Juan F. Giménez Pla, Laura Martínez Gómez, Andrés Soler Valero, Alicia Piedrabuena Cuesta, Mercedes Sanchis Almenara, Raquel Marzo Roselló
Instituto de Biomecánica (IBV)
Universitat Politècnica de València. Edificio 9C. Camino de Vera s/n (E46022) Valencia. Spain
Active ergonomics involves performing physical exercises adapted to the requirements of the workplace as a strategy to prevent musculoskeletal disorders. The fitwork project focused on the development of a good practice manual, which helps occupational health professionals to implement physical activity programs in the workplace.
Promoting health in the workplace is a current issue that is increasingly included in the agenda of public administrations and boards of directors of business organizations. This is due to various reasons that include the losses in productivity and absenteeism caused by musculoskeletal disorders, obesity and non-contagious diseases, aging of the working population, increase in the retirement age (which involves maintaining the welfare state) and the sedentary lifestyle of adult European population.
In relation to musculoskeletal disorders (MSD), ergonomics and risk assessment are essential to improve the working conditions of people and significantly contribute to the prevention of injuries and ailments in the workplace. The situation created by risk assessment is improved by the so-called active ergonomics, which posits improving the physical condition and strengthening the parts of the musculoskeletal system that become more fatigued during daily work activity as a strategy to increase the resistance to musculoskeletal disorders. This approach is based on studies showing that physical activity is associated with a lower prevalence of musculoskeletal disorders and on results that relate decreases in the perception of joint pain with moderate exercises.
The implementation of active ergonomics in the workplace necessarily involves implementing a program of physical exercises defined to strengthen the elements of the musculoskeletal system that are most engaged in daily activity. However, some difficulties arise when considering the implementation of a physical exercise program in the workplace. On the one hand, occupational health professionals have solid knowledge in ergonomics and occupational risk assessment, but they do not have specific training in physical activity or physiotherapy. On the other hand, it is difficult to combine the implementation of health promotion programs with daily work activity.
An international consortium of organizations proposed the fitwork project with the purpose of supporting the experts in occupational risk prevention when implementing active ergonomics programs in a company. The main objective of the project was to generate a manual of good practices to implement physical activity programs in the workplace by combining the different knowledge of an international consortium about occupational risk assessment (IBV), physical activity (UC), motivation in sports practice (TU/e) and implementation of health programs in the workplace (ENWHP and ROM).
In order to achieve the objective established, the project team proposed three basic lines of action:
♦ Collecting information both on the best healthcare practices implemented in companies, and on the needs in the workplace.
♦ Designing a physical activity plan and implementing it in two companies through a 24-week pilot.
♦ Writing a guide of good practices for the implementation of physical activity plans in the workplace.
The information on good practices in healthcare in companies was collected through a questionnaire answered by 31 companies from 7 different countries of the European Union and Canada. The questionnaire contained 20 questions, focused on characterizing both the staff of the participating companies and the work environment. Similarly, the questionnaire included questions about the type of information collected in relation to the workers' health, causes of absenteeism, and health promotion programs sponsored by companies. All the information collected was processed and analyzed to generate a list of the main conclusions.
Figure 1: Physical exercises associated with specific parts of the musculoskeletal system
The collection of information about the needs in the workplace focused on identifying the most common work requirements faced by the employees in their daily performance. To meet these requirements, people use various parts of their musculoskeletal system that may be at risk of injury if correction measures are not applied. One of these measures is the strengthening of the musculoskeletal system by performing physical activities; consequently, the collection of the requirements was accompanied by a series of appropriate physical exercises to improve the worker's resistance to potential muscle fatigue and injuries (Figure 1).
According to the assessment of the work requirements faced by the workers, a physical activity plan was designed in two companies belonging to different productive industries (KOMAG, engineering services in Poland, and INNEX, textile manufacturing in Italy). Whereas in Poland the risks assessed were typically office-based, the work performance in Italy focused on production tasks. The risk assessment made it possible to identify the parts of the musculoskeletal system that supported more weight and, therefore, were at greater risk of suffering injuries. The experts in physical activity selected the most appropriate exercises for each participating group (white collar vs. blue collar) and visited the facilities of the companies in Poland and Italy to design an implementation plan for the exercise program, taking advantage of the company environment and means, without additional equipment. This implementation should be based on the needs and expectations of the workers, beyond occupational risks, and should include ways to motivate workers, implement corrections and assess partial results.
In order to meet the needs of all the workers, the program included three levels: basic, intermediate and advanced. Several workers with an advanced level of physical activity were selected as program ambassadors to encourage their colleagues to perform and follow the exercises, recommend level changes, as well as to collect user problems and proposals for improvement. Similarly, the 45 participants in the pilot (including the control group users), performed three program assessments (at the beginning, three months later, and at the end of the test), in order to assess the partial results obtained after the implementation. These assessments were carried out using seven questionnaires, four of them were generic and validated such as PAR-Q or SF-36, and three of them were designed for the program. The responses of the users during the assessments were compiled and analyzed, generating a list of conclusions associated with the pilot test.
Figure 2: Cover of the good practice guide
The good practice guide (Figure 2) used the partial results obtained in all the previous tasks, performed throughout the project, including the questionnaire passed out to the companies, the pilot test, and the identification of the workplace requirements. The knowledge gathered throughout the project was combined with that accrued by the ENWHP (European Network for Worksite Health Promotion) in the implementation of health promotion plans at work. The good practice guide is available on the project website and is intended to be a support tool for occupational health professionals who want to implement active ergonomics and healthcare programs in the workplace.
According to the project results, health promotion for business organizations must be approached from a strategic position by incorporating it into the culture of organization. This implies proposals for the near future, with continuous assessments to determine which programs work and which fail, together with internal communication campaigns that make the programs accessible to all workers. In the same way, the programs must be based on the real needs of the workers so as to achieve changes in the lifestyle habits of the employees.
With regard to the results obtained in the pilots, the physical activity programs implemented in the companies enhanced the workers’ perception of their health, although there were no significant changes in the anthropometric parameters and health indices. However, the results show changes in the muscle mass of the upper limb and in the parameters of heart recovery that should be confirmed by further interventions in the long run. Additionally, the workers considered as sedentary (office workers) feel that their well-being improves when they increase their level of physical activity, whereas this assumption does not apply to production workers, who endure a much greater physical burden in their daily work. Besides, when companies approach demonstration projects, the participation of the senior management is essential to generate a strong commitment of the employees to the programs intended to be implemented (physical activity, in this case). In addition, the presence of instructors who help and advise on the exercises and the use of electronic devices also helps to increase commitment and adherence to the program.
Finally, it should be noted that the fitwork project focused on showing that the implementation of physical activity programs and active ergonomics in the workplace is feasible, using the companies own resources and facilities. The implementation of these programs has a potential positive impact on the workers’ health, although this impact must be evidenced in the near future (3 years). The good practices guide published as a result of the fitwork project should be a reference document for company managers and occupational health professionals to be aware of the actions and resources necessary to turn the employees’ health in an asset and a value for their organizations.
The fitwork project (http://fitwork.eu/) was co-funded by the Erasmus + Sport program of the European Union. The project started in January 2017 and ended in June 2018.
Support for collaborative Partnership in the field of Sport. Agreement number: 2016-3600/001-001. Project number: 579903-EPP-1-2016-2-ES-SPO-SCP. Project Duration: 18 months.
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 Instituto de Biomecánica de Valencia, Spain
 University of Coimbra, Portugal
 Technical University of Eindhoven, Holland
 European Network for Worksite Health Promotion
 Romtens, Romania
 Goetzel, R., Ozminkowski, R., The Health and Cost benefits of Work Site Health-Promotion programs, Annual Review of Public Health, 2008, 29, 303-323