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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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Presentation on theme: "Ron Plotnikoff, PhD Professor University of Alberta Acknowledgment: Tricia Prodaniuk, MA, BPE Research Coordinator Slides can only be copied with permission."— Presentation transcript:

1 Ron Plotnikoff, PhD Professor University of Alberta Acknowledgment: Tricia Prodaniuk, MA, BPE Research Coordinator Slides can only be copied with permission. Physical Activity in the Workplace

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 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

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

5 Leading Causes of Death in Alberta

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

7   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

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

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


11 What can we do and where?

12   Downstream –   Midstream –   Upstream – 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 McKinlay’s (1995)

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

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   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

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

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

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

21 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:

22 llPllParticipation program rate is 20-30% with only half of these participating on a regular basis. llOllOf 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?

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

24   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

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

26 Behaviour Change Theories

27 l lProtection Motivation Theory l lTheory of Planned Behavior l lTranstheoretical Model l lSocial Cognitive Theory Theories at the Individual Level:

28 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

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

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

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

32 l l One of the most popular models in Health Promotion & Health Education in the past decade. l l Prochaska & DiClemente (1983); originally based on smoking behaviour Marcus – PA domain; worksite Transtheoretical Model

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

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

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

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

37 An Example…

38 l l Large Randomized Controlled Trial in Alberta (n=900) l l 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)

39 Step Series

40 Canada’s PA Guide

41 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

42 Time 321 Physical Activity Means Group control standard stage Women Standard Stage Control

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

45 2598 employees - 5 large Canadian workplaces were randomized and completed baseline measures Exp grp received 1 weekly PA and nutrition message (with links) for 12 wks. Methods

46 TIME 321 Estimated Marginal Means GROUP experimental group control group Men Control Exp.

47 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

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


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

51 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…

52 l l Definition F F One’s confidence in one’s ability to take action l l Application F F Provide training, guidance, in performing action F F Use progressive goal setting F F Give verbal reinforcement F F Demonstrate desired behaviours F F Reduce anxiety Theory: Self-efficacy Important

53 l l Demographical Factors: F F Age F F Sex F F Occupation F F Socio Economic Status F F Language/culture l l Stage of Readiness Tailoring Considerations

54 Our knowledge base is limited l l Most successful programs are grounded in theory (mainly at the individual level) l l Individual level strategies are partially successful – however, long-term data are needed l l Organization capacity appears to be important

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

56   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

57   Individual   Social   Organizational   Community   Government Policy & Legislation   Physical Environment Levels of Intervention



60 An Example…

61 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

62 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),

63 Phase I: Objective: development of the Program Standard Process: literature review, expert and stakeholder review Phase II: Objective: development of the Audit Tool Process: literature review, expert and stakeholder review, pilot testing Phase III: Objective: trialing the Program Standard & Audit Tool. Process: trial across diverse workplaces, qualitative interviews, revisions based on feedback Three-phased Project

64 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

65 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

66 P REPARATION P ROGRAM COMPONENTS P ROCEDURES Management & Employee Commitment Environment & Needs Assessment Program Administration Safety & Emergency Management INDIVIDUAL COMMUNITY SOCIAL ORGANIZATION POLICY

67   Management and Employee Commitment   Environmental and Needs Assessment Preparation

68   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

69   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

70 The Pedometer Craze

71   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

72   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

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

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

75 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, 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 Health Education. AHHP Publications:

76   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

77   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

78 Physical Environment Level …. Design: Longitudinal Study assessed 4 interventions for increasing stair use: 1. carpet and painting the walls 2. 2.framed art on stair landings 3. 3.motivational signs throughout the building 4. 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,

79   Program Administration e.g. evaluation   Risk Management Procedures

80 The “Framework” 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).

81 l Workplace Physical Activity Framework – High recommended/ranked in a critique of workplace health assessment tools l See: Comprehensive Workplace Health Promotion Catalogue of Situational Assessment Tools (2006, U of T)

82 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

83   Plotnikoff, R., & Moodie, J. (2003) Canadian Coalition for Active Living Policy Platform – Workplace Action Plan Other PA/Workplace Initiatives

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

85 1. 1. 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 Recommendations

86 6. 6.Use linkages with other program settings eg community, home/family 7. 7.Evaluate where possible; use valid/reliable measures; attitude & behaviour 8. 8.Ensure “buy in” from the top 9. 9.Ensure programs meet the needs of all employees Recommendations

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

88 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

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

90 Thank you! Questions? Please contact or for further *Slides can only be copied with permission.

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