A Cluster Randomized Controlled Trial on the Effects of Technologyaided Testing and Feedback on Physical Activity and Biological Age Among Employees in a Medium-sized Enterprise

O iginal A icle A Clus e Randomized Con olled T ial on he E ec s o Technology- aided Tes ing and Feedback on Physical Ac i i y and Biological Age Among Employees in a Medium-sized En e p ise Mika Liukkonen 1 , 2 , Clas-Håkan Nygå d 1 , * , Raija Laukkanen 3 1 Uni e si y o Tampe e, Tampe e, Finland 2 Spo s Ins i u e Pajulah i, Nas ola, Finland 3 Uni e si y o Oulu, Oulu, Finland a icle in o A icle his o y: Recei ed 30 Ma ch 2016 Recei ed in e ised o m 7 No embe 2016 Accep ed 1 Ma ch 2017 A ailable online 4 Ap il 2017 abs ac Backg ound: I has been sugges ed ha engaging echnology can empowe indi iduals o be mo e p oac i e abou hei heal h and educe hei heal h isks. The aim o he p esen in e en ion was o s udy he e ec s o echnology-aided es ing and eedback on physical ac i i y and biological age o employees in a middle-sized en e p ise. Me hods: In all, 121 employees (mean age 42 10 yea s) pa icipa ed in he 12-mon h h ee-a m clus e andomized ial. The fi ness measu emen p ocess (Body Age) de e mined he pa icipan s’biological age in yea s. Physical ac i i y was measu ed wi h he In e na ional Physical Ac i i y Ques ionnai e Sho Fo m. Resul s: Physical ac i i y did no change du ing he in e en ion. Biological age (be e fi ness) imp o ed in all g oups s a is ically significan ly (p<0.001), bu wi h no in e ac ion e ec s. The mean changes (yea s) in he g oups we e 2.20 o he con ols, e2.83 o he g oup ecei ing hei biological age and eedback, and 2.31 o he g oup ecei ing hei biological age, eedback, and a aining compu e . Conclusion: Technology-aided es ing wi h eedback does no seem o change he amoun o physical ac i i y bu may enhance physical fi ness measu ed by biological age. Ó2017 Occupa ional Sa e y and Heal h Resea ch Ins i u e, Published by Else ie Ko ea LLC. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/). 1. In oduc ion Employe -sponso ed wellness p og ams ha e achie ed signifi- can imp o emen s in ca dio ascula isk ac o s [1], such as weigh managemen and wais ci cum e ence [2,3]. Pa icipa ion in well- s uc u ed wo ksi e wellness p og ams may inc ease heal h and li e sa is ac ion o employees, and hey appea o help employees de elop and main ain heal hy beha io s [4e7]. Pa icipa ion in wo kplace physical ac i i y p og ams can also be associa ed wi h imp o emen s in he men al componen o heal h- ela ed quali y o li e, al hough he physical ac i i y le el emains he same [8]. Howe e , ewe small businesses adop wo kplace heal h p omo- ion p og ams compa ed wi h la ge businesses [9]. While pa icipa ion in wo ksi e wellness p og ams may inc ease employees’heal h and li e sa is ac ion, echnology-aided me hods a e expec ed o inc ease encou agemen and mo i a e changes in heal h beha io be e han, o example, he adi ional es ing o physical capaci y [10]. Wo kplace heal h p omo ion in e en ions may imp o e physical ac i i y and die a y beha io , and encou age a heal hy weigh , bu he e is no e idence o inc eased e ficacy associa ed wi h specific in e en ion ypes [11]. P e ious s udies a e inconclusi e, and some ha e sugges ed ha he e ec i eness o in e en ions in physical ac i i y and p oduc i i y- ela ed ou - comes in occupa ional se ings could be poo [12,13]. Thus, i has also been sugges ed ha engaging echnology can empowe in- di iduals o be mo e p oac i e abou hei heal h and educe hei heal h isks [14]. Ou s udy concen a ed on s udying he e ec s o echnology- aided me hods and measu emen s o physical ac i i y using he Body Age me hod. Body Age is a fi ness assessmen me hod and a p oduc concep de eloped in he la e 1980s. Body Age applies a pe son’s demog aphics, heal h s a us, li es yle ques ionnai es, and *Co esponding au ho . Uni e si y o Tampe e, PB 100, FI-33014 Tampe e, Finland. E-mail add ess: clas-hakan.nyga d@u a.fi(C.-H. Nygå d). Con en s lis s a ailable a ScienceDi ec Sa e y and Heal h a Wo k jou nal homepage: www.e-shaw.o g 2093-7911/$ esee on ma e Ó2017 Occupa ional Sa e y and Heal h Resea ch Ins i u e, Published by Else ie Ko ea LLC. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/). h p://dx.doi.o g/10.1016/j.shaw.2017.03.003 Sa e y and Heal h a Wo k 8 (2017) 393e397 fi ness assessmen s. Reliable and epea able assessmen s a e made possible by ha dwa e p o ided by he Body Age Sys em, he ein e e ed o as he es sys em (Pola Elec o Inc., Kempele, Finland). The fi ness assessmen esul s a e cha ac e ized by a Body Age sco e, which defines he pe son’s biological age (in yea s). The so wa e o he es sys em gene a es an assessmen epo au o- ma ically [15]. He e ogenei y o he age- ela ed physiological changes is shown by he “biological age,”which de e mines he a e o aging expe- ienced by each indi idual. Biological age is defined as he unc- ional capabili y o a human, and he selec ed bioma ke s encompass a ious complex physiopa hological ac o s ela ed o in insic and ex insic physiological and unc ional aging. I can be measu ed, o example, by unc ional capaci y es s, blood es s, and skin, e inal, and s eng h es s [16]. The biological age index is commonly cons uc ed om a numbe o he mos eliable bio- ma ke s o aging [17]. Compa ed wi h indi idual bioma ke s, he index has been shown o be a eliable bioma ke o mo ali y, and a cogni i e and physical pe o mance p ognos ic ac o . The co e- la ion is no demons a ed only wi h indi idual bioma ke s [17].To ou knowledge, he applicabili y o Body Age o occupa ional heal h se ices has no been s udied p e iously. The pu pose o he p esen s udy was o de e mine he e ec s o echnology-aided es ing and eedback gi en (Body Age sco e) on physical ac i i y and biological age du ing a 12-mon h ollow-up pe iod in a clus e andomized con olled s udy in a medium- sized en e p ise. 2. Ma e ials and me hods 2.1. S udy sampling and design This s udy was ca ied ou among employees o a medium-sized en e p ise in ecycling. The ci cula economy company p o ides comp ehensi e en i onmen al managemen se ices. The in e - en ion p ojec ook place in i s main si e (Riihimäki, Finland) in he yea s 2008e2009. The company employed bo h blue and whi e colla wo ke s, he majo i y wo king in manu ac u ing bu a pa also in adminis a ion. All employees (n¼220) we e in i ed o pa icipa e in he physical ac i i y in e en ion p og am. Bo h he occupa ional heal h nu se and he execu i e di ec o in o med all he employees be o ehand, and e e yone could sign up o he s udy. In addi ion, elec onic in o ma ion channels deli e ed gen- e al in o ma ion abou he s udy. In all 67% (149) o he employees egis e ed o he s udy and we e clus e andomized in o h ee g oups based on age, sex, and occupa ion (blue and whi e colla ). The s udy was ca ied ou h ough he occupa ional heal h se ice in he company and coo dina ed by an occupa ional heal h nu se. An e hics commi ee app o al s a emen was ob ained om he Lah i Region Hospi al E hics Commi ee. W i en in o med consen was ob ained om he pa icipan s. 2.2. Pa icipan s The inclusion c i e ia we e eadiness o pa icipa e in he s udy, age be ween 18 and 64 yea s, and he occupa ional physician in he company app o ing he sel - epo ed medical his o y. The exclu- sion c i e ia we e p egnancy, co ona y a e y disease, uncon olled hype ension (blood p essu e >200/110 mmHg), and he use o a pacemake . Con aindica ions o he s udy also included se e e a hy hmias, myoca dial in a c ion o bypass su ge y in he las 6 mon hs, angioplas y o h omboly ic he apy, al ula hea dis- ease, o o he p oblema ic hea ailu es. Se e e symp oms o s ess, an unbalanced sys emic disease, acu e in ec ion, and ecen se e e inju y o su ge y we e also con aindica ions o he s udy. S udy pa icipan s’cha ac e is ics a e shown in Table 1. Du ing he 1 s 3 mon hs, 11 employees we e made edundan o economic and p oduc ion easons, and hey he e o e d opped ou o he s udy. The analysis includes employees wi h esul s om baseline as well as he 6-mon h and 12-mon h ollow-ups (n¼121). The e we e almos no significan di e ences a baseline in backg ound and ou come a iables. All g oups we e simila excep o he wall si . Body Age was highe han ch onological age in all g oups a baseline. 2.3. Tes sys em and p ocedu e The Body Age Sys em is p ima ily a ge ed o use in fi ness and heal h- ela ed fi ness en i onmen s o mo i a e indi iduals o be physically ac i e o be e heal h and fi ness, and o imp o e hei o e all well-being. The Body Age measu emen p ocess is used o o m a biological age [15]. The measu emen includes muscula s eng h, flexibili y, ae obic fi ness, and body composi ion by means o es s pe o med Table 1 Demog aphic and clinical cha ac e is ics o he s udy pa icipan s by g oup Va iables G oup p A(n¼42) B (n¼43) C (n¼36) Demog aphic a iables No. o men, n(%) 34 (81) 35 (81) 27 (75) 0.67 Age (y), mean (SD) 42 (10) 43 (10) 40 (10) 0.33 Body mass index (kg/m 2 ), mean (SD) 27.2 (4.6) 26.8 (3.9) 26.3 (3.9) 0.63 Cu en smoke , n(%) 9 (21) 10 (23) 11 (31) 0.70 Clinical a iables Blood p essu e (mmHg) Sys olic, mean (SD) 135 (11) 136 (9) 138 (12) 0.60 Dias olic, mean (SD) 93 (14) 93 (12) 91 (12) 0.59 Body age di e ence om ch onological age (yea s), mean (SD) 4.23 (5.21) 2.59 (5.86) 2.52 (6.85) 0.24 Body age index (yea s), mean (SD) 46.1 (11.0) 45.9 (12.4) 42.6 (12.0) 0.31 Body a , % (SD) 26.6 (9.1) 25.3 (7.0) 26.5 (9.1) 0.68 Biceps s eng h (kg), mean (SD) 41.7 (11.7) 44.3 (12.2) 41.0 (13.2) 0.39 Wall si (s), mean (SD) 111 (52) 123 (61) 145 (64) 0.02* Si and each (cm), mean (SD) 33.8 (8.5) 34.5 (8.1) 37.1 (9.2) 0.17 C unch epe i ions, mean (SD) 31.8 (15.4) 38.2 (15.9) 33.5 (17.8) 0.13 VO2 max (mL/kg/min), mean (SD) 35.3 (7.1) 36.4 (8.8) 39.0 (10.1) 0.13 *S a is ically significan acco ding o he p<0.05 le el. Sa Heal h Wo k 2017;8:393e397394 in a s anda dized manne . Selec ed es s a e based on easy access and indi idual es s a e based on esea ch e idence. The mea- su emen ca ego y comp ises assessmen s ha ypically cha ac- e ize he pe son’s physiological s a e wi h measu able a iables. The measu emen ca ego y includes ou subca ego ies, which a e ela ed o he indi idual’s biome ics, ca dio ascula cha ac e is- ics, body composi ion cha ac e is ics, and musculoskele al cha ac e is ics. The Body Age sco e (S BA ) is exp essed wi h he ollowing o - mula [15]: SBA ¼CA þX N i¼1 D MC iWMC iþX M j¼1 D AC jWAC j whe e CA is he es pa icipan ’s ch onological age (yea s), and D MC i and W MC i a e he age alue and co esponding weigh (kg), espec i ely, a ising om assessmen iin he measu emen ca e- go y. Pa ame e s D AC j and W AC j ep esen he age alue and co e- sponding weigh , espec i ely, a ising om assessmen jin he app aisal ca ego y. Indices jand i un o e he numbe o assess- men s applied in he measu emen and app aisal ca ego ies, espec i ely. The age alue o each assessmen ep esen s an age inc emen o dec emen o he Body Age, and depends on how he co esponding es esul s anks in s a is ical da a o simila de- mog aphics. The anking is based on gene ally accep ed da a p o- ided by scien ific publica ions. Fo Body Age calcula ion, he sex- and age-specific classifica ion o each assessmen is used. The numbe o classifica ions a ies om fi e o se en depending on he assessmen . Depending on he numbe o classifica ions, each class o each assessmen a ec s Body Age. Fo example, o he ca dio ascula assessmen , a se en-scale classifica ion o VO2 max is used as a e e ence [18]. I he es pa icipan sco es in he “ e y low”ca ego y, his esul s in 4 yea s being added o his/he Body Age sco e. I he es pa icipan sco es in he “eli e”ca ego y, his esul s in 4 yea s being sub ac ed om his/he Body Age. The Body Age measu emen p ocess was ca ied ou as ollows: pe sonal in o ma ion (name, da e o bi h) and he comple ed, p efilled o ms we e inpu ed in o he coded compu e sys em. Each pa icipan ’s weigh (kg) and heigh (m) we e measu ed, and esul s we e inpu ed in o he sys em. The measu emen p o ocol con inued wi h a nonexe cise fi ness es based on hea a e a iabili y (Pola Elec o Inc., Kempele, Finland) [15]. Blood p es- su e was measu ed in a si ing posi ion a e a 5-minu e es pe iod. The physical es s began wi h a 90  wall si es . The pa icipan sa agains a wall wi h knees ben a a 90  angle o suppo his/he body weigh o as long as possible. S a ic uppe -body powe gene a ion p ope ies we e es ed wi h a 5-second biceps cu l, wi h he o ea m ben a an angle o 90  while he pa icipan was in a s anding posi ion. The pe o mance was epea ed h ee imes. Abdominal muscle endu ance was measu ed using 60-second maximum c unch epe i ion pe o mance wi h a knee angle o 90  . The flexibili y assessmen consis ed o a modified si -and- each es implemen ed wi h a handle in eg a ed in o he es sys em. A e he assessmen s and calcula ion o he Body Age sco e, he es sys em au oma ically gene a ed a es epo comp ising eedback om he o e all assessmen [15]. 2.4. In e na ional Physical Ac i i y Ques ionnai e The In e na ional Physical Ac i i y Ques ionnai e Sho Fo m (IPAQ-SF) has been ecommended as a cos -e ec i e me hod o assessing physical ac i i y [19]. I is widely used in wo ksi e well- ness p og ams o ob ain physical ac i i y es ima es. In he p esen s udy, he pu pose o he IPAQ-SF was o ob ain compa able es i- ma es o physical ac i i y, and i was used o obse e ac i i y es i- ma es in gene al. Con inuous sco e le els we e used and he esul s exp essed as me abolic equi alen o ask (MET)-min/week: MET le el minu es o ac i i y e en s pe week. METs a e he mul- iples o es ing me abolic a e and MET-min sco es a e equi alen o kilocalo ies o a 60-kg pe son. 2.5. In e en ion Body Age measu emen and physical ac i i y ques ionnai es we e conduc ed a 0 mon hs, 6 mon hs, and 12 mon hs. The pa - icipan s comple ed all ou come o ms (and he in o med consen o m a baseline) be o e each Body Age measu emen . A baseline, g oup A ecei ed only he sepa a e es esul s (no he Body Age index). G oup B ecei ed he Body Age esul s (index in yea s). G oup C ecei ed bo h Body Age and sepa a e es esul s, as well as a aining compu e (FT60; Pola Elec o Inc.) o suppo olun a y aining. The epo included all he esul s ela ed o he o e all popula ion esul s. The pa icipan s we e gi en a sepa a e aining p og am, and an occupa ional heal h nu se wen h ough he epo in de ail wi h each pa icipan . Be ween he 6 h and 12 h mon h o he in e en ion, all pa ic- ipan s we e con ac ed by phone mon hly. The esea ch nu se called hem o comple e he physical ac i i y ques ionnai e and p o ided guidance i needed. 2.6. S a is ical me hods The da a a e p esen ed as means wi h s anda d de ia ions o as coun s wi h pe cen ages. S a is ical compa isons we e made using he chi-squa e es , Fishe ’s exac es , analysis o a iance, o boo s ap- ype analysis o a iance. In he case o iola ion o as- sump ions (non-no mali y), a boo s ap- ype es was used. No mali y o he a iables was es ed using he Shapi oeWilk W es . Repea ed measu es we e analyzed using gene alizing es i- ma ing equa ion models wi h an uns uc u ed co ela ion s uc- u e. Gene alized es ima ing equa ions we e de eloped as an ex ension o he gene al linea model (e.g., eg ession analysis) o analyze longi udinal and o he co ela ed da a. Gene alizing es i- ma ing equa ion models ake in o accoun he co ela ion be ween epea ed measu emen s in he same indi idual; models do no equi e comple e da a and can be fi e en when indi iduals do no ha e obse a ions a all ime poin s. A di e ence be ween he a iables was conside ed s a is ically significan o p<0.05. 3. Resul s The Body Age di e ence dec eased significan ly du ing he in e en ion, as shown in Fig. 1. Howe e , no in e ac ion e ec was ound. The mean changes (yea s) in he g oups we e as ollows: A2.20 [95% confidence in e al (CI): 3.09 o 1.30], B 2.83 (95% CI: e3.76 o 1.91), and C 2.31 (95% CI: e3.24 o 1.37); he e we e no s a is ically significan di e ences in he changes be ween he g oups (p¼0.13). Changes o e ime we e s a is ically significan in all g oups (p<0.001). The e we e significan di e ences in physical ac i i y be ween he g oups (p¼0.027), howe e he changes we e no significan (p¼0.98) andwi hno in e ac ione ec s (p¼0.63)as shownin Fig. 2. The mean changes (MET/min/wk) in he g oups, om baseline o he end, we e as ollows: A 89 (95% CI: e1,109 o 926), B 17 (95% CI: e1,021 o 987), and C 127 (95% CI: e904 o 1,158). M. Liukkonen e al / E ec s o Technology-aided Tes ing and Feedback 395 4. Discussion The Body Age sco e dec eased in all g oups, which sugges s ha he pa icipan s’fi ness inc eased, bu he e we e no s a is ically significan di e ences be ween he g oups in ei he body age o physical ac i i y a e he in e en ion. Thus, awa eness o Body Age did no ha e any e ec on biological age. Ou esul s con adic o he s udies ha show ha employe -sponso ed wellness p o- g ams ha e achie ed significan imp o emen s in ca dio ascula isk ac o s, such as weigh managemen and wais ci cum e ence [1e3]. Pa icipa ion in well-s uc u ed wo ksi e wellness p og ams ha e also inc eased heal h and li e sa is ac ion o employees, and helped employees de elop and main ain heal hy beha io s [4e7]. Pa icipa ion in wo kplace physical ac i i y p og ams has also been associa ed wi h imp o emen s in he men al componen o heal h- ela ed quali y o li e, e en hough he physical ac i i y le el e- mains he same [8]. Sel - epo ed physical ac i i y le els (acco ding o he IPAQ-SF) did no change du ing he in e en ion pe iod. One possible explana ion could be ha he measu emen o physical ac i i y was unsa is ac o y. This is ypically an inhe en bias in sel - epo ed da a, as hey o e es ima e physical ac i i y as measu ed by objec- i e c i e ion [20]. The e o e, i he IPAQ-SF o e es ima es physical ac i i y, he finding ha he e was no change in sel - epo ed physical ac i i y du ing he in e en ion pe iod could ac ually mean a eal dec ease in physical ac i i y. A limi a ion o he s udy was ha he Biological Age me hod has no been es ed o eliabili y, al hough he me hod includes sepa- a e measu emen s ha all ha e widely been used and es ed [15]. Du ing he s udy, howe e , all g oups imp o ed hei biological age du ing he 12 mon hs. The bigges imp o emen s in ime occu ed wi hin he fi s 6 mon hs. Sys olic blood p essu e le els imp o ed significan ly and hus pa ly explain he esul s. Blood p essu e is a sensi i e measu e, which may also be a ec ed, in addi ion o physical ac i i y, by men al s ess. Men al s ess was minimized by ha he blood p essu e was measu ed a e a es pe iod o 5 minu es. Thus, he es ing could be, a leas in baseline, a mo e s ess ul si ua ion han du ing he ollow-ups. The eedback could also ha e a ec ed he pa icipan s’heal h beha io in many ways, such as a ec ing hei die , sleep quan i y, and e e yday choices. The imp o emen in biological age could also pa ly be explained by a lea ning e ec : he pa icipan s lea ned how o do he di e en es s. The change in biological age was a he as , and a longe ollow-up should be impo an in u u e in e en ions o see i he changes pe sis in he long un. Time (mon hs) 0612 QAPI 0 1,000 2,000 3,000 4,000 5,000 6,000 G oup: p = 0.027 Time: p = 0.98 In e ac ion: p = 0.63 A B C Fig. 2. Physical ac i i y (IPAQ-SF; MET/min/wk du ing he in e en ion, mean, and 95% confidence in e al) in he g oups (n¼121). G oups a e exp essed wi h le e s A (con ols, adi ional eedback), B (biological age and eedback), and C (biological age, eedback, and aining compu e ). IPAQ-SF, In e na ional Physical Ac i i y Ques ion- nai e Sho Fo m; MET, me abolic equi alen o ask. Time (mon hs) 0612 Body age di e ence (yea s) –5 –4 –3 –2 –1 0 1 2 3 4 5 6 7 8 9 G oup: p = 0.13 Time: p < 0.001 In e ac ion: p = 0.75 A B C Fig. 1. Body age di e ences (yea s, mean, and 95% confidence in e al) be ween g oups du ing he in e en ion (n¼121). G oups a e exp essed wi h le e s A (con- ols, adi ional eedback), B (biological age and eedback), and C (biological age, eedback, and aining compu e ). Sa Heal h Wo k 2017;8:393e397396 The s udy was a clus e andomized con olled s udy. The p o- g am in ol ed 70% o he company’s employees. Pa icipa ion was olun a y, and we canno ule ou ha hose who olun ee ed may mo e likely ha e o he li es yle ac i i ies ha a e posi i e o educ ion o biological age han hose who did no pa icipa e, which may ha e a ec ed he esul s. The sel - aining does no seem o ha e been su ficien , al hough he pa icipan s ecei ed app op ia e guidance in inc easing physical ac i i y. O ganized aining sessions o pe sonal aine s could ha e been a be e solu ion, al hough sel - aining wi h possible backup, i needed, is a e y ealis ic and economical si ua ion o mos companies. A s eng h o he s udy was he good compliance by he man- agemen , occupa ional heal h ca e, and employees ( he pa icipa- ion a e was 70% a baseline). The p og am mo i a ed and engaged he people in ol ed, al hough his was no adequa e o help hem each a highe le el o fi ness. The Body Age me hod was also pe cei ed as quick and easy o use, and ga e he occupa ional heal h ca e in o ma ion abou he heal h and fi ness o he em- ployees. The in e en ion was success ully comple ed by he em- ployees. They we e en husias ic ega ding pa icipa ion, and all measu emen s we e conduc ed in acco dance wi h a se p e es ed p o ocols. The basis o his in e en ion was easy o manage, and he pa icipan s calcula ed measu emen s du ing hei wo kday. Days we e o ganized wi h a simila p o ocol o in ol e all pa ici- pan s. A limi a ion is ha he s udy was no blinded, because he employees knew and alked o each o he du ing wo king hou s, and, in addi ion, mos o hem li ed in he same small own. The e o e, he wo ke s could discuss he physical ac i i y and es esul s wi h each o he . Thus, he e could ha e been a Haw ho ne e ec in he e e ence g oup (A), which ecei ed only indi idual es esul s bu no he body age. This dis u bs and ce ainly a ec s he andomized and con olled s udy design. I he s udy would ha e been ca ied ou in di e en ci ies, he esul s migh ha e di e ed. 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