Physical activity interventions in workplace health promotion: objectives, related outcomes, and consideration of the setting-a scoping review of reviews.

Background: The workplace is a recognized setting for promoting health among adults, and physical activity (PA) interventions are an integral part of workplace health promotion (WHP). Objectives: The present review of reviews aims to provide an overview of the main objectives and related outcomes addressed in WHP-related PA interventions, as well as the setting-specific aspects considered in the research field. Methods: A scoping review of reviews was conducted. Reviews were included if they were peer-reviewed, written in English, and focused on PA interventions conducted in the context of WHP. A literature search was conducted in PubMed, SPORTDiscus, and Web of Science. Reviews were included if they had been published after the year 2000. Information on the following dimensions was extracted: author, region, number of primary studies included, target group(s), PA interventions included, main objective(s), related outcomes, and setting-specific aspects. Results: A total of 17 reviews were included. Six reviews aimed at solely identifying the effectiveness of promoting daily PA and reducing sedentary behavior. Eleven reviews showed a combined approach considering physical activity behavior and/or health and job-related outcomes. Outcomes in the primary studies were heterogeneous. None of the reviews had an explicit definition of WHP and setting-specific information was very general and sparse. The reported setting-specific information was referred to the general importance of the workplace setting, the specific importance as an access route to target groups, and implementation aspects. Regarding the additional characteristics of the reviews, the selection of primary studies was restricted to a specific region in 2 of the 17 reviews in advance. Three reviews restricted the target group (sedentary workers, women, desk-based workers), while eleven reviews included working adults in general and, three reviews gave no information about the target group. Eleven intervention approaches of the reviews were behaviorally oriented, two focused solely on environmental interventions, and four reviews can be attributed to a combined approach considering behavioral and environmental interventions. Conclusion: For sustainable future developments, the present results indicate a strong need for conceptual consolidation of WHP in the research field of PA interventions. Therefore, both WHP and health-related PA interventions need to take a comprehensive approach comprising behavioral and environmental interventions.

Influencing factors on the health of nurses-a regression analysis considering individual and organizational determinants in Germany.

BACKGROUND: The care sector is characterized by high absenteeism of nursing care employees due to illness. Organizational determinants that can affect the mental health of nurses are known. Although nurses are confronted with different framework conditions in different care settings, there is a lack of comparative data in Germany. METHODS: The purpose of this study was to examined the relationship between work demands and employee health in different care settings. This cross-sectional survey was conducted between June and October 2021 in four acute care hospitals, seven inpatient care facilities, and five outpatient care services in Germany. 528 nursing care employees (acute care hospitals n = 234; inpatient care facilities n = 152; outpatient care services n = 142) participated in the survey (participation rate: 22.6%-27.9%). For each care setting, data was collected via questionnaire on individual determinants (gender, age, profession, working time), organizational work demands (quantitative workload, qualitative workload, organization of work, social work climate, after work situation, verbal violence, threats, physical violence) and employee health (subjective health status and work ability). Descriptive statistics and binary logistic regressions were performed. RESULTS: Increasing age (OR = 0.650, 95% CI = 0.424-0.996) as an individual determinant and organization of work (OR = 0.595, CI = 0.362-0.978) as an organizational determinant were negatively associated with subjective health. Furthermore, age (OR = 0.555, 95% CI = 0.353-0.875), a demanding organization of work (OR = 0.520, CI = 0.315-0.858), increasing quantitative workloads (OR = 0.565, CI = 0.343-0.930) and a poorer perceived social work climate (OR = 0.610, CI = 0.376-0.991) were associated with lower work ability. CONCLUSIONS: Based on the study results, health programs should target both individual and organizational factors. The findings seem to support the importance to include nursing care employees in the planning process, as it can have an impact on their health. TRIAL REGISTRATION: The project was registered in the German Clinical Trial Register (DRKS00024961, 09/04/2021).

Attention to Progression Principles and Variables of Exercise Prescription in Workplace-Related Resistance Training Interventions: A Systematic Review of Controlled Trials.

Background: The workplace is an important setting for adult health promotion including exercise training such as resistance training (RT). Since the reporting of exercise training interventions is generally inconsistent, the objective of this systematic review was to investigate the attention to principles of RT progression and variables of RT exercise prescription in workplace-related RT interventions. Methods: A systematic literature search was conducted in the databases LIVIVO, PubMed, SPORTDiscus, and Web of Science (2000-2020). Controlled trials with apparently healthy "employees" and a main focus on RT were included. RT principles and variables were extracted and rated by two reviewers (reported, not reported, or unclear). Sum scores for each RT intervention and percentages regarding each principle and variable were calculated. Results: Overall, 21 articles were included (18 primary studies, 3 protocols). Summarized narratively, the interventions showed different positive effects on strength- or performance-related and/or health- or complaint-related outcomes. The reporting of the RT principles and variables was varied [progressive overload: 94% of the studies, specificity: 78%, variation (periodization): 39%, muscle action: 94%, loading: 94%, volume; 67%, exercise selection: 89%, exercise order: 47%, rest periods between sets: 33%, rest periods between exercises: 27%, repetition velocity: 44%, and frequency: 100%]. Conclusion: Several key RT principles and variables were reported inconsistently, reducing reproducibility and pointing to the need for standardized RT intervention reporting in workplace-related interventions. Exercise science and workplace promotion should be further linked, since accurate reporting is a prerequisite for transferring robust findings into practice.

Association Between Health Literacy and Work Ability in Employees With Health-Related Risk Factors: A Structural Model.

INTRODUCTION: In workplace health promotion (WHP), health literacy and work ability are considered as outcomes of high interest. Therefore, the question arises as to what extent individual health literacy skills have an impact on work ability alongside sociodemographic influences. OBJECTIVES: This study aimed to examine the associations between a structural model of health literacy as well as sociodemographic context factors and the work ability among employees with health-related risk factors. MATERIALS AND METHODS: The study was based on baseline data of a workplace-related intervention (158 employees with health-related risk factors, 53.8% women, 48 ± 10 years). Health literacy skills were assessed with Lenartz's Questionnaire (measuring "self-perception", "proactive approach to health", "dealing with health information", "self-control", "self-regulation", and "communication and cooperation"). Work ability was measured by the German Short Form of the Work Ability Index (WAI). As sociodemographic context factors, sex, age, and educational level were assessed. The associations were examined using structural equation modeling with partial least squares (SmartPLS 2.0.M3). Common quality criteria were applied and significance level was set at α = 5%. RESULTS: Model's reliability, validity, and structure could be validated. Regarding the impact on work ability, "self-regulation" showed a statistically significant direct effect (ß = 0.32, t (∞) = 4.00, p < 0.01, f 2 = 0.09) and "self-perception" had a significant indirect effect (ß = 0.13, t (∞) = 2.53, p < 0.05). The only additional association with work ability was found for age (ß = -0.25, t (∞) = 3.82, p < 0.01, f 2 = 0.04). The WAI score variance was explained to 17.5% by the health literacy skills and to 27.5% considering the additional sociodemographic context factors. CONCLUSION: According to the structural model of health literacy, in employees with health-related risk factors, a target group-specific WHP approach could be the encouragement of self-regulation and self-perception. However, additional resources and conditions influencing work ability should be considered.

Health literacy, health status and health behaviors of German students- study protocol for the "Healthy Habits" cohort study.

BACKGROUND: The emerging adulthood is traditionally viewed as a time of optimal health, but also as a critical life span, characterized by changing life circumstances and the establishment of an individual lifestyle. Especially university life seems to hold several challenges impeding the manifestation of a health supporting manner, as many students tend to show a poorer health behavior and a higher amount of health-related problems than comparable age groups. This, along with a steady growth of the higher education sector, brings increased attention to the university setting in the context of prevention. To date, there are few empirical longitudinal and coherent cross-sectional data on the status of students' health literacy, health status, and health behaviors, and on the impact of the study format on students' health. The aim of this prospective cohort study is to reduce this research gap. METHODS: Starting during winter semester 2020/21, the prospective cohort study collects data on health literacy, health status and health behavior on a semester-by-semester basis. All enrolled students of the IST University of Applied Sciences, regardless of study format and discipline, can participate in the study at the beginning of their first semester. The data are collected digitally via a specifically programmed app. A total of 103 items assess the subjectively perceived health status, life and study satisfaction, sleep quality, perceived stress, physical activity, diet, smoking, alcohol consumption, drug addiction and health literacy. Statistical analysis uses (1) multivariate methods to look at changes within the three health dimensions over time and (2) the association between the three health dimensions using multiple regression methods and correlations. DISCUSSION: This cohort study collects comprehensive health data from students on the course of study. It is assumed that gathered data will provide information on how the state of health develops over the study period. Also, different degrees of correlations of health behavior and health literacy will reveal different impacts on the state of students' health. Furthermore, this study will contribute to empirically justified development of target group-specific interventions. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00023397 (registered on October 26, 2020).

Supporting Cross-Company Networks in Workplace Health Promotion through Social Network Analysis-Description of the Methodological Approach and First Results from a Model Project on Physical Activity Promotion in Germany.

Cross-company networking and counseling is considered to be a promising approach for workplace health promotion in small and medium-sized enterprises. However, a systematic and empirical approach on how such networks can be developed is lacking. The aims of the present paper are to describe the approach of a social network analysis supporting the development of a cross-company network promoting physical activity and to present first results. In the process of developing the methodological approach, a common understanding of the nodes and edges within the project was elaborated. Based on the BIG-model as the theoretical framework of the project, five measuring points and an application-oriented data collection table were determined. Using Gephi, network size, degree, and distance measures, as well as density and clustering measures, were calculated and visualized in the course of the time. First results showed a continuous expansion and densification of the network. The application experience showed that the application of social network analysis in practical cross-company network development is promising but currently still very resource intensive. In order to address the current major challenges and enable routine application, the development of an application-oriented and feasible tool could make an essential contribution.

Questionnaire choice affects the prevalence of recommended physical activity: an online survey comparing four measuring instruments within the same sample.

BACKGROUND: Since prevalence estimates of recommended physical activity (PA) considerably vary between different surveys, prevalence might be crucially affected by the choice of measuring instrument. The aim of the present study is to compare the results of four PA questionnaires regarding the current moderate- and vigorous-intensity aerobic PA (MVPA) recommendations of the World Health Organization. METHODS: Within an online survey, participants answered the German Health Interview and Examination Survey for Adults (DEGS), the European Health Interview Survey PA Questionnaire (EHIS), the Eurobarometer (EURO), and a single-item measure (SIM). Weekly volume of MVPA was compared via a Friedman test and the prevalence of participants achieving the WHO's MVPA recommendation via Cochran's Q. Agreement between all questionnaire pairs was evaluated via Kappa statistics. RESULTS: One hundred seventy-six participants were included in the analyses (70.5% female, mean age: 33.1 years (SD=12.2)). Between the four questionnaires, the weekly volume of MVPA statistically significant differed (SIM: MED=90.0 (MIN=0.0, MAX=210.0), DEGS: MED=120.0 (MIN=0.0, MAX=420.0), EHIS: MED=24.0 (MIN=0.0, MAX=1395.0), EURO: MED=51.0 (MIN=0.0, MAX=2430.0), p<.001, all pairwise comparisons p<.01), as well as the prevalence of participants achieving the MVPA recommendations (SIM 31.3% (95% CI 24.5-38.7), DEGS 43.2% (95% CI 35.8-50.8), EHIS 67.0% (95% CI 59.6-73.9), EURO 87.5% (95% CI 81.7-92.0), p<.001), except between SIM and DEGS (p=.067). Agreement was weak between all questionnaire pairs (all κ< 0.60). CONCLUSIONS: Questionnaire choice crucially affects the resulting MVPA data and hence the prevalence of achieving recommended PA levels within the same sample. Therefore, for PA surveillance, standardised survey and analysis methods and efforts to harmonise monitoring systems are needed, since whether recommended levels of PA are achieved should not be determined by the choice of one measuring instrument or another.

Associations between health-related skills and young adults' work ability within a structural health literacy model.

Young adults have a high societal relevance but are still an under-represented target group in health promotion. Health literacy is widely acknowledged as one of the strongest predictors and key determinant of health, so its influence on work ability is of great interest. The purpose of the study was to examine the associations between health-related skills and work ability within the structural model of health literacy of Lenartz, Soellner and colleagues, which explains health behaviour and health through the indirect and direct influence of six 'advanced skills' ('self-perception', 'proactive approach to health', 'dealing with health information', 'self-control', 'self-regulation' and 'communication and cooperation'). The cross-sectional study was based on baseline data of a health literacy promotion intervention (495 vocational school students, 59.0% female, age span 18-25 years). Structural equation modelling with partial least squares was used to examine the associations between the six constructs of the model and the Work Ability Index (WAI). Mean WAI score was 39.7 ± 4.5 (51.1% categorized 'moderate'/'poor'). Five out of six constructs of the model showed a statistically significant indirect or direct effect, respectively, on work ability. The model explained 24.8% of the WAI score variance. Our findings show associations between the health literacy model and the work ability among young employees. In view of demographic change, it is crucial to develop and analyse target group-specific health literacy interventions. The model offers new facets in the modelling of health literacy.

Theory-Based, Participatory Development of a Cross-Company Network Promoting Physical Activity in Germany: A Mixed-Methods Approach.

The untapped potential of workplace health promotion (WHP) in smaller companies and the promising approach to promote physical activity in the workplace requires application-oriented approaches. This study describes the participatory, theory-based development of a cross-company network with a multicomponent intervention for promoting physical activity in smaller companies. The BIG-Manual (from the "Movement as an Investment for Health" project, German-BIG) was the theoretical framework for developing the cross-company network. Qualitative and quantitative data sources were used to identify the requests and requirements of stakeholders (employees on site, local exercise providers, company representatives and network partners) regarding measures promoting physical activity and the cross-company network. The methods applied included two workshops (n = 13; n = 15), individual semi-structured interviews (n = 8) and a survey (n = 285). The analysis revealed that a large number of stakeholders must be taken into consideration for physical activity promotion in cross-company networks. Many similarities between the requests of employees and further stakeholders concerning a multicomponent intervention for promoting physical activity could be identified. Present gender-specific and physical activity-related differences show the importance of target group-specific intervention planning in the context of WHP. This study makes an important contribution for the development of future cross-company networks promoting physical activity and yields valuable information for the design of a multicomponent intervention promoting physical activity.

Engagement with a Web-Based Health Promotion Intervention among Vocational School Students: A Secondary User and Usage Analysis.

Engagement with web-based interventions is both generally low and typically declining. Visits and revisits remain a challenge. Based on log data of a web-based cluster randomized controlled trial conducted in vocational schools, the present secondary analysis aimed to identify influencing factors on initially logging in to a health promotion platform among young adults and to examine the engagement over the course of an eight-week intervention. Data of 336 students (62.2% female, age span 18-25) from two intervention arms (web-based intervention and web-based intervention with an additional initial face-to-face contact) was included. Binary logistic regression and log-data visualization were performed. An additional initial face-to-face contact (odds ratio (OR) = 2.971, p = 0.005), female sex (OR = 2.237, p = 0.046) and the health-related skill "dealing with health information" (OR = 2.179, p = 0.030) significantly increased the likelihood of initially logging in. Other variables showed no influence. 16.6% of all potential users logged in at least once, of which 57.4% revisited the platform. Most logins were tracked at the beginning of the intervention and repeated engagement was low. To increase the engagement with web-based interventions, health-related skills should be fostered. In addition, a strategy could be to interlink comparable interventions in vocational schools more regularly with everyday teaching through multi-component interventions.

Health literacy promotion among young adults: a web-based intervention in German vocational schools.

Against the background of an ageing population, the target group of young adults holds strong societal relevance as the future workforce. At the same time, young adults find themselves in a critical phase of life regarding the manifestation of a healthy lifestyle. In this context, young adults' health literacy gains importance. Web-based interventions implemented in educational settings offer the potential for promoting health literacy, although longitudinal studies remain scarce. Within a pre-post cluster randomized controlled trial with 6-month follow-up, this study investigated whether an 8-week web-based intervention in vocational schools (with or without an additional initial face-to-face measure) improves individual competencies within a structural model of health literacy ('self-perception', 'proactive approach to health', 'dealing with health information', 'self-control', 'self-regulation' and 'communication and cooperation'). The control condition was regular school lessons following the curriculum only. A multi-level regression analysis was performed using the control group as reference. None of the interventions showed a significant improvement in any of the dimensions. Significant differences between the intervention and control were obtained for some dimensions, albeit showing reductions. Future research must examine how to build impactful health literacy promotion in educational settings. Investigations into linking digital and face-to-face measures should continue.

Health coaching for promoting physical activity in low back pain patients: a secondary analysis on the usage and acceptance.

BACKGROUND: Multicomponent interventions combined with health coaching are widely recommended to improve a healthy lifestyle. The aim of the present study was to analyse the usage and acceptance of a multicomponent intervention (telephone, web and face-to-face coaching) for low back pain patients, and thereby gain an understanding of why this intervention was not as effective as expected. METHODS: A secondary analysis of a randomised controlled trial, aimed at promoting physical activity, was conducted. It was a cross-sectional study based on data of a multicomponent intervention group (baseline = 201 participants). For evaluating the usage and acceptance, descriptive statistics were applied. RESULTS: Over half (n = 118) of the patients participated at least once in the telephone coaching. Approximately half of the participants (44 of 90) rated the telephone coaching as "good".34 of 92 (37%) participants reported of visiting the web-platform. The web-platform was comprehensible for nearly one-quarter (n = 8 of 33) and very useful for one participant.The face-to-face-contact was rated highly (range: 79.4-88.2 out of 100). CONCLUSION: Usage of the telephone coaching approach was moderate with even fewer participants visiting the web-platform. In addition, these approaches were not rated as very useful. The acceptance of the face-to-face contact was high.Since the usage and acceptance could influence the effectiveness, utilisation and acceptance studies might help to explain the reason for non-effective lifestyle interventions. Therefore, more studies analysing the usage and acceptance are needed. To improve the usage and acceptance, a stronger participatory orientation in the design of interventions and the integration of face-to-face contact could be helpful.

Show cards of the Global Physical Activity Questionnaire (GPAQ) - do they impact validity? A crossover study.

BACKGROUND: The Global Physical Activity Questionnaire (GPAQ) is applied internationally as a tool to assess the level of physical activity. The GPAQ was designed as an interview, including the use of show cards, which visualise activities of moderate and intensive physical activity and support the distinction between these intensities. The self-administered version of the GPAQ is used in the application-oriented research for reasons of economy and practicality. However, the use of show cards often remains unknown. The aim of the present study was to examine differences in validity between two self-administered versions of the GPAQ with and without show cards. METHODS: In this crossover study, two groups (n = 54; 57.4% female; 28.3 ± 12.2 years) received the GPAQ with or without show cards after 7 days and the respective other version after additional 7 days. For validation, all participants wore an accelerometer (ActiGraph GT3X+) on all 14 days. Differences between GPAQ versions and accelerometer data were compared by Wilcoxon signed rank test. Additionally, Spearman analyses and Bland-Altman plots were calculated. RESULTS: No statistically significant difference between the GPAQ versions could be found in regard to the accuracy of physical activity assessment (p > 0.05). Both GPAQ versions show similar correlation coefficients for vigorous physical activity (rho = 0.31-0.42) and sedentary behaviour (rho = 0.29-0.32). No statistically significant correlation was found for physical activity of moderate intensity. The Bland-Altman plots support these results, as both GPAQ versions have the same trends in terms of overestimation and underestimation of physical activity. CONCLUSION: The use of show cards had no significant impact on questionnaire validity. Therefore, both GPAQ versions can be applied interchangeably. Nevertheless the exact description of application of the GPAQ is desirable in terms of reproducibility and transparent scientific research.

Influence of Health Literacy on the Physical Activity of Working Adults: A Cross-Sectional Analysis of the TRISEARCH Trial.

Studies show that high health literacy (HL) can support the promotion and maintenance of healthy behavior such as physical activity (PA). However, most studies rely on subjective data. The aim of the present study is to investigate the relationship between HL and PA, not only with subjectively but also with objectively measured PA data. The present study is a pooled analysis of baseline data from the research association TRISEARCH (2015-2018), which focused on the HL of working adults. HL was measured by Lenartz' questionnaire, and PA by the Global Physical Activity Questionnaire (GPAQ; n = 1056). A subsample (n = 124) also received accelerometers (Actigraph GT3X+) to provide more objective PA data. Partial correlations and regression models were used to investigate the relationship between HL and questionnaire- and accelerometer-derived PA. Very low and medium partial correlations could be found for HL subscales and daily PA by questionnaire (r = -0.06, p < 0.05) and accelerometer (r = 0.26, p < 0.01). No subscale of HL made a significant contribution to the amount of daily PA (all p > 0.05). Not all subscales of HL seem to have an influence on the occurrence of healthy behavior, such as PA. This should be considered when HL-based interventions are designed. Further investigation of the relationship between HL and PA is needed. Objective assessments of both HL and PA can provide additional information for this task.