Activate Your Health, a 3-year, multi-site, workplace healthy lifestyle promotion program: study design

The World Health Organization states that chronic conditions are the leading cause of death and disability worldwide [1]. More than one out of every five Canadian lives with one of the following chronic conditions: cardiovascular disease, cancer, chronic respiratory disease, or diabetes [2]. These four chronic diseases represent 67% of annual deaths [3].

In Canada, 50% of workers live with a minimum of one chronic condition [4]. This situation increases absence rates due to functional limitations and creates a financial burden to the employers [5]. Moreover, poor health and unhealthy lifestyle habits were observed to decrease productivity [6]. Thus, decreasing chronic conditions is crucial. This could be achieved by adopting healthy lifestyle habits [7, 8]: i.e., being physically active, eating healthy, limiting alcohol and tobacco, and having good sleep habits, [9] which can prevent at least 70% of major chronic diseases [10]. Engaging in 180 min of moderate intensity physical activity (PA) per week, which is roughly the recommended amount of PA, decreases the risk of mortality [11]. However, it has been noted that the Canadians lack compliance to the recommendations for a healthy lifestyle. For example, 78% of Canadians are not sufficiently active and 60% have poor eating habits [12]. It is also encouraging to note that partly fulfilling the recommendations could have beneficial effects on health. For example, a sedentary individual who does any PA would benefit from a decrease in mortality risk [11].

Some of the reasons for failing to comply with these healthy lifestyle recommendations are a lack of time, social norms, built environment and cost [13]. As workers spend roughly 8 h per day at work [14], a program targeting changes in the lifestyle habits could begin at the workplace. To do so, some companies have started seeking the help of health specialists to improve their workers’ lifestyle habits and working environment by implementing a workplace health promotion program (WHPP). Studies indicate that these programs are beneficial for the workers’ physical [15, 16] and mental [17, 18] health, but also improve their work performance by increasing productivity [19, 20] and decreasing absenteeism [21]. These changes indirectly reduce health-care costs [22] and increase “return on investment (ROI)” [19, 22]. Hence, WHPP would advantage the workers, employers and the society as a whole [23‐25]. However, this type of program needs to be designed properly. For example, a WHPP offering only a health-related questionnaire and/or an online platform does not lead to a successful outcome [26]. Moreover, to detect the population health effects and to yield a positive ROI, a minimum of 3 years of implementation is suggested [26].

Capsana is a Canadian organization dedicated to promoting healthy lifestyle habits, and preventing and managing chronic diseases in the workplace for the past 25 years. In 2015, Capsana [27] created a program called “Activate Your Health”. This WHPP allows workers to adopt healthy lifestyle habits in their workplace with web-based and tailored interventions along with personalized advice over a 3-year period. The program also helps workers identify their risk factors associated with chronic diseases. In addition, it also assists the employers in changing the culture of health within the company in the goal of supporting the employees in achieving a better health profile and lifestyle habits. The eventual goals of the evaluation component of the Activate Your Health program are to evaluate the effectiveness of this WHPP on the short and long term, investigate which workers would benefit the most, compare the responses to the different interventions, and identify the challenges associated with the implementation of this type of program in the participating workplaces. We hypothesize that the option targeting several lifestyle habits at once will yield the biggest improvement in health and work-related parameters. The aim of the current paper is to describe the Activate Your Health WHPP.

There is a growing body of literature confirming that WHPPs are advantageous for employees’ physical and mental health, and this has been confirmed objectively and/or subjectively [35‐38]. WHPP also improves employee’s lifestyle habits, which are related to the presence of chronic diseases [9, 10]. These programs benefit the individual, company and the society [23‐25]. The current study describes a recently implemented program called Activate Your Health that aims to improve employees’ lifestyle habits through a WHPP in the working environment. The data collected through this WHPP will be used for the first time to evaluate the efficacy of this large-scale program.

One of the potential strengths of the Activate Your Health is that it targets multiple modifiable lifestyle habits and biometric measures associated with a decrease in the risk of cardiovascular disease and stroke [39]: eating healthy, being physically active, discontinuing smoking, and maintaining a healthy weight, blood pressure range, blood cholesterol and glycaemia. Recent studies in the field targeting at least three habits [40, 41] were observed to be effective. Therefore, it is expected that multiple lifestyle habits in one option would lead to greater health benefits for employees. Adherence rates in WHPP are generally in the low range [42] (< 50%), and web-based interventions, when tailored, were observed to be effective [43] only for a short period of time after the study period [44]. In the current study protocol, the web-based tailored interventions are accompanied with the support of different health professionals (nurse, nutritionist and exercise specialist/kinesiologist) throughout the 3-year period. Therefore, the adherence rate and effectiveness of the options A, B and C are expected to be higher. In addition, a study [45] with a similar approach, i.e., targeting six health behaviors, but differing in the study population (male participants at high risk of cardiovascular disease without a control group), the variety of interventions offered (3.5 h of health promotion class), and study duration (6 months) led to an increase in physical activity, improved stress management, diet control, blood pressure, total cholesterol and BMI, which are some of the variables that will be included in future studies. Therefore, Activate Your Health might lead to similar or better results as it regroups any health profile of employees, has a longer study period, provides different interventions that are web-based, and support the company in creating a favorable work environment.

One of the advantages of the Activate Your Health program is the varying number of interventions, which allows us to compare the effect of different combinations of interventions on health and work-related variables. We did exclude the option D as none of the companies chose that option. We can deduct that such an option might be less appealing for companies. It would have been interesting to compare the option A, which contains all the interventions targeting eating and PA habits vs. the option D, which had only interventions improving eating habits. Nevertheless, we do have the limited option (control group) that did not receive any interventions to compare the effectiveness with the other options. Moreover, Nöhammer et al. (2010) suggested that WHPP could benefit from documenting the employee’s perspective of the interventions. At the end of the current WHPP, a questionnaire regarding each intervention will be sent to all the employees, in order to study their perspective. Also, throughout the year, Capsana also supports each company in the creation of a favorable environment by providing advice and/or help [46]. Modifying the work environment by decreasing unhealthy food available at the work site within the company, for example, could have positive impact on the employees’ health and the organization as a whole [46].

Some limitations should be considered. The data collection method consists of filling questionnaires. Most of the variables of interest, such as PA level and eating habits, in the current program and its variations come from these self-reported answers. Objective measures such as accelerometer data could have been used to identify the changes that are taking place within the different options. Moreover, participants who have successfully changed their lifestyle habits will be more inclined to remain actively involved in the Activate Your Health program, and to be reassessed, which was the case in another study [47]. In addition, Nilsen et al. [47] (2014) noted the majority of their participants with diabetes who dropped out were the participants with a poor life satisfaction and needed help with their lifestyle habits. Taking these observations into account, specific analysis will be performed to examine this aspect in Activate Your Health.

In the Activate Your Health program, among other advantages, assessing employees’ health using health-related assessments, targeting several lifestyle habits at once, offering tailored interventions, providing social platforms, improving the workplace environment, and offering a three-year program would most likely improve employees’ lifestyle habits [46]. Future studies will also focus on gender and body weight status response. In the end, the goal would be to articulate which type of intervention works best and for whom, to consolidate but also to improve interventions.