Damien Bennett
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Damien Bennett
- 1. Dr Damien Bennett, IPH Conference,15th November
- 2. 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
- 3. 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
- 4. 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)
- 5. 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).
- 6. Setting • PHA HQ - city centre office building • Building design
- 7. 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
- 8. 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
- 9. The Physical activity / health gap -100 100 300 500 700 900 1100 Count Time Cumulaitve total taking lift vs stairs - Going up (8am to 5.10pm) Cumulative Lift UP Cumulative Stairs UP
- 10. Before
- 11. After
- 13. BeforeAfter
- 14. First steps Videos, launch document etc
- 16. 16.6% 30.2% 29.2% 0 5 10 15 20 25 30 35 40 Pre Post 6mth post % stair use Total
- 17. Reminder - Physical activity / health gap 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Count 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 Count Time Cumulaitve total taking elevator vs stairs - Total journeys Elevator total - PRE Elevatortotal - POST Stairs total - PRE Stairs total - POST
- 19. Toolkit
- 20. Effectiveness and cost effectiveness of the £ for lb. workplace-based, peer-led weight management programme, 2016
- 21. 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
- 22. 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
- 23. Organisations 35 organisations Across NI Private, public, third sector Wide variety of industries - Manufacturing, IT, Construction, Tourism, Academic, Public sector, Voluntary sector
- 24. 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
- 25. 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)
- 26. 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!!
- 27. 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 Cumulaitvesavings Year of intervention Economic benefit of additional employment Savings in social care costs Savings in healthcare costs Cumulative net savings in costs by cost perspective over 25 years (with discounting)
- 28. Lose – win – win LOSE – Av 2.4kg loss, 24% > 5% weight loss WIN – Excellent VFM - cost saving from Year 2 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
- 29. The End
Editor's Notes
- If physical inactivity reduced by 25% > 1.3 million deaths prevented annually
- “Employers are recognizing the competitive advantage that a healthy workplace can provide to them (WHO 2010) ….it’s the smart thing to do Peer-led workplace based programmes – very powerful due to “multiple levels of influence” (WHO 2007).
- - employers + representatives (e.g. HR directors and senior managers), facilities managers, PH professionals, trade unions, employee reps and employees “help employees to be physically active during the working day by..putting up signs at strategic points and distributing written information to encourage them to use the stairs rather than lifts” (11).
- Significant increases post-intervention. 82% increase - total stair journeys -16.6% to 30.2% (14% absolute increase, p=1.9 x 10-26) 81% increase - upward journeys - 14.5% to 26.3% (11.8% absolute increase, p=3.5 x 10-12) 86% increase - downward journeys - 18.8% to 34.7% (16% absolute increase, p=3.4 x 10-16)
- At the IPH conference recently the pres on Green Gyms and the TCV schemes highlighted 2 elements that were key to their successful schemes- The importance of doing things together feeling appreciated. PFP relies heavily on these in its operation on the ground as its delivered in the workplace by volunteer champions. Charitable donation a KEY element as ensures a lot of people join and keep going to the end as they knew their efforts would help others.
- NB – promotes an evidence based methods to safe sustainable weight loss. Incorporates NICE guidance on calorie restriction - recc 600 cal deficit.
- At enrolment – measure wt, height and waist circumference and demographic details. At each of the 12 sessions weight was measured and at 12 week weight and waist circumference were measured.
- with most gains from employment (≈ £87,000), followed by healthcare (≈ £38,000) and social-care (≈ £30,000) savings. with much smaller savings associated with CHD, stroke and cancers.