Ron Plotnikoff, PhDProfessor

University of Alberta

Acknowledgment:Tricia Prodaniuk, MA, BPE

Research Coordinator

Slides can only be copied with permission.

Physical Activity in the Workplace

Director, Physical Activity and Population Health Lab (PAPH)Centre for Health Promotion Studies

Faculty of Physical EducationAlberta Centre for Active Living

Dept. of Public Health Science (Adjunct) University of Alberta

Health Scholar: Alberta Heritage Medical Foundation

New Investigator: Canadian Institutes for Health Research

PAPH Research Team is focused on the:

development of efficacious/effective PA programs, for

the primary and secondary prevention and treatment

of cardio vascular disease and diabetes, and the

promotion of general health.

PAPH: Physical Activity and Population Health Research Lab

Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion

Overview

Leading Causes of Death in Alberta

3.73

2.97

3.843.64

3.32

2.21

2.95

2.53.042.37

3.63

2.55

0

1

2

3

4

5

Tabacco Nutrition Physical Activity

RHA involvement in Schools, Workplaces, Health care, and community for 2002

Smoking Bans in workplaces; PA =/>more important (Population Health Perspective)

Time is one of the greatest barriers of PA – workplace is an ideal context for PA to, at & from work

Aging workforce

Workplace stress is increasing

40% of workers want rec/ex. facilities/programs

Workplace Issues

Approximately two-thirds of Canadian adults are risking their health and quality of life because of inactive lifestyles.

(CFLRI, 2001)(CFLRI, 2001)

Prevalence

Physical Activity/CVD: Population Attributable Risk

↑ Obesity

↑ Diabetes Type II

= ↑ Mortality/Morbidity & Economic Costs

Of Great Significance

CONTRIBUTING CONTRIBUTING FACTORSFACTORS

CONTRIBUTING CONTRIBUTING FACTORSFACTORS

What can we do and where?What can we do and where?

Downstream –

Midstream –

Upstream –

individually orientedtreatments

interventions aimed atinterventions aimed atworksite organizationsworksite organizations,,health care settings andentire communities

macro-level programsand healthy publicpolicies

Population Model of Prevention

McKinlay’s (1995)

The majority of Canadian adults are in the workforce.

The majority of adults are (have been) employed in workplace settings.

Importance of the Workplace

Most Can. adults (15M) spend 1/2 their waking hours in the workplace

Workplaces offer unique opportunities for health promotion

Potential to be more successful than community settings - exposure to mass reach approaches

Corporate Image and recruitment

self-esteem, self-efficacy and self-determined employees organizational support for good health practices positive effect on work culture

Productivity

increased arousal, work satisfaction, leadership development, develops communication and interpersonal skills

Employer Benefits of Workplace PA Programs

Decreased absenteeism

Toronto Life Assurance- lower absenteeism was linked to to current participation rather membership versus non-membership

Decreased Turnover

studies indicate a reduction in turnover among active employees versus inactive

helped to retain female who were employed as clerks, service workers, semi-skilled operatives and general labourers

Lower medical costs

drug purchases doctors’ visits hospital days disability days

Improved health and well-being

Social benefits (Reducing barriers between co-workers)

Increase employee commitment

Employee Benefits of PA

Cancer

Type II Diabetes

Anxiety

Cardiac Risk

Health Hazard Appraisal Scores

Blood Pressure

Body Mass Index

Bone density

Health Benefits of Workplace PA Programs

Intervention Type: Behaviour Modification (.34) Exercise Prescription (.14) Health Ed/Risk Appraisal (.06)

Worksite: University (.24) Public (.14) Corporate (.05)

Setting Onsite (.15) Offsite (.13) Dishman et al. Am J of Prev Med 15:344-361

Workplace PA Meta-analysis: Moderators of intervention effects (r)

Activity Supervision Supervised (.15) Not supervised (.12)

Incentive Reinforcement Incentives (.18) No Incentives (.10)

PA Measure Self-report (.14) Cardiorespiratory fitness (.09)

Workplace PA Meta-analysis con’t:

Participation program rate is 20-30% with only half of these participating on a regular basis.

Of the best published intervention studies – at best “small effects” on program impact ie. fitness/behaviour

….We need programs… and better ones where ones exist.

How Successful are our programs?

Demographics: gender, socioeconomic status,

occupation, visible minority groups (culture, language)

Organizational Capacity (will, infrastructure, leadership)

Working conditions

Physical environments

Factors Associated with Participation Rates

Individual level focus (P & R)

Programs not theoretically grounded (P & R)

Poor measurement (i.e., validity / reliability) (P & R)

Poor definitions of the intervention (P)

Employer cost (i.e., time and money) (P)

Lack of randomized controlled trials (R)

Practice (P) and Research (R) Limitations

Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion

Overview

Behaviour Change Theories

Protection Motivation Theory

Theory of Planned Behavior

Transtheoretical Model

Social Cognitive Theory

Theories at the Individual Level:

1. the desire to avoid illness or to get well (value) and,

2. The belief that a specific health action available to a person would prevent or remedy the illness - (expectancy).

Value Expectancy Theories

Protection Motivation TheoryProtection Motivation TheoryProtection Motivation TheoryProtection Motivation Theory

PROTECTION

MOTIVATION

Vulnerability

Fear

Severity

Self Efficacy(perceived ability)

Response Efficacy

(perceived consequences)

THREAT APPRAISAL

COPING APPRAISAL

Protection Motivation TheoryProtection Motivation TheoryProtection Motivation TheoryProtection Motivation Theory

Vulnerability

Fear

Severity

Self Efficacy(perceived ability)

Response Efficacy

(perceived consequences)

THREAT APPRAISAL

COPING APPRAISAL

Intentions BEHAVIOR

Theory of Planned BehaviorTheory of Planned BehaviorTheory of Planned BehaviorTheory of Planned Behavior

Attitude Toward Behavior

Subjective Norms

Perceived Behavioral

Control

BehaviorIntention

One of the most popular models in Health Promotion & Health Education in the past decade.

Prochaska & DiClemente (1983); originally based on smoking behaviour

Marcus – PA domain; worksite

Transtheoretical ModelTranstheoretical Model

Maintenance

Action

Preparation

Contemplation

Pre-Contemplation

Stage of Behaviour Change Model

TTM - Constructs TTM - Constructs

Self-efficacy Decisional Balance

+ Pros

- Cons 10 Processes of

Change

Health practitioners seem to like it….Why?

…staging concept; easy to use widgets

Transtheoretical ModelTranstheoretical Model

Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion

Overview

An Example…An Example…

Large Randomized Controlled Trial in Alberta (n=900)

Funded by the Canadian Institutes for Health Research and Alberta Heritage Foundation for Medical Research

Workplace Physical Activity Study Plotnikoff et al (under review, Am J Health Prom)

Step Series

Canada’s PA Guide

• Pre- and post-test exp/control group design

• Interventions were delivered at baseline and 6 months

• PA behaviour was assessed at baseline, 6 & 12 months

Methods - Results

Time

321

Ph

ysic

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ctiv

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ea

ns

1200

1100

1000

900

800

Group

control

standard

stage

Women

StandardStage

Control

Workplace Physical Activity and Healthy Eating - Electronic

Messaging Study Plotnikoff, McCargar, Wilson & Loucaides

(2005) American Journal of Health Promotion

Funded by Health Canada

• To assess the efficacy of a 12-week electronic messaging intervention for the promotion of PA and nutrition behaviour in the workplace

Purpose

• 2598 employees - 5 large Canadian workplaces were randomized and completed baseline measures

• Exp grp received 1 weekly PA and nutrition email message (with links) for 12 wks.

Methods

TIME

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Est

ima

ted

Ma

rgin

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960

940

920

900

880

860

840

820

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GROUP

experimental group

control group

Men

Control

Exp.

• Tailored print-based info on PA readiness worked well for women (Study 1)

• General e-messaging worked for both genders (Study 2)

• In follow-up interviews with 10% of Study 1, women > importance of tailoring messaging/information re: gender specificity

• Consistent with much of women’s health information e.g., decisional aids

Discussion

• Study recruitment: more women participants

• Men have higher baseline activity scores than women (both studies) -- ceiling effects for men

Discussion Con’t

500

600

700

800

900

1000

Time1

Time2

Time3

ME

t.m

inu

tes

Male

Female

- self-efficacy

- intention

- cons

Men reported Men reported higher meanshigher means

Women reported Women reported higher meanshigher means

Gender Differences

At their best, theories explain:

~40-50% of intention to do a behaviour

~20-30% of actual behaviour

This declines over time….

To recap a few important points…

Definition One’s confidence in one’s ability to take action

Application Provide training, guidance, in performing action Use progressive goal setting Give verbal reinforcement Demonstrate desired behaviours Reduce anxiety

Theory: Self-efficacy Important

Demographical Factors: Age Sex Occupation Socio Economic Status Language/culture

Stage of Readiness

Tailoring Considerations

Our knowledge base is limited Most successful programs are grounded in

theory (mainly at the individual level)

Individual level strategies are partially successful – however, long-term data are needed

Organization capacity appears to be important

Current/Future Directions

Where is the field going? …

Ecological Models

The interaction between the individual (e.g., knowledge & attitudes & behaviours) with the environment (e.g., social,

organizational, community, policy/legislation).

Richard et al., Green et al., - health promotion Sallis and Owen – PA domain

Ecological Models

Individual Social Organizational Community Government Policy & Legislation Physical Environment

Levels of Intervention

INDIVIDUAL

POLICY

SOCIAL

COMMUNITY

ORGANIZATION

PHYSICAL

ENV

INDIVIDUAL

POLICY

SOCIAL

COMMUNITY

ORGANIZATION

PHYSICAL

ENV

An Example…An Example…

Ron Plotnikoff

Tricia Prodaniuk

Allan Fein

Leah Milton

Health Promotion Practice, 2005

Funded by Alberta Community Development

Program Standard and Audit Tool for Workplace Physical

Activity

Needs Assessment

51 in-depth interviews:

key stakeholders, managers and practitioners

government and private institutions in Alberta

Plotnikoff, R.C., Poon, P.P.L., McGannon, K.R., & Prodaniuk, T. (2004) Can workplace active living work? Perspectives from the workplace. Avante, 10(2), 57-70.

Phase I: 2000-2001 Objective: development of the Program StandardProcess: literature review, expert and stakeholder review

Phase II: 2001-2002 Objective: development of the Audit ToolProcess: literature review, expert and stakeholder

review, pilot testing

Phase III: 2002-2003 Objective: trialing the Program Standard & Audit Tool.Process: trial across diverse workplaces, qualitative

interviews, revisions based on feedback

Three-phased Project

Program Standard

Standard of best practices for workplace PA programs.

Based on an ecological framework

Modeled after the OHS Partnerships Program

Developed through:

Literature review

Expert and stakeholder review

Workplace consultations / trials

Audit Tool

Measures a workplace PA program against the Program Standard.

45 yes / no questions that require validation procedures

Validation procedures:

1. Observation: observing the factor in the workplace

2. Documentation: having a document in place

3. Interview: talking to employees

PREPARATION PROGRAM COMPONENTS

PROCEDURES

Management & Employee

Commitment

Environment & Needs

Assessment

Program Administration

Safety & Emergency

Management

IND

IVID

UA

L

CO

MM

UN

ITY

SOCIAL

OR

GA

NIZ

ATI

ON

POLICY

Management and Employee Commitment

Environmental and Needs Assessment

Preparation

Knowledge – Re: the benefits of being and how to be physically active

Attitudes/cognitions – Re: How the individual feels/thinks about PA

Behaviours / Skills – Performing specific physical activities; also includes skills such as time management

Individual level

Program Components

Individual counseling Behaviour modification Incentives Telephone prompting Monitoring Goal setting Health education Print materials/staged matched Information technology Publicly displayed attendance charts

Potential Strategies at the Individual level

The Pedometer Craze

Relationships between individuals that influence PA Includes relationships within and outside of the

workplace

Social climate needs to be examined for its capacity to influence PA

Positive and enhancing relationships are necessary to foster PA

Social level

Program Components

Refers to how the capacity (infrastructure/will) of the organization influences PA adoption, participation and adherence

Includes “top down” leadership and “bottom up” champions

Organization level

Program Components

• Capability of an organization to promote health, formed by its will to act and infrastructure and leadership to drive organizational change.

Example: Capacity

• Will to Act• Infrastructure• Leadership

(The Singapore Declaration, 1998)

Capacity

Anderson, D., Plotnikoff, R., Raine, K., Cook, K., Smith, C., & Barrett, L. (2004). Towards the development of scales to measure “will” to promote heart health within health organizations. Health Promotion International, 19, 471-481. Barrett, L.L., Plotnikoff, R.C., Raine, K., & Anderson, D. Development of measure of organizational leadership for health promotion. (2005) Health Education & Behavior. Plotnikoff, R., Anderson, D., Raine, K., Cook, K., Barrett, L., & Prodaniuk, T. Scale development of individual and organization infrastructure for heart health promotion in Regional Health Authorities. 2005 Health Education.

AHHP Publications:

Addresses partnerships between groups within the workplace and relationships with other organizations outside of the workplace that foster PA

Opportunities to partner with community organizations, other corporations or the government re: specific services, funding or exercise space should be sought

Community level

Program Components

Can include micro policy initiatives within the workplace that foster PA or macro, government policies that address:

Time for PA Formal recognition of participation Commuting policies Incentives for participation Implementation of programs Equity of access

Policy level

Program Components

Physical Environment Level….Design: Longitudinal Study assessed 4 interventions for increasing stair use:

1. new carpet and painting the walls

2. framed art on stair landings

3. motivational signs throughout the building

4. playing music in the stairwell

N=664 employees CDC Rhodes Building in Atlanta Georgia

Proximity sensors installed in stairwell monitored stair usage

Results: Signage increased stair usage in the first three months; Music increased stair usage in the second three months.

Conclusion: Motivational signage, and music can increase PA

Kerr, N.A., Yore, M.M., Ham, S.A. & Dietz, W.H. (2004). Increasing stair use in a worksite through environmental changes. American Journal of Health Promotion, 18, 312-215.

Program Administration e.g. evaluation

Risk Management

Procedures

The “Framework”

http://www.centre4activeliving.ca/research/reresources.html

Download the “Program Standard”, and the “Audit Tool” free of charge from the

Alberta Centre for Active Living website.

Plotnikoff, R., Prodaniuk, P, Fein, A., & Milton. Development of an ecological assessment tool for a workplace physical activity program standard, Health Promotion Practice (2005).

Workplace Physical Activity FrameworkWorkplace Physical Activity Framework – High recommended/ranked in a – High recommended/ranked in a critique of workplace health assessment critique of workplace health assessment toolstools

See: www.thcu.ca/workplace/satSee: www.thcu.ca/workplace/sat

Comprehensive Workplace Health Promotion Catalogue of Situational Assessment Tools (2006, U of T)

Internet resource which provides info on:

Research

What works & how to get started

Template for practitioners in developing a Business Case for PA in their organization

Health Canada’s Business Case for Active Living at Work

http://www.hc-sc.gc.ca/hppb/fitness/work/

Plotnikoff, R., & Moodie, J. (2003) Canadian Coalition for Active Living Policy Platform – Workplace Action Plan

Other PA/Workplace Initiatives

Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion

Overview

1. Emphasize the broad spectrum of PA2. Take an ecological approach3. Base programs on major theories of

behaviour change, org. change (and communication/marketing sciences)

4. Learn from other worksite behaviour change programs eg tobacco control

5. Partner/Collaborate intersectorally & interdisciplinary with govt, industry, university

Recommendations

6. Use linkages with other program settings eg community, home/family

7. Evaluate where possible; use valid/reliable measures; attitude & behaviour

8. Ensure “buy in” from the top

9. Ensure programs meet the needs of all employees

Recommendations

Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion

Overview

You have been asked to develop a physical activity program for a mid-size company which has had no such program in the company’s history. You have been provided with a “generous budget” to develop the program and the management wants to ensure that the majority of the employees will adhere to the program.

Scenario

What specific “ecological components” should the program target? In what order? And why?

Individual

Social

Organizational

Community

Policy

Physical Environment

Discussion

Thank you!

Questions?

Please contact paph@ualberta.ca, ron.plotnikoff@ualberta.ca, or 492-4372 for further information.

*Slides can only be copied with permission.