This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
Worksites have had a history of more rhetoric than evidence on strategies to promote physical activity. Much has been written about their potential, especially to lower costs or reduce absenteeism. There is limited research evidence to support this enthusiasm. In Australia, many programs have been conducted but a few have been evaluated. Recent initiatives have included combined behavioural and environmental strategies in the worksite setting, and appear to show more promise. Future programs may use technologies such as intranet communication to deliver health messages. In addition, the worksite can be used as a setting for environmental interventions, such as 'walk to work' events, and encouraging stair use at worksites.
In the 1970s, many large companies in the USA, and some in Australia, claimed there were benefits to reducing the risk of cardiovascular disease for senior management and executives. This claim manifested in the establishment of corporate fitness programs and that often included the building and staffing of on-site gymnasia, the offering of circuit and aerobics classes, and the provision of weights equipment and other activities.
The primary aim of worksite programs was to provide opportunities for employees to increase cardiorespiratory fitness and the key message was that staff should undertake regular vigorous exercise consistent with the American College of Sporting Medicines' then current fitness guidelines (see Sallis and Owen 1999, Chapter 4). During the economic growth period in the 1980s, worksite programs continued to appear across Australia in companies such as Telstra, Xerox, Coca Cola, and in several National banks.
Gradually, a broader approach began to be taken and, in some cases, worksite exercise programs and facilities were made available to all employees. During the 1980s, an extensive body of research studies of variable quality accumulated, investigating rates of participation and adherence to various fitness, exercise and activity regimens. Worksites were seen as useful settings for programs because of the possible economic benefits of this setting, and the convenience of the worksite setting for implementing structured exercise programs.
Although many papers have been published, collectively they represent a haphazard mix of programs, selected worksite populations and with uneven research quality. Most of the reported data were from studies conducted in the USA and many were linked with attempts by large employer groups and health insurance bodies to contain the costs of medical care (see Dishman et al. 1998). In a review of published worksite interventions, Dishman et al. (1998) identified the shortage of evidence to substantiate the benefits of worksite programs, and noted that effects were uncorrelated with the intensity of programs or theoretical frameworks underpinning specific interventions. Much more seems to have been written about improvements in work productivity outcomes or cost savings than can be substantiated (Shephard 1996).
In the USA, the employer typically pays for the personal health insurance of the employee and their families, and retirees. Thus, in the USA the most expensive health care costs are associated with long-term chronic disease including heart disease, cancer and diabetes (Warner et al. 1988). In Australia, the greatest health care costs are due to musculoskeletal injury and stress. So, there are very important differences in the economic incentives and corresponding organisational objectives for workplace health promotion initiatives in Australia and the USA.
In Australia, the USA and elsewhere, the 1990s have seen a shift away from the promotion of fitness and physical activity as a sole issue in worksites and an increased interest in more comprehensive worksite health programs. Many of the limitations of individually-orientated lifestyle-change and advice-giving programs and resources have been recognised, and there is interest in combining socio-behavioural programs with structural-environmental interventions (Veitch et al. 1999a).
The current status of physical activity initiatives, and health promotion initiatives more generally, in the workplace in Australia is best described as ad hoc. There have been examples of State-based initiatives in research and program delivery but there is no coordinating body or forum for discussion and debate.
One large trial in Australia - the National Workplace Health Project (NWHP) - examined the effectiveness of socio-behavioural and environmental approaches promoting physical activity, healthy eating, smoking cessation and non-hazardous alcohol consumption (Simpson et al. 2000, Harris et al. 1999). The NWHP is one of the few studies in the world to have tested individual and environmental approaches separately and to have evaluated the process of implementing health strategies. More details of this case study and the future of this approach are discussed in the following sections.
Other initiatives, such as Gutbusters (Egger 1999, Egger 2000) are also being used through worksites, and although they are aimed primarily at achieving weight loss, they include components of advice on physical activity.
Worksites are seen as potentially important settings for programs aimed at physical activity because there is the opportunity to reach a 'captive' group of adults that spends a large proportion of its waking hours at work. Moreover, programs in worksites can benefit from the economies of scale and can target harder-to-reach populations, such as males, lower-SES people and migrants (see Veitch et al. 1999b).
Organisations have been interested in worksite programs to generally improve the health of their employees and many see the potential to reduce health care costs, absenteeism, accidents and injuries. In addition, benefits such as improved teamwork, communication and morale have been researched.
A reduction in the risk of cardiovascular disease remains an important incentive for many programs but in the last decade there has been greater interest in programs that address stress management and the prevention of occupational injuries, especially those related to manual handling.
The shared history and common beliefs held by the workforce of an organisation mean that the 'culture' of an organisation can exert a powerful influence on the attitudes and behaviours of individual workers(Robbins 1993). Health strategies that can recognise and utilise such cultural nuances of the workplace are more likely to be successful in achieving higher participation and, ultimately, more positive health outcomes than programs that are not culturally relevant. Conversely, the culture of an organisation can act as a powerful barrier to health programs that fail to consider, or do not reflect, the unique aspects of culture (Harris et al. 1999).
Other advantages of the worksite setting include the ability to use existing resources and networks that can make the implementation of programs easier. For example, employees can be recruited through communications via email, posters in the work canteen and enclosures with employee pay slips.
The implementation of programs at worksites has several well-known limitations. Programs usually require approval from various departments and levels of management, as well as employees, via representative organisations such as unions. Gaining such support and endorsement can take a significant amount of time. Company agendas and priorities can change, often suddenly.
Until programs and activities become entrenched in the culture of a company, they can be subject to limited, short-term support. In this climate, brief, discrete activities are favoured over more comprehensive approaches. Furthermore, worksite initiatives need to foster widespread support to avoid the potential set-backs caused when key staff leave or are relocated within the organisation.
Many of the barriers to effective interventions that have been discussed so far, are related to the economic climate and systems present in the workplace. Another major limitation that has affected many programs is the low level of participation and poor adherence rates. It has been reported previously that up to 50 per cent of participants can drop out of worksite-based programs in the first six months. Moreover, it has been argued that programs are likely to attract employees who are active already, who least need the incentive of on-site, convenient, facilities and programs (Dishman et al. 1998).
While it is generally appreciated that a range of programs has been developed for specific worksites across Australia, it is difficult to obtain specific details of the program components or to obtain the results of evaluations. Some programs have been presented at health promotion conferences but few have been earmarked for widespread dissemination, and little information has been published in scientific journals. Common features of these programs include screening for risk factors for chronic diseases, education seminars, organised on-site physical activity classes, and incentives for use of off-site health and fitness facilities. According to Dishman et al. (1998), generally, these programs are not evidence-based. The styles and types of programs typically used are shown in Table 7.
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Education programs can be run during lunchtime or after work and are usually voluntary. Qualified exercise instructors can be employed to run lunchtime classes (often circuit or weights classes) on either an on-going basis or as a short course, e.g. a 6- to 8-week block of tennis. Larger companies may fund the maintenance of on-site exercise facilities but it is now more common for programs to make use of low-cost, convenient areas, such as staff rooms or to link with local public or private recreational facilities. Companies and employers outside of the typical office-based professions often find innovative ways to provide and encourage physical activity and there are many examples across Australia. The Western Australian Department of Conservation and Land Management established a program in 1993 and at various depots around WA, and employees converted unused sheds to create exercise areas. Using local resources, they built weights equipment and marked out their own walking trails.
Most worksite programs have focused on less effective approaches that reach individual employees with educational and motivational strategies, either one-on-one or to small groups. The provision of these programs has been criticised due to their limited capacity to reach those most in need. Newly-emerging options that may provide educational and behaviour-change services using worksite intranet systems are under development. These systems have the potential to reach large numbers and to have a greater impact than have earlier print-based self instructional physical activity programs (Marcus et al. 1998; Fotheringham et al. 2000).
The management of occupational health and safety is increasingly coupled with rehabilitation within the domain of human resource management. This was recognised formally in the Workplace Injury Management and Workers Compensation Act 1998 (NSW), which integrates these previously distinct management domains. Importantly, the Act specifies prevention as the guiding principle for all organisational efforts in this arena.It is logical to assume that advocates of workplace physical activity and advocates of health protection would collaborate in their common goal of creating a more healthy workplace; however, there has been considerable debate concerning priorities, strategies and cost-effectiveness of each approach (Shephard 1996, Walsh et al. 1991, Wegman and Fine 1990). It is only relatively recently that practitioners and researchers have begun to recognise the potential benefits associated with a more integrated approach to managing health at work (Sorensen et al. 1995, Baker et al. 1996).
For more than 20 years, the field of occupational health and safety (OHS) has adopted an industry-based approach to preventing injury. This approach is reflected in OHS legislation in each State, which refers to industry-based regulations and codes of practice. The depth of knowledge, skills and systems that have been developed for the more effective management of OHS must be understood by physical activity practitioners and advocates if they are to truly integrate strategies within the workplace setting.
A recent meta-analysis of 26 studies concluded that there was no clear evidence that worksite interventions aimed at increasing levels of physical activity or fitness were effective (Dishman et al. 1998), although the review was limited by the variability in design, measurement and, or, the representativeness of worksite samples. This review suggests that current evidence for the effectiveness of workplace initiatives is weak. Although this could imply that the worksite setting should be left alone, an alternative perspective is that the workplace still has potential as a setting. The challenge is to find ways to work better in this setting.
The following examples illustrate the range and diversity of workplace physical activity initiatives in Australia and the different frameworks within which they are being pursued. Limited data are available but some provide useful frameworks for action in this area.
The VicHealth Workplace Program aims to lead and facilitate sustainable improvements in organisational health, providing a broad framework for physical activity in initiatives and other health promotion strategies. The program attempts to build the capabilities of organisations, communities and individuals in ways that: 1. change social, economic and physical environments to improve the health of all Victorians; and 2. strengthen the understanding and the skills of individuals in ways that support their efforts to achieve and maintain health. VicHealth has developed a framework that looks beyond a focus on individual health to a focus on understanding the health of individuals within the context of organisations and the communities in which they operate. The 'Partnerships with Healthy Industry' program aims to bring the principles of organisational health to Victoria's workplaces with a focus on sustainable change and improvement through education and consulting. The program helps organisations develop and design their own organisational health strategies, thereby affecting the culture, systems and practices of the organisation. For more information contact VicHealth web site or workplace@vichealth.vic.gov.au.
Stairways to Health encouraged stair use to increase incidental activity and help meet current physical activity guidelines. This is more of an environmental intervention in a worksite, rather than a workplace-initiated project. Two sets of motivational signs were displayed at the lifts adjacent to the stairs in a multi-story office block over five months. Stair use increased by five per cent; overall men and people aged under 30 years were more likely to use stairs than women; overweight people were less likely. Men increased their use by 10 per cent, which was statistically significant, and at the end of the project 58 per cent of staff used the stairs at a level that was likely to have a cardioprotective effect. Staff were aware of the signs and thought them personally relevant (unpublished data, South Eastern Sydney Health Promotion Unit).
Climb to the Top was an innovative worksite program that encouraged people to use the stairs in their workplace every day. By encouraging employees to replace the lift with stairs, the program promoted incidental opportunities for exercise at work. Workers formed teams of up to 10 people and endeavour to climb the equivalent height of Mount Everest using the stairs in their workplace during stair-climbing month of August. The 8,848-metre-high Mount Everest equates to 2,212 floors (flights of stairs) which could be achieved by ten people walking about 10 floors (flights) per day for one month. Climb to the Top was first conducted in Western Australia in 1991, involved 120 teams. The success of the program has seen the number of participants grow each year with 600 teams in 1999. Climb to the Top plays a very important role in the National Heart Foundation's commitment to encourage Western Australians to be more active.
The National Workplace Health Project (NWHP) was a strong effort to obtain evidence about worksite. It was Australia's largest controlled trial of worksite health promotion. The study investigated the efficacy of behavioural and environmental approaches to promoting physical activity and other lifestyle changes. Twenty worksites were assigned randomly to one of four health programs: minimal program, sociobehavioural-only program (counselling and group education components), environmental-only program (utilising policies and information channels and targeting physical features at work, e.g. exercise equipment and vending machines), and combination sociobehavioural and environmental programs. The programs commenced in 1995 and ran for two years, with measures at baseline, 12 months and 24 months. The study developed an adaptable model for program planning and implementation and a Checklist for Health-promoting Environments at Work (CHEW). This instrument audits the health-promoting work environment and can monitor changes over time.
The Men's Health Project (the Project) is a two-year Healthway-funded, joint initiative of the Cancer Foundation of WA, Diabetes Australia-WA and the Heart Foundation. The Project focuses on blue-collar men aged 40-60 years and aims to influence nutrition, physical activity and health service utilisation. It will also encourage these men to make healthy lifestyle choices that will enhance their current life and also help to reduce their risk of certain diseases, especially cancer, diabetes and heart disease in the future.
The potential to promote physical activity through the workplace setting lies in the ability of the practitioner to link regular activity with health issues that are relevant to the individual employee, their work team and their job. New approaches, including intranet usage, or combining behavioural with environmental components, may offer promise. Some evidence for success in this area comes from health programs for employees in the armed services, emergency services or paramilitary organisations (Shephard 1996, Gomel et al. 1993). For these employees, lack of physical fitness represents an occupational hazard.
Overall in Australia, workplace physical activity programs are moving ahead of research. Many large-scale workplace programs are currently underway with varying degrees of integration, although few have been published and few are being evaluated with any real rigor. The evidence that these can contribute to population levels of physical activity remains mostly unproven.
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Egger G. (2000). Intervening in men’s nutrition: lessons from the GutBuster program. Australian Journal of Nutrition and Dietetics 57(1):46-9.
Egger G. (1999). A descriptive evaluation of the GutBuster’s ‘waist loss’ correspondence program for men. Paper presented to the Australian Society for the Study of Obesity meeting, Sydney.
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Walsh D, Jennings S, Mangione T, et al. (1991). Health promotion versus health protection? Employees’ perceptions and concerns. Journal of Public Health Policy 12:148-64.
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Next: Part 2 (cont.) - 2.5 Media- and community-wide interventions to promote physical activity
Previous: Part 2 - 2.3 Schools as settings for intervention
This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
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