Ron Plotnikoff, PhD

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Physical Activity in the Workplace

• Ron Plotnikoff, PhD
• Professor
• University of Alberta
• Acknowledgment
• Tricia Prodaniuk, MA, BPE
• Research Coordinator
• Slides can only be copied with permission.

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• Director, Physical Activity and Population Health
  Lab (PAPH)
• Centre for Health Promotion Studies
• Faculty of Physical Education
• Alberta 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

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PAPH Physical Activity and Population Health
Research Lab

• 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.

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Overview

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

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Leading Causes of Death in Alberta
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RHA involvement in Schools, Workplaces, Health
care, and community for 2002
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Workplace Issues

• Smoking Bans in workplaces PA /gtmore 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

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Prevalence

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

(CFLRI, 2001)
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Of Great Significance

• Physical Activity/CVD Population Attributable
  Risk
• ? Obesity
• ? Diabetes Type II
• ? Mortality/Morbidity Economic Costs

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CONTRIBUTING FACTORS
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What can we do and where?
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Population Model of Prevention

• Downstream
• Midstream
• Upstream

• individually oriented
• treatments
• interventions aimed at
• worksite organizations,
• health care settings and
• entire communities
• macro-level programs
• and healthy public
• policies

McKinlays (1995)
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Importance of the Workplace

• The majority of Canadian adults are in the
  workforce.
• The majority of adults are (have been) employed
  in workplace settings.

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• 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

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Employer Benefits of Workplace PA Programs

• 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

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• 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

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• Lower medical costs
• drug purchases
• doctors visits
• hospital days
• disability days

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Employee Benefits of PA

• Improved health and well-being
• Social benefits (Reducing barriers between
  co-workers)
• Increase employee commitment

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Health Benefits of Workplace PA Programs

• Cancer
• Type II Diabetes
• Anxiety
• Cardiac Risk
• Health Hazard Appraisal Scores
• Blood Pressure
• Body Mass Index
• Bone density

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

• 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 15344-361

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Workplace PA Meta-analysis cont

• Activity Supervision
• Supervised (.15)
• Not supervised (.12)
• Incentive Reinforcement
• Incentives (.18)
• No Incentives (.10)
• PA Measure
• Self-report (.14)
• Cardiorespiratory fitness (.09)

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How Successful are our programs?

• 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.

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Factors Associated with Participation Rates

• Demographics gender, socioeconomic status,
  occupation, visible minority groups (culture,
  language)
• Organizational Capacity (will, infrastructure,
  leadership)
• Working conditions
• Physical environments

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Practice (P) and Research (R) Limitations

• 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)

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Overview

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

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• Behaviour Change Theories

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Theories at the Individual Level

• Protection Motivation Theory
• Theory of Planned Behavior
• Transtheoretical Model
• Social Cognitive Theory

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Value Expectancy Theories

• 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).

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Protection Motivation Theory
Vulnerability Fear Severity
THREAT APPRAISAL
PROTECTION MOTIVATION
Self Efficacy(perceived ability) Response
Efficacy (perceived consequences)
COPING APPRAISAL
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Protection Motivation Theory
Vulnerability Fear Severity
THREAT APPRAISAL
Intentions
BEHAVIOR
Self Efficacy(perceived ability) Response
Efficacy (perceived consequences)
COPING APPRAISAL
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Theory of Planned Behavior
Attitude Toward Behavior
Subjective Norms
Behavior
Intention
Perceived Behavioral Control
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Transtheoretical Model

• 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

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Stage of Behaviour Change Model

• Maintenance
• Action
• Preparation
• Contemplation
• Pre-Contemplation

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TTM - Constructs

• Self-efficacy
• Decisional Balance
• Pros
• - Cons
• 10 Processes of Change

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Transtheoretical Model

• Health practitioners seem to like it.Why?
• staging concept easy to use widgets

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Overview

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

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

• Large Randomized Controlled Trial in Alberta
  (n900)
• Funded by the Canadian Institutes for Health
  Research and Alberta Heritage Foundation for
  Medical Research

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Step Series
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Canadas PA Guide
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Methods - Results

• 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

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Women

Stage
1200
Standard
1100
Control
1000
Group
Physical Activity Means
control
900
standard
800
stage
3
2
1
Time
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• Workplace Physical Activity and Healthy Eating -
  Electronic Messaging Study
• Plotnikoff, McCargar, Wilson Loucaides
• (2005) American Journal of Health Promotion
• Funded by Health Canada

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Purpose

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

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Methods

• 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.

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Men
Exp.
960
940
Control
920
900
880
Estimated Marginal Means
860
GROUP
840
experimental group
820
800
control group
3
2
1
TIME
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Discussion

• 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 gt importance of tailoring
  messaging/information re gender specificity
• Consistent with much of womens health
  information e.g., decisional aids

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Discussion Cont

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

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Gender Differences

• - self-efficacy
• - intention
• - cons

Men reported higher means
Women reported higher means
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To recap a few important points
At their best, theories explain 40-50 of
intention to do a behaviour 20-30 of actual
behaviour
This declines over time.
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Theory Self-efficacy Important

• Definition
• Ones confidence in ones ability to take action
• Application
• Provide training, guidance, in performing action
• Use progressive goal setting
• Give verbal reinforcement
• Demonstrate desired behaviours
• Reduce anxiety

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Tailoring Considerations

• Demographical Factors
• Age
• Sex
• Occupation
• Socio Economic Status
• Language/culture
• Stage of Readiness

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• 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

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• Current/Future Directions
• Where is the field going?
• Ecological Models

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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

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Levels of Intervention

• Individual
• Social
• Organizational
• Community
• Government Policy Legislation
• Physical Environment

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An Example
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Program Standard and Audit Tool for Workplace
Physical Activity

• Ron Plotnikoff
• Tricia Prodaniuk
• Allan Fein
• Leah Milton
• Health Promotion Practice, 2005
• Funded by Alberta Community Development

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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.
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Three-phased Project

• Phase I 2000-2001
• Objective development of the Program Standard
• Process literature review, expert and
  stakeholder review
• Phase II 2001-2002
• Objective development of the Audit Tool
• Process 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

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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

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Audit Tool

• Measures a workplace PA program against the
  Program Standard.
• 45 yes / no questions that require validation
  procedures
• Validation procedures
• Observation observing the factor in the
  workplace
• Documentation having a document in place
• Interview talking to employees

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Management Employee Commitment
Program Administration
Environment Needs Assessment
Safety Emergency Management
PREPARATION
PROGRAM COMPONENTS
PROCEDURES
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Preparation

• Management and Employee Commitment
• Environmental and Needs Assessment

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Program Components
Individual level

• 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

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Potential Strategies at the Individual level

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

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The Pedometer Craze
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Program Components
Social level

• 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

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Program Components
Organization level

• Refers to how the capacity (infrastructure/will)
  of the organization influences PA adoption,
  participation and adherence
• Includes top down leadership and bottom up
  champions

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Example Capacity

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

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Capacity

• Will to Act
• Infrastructure
• Leadership
• (The Singapore Declaration, 1998)

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AHHP Publications
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.
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Program Components
Community level

• 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

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Program Components
Policy level

• 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

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Physical Environment Level.

• Design Longitudinal Study assessed 4
  interventions for increasing stair use
• new carpet and painting the walls
• framed art on stair landings
• motivational signs throughout the building
• playing music in the stairwell
• N664 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.
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Procedures

• Program Administration e.g. evaluation
• Risk Management

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The Framework
http//www.centre4activeliving.ca/research/reresou
rces.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).
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Comprehensive Workplace Health Promotion
Catalogue of Situational Assessment Tools (2006,
U of T)

• Workplace Physical Activity Framework High
  recommended/ranked in a critique of workplace
  health assessment tools
• See www.thcu.ca/workplace/sat

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Health Canadas Business Case for Active Living
at Work
http//www.hc-sc.gc.ca/hppb/fitness/work/

• 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

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Other PA/Workplace Initiatives

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

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Overview

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

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Recommendations

• Emphasize the broad spectrum of PA
• Take an ecological approach
• Base programs on major theories of behaviour
  change, org. change (and communication/marketing
  sciences)
• Learn from other worksite behaviour change
  programs eg tobacco control
• Partner/Collaborate intersectorally
  interdisciplinary with govt, industry, university

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Recommendations

• Use linkages with other program settings eg
  community, home/family
• Evaluate where possible use valid/reliable
  measures attitude behaviour
• Ensure buy in from the top
• Ensure programs meet the needs of all employees

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Overview

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

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Scenario

• You have been asked to develop a physical
  activity program for a mid-size company which has
  had no such program in the companys 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.

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Discussion

• What specific ecological components should the
  program target? In what order? And why?
• Individual
• Social
• Organizational
• Community
• Policy
• Physical Environment

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• Thank you!
• Questions?
• Please contact paph_at_ualberta.ca,
  ron.plotnikoff_at_ualberta.ca, or 492-4372 for
  further information.
• Slides can only be copied with permission.