Review and special article
Meta-Analysis of Workplace Physical Activity Interventions

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Context

Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research.

Evidence acquisition

Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008.

Evidence synthesis

Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, −0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, −12.6 mg/dL on fasting glucose.

Conclusions

These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.

Introduction

Although strong evidence shows that exercisers are healthier than non-exercisers, most adults do not perform enough physical activity to achieve health and well-being benefits.1 Workplaces may implement physical programs in hopes of keeping workers healthy and reducing healthcare costs.2 Because employed adults spend about half of their workday waking hours at workplaces, offering physical activity programs at work may be an efficient strategy to increase physical actvity.3, 4, 5 Convenience, group support, existing patterns of formal and informal communication among employees in a worksite, and possible corporate behavior norms are potential advantages of worksite programs over other approaches.6, 7, 8 Workplace programs may be especially important because the imbalance between physical activity and energy intake at work may contribute to the obesity epidemic.4 This meta-analysis addresses the need to quantitatively synthesize the rapidly growing literature reporting workplace physical activity programs.

Despite the potential health and economic benefits of worksite health promotion,2 no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from these programs. Several previous narrative reviews were limited in scope and unable to address either the magnitude of outcomes or potential workplace moderators of outcomes.4, 5, 9, 10 The broadest narrative review was conducted using studies published before 1995.11 Two previous meta-analyses addressed physical activity behavior outcomes across some studies included in this project. One 1998 meta-analysis of 26 studies reported an effect size consistent with a standardized mean difference of 0.22, which was not significantly different from zero. The authors noted that their attempted moderator analyses suffered from inadequate statistical power.3 A 1996 meta-analysis synthesized data for diverse adults and reported a workplace effect size consistent with a standardized mean difference of 0.35.12

This meta-analysis moves beyond the previous reported quantitative syntheses by greatly expanding the search strategies to ensure a more comprehensive synthesis, addressing both physical activity behavior and health outcomes, examining work-related outcomes, and conducting exploratory moderator analyses. The research questions were as follows: (1) What are the overall effects of interventions to increase physical activity on physical activity behavior; health (fitness, lipids, anthropometric measures, diabetes risk); well-being (quality of life, mood); and work-related outcomes (work attendance, healthcare utilization, job stress, and job satisfaction)? (2) Do interventions' effects on outcomes vary depending on workplace characteristics? (3) What are the effects of interventions on outcomes among studies comparing treatment subjects before versus after interventions?

Section snippets

Methods

Standard strategies for quantitative systematic reviews were used to locate and secure potential primary studies, determine eligibility, extract data from research reports, meta-analyze primary study results, and interpret findings.

Results

Approximately 38,231 subjects participated in the studies included in the meta-analysis (k=206 comparisons, s=138 reports).17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108,

Discussion

These findings document that some interventions improve physical activity in some subjects, and these changes may in turn improve selected health outcomes, work culture, and job stress. However, significant heterogeneity requires cautious interpretation of findings.

The physical activity mean effect size of 0.21 is similar to that reported in 26 worksite studies (r=0.11, d=0.22)3 and smaller than the effect size reported of 33 workplace studies (r=0.17, d=0.35).12 This might reflect more

Conclusion

Well-designed studies evaluating worksite physical activity promotion programs are needed. Direct comparisons between programs that allow employees to participate on paid work time versus those that do not should be investigated. Also necessary are direct comparisons of programs with and without worksite fitness facilities to determine whether the cost of providing onsite facilities is justified by improvements in employee health and productivity. Investigations targeting at-risk subjects would

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