Elsevier

Preventive Medicine

Volume 49, Issues 2–3, August–September 2009, Pages 108-114
Preventive Medicine

Worksite Opportunities for Wellness (WOW): Effects on cardiovascular disease risk factors after 1 year

https://doi.org/10.1016/j.ypmed.2009.06.022Get rights and content

Abstract

Objective

To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors.

Methods

In St Louis, Missouri from 2005 to 2006, 151 employees (134 F, 17 M, 81% overweight/obese) participated in a cohort-randomized trial comparing assessments + intervention (worksite A) with assessments only (worksite B) for 1 year. All participants received personal health reports containing their assessment results. The intervention was designed to promote physical activity and favorable dietary patterns using pedometers, healthy snack cart, WeightWatchers® meetings, group exercise classes, seminars, team competitions, and participation rewards. Outcomes included BMI, body composition, blood pressure, fitness, lipids, and Framingham 10-year coronary heart disease risk.

Results

123 participants, aged 45 ± 9 yr, with BMI 32.9 ± 8.8 kg/m2 completed 1 year. Improvements (P   0.05) were observed at both worksites for fitness, blood pressure, and total-, HDL-, and LDL-cholesterol. Additional improvements occurred at worksite A in BMI, fat mass, Framingham risk score, and prevalence of the metabolic syndrome; only the changes in BMI and fat mass were different between worksites.

Conclusion

A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors, but many of the improvements were achieved with worksite health assessments and personalized health reports in the absence of an intervention.

Introduction

Obesity is a major public health problem in the United States because of its high prevalence (Flegal et al., 2002), causal relationship with serious medical illnesses (Allison et al., 1999, Hu et al., 2001, Hubert et al., 1983, Manson et al., 1990), economic impact, and negative effects on work performance (Pronk et al., 2004). In 2003, the National Business Group on Health established The Institute on the Costs and Health Effects of Obesity, with a core objective being to “propose innovative solutions that large employers can implement to control costs related to lifestyle-related behaviors” (National Business Group on Health, 2008). The worksite offers a unique setting to implement health promotion programs and provides an ideal opportunity to engage large numbers of individuals in a very efficient and cost-effective manner (Hennrikus and Jeffery, 1996, Kumanyika et al., 2002).

There is substantial evidence from several large-scale, prospective, longitudinal studies, such as the Framingham Heart Study (Grundy et al., 1998), Diabetes Prevention Program (Diabetes Prevention Program Research Group, 2002), Multiple Risk Factor Intervention Trial (Leon et al., 1997), and the Nurses' Health Study (Stampfer et al., 2000), that improving dietary habits and/or increasing physical activity can effectively reduce risks for developing cardiovascular diseases and type 2 diabetes, thereby enhancing overall health. Exercise also provides psychological benefits and enhances quality of life (LaCroix et al., 1993). Therefore, a worksite health promotion program that is feasible, enjoyable, and effective may have significant benefits not only for employees, but for employers and society as well.

A variety of worksite interventions have been implemented, with most assessing the feasibility of environmental changes (Biener et al., 1999) or relatively short-term changes in dietary (Beresford et al., 2001, French et al., 2001, Jeffery et al., 1993, Jeffery et al., 1994, Tilley et al., 1999) or physical activity (Emmons et al., 1999) patterns. Several worksite programs included an evaluation of cardiovascular disease risk factors, some of which lasted more than 6 months (Engbers et al., 2007, Gemson et al., 2008, Glasgow et al., 1995, Glasgow et al., 1997, Naito et al., 2008), but the results were variable. In the present study, we implemented a novel, 1-year worksite intervention called “Worksite Opportunities for Wellness” (WOW) among medical center employees and compared it to an assessment only condition that included personalized health reports. We hypothesized that our WOW intervention would be feasible and effective for reducing the prevalence or severity of obesity and cardiovascular disease risk factors.

Section snippets

Methods

Eligible subjects included females and males 18 years of age and older who were employed at 1 of 2 selected worksites within a large medical center in St. Louis, Missouri, USA. We recruited subjects during an informational presentation about the study at each worksite, as well as with flyers and e-mail messages. All employees were eligible, including those who smoked, had pre-existing disease (e.g., hypertension, diabetes), or used medications, but medication use was documented at each

Results

Subjects included 151 employees (134F, 17M). The disproportionate number of females is reflective of the sex distribution at our worksites. There were more African Americans at worksite A (42%) than at worksite B (15%, P  < 0.01), and more college graduates at worksite B (70%) than at worksite A (37%), but the sites were matched on sex and age. During the year-long study, 16 of 84 subjects at worksite A and 12 of 67 subjects at worksite B were lost to follow-up and therefore did not have final

Discussion

We have demonstrated that a multi-faceted worksite health promotion program was feasible and effective for improving cardiovascular disease risk factors among employees, but that many of the improvements were achieved with worksite health assessments and personalized health reports in the absence of an intervention.

Two observations from the present study are noteworthy. First, improvements occurred in cardiovascular disease risk factors after 1 year even in the absence of dramatic weight loss.

Conclusions

In summary, our multi-component worksite intervention was associated with significant improvements in cardiovascular disease risk factors and physical fitness among employees, but many of the health benefits appeared to be attributable to the health assessments and personalized feedback rather than the intervention. Conducting annual health assessments and providing personalized health reports are important steps that many employers should take to enhance the health of their employees.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgments

We thank Laura Weber, MS RD, for creating the monthly newsletters; DPT students in the Program in Physical Therapy at Washington University School of Medicine for their assistance with data collection, intervention delivery, and data entry; and our subjects for their participation and enthusiasm.

This study was funded by CDC R01 DP000092 (location of grant support: Saint Louis/Missouri/USA).

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