1. Exercise Is Medicine In the Workplace Elizabeth Joy, MD, MPH, FACSM Medical Director, Clinical Outcomes Research Intermountain Healthcare Adjunct Professor, Family & Preventive Medicine University of Utah School of Medicine

2. 40,000,000 – 50,000,000 US adults do not meet recommended physical activity levels

3. Epidemic of Physical Inactivity

5. 1999 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

6. Half of all adults in the United States will be obese by 2030. Lancet 2011 Resulting in: 7.8 million extra cases of diabetes 6.8 million extra cases of coronary heart disease and stroke 539,000 extra cancer cases by 2030 Increase in health care costs of $66 billion per year by 2030.

7. Michelangelo's DAVID Goes Home To Italy His Proud Sponsors were: After a two year visit to the United States, Michelangelo's David is returning to Italy...

8. Physical inactivity: the biggest public health problem of the 21st century Steven N Blair Br J Sports Med January 2009 43(1)

9. Fit vs. Fat

10. Physical Activity vs. Exercise Physical Activity: – Physical activity includes activity that is part of your daily life. Household, workplace and lifestyle physical activity are three of the most common types of physical activity Exercise: – Exercise is a form of physical activity that is planned, structured and done to improve at least one aspect of physical fitness, that is, strength, flexibility or endurance.

11. Adults Moderate intensity aerobic activity for at least 150 minutes per week Resistance training 2 times per week

13. Making the Case: Why Businesses Should Care about Physical Activity in the Workplace Health care costs are a significant and growing element of overall employment costs for businesses offering benefits Companies of all sizes are affected by absenteeism and lost productivity from employee illness, injury, obesity, and/or chronic conditions. Obesity alone has been estimated to cost employers almost $2,500/employee/year, including direct medical expenditures and absenteeism.

14. Vast majority of U.S. citizens are linked in some way to a worksite. Provides a unique opportunity to improve employees’ lives and transform the workplace.

15. The Association Between Optimal Lifestyle Adherence and Short-Term Incidence of Chronic Conditions among Employees Optimal lifestyle defined as: 5+ servings F&V, No tobacco use, > 150 min PA, limited or no ETOH N=6848 employees Evaluated incidence of heart disease, diabetes, high blood pressure, cancer, back pain, and high cholesterol over 2 years Adherence to optimal lifestyle, in particular adequate physical activity, was associated with lower risk of developing several chronic conditions Population Health Management Pronk 2010

16. Adherence to any 3 components of the optimal lifestyle was associated with a, – 46% reduction in development of diabetes – 31% reduction in the development of low back pain Adherence to all 4 optimal lifestyle components was significantly associated with a – 56% reduction in the development of low back pain Physical activity was associated with a – 40% lower development of heart disease – 20% reduction in high cholesterol – >50% reduction in the risk of developing diabetes

20. WE NEED TO MOVE MORE…. Regular exercise Out of their chair & off the couch Active living: active transportation, household activities (gardening), play, walk the dog

21. STRATEGY 1 Identify, summarize, and disseminate best practices, models, and evidence-based physical activity interventions in the workplace. STRATEGY 2 Encourage business and industry to interact with all other sectors to identify opportunities to promote physical activity within the workplace and throughout society. STRATEGY 3 Educate business and industry leaders regarding their role as positive agents of change to promote physical activity and healthy lifestyles within the workplace and throughout society, giving particular consideration to efforts targeting low-resource populations. STRATEGY 4 Develop legislation and policy agendas that promote employer- sponsored physical activity programs while protecting individual employees’ and dependents’ rights. STRATEGY 5 Develop a plan for monitoring and evaluating worksite health promotion programs.

23. 7 Steps to Wellness Step 1: Building Support – Make the case for a culture of wellness that values physical activity among employees – Support is something that needs to be maintained and it is a continual process Step 2: Planning and Assessing – Develop a Wellness Committee – Create and follow time lines – Integrate ongoing assessment to evaluate and enhance the program.

24. Step 3: Promoting – Market the programs and activities to employees. – Determine incentives or rewards you will provide to encourage employee participation Step 4: Implementing – Determine the readiness for change, and resources of both your employees and organization – Think of this as 4 stages: 1) getting started 3) moving forward 2) building momentum 4) keeping the pace What barriers do you anticipate? How would you overcome them?

25. Step 5: Evaluating – How would you evaluate success? – What are the metrics? Step 6: Sharing Results – How would you share your program successes with others—both internal and external to the organization? Step 7: Sustaining – How do you maintain buy-in, build resources to support the program(s), and leverage organizational and community resources.

26. 1.Capturing CEO Support 2.Creating Cohesive Wellness Teams 3.Collecting Data To Drive Health Efforts 4.Carefully Crafting An Operating Plan 5.Choosing Appropriate Interventions 6.Creating A Supportive Environment 7.Carefully Evaluating Outcomes

27. WELCOA Case Study “The most important lessons learned along the way include the importance of management buy-in and commitment, staying the course with continuous improvement, creating a supportive work environment, the importance of meaningful incentives, and communication, communication, communication!“

28. Well Workplace Checklist Interactive assessment to determine how your organization is doing with respect to worksite wellness. Complete all of the questions associated with the Checklist — the entire process should be about 20 minutes. Download a short report outlining your overall scores. Full report to follow by email. http://www.welcoa.org/wwpchecklist/

29. Example Policies Policies that May Promote Physical Activity: – Allowing employees to use paid time (not lunch or breaks) to be active during the workday. – Allowing employees to use flex time. (This means starting earlier or later than the typical workday or permitting employees to work longer hours on some days to allow for additional time off later.) – Allowing for incentives or rewards for employees who are physically active. Policies that May Hinder Physical Activity: – Requiring a strict dress code policy. – Mandating employees to be on-site at all times. – Scheduling mandatory meetings during the lunch hour.

30. Example Programs

31. How Many Calories Do You Burn Walking Up the Stairs? 2 – 3 calories per flight 10 calories per minute ascending 7 calories per minute descending 100 calories (1 mile)  ascend for 10 minutes 300 calories (3 miles)  ascend for 20 minutes, and descend for 15 minutes

32. Changing the Environment

33. A systematic review of the cost-effectiveness of worksite physical activity and/or nutrition programs. Scand J Work Environ Health. 2012 Sep;38(5):393-408 – There is substantial need for improvement of the methodological quality of studies Return on Investment

34. Physical inactivity: the biggest public health problem of the 21st century Steven N Blair Br J Sports Med January 2009 43(1)

35. Fit vs. Fat

36. Sitting is Dangerous to Your Health

37. Summary Conclusive evidence that 150 minutes/week of MVPA reduces all-cause mortality Fitness matters more than fatness Time spent sitting is an independent predictor of mortality The NEW EXERCISE PRESCRIPTION:: 150 minutes of MVPA weekly + movement throughout the day to avoid prolonged sitting None is bad, some is good, more is better

38. Liz.Joy@imail.org Thank You!!!