Background
Methods
Sample and instrumentation
Intervention
The employees in STEP participated in a 6-month intervention consisting of
Timing | Elements of HAPA | Content of the e-mail message | |
---|---|---|---|
ORIENTATION
| |||
Preliminary meeting | Risk perception | · Information on the intervention, benefits of physical activity (PA), PA recommendations and walking | |
· Instructions on monitoring PA with a pedometer and a logbook and assessing the average number of daily steps at baseline | |||
· Presentation of the ultimate goal of adding 4000 moderate-intensity steps to the baseline on 5 days of the week | |||
MOTIVATIONAL PHASE (INTENTION BUILDING)
| |||
1st e-mail
“Regaining strength by physical activity”
| Within 2 weeks from the preliminary meeting | Positive outcome expectations, pre-action self-efficacy, action planning | · Benefits of integrating short bouts of PA into daily routine |
· The 1st goal of adding 2000 steps to the baseline on 2 days of the week | |||
· Simple tips for accumulating 2000 steps | |||
VOLITIONAL PHASE (INTENTION): PLANNING, PREPARING AND INITIATING PHYSICAL ACTIVITY
| |||
2nd e-mail
“Finding time through experience”
| 4 weeks after the 1st e-mail | Positive outcome expectations, risk perception, action planning, coping planning, self-monitoring | · Positive outcomes after even a short bout of PA |
· Examples of finding time and places to be more active | |||
· The 2nd goal of adding 2000 steps to the baseline on 5 days of the week | |||
3rd e-mail
“Making physical activity one’s own thing”
| 4 weeks after the 2nd e-mail | Positive outcome expectancies, risk perception, coping planning, maintenance self-efficacy, action planning | · Positive outcomes from being physically active |
· Examples of accumulating 4000 steps | |||
· The 3rd goal of adding 4000 steps on 2 days and 2000 steps on 3 days of the week to the baseline | |||
VOLITIONAL PHASE (MAINTENANCE)
| |||
4th e-mail
“Preparing oneself against barriers”
| 4 weeks after the 3rd e-mail | Action planning, coping planning, maintenance planning, maintenance self-efficacy | · The importance of regularity in PA |
· The most critical barriers for PA and the ways to overcome them | |||
· Example of a 30-minute walking session with 4000 steps | |||
· The 4th goal of adding 4000 steps on 4 days and 2000 steps on 1 day of the week to the baseline | |||
5th e-mail
“Getting oneself going”
| 4 weeks after the 4th e-mail | Action planning, coping planning, maintenance self-efficacy, recovery self-efficacy | · Tips for making it easier to “get oneself going” |
· The 5th goal of adding 4000 steps to the baseline on 5 days of the week | |||
6th e-mail “Establishing a physically active lifestyle”
| 4 weeks after the 5th e-mail | Action self-efficacy, maintenance self-efficacy, recovery self-efficacy, action planning | · Learning sustainable ways to be physically active |
· The importance of regularity and the possibility of rewarding oneself | |||
· Maintenance of current PA level and supplementation with muscle strengthening exercises on 2 days of the week | |||
· A printable form for a weekly action plan and monitoring |
Evaluation
Dimension | Evaluation question | Indicator | Measure |
---|---|---|---|
Reach | to what extent were the occupational health care units (OHC) and employees willing to take part and how representative were they? | Number of OHC’s and employees responding and being willing to participate in the study | Process evaluation and baseline questionnaire |
Effectiveness | What impact did the intervention have on participants walking and sitting? | Weekly minutes of walking at work, for transportation, in stairs, for leisure and of total walking; Daily minutes of sitting during a working and a non-working day | Baseline questionnaire and follow-up questionnaires at 2 and 6 months |
Did the intervention cause negative outcomes (adverse effects)? | Incidence of adverse effects due to physical activity | Follow-up questionnaires at 2 and 6 months | |
Adoption | To what extent did the recruited agents and participants complete the study? | Number of occupational health care units, worksites and participants completing the study. | Process evaluation and follow-up questionnaires at 2 and 6 months |
Implementation | Were the various intervention actions delivered as intended? | Setting level: Delivery of e-mail messages Individual level: Attendance to the preliminary meeting; Use of pedometers and logbooks, receiving and reading e-mail messages | Notes kept by the researcher; follow-up questionnaires at 2 and 6 months; standardized records kept by the occupational health care |
Maintenance | To what extent were the intervention actions maintained? | Setting level: The number of worksites where some of the intervention actions existed 6 months after the cessation of the study | Telephone-interview of the employer-representatives at 12 months |
What were the long-term effects? | Individual level: Changes in walking, sitting and subjective work ability 6 months after the cessation of the study | Baseline questionnaire and follow-up questionnaire at 12 months |
Statistics
Results
Reach
Effectiveness
Participants | ||
---|---|---|
STEP (N = 123) | COMP (N = 118) | |
Age (years), mean (SD) | 44.1 (9.4) | 45.3 (9.1) |
Women, N (%) | 87 (71) | 78 (66) |
Married, N (%) | 99 (81) | 96 (81) |
Taking care of children under 18 years of age, N (%) | 61 (50) | 69 (59) |
Education, N (%) | ||
Basic | 7 (6) | 11 (9) |
Polytechnic or vocational school | 79 (64) | 75 (64) |
University degree | 37 (30) | 32 (27) |
Working hours per week, mean (SD) | 37.4 (6.1) | 37.1 (6.8) |
Perceived physical loading at work, N (%) | ||
Sedentary | 113 (93) | 110 (93) |
Mainly standing or light mobility | 8 (6) | 8 (7) |
Heavy | 1 (1) | 0 (0) |
Subjective work ability (scale 0–10), mean (SD) | 8.0 (1.3) | 8.0 (1.4) |
Perceived health, N (%) | ||
Good or fairly good | 82 (67) | 76 (64) |
Average | 35 (29) | 34 (29) |
Fairly poor or poor | 5 (4) | 8 (7) |
Body mass index > 25 kg/m2, N (%) | 63 (51) | 76 (64) |
Baseline | 2 months | 6 months | 12 months | |||||
---|---|---|---|---|---|---|---|---|
STEP | COMP | STEP | COMP | STEP | COMP | STEP | COMP | |
Walking at work, N
|
121
|
117
|
103
|
102
|
87
|
95
|
88
|
82
|
·Weekly minutes, mean (SD) | 144 (209) | 157 (236) | 150 (159) | 174 (239) | 158 (186) | 161 (254) | 172 (191) | 145 (155) |
·Walkers, % | 98 | 96 | 98 | 98 | 99 | 94 | 99 | 96 |
Walking for transportation, N
|
121
|
115
|
106
|
102
|
87
|
96
|
85
|
85
|
·Weekly minutes, mean (SD) | 115 (172) | 134 (168) | 134 (142) | 163 (203) | 136 (147) | 138 (172) | 170 (298) | 127 (172) |
·Walkers, % | 77 | 81 | 88 | 79 | 88 | 86 | 83 | 79 |
Walking stairs, N
|
120
|
117
|
105
|
100
|
86
|
96
|
87
|
87
|
·Weekly minutes, mean (SD) | 38 (45) | 46 (100) | 62 (65) | 49 (60) | 67 (89) | 46 (52) | 63 (63) | 56 (79) |
·Walkers, % | 86 | 81 | 91 | 79 | 91 | 86 | 93 | 79 |
Walking for leisure, N
|
122
|
117
|
106
|
100
|
88
|
95
|
88
|
86
|
·Weekly minutes, mean (SD) | 72 (96) | 68 (125) | 105 (96) | 90 (119) | 96 (90) | 80 (133) | 115 (130) | 79 (102) |
·Walkers, % | 74 | 71 | 87 | 84 | 85 | 70 | 87 | 76 |
Total walking, N
|
117
|
112
|
101
|
99
|
86
|
94
|
84
|
80
|
·Weekly minutes, mean (SD) | 370 (311) | 400 (401) | 455 (255) | 465 (433) | 457 (306) | 431 (403) | 521 (468) | 395 (319) |
·Walkers, % | 100 | 100 | 100 | 100 | 100 | 99 | 99 | 99 |
Sitting during a working day, N
|
121
|
118
|
107
|
102
|
87
|
94
|
87
|
85
|
·Daily minutes, mean (SD) | 544 (152) | 554 (161) | 502 (147) | 513 (175) | 503 (165) | 520 (169) | 477 (159) | 510 (183) |
Sitting during a non-working day, N
|
121
|
117
|
105
|
100
|
87
|
96
|
87
|
87
|
·Daily minutes, mean (SD) | 347 (165) | 382 (180) | 333 (168) | 339 (170) | 331(156) | 363 (176) | 300 (153) | 347 (165) |
Logistic regressiona
| Linear modelb
| |||||
---|---|---|---|---|---|---|
Odds ratio 95% confidence interval | Geometric mean ratio 95% confidence interval | |||||
2 months | 6 months | 12 months | 2 months | 6 months | 12 months | |
Walking at work | 0.73 0.06 to 8.89 | 4.20 0.31 to 57 | 2.39 0.15 to 37.3 | 1.11 0.92 to 1.35 | 1.09 0.89 to 1.32 | 1.13 0.92 to 1.38 |
Walking for transportation | 2.12 0.94 to 4.81 | 1.28 0.53 to 3.12 | 1.57 0.68 to 3.61 | 0.84 0.64 to 1.11 | 1.08 0.82 to 1.44 | 1.03 0.77 to 1.39 |
Walking stairs | 1.44 0.64 to 3.25 | 0.97 0.40 to 2.34 | 2.24 0.94 to 5.31 | 1.26 0.98 to 1.61 | 1.27 0.98 to 1.64 | 1.18 0.91 to 1.53 |
Walking for leisure | 1.18 0.58 to 2.40 | 1.86 0.94 to 3.69 | 2.07 0.99 to 4.34 | 1.22 0.96 to 1.54 | 1.09 0.85 to 1.39 | 1.21 0.94 to 1.55 |
Total walking |
·
|
·
|
·
| 1.19 0.95 to 1.49 | 1.19 0.95 to 1.51 | 1.25 0.98 to 1.59 |
Mean differencec 95% confidence interval | ||||||
2 months | 6 months | 12 months | ||||
Sitting during working day |
·
|
·
|
·
| −3 −45 to 40 | −4 −46 to 38 | −9 −56 to 37 |
Sitting during non-working day |
·
|
·
|
·
| 30 −9 to 70 | 1 −42 to 44 | −9 −52 to 33 |
Subjective work ability(scale 0–10) |
··
|
··
|
··
|
··
|
··
| 0.3 −0.1 to 0.6 |