Comparison of physical activity,fatigue,and dynamic balance levels of health workers according to their working positions 1

Abstract

BACKGROUND:

Many studies have evaluated physical activity and fatigue. However, a causal relationship between physical activity, fatigue and balance in healthcare workers has not been established.

OBJECTIVE:

To evaluate the activity levels, fatigue, and dynamic balance of health workers who work actively or in a desk job in many different units in the hospital.

METHODS:

72 Health workers from two different groups participated in the study, 37 were active workers (AW), and 35 were desk workers (DW) at the Diyarbakir Gazi Yaşargil Training and Research Hospital. Participants were given a Sociodemographic Information Form, an International Physical Activity Questionnaire (IPAQ), and a 30-s Chair Stand Test (30-s CST) with a Modified Borg Scale (MBS) before starting work in the morning and at the end of work.

RESULTS:

69.4% of the study participants were female, and 54.2% were between 20 and 30 years old. It was found that the values of moderate physical activity, walking, and total physical activity were significantly higher in active workers than desk workers (p = 0.000). There was no statistically significant difference between the means of work start and after work fatigue of both groups (p > 0.05). A statistically significant difference was found when the starting and finishing work values of the dynamic balance tests of the groups were compared (p = 0.006).

CONCLUSION:

It was found that the level of physical activity and dynamic balance of individuals working at desk jobs was significantly lower than that of the active group.

Keywords

Balance desk worker healthcare professionals lassitude occupational health

1 Introduction

Working life is a sphere of social activity that ensures the continuity of human life. In recent years, the problems of professional life caused by intense competition, environment and stress, the workload caused by the increase in computer use, and the development of new risk factors for employees affect people’s physical lives [1].

A sedentary lifestyle, which is common both in public life and in working life, is a significant public health problem due to its adverse effects on health. Physical activity (PA) is essential as it has many beneficial effects on mental and physiological health and fitness [2]. The World Health Organization (WHO) defines physical activity as any bodily movement produced by skeletal muscles that require burn energy. Physical activity improves mobility, cognition, and independent functioning, preventing many conditions such as sarcopenia, osteoporosis, and loss of balance. WHO reports that more than a quarter of the World’s adult population (1.4 billion adults), 23% of men and 32% of women, are not active enough [3].

Health workers should make physical activity a way of life, both as a role models and as a professional requirement that requires high endurance and performance. While the fatigue experienced by health workers due to rotating work shifts and difficult tasks increases, it is also becoming difficult to perform physical exercises [4].

Fatigue is a non-objective finding that prevents a person from continuing his life activities, expressed as burnout and asthenia. Physiological and mental adverse effects of fatigue on individuals reduce their self-care and living standards [5]. One of the main consequences caused by fatigue is that it causes less movement, which causes health professionals not to provide enough efficient health care. It has been supported by various clinical findings that fatigue restricts health workers’ individual and social functions [6].

Balance losses due to fatigue can lead to an increased risk of falling. Night insomnia, which persists for long periods, slows down the reaction time and increases postural release in monotonous performance tasks that require attention and memory. The studies that evaluated fatigue’s effect on balance performance were limited [7, 8].

This study was planned to evaluate the activity levels, fatigue, and dynamic balances of health care workers working actively or at a desk job in many different units in the hospital.

2 Methods

2.1 Type of research

This research is a cross-sectional type of study.

2.1.1 The Universe and Sample of the Research

The research was carried out with 72 health workers working at Diyarbakır Gazi Yaşargil Training and Research Hospital of the University of Health Sciences. The study was completed by collecting data for one month between February 10th and March 10th, 2021.

The Power Analysis Program was used to calculate the number of individuals included in the study. It was found that a total of 82 people should be included in the study so that there are at least 41 people in each of the groups for 5% type I error and 80% power levels [9]. As there may be individuals who do not want to continue with the study or could not complete the test, more than the sample size was included. Two different groups were planned to be included in the study, such as 45 people who work actively during the day (physiotherapist, nurse, health technician) and 45 people who work at the desk (officer, automation personnel, data preparation). The study was completed with 37 active workers and 35 desk-based workers.

Inclusion criteria: Being a worker of Health Sciences University Diyarbakır Gazi Yaşargil Training and Research Hospital, voluntarily accepting to participate in the research, and providing written consent.

Exclusion criteria: Those who did not want to answer the questionnaire, those who had a mental disability or any psychiatric disorder at a level that could not answer the questions, those who had balance problems, and those who had lower limb problems that would affect fatigue were not included in the study.

Withdrawal criteria: Health workers could voluntarily withdraw from the study.

2.1.2 Data Collection Tools and Application of the Research

The survey form, which the researchers created by scanning the relevant literature, was filled in according to the self-declaration of the person by interviewing face-to-face voluntarily.

A Sociodemographic Information Form and an International Physical Activity Questionnaire were applied to the participants. Participants were given a 30-s Chair Stand Test to evaluate dynamic balance with a Modified Borg Scale for fatigue before starting work in the morning. The second assessment was repeated by taking a Modified Borg Scale and a 30-s Chair Stand Test at the end of the job.

Survey Forms Used:

Sociodemographic Information Form: There are questions about demographic information prepared by scanning the relevant literature.

International Physical Activity Questionnaire (Short Form): The questionnaire was designed by Craig et al. [10], and the Turkish validity and reliability were conducted by Savcı and his colleagues [11]. During the last seven days with the questionnaire; vigorous physical activity (football, aerobics, fast cycling, lifting weights, carrying loads, etc.) duration, Moderate physical activity (carrying light loads, cycling at average speed, folk dances, dancing, table tennis, etc.) duration, Walking and sitting times of one day are questioned. The total physical activity score is calculated by converting vigorous activity, moderate activity, and walking times into Metabolic Equivalent Task (MET) corresponding to basal metabolic rate:

According to the total physical activity score, the participant’s physical activity levels were grouped as follows:

Physically inactive: below 600 MET-min/week,

Low-level physical activity: from 600–3000 MET-min/week,

Sufficient physical activity: over 3000 MET-min/week.

Modified Borg Scale: it is a scale developed by Borg and Dahlstrom in 1982. The “Modified Borg Scale assesses the level of perceived fatigue.” Individuals are asked to score their fatigue level between 0 and 10 on this scale. In the score evaluation, “0” means that there is no fatigue at all, and “10” means that very severe fatigue is felt [12].

30-s Chair Stand Test: In the test, the individual will sit in the middle of the chair without armrests, with a sitting height of 43.18 cm, with his/her back upright and straight, arms crossed on his chest, feet fully pressed to the floor. With the start command, he/she will get up from the chair without pushing it with his/her arms, take an upright standing position and sit down again. Before scoring, he/she will be tested that he/she has learned to practice sitting down and getting up twice. The number of correct stand-ups will be recorded as a test score in thirty seconds [13].

2.2 Evaluation of data

The research data were recorded on a computer and evaluated using the SPSS 21.0 package program for statistical analysis. Numbers, percentages, mean and standard deviations are placed together in the tables. Compliance with normal distribution was made by the Kolmogorov-Smirnov test. While statistical analyses were performed, the chi-square test, t-test, and Spearman correlation tests were used in independent groups. P-value of < 0.05 was accepted as the significance level.

3 Results

Of the participants in the study, 69.4% (n = 50) were female, and 30.6% (22) were male. The highest participation rate in the study, with 54.2% , was from the 20-30 age group(39). 52.8% of the participants were single, 62.5% had graduated from university, 63.9% had smoked, and 88.9% had never used alcohol. When taken individually, it was seen that the distribution between the groups was close to each other, and their gender and marital status showed similarity (p > 0.05) (Table 1).

Table 1
Sociodemographic characteristics of the study groups

Desk workers Active workers Total p-value

n % * n % * n % *

Gender

Female 27 77.1 23 62.2 50 69.4 >0.05

Male 8 33.3 14 37.8 22 30.6

Age

20–30 25 71.4 14 37.8 39 54.2 <0.05

31–40 10 28.6 22 59.5 32 44.4

41–50 0 0.0 1 2.7 1 1.4

Marital Status

Single/Divorced 20 57.1 19 51.4 39 54.2 >0.05

Married 15 42.9 18 48.6 33 45.8

Educational Status

High school 20 57.1 7 18.9 27 37.5 <0.05

University 15 42.9 30 81.1 45 62.5

	Desk workers	Active workers	Total	p-value
Gender
Female	27	77.1	23	62.2	50	69.4	>0.05
Male	8	33.3	14	37.8	22	30.6
Age
20–30	25	71.4	14	37.8	39	54.2	<0.05
31–40	10	28.6	22	59.5	32	44.4
41–50	0	0.0	1	2.7	1	1.4
Marital Status
Single/Divorced	20	57.1	19	51.4	39	54.2	>0.05
Married	15	42.9	18	48.6	33	45.8
Educational Status
High school	20	57.1	7	18.9	27	37.5	<0.05
University	15	42.9	30	81.1	45	62.5

*Column Percentage.

It was determined that 1.4% (1) of all participants were not physically active, 19.4% (14) had a low level of physical activity, and 79.2% (57) had a sufficient level of physical activity to maintain their health, according to the level of physical activity of all participants.

It was determined that 97.3% of the active workers and 60.0% of the desk workers had sufficient physical activity levels, and there was a statistically significant difference between the groups (X2 = 15.189, p = 0.001) (Fig. 1).

Fig. 1

Comparison of the physical activity levels of the groups.

Between the groups of participants, the level of physical activity, moderate physical activity, walking, and total physical activity score averages were determined to be higher for active workers as statistically significant (Table 2).

Table 2

Comparison of physical activity score averages of groups

	Desk workers Mean±SD*	Active workers Mean±SD*	Statistics	p-value
Vigorous	357.08±1194.71	327.62±887.09	t = 0.118	0.905
Moderate	1137,14±1733.41	4887.13±4522.10	t = –4.693	<0.001
Walking	2131.80±1704.37	3835.78±2928.28	t = –3.037	0.004
Sitting	887.14±206.09	1004.37±1089.79	t = –0.642	0.534
Total	4513.17±2985.85	9891.54±5828.78	t = –4.966	<0.001

*MET-min/week.

There was no statistical difference between the fatigue results of both groups at starting work and after work (p > 0.05). A statistically significant difference was observed when the starting work and after work values of the dynamic balance tests of the groups were compared (p = 0.006) (Table 3).

Table 3

Comparison of fatigue and balance averages of groups

		Start work	After work	P-value
Fatigue	Deskworkers	3.68±2.89	6.11±2.66	>0.05
	Active workers	3.13±2.32	5.08±2.24
Balance	Deskworkers	14.28±5.31	13.2±5.14	0.006
	Active workers	16.13±4.92	16.4±4.33

There is a positive, moderate, and significant correlation between IPAQ and the 30-sCST. A negative, moderately significant correlation was found between the MBS and 30-s CST(Table 4).

Table 4

Correlation of scale and tests

		IPAQ	MBS	30-s CST
IPAQ	R
	P
MBS	R	0.084
	P	0.485
30-s CST	R	0.354	0.352
	P	0.002	0.002

4 Discussion

Hospitals are particular working environments that can negatively affect employees’ physical and mental health. Dealing with medical diseases for many years, working under a heavy workload and physical load due to long shifts, and lack of personnel create various risks for health personnel [4]. This study, which deconstructs the results of physical activity levels, fatigue, and balanced assessments of health workers under intensive working conditions, is the first study conducted in the literature.

The findings of our study revealed that the level of physical activity of all health workers was sufficient to maintain their health (79.2% ), but the level of physical activity of the active working group was significantly higher compared to those working at the desk. Yildirim et al. reported that 63.9% of the doctors and 36.1% of the nurses had high physical activity levels [14]. In a study conducted with health professionals in Nigeria, it was reported that 20.8% of them met adequate levels of physical activity, unlike our findings [15]. In a study conducted in a hospital in Greece, it was found that active workers (medical and nursing) have a higher level of physical activity than desk workers (administrative and technical) [4]. Adequate physical activity level strengthens the movement system, increasing the freedom of movement of individuals and their capacity to perform their daily work and tasks.

Among the physical activity levels of the participants, moderate physical activity (DW:1137.14±1733.41, AW:4887.13±4522.10), walking (DW:2131.80±1704.37, AW:3835.78±2928.28), and total physical activity (DW:4513.17±2985.85, AW:9891.54±5828.78) average score was found to be statistically significantly higher in active workers. In his study with Sen health workers, he found that the average level of physical activity was 742.46±1286.88, walking was 1066.08±1279.59, and the average level of total physical activity was 1873.18±2534.84 [16]. Lipert et al. found health department students’ average physical activity level as 1753.0±2 379.1, walking level as 2902.3±3 415.8, and total physical activity level as 6266.3±6 925.5 [17] and determined the average level of total physical activity in desk workers as 2249.62±2253.91 MET-min/hf [18]. Since the work of healthcare professionals consists predominantly of light-intensity physical activities, they are one of the most active occupational groups since employees stand and walk more while performing their direct patient care duties.

Health workers experience more fatigue than other occupational groups due to heavy workload, long shift hours, high work stress, and performance system. The fact that desk workers sit for long hours of the day and the mental fatigue they experience reduces their willingness to spare time for physical activity [18]. Although both groups in our study started the day with a certain level of fatigue and had increased fatigue values during the day, no statistical difference was observed between the groups’ fatigue results at the beginning of the workday and after work. A study conducted during the epidemic found that 72% of frontline health workers reported moderate to high fatigue, while healthcare workers in the background, such as desk jobs, were more likely to report severe fatigue (53.8% ) [19]. As the computer usage time of individuals with sedentary occupations working at a desk increases, their fatigue levels also increase [20].

Dynamic balance is an important criterion that is often used in forecasting, prevention, and rehabilitation of the injury risk of the musculoskeletal system in the lower extremities. Pathologies in the balance can result in problems with postural stability and a fall. As a result of a fall, in addition to a severe labor and material loss, physical, social, and psychological problems may occur, so it may be essential to evaluate the balance in the working segment [21]. In our study, a statistically significant difference was observed when the beginning of the workday and after work values of the dynamic balance tests of the groups were compared. Kocabıyık, in his study with nurses, reported an increase in balance parameters of workers when compared before and after the shift. [22]. Turhan, in his study with office workers, he noted no significant difference between the groups regarding dynamic and static balance [23].

According to our study, it was found that physical activity has a positive correlation with balance, and fatigue has a negative correlation with balance. It was evident that the level of balance dec physical activity for better health differs between adults in sedentary and physically active occupations with a parallel increase [24]. Sayaca et al. indicated that better dynamic balance values were obtained in groups with high daily physical activity values [25]. According to Aron et al., fatigue negatively affects a person’s ability to perform balance assessments, reducing balance scores [26].

4.1 Limitations of the research

In the literature, no study has been found examining the results of physical activity levels, fatigue, and balance assessments of health workers who work at the desk and actively. Consequently, studies on desk workers and other health workers are discussed separately.

5 Conclusions

It was determined that the level of physical activity of the vast majority of participants was sufficient to maintain health. It was found that the level of physical activity and dynamic balance of individuals working at desk jobs was significantly lower than that of the active group. While the level of physical activity and balance increase incoordination, fatigue and balance oppositely affect each other.

In order to protect and improve health, the necessary support, training, and facilities should be provided to increase the level of physical activity of employees. Reducing employees’ workload and organizing shift schedules will positively affect fatigue by reducing work stress.

Ethical approval

In order to conduct the research, approval was obtained from the Ethics Research Board of Dicle University Faculty of Medicine (Number: 135, Date: 04/02/2021). Permission was obtained from the Diyarbakır Gazi Yaşargil Training and Research Hospital Chief Medical Officer’s Office to conduct the study.

Informed consent

All health workers were informed about the study and signed an informed consent form stating that they agree to participate in the study.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.

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