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Open Access 01-12-2024 | Mood Disorders | Research

Improving movement behavior in office workers: effects of two multi-level cluster-RCT interventions on mental health

Authors: Lisa-Marie Larisch, Victoria Blom, Maria Hagströmer, Maria Ekblom, Örjan Ekblom, Jonna Nilsson, Lena V. Kallings

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period.

Methods

Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models.

Results

Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (β = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (β = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress.

Conclusions

The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components.

Trial registration

ISRCTN92968402 (27 February 2018).

Available only for authorised users

World Health Organization. WHO Guidelines on mental health at work. Geneva, Switzerland; 2022. Available from: https://www.who.int/publications/i/item/9789240053052

The regulations on organizational and social work environment (AFS 2015:4). https://www.av.se/arbetsmiljoarbete-ochinspektioner/publikationer/foreskrifter/organisatorisk-och-social-arbetsmiljoafs-20154/.

Stubbs B, Koyanagi A, Hallgren M, Firth J, Richards J, Schuch F, et al. Physical activity and anxiety: a perspective from the world health survey. J Affect Disord. 2017;208:545–52.PubMedCrossRef

Gerber M, Pühse U. Do exercise and fitness protect against stress-induced health complaints? A review of the literature. Scand J Public Health. 2009;37:801–19.PubMedCrossRef

Puig-Ribera A, Martínez-Lemos I, Giné-Garriga M, González-Suárez ÁM, Bort-Roig J, Fortuño J, et al. Self-reported sitting time and physical activity: Interactive associations with mental well-being and productivity in office employees. BMC Public Health. 2015;15(1):1–10.CrossRef

Huang Y, Li L, Gan Y, Wang C, Jiang H, Cao S, et al. Sedentary behaviors and risk of depression: a meta-analysis of prospective studies. Transl Psychiatry. 2020;10(1):1–10.CrossRef

Allen MS, Walter EE, Swann C. Sedentary behaviour and risk of anxiety: a systematic review and meta-analysis. J Affect Disord. 2019;242:5–13.PubMedCrossRef

Clemes SA, Oconnell SE, Edwardson CL. Office workers objectively measured sedentary behavior and physical activity during and outside working hours. J Occup Environ Med. 2014;56(3):298–303.PubMedCrossRef

Parry S, Straker L. The contribution of office work to sedentary behaviour associated risk. BMC Public Health. 2013;13:296.PubMedPubMedCentralCrossRef

10.

Thorp AA, Healy GN, Winkler E, Clark BK, Gardiner PA, Owen N, et al. Prolonged sedentary time and physical activity in workplace and non-work contexts: a cross-sectional study of office, customer service and call centre employees. Int J Behav Nutr Phys Act. 2012;9:128.PubMedPubMedCentralCrossRef

11.

Chu AHY, Koh D, Moy FM, Müller-Riemenschneider F. Do workplace physical activity interventions improve mental health outcomes? Occup Med (Chic Ill). 2014;64:235–45.CrossRef

12.

Abdin S, Welch RK, Byron-Daniel J, Meyrick J. The effectiveness of physical activity interventions in improving well-being across office-based workplace settings: a systematic review. Public Health. 2018;160:70–6.PubMedCrossRef

13.

Sköld MB, Bayattork M, Andersen LL, Schlünssen V. Psychosocial effects of workplace exercise – a systematic review. Scand J Work Environ Heal. 2019;45(6):533–45.CrossRef

14.

Nguyen TM, Nguyen VH, Kim JH. Physical exercise and health-related quality of life in office workers: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(7):3791.PubMedPubMedCentralCrossRef

15.

Chu AHY, Ng SHX, Tan CS, Win AM, Koh D, Müller-Riemenschneider F. A systematic review and meta-analysis of workplace intervention strategies to reduce sedentary time in white-collar workers. Obes Rev. 2016;17(5):467–81.PubMedCrossRef

16.

Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Pedisic Z. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev. 2018;2018(6).

17.

Malik SH, Blake H, Suggs LS. A systematic review of workplace health promotion interventions for increasing physical activity. Br J Health Psychol. 2014;19(1):149–80.PubMedCrossRef

18.

Lock M, Post D, Dollman J, Parfitt G. Efficacy of theory-informed workplace physical activity interventions: a systematic literature review with meta-analyses. Health Psychol Rev. 2021;15(4):483–507. https://doi.org/10.1080/17437199.2020.1718528.CrossRefPubMed

19.

Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.PubMedPubMedCentralCrossRef

20.

Neuhaus M, Eakin EG, Straker L, Owen N, Dunstan DW, Reid N, et al. Reducing occupational sedentary time a systematic review and meta-analysis of evidence on activity-permissive workstations. Obes Rev. 2014;15:822–38.PubMedCrossRef

21.

Malik SH, Blake H, Suggs LS. A systematic review of workplace health promotion interventions for increasing physical activity. Br J Health Psychol. 2014;19:149–80.PubMedCrossRef

22.

Commissaris DACM, Huysmans MA, Mathiassen SE, Srinivasan D, Koppes LLJ, Hendriksen IJM. Interventions to reduce sedentary behavior and increase physical activity during productive work: a systematic review. Scand J Work Environ Heal. 2016;42(3):181–91.

23.

Rothman A, Baldwin A, Hertel A, Fuglestad P. Self-regulation and behaviour change: disentagling behaviour initiation and behavioural maintenance. In: Vohs IKD, Baumeister RF, editors. Handbook of self-regulation: research, theory and applications. New York, USA: The Guilford Press; 2011.

24.

Teychenne M, White RL, Richards J, Schuch FB, Rosenbaum S, Bennie JA. Do we need physical activity guidelines for mental health: What does the evidence tell us? Ment Health Phys Act. 2020;18(August 2019):100315. https://doi.org/10.1016/j.mhpa.2019.100315.CrossRef

25.

White RL, Babic MJ, Parker PD, Lubans DR, Astell-Burt T, Lonsdale C. Domain-specific physical activity and mental health: a meta-analysis. Am J Prev Med. 2017;52(5):653–66.PubMedCrossRef

26.

Sallis JF. Needs and challenges related to multilevel interventions physical activity examples. Heal Educ Behav. 2018;45(5):661–7.CrossRef

27.

Sallis J, Owen N, Fisher E. Ecological models of health behavior. In: Glanz K, Rimer B, Viswanath K, editors. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: CA; 2008. p. 465–82.

28.

Edwardson CL, Yates T, Biddle SJH, Davies MJ, Dunstan DW, Esliger DW, et al. Effectiveness of the stand more at (SMArT) work intervention: Cluster randomised controlled trial. BMJ. 2018;363:k3870.PubMedPubMedCentralCrossRef

29.

Pereira MA, Mullane SL, Toledo MJL, Larouche ML, Rydell SA, Vuong B, et al. Efficacy of the ‘Stand and move at work’ multicomponent workplace intervention to reduce sedentary time and improve cardiometabolic risk: a group randomized clinical trial. Int J Behav Nutr Phys Act. 2020;17(1):1–11.CrossRef

30.

Edwardson CL, Biddle SJH, Clemes SA, Davies MJ, Dunstan DW, Eborall H, et al. Effectiveness of an intervention for reducing sitting time and improving health in office workers: Three arm cluster randomised controlled trial. BMJ. 2022;378:e06928. https://doi.org/10.1136/bmj-2021-069288.CrossRef

31.

Kandola A, Ashdown-Franks G, Hendrikse J, Sabiston CM, Stubbs B. Physical activity and depression: Towards understanding the antidepressant mechanisms of physical activity. Neurosci Biobehav Rev. 2019;107(September):525–39. https://doi.org/10.1016/j.neubiorev.2019.09.040.CrossRefPubMed

32.

Hallgren M, Kraepelien M, Jehagen A, Lindefors N, Zeebari Z, Kaldo V, et al. Physical exercise and internet-based cognitive behavioural therapy in the treatment of depression: randomised controlled trial. Br J Psychiatry. 2015;207:227.PubMedCrossRef

33.

Nooijen CFJ, Blom V, Ekblom Ö, Ekblom MM, Kallings LV. Improving office workers’ mental health and cognition: a 3-arm cluster randomized controlled trial targeting physical activity and sedentary behavior in multi-component interventions. BMC Public Health. 2019;19(1):1–10.CrossRef

34.

Larisch LM, Bojsen-Møller E, Nooijen CFJ, Blom V, Ekblom M, Ekblom Ö, et al. Effects of two randomized and controlled multi-component interventions focusing on 24-hour movement behavior among office workers: a compositional data analysis. Int J Environ Res Public Health. 2021;18(8):4191.PubMedPubMedCentralCrossRef

35.

Nooijen CFJ, Blom V, Ekblom Ö, Heiland EG, Larisch LM, Bojsen-Møller E, et al. The effectiveness of multi-component interventions targeting physical activity or sedentary behaviour amongst office workers: A three-arm cluster randomised controlled trial. BMC Public Health. 2020;20(1):1–26.CrossRef

36.

Bojsen-Møller E, Wang R, Nilsson J, Heiland EG, Boraxbekk CJ, Kallings LV, et al. The effect of two multi-component behavior change interventions on cognitive functions. BMC Public Health. 2022;22(1):1–12. https://doi.org/10.1186/s12889-022-13490-5.CrossRef

37.

Blom V, Drake E, Kallings LV, Ekblom MM, Nooijen CFJ. The effects on self-efficacy, motivation and perceived barriers of an intervention targeting physical activity and sedentary behaviours in office workers: a cluster randomized control trial. BMC Public Health. 2021;21(1):1–9.CrossRef

38.

American Psychological Association. Cognitive Behavioral Therapy. 2017. Available from: https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral. Cited 2023 Feb 9

39.

Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31.PubMedCrossRef

40.

Fordham B, Sugavanam T, Edwards K, Stallard P, Howard R, Das Nair R, et al. The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis. Psychol Med. 2021;51(1):21–9.PubMedPubMedCentralCrossRef

41.

Miller WR, Rollnick S. Motivational interviewing: Helping people change. 3rd ed. Guilford Press; 2013.

42.

Brawley LR, Rejeski WJ, Lutes L. A group-mediated cognitive-behavioral intervention for increasing adherence to physical activity in older adults. J Appl Biobehav Res. 2000;5(1):47–65.CrossRef

43.

Schneider JK, Cook JH, Luke DA. Unexpected effects of cognitive-behavioural therapy on self-reported exercise behaviour and functional outcomes in older adults. Age Ageing. 2011;40(2):163–8.PubMedCrossRef

44.

Nooijen CFJ, Blom V, Ekblom Ö, Heiland EG, Larisch L-M, Bojsen-Møller E, et al. The effectiveness of multi-component interventions targeting physical activity or sedentary behaviour amongst office workers- a three-arm cluster randomised controlled trial. BMC Public Health. 2020;20:1329.PubMedPubMedCentralCrossRef

45.

Larisch LM, Kallings LV, ThedinJakobsson B, Blom V. “It depends on the boss”–a qualitative study of multi-level interventions aiming at office workers’ movement behaviour and mental health. Int J Qual Stud Health Well-being. 2023;18(1):2258564. https://doi.org/10.1080/17482631.2023.2258564.CrossRefPubMedPubMedCentral

46.

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.PubMedCrossRef

47.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatr scand. 1983;67(6):361–70.PubMedCrossRef

48.

Bech PER, Olsen LISR, Hospital FG. Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 mental health subscale and the WHO-Five well-being scale. Int J Methods Psychiatr Res. 2001;12(2):85–91.CrossRef

49.

Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76.PubMedCrossRef

50.

Bech P, Lunde M, Lindberg L, Martiny K. Psychiatric outcome studies ( POS ): Does treatment help the patients ? A Popperian approach to research in clinical psychiatry. Nord J Psychiatry ISSN. 2009;611(sup46):4–34.

51.

Elo AL, Leppänen A, Jahkola A. Validity of a single-item measure of stress symptoms. Scand J Work Environ Health. 2003;29(6):444–51.PubMedCrossRef

52.

Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Heal Sci Educ. 2010;15(5):625–32.CrossRef

53.

Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. J Psychosom Res. 2002;52(2):69–77.PubMedCrossRef

54.

Arapovic-Johansson B, Wåhlin C, Kwak L, Björklund C, Jensen I. Work-related stress assessed by a text message single-item stress question. Occup Med (Chic Ill). 2017;67(8):601–8.CrossRef

55.

R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2013. Available from: http://www.r-project.org/

56.

Bates D, Mächler M, Bolker BM, Walker SC. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1).

57.

Matthay EC, Hagan E, Gottlieb LM, Tan ML, Vlahov D, Adler N, et al. Powering population health research: Considerations for plausible and actionable effect sizes. SSM - Popul Heal. 2021;14:100789. https://doi.org/10.1016/j.ssmph.2021.100789.CrossRef

58.

Qiu Y, Mao Z, Yun D. Can the add-on placebo effect augment the physical and mental health outcomes of exercise? A meta-analysis. Appl Psychol Heal Well-Being. 2022;14(2):483–98.CrossRef

59.

Lindheimer JB, Szabo A, Raglin JS, Beedie C. Advancing the understanding of placebo effects in psychological outcomes of exercise: Lessons learned and future directions. Eur J Sport Sci. 2020;20(3):326–37.PubMedCrossRef

60.

Höglund P, Hakelind C, Nordin S. Severity and prevalence of various types of mental ill-health in a general adult population: Age and sex differences. BMC Psychiatry. 2020;20(1):209.PubMedPubMedCentralCrossRef

61.

Public Health Agency of Sweden. Statistik psykisk hälsa: vuxna 45–65 år. 2023. Available from: https://www.folkhalsomyndigheten.se/livsvillkor-levnadsvanor/psykisk-halsa-och-suicidprevention/statistik-psykisk-halsa/statistik-psykisk-halsa-vuxna--4564-ar/#:~:text=I åldersgruppen 45–64 år,oftast till följd av ångestsyndrom. Cited 2023 Apr 25

62.

Aujla N, Abrams KR, Davies MJ, Taub N, Skinner TC, Khunti K. The prevalence of depression in White-European and South-Asian people with impaired glucose regulation and screen-detected type 2 diabetes mellitus. Plos One. 2009;4(11):1–7.CrossRef

63.

Hajos TRS, Pouwer F, De Grooth R, Holleman F, Twisk JWR, Diamant M, et al. The longitudinal association between glycaemic control and health-related quality of life following insulin therapy optimisation in type 2 diabetes patients. A prospective observational study in secondary care. Qual Life Res. 2012;21(8):1359–65.PubMedCrossRef

64.

Delaney L, Doyle O, McKenzie K, Wall P. The distribution of wellbeing in Ireland. Ir J Psychol Med. 2009;26(3):119–26.PubMedCrossRef

65.

Hagströmer M, Oja P, Sjöström M. Physical activity and inactivity in an adult population assessed by accelerometry. Med Sci Sports Exerc. 2007;39(9):1502–8.PubMedCrossRef

66.

Bernard P, Doré I, Romain AJ, Hains-Monfette G, Kingsbury C, Sabiston C. Dose response association of objective physical activity with mental health in a representative national sample of adults: A cross-sectional study. Plos One. 2018;13(10):1–16.CrossRef

67.

Coffeng JK, Boot CRL, Duijts SFA, Twisk JWR, Van Mechelen W, Hendriksen IJM. Effectiveness of a worksite social & physical environment intervention on need for recovery, physical activity and relaxation; results of a randomized controlled trial. Plos One. 2014;9(12):1–26.CrossRef

68.

Renaud LR, Jelsma JGM, Huysmans MA, Van Nassau F, Lakerveld J, Spekl EM, et al. Effectiveness of the multi-component dynamic work intervention to reduce sitting time in office workers – Results from a pragmatic cluster randomised controlled trial. Appl Ergon. 2020;84:103027.PubMedCrossRef

69.

Hadgraft NT, Brakenridge CL, Lamontagne AD, Fjeldsoe BS, Lynch BM, Dunstan DW, et al. Feasibility and acceptability of reducing workplace sitting time: A qualitative study with Australian office workers. BMC Public Health. 2016;16(1):1–14. https://doi.org/10.1186/s12889-016-3611-y.CrossRef

70.

Safi A, Cole M, Kelly AL, Zariwala MG, Walker NC. Workplace physical activity barriers and facilitators: a qualitative study based on employees physical activity levels. Int J Environ Res Public Health. 2022;19(15):1–16.CrossRef

71.

O’Cathain A. A Practical Guide to Using Qualitative Research with Randomized Controlled Trials. First. Oxford: Oxford University Press; 2018;107.

72.

Wang R, Blom V, Nooijen CFJ, Kallings LV, Ekblom Ö, Ekblom MM. The role of executive function in the effectiveness of multi-component interventions targeting physical activity behavior in office workers. Int J Environ Res Public Health. 2022;19(1):1–14.

73.

Bauman AE, Sallis JF, Dzewaltowski DA, Owen N. Toward a better understanding of the influences on physical activity: The role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med. 2002;23(2 SUPPL. 1):5–14.PubMedCrossRef

Title: Improving movement behavior in office workers: effects of two multi-level cluster-RCT interventions on mental health
Authors: Lisa-Marie Larisch
Victoria Blom
Maria Hagströmer
Maria Ekblom
Örjan Ekblom
Jonna Nilsson
Lena V. Kallings
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Anxiety
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-17647-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improving movement behavior in office workers: effects of two multi-level cluster-RCT interventions on mental health

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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