Investigating Associations Between Physical Activity and Presenteeism

Abstract

Objective

The aim of this study is to scope the literature on what is currently known between physical activity and presenteeism.

Data Source

A search strategy was conducting in six scientific databases.

Study Inclusion and Exclusion Criteria

Studies written in English about the relation between physical activity and presenteeism were considered for inclusion.

Data Extraction

Data on definitions and measurement of presenteeism and physical activity were extracted.

Data Synthesis

The data is categorized according to the understanding of presenteeism of the studies to give a better idea of how this phenomenon is studied in relation to physical activity.

Results

After screening 9773 titles and abstracts and 269 full-text articles, 57 unique articles fulfilled our eligibility criteria. The majority of the articles were published since 2010 and originated predominantly in the United States. Most studies (70%) define presenteeism as lost productivity due to health problems, according to the American line of research, whereas 19% of the studies define it as “working while ill” which refers to the European line of research. The studies that reflected the American school of thought tends to report more results that supported their hypothesis (i.e., that more physical activity is associated with less presenteeism).

Conclusion

This review has highlighted the homogeneity in how presenteeism is conceptualized and measured in studies included in our sample. Research on physical activity and presenteeism should be expanded across various disciplines in social sciences to respond to the needs that many researchers have expressed to promote healthier organizations.

Keywords

physical activity presenteeism scoping review productivity loss working while ill occupational health

Introduction

Presenteeism, which refers to an attendance behavior “[…] aimed at meeting work and performance demands during impaired capacity owing to ill-health”,¹ is highly prevalent in all occupations, industries, sectors, and countries.^2,3 This adaptive behavior is considered an important economic concern because of the high costs it entails in terms of lost productivity.⁴ Research suggests that presenteeism may account for more than half of the total loss of health-related costs.⁵ For employees, working while ill is associated with poorer health and an increased risk of future absenteeism.⁶ The current pandemic context and the ongoing organizational changes generated by it has exacerbated psychosocial constraints such as excessive job demands and long working hours.^7,8 Studies show that high job demands and difficulties to replace employees are strong predictors of presenteeism.⁹ For example, teleworkers and healthcare workers saw their workload increase,^7,10,11 as well as the boundaries between work and personal life being blurred.¹²

Presenteeism is a multidimensional concept and so are its antecedents. Among the personal factors identified as potentially contributing to presenteeism are lifestyle habits.¹³ Factors related to employee lifestyle habits would explain only a small proportion of the total variance in productivity^14,15 and work-related factors (e.g., overly high demands or lack of resources) remain the most influential factors on presenteeism. Nevertheless, there is a need to better understand the link between presenteeism and lifestyle habits and to promote healthier workplaces.^16,17

According to the Job Demands-Resources model (JDR), demands and resources affect employee health through two distinct pathways: the energetic process and the motivational process.¹⁸ The energetic process (also known as “health deterioration”) suggests that jobs that are demanding or have persistent demands deplete employees' resources.^19,20 The second process proposed is motivational in nature, that is, resources are assumed to have motivational value, leading to a high state of engagement (e.g., psychological vitality).²¹ One reason for using the JDR model to study presenteeism is that demands and resources have effects on both health and performance,²⁰ which are the two core dimensions of presenteeism.¹

One area of research that has not yet been fully investigated by the JDR model is that of personal resources.²² The model proposes that resources are divided into two categories: occupational resources and personal resources. Physical activity, because of its energetic nature and its known effects on mental and physical health,²³ would affect health through the energetic process. Physical activity, due to its known beneficial effects on recovery at work²⁴ and presence at work,^25-27 would also intervene on performance through the motivational process. As a potential personal resource, physical activity could serve to increase engagement and well-being at work²⁷ and thus positively influence work performance. The three-wave longitudinal study by Demerouti et al.²⁸ showed a reciprocal relationship between exhaustion and presenteeism, “[…] suggesting that when employees experience exhaustion, they mobilize compensation strategies, which ultimately increases their exhaustion” (p.50). Some studies have shown that physical activity reduces the risk for emotional exhaustion^29, and contributes to improving the health of employees.³⁰ Thus, physical activity could constitute a personal resource for employees to mitigate the potentially negative effects of presenteeism on their health, and ultimately shift to more functional presenteeism.³¹ According to Karanika-Murray and Biron,³¹ functional presenteeism means “[…] being able to maintain a usual level of productivity with no further deterioration to health and perhaps even with the possibility to facility recovery from the health condition” (p.235).

Despite the widely recognized importance of physical activity for mental and physical health, several questions remain regarding the role of physical activity as a resource to prevent and better manage presenteeism. There are several inconsistencies in the results of studies examining the relationship between physical activity and presenteeism. For example, some studies showed a negative relationship between physical activity and presenteeism,^17,32 whereas others revealed no significant relationship.^33,34 Moreover, studies that have examined the relationship between physical activity and presenteeism have used varied methodologies, which makes comparisons between studies difficult.^26,35,36 It is therefore essential to interpret these results with caution given the lack of consistency in the results,³⁶ the possibility of bias in certain studies (e.g. a very physically active sample), the variability in the methods used in these studies (in particular in the measurement of presenteeism), and in the criteria used to define physically active vs inactive individuals.²⁷ Similarly, Brown et al.²⁷ conducted a systematic review of the impact of physical activity on presenteeism and found many variations in how studies conceptualize and assess presenteeism. These inconsistencies limit the interpretation of results and the possibilities of transferring knowledge to promote healthier presenteeism management.

Considering the costs of presenteeism to organizations and society, it is important to clarify the role that physical activity can play in reducing it. Clarification through a scoping review is warranted, as the scientific literature between physical activity and presenteeism is large, complex, and heterogeneous in nature as evidenced by the most recent review on the topic.²⁷ A scoping review is particularly useful to identify the types of available evidence in a given field, clarify key concepts/definitions in the literature, examine how research is conducted and identify and analyze knowledge gaps. Those purposes are precisely the objectives of our study that we will try to meet by answering these research questions (RQ): RQ1: How is physical activity measured in studies and in what context (i.e., domains, types, and intensity)? RQ2: How is presenteeism conceptualized and measured in those studies? RQ3: What are the results of the studies included in the review? RQ4: What is known (and what is not) from the existing literature about the association between physical activity and presenteeism over the past 20 years (2000-2020)?

Design

Approach

We undertook a scoping review to map the literature on the relation between presenteeism and physical activity. The protocol was drafted following the methods outlined by the Joanna Briggs Institute Methods Manual for scoping reviews³⁷ and reported findings using the elements provided in the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols (PRISMA-P). Since our full methods are available in our published protocol,³⁸ they are outlined briefly below. As definitions of presenteeism are used to categorize the results of our study, we briefly define here the three most dominant schools of thought in the scientific literature.

The Definitions of Presenteeism

The definition of presenteeism has evolved over the years. Originally, presenteeism was seen as the opposite of absenteeism.³⁹ However, three lines of research have emerged over time and offered different proposals to try to better understand presenteeism.⁴⁰ The different ways of studying and understanding presenteeism reflect the unique perspectives and priorities of the various disciplines addressing the subject.⁴¹ The different definitions of the term presenteeism also lead to a degree of confusion in how it is measured, the heterogeneity of which also limits the interpretation of empirical findings.⁴² We briefly define each line of research (for more details, see Ruhle et al., 2020). We included in our search strategy, keywords from the two first school of thoughts as they both encompass the health constraint, which is not the case of the third school of thoughts. The European and American schools of thought are the most represented in the scientific literature and are often opposed to each other, as they do not approach the phenomenon from the same perspective.

The European Line of Research – “Working While Ill”

European researchers have been more interested in the act of presenteeism, its determinants and its frequency. Several of these researchers^39,43 define presenteeism as the phenomenon of an individual reporting to work while ill. This line of research also characterizes the act of presenteeism as the result of a complex decision-making process of the sick employee deciding between going to work or staying home. This view of presenteeism therefore does not confound cause and effect, which is a criticism of the North American school of thought⁴⁰ described below. Furthermore, this definition does not ignore the possible positive effects of presenteeism that are often overlooked.¹³ Along with this, presenteeism has recently been defined as an adaptive behavior allowing one to balance poor health with the demands at work.^1,44

The American Line of Research – “Lost Productivity Due to Health Problems or Illness”

North American researchers focus more on the consequences of presenteeism. Presenteeism is then discussed in terms of productivity, where it is defined as a loss of productivity at work due to a health constraint.³⁹ However, some authors criticize this definition because it considers presenteeism in terms of its consequences rather than what it actually is.⁴⁵ This complicates the way presenteeism is measured, as the tools assess lost productivity rather than directly measuring presenteeism. Furthermore, this definition simplifies the phenomenon and does not take into account the severity, type, or nature of the employee's health constraints.⁴⁶ However, it is necessary to consider these characteristics of health strain to understand the impact it may have on the employee and the organization and how presenteeism operates.^41,47 Furthermore, this one-dimensional view assumes that presenteeism is implicitly bad and negative,⁴⁶ which is further challenged by a few authors.^1,9,48

The Non-Illness-Related Line of Research – “Non-Illness-Related Reasons”

In this line of thinking, an employee could be present at work, but not be effective or perform tasks that are unrelated to their job, simply because they are unfocused or disinterested. Indeed, there are many other reasons for lost productivity that are not attributable to a health issue (e.g., emailing friends, planning vacations, etc.).⁴¹ This is referred to as non-illness-related presenteeism (for more details see D'Abate & Eddy, 2007).⁴⁹

The Definition of Physical Activity and Its Domains

According to the World Health Organization (WHO), physical activity refers to any bodily movement produced by skeletal muscles that results in energy expenditure.⁵⁰ The WHO recommends that adults (18-64 years old) weekly engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity and should also do muscle-strengthening activities at moderate or greater intensity on 2 or more days a week. Thus, adults achieving this recommendation are considered active. A scale ranging from inactive to very active categorizes adults according to the number of minutes of physical activity they perform per week. All four domains of physical activity (leisure, transport, household and occupational) can contribute to the recommended weekly volume. However, the contribution of each physical activity domain can vary greatly from one individual to another, so it is important to have specific information about each of these domains. We included keywords of all four domains in our search strategy.

Data Sources

The search strategy has been validated by a senior researcher (CB) and a reference librarian. The identification of the relevant studies was an iterative process that involved pre-testing many different combinations of subject headings, search terms and synonyms, to achieve the highest level of coverage. The primary searches were conducted in six databases: MEDLINE, CINAHL, PsycINFO, ABI Inform Global, Web of Science and Business Source Premier to identify peer-reviewed articles. The start date of searches was set to 2000. As one of the principles of scoping review is to be as broad as possible, there was no end date restrictions. Additional searches were conducted by scanning the reference lists of suitable studies and through personal collections. We have provided a supplementary table (Appendix A – Table 5) that includes all the key words used in the research strategy for MEDLINE.

Inclusion and Exclusion Criteria

Studies that report new empirical data using a quantitative or qualitative design or mixed method on the relationship between physical activity and presenteeism were included (whether it is correlational or causal). Studies using health risk assessment (HRA), measuring health behaviors (such as physical activity), but not exclusively, were also included. HRA are often used in workplace to identify the presence of biologic and lifestyle risks, various chronic diseases, and health conditions among the workforces. Many studies on physical activity and presenteeism use these types of tools to measure physical activity, and therefore, other health-related behaviors. By including studies that use HRAs to measure physical activity, we would ensure that these studies are included. Studies that have different definitions and domains of physical activity (structured or not, leisure, transport, household or occupational), and for which the other criteria apply, were included. Ergonomic exercises were not considered as physical activities. Studies dealing with non-working age populations such as the elderly or children were excluded, as well as those published in languages other than English.

As suggested by Arksey & O’Malley,⁵¹ development of inclusion criteria post hoc may be useful as researchers may not wish to strictly limit the process of identifying relevant studies or selecting studies at the outset. During the full-text screening, the researchers agreed that studies that pooled physical activity with other risks (e.g., pooling physical activity and sedentary time to make a score for both behaviors) would be excluded because it prevented independent analysis of the relationship between physical activity and presenteeism.

Study Selection Process

All search results were downloaded and imported into a reference management software program (EndNote, V.X9) and then into the software Covidence to facilitate our process of screening for inclusion. For the level 1 screening, two reviewers (VH & JD) independently screened articles by the title and the abstract. For level 2 screening, the same two reviewers screened the full-text articles. Discrepancies at both levels of screening were discussed and resolved by three authors. Following each screening, interrater reliability was assessed using Cohen's Kappa statistic, κ⁵¹. The agreement between the two reviewers in the first and second level of screening was moderate (respectively κ = .47 and κ = .58).⁵²

Data Extraction and Data Synthesis

A data-charting form was jointly developed by two reviewers (VH & JD) and updated in an iterative process as the charting was conducted. The data were extracted by one reviewer (VH), and a random subset of 25% or the selected studies were checked by another reviewer (CB) to verify repeatability and accuracy.

We extracted data on article characteristics (e.g., the study of the population, study design, country, sample size) and on presenteeism and physical activity characteristics (e.g., definition and measure of presenteeism and type, frequency, and measure of physical activity).

Results

Literature Search

After screening 9773 titles and abstracts and 269 full-text articles, 57 unique articles fulfilled our eligibility criteria (Figure 1). No additional articles were identified through scanning reference lists and personal collections.

Figure 1.

Flow diagram indicating flow of references and study selection.

Characteristics of Included Articles

A majority of articles were published since 2010 (77%) and originated predominantly in the USA (41%), the Netherlands (10%), Australia (10%) and Sweden (10%). Regarding the study design, 33 were observational and 11 were longitudinal. Ten studies were randomized control trial and 3 were interventions (see Table 1 for more details on studies characteristics).

Table 1.

Characteristics of Included Studies (N = 57) Investigating the Relation Between Presenteeism and Physical Activity.

Authors, year	Country	N	Study Population	Study Design
Agaliotis et al., 2013⁵³	Australia	360	People with chronic knee pain in paid employment at baseline	Randomized control trial
Alavinia, Molenaar, and Burdof, 2009⁵⁴	The Netherlands	252	Workers in 24 different companies	Observational
Bedrosian et al., 2012⁵⁵	United States	46 818	Adult employees who completed a health risk assessment questionnaire through employers or health care plans	Observational
Bernaards, Proper, and Hildebrandt, 2007⁵⁶	The Netherlands	343	Computer (white-collar) workers with neck and upper limb symptoms	Randomized control trial
Block et al., 2008²⁶	United States	787	Non-medical regional employees of Kaiser Permanente Northern California	Randomized control trial
Boles, Pelletier, and Lynch, 2004⁵⁷	United States	2264	Employees of a large national employer	Observational
Brämberg et al., 2017⁵⁸	Sweden	159	Participants with predominantly chronic back and neck pain	Randomized control trial
Burton, Chen, et al., 2005⁵⁹	United States	28,375	Employees of a large national financial company	Observational
Burton, McCalister, et al., 2005²⁵	United States	999	Employees (customer service and telephone call center services) who worked in one of three locations with an on-site corporate fitness center of a large financial services company	Observational
Burton et al., 2006⁶⁰	United States	7026	Employees of a national financial services company that responded to a health risk appraisal	Longitudinal
Brown et al., 2013⁶¹	Australia	108	Office employees	Observational
Burton et al., 2014⁶²	United States	4345	Employees of a US-based Fortune 100 company with employees in more than 20 countries and multiple worksites in the US, financial sector	Observational
Callen, Lindley, and Niederhauser, 2013⁶³	United States	1728	Employees who volunteered to participate in a health risk assessment from a government security complex	Observational
Chang et al., 2015⁶⁴	Taiwan	816	Employees in seven enterprises including one communication company, three high-tech manufacturers, one financial corporation, one environmental lean-up enterprise, and one government agency	Observational
Christensen et al., 2013⁶⁵	Denmark	144	Being female, overweight (i.e., body mass index>25 or body fat percentage>33 for the age of 18 to 40 years or>34 for older than 40 years), and being health care worker or primarily working with elderly care	Randomized control trial
Christensen et al., 2015⁶⁶	Denmark	139	Female health care workers	Randomized control trial
de Vries et al., 2012⁶⁷	The Netherlands	241	Workers diagnosed with chronic nonspecific musculoskeletal pain	Observational
DiBonaventura et al., 2011⁶⁸	United States	695	Workers with hepatitis C diagnosis	Observational
Fonseca et al., 2010³⁶	Brazil	620	Employees at the general motors Brazil automotive company	Observational
Guertler et al., 2015⁶⁹	Australia	710	Working adults who completed an online survey	Observational
Hagberg et al., 2007⁷⁰	Sweden	1283	Workers who used computer	Longitudinal
Haglund et al., 2013⁷¹	Sweden	1173	Adults with spondyloarthritis	Observational
Haglund et al., 2015⁷²	Sweden	1773	Patients with spondyloarthritis (SpA	Longitudinal
Hartman et al., 2016⁷³	The Netherlands	4231	A random sample selected via a large Internet panel organization	Longitudinal
Howarth, Quesada, and Mills, 2017⁷⁴	Various countries	117 274	Employees from 254 multinational companies	Observational
Kirkham et al., 2015⁷⁵	United States	17,089	Employees form a large manufacturer of computer components	Longitudinal
Kowlessar et al., 2011⁷⁶	United States	77,410	Employees of a large multinational company based in the Midwestern United States	Observational
Lenneman et al., 2011¹⁴	United States	577 186	Individuals who completed the health risk assessment and the work productivity and activity impairment questionnaire over a span of nearly four years	Longitudinal
Mandiracioglu et al., 2015⁷⁷	Turkey	413	Employees from four different private sector workplaces	Observational
Merrill et al., 2012¹⁶	United States	19,803	Employees from three geographically diverse US companies	Observational
Michishita et al., 2017⁷⁸	Japan	130	With- and blue-collar workers from different workplaces	Randomized control trial
Musich et al., 2006⁷⁹	Australia	224	Employees from a private insurance provider	Observational
Musich et al., 2006³⁴	Australia	1523	Employees across ten diverse corporations	Observational
Nakata et al., 2018⁸⁰	Japan	233	Employed adults with a self-reported osteoarthritis diagnosis	Observational
Pelletier, Boles, and Lynch, 2004⁸¹	United States	500	Employees who participated in a wellness program at a large national employer	Observational
Pronk et al., 2004⁸²	United States	683	Employees from 3 managed care plans and active employees from a self-insured corporation	Observational
Puig-Ribera et al., 2008⁸³	Spain	70	Employees from a university	Randomized control trial
Puig-Ribera et al., 2015⁸⁴	Spain	557	University office employees	Observational
Puig-Ribera et al., 2017⁸⁵	Spain	264	Employees from six Spanish university campuses	Randomized control trial
Schwarz and Hasson, 2011⁸⁶	Sweden	177	Employees from a dental public health care organization	Randomized control trial
Shi et al., 2013⁸⁷	United States	19,121	Employees from five employers across three industries (finance and insurance industry, manufacturing industry, and health care industry)	Longitudinal
Sung Won et al., 2019⁸⁸	Korea	19,294	Wage workers above the age of 20	Observational
Taloyan et al., 2012⁸⁹	Sweden	7445	Representative sample of the Swedish workers	Longitudinal
Thogersen-Ntoumani et al., 2017⁹⁰	Not mentioned	217	Older manual workers	Observational
Tucker et al., 2016⁹¹	United States	42	Registered nurses and medical assistants	Intervention
Valentine, Ferebee, and Heitner, 2019⁹²	United States	19	Long-term contract employees who work in health care organizations, offering wellness programs in the New York City Metropolitan area	Intervention
Van den Heuvel et al., 2007⁹³	The Netherlands	654	Computer workers with neck/shoulder or hand/arm symptoms from five different companies	Observational
Van Scheppingen et al., 2014⁹⁴	The Netherlands	629	Dutch employees	Intervention
Van Wormer et al., 2011⁹⁵	United States	2823	Employed adults who participated in a community-based cardiometabolic risk factor screening program	Observational
Van Wormer, Boucher, and Sidebottom, 2015⁹⁶	United States	1273	Employed adults who participated in a heart health screening program in 2009 and in 2011	Longitudinal
Walker et al., 2017⁹⁷	United States	6515	Employees from a public university system	Longitudinal
Walker et al., 2017⁹⁸	United States	10 791	Employees at a large university system	Observational
Walker et al., 2017¹⁷	United States	n2015 = 10,791 and n2009 = 10,165	Large population of university employees	Observational
Williden, Schofield, and Duncan, 2012⁹⁹	New Zealand	747	Participants were employees of nine organizations	Observational
Winona Pit, and Hansen 2016¹⁰⁰	Australia	92	General practitioners	Observational
Yu, Wang, and Yu, 2015¹⁰¹	China	1506	Employees in a Chinese petrochemical corporation	Observational
Zhang et al., 2020¹⁰²	Canada	196	Employees enrolled in a pharmacist-led wellness program	Longitudinal

RQ1

How Is Physical Activity Measured in Studies and in What Context (i.e., Domains, Types, and Intensity)?

Ten studies^{26,56,67,73,82,84,85,90,99,103} (18%) used a validated questionnaire such as the International Physical Activity Questionnaire (IPAQ) or the Baecke Questionnaire to measure physical activity. Twelve other studies (21%) used a single-item question like “In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate?” Five studies (9%) reported using guidelines from WHO⁵⁰ or Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System to assess physical activity. Finally, four studies (7%) objectively measured physical activity with a pedometer⁸³ or an accelerometer.^61,78,91

Six studies (11%) were interested in different domains of physical activity.^{26,36,56,67,73,90} For three of these studies,^26,56,73 these domains were transport, occupational and at school, household and leisure. The other three studies did not include the household domain. Inversely, in the study of Winona Pit & Hansen,¹⁰⁰ physical activity excluded all activities that were related to household and occupational. In the same way, a study by Alavinia et al.⁵⁴ considered only physical activities during leisure.

Seven studies (12%) specified the type of physical activity (e.g., stretching, aerobic physical activity or muscle-strengthening physical activity).^{17,58,63,65,66,92,98} Three of these studies were randomized control trials^58,65,66 and one was an intervention study.⁹² The three other studies were observational.^17,63,98

Thirteen studies (23%) referred to the intensity of the activity (e.g., moderate, or vigorous). Fifteen studies (26%) used a cut-off to categorize employees that were physically active and physically inactive. Most of these studies (60%) used the cut-off based on the recommendations of the World Health Organization (WHO) that is 150 minutes of moderate-intensity activity or 75 minutes high or very high-intensity activity per week. The study of Burton et al.⁶² was the only one that referred to a three-level risk classification (sufficiently active, insufficiently active, inactive). Thirteen studies (23%) did not mention any details regarding the type, frequency, or duration of physical activity. A supplementary file (Appendix B – Table 2) contains detailed results for RQ1.

RQ2

How Is Presenteeism Conceptualized and Measured in Those Studies?

Results were categorized according to the three lines of research to better visualize the scope of the knowledge gained on presenteeism and physical activity. Only one study⁹⁶ did not use a definition for presenteeism (2%).

The European Line of Research – “Working While Ill”

Eleven studies (19%) defined presenteeism according to the European line of research “working while ill.” Sweden is the country where the most studies are reported in this line of research with three studies, followed by the United States with two studies. Four studies referred to the intensity of the ill health. For example, Winona Pit & Hansen¹⁰⁰ defined presenteeism as “Having gone to work despite feeling that one really should have taken sick leave due to one’s state of health.” Seven of these studies (63%) used the single-item question such as “How many times during the last 12 months have you gone to work although your state of health implied that you should have taken sick leave?”.⁴³ The four other studies used either the World Health Organization Health and Performance Questionnaire (HPQ), Stanford Presenteeism Scale (SPS), the Work Limitation Questionnaire (WLQ) or an adapted version of items used in other questionnaires.

The American Line of Research – “Lost Productivity Due to Health Problems or Illness”

Studies that defined presenteeism as “Reduced productivity while at work” but without mentioning health problems were also included in this category. It is important to note that these studies did not refer to non-illness-related reasons either.

Forty studies (70%) referred to presenteeism as the “lost productivity due to health problems or illness” (n = 25) or referred to presenteeism but without mentioning health problems (n = 15) (“Reduced productivity while at work”). The United States is the country where the most studies are reported in this line of research with nineteen studies (48%), followed by Australia with five studies.

Fifteen of all the forty studies used the WLQ to assess presenteeism, 8 used the HPQ and 10 used the Work Productivity and Activity Impairment Questionnaire (WPAI). The other studies used different tools such as the Quantity & Quality method, the Work Functioning Impairment Scale, a single-item question, or the Valuation of Lost Productivity questionnaire. Two studies^65,66 used a combined sum score using for example one item from the HPQ to assess productivity and one item from the WAI to assess work ability.

The Non-Illness-Related Line of Research – “Non-Illness-Related Reasons”

Five studies (9%) used a definition of presenteeism accordingly to a third line of research in which causes of presenteeism are not strictly confined to illness. For example, Howarth et al.⁷⁴ suggested that presenteeism is when an employee attends work but is not fully functional due to illness, work overload or decreased motivation. Williden et al.⁹⁹ defined presenteeism as being “present at work, yet not able to function at full capacity.” Of the four studies¹, two were led by researchers from the Netherlands, one from the United States and one from New Zealand.

A supplementary file (Appendix C – Table 3) contains detailed results for RQ2.

RQ3

What Are the Results of the Studies Included in the Review?

To highlight what the results show about the relationship between presenteeism and physical activity, we identified whether the hypothesis was supported or not (i.e., that physical activity can reduce and/or prevent presenteeism). “Supported” means that the relationship is consistent with the hypothesis that is the more physically active an employee is, the less at risk he/she is to report presenteeism. Inversely, “not supported” means that being physically active is associated with more presenteeism. When no association or effect (for intervention studies and RCT) was found, we classified the results as neutral. Finally, if the results went in more than one direction (supported, not supported and/or neutral), we indicated “mixed.”

Supported –Results Supporting the Hypothesis

Twenty-seven studies (47%) were categorized “Supported” as results indicate a negative relationship (i.e., more physical activity is associated with less presenteeism) or a positive impact (i.e., physical activity contributes to the reduction of presenteeism). From those studies, 17 were observational, 5 were RCT and 5 were longitudinal. From the twenty-seven studies that supported the hypothesis that more physically active employees reported presenteeism), two were categorized in the European line of research (7%), twenty-two were from the American line of research (82%) and 3 from the non-illness line of research (11%).

Results That Did Not Support the Hypothesis of a Negative Association Between Physical Activity and Presenteeism

Two observational studies (4%)^54,88 reported results that did not support the hypothesis of a negative association between physical activity and presenteeism. This indicates that there was an elevated risk of presenteeism for workers who participated in leisure and sports activities compared to those who did not. One of the studies was from the European line of research (50%) and the other was from the American line of research (50%).

Neutral – Results Showed No Association or Effect

Eighteen studies (32%) were categorized “Neutral” as results indicate no relationship or no effect. Of those studies, 7 were observational, 3 were RCT, 3 were intervention studies and 5 were longitudinal. From all those studies (except from one study that did not report the definition of presenteeism used⁹⁶), six were from the European line of research (35%), ten were from the American line of research (59%) and one was from the non-illness line of research (6%).

Mixed Results

Nine studies (16%) were categorized “mixed” as results indicate either positive, negative or no relationship or effect. Of those studies, 6 were observational, 2 were RCT and one was longitudinal. Two studies (22%) defined presenteeism as working while ill whereas seven (78%) referred to productivity losses instead.

Finally, one observational study⁷⁴ did not report the results from the relationship between presenteeism and physical activity. A supplementary file (Appendix D – Table 4) contains detailed results for RQ3.

RQ4

What Is Known (and What Is Not) from the Existing Literature About the Associations Between Physical Activity and Presenteeism Over the Past 20 Years (2000–2020)?

What Do We Know

From the fifty-seven studies included in this review, we observe that the researchers who are more interested in the relationship between physical activity and presenteeism are more likely to define presenteeism in a way that is consistent with the American research line (“lost productivity due to health problems or illness”). Seventy percent of the studies fall into this category. The measurement tool most frequently used by these researchers is the WLQ. The United States was also the country the most represented in our sample. It is the country where most of the longitudinal studies were conducted with 6 longitudinal studies (55%) followed by Sweden with 3 longitudinal studies (27%). The studies in this research area seem to report more positive results than neutral, mixed, or negative results. The studies categorized in this line of research represented 82% of the studies that reported results that supported their hypothesis.

The European line of research and the non-illness-related line of research appear to report fewer positive outcomes with only 7% and 11% of the studies reporting results that support their hypothesis, respectively.

What We Don’t Know

This scoping review highlights the existing challenge in determining the optimal frequency, intensity, duration, and type of physical activity required to provide greater productivity benefits.^27,98 Further research incorporating variations in the different components of physical activity is therefore required.^36,104 In addition, it would be important to use both an objective (e.g., accelerometer) and subjective (e.g., self-reported) measure to measure physical activity.²⁷ It would also be important to conduct analyses controlling for lifestyle-related health problems since lifestyle habits, when unhealthy, increase the risk of health problems, chronic diseases, and mortality.^69,105 Finally, all the studies included in this review had a quantitative methodology. It would be helpful to conduct more qualitative research on presenteeism and physical activity to document the rich complexity and shades of this relationship. For example, conducting interviews with employees could help researchers understand how work-related physical activity is considered detrimental to workers' health and performance, while leisure-time physical activity is beneficial.¹⁰⁶ It has recently been suggested that this paradox regarding the context of physical activity and its influence on workers' health should be further investigated.^50,107

Discussion

The purpose of this review was to map out the extent of the literature on the relationship between physical activity and presenteeism. The results indicate a strong interest in this relationship among researchers who consider productivity losses due to health impairment as presenteeism (namely the American line of research). There was also a clear preference for the WLQ measurement tool among these researchers. It appears, therefore, that there is a certain homogeneity in the literature included in this review, even though the field of research on presenteeism is heterogeneous. Thus, we recognize the rather one-dimensional nature of how presenteeism is defined and measured in most of the studies included in this review.

The results lead us to believe that research on the relationship between presenteeism and physical activity is mainly conducted in a more “medical” field. Forty-four percent of the studies included were published in the Journal of Occupational and Environmental Medicine with another 19% of the studies that have been published in a journal in the medical field (e.g., Occupational and Environmental Medicine, Journal of Preventive Medicine and Public Health). This finding is not surprising given the preventive character of physical activity. On the other hand, it seems that it leads to results that are quite homogeneous, with 82% of the studies that support their hypothesis coming from the American line of research.

Presenteeism is a phenomenon of growing interest in social sciences. Its determinants, notably physical activity, should be of equal interest in this field of research. Investigating this relationship from a more organizational perspective could lead us to innovate in how to manage and prevent presenteeism. Following the proposition made by Ruhle and colleagues⁴⁰ in the position paper about presenteeism, we encouraged researchers to adopt the definition of presenteeism as a behavior of working with an altered state of health. This definition implies that presenteeism is viewed as a behavior that may or may not have an influence on productivity, and that is neither viewed as positive or negative. By adopting this neutral and behavioral definition of presenteeism, it allows researchers to expand the scope of their studies (e.g., by considering that it is possible to do presenteeism while teleworking) and consider that presenteeism could have potential benefits for individual’s health and for their performance. The role of individual resources such as physical activity, and organizational resources such as job control or social support could be determinant in explaining whether or not presenteeism is functional and beneficial. Functional presenteeism, according to the Health-Performance Framework of presenteeism by Karanika-Murray and Biron,¹ is the optimal balance between job and health constraints. Similar to psychosocially resourceful work environment that mitigate the impact of presenteeism within their employees,¹⁰⁸ employees with a multitude of personal resources, such as physical activity, could mitigate the potentially negative effects of presenteeism on their health and performance. The value of physical activity as an individual resource is an area of research that deserves further study, especially in the post-pandemic context. Teleworking and hybrid work present additional challenges for organizations. These forms of work should be accompanied by sufficient resources, specifically job control for employees since job control is known to be associated with improved physical activity levels of employees.¹⁰⁹

Furthermore, the recent pandemic context has highlighted the importance of preventing chronic illnesses and has exacerbated mental health problems. Chronic illnesses and mental health issues are known to increase the likelihood of working while ill⁹ and of productivity losses at work.^110,111 Physical activity has widely been shown to prevent chronic illnesses and mental health problems.^23,112,113

Even though scientists have recognized the need for more in-depth study of lifestyle habits in relation to presenteeism for over more than a decade,¹¹⁴ there is still a scarcity of studies.¹⁰⁰ The lack of studies examining the effects of lifestyle habits on presenteeism is particularly worrisome considering that they play a key role in workers' health. In addition, most adults do not engage in sufficient physical activity²³ and more than half of the population reports engaging in two or more unhealthy behaviors at the same time (e.g., smoking and being physically inactive).¹¹⁵

There are some strengths and limitations of this study that need to be mentioned. A major strength of this review is the comprehensive search for articles, combining six electronic databases, hand searching of journals, and reference lists of the included studies. Nevertheless, presenteeism and its relationship with physical activity are still a relatively new field of health promotion research. There are probably unpublished trials that contain valuable information that was not included.

We included a wide variety of studies that provide information on the relationship between presenteeism and physical activity. Using the Arksey and O’Malley framework,⁵¹ we synthesized and compare studies in terms of measure and conceptualization. However, considering the lack of consensus on the measure and conceptualization of presenteeism, a comprehensive search strategy remains challenging. The search strategy was refined in an iterative process following the publication of the protocol.³⁸ The initial search strategy included work ability, work performance, and other work outcomes that are related to presenteeism, without explicitly referring to it. However, the final search strategy excluded studies in which presenteeism was missing in order to provide clearer answers to the research questions.

Similarly, some studies that focused on health promotion programs that included physical activity but did not necessarily refer to physical activity in the abstract, title or keywords, may have slipped under our radar during the first screening. This suggests that our review has a potential bias regarding the studies included, which could explain the over-representation of the American line of thought. Considering these observations, we believe that research on physical activity and presenteeism should be opened up across various disciplines (other than the ones favored by the American line of thought), in order to respond to the needs that many researchers have expressed to better manage presenteeism, preventing physical and mental health problems and their consequences on productivity.

To increase feasibility, we limited inclusion to articles made available in the past 20 years. However, this is likely not a substantial limitation, as most of the studies were published in the past 10 years. We also limited inclusion to studies written in English, which may have resulted in the exclusion of eligible studies. Given the large number of articles included, the data were extracted by one reviewer and a sample of 25% of the total was verified by a second reviewer. However, the data are likely valid, as a pilot test was conducted prior to embarking on data extraction with both reviewers.

Conclusion

This review has highlighted the homogeneity of how presenteeism is conceptualized and measured in studies that investigate the relationship between physical activity and presenteeism. Most of the studies that reported positive outcomes (e.g., more physical activity is associated with less presenteeism) were categorized in the American line of research which defines presenteeism as lost productivity due to health problems or illness. It seems essential to broaden the horizons of this area of research to other fields outside the medical field (e.g., social sciences), in order to benefit from a more organizational view of presenteeism. Studies with a longitudinal design are lacking in this field and would shed light on this relationship with tracking changes in physical activity and presenteeism over time and analyzing what influences them.

So What?

What is Already Known on This Topic?

There are inconsistencies in studies examining the relationship between physical activity and presenteeism that limit the interpretation of results and the potential for knowledge transfer to promote healthier presenteeism management.

What Does This Article Add?

Most of the studies included in this review defined presenteeism as a “lost productivity due to health problems”, which is consistent with the American research line. The studies in this research area seem to report results supporting the hypothesis that physical activity reduces presenteeism. It appears that there is a certain homogeneity in the literature included in this review, even though the field of research on presenteeism is heterogeneous.

What are the Implications for Health Promotion Practice or Research?

The results lead us to believe that research on the relationship between presenteeism and physical activity is mainly conducted in a more “medical” field. Investigating this relationship in a more holistic way by considering presenteeism as a function of both health and performance could lead us to innovate in how to promote healthier organizations.

Supplemental Material

Supplemental Material - Investigating Associations Between Physical Activity and Presenteeism – A Scoping Review

Supplemental Material for Investigating Associations Between Physical Activity and Presenteeism – A Scoping Review by Valérie Hervieux, Caroline Biron and Justine Dima in American Journal of Health Promotion

Footnotes

Acknowledgments

We thank Louise Leblanc who reviewed the protocol for this study and the reviewers during the publication of the protocol who helped to improve it.

Author Contributions

VH conceptualized the protocol, acquired funding, coordinated the study, screened and extracted data. VH also drafted the manuscript. JD screened data and edited the manuscript. CB extracted some of the data and edited the manuscript. CB also supervised the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: VH and CB receive funding from the Social Sciences and Humanities Research Council of Canada (767-2021-1589). The funder had no role in the design of the study; collection, analysis, and interpretation of data; or in writing the manuscript.

ORCID iDs

Valerie Hervieux

Justine Dima

Supplemental Material

Supplemental material for this article is available online.

Note

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