Company-Level Assessments and Organizational Policy Recommendations for the Promotion of Physical Activity and Cardiorespiratory Fitness : ACSM's Health & Fitness Journal

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Columns: Worksite Health Promotion

Company-Level Assessments and Organizational Policy Recommendations for the Promotion of Physical Activity and Cardiorespiratory Fitness

Pronk, Nico P. Ph.D., FACSM, FAWHP

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ACSM's Health & Fitness Journal: 11/12 2022 - Volume 26 - Issue 6 - p 47-50
doi: 10.1249/FIT.0000000000000819
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INTRODUCTION

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Habitual physical activity and resulting cardiorespiratory fitness (CRF) is beneficial to the health and well-being of workers (1,2). It also should be noted, however, that additional benefits accrue to employers when employees are active, less sedentary, and fit. Employers should not merely rely on programs that attempt to improve levels of physical activity through individually focused behavior change initiatives alone. Rather, at the same time, employers should create environments that promote physical activity, reduce sedentary behavior, and optimize CRF. Doing so has been identified with myriad company benefits, and Table 1 presents 20 selected examples of such benefits.

TABLE 1 - Twenty Selected Company-Level Benefits of Habitual Physical Activity and Cardiorespiratory Fitness
1 Higher overall productivity
2 Lower illness absence
3 Lower presenteeism
4 Reduced physical injury and cognitive impairment rates
5 Improved overall worker health and well-being
6 Improved organizational culture of health and well-being
7 Enhanced customer experience
8 Enhanced coworker interactions and teamwork
9 Improved team performance
10 Enhanced marketplace performance
11 Enhanced corporate financial performance
12 Enhanced corporate image
13 Enhanced retention of talent
14 Enhanced talent recruitment
15 Higher job satisfaction
16 Reduced health care need
17 Lower health care costs
18 Lower disability costs
19 Reduced frequency of errors
20 Reduced reportable injuries
Selected examples of enterprise/organization/company-level benefits of an active and fit workforce. Examples adapted from Pronk (1,2).

To improve upon current levels of movement and fitness through organizational initiatives, company-level assessments are needed to identify opportunities for change and to establish markers for progress. Such assessments should consider the physical, emotional, social, cultural, and economic environments. Baseline assessments can support the identification of gaps and generate recommendations for changes, whereas follow-up assessments can be used to monitor progress. This column is focused on highlighting available assessments and scorecards that address this topic and special emphasis is placed upon policy approaches.

COMPANY-LEVEL ASSESSMENT TOOLS

Measuring change of company-initiated programs and policies that affect employees regardless of their health status (e.g., establishing walking trails on the company campus) can only be accomplished when reliable and valid measurement tools are available. Company-level assessment tools designed to measure ways in which an organization promotes and enables movement, physical activity, or CRF at the workplace come in various forms—some focused on multiple health behaviors (3–5), whereas others include broader environmental interests such as safety (6), culture (7), or other health risks (8–11). For example, the Environmental Assessment Tool (4) and the Checklist of Health Promotion Environments at Worksites (5), represent assessment tools with a specific focus on physical activity environments. The Workplace Integrated Safety and Health (WISH) questionnaire, on the other hand, is designed to place health factors in the context of organizational safety, important program design features, and conditions of work (6). The WISH assessment tool informs organizational priority setting and decision making by addressing working conditions (e.g., hierarchy of controls), leadership commitment and vision (e.g., clear, consistent communications, accountability), participation (e.g., providing a voice and engaging workers in decision making), comprehensive and collaborative strategies (e.g., collaboration across organizational functions), adherence (e.g., following evolving standards for prevention and control), and data-driven change (e.g., using data to monitor progress and inform decision making). The Centers for Disease Control and Prevention's (CDC) Worksite Health Scorecard places physical activity alongside other health risks and health behaviors and is focused on the environmental drivers that will enable promotion of health (12,13). Scorecards that place activity promotion at the workplace alongside the need for health improvement and sustainable development represent more recent innovations in measurement. Such scorecards manage to bridge the gap between executives responsible for corporate operational and financial performance and those with responsibility for health—an example is the Vitality Institute's Comprehensive Health Metrics Scorecard (14). Comprehensive reviews on the state of science concerning available measures of worksite environmental and policy supports for physical activity indicate that gaps in measurement of the workplace social environment remain and that despite the numerous benefits to activity and fitness, incentives may be needed to increase access and reduce barriers to participation and engagement (8,15). A listing of selected measurement tools is presented in Table 2.

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TABLE 2 - Selected Measurement Tools for Worksite Environments for Physical Activity and Cardiorespiratory Fitness
Name of Measurement Tool Source Resources Access
1 CDC Worksite Health Scorecard CDC https://nccd.cdc.gov/DPH_WHSC/HealthScorecard/Home.aspx
2 CHEW Academic research https://drjimsallis.org/Documents/Measures_documents/CHEW_survey.pdf
3 EAT Academic research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917629/
4 HERO Scorecard HERO https://hero-health.org/wp-content/uploads/2016/07/HERO-Scorecard-V5-Overview_Final.pdf
5 Life Simple 7 AHA https://www.heart.org/en/healthy-living/company-collaboration/well-being-works-better/lifes-simple-7
6 NIOSH WellBQ NIOSH https://www.cdc.gov/niosh/twh/wellbq/default.html
7 WELCOA Well Workplace Checklist WELCOA https://www.welcoa.org/wp/wp-content/uploads/2019/01/WELCOA-Checklist-Questions.pdf
8 Vitality Health Metrics Scorecard Vitality Institute http://thevitalityinstitute.org/projects/health-metrics-reporting/
9 WISH Center for Work, Health, and Well-Being at the Harvard Chan School of Public Health https://centerforworkhealth.sph.harvard.edu/resources/workplace-integrated-safety-and-health-wish-assessment
AHA indicates American Heart Association; CDC, Centers for Disease Control and Prevention; CHEW, Checklist of Health Promotion Environments at Worksites; EAT, Environmental Assessment Tool; HERO, Health Enhancement Research Organization; NIOSH, National Institute for Occupational Safety and Health; WellBQ, Worker Well-Being Questionnaire; WELCOA, Wellness Council of America; WISH, Workplace Integrated Safety and Health Checklist.

POLICY SUPPORTS FOR PHYSICAL ACTIVITY AT THE WORKPLACE

Policy approaches should be considered essential components of physical activity and CRF programs at the workplace. In a review on the importance of physical fitness on company performance and productivity, Etemadi and colleagues (15) identified policy recommendations based on 61 published articles addressing fitness and company performance and productivity. These recommendations include the following:

  • Organizations should document a corporate policy that relates specifically to employee health and physical activity and that the support of management will be essential to the success of such a policy.
  • Introduce policies that encourage or reward active commuting to work or the introduction of complete streets.
  • Organizations may benefit from understanding what personal, environmental, and organizational factors may impact employee interest and willingness to participate in physical activity.
  • Introducing workplace policies that subsidize fitness counseling or gym/recreation memberships may be an effective way to increase and support employee physical activity and reduce barriers to physical activity.
  • The more environmental policy factors present in the workplace, the more overall and recreational physical activity is reported by employees both during work hours as well as outside of work.

The list outlined above makes clear that besides policies specific to the company, broader public policy may have a direct impact on activity and fitness levels of the workforce (16). Ablah and coworkers (17) reported that policy initiatives may be used to create a workplace culture where being active is the norm. Leveraging public policy along with written policies that may be implemented at individual worksites may be particularly powerful because it connects directly to places beyond the worksite that are more proximal to where workers and their families live, play, learn, and worship, thereby integrating such levers into other parts of their lives (18). Table 3 presents examples of public policies as well as organizational policies that support physical activity.

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TABLE 3 - Examples of Policies to Support Physical Activity at the Workplace
Public Policies Organizational Policies (Written policies)
1 Supporting workplace health and well-being programs through tax credits Short activity breaks policy
2 Workplace health and wellness grants Paid time to exercise
3 Workplace wellness incentives that stem from the ADA and GINA legislation Stretching at the beginning of shifts
4 Subsidies for employers for public transportation and active commuting support Flextime for physical activity
5 Complete streets policies Walking meetings policy
For more information on this topic, see Hipp et al. (8), Pronk and Kottke (16), Ablah et al. (18), and Pronk et al. (19)
ADA, Americans with Disability Act; GINA, Genetic Information Nondiscrimination Act.

MONITORING THE CHANGE PROCESS

Once decisions have been made on what measurement tool(s) to implement, a plan should be developed to establish the baseline, monitor the change process, and reassess to derive the outcomes of the initiatives to improve activity levels or CRF. The CDC has outlined a very nicely designed process to do this type of work: step 1, determine the baseline; step 2, detail the process; and step 3, measure and report the outcomes (for more information, see https://www.cdc.gov/workplacehealthpromotion/health-strategies/physical-activity/evaluation-measures/organizational-change.html). An adapted, brief outline of these steps is presented here:

Step 1: determine the baseline

  • Assess current workplace programs
  • List current physical activity options
    •  o Number of physical activity programs
    •  o Use of physical activity facilities
    •  o Availability of educational materials
    •  o Number of physical activity-related policies
    •  o Number of stairway signs, walking trails, and exercise rooms available
  • Conduct baseline workplace walkability audit
  • Note the number of partnerships with community resources (e.g., YMCAs)
  • Determine costs of current programs
  • Conduct survey of employee satisfaction with current program.

Step 2: track the process

  • Document degree of implementation of each intervention
    •  o Track the numbers for employee reach, participation,    program steps implemented as planned, and number of    successful participants (20)
    •  o Report activities over a specific timeline (month, year, etc.)
    •  o Monitor the budget
    •  o Reassess employee satisfaction

Step 3: measure and report the outcomes

  • Measure changes program options and changes in participation
    •  o Number of new programs
    •  o Number of new educational materials
    •  o Number of physical activity-related policies
    •  o Number and type of new environmental supports
  • Document walkability of the physical environment for the company/worksite
  • Report program costs, expenses incurred
  • Capital investments, staffing, equipment, incentives
  • Report the observed changes in survey responses for employee satisfaction
  • Write, submit, and present results, conclusions, and recommended next steps to executive leadership and other critical stakeholders.

CONCLUSIONS

Increased physical activity and CRF continue to be some of the best investments for employers to consider when it comes to optimizing workforce performance, lowering costs, and improving productivity. The workplace itself is a setting highly conducive to implementation of the needed support structures that will enable a physical activity-friendly environment. To do this efficiently and effectively, companies should deploy measurement tools that assess efforts at the organizational level, implement measurement before and following change initiatives, and ensure to present results and recommendations for improvement to leadership and critical partners.

References

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