Rates of overweight and obesity have risen drastically in the United States in the last thirty years. As a result of the overweight and obesity epidemic, health care costs in the United States have also grown exponentially. Often, employers have to bear the brunt of these rising health care costs along with the side effects of overweight and obesity, including increased presenteeism, absenteeism, and lack of productivity. An excellent intervention for the growing overweight and obesity epidemic is worksite wellness programs, a relatively recent trend in the field of health education.
This study assessed the effects of an evidence-based physical activity behavior change program on mass transit employees. The evidence-based behavior change program, Active Living Every Day, was originally designed as a 20-week curriculum. This study condensed the program into a 6-week format. This study was delivered in two phases. The first phase received the 6-week version of the program in its original format, without any tailoring. The second phase received a 6-week version of the program, which was tailored to meet the needs of the mass transit population. Tailoring of the program was done using focus groups after the conclusion of Phase 1 of the intervention, using the Nominal Group Technique. Phase 1 (n = 7) occurred from mid-October 2010 to December 2010. The focus group was held in December 2010. The ALED program was facilitated by a trained ALED facilitator and was held at the worksite for employees' convenience.
Phase 1 participants had a mean age of 47.6 ± 9 years, with a range of 35–58 years. Average BMI was 32.5 ± 8.9, with a range of 17.8–44.3. Phase 2 (n = 19) occurred from mid-January 2011 to February 2011. The follow-up focus group occurred in February 2011. Phase 2 participants had a mean age of 46.6 ± 11.7 years, with a range of 27–72 years. Average BMI was 32.1 ± 1.9, with a range of 21.6 to 53.7. The study assessed the effects of the non-tailored and tailored version of the intervention on participants' physical activity levels, barriers to physical activity, stages of change, self-efficacy, processes of change, sleep quality, stress, fatigue, overall health status, functionality, participants' feelings toward physical activity, and physical activity enjoyment. Outcome measures were collected at baseline and post-intervention. In Phase 1, statistically significant changes were seen in caring about consequences to others (p = 0.05), increasing healthy opportunities (p = 0.007), committing oneself (p = 0.005), and reminding oneself (p = 0.04). These factors were all part of the processes of change. For Phase 2, statistically significant changes were seen in decisional balance ( p = 0.029), increasing healthy opportunities (p = 0.006), substituting alternatives (p = 0.017), rewarding oneself (p = 0.041), reminding oneself (p = 0.034), sleep quality (p = 0.004), physical activity affect (p = 0.001), physical activity enjoyment (p = 0.001), perceived stress (p = 0.004), reduced motivation (p = 0.24), and overall physical and mental health ( p = 0.02). Comparing the non-tailored version of ALED to the tailored version, statistically significant changes were exhibited in two measures: increasing healthy opportunities (p = 0.013) and physical fatigue (p = 0.002).
It is inconclusive to determine whether tailoring the ALED intervention had any significant impacts on the outcome measures. The ALED intervention, however, is a relatively inexpensive and easy to implement worksite wellness program and did demonstrate significant changes in participants' processes of change, sleep quality, perceived stress, fatigue, physical activity enjoyment, and overall physical and mental health status. One explanation for the lack of significance from non-tailored to tailored versions may be the small sample size in the nontailored version. Because of this and other factors, more studies need to be completed to determine its effectiveness for the tailored version.