Physical activity at work, musculoskeletal disorders and sustained employment: Time for paradigm change for improved prevention?

Transcription

1 P r æ s e n t a t i Physical activity at work, musculoskeletal disorders and sustained employment: Time for paradigm change for improved prevention? Professor Andreas Holtermann National Research Centre for the Working Environment, Copenhagen, Denmark

2 How achieve sustainable employability for all until 70+? Not sufficient to prevent harm from work (safe work) We need to be more ambitious Vision Work should be designed, so directly promotes work capacity, health and sustainable employment for all

3 The Danish picture Retirement age Currently: 65 years In 2030: 68 years In 2040: 70 years In 2050: 72 years Percentage of working population - Academics: 11% - Physically demanding job: 39%

4 Who has the largest challenges with physical activity, health and sustained employment?

5 Who has the healthiest work? Mid-age cleaner Mid-age professor

6 The physical activity health paradox If physical activity is so healthy how can those being most physical active at work have such poor fitness, health and employability?

7 I) High physical demands at work increase risk for poor employability All Short education only

8 Risk for long-term sickness absence (%) Ref Perceived physical exertion at work Risk factor for longterm sick-leave (>8 weeks) Andersen et.al. SJWEH, 2012

9 Hazard Ratio Physical work demands during working life and risk of disability pension 2,5 2 1,5 Risk of disability pension * 55% * 95% * 121% 1 0,5 0 Stillesiddende Low physical demands arbejde Moderate physical fysisk demands arbejde High Hårdt physical fysisk demands arbejde Very Meget high hårdt physical fysisk demands arbejde Sundstrup et al 2017

10 Physical work demands during working life and long-term sickness absence Years with heavy and frequent lifting and risk of long-term sickness absence Sundstrup et al 2017

11 II) High physical activity at work A strong barrier to work with reduced health Forward bending of back for cleaner with low back pain over the day

12 III) High physical activity demands at work barrier for a healthy active lifestyle

13 Steps/sec Leisure time activity Female elderly care worker, 61 years, BMI 26 kg/m 2, Vo2max 21 mlo 2 /min/kg / 16-Nov-2011 % row 0 cycle Cycle 0 stairs Stairs time 0 Run run 0 Walk walk 4 move Move 3 stand Stand 5 Sit sit 69 Lie lie 19 off 0 14:00 15:00 16:00 17:00 18:00 19:00 20:00 14:00 Total steps: 1573, Avg.speed: 1.77 steps/s 20: Sit/lie 88% of leisure

14 Steps/sec row Cycle cycle Stairs stairs Run run Walk walk Move move Stand stand Sit Lie / 18-Nov-2011 % sit lie off 07:00 08:00 09:00 10:00 11:00 12:00 13:00 06:30 Total steps: 10265, Avg.speed: 1.92 steps/s 13: Physical activity at work Female elderly care worker, 61 years, BMI 26 kg/m 2, Vo2max 21 mlo 2 /min/kg Sits down 14%

15 IV) Physical activity at leisure the same effect as during work? Work Leisure Adjusted for Age, Gender, Smoking, Alcohol, BMI, Chronic disease, Questionnaire method, Social support, Emotional demands, Social class and leisure/work physical activity Holtermann et al, BJSM 2012

16 V) High physical work demands increase risk for musculoskeletal pain, which strongly increases risk for sick leave and early retirement Risk for long-term sickness absence Neck/shoulder pain intensity (0=non, 10=worst possible)

17 Percentage with pain (%) Why is high physical work demands particularly challenging for ageing workers? Percentage with pain weekly or daily in Denmark (n=30.000) Age Females Males

18 Physical fitness (Lo 2 /min) Why is high physical work demands particularly challenging for ageing workers? Decreased physical fitness Females average maximal physical fitness 2 1 Physical demands for cleaner Illustration Karen Søgaard Age (years)

19 Functional capacity, ageing and demands Threshold for physical demanding work Disability threshold Age Peeters et al 2013, Bulletin of the World Health Organization

20 Balance between physical work demands and physical fitness - importance for early retirement? Risik disability pension Low High Physical work demands High Low Karpansalo JOEM 2002 Cardiorespiratory fitness

21 Physical fitness (Lo 2 /min) What can workplaces do to improve employability for workers with high physical work demands? Tailor physical work demands to workers age 2 Females average maximal physical fitness Age (years) Illustration Karen Søgaard

22 Are physical work demands tailored to workers age?

23 What about increasing cardiorespiratory fitness by workplace physical exercise? A workplace RCT among cleaners Intervention group 60 min/week 2 sessions/week Aerobic physical exercise At the worksite In paid working time Control group Lectures on healthy living Intervention mapping Aerobics Aerobic circiut training Indoor biking Running Korshøj et al, 2015 Præsentationstitel 23

24 Results between groups Cardiorespiratory fitness Korshøj et al Adjusted for baseline value of the respective outcome, age, sex, daily use of antihypertension and/or heart medication, smoking status and baseline leisure time physical activity.

25 Results between groups Sleeping heart rate Korshøj et al Adjusted for baseline value of the respective outcome, age, sex, use of antihypertension and/or heart medication, smoking status and baseline cardiorespiratory fitness.

26 Results between groups Aerobic workload during working hours Korshøj et al Adjusted for baseline value of the respective outcome, age, sex, use of antihypertension and/or heart medication, smoking status and baseline cardiorespiratory fitness.

27 Results between groups High sensitive C-reactive protein Korshøj et al Adjusted for baseline value of the respective outcome, age, gender, BMI, daily use of cholesterol and/or hormone medication, smoking, alcohol consumption and leisure-time physical activity.

28 Who needs physical exercise at work most for maintaining work capacity?

29 Who is offered workplace exercises during paid hours? Military firefighters Police Whitecollars Semiskilled &skilled workers Bluecollars manual jobs

30 Workplace intervention for promoting physical work capacity among eldercare workers Copenhagen municipality 1 hour weekly tailored mandatory physical exercise as paid work for eldercare workers Not with purpose of increasing health or well-being, but to maintain sufficient work capacity for a long working life

31 Need a new approach for improving sustained employability Going a step further than just preventing harm from work (safe work) Aims to organize work, so directly promotes health, work capacity and sustainable employment (healthy work)

32 The Goldilocks principle of work design The physical activity during productive work is often not just right Could it be designed to be just right to promote health and fitness? Illustration: Birte Mølgaard Præsentationstitel 32

33 Physical activity and movements are healthy!. if comprise sufficient variation, breaks and time for recovery Without sufficient variation, breaks and recovery can cause overload and health issues

34 Workload Current ergonomic minimization of workload for preventing harm approach Good for promoting health and fitness? Time

35 Time Workload Goldilocks Fit Work Design Design work to provide healthy balance of: Variation Stimulation of heart and muscles Rest and recovery

36 Heart rate Distribution of physical activities at work Heart rate reserve (%) Stairs Health promoting work modifications Run Walk Move Standing still Sitting 9:00 12:00 15:00 Fitness improvement Rest Præsentationstitel 36

37 Design childcare work making children more physical active and improve work capacity, health and sustainable employment for workers

38 Worker 1 Worker 2 Stairs Run Walk Move Stand Sit Stairs Run Walk Move Stand Sit Modifying work tasks Changed time-pattern Stairs Run Walk Move Stand Sit Stairs Run Walk Move Stand Sit Præsentationstitel 38

39 Jobrotation Worker 1 Worker 2 Stairs Run Walk Move Stand Sit Stairs Run Walk Move Stand Sit Stairs Run Walk Move Stand Sit Stairs Run Walk Move Stand Sit

40 Is it possible to develop and implement the Goldilocks Principle at your workplace? Fit work design - - Variation - - Stimuli of heart and muscles - - Rest and recovery Illustration: Birte Mølgaard

41 Vision Design work, so directly promotes work capacity, health and sustainable employment for all Andreas Holtermann Illustration: Birte Mølgaard