inside the company, not only in regards to the workers but also involving and maybe encouraged by employers and managers. Basically, this model points out the importance of behavior changes to favor adhesion in order to, in fine, induce overall health benefits for the individuals, which will ultimately improve productivity and reduce sick leaves.

Although this new model tends to propose an updated framework for the implementation of workplace physical activity programs, it also calls for more researches combining both higher physical activity and lower sedentary strategies. Importantly, it should also lead us to enlarge our reflection to identify all the potential mechanisms that are specific to the working environment and that could empower health-related strategies and interventions. This is to us where health-related physical activity strategies should combine with and benefit from ergonomics approaches (and reciprocally).

Indeed, health-focused approaches should not only introduce new healthy behaviors and alternatives, it should also consider the core nature and definition of “the work-task”, its requirement, the structural, organizational and human configuration of the workplace. In other words, there is actually a need to (re)introduce punctual physical “activity alternatives” [29] whose sustained efficacy has been shown reduced [23, 24], and to engage into a deeper reflection fundamentally reconsidering the work itself in an integrated way, as proposed by ergonomists in professional risk prevention approaches [30].

Indeed, sedentary behaviors that are the consequence of the “tertiarisation” of work must be considered as occupational risks [31]. Similarly to some industrial manual tasks physically demanding and/or not adapted to human motion, the seated and low-energy demanding nature of tertiary activities should indeed be considered as a main work-induced health-risk, and should, as such, be integrated in preventive strategies for professional risks. As stated by Beaujouan et al., these preventive strategies (related to work-induced risks) have to be part of the “work-task” definition itself to create effective, long term and sustained actions that do not alter the realization of the task by employees, which could potentially lead to adverse results [32]. Combining an ergonomic approach to the usual physical activity and sedentary behaviors interventions will require a high level of understanding of the work-task itself (from a human and operational perspective), its demands, organization and expected performances, its specific environment, but also the related decisional network including collaborators, managers and peers whose implication and involvement are crucial for the realization of the task itself but also and maybe mainly for the efficacy and success of the whole process [33]. As an example, Wilkerson et al. recently obtained a relationship between the efficacy of intervention tending to increase employees standing time at work and workplace-related factors such as specific social norms, local and overall connectivity, proximity of coworkers, regulative strategies or perceived behavioral and hierarchical control [34]. Ergonomics, as a science interested in “human work”, can add to our usual physical interventions such understanding and knowledge, proposing here an innovative approach that could help avoid or reduce the limitations and barriers actually pointed out by the literature [19, 24].

This combined approach seems to find its legitimacy when it comes to the analysis of the high level of attrition lately proposed by Genin et al. (2018). Indeed, in their paper, the authors point out the lack of adequation between the expected efficacy of worksite based physical activity programs and the observed results and adhesion rate [25]. From an ergonomic point of view, while most of the structured physical activity interventions implemented within companies have been elaborated in regards to the usually expressed barriers to physical activity (as detailed above), they seem to lack from a deeper consideration of the coupling between the characteristics of the workers, the work-task itself, the means of work and the program implemented, which could explain their low level of success. The ergonomics and anthropology of human practices have developed conceptual models, reflexive and operational approaches that can help us consider the intrinsic sensitivity and sensibility of workers that could help improve their implication and adhesion, on top of the physiological and physical dimensions [35–38]. This has been nicely illustrated recently by Seaton et al. who clearly underlined the important role of employees’ emotional outlook and positive emotion (positively related to ego-resilience) in their engagement into worksite health-related interventions, highlighting here the need to mobilize the employees human resources to empower these interventions [39]. The implementation of physical activity interventions and/or sedentary-reduction actions among employees, within their worksite, should then not only consider the operational feasibility of such interventions but also their coherence and compatibility with the working environment, structuration, functioning as well as the workers and the way they live and experience their work. With this preoccupation, it is no longer only a question of evaluating the effects produced by the intervention but the interventional process as a whole, its determinants and the entire effects produced (desired and unexpected). In fact, evaluating worksite interventions requires the use of other frameworks, more systemic, multifactorial and that consider the entire process [40, 41].

4. Conclusion

This Sounding Board paper proposes then a new framework that could be used when elaborating, implementing and evaluating worksite health-interventions based on the promotion of physical activity and the reduction of sedentary time, after consideration of the actual literature in the field. In addition, we collectively raise new perspectives and believe that such interventions should rest on a multidisciplinary approach combining physical activity, public health and health specialists as well as ergonomists that are experts in human work sciences, in order to empower our actions and their sustainability.

Conflict of interest

None to report.