A Million Steps: Developing a Health Promotion Program at the Workplace to Enhance Physical Activity

Abstract

The workplace is a key setting for the prevention of occupational risks and for promoting healthy activities such as physical activity. Developing a physically active lifestyle results in many health benefits, improving both well-being and quality of life. This article details the experience of two Spanish companies that implemented a program to promote physical exercise in the workplace, called “A Million Steps.” This program aimed to increase the physical activity of participants, challenging them to reach at least a million steps in a month through group walks. Participant workers reached the set goal and highlighted the motivational and interpersonal functions of the program.

Physical inactivity has been identified as one of the principal risk factors for illness and premature mortality in high-income countries of the world (Council of the European Union, 2013). The World Health Organization (WHO; 2014), in its Global Status Report on Noncommunicable Diseases, estimated that 3.2 million individuals die each year due to insufficient physical activity. Lack of physical activity was also responsible for 69.3 million disability-adjusted life years in 2010 globally, 2.8% of total disability-adjusted life years (Lim et al., 2012). Physical inactivity, together with a reduced intake of fruits and vegetables, and tobacco and alcohol use generate most preventable illnesses (WHO, 2010).

Scientific evidence supports claims that physical activity results in less risk of contracting cardiovascular illnesses, type 2 diabetes, arterial hypertension, hyperlipidemia, metabolic syndrome, certain types of cancer (e.g., colon and breast), and depression. Likewise, physical activity prevents weight gain, reduces the risk of falls, and improves muscular and cardiorespiratory health as well as improving cognitive function (Centers for Disease Control and Prevention [CDC], 2012). Therefore, the WHO recommends that engaging in physical activity is essential for all age groups, particularly children and older adults (WHO, 2010).

During the last 5 years, the number of health promotion programs has multiplied in a variety of settings, used new strategies for developing processes, and implemented individual or group activities to change risk behaviors and adopt healthy lifestyles (WHO, 2011). Work settings offer the opportunity to promote healthy living habits including physical activity. The evidence accumulated in the last three decades from European, American, Australian, and Canadian studies (WHO, 2009) supports that well-designed and evidence-based programs can achieve positive health outcomes as well as save company resources (Goetzel et al., 2014).

Therefore, the workplace has been identified as a key setting, not exclusively focused on the prevention of occupational risks, but a setting for developing these interventions, offering an opportunity to reach the working population to promote healthy living habits (Carpintero Pérez, Lago Antón, Neyra Castañeda, & Terol Conthe, 2014). Studies have confirmed that adopting health promotion programs at the workplace, which could include interventions to promote physical activity, are beneficial for workers’ health, productivity, and quality of life as well as company profits (Baicker, Cutler, & Song, 2011). Although no conclusive evidence has shown that a stand-alone physical activity program can produce return on investment (ROI), physical activity itself is a pillar of any comprehensive wellness program and is one way to shift companies’ principles toward a culture of wellness (CDC, 2011).

Although the prevention of workers’ health risks is legally regulated in countries, health promotion activities require alliances among all workers, companies, and societal stakeholders to improve the health and well-being of employees (Barrios Casas & Paravic Klijn, 2006). Many companies are initiating health promotion programs (Goetzel, Henke, Head, Benevent, & Calitz, 2017; Joyce et al., 2016; Pereira, Coombes, Comans, & Johnston, 2015). This article reports the experiences of two companies that initiated workplace health promotion programs to enhance physical activity through group walks.

A Million Steps

A Million Steps, a health promotion program initiative of the Regional Ministry of Health of the Government of Andalusia (Spain), promoted physical exercise through group walks. The program started from a cooperative proposal, challenging participants to reach a total of at least 1 million steps in a month, measured by pedometers. In some cases, to increase the initial challenge of 1 million steps, it was suggested to make “imaginary journeys” whose steps cover the distance between the participants’ residence and some place else with a special meaning to the participants. Beyond the promotion of physical activity and the acquisition of healthy habits, it was also expected that the program would encourage interpersonal relationships and mutual support among coworkers to support accomplishing future common tasks.

Two Spanish companies voluntarily initiated the Million Steps program. The privately held aeronautical company, Airbus Defense and Space, a division of Airbus Group, the largest European industrial flagship, and the state-owned company, Local Council of the Province of Cádiz, that provides technical, financial, and technological support to the local governing authorities of the province of Cádiz in the southwest of Spain and, in some cases, directs services to citizens, were chosen to participate in the pilot program. Airbus Defense and Space employs around 500 workers and has four technological branches (i.e., metal structures, assembly, superplastic forming, and composite materials) as well as programs for Airbus aircraft families. The Local Council of the Province of Cadiz employs approximately 1,500 workers who coordinate municipal services and organize specific supramunicipal services.

To adapt the A Million Steps program to both companies, a literature review was conducted to find a suitable systematic workplace health promotion model on which to base the program. The “Workplace Health Model,” proposed by the CDC (2013), was selected. This model uses a coordinated approach for developing workplace health promotion programs to meet the health and safety needs of all employees. This model emphasizes four main steps: assessment, planning, implementation, and evaluation.

Assessment

The assessment phase was intended to define employee health risks and describe current health promotion activities, capacity, and needs (CDC, 2013). To accomplish this, the assessment was executed at individual, interpersonal, and institutional levels. On an individual level, the results of periodic occupational surveillance examinations were analyzed to detect health risks which could be managed effectively by occupational injury and illness prevention interventions. One of the main factors detected was the high prevalence of sedentary lifestyle among workers in both companies. On an interpersonal level, a positive work environment was found to favor collaboration. A human resources (HR) survey, “Airbus Group Engagement Survey” developed by Gallup, assessed social work networks including the relationship between coworkers, managers, and team leaders. Survey results demonstrated that the quality of relationships could contribute to developing collaborative health programs. At the institutional level, structural, political, and cultural elements were analyzed. The presence of an Occupational Health Service (OHS) located at the workplace was considered a positive factor. Regarding company policies, both companies had already implemented control systems for occupational health hazards whose quality is endorsed by external, independent entities. To evaluate the cultural components of the workplace, a survey about safety culture was distributed by OHS using The Nordic Safety Climate Questionnaire (NOSACQ-50; Kines et al., 2011). The results demonstrated integration of safety and prevention in all company activities. Based on previous data, workplace conditions were considered adequate for health promotion programs targeting physical activity to reduce the prevalence of sedentary lifestyles among workers.

Planning

Planning is a process to develop the components of a workplace health programs, including securing leadership support, developing a workplace health improvement plan, defining program management, establishing dedicated resources, and designing a communication plan (CDC, 2013).

The first step in planning the program was receiving management support. First, the individual responsible for the “A Million Steps” program at the Regional Ministry of Health of the Government of Andalusia was contacted to share interest in adapting the program to the two selected companies. Once the contact was made, companies’ executives were informed about the program; authorization to implement the program was requested and granted. At the same time, the workplace health and safety committee was informed about the program. This committee is composed of workers (unions), executives, and occupational health and safety technicians; the committee’s purpose is to continuously examine and analyze the companies’ health and safety data and programs. Several workers and team leaders, considered opinion leaders, were also informed of the program to evaluate their perceptions regarding the suitability of the program. Only positive feedback was provided so an agreement to join the initiative was signed by both companies and the Regional Ministry of Health.

Once the program was endorsed, a workplace health improvement plan, including objectives, timeline, needed resources, role definitions and responsibilities, communication strategies and data gathering plan, was created. The OHS was responsible for operational project management. A coordinator was appointed for each participating group who served as a link between these groups and program management.

Initially, needed resources included pedometers and documentation. The Regional Ministry of Health of the Government of Andalusia supplied these resources without cost to both companies and printed promotional posters and registration forms. No additional personnel were hired because OHS personnel were able to include program management duties in their normal workdays.

A communications strategy was developed to ensure the target audience received necessary information about the benefits of physical exercise, the purpose of the program, and instructions for registration. Communication was disseminated via a variety of channels (e.g., posters in crowded workplace venues, email, and intranet). In addition, all workers with appointments in the OHS during the recruitment period received information about the program.

To gather program evaluation data, the coordinator of each group acted as “steps treasurer,” documenting the number of steps walked by each member of the group during the week. In addition to steps walked, the document included two blank spaces, one for incidents in the development of the activity and the other to reflect participants’ feelings about their program experiences. Moreover, selected participants were interviewed by members of project management during and at the end of the program. A web-based blog was also created as a conduit for those participants who wished to convey their experiences to the group.

Implementation

Program implementation included all the steps needed to put health promotion interventions into place and offer them to employees (CDC, 2013). All workers, regardless of physical condition, were invited to enroll in the program. The intervention began with participants organizing groups and electing a “steps treasurer” for each group. The most frequent links among group members were work areas and professional groups. Most groups included both company personnel and subcontracted and in-training staff; the groups were as equal as possible in number of participants.

Once program management had a definite list of groups, an inaugural event was organized. During the event, program objectives and procedures were discussed and questions answered; registration forms and pedometers were distributed to the “steps treasurers.” From this point, the intervention was implemented during the ensuing month. Participants met outside the workplace daily to walk together during their leisure time; pedometers were used to record steps taken. The “steps treasurers” registered reported steps in the provided document. Program management provided continuous monitoring of activity progress through coordinators to ensure that the “workplace health improvement plan” was closely followed.

At the conclusion of the program, another event recognized the participants; individual diplomas were awarded to each participant detailing the number of steps the individual contributed to the group. Company executives and authorities from the Regional Ministry of Health took part in the event.

Evaluation

To evaluate the impact of the program, a descriptive cross-sectional study was completed using data from the steps document provided by each group treasurer. In the aeronautical company, a total of 107 workers took part in five program groups. The participants reported an average age of 40.9 years (range = 23-59 years) and were mainly men (77%). Together, the aeronautical company groups recorded 3,993,407 steps in the study month, equivalent to a distance of 1,736.92 miles (2,795.30 km) or 450,384 minutes walking. In the local administration unit, a total of 79 workers were part of 10 groups. The participants reported an average age of 45.8 years (range = 37-62 years) with a clear predominance of women (76%). This group recorded 12,349,039 steps, equivalent to 5,371.34 miles (8,644.33 km) or 1,392,748 minutes walking. In both cases, results indicated that, on average, the participants surpassed recommendations (i.e., 150-300 minutes of moderate aerobic exercise each week; WHO, 2010) during the course of the program.

Moreover, participants’ perceptions with regard to program benefits were evaluated. The qualitative study staff analyzed the contents of participants’ interviews and blog posts. Study data showed that the participants felt the program encouraged initiation of physical exercise among those who did not exercise at all and increased intensity and duration of exercise in those workers who did exercise routinely. Likewise, the workers thought the program facilitated concurrent acquisition of other healthy habits because many of them independently adopted a healthier diet or decided to quit smoking. In addition, the program fulfilled a socializing function, favoring social relationships among company employees and the development of teamwork skills.

Discussion

Now that program outcomes have been documented, it is possible to highlight program advantages which must be considered. On a functional level, the simplicity of the procedure facilitated organizational tasks as well as participation in physical activity. Furthermore, the program was compatible and actually created synergies with other health promotion programs and activities in the workplace. Other advantages include low cost because the required materials were not expensive, and coordination of the program did not require additional personnel or overtime. Moreover, worker exercise did not consume productive work time because walking occurred during the employees’ leisure time.

On a social level, the collaboration of all participants allowed employees and employee groups to reach their goal. The program is integrative; each participant contributes to goal achievement according to each worker’s ability.

With regard to participants, it should be highlighted that the activity is attractive to potential participants because rather than prescribing or recommending health promotion behaviors to individuals, worker groups are challenged to “walk a million steps.” Fulfilling the challenge is the motivator, which strengthens groups’ adherence to the program goal. The short time frame for the program allows participants to reach short term goals, reinforcing the goal of regular exercise. In addition, program activities can be adapted by each group and each participant, encouraging self-controlled progression in participating in program activities. Finally, the program structure affects the social work environment and reinforces the opportunities for physical activity among families and friends. Program evaluation results indicated that physical activity could promote bonds between public sector and private company employees; these bonds could motivate employees to continue health-promoting behaviors. As previously mentioned, this program can be easily exported to other workplaces around the world.

Future Considerations

Among the principal limitations of the program was the structure of the program evaluation to determine program efficacy; for example, the program evaluation would have been strengthened by conducting an experimental study. It would also be desirable to improve the way physical activity was measured using accelerometers, which have been used in other studies (Lee & Shiroma, 2014). These devices allow the recording of not only the frequency and duration of the physical activity but also the intensity. The program could also be evaluated by increases in participants’ physical activity over time. Likewise, it would be appropriate to evaluate the impact of the activity on participants’ attitudes toward exercise. On an operational level, it is recommended that program activities be more diverse with the addition of training and motivational activities that promote the benefits of physical exercise and offer advice to participants.