Background
Work ability reflects the relation between the capacity and demands of the worker [
1]. When the workers capacity does not exceed the demands at work with a certain safety margin, this may be expressed as a decreased work ability [
2]. The importance of good work ability is highlighted by the relation between lowered work ability and stress and burnout [
3], chronic diseases [
4], long term sickness absence [
5‐
7], early retirement from the labour market [
8,
9] and all cause mortality [
10]. Accordingly, a one point reduction in work ability on a single item 10 point scale is recently shown to increase the risk for long term sickness absence by 15%, and early retirement from the labour marked by 33% [
7].
Workers with high physical work demands are well documented to be at elevated risk for impaired work ability [
11‐
13], musculoskeletal disorders [
14], cardiovascular disease [
15], all-cause mortality [
16], long term sickness absence [
17] and early retirement from the labour market [
7]. Specifically, prolonged standing, highly repetitive work, heavy lifting, working with the hands lifted to shoulder height or higher, and working with the back twisted or bent forward are physical exposures, that have been shown to predict impaired work ability, musculoskeletal disorders and enhance long term sickness absence [
14,
17,
18]. Therefore, workers in job groups exposed to these physical factors at work are at particular need for health promoting initiatives for preserving or improving their work ability [
11].
Previous initiatives applying individual counselling and education among employees with high physical work demands have not been able to show positive effects for improving work ability [
19]. In contrast, physical exercise training has been shown to prevent impairment of work ability [
20]. Because high physical work demands does not have the same positive effect on physical capacity as physical exercise training [
21‐
25], it may be effective to improve physical capacity and preserve work ability among employees with high physical work demands through physical exercise training. Accordingly, physical exercise training interventions have shown positive effects on work ability [
11,
26]. The international recommendation of health promoting physical exercise training for healthy adults is at least 30 min moderate physical activity 5 days per week [
27]. However, among employees with high physical work demands, specific health promoting physical exercise training recommendations (i.e. type, frequency, duration and intensity) remain to be established. Another initiative for preserving work ability among employees with high physical work demands is to reduce the relative workload by either participatory ergonomic intervention [
28] or by reducing the excessive body weight [
29]. By improving working techniques and cooperation with colleagues, the physical overload and peak loads can be reduced [
28]. Reduction in excessive body weight may lower the relative workload on both the musculoskeletal and cardiovascular system, and therefore preserve work ability [
29,
30]. A third initiative for preserving work ability among employees with high physical work demands may be to improve their ability to cope with their musculoskeletal disorders by cognitive behavioral theory based training (CBTr). Cognitive behavioral therapy interventions are previously shown effective for facilitation of early return to work [
31‐
33]. However, the effects of these initiatives for primary prevention of reduced work ability and sickness absence among employees with high physical work demands still remain to be established.
In the last decade, more focus has been on the workplace as a convenient arena for health promoting initiatives [
26] such as smoking cessation [
34], promotion of physical activity [
35], dietary intake modification [
36] reduction of overweight [
37], reduction of alcohol consumption [
38], prevention of musculoskeletal disorders [
39] and prevention of sickness absence among employees with musculoskeletal disorders [
40]. However, RCTs targeting the physical workload, lifestyle factors (e.g. physical exercise training) and physical capacity and pain-related cognitive and behavioral skills for preserving sufficient levels of work ability are still lacking [
11].
In the FINALE programme, health impairing effects originating from a mismatch between individual capacities and physical work demands (i.e. musculoskeletal disorders, poor work ability and sickness absence) is defined as physical deterioration. The overall aim of the FINALE programme is to evaluate effects on 1) the balance between individual capacities (i.e. ergonomic skills, muscular strength, aerobic capacity, postural stability and pain-related cognitive and behavioral skills) and physical work demands (i.e. physical exertion and reduced excessive body weight), and 2) the resulting effects on physical deterioration (i.e. musculoskeletal disorders, work ability and sickness absence) from tailored interventions to the individual capacities, physical work demands and health profile of employees from 4 job groups (i.e. cleaners, health-care workers, construction workers and industrial workers). The consequent main outcomes are musculoskeletal disorders, work ability, physical capacity, body mass index (BMI), kinesiophobia, rate of physical exertion during work and sickness absence. The primary outcome is specifically tailored to each respective intervention.
Discussion
Physical work demands exceeding the safety margin of the individual physical capacities (i.e. poor work ability) is generally considered to enhance the risk for physical deterioration, defined as musculoskeletal disorders, poor work ability and sickness absence. However, effective interventions for preventing physical deterioration in job groups at high risk remain to be established. The aim of the FINALE programme, being an umbrella for 4 tailored interventions among job groups with high risk for physical deterioration, is to evaluate the effects of balancing the relation between individual capacities and physical work demands on physical deterioration. The background, design, conceptual model and interventions of the FINALE programme have been described.
Strengths and limitations of the FINALE programme
A strength of the FINALE programme is that it constitutes 3 RCTs tailored to the physical work demands, physical capacities and health profile of different job groups characterized by a high risk for physical deterioration. This feature of the FINALE programme enhances the probability for enabling evidence-based information for public health policy and health promotion strategies among employees in job groups with high risk for physical deterioration. Another strength of the FINALE programme is that all interventions take place at workplaces, providing a high external validity of the findings. An additional strength is that several workplaces with different characteristics (e.g. rural, urban, private and municipal) from different regions of Denmark are included in the FINALE programme. Moreover, numerous subjective and objective work and health-related measures are collected. Because the same FINALE-questionnaire and many common objective measures are included in the studies, the data from all interventions can potentially be merged and analysed.
A limitation of the FINALE programme is that only simple measures of process evaluation such as proportion of workers in uptake, actual start of the programme and actual completion of the RCT are collected. Moreover, no economical cost-effectiveness evaluations are included. Another limitation is that the intervention among industrial workers is an exploratory, not well controlled study.
Impact of results
The study population of the FINALE programme (i.e. employees in job groups with high physical demands) is well documented to have a high risk for physical deterioration. If proven effective, the specific tailored interventions to the different job groups can provide meaningful scientifically based information for public health policy and health promotion strategies for employees in these job groups at high risk for physical deterioration. This knowledge can be beneficial for occupational health professionals, supervisors, companies and employees in these job groups. Because the interventions are carried out during ordinary circumstances at a wide range of Danish workplaces, it is expected that the findings can be transferred and interventions implemented in other workplaces with high physical demands.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
AH led the writing of the manuscript, and wrote the first draft of the abstract, background, methods and discussion. All authors contributed to the design and protocol of parts of the FINALE programme. KS is responsible for conception and design of the FINALE study and wrote the grant application, with contributions from MBJ, JRC, GS, JEA. MBJ and KS wrote the specific information about the FINALE - Clean study. JRC and KO wrote the specific information about the FINALE - Health study. BG and GS wrote the specific information about the FINALE - Construct study. AH and KS wrote the specific information about the FINALE - Indust study. All authors read and approved the manuscript.