Ron Plotnikoff, PhD Professor University of Alberta Acknowledgment: Tricia Prodaniuk, MA, BPE

1. 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.

2. 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

3. 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.

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

5. Leading Causes of Death in Alberta

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

7. Workplace Issues • 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

8. Prevalence Approximately two-thirds of Canadian adults are risking their health and quality of life because of inactive lifestyles. (CFLRI, 2001)

9. Of Great Significance Physical Activity/CVD: Population Attributable Risk • ↑ Obesity • ↑ Diabetes Type II • = ↑Mortality/Morbidity & Economic Costs

10. CONTRIBUTING FACTORS

11. What can we do and where?

12. individually oriented treatments interventions aimed at worksite organizations, health care settings and entire communities macro-level programs and healthy public policies Population Model of Prevention • Downstream – • Midstream – • Upstream – McKinlay’s (1995)

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

14. 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

15. 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

16. 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

17. Lower medical costs • drug purchases • doctors’ visits • hospital days • disability days

18. Employee Benefits of PA • Improved health and well-being • Social benefits (Reducing barriers between co-workers) • Increase employee commitment

19. Health Benefits of Workplace PA Programs • Cancer • Type II Diabetes • Anxiety • Cardiac Risk • Health Hazard Appraisal Scores • Blood Pressure • Body Mass Index • Bone density

20. 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 Med15:344-361

21. Workplace PA Meta-analysis con’t: Activity Supervision • Supervised (.15) • Not supervised (.12) Incentive Reinforcement • Incentives (.18) • No Incentives (.10) PA Measure • Self-report (.14) • Cardiorespiratory fitness (.09)

22. 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.

23. Factors Associated with Participation Rates • Demographics: gender, socioeconomic status, occupation, visible minority groups (culture, language) • Organizational Capacity (will, infrastructure, leadership) • Working conditions • Physical environments

24. 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)

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

26. Behaviour Change Theories

27. Theories at the Individual Level: • Protection Motivation Theory • Theory of Planned Behavior • Transtheoretical Model • Social Cognitive Theory

28. 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).

29. Protection Motivation Theory Vulnerability Fear Severity THREAT APPRAISAL PROTECTION MOTIVATION Self Efficacy(perceived ability) Response Efficacy (perceived consequences) COPING APPRAISAL

30. Protection Motivation Theory Vulnerability Fear Severity THREAT APPRAISAL Intentions BEHAVIOR Self Efficacy(perceived ability) Response Efficacy (perceived consequences) COPING APPRAISAL

31. Theory of Planned Behavior Attitude Toward Behavior Subjective Norms Intention Behavior Perceived Behavioral Control

32. 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

33. Stage of Behaviour Change Model Maintenance Action Preparation Contemplation Pre-Contemplation

34. TTM - Constructs • Self-efficacy • Decisional Balance + Pros - Cons • 10 Processes of Change

35. Transtheoretical Model • Health practitioners seem to like it….Why? …staging concept; easy to use widgets

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

37. An Example…

38. Workplace Physical Activity StudyPlotnikoff et al (under review, Am J Health Prom) • Large Randomized Controlled Trial in Alberta (n=900) • Funded by the Canadian Institutes for Health Research and Alberta Heritage Foundation for Medical Research

39. Step Series

40. Canada’s PA Guide

41. 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

42. Women Stage 1200 Standard 1100 Control 1000 Group Physical Activity Means control 900 standard 800 stage 1 2 3 Time

43. Workplace Physical Activity and Healthy Eating - Electronic Messaging Study Plotnikoff, McCargar, Wilson & Loucaides (2005) American Journal of Health Promotion Funded by Health Canada

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

45. 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.

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

47. 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 > importance of tailoring messaging/information re: gender specificity • Consistent with much of women’s health information e.g., decisional aids

48. Discussion Con’t • Study recruitment: more women participants • Men have higher baseline activity scores than women (both studies) -- ceiling effects for men

50. Gender Differences - self-efficacy - intention - cons Men reported higher means Women reported higher means