Green is good

The reasons why a recycle-resuse-reduce policy at the workplace is good for the environment are plain to see. But there are other reasons why green is good!

• Take time to smell the flowers
  Apart from the physical health benefits of physical activity and interacting socially with your friends on a walk in a park, there are psychological benefits from taking time to experience nature.
• Eat a bowl of tea
  Drinking green tea has been found to be associated with lower risks of breast cancer recurrence (though the jury is still out on whether the benefits of green tea consumption extends to lowering the risk of breast cancer incidence), according to a recent meta-analysis (Ogunleye et al., 2010).
• Eat enough fruit and veg
  Fruit and vegetable consumption has been reliably associated with lower risks of cancer, with fruits being particularly protective for head-neck and esophagus cancers, and both playing a protective role for cancers involving the pancreatic, stomach, colorectal, bladder, cervix, ovarian, endometrium, and breast (Block et al., 1991), although a more recent meta-analysis indicates that moderate rather than high consumption of fruit and vegetables is adequate for lowering cancer risk (Key, 2011).
  In contrast, each additional portion of fruit and vegetables consumed a day is associated with lowering the risk of cardiovascular disease by at least 4% (Dauchet et al., 2006; WHO, 2004), while eating 3 or more servings of fruit and vegetables daily is linked to a lower risk of stroke (He et al., 2006). At the same time, it is thought that eating fruits and vegetables which contain vitamin C, potassium, folate, and the all-important dietary fibre, have positive health benefits which dietary flavonoid supplements do not provide (Egert and Rimbach, 2011).

Healthy eating at the workplace

The vast majority of research on the efficacy of workplace interventions focus on the role of exercise and physical activity. Indeed, many studies show that educating employees about the mental, social, and physical health benefits of exercise leads to an increase in physical activity.

Implementing worksite exercise programmes which can range from recommending 1,000 steps a day to providing in-house aerobic and strength training during protected time over an extended period improves employees’ health: physical health benefits are better body mass index or BMI, blood pressure (BP), HDL cholesterol, body fat proportion, and waist circumference, while mental health benefits include improved psychological mood and wellbeing. These workplace interventions are influential in achieving greater productivity as employees report better job satisfaction and spend fewer days absent from work due to ill health.

In contrast, studies on healthy eating workplace interventions show more mixed results. The health benefits of eating whole grains, fruits and vegetables are well established for community samples. But compared to the benefits from workplace physical activity interventions, programmes which focus on healthy eating tend to achieve less dramatic results. A review by Anderson and colleagues (2009) indicates small though significant reductions in weight and improvements in BMI for 6 and 9 randomized controlled studies respectively. In another review, Mhurchu and colleagues (2010) suggest that changing the environment (e.g., providing healthy choices in the canteen), as well as educating employees about the benefits of healthy eating, does bring about dietary changes. Furthermore, few studies measure objective outcomes such as BMI or corporate outcomes such as absenteeism.

This may be because interventions which focus primarily on changing eating patterns are not as effective as those which increase physical activity and encourage healthy eating. Alternatively, other factors may be at play. A randomized controlled study by Barrington and colleagues (2012) shows that even at baseline (before any workplace intervention takes place), workers who report higher levels of stress show fewer healthy behaviours — a tendency to eat while doing other activities and less leisure-time exercise. Moreover, those unaware of preoccupied eating also eat fewer fruits and vegetables and more fast food.

Workplace interventions may need to consider the impact of stress levels and take steps to counter its effects on eating and exercise behaviours among employees. While a holistic approach which tackles food choices, physical activity, and stress management is commendable, it may also be important to provide employees with effective strategies for managing stress. A recent study showed that social support was not helpful for improving BMI, even though there was a positive correlation between workplace social support and physical activity/fruit-vegetable intake (Tamers et al., 2011). Instead, interventions which specifically target how employees manage their stress may be the way to go.

Increasing physical activity at the workplace

Physical activity not only helps improve cardiovascular health but has important implications for psychosocial health. A meta-analysis of intervention studies including 8 randomized controlled trials reveals that physical activity is reliably associated with better quality of life and emotional wellbeing (Brown, Gilson, Burton, & Brown, 2011).

Promoting messages about the benefits of physical activity at the workplace is one way to increase physical activity among employees. Implementing organizational-level policy change such as free membership to fitness clubs and in-house exercise programmes during protected time is another. But not all workplace interventions are created equal. Some interventions can be more effective than others, while retaining a relatively cost-efficient status.

Here are 8 things to know about effective interventions.

1. Measure objective health measures
   Educating employees about the benefits of increasing their levels of physical activity may be effective, but these benefits may not be observed in self-report measures of activity level. Using a randomized controlled matched-worksite design, McEachan et al. (2011) compared employees educated on the benefits of physical activity with controls without access to an equivalent intervention. In this study of 1025 respondents, employees who received the intervention were not reporting more physical activity after 9 months than controls, but they had significantly lower systolic blood pressure and a lower resting heart rate. Objective health measures are useful indicators of programme effectiveness.

2. Emphasize the socioemotional benefits of physical activity
   Promoting the mental health, social, and physical health benefits of physical activity may be more effective than emphasizing only physical health benefits alone. Moreover, promoting each type of benefit at one time may be more effective than educating employees about all three types of benefits altogether. Because it is easier to absorb new information in smaller chunks, promoting mental health benefits separately from physical health benefits may prove to be an effective strategy for increasing physical activity among employees. The workplace intervention in McEachan and colleagues’s (2011) study promoted each category of benefits to employees in different months.

3. Use a variey of communication channels
   Using a combination of different channels to communicate the benefits of physical activity may also be more effective than relying primarily on email. The workplace programme which reduced systolic blood pressure and resting heart rate in the McEachan et al. (2011) study distributed the benefits of physical activity over several months in the form of posters, leaflets, a management support letter, a knowledge quiz, an email reminder, a newsletter, as well as a physical activity team challenge.

4. Tailor your programme to the target audience
   Giving employees a pedometer, in addition to information about the benefits of walking and stair-use, increases walking behaviour compared to controls Aittasalo et al. (2012). At the same time, adults with more years of education are more likely to increase their step count with a pedometer. Pedometer awareness has also been associated with greater pedometer use (Craig et al., 2006; Eakin et al., 2007). An intervention involving pedometers can therefore be an cost-efficient strategy for employees with high levels of education. On the other hand, the benefits of giving employees a pedometer may be optimized by impressing upon employees, who have varying levels of education, the benefits of walking and launching a campaign to raise their awareness about pedometers.

5. Identify factors associated with increased physical activity  
   Common sense dictates that a programme targeted to increase physical activity alone will be not be effective in raising the health status of employees unless it is combined with a campaign which encourages healthy eating. However, it is also important to focus on aspects of healthy eating found to significantly contribute to healthy behaviour. A study of 573 employees in sedentary occupations showed that encouraging employees to log 10,000 steps daily was more effective in reducing waist circumference among those who ate at least two servings of fruit a day (Freak-Poli et al., 2011).

6. Use facilities accessible to all employees
   Encouraging employees to use the stairs in place of lifts (elevators) increases physical activity at the workplace. In a study of 160 office workers, employees who used the stairs for 10 minutes three times a week over 10 weeks had improved aerobic fitness compared to controls (Andersen et al., 2013). Benefits extended to improved systolic and diastolic blood pressure for the stair-use group over controls, among those with poor fitness at baseline.

7. Find the right place to motivate employees
   It’s easy to say “take the stairs”. It’s much harder to get everyone to actually take the stairs. Although the physical health benefits of using the stairs over the lift are well established, few studies focus on the effectiveness of campaigns which encourage stair-use. In a study involving two worksites with 500 and 1200 employees and 4 and 5 floors respectively, Eves and colleagues (2013) found that combining a stairwell message such as “stair climbing always burns calories” with an arrow pointing to the stair riser, with posters carrying information about the benefits of stair climbing (and calories consumed by stair use) to be more effective than posters alone, at increasing stair use. Not only were the stairs used more frequently (as clocked by infrared technology) but employees exposed to posters and stairwell messages were more informed about calorie information associated with stair use.