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Dr Damien Bennett, IPH Conference,15th November
Background
Physical inactivity - public health priority
Worldwide, population attributable risk (9%)
greater than smoking (8.7%)
In NI (2012/13) - 41% men + 51% women in NI
not meeting minimum recommended PA levels
Workplace physical activity programmes are effective in:
Changing behaviours
Improving health-related outcomes –BMI, blood pressure + other cardiovascular disease risk factors
Facilitating organizational-level change – e.g. reduced absenteeism
Other benefits:
Enhanced productivity
Improved corporate image
Completive advantage
Smart thing to do!
The workplace – a health promoting setting
Preventing Diseases in the Workplace through
Diet and Physical Activity (WHO/World Economic
Forum Report, 2007)
The workplace – a health promoting setting
But – why the stairs?
Simple, easy and effective
Incorporate physical activity into working day
No extra cost or time for employees
Minimal cost for employers
Great way to get “everybody active, every day”
(PHE, 2014)
The stairs – what’s the evidence?
PHE - ‘…strong evidence for the effectiveness of interventions to increase
stair use and that “the strongest evidence comes from signs placed to
encourage stair use” (9).
NICE - employers + representatives + PH professionals ….“help employees to
be physically active …by..putting up signs at strategic points and
distributing written information to encourage them to use the stairs
rather than lifts” (11).
NICE - “facility managers … ensure that staircases are clearly signposted
and are attractive to use” (12).
US Community Preventative Services Task Force - “recommends point-of-
decision prompts on the basis of strong evidence of effectiveness”
(10).
Setting• PHA HQ - city centre office building
• Building design
Methods
Conceived, designed, implemented and evaluated – in
PHA
Multi-component intervention
(1) Motivational Point of decision prompts (PODPs)
(2) Signposting footprints
Installed - each floor of building
Measurements made before, 4 weeks + 6mths after
How were we doing?
• Badly! - Less than 15% of upward journeys 19% of downward journeys
• Almost 1000 upward journeys + 900 downward journeys with lift every working day.
• > 11,000 calories per day forgone
• Upward elevator journeys – 50% involve one person- wastes electricity + damages environment.
Method: Direct observation for Baseline measurement - over one working day
The Physical activity / health gap
-100
100
300
500
700
900
1100
Co
un
t
Time
Cumulaitve total taking lift vs stairs - Going up (8am to 5.10pm)
Cumulative Lift UP
Cumulative Stairs UP
Before
After
BeforeAfter
First steps
Videos, launch document etc
16.6%
30.2%
0
5
10
15
20
25
30
35
40
Pre Post
%stairuse
Total
-
-
Results
16.6%
30.2% 29.2%
0
5
10
15
20
25
30
35
40
Pre Post 6mth post
%stairuse
Total
Reminder - Physical activity / health gap
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Co
un
t
Time
Cumulaitve total taking elevator vs stairs - Total journeys
Elevator total - PRE
Stairs total - PRE
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Co
un
t
Time
Cumulaitve total taking elevator vs stairs - Total journeys
Elevator total - PRE
Elevatortotal - POST
Stairs total - PRE
Stairs total - POST
Toolkit Theory to
practice!
Toolkit
Toolkit - where can I get it?
Go to PHA website
(http://www.publichealth.hscni.net)
+
search “Take the Stairs”
Effectiveness and cost effectiveness of the
£ for lb. workplace-based, peer-led
weight management programme, 2016
Intervention – key elements
Peer (not professional) led – Work champions
[Training of Champions – 2workshops (start + mid-point) -
BHSCT dietitian + physical activity professional]
Workplace based
Low cost - < £20K
Incentivised - £1 pledge to charity for every lb.
weight loss
Foundation – NHS Choices 12-week guide,
Losing weight: Getting Started
Programme
Who? - Adults, BMI >25 kg/m2
How?
Healthy eating, physical activity + behaviour
change advice
Daily 600 kcal deficit diet - most participants
Practical strategies - ↓calories + ↑ physical
activity
Weekly weigh ins
Organisations35 organisations
Across NI
Private, public, third
sector
Wide variety of
industries -
Manufacturing, IT,
Construction,
Tourism, Academic,
Public sector,
Voluntary sector
Analysis
Department of Health recommendations - Developing a specification for lifestyle weight management services: Best practice guidance for tier 2 services
Categories
Enrolled, Engaged (≥ 1 session), Completed – (last 3 sessions)
Variables
Weight, % Weight, BMI
Tests
Chi squared, t-tests, Multivariate and logistical regression analysis
Cost-effectiveness - PHE weight management economic assessment tool
Results - effectiveness
Overall
• Mean weight loss = 2.4kg (2.7%)
• Mean BMI loss = 0.8 kg/m2 (2.6%)
• 24% lost ≥ 5% baseline weight
Gender
Men lost significantly more weight than women
(Average 3.3kg v 1.6kg, 3.4% v 1.9% bodyweight)
Males over 3 times as likely to lose ≥ 5% weight (Logistical regression)
33% of males vs 16% of females lost ≥ 5% weight (p < 0.0001)
Results – cost effectiveness
By year 3 benefits > costs - all perspectives (social care, employment and healthcare)
Benefits increase rapidly for 6 yrs, gradually for next 20 yrs
Over 25 years - cumulative economic benefit = £156,223
Main healthcare savings - diabetes care = £37,410
Cost per QALY (health and social care) = £5,807 in first year + cost saving thereafter.
Excellent value for money!!
Results – Cost Savings
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Cu
mu
lait
ve s
avin
gs
Year of intervention
Economicbenefit ofadditionalemployment
Savings insocial carecosts
Savings inhealthcarecosts
Cumulative net savings in costs by cost
perspective over 25 years (with discounting)
Lose – win – winLOSE – Av 2.4kg loss, 24%
> 5% weight loss
WIN – Excellent VFM - cost saving from Year 3
WIN – physical + mental health benefits
WIN – positive corporate image
WIN - £17,000 - NI charities
BOUNS
Male participants:
- over twice as likely to complete
- three times more likely to lose ≥ 5% weight
The End
