Publications by authors named "David M Hallman"

51 Publications

Working from home during the COVID-19 outbreak in Sweden: effects on 24-h time-use in office workers.

BMC Public Health 2021 03 17;21(1):528. Epub 2021 Mar 17.

Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden.

Background: The COVID-19 pandemic has triggered national recommendations encouraging people to work from home (WFH), but the possible impact of WFH on physical behaviors is unknown. This study aimed to determine the extent to which the 24-h allocation of time to different physical behaviors changes between days working at the office (WAO) and days WFH in office workers during the pandemic.

Methods: Data were collected on 27 office workers with full-time employment at a Swedish municipal division during the COVID-19 outbreak in May-July 2020. A thigh-worn accelerometer (Axivity) was used to assess physical behavior (sedentary, stand, move) during seven consecutive days. A diary was used to identify periods of work, leisure and sleep. 24-h compositions of sedentary, standing and moving behaviors during work and non-work time were examined using Compositional data analysis (CoDA), and differences between days WAO and days WFH were determined using repeated measures ANOVA.

Results: Days WFH were associated with more time spent sleeping relative to awake, and the effect size was large (F = 7.4; p = 0.01; η = 0.22). The increase (34 min) in sleep time during WFH occurred at the expense of a reduction in work and leisure time by 26 min and 7 min, respectively. Sedentary, standing and moving behaviors did not change markedly during days WFH compared to days WAO.

Conclusion: Days working from home during the COVID-19 pandemic in Sweden were associated with longer duration of sleep than days working at the office. This behavioral change may be beneficial to health.
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http://dx.doi.org/10.1186/s12889-021-10582-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968563PMC
March 2021

Work-Time Compositions of Physical Behaviors and Trajectories of Sick Leave Due to Musculoskeletal Pain.

Int J Environ Res Public Health 2021 Feb 5;18(4). Epub 2021 Feb 5.

National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.

We aimed to investigate the association between work-time compositions of physical behavior and sick leave trajectories due to musculoskeletal pain over one year. We conducted a secondary analysis using the data of 981 workers in a Danish prospective cohort (DPHACTO 2012-2014). At baseline, we assessed physical behaviors (sitting, standing, light physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA)) at work and during leisure, using accelerometers. Over 1 year follow-up, workers reported sick-leave days due to musculoskeletal pain at 4-week intervals. Four distinct trajectories of sick leave were previously identified in this cohort ("no sick leave", "few days-increasing trajectory", "some days-decreasing trajectory", "some days-increasing trajectory"), and used as an outcome in multinomial regression models with work-time compositions as predictors, adjusted for compositions of behavior during leisure, age, sex, body mass index, and smoking habits. More time spent sitting relative to the other behaviors was negatively associated with the trajectory of few days-increasing sick leave ( = 0.004), while time in LIPA was positively associated with the trajectory of some days-increasing sick leave ( = 0.009). Standing and MVPA were not significantly associated with sick leave trajectories. In conclusion, work-time compositions with more sitting relative to the other behaviors had lower risk for an increasing trajectory of sick leave due to pain, while compositions with more LIPA had higher risk. This may have implications for prevention of pain-related sick leave in blue-collar workers.
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http://dx.doi.org/10.3390/ijerph18041508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915038PMC
February 2021

Effects of relocation to activity-based workplaces on perceived productivity: Importance of change-oriented leadership.

Appl Ergon 2021 May 23;93:103348. Epub 2021 Jan 23.

Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, SE-801 76, Gävle, Sweden. Electronic address:

Activity-based workplaces (ABWs) are becoming popular in Western countries and were implemented at four office sites of a large Swedish government agency. A fifth office was used as a control group. The study aim was to examine the effects of relocation to ABW on perceived productivity among employees and to determine if perceived change-oriented leadership behavior prior to relocation moderates potential effects. Data were collected three months prior to relocation, and three and 12 months after. 407 respondents were included in linear mixed regression models. Perceived productivity decreased significantly after relocation compared to the control group and these effects persisted 12 months after the relocation. However, the decrease in perceived productivity was significantly smaller among employees perceiving high change-oriented leadership before relocation. Our results point out the importance of a change-oriented leadership behavior during the implementation to avoid productivity loss among employees when implementing ABWs.
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http://dx.doi.org/10.1016/j.apergo.2020.103348DOI Listing
May 2021

Stress-Related Responses to Alternations between Repetitive Physical Work and Cognitive Tasks of Different Difficulties.

Int J Environ Res Public Health 2020 11 17;17(22). Epub 2020 Nov 17.

Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, 801 76 Gävle, Sweden.

Alternating between physical and cognitive tasks has been proposed as an alternative in job rotation, allowing workers to recover from the physical work while still being productive. However, effects of such alternations on stress have not been investigated. This controlled experiment aimed at determining the extent to which stress-related responses develop during alternating physical and cognitive work, and to determine the extent to which cognitive task (CT) difficulty influences these responses. Fifteen women performed three sessions of 10 consecutive work bouts each including a seven-minute repetitive physical task (pipetting) and a three-minute CT (-back) at one of three difficulty levels. Stress was assessed in terms of changes in heart rate variability, blood pressure, salivary alpha-amylase, salivary cortisol, perceived stress, and cognitive performance. The work session did not result in any marked stress response, and CT difficulty did not significantly influence stress, apart from alpha-amylase being higher at the easiest CT (F = 5.34, = 0.02). Thus, according to our results, alternating between repetitive physical tasks and cognitive tasks may be a feasible alternative to classic job rotation between physical tasks only, even if the cognitive task is quite difficult. Future studies should address possible effects of the temporal pattern of alternations, and combine even other occupationally relevant tasks, preferably for extended periods of time.
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http://dx.doi.org/10.3390/ijerph17228509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698406PMC
November 2020

Objective measures of cognitive performance in activity based workplaces and traditional office types.

J Environ Psychol 2020 Dec 8;72:101503. Epub 2020 Oct 8.

Faculty of Health and Occupational Studies, Centre for Musculoskeletal Research, University of Gävle, Sweden.

Distraction from the background environment while performing concentrationdemanding tasks is a common issue for office employees in shared work areas. However, few field studies have been conducted on the effects of different office types and work areas on objective measurements of cognitive performance. The first aim of the present field study was to investigate, before relocation to an activity-based workplace (ABW), differences in performance on a concentration-demanding cognitive task between individuals in shared/open-plan offices compared to cell offices. The second aim was to investigate, after relocation, how performance differs (withinperson) between different work areas within the ABW. This study included employees from five offices (n = 113), of which four relocated into an ABW. An acoustician measured the equivalent sound levels of the work areas. Data were analyzed using linear regression (aim 1) and mixed models (aim 2). Before relocation, employees working in shared/open-plan offices performed significantly worse (14%) than those in cell-offices, which had a 15 LAeq lower noise level. After relocation, employees performed significantly worse in the active zone without noise restrictions, compared to all other work areas. When shifting open-plan area from the active zone to the quiet zone cognitive performance increased significantly by 16.9%, and switching to individual working rooms increased performance by 21.9%. The results clearly demonstrate the importance for organizations to provide quiet areas or rooms with few distractions for employees working on tasks that demand concentration in an ABW. A daily drop in performance for each employee may be expensive for the organization in the long run.
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http://dx.doi.org/10.1016/j.jenvp.2020.101503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543894PMC
December 2020

Combined Effects of Physical Behavior Compositions and Psychosocial Resources on Perceived Exertion Among Eldercare Workers.

Ann Work Expo Health 2020 11;64(9):923-935

Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden.

Objectives: High perceived physical exertion is common in eldercare workers and a strong predictor for impaired health. However, little is known on how physical behaviors at work associate with physical exertion in this group. The aim of this study was to determine the extent to which the composition of physical behaviors at work is associated with perceived physical exertion in nursing home eldercare workers, and the extent to which these associations are modified by psychosocial resources.

Methods: Our population consisted of 399 female eldercare workers from 126 wards in 20 different nursing homes. We evaluated time spent in physical behaviors at work [sitting, standing still, light activities (LAs), and moderate to vigorous activities (MVAs)] using triaxial accelerometers worn, on average, for three working days. We accounted for inherent codependency between the behaviors using compositional data analysis. We used multilevel linear mixed regression models to determine associations between the behaviors and perceived exertion, measured on a numeric rating scale (0-10), and included interactions between each behavior and psychosocial resources (influence at work, social support, and quality of leadership) to determine a possible moderating effect of resources. Regression results were illustrated using isotemporal substitution.

Results: Sitting was negatively (β: -0.64; P < 0.01) while MVA was positively (β: 0.95; P = 0.02) associated with perceived exertion. According to isotemporal substitution, replacing 30 min of MVA by sitting would, for an average worker, be associated with a decrease in physical exertion by -0.14 on the 0-10 scale. Job resources marginally moderated the association between LA and exertion. Thus, among workers with low influence and low social support, we found a positive association between LA and exertion, while that was not found for workers with medium or high influence and support (interactions for influence and support: P = 0.08 and P = 0.10).

Conclusions: Our findings suggest that reallocating time from MVA to sitting can mitigate perceived physical exertion in eldercare workers. More time in LA increased physical exertion only for workers with low psychosocial resources, supporting a positive effect of a better psychosocial work environment in elderly care.
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http://dx.doi.org/10.1093/annweh/wxaa079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751016PMC
November 2020

Sense of Coherence, Health, Well-Being, and Work Satisfaction before and after Implementing Activity-Based Workplaces.

Int J Environ Res Public Health 2020 07 21;17(14). Epub 2020 Jul 21.

Faculty of Health and Occupational Studies, Department of Occupational Health Sciences and Psychology, University of Gavle, 801 76 Gävle, Sweden.

Activity-based workplaces (ABWs) are implemented with possible implications for health, well-being, and work satisfaction in the workplace. Drawing on the theoretical framework, i.e., sense of coherence (SOC), the aim was to investigate how indicators pf SOC-meaningfulness, manageability and comprehensibility-are associated with, or function as barriers or facilitators for, health, well-being and work satisfaction during relocation to an ABW. We followed the implementation of ABWs at the Swedish Transport Administration (2018-2019). Questionnaires were administered before ( = 536), 3 months ( = 409) and 9 months ( = 373) after relocation. Focus group interviews (15) were conducted before and after. Data were analyzed using repeated measures ANOVA and content analysis. Relocation to an ABW was associated with a reduced work satisfaction (physical < 0.001; psychosocial < 0.001), and minor changes in health and occupational well-being during relocation ( > 0.001). The reduction in work satisfaction was smaller among employees with high meaningfulness in the relocation process ( < 0.001). All SOC indicators were positively associated with overall health, well-being and work satisfaction ( < 0.001). Interviews suggested that meaningfulness was facilitated by participation in the presented activities and that communication before relocation was crucial. The results indicate that organizations implementing ABWs should promote perceived meaningfulness in the process to mitigate possible declines in satisfaction with the physical and psychosocial work environment.
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http://dx.doi.org/10.3390/ijerph17145250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400008PMC
July 2020

Sitting, standing and moving during work and leisure among male and female office workers of different age: a compositional data analysis.

BMC Public Health 2020 Jun 1;20(1):826. Epub 2020 Jun 1.

Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden.

Background: Gendered patterns of physical activity behaviours may help explaining health inequalities between men and women. However, evidence on such patterns in the working population is sparse. This study aimed at documenting and comparing compositions of sitting, standing and moving at work and during leisure among male and female office workers of different age.

Methods: Sitting (including lying), standing and moving were measured using accelerometry for, on average, four working days in 55 male and 57 female Swedish office workers. Behaviours were described in terms of time spent in four exhaustive categories: sitting in short (< 30 min) and long (≥30 min) bouts, standing, and moving. In a compositional data analysis approach, isometric log-ratios (ilr) were calculated for time sitting relative to non-sitting, time in short relative to long sitting bouts, and time in standing relative to moving. Differences between genders (men vs. women), domains (work vs. leisure), and according to age were examined for each ilr using ANOVA.

Results: At work, time spent sitting in short bouts, sitting in long bouts, standing, and moving was, on average, 29, 43, 21 and 7% among men, and 28, 38, 26 and 7% among women. Corresponding proportions during leisure were 34, 27, 27 and 13% among men and 28, 27, 32 and 13% among women. Men spent more time sitting relative to non-sitting ([Formula: see text] =0.04, p = 0.03) than women, and less time standing relative to moving ([Formula: see text] =0.07, p = 0.01). At work compared to during leisure, both genders spent more time sitting relative to non-sitting ([Formula: see text] =0.47, p < 0.01); within sitting more time was spent in long relative to short sitting bouts ([Formula: see text] =0.26, p < 0.01), and within non-sitting, more time was spent standing than moving ([Formula: see text] =0.12, p < 0.01). Older workers spent less of their non-sitting time moving than younger workers ([Formula: see text] =0.07, p = 0.01).

Conclusion: Male office workers spent more time sitting relative to non-sitting than female workers, and more time moving relative to standing. Both genders were sitting more at work than during leisure. Older workers moved less than younger. These workers could likely benefit from interventions to reduce or break up prolonged sitting time, preferably by moving more.
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http://dx.doi.org/10.1186/s12889-020-08909-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268323PMC
June 2020

Do organisational and ward-level factors explain the variance in multi-site musculoskeletal pain in eldercare workers? A multi-level cross-sectional study.

Int Arch Occup Environ Health 2020 Oct 18;93(7):891-898. Epub 2020 Apr 18.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Purpose: Multi-site musculoskeletal pain (MSP) is highly prevalent among eldercare workers, leading to increased incidence of sickness absence and early retirement. Most research on MSP in eldercare workers has focused on individual-level factors reported by the employees, with limited focus at the organisation and ward level. To address this gap, the aim of this study was to investigate whether organisation and ward-level factors explain the variance in MSP among Danish eldercare workers.

Methods: A multi-level cross-sectional study was conducted among 20 Danish nursing homes, containing 126 wards, and 418 workers who participated in measurements of organisational factors, working environment factors, and MSP (classified as reporting pain in 2 or more body regions). Data were collected at the level of the organisation, ward, and individual. The proportion of variance in MSP explained by each level was estimated using variance components analysis. The association between factors at each level of the organisation and MSP was investigated using generalised linear mixed-effects regression.

Results: Sixty seven percent of participants reported having MSP. The organisational and ward-level factors explained 0% of the variance in MSP, while the individual-level factors explained 100% of the variance in MSP. Moreover, no factors at the organisational and ward levels showed statistically significant associations with MSP. Individual-level perceived physical exertion and quantitative demands had a statistically significant association with a higher prevalence of MSP.

Conclusions: The organisation and ward levels did not contribute to explaining any of the variance in MSP. All variance in MSP was explained at the individual level.
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http://dx.doi.org/10.1007/s00420-020-01540-7DOI Listing
October 2020

Occupational and Individual Determinants of Work-life Balance among Office Workers with Flexible Work Arrangements.

Int J Environ Res Public Health 2020 02 22;17(4). Epub 2020 Feb 22.

Department of Occupational Health Sciences and Psychology, University of Gävle, 801 76 Gävle, Sweden.

Flexible work arrangements permitting workers to work anytime and anywhere are increasingly common. This flexibility can introduce both challenges and opportunities for the organisation, as well as for worker work-life balance (WLB). This cross-sectional study aimed to examine the extent to which occupational factors (organizational, leadership and psychosocial) and individual work-related behaviours (over-commitment, overtime work and boundary management) are associated with WLB, and whether these associations are modified by the perceived level of flexibility at work (i.e., control over when, where, and how to do the work). In total, 2960 full-time office workers with flexible work arrangements at the Swedish Transport Administration participated. Associations were determined using linear regression analyses with adjustment for covariates. The strongest negative associations with WLB were found for over-commitment, quantitative job demands, expectations of availability, and overtime work. Strongest positive associations were found for boundary management, information about organizing work, social support, and relation-oriented leadership. Perceived flexibility was positively associated with WLB, and interacted with several of the examined factors, buffering their negative associations with WLB. Results suggest that WLB can be promoted by organizational initiatives focusing on minimizing excessive job demands, increasing psychosocial resources, supporting boundary management, and enhancing perceived flexibility.
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http://dx.doi.org/10.3390/ijerph17041418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068342PMC
February 2020

The effect of a single spinal manipulation on cardiovascular autonomic activity and the relationship to pressure pain threshold: a randomized, cross-over, sham-controlled trial.

Chiropr Man Therap 2020 20;28(1). Epub 2020 Jan 20.

5Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.

Background: The autonomic nervous system interacts with the pain system. Knowledge on the effects of high velocity low amplitude spinal manipulations (SM) on autonomic activity and experimentally induced pain is limited. In particular, the effects of SM on autonomic activity and pain beyond the immediate post intervention period as well as the relationship between these two outcomes are understudied. Thus, new research is needed to provide further insight on this issue.

Objectives: The aim was to assess the effect of a single SM (i.e. SM vs. sham) on cardiovascular autonomic activity. Also, we assessed the relationship between cardiovascular autonomic activity and level of pain threshold after the interventions.

Method: We conducted a randomized, cross-over, sham-controlled trial on healthy first-year chiropractic students comprising two experimental sessions separated by 48 h. During each session, subjects received, in a random order, either a thoracic SM or a sham manipulation. Cardiovascular autonomic activity was assessed using heart rate and systolic blood pressure variabilities. Pain sensitivity was assessed using pressure pain threshold. Measurements were performed at baseline and repeated three times (every 12 min) during the post intervention period. Participants and outcome assessors were blinded. The effect of the SM was tested with linear mixed models. The relationship between autonomic outcomes and pressure pain threshold was tested with bivariate correlations.

Results: Fifty-one participants were included, forty-one were finally analyzed. We found no statistically significant difference between SM and sham in cardiovascular autonomic activity post intervention. Similarly, we found no post-intervention relationship between cardiovascular autonomic activity and pressure pain threshold.

Conclusion: Our results suggest that a single SM of the thoracic spine has no specific effect on cardiovascular autonomic activity. Also, we found no relationship between cardiovascular autonomic activity and pressure pain threshold after the SM. Further experimental research should consider the use of several markers of autonomic activity and a more comprehensive pain assessment.

Trial Registration: N° NCT03273868. Registered September 6, 2017.
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http://dx.doi.org/10.1186/s12998-019-0293-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971986PMC
January 2021

Accelerometer-Measured Physical Activity at Work and Need for Recovery: A Compositional Analysis of Cross-sectional Data.

Ann Work Expo Health 2020 02;64(2):138-151

Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Copenhagen, Denmark.

Objectives: Previous research has shown strong associations between occupational physical activity (OPA) and need for recovery (NFR). However this research has only utilized self-reported measures of OPA which may be biased. Thus, there is a need for investigating if the previously documented association between self-reported OPA and NFR can be found when using technical measures of OPA. There is also the need to investigate whether older workers are particularly susceptible to increased NFR, since age-related declines in physical capacity mean that it is likely these workers will have a higher NFR for a given physical activity. The aim of this study was to investigate the association between technically measured OPA and NFR, and whether this relationship is modified by age.

Methods: This study utilized data from the Danish Physical Activity Cohort with Objective Measurements cohort-comprising Danish workers (n = 840) from the cleaning, manufacturing, and transportation sectors. OPA was measured by accelerometers attached to the thigh and upper back for at least one work day and classified into four physical behaviour categories (sedentary, standing, light, or moderate/vigorous). NFR was measured using a shortened version of the Danish NFR scale. Analysis was conducted using linear regression and isotemporal substitution analyses for compositional data.

Results: The overall association between OPA and NFR was statistically significant in the unadjusted model (P < 0.001), but not when adjusted for age, sex, occupation, and shift work (P = 0.166). Isotemporal substitution showed small but significant reductions in NFR when increasing sedentary time relative to other behaviours (adjusted: ΔNFR = -0.010 [-0.019; -0.001]). There were no significant interactions between age and OPA (P = 0.409).

Conclusions: This study found significant associations between OPA and NFR, but the effect sizes were small. Reallocating 30 min to sedentary behaviours from other behaviours was associated with a reduced NFR, but the effect size may not be practically relevant. Moreover, no clear modifying effects of age were identified.
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http://dx.doi.org/10.1093/annweh/wxz095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031076PMC
February 2020

Objectively measured versus self-reported occupational physical activity and multisite musculoskeletal pain: a prospective follow-up study at 20 nursing homes in Denmark.

Int Arch Occup Environ Health 2020 04 23;93(3):381-389. Epub 2019 Nov 23.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Purpose: To explore the prospective association of objectively measured and self-reported occupational physical activity (OPA) with multisite musculoskeletal pain (MSP) among Danish eldercare workers.

Methods: The study population consisted of eldercare workers in 20 Danish nursing homes (N = 553, response rate 59%, 525 female). Baseline data were collected in 2013-2014 and the 1-year follow-up was completed in 2016. At baseline, we measured objective OPA by a thigh-worn ActiGraph GT3X + accelerometer during work and self-reported OPA by a questionnaire survey. Information on musculoskeletal pain during the past four weeks in seven different body sites was reported by a structured questionnaire at baseline (n = 389) and by SMS and telephone interview during follow-up (n = 284). MSP was defined as having pain in two or more body sites. Using log-binomial models we calculated risk ratios (RRs) with their 95% confidence intervals (CIs) to estimate the association between objectively measured and self-reported OPA and MSP.

Results: We found statistically significant positive associations between self-reported OPA (RR for high OPA 1.24, 95% CI 1.05-1.46) and MSP while there was no significant association found between objective OPA and MSP.

Conclusion: Our study indicates that self-reported, but not objectively measured OPA is positively associated with MSP. This finding highlights the need for better understanding, use, and interpretation of self-reported and objectively measured OPA in the study of MSP.
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http://dx.doi.org/10.1007/s00420-019-01495-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078130PMC
April 2020

Association between Psychosocial Working Conditions and Perceived Physical Exertion among Eldercare Workers: A Cross-Sectional Multilevel Analysis of Nursing Homes, Wards and Workers.

Int J Environ Res Public Health 2019 09 26;16(19). Epub 2019 Sep 26.

Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden.

This cross-sectional multilevel study aims at investigating the associations between psychosocial working conditions of different workplace levels and perceived physical exertion among eldercare workers. Data were obtained from the 'Danish Observational Study of Eldercare work and musculoskeletal disorderS' (DOSES) study, including 536 eldercare workers, nested in 126 wards and 20 nursing homes. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ). The physical workload was measured with a self-administered scale (0-10) rating perceived physical exertion. Multilevel linear mixed models were used to determine associations of psychosocial conditions between nursing homes, wards, and workers with physical exertion. Most of the variance in the perceived physical exertion was explained by differences between workers (83%), but some variance was explained by wards (11%) and nursing homes (6%). Workers employed in nursing homes with low influence ( = 0.01) and poor leadership ( = 0.02), and in wards with high quantitative demands ( = 0.03), high work pace ( < 0.001), and low justice ( = 0.01) were at increased risk of reporting higher physical exertion. The strongest associations were found for low influence, low quality of leadership, and high work pace at nursing homes and ward levels. In conclusion, improving specific psychosocial working conditions at nursing home and ward levels may be of particular importance to reduce excessive physical workload in eldercare workers.
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http://dx.doi.org/10.3390/ijerph16193610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801705PMC
September 2019

Calibration of Self-Reported Time Spent Sitting, Standing and Walking among Office Workers: A Compositional Data Analysis.

Int J Environ Res Public Health 2019 08 27;16(17). Epub 2019 Aug 27.

Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, 1081 BT Amsterdam, The Netherlands.

We developed and evaluated calibration models predicting objectively measured sitting, standing and walking time from self-reported data using a compositional data analysis (CoDA) approach. A total of 98 office workers (48 women) at the Swedish Transport Administration participated. At baseline and three-months follow-up, time spent sitting, standing and walking at work was assessed for five working days using a thigh-worn accelerometer (Actigraph), as well as by self-report (IPAQ). Individual compositions of time spent in the three behaviors were expressed by isometric log-ratios (ILR). Calibration models predicting objectively measured ILRs from self-reported ILRs were constructed using baseline data, and then validated using follow-up data. Un-calibrated self-reports were inaccurate; root-mean-square (RMS) errors of ILRs for sitting, standing and walking were 1.21, 1.24 and 1.03, respectively. Calibration reduced these errors to 36% (sitting), 40% (standing), and 24% (walking) of those prior to calibration. Calibration models remained effective for follow-up data, reducing RMS errors to 33% (sitting), 51% (standing), and 31% (walking). Thus, compositional calibration models were effective in reducing errors in self-reported physical behaviors during office work. Calibration of self-reports may present a cost-effective method for obtaining physical behavior data with satisfying accuracy in large-scale cohort and intervention studies.
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http://dx.doi.org/10.3390/ijerph16173111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747301PMC
August 2019

Movement behavior profiles and obesity: a latent profile analysis of 24-h time-use composition among Danish workers.

Int J Obes (Lond) 2020 02 24;44(2):409-417. Epub 2019 Jul 24.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Background/objectives: An element of obesity prevention is increasing total physical activity energy expenditure. However, this approach does not incorporate the balance of various movement behaviors-physical activity, sedentary behaviors and sleep-across domains of the day. We aimed to identify time-use profiles over work and leisure, termed 'movement behavior profiles' and to investigate their association with obesity.

Subjects/methods: Eight-hundred-and-seven workers completed (a) thigh accelerometry and diaries to determine their 24-h composition of behaviors (sedentary and standing, light physical activity and moderate-to-vigorous physical activity at work and leisure, and time in bed) and (b) obesity measurements. Movement behavior profiles were determined using latent profile analyses of isometric log-ratios of the 24-h composition, and labeled according to animal movement behavior traits. Linear models were applied to determine the association between profiles and obesity.

Results: Four profiles were identified, labeled as "Chimpanzees" (n = 226), "Lions" (n = 179), "Ants" (n = 244), and "Koalas" (n = 158). "Chimpanzees" work time was evenly distributed between behaviors while their leisure time was predominantly active. Compared to Chimpanzees, "Lions" were more active at work and sedentary during leisure and spent more time in bed; "Ants" were more active at work and during leisure; "Koalas" were more sedentary at work and leisure and spent similar time in bed. With "Chimpanzees" as reference, "Lions" had least favorable obesity indicators: +2.0 (95% confidence interval [CI] 0.6, 3.4) %body fat, +4.3 cm (1.4, 7.3) waist circumference and +1.0 (2.0, 0.0) Body Mass Index (BMI), followed by "Koalas" +2.0 (0.4, 3.7) %body fat, +3.1 cm (0.1, 6.0) waist circumference, and +0.8 (-0.30, 1.94) BMI. No significant differences were found between "Chimpanzees" and "Ants".

Conclusions: Movement behavior profiles across work and leisure time-use compositions are associated with obesity. Achieving adequate balance between work and leisure movement behaviors should be further investigated as a potential obesity prevention strategy.
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http://dx.doi.org/10.1038/s41366-019-0419-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997119PMC
February 2020

Sick leave due to musculoskeletal pain: determinants of distinct trajectories over 1 year.

Int Arch Occup Environ Health 2019 11 4;92(8):1099-1108. Epub 2019 Jun 4.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Purpose: This study aimed to identify sub-groups of workers with different trajectories of sick leave due to musculoskeletal pain over 1 year, and to investigate the extent to which the identified trajectories are associated with personal, occupational, lifestyle, and pain-related factors at baseline.

Methods: Data on 981 blue- and white-collar workers were analyzed in the DPHACTO cohort (2012-2014). The number of days on sick leave due to pain was reported using text messages at 4-week intervals across 1 year. Latent class growth analysis was used to distinguish sub-groups with different trajectories of sick leave. A web-based questionnaire at baseline was used to assess personal, occupational (physical and psychosocial), lifestyle, and pain-related factors. Multinomial regression models were constructed to determine associations between baseline factors and trajectories of sick leave (referencing no sick leave), with adjustment for potential confounders.

Results: Four distinct sub-groups were identified, with trajectories of sick leave due to pain ranging from no sick leave (prevalence 76%; average 0.5 days/year) to some days and increasing sick leave due to pain over 1 year (2%; 89 days/year). The increasing trajectory of sick leave was associated with higher perceived physical exertion, more time in manual work, less social community and influence at work, less leisure-time physical activity, smoking, and more severe symptoms (e.g., multisite pain, low back pain intensity, and pain interference).

Conclusions: We identified four distinct trajectories of sick leave due to musculoskeletal pain. The sub-group with increasing sick leave due to pain was associated with several modifiable physical and psychosocial factors at work and outside work, which may have implications for prevention.
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http://dx.doi.org/10.1007/s00420-019-01447-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814632PMC
November 2019

Correction of bias in self-reported sitting time among office workers - a study based on compositional data analysis.

Scand J Work Environ Health 2020 01 23;46(1):32-42. Epub 2019 Apr 23.

Department of Public and Occupational Health, Amsterdam UMC, location VUmc, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.

Objective Emerging evidence suggests that excessive sitting has negative health effects. However, this evidence largely relies on research using self-reported sitting time, which is known to be biased. To correct this bias, we aimed at developing a calibration model estimating "true" sitting from self-reported sitting. Methods Occupational sitting time was estimated by self-reports (the International Physical Activity Questionnaire) and objective measurements (thigh-worn accelerometer) among 99 Swedish office workers at a governmental agency, at baseline and 3 and 12 months afterwards. Following compositional data analysis procedures, both sitting estimates were transformed into isometric log-ratios (ILR). This effectively addresses that times spent in various activities are inherently dependent and can be presented as values of only 0-100%. Linear regression was used to develop a simple calibration model estimating objectively measured "true" sitting ILR (dependent variable) from self-reported sitting ILR (independent variable). Additional self-reported variables were then added to construct a full calibration model. Performance of the models was assessed by root-mean-square (RMS) differences between estimated and objectively measured values. Models developed on baseline data were validated using the follow-up datasets. Results Uncalibrated self-reported sitting ILR showed an RMS error of 0.767. Simple and full calibration models (incorporating body mass index, office type, and gender) reduced this error to 0.422 (55%) and 0.398 (52%), respectively. In the validations, model performance decreased to 57%/62% (simple models) and 57%/62% (full models) for the two follow-up data sets, respectively. Conclusions Calibration adjusting for errors in self-reported sitting led to substantially more correct estimates of "true" sitting than uncalibrated self-reports. Validation indicated that model performance would change somewhat in new datasets and that full models perform no better than simple models, but calibration remained effective.
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http://dx.doi.org/10.5271/sjweh.3827DOI Listing
January 2020

The acute effects of joint manipulative techniques on markers of autonomic nervous system activity: a systematic review and meta-analysis of randomized sham-controlled trials.

Chiropr Man Therap 2019 12;27:17. Epub 2019 Mar 12.

5Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.

Background: The autonomic nervous system (ANS) interests many chiropractors and manual therapists, because joint manipulative techniques (JMT), e.g. high velocity low amplitude (HVLA) manipulations and mobilizations, appear to produce acute changes in ANS mediated physiology. The complexity of this issue justifies a systematic critical literature review.

Objective: To review the literature comparing the acute changes in markers of ANS activity between JMT applied on spinal or peripheral joints and a sham procedure in healthy or symptomatic subjects.

Method: We searched PsycINFO, PEDro, PubMed, Cochrane library, EMBASE, and Medline up to December 2017. We updated the search with PubMed, Cochrane library, EMBASE, and Medline including July 2018. Inclusion criteria were: randomized sham-controlled trials assessing the effect of JMT on markers of ANS activity; manually applied JMT, regardless of technique, applied on either healthy or symptomatic humans; outcome measurements recorded at baseline and repeated during and/or after interventions. Selection of articles and data extraction were performed independently by two reviewers. The quality of studies was assessed using the tool and a technical check-list. Results were reported narratively with some meta-analyses. The GRADE approach was used to assess the certainty of evidence.

Results: Twenty-nine of 2267 studies were included in the synthesis. Mobilizations (oscillatory technique) probably produce an immediate and short-term, bilateral increase in skin sympathetic nerve activity (reflected by an increase in skin conductance) regardless of the area treated (moderate-certainty evidence). It is uncertain whether the sympathetic arousal also explains an increase in respiratory rate (very low-certainty evidence). Our evaluation of the literature suggests that spinal sustained apophyseal glides (SNAGs) mobilization and HVLA manipulation of the spine may have no acute effect on the studied markers of ANS activity (very low- to low-certainty evidence).

Conclusion: Some types of mobilizations probably produce an immediate and short-term, statistically significant increase in skin sympathetic nerve activity when compared to a sham procedure, whereas spinal SNAGs and spinal HVLA techniques may have no acute effect on the studied markers of ANS activity. No region-specific results were noted. The literature suffers from several shortcomings, for which reason we strongly suggest further research.
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http://dx.doi.org/10.1186/s12998-019-0235-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413458PMC
July 2019

Objectively Measured Sitting and Standing in Workers: Cross-Sectional Relationship with Autonomic Cardiac Modulation.

Int J Environ Res Public Health 2019 02 22;16(4). Epub 2019 Feb 22.

National Research Centre for the Working Environment, Copenhagen 2100, Denmark.

Excessive sitting and standing are proposed risk factors for cardiovascular diseases (CVDs), possibly due to autonomic imbalance. This study examines the association of objectively measured sitting and standing with nocturnal autonomic cardiac modulation. The cross-sectional study examined 490 blue-collar workers in three Danish occupational sectors. Sitting and standing during work and leisure were assessed during 1⁻5 days using accelerometers. Heart rate (HR) and heart rate variability (HRV) were obtained during nocturnal sleep as markers of resting autonomic modulation. The associations of sitting and standing still (h/day) with HR and HRV were assessed with linear regression models, adjusted for age, gender, body mass index, smoking, and physical activity. More sitting time during leisure was associated with elevated HR ( = 0.02), and showed a trend towards reduced HRV. More standing time at work was associated with lower HR ( = 0.02), and with increased parasympathetic indices of HRV (root mean squared successive differences of R-R intervals = 0.05; high-frequency power = 0.07). These findings, while cross-sectional and restricted to blue-collar workers, suggest that sitting at leisure is detrimental to autonomic cardiac modulation, but standing at work is beneficial. However, the small effect size is likely insufficient to mitigate the previously shown detrimental effects of prolonged standing on CVD.
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http://dx.doi.org/10.3390/ijerph16040650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406480PMC
February 2019

The association between multisite musculoskeletal pain and cardiac autonomic modulation during work, leisure and sleep - a cross-sectional study.

BMC Musculoskelet Disord 2018 Nov 20;19(1):405. Epub 2018 Nov 20.

National Research Centre for the Working Environment (NRCWE), Lersø Parkallé 105, 2100, Copenhagen Ø, DK, Denmark.

Background: The prevention and rehabilitation of multisite musculoskeletal pain would benefit from studies aiming to understand its underlying mechanism. Autonomic imbalance is a suggested mechanism for multisite pain, but hardly been studied during normal daily living. Therefore, the aim of the study is to investigate the association between multisite musculoskeletal pain and cardiac autonomic modulation during work, leisure and sleep.

Methods: This study is based on data from the "Danish Physical activity cohort with objective measurements" among 568 blue-collar workers. Pain intensity scales were dichotomized according to the median of each scale, and the number of pain sites was calculated. No site was regarded as the pain-free, one site was considered as single-site musculoskeletal pain and pain in two or more sites was regarded as multisite musculoskeletal pain. Heart rate variability (HRV) was measured by an electrocardiogram system (ActiHeart) and physical activity using accelerometers (Actigraph). Crude and adjusted linear mixed models were applied to investigate the association between groups and cardiac autonomic regulation during work, leisure and sleep.

Results: There was no significant difference between groups and no significant interaction between groups and domains in the crude or adjusted models for any HRV index. Significant differences between domains were found in the crude and adjusted model for all indices, except SDNN; sleep time showed higher values than leisure and work time, except for LF and LF/HF, which were higher during work.

Conclusion: This cross-sectional study showed that multisite musculoskeletal pain is not associated with imbalanced cardiac autonomic regulation during work, leisure and sleep time.
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http://dx.doi.org/10.1186/s12891-018-2312-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247621PMC
November 2018

A comparison of standard and compositional data analysis in studies addressing group differences in sedentary behavior and physical activity.

Int J Behav Nutr Phys Act 2018 06 15;15(1):53. Epub 2018 Jun 15.

National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark.

Background: Data on time spent in physical activity, sedentary behavior and sleep during a day is compositional in nature, i.e. they add up to a constant value. Compositional data have fundamentally different properties from unconstrained data in real space, and require other analytical procedures, referred to as compositional data analysis (CoDA). Most physical activity and sedentary behavior studies, however, still apply analytical procedures adapted to data in real space, which can lead to misleading results. The present study describes a comparison of time spent sedentary and in physical activity between age groups and sexes, and investigates the extent to which results obtained by CoDA differ from those obtained using standard analytical procedures.

Methods: Time spent sedentary, standing, and in physical activity (walking/running/stair climbing/cycling) during work and leisure was determined for 1-4 days among 677 blue-collar workers using accelerometry. Differences between sexes and age groups were tested using MANOVA, using both a standard and a CoDA approach based on isometric log-ratio transformed data.

Results: When determining differences between sexes for different activities time at work, the effect size using standard analysis (η = 0.045, p < 0.001) was 15% smaller than that obtained with CoDA (η = 0.052, p < 0.001), although both approaches suggested a statistically significant difference. When determining corresponding differences between age groups, CoDA resulted in a 60% larger, and significant, effect size (η = 0.012, p = 0.02) than that obtained with the standard approach (η = 0.008, p = 0.07). During leisure, results based on standard (age; η = 0.007, p = 0.09; sex; η = 0.052, p < 0.001) and CoDA (age; η = 0.007, p = 0.09; sex; η = 0.051, p < 0.001) analyses were similar.

Conclusion: Results and, hence, inferences concerning age and sex-based differences in time spent sedentary and in physical activity at work differed between CoDA and standard analysis. We encourage researchers to use CoDA in similar studies, to adequately account for the compositional nature of data on physical activity and sedentary behavior.
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http://dx.doi.org/10.1186/s12966-018-0685-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003121PMC
June 2018

Prolonged sitting at work is associated with a favorable time course of low-back pain among blue-collar workers: a prospective study in the DPhacto cohort.

Scand J Work Environ Health 2018 09 15;44(5):530-538. Epub 2018 Mar 15.

National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen, Denmark.

Objective Low-back pain (LBP) is a massive health problem. Sitting at work has been suggested to be both a risk and protective factor for LBP. Thus, the objective of this study was to investigate the association between total and temporal patterns of objectively measured sitting duration and individual time course of LBP. Methods The analysis was performed among 665 participants from the DPhacto cohort of mainly blue-collar workers. Sitting at work was measured by accelerometry at baseline, expressed in total duration and temporal pattern [% of working time spent in brief bursts (≤5 minutes), moderate (>5 - ≤20 minutes) and prolonged periods (>20 minutes)] of sitting. Time course of LBP (0-10 scale) were collected by monthly text messages across one year. Linear mixed models were applied to investigate the association, adjusting for potential confounders. Results Significant negative associations between sitting duration at work and adjusted time course of LBP were found; total sitting (B -0.01, 95% CI -0.01- -0.004), brief bursts (B -0.01, 95% CI -0.02- -0.01), moderate (B -0.01, 95% CI -0.01- -0.008) and prolonged periods (B -0.01, 95% CI -0.02- -0.01). Meaning, a 5-minute increase of sitting at work will correspond to a decrease in one year time course of LBP by -0.05 points. Conclusion Longer duration of total and temporal sitting periods at work was significantly associated with a favorable time course of LBP. This finding shows sitting at work to be beneficial for LBP, among populations of mainly blue-collar workers, by protecting from LBP aggravation.
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http://dx.doi.org/10.5271/sjweh.3726DOI Listing
September 2018

Shift work is associated with reduced heart rate variability among men but not women.

Int J Cardiol 2018 05 9;258:109-114. Epub 2018 Feb 9.

Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.

Background: Imbalance in the autonomic nervous system due to a disrupted circadian rhythm may be a cause of shift work-related cardiovascular diseases.

Objective: We aimed to determine the association between shift work and cardiac autonomic activity in blue-collar workers.

Methods: The study included 665 blue-collar workers aged 18-68 years in different occupations from two Danish cohort studies. Time and frequency domain parameters of heart rate variability (HRV) were measured during sleep using the Actiheart monitor, and used as markers of cardiac autonomic function. Multiple linear regression analyses were used to investigate differences in HRV between day and shift workers.

Results: Shift workers had no significantly different HRV parameters than day workers, except for a lower VLF (B: 0.21; 95% CI: -0.36-0.05). The lower VLF was only present among non-night shift workers (p < 0.05) and not among night shift workers (p > 0.05). Results differed significantly by gender (p for interaction < 0.10): among men, shift work was negatively associated with RMSSD (B: -7.83; 95% CI: -14.28-1.38), SDNN (B: -7.0; 95% CI: -12.27-1.78), VLF (B: -0.27; 95% CI: -0.46-0.09) and Total Power (B: -0.61; 95% CI: -1.20-0.03), while among women, shift work was only associated with the LF/HF ratio (B: -0.29; 95% CI: -0.54-0.03).

Conclusion: Shift work was particularly associated with lower HRV during sleep among men. This indicates that shift work causes imbalance in the autonomic nervous system among men, which might increase their risk of cardiovascular diseases.
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http://dx.doi.org/10.1016/j.ijcard.2018.01.089DOI Listing
May 2018

Differences in heart rate reserve of similar physical activities during work and in leisure time - A study among Danish blue-collar workers.

Physiol Behav 2018 03 16;186:45-51. Epub 2018 Jan 16.

National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.

Recent studies suggest that while leisure-time physical activity (LTPA) promotes general health, engaging in occupational physical activity (OPA) may have negative health consequences. It has been hypothesized that the different health effects from OPA and LTPA can be explained by differences in physical activity (PA) intensity in these two domains. To assess the intensity of OPA and LTPA, we aimed to study the percentage heart rate reserve (%HRR) during similar types of OPA and LTPA during workdays. Data from the NOMAD study on Danish blue-collar workers (n=124) with objective measurements of PA (using accelerometers) and heart rate (using heart rate monitors) for 4 workdays were analysed. Activities of sitting, standing, moving, walking, and stair climbing were identified and %HRR in each of these activities was determined for work and leisure. %HRR was significantly higher during OPA than LTPA. These differences were more pronounced in men than in women. Although not statistically significant in the fully adjusted model, we found indications that these differences were more pronounced in those with low compared to high fitness. To our knowledge, this is the first study with objective measurements showing that %HRR is higher during the same gross-body postural activities when performed at work compared to leisure-time during workdays. This elevated intensity may help explaining the negative health consequences of engagement in high levels of OPA. Future guidelines should distinguish OPA from LTPA, possibly by advising workers to remain active during their leisure time, in particular when they are highly active at work.
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http://dx.doi.org/10.1016/j.physbeh.2018.01.011DOI Listing
March 2018

Sitting patterns after relocation to activity-based offices: A controlled study of a natural intervention.

Prev Med 2018 06 1;111:384-390. Epub 2017 Dec 1.

Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.

This study determined the effect of relocating workers from traditional to activity-based offices on objectively measured sitting patterns. Office workers (n=493) from five office-sites within a large Swedish government agency were included in a controlled study of a natural intervention (2015-2017). At four sites, traditional offices were replaced by activity-based offices, while workers at one site with no relocation acted as controls. Sitting, standing and walking were measured objectively for 5-8days in a sub-sample (n=110) using accelerometry (Actigraph). Total sitting time (% of working time) and time spent in short (<5min), moderate (5-30min) and prolonged (>30min) uninterrupted periods in sitting were determined. Intervention effects were determined at 3- and 12-month follow-ups using linear mixed models adjusted for baseline age, gender and office type, and stratified by office-site (referencing controls). The relocation to activity-based offices did not result in an overall effect (across sites) on occupational sitting time (all p>0.05), while walking time had increased significantly by 1.4% of the working time at 12months compared with controls. Heterogeneous results were found across offices after 12months on total sitting time compared with controls (estimated change -18.3% time-1.4% time), prolonged sitting (change -18.3% to -3.8%), walking (change 0.5%-3.5%) and standing (change -1.4%-13.9%). In conclusion, relocation to activity-based offices had a limited overall effect on occupational sitting patterns in the studied organization, but differed considerably between office sites. Site-specific determinants of sitting behavior in activity-based offices need be identified.
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http://dx.doi.org/10.1016/j.ypmed.2017.11.031DOI Listing
June 2018

Different autonomic responses to occupational and leisure time physical activities among blue-collar workers.

Int Arch Occup Environ Health 2018 Apr 24;91(3):293-304. Epub 2017 Nov 24.

National Research Centre for the Working Environment (NRCWE), Lersø Parkallé 105, 2100, Copenhagen Ø, Denmark.

Purpose: The differential effect of occupational and leisure time physical activity on cardiovascular health is termed the physical activity health paradox. Cardiac autonomic modulation could bring insights about the underlying mechanism behind this differential effect. The aim was to compare heart rate variability (HRV) during different activities (sitting, standing and moving) at work and leisure among blue-collar workers.

Methods: One hundred thirty-eight workers from the NOMAD cohort were included. Data from physical activity and HRV were obtained for 3-4 days using tri-axial accelerometers (Actigraph GT3X+) and a heart rate monitor (Actiheart). HRV indices were determined during sitting, standing and moving both at work and leisure. Linear mixed-models with two fixed factors (activities and domains) were applied to investigate differences in HRV indices adjusting for individual and occupational factors.

Results: The results showed significant effects of domain (p < 0.01), physical activity type (p < 0.01) and interaction between domain and activity type (p < 0.01) on HRV indices. Mean heart rate (IBI) and parasympathetic measures of HRV (RMSSD and HF) were lower for sitting (p < 0.01) and higher for moving (p < 0.01) during work compared with leisure, while no difference between domains was found for standing (p > 0.05). Sympathovagal balance (LF/HF) was higher during work for sitting and moving (p < 0.01), but showed no difference for standing (p = 0.62).

Conclusions: Differences in cardiac autonomic modulation between work and leisure were found, indicating sympathetic predominance during work and parasympathetic predominance during leisure for sitting. Autonomic responses can be part of the mechanism that explains the differential effect of occupational and leisure time physical activity on health.
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http://dx.doi.org/10.1007/s00420-017-1279-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845059PMC
April 2018

Time course of neck-shoulder pain among workers: A longitudinal latent class growth analysis.

Scand J Work Environ Health 2018 01 9;44(1):47-57. Epub 2017 Nov 9.

Centre for Musculoskeletal Research, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden.

Objectives The aims of this study were to (i) identify trajectories of neck-shoulder pain (NSP) over one year in an occupational population and (ii) determine whether these trajectories are predicted by NSP characteristics as well as personal and occupational factors at baseline. Methods This longitudinal study was conducted among Danish workers (N=748) from 2012-2014. Text messages were used to collect frequent data on NSP over one year (14 waves in total). Peak NSP intensity in the past month was rated on a 0-10 numeric scale. A baseline questionnaire covered NSP characteristics (pain intensity, duration, comorbidity, pain medication, and pain interference) as well as personal (age, gender, body mass index) and occupational (seniority, work type, physical strain at work) factors. Latent class growth analysis was used to distinguish trajectories of NSP. Multivariate regression models with odds ratios (OR) were constructed to predict trajectories of NSP. Results Six distinct trajectories of NSP were identified (asymptomatic 11%, very low NSP 10%, low recovering NSP 18%, moderate recovering NSP 28%, strong fluctuating NSP 24% and severe persistent NSP 9% of the workers). Female gender, age, physical strain at work, NSP intensity and duration, pain medication, and pain interference in daily work at baseline were positively associated with severe persistent NSP and strong fluctuating NSP (all P<0.05). Altogether, personal and occupational factors accounted for 14% of the variance, while NSP characteristics accounted for 54%. Conclusions In an occupational sample, six distinct trajectories of NSP were identified. Physical strain at work appears to be a pertinent occupational factor predicting strong fluctuating and severe persistent NSP.
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http://dx.doi.org/10.5271/sjweh.3690DOI Listing
January 2018

Is objectively measured sitting at work associated with low-back pain? A cross sectional study in the DPhacto cohort.

Scand J Work Environ Health 2018 01 27;44(1):96-105. Epub 2017 Oct 27.

National Research Centre for the Working Environment (NRCWE), Lersø Parkallé 105, 2100 Copenhagen, Denmark.

Objectives Low-back pain (LBP) is a substantial health challenge due to the risk for long-term sickness absence and early retirement. Several biomechanical exposures at work, including sitting, have been suggested to increase the risk for LBP. The objectives of this study were to determine (i) the extent to which temporal patterns and total amount of objectively measured sitting is associated with LBP intensity and (ii) whether selected modifiers influence these associations. Methods This cross sectional study uses baseline data from the Danish PHysical ACTivity cohort with Objective measurements (DPhacto) of physical activities in the cleaning, transport and manufacturing sectors. Peak intensity of LBP was collected by questionnaire on a 0-10 scale and sitting was expressed in terms of total duration and temporal pattern, ie, time spent in brief bursts (≤5 minutes), moderate periods (>5-≤20 minutes), and prolonged periods of sitting (>20 minutes); both during work and whole day (waking hours only). Associations were determined using linear regression in models accounting for moderation and confounding. Factors evaluated as moderators or confounders were assessed by questionnaire. Results The population consisted of 704 participants. No significant associations were found between total duration or temporal patterns of sitting and LBP intensity, neither during work nor for the whole day. Body mass index (BMI) significantly moderated the association between sitting and LBP; participants with a high and low BMI showing a negative and positive association, respectively. Conclusion Sitting was not independently associated with peak LBP intensity, suggesting other exposures are more powerful risk factors for LBP.
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http://dx.doi.org/10.5271/sjweh.3680DOI Listing
January 2018

Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders.

BMC Musculoskelet Disord 2017 Sep 12;18(1):395. Epub 2017 Sep 12.

Department of Radiology, Temple University Medical School, Philadelphia, PA, USA.

Background: This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs?

Methods: PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies.

Results: Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity.

Conclusions: Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided.
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http://dx.doi.org/10.1186/s12891-017-1694-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596923PMC
September 2017