Personality traits as predictors of exercise treatment adherence in major depressive disorder: lessons from a randomised clinical trial.

OBJECTIVE: The objective of this study was to explore the determinants of adherence in the EFFORT-D (EFFect Of Running Therapy) study in a specialised mental health care hospital setting. METHODS: Patients with major depressive disorder (MDD) were given treatment as usual and half were randomised to an exercise intervention. Adherence was measured at 3 months (T3) and 6 months (T6) and was defined as participation in the overall study protocol (total n = 42, adhered n = 28) or intervention (total n = 24, adhered n = 9). Potential determinants were age, BMI, tobacco and alcohol use, severity of depression, anxiety, fitness (VO2max kg-1 and Wmax kg-1) and personality traits at baseline. ANOVA, Chi-square tests and block-wise logistic regression were performed, and reliability of the scales was determined. RESULTS: Numbers were found too low for analyses on smoking, drinking and anxiety. Higher agreeableness was significantly associated with better adherence to the overall study protocol (OR 1.2; p = 0.03; 95% CI: 1.01-1.4) and severity of depression was negatively associated with adherence in the intervention group (OR 0.70; p = 0.046;95% CI: 0.49-0.99). CONCLUSIONS: To adhere to a study protocol involving exercise or to a clinical exercise programme, MDD patients need substantial personal support. Measurement of personality traits and the severity of depression as potential predictors of adherence could be considered for this purpose. Keypoints Adherence to exercise and study protocols in a randomised controlled trial was low Patients with severe major depressive disorder need substantial personal support Measurement of personality traits could be considered.

From impact factors to real impact: translating evidence on lifestyle interventions into routine mental health care.

The scandal of premature mortality in people with serious mental illness is well established. Despite an increase in studies evaluating the efficacy of lifestyle interventions, translating this evidence into routine clinical care and policies is challenging, in part due to limited effectiveness or implementation research. We highlight the challenge of implementation that is increasingly recognized in clinical practice, advocate for adopting implementation science to study the implementation and systematic update of effective interventions in practice and policy, and provide directions for future research.

Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV.

BACKGROUND: Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation. METHODS: Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which ≥80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study. RESULTS: Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI. CONCLUSIONS: This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.

Changes in physical and psychiatric health after a multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: The MULTI study I.

Patients hospitalized with severe mental illness (SMI) often have an unhealthy lifestyle. Changing their sedentary behavior and deficiency in physical activity is challenging and effective interventions are lacking. We evaluated changes in sedentary behavior, physical activity, metabolic health and psychotic symptoms after 18 months of Multidisciplinary Lifestyle enhancing Treatment for Inpatients with SMI (MULTI) compared to treatment as usual (TAU) and explored mediation by change in total activity. We measured sedentary behavior and physical activity using accelerometry (ActiGraph GT3X+), reflected in total activity counts. Data on metabolic health and psychotic symptoms were retrieved from routine screening data within our cohort of inpatients with SMI. Of 65 patients receiving MULTI versus 43 receiving TAU, data were analyzed using linear and logistic multilevel regression, adjusting for baseline values of outcome and differences between groups. Compared to TAU, in which no improvements were observed, we found significantly (p < 0.05) improved total activity (B = 0.5 standardized total activity counts per hour), moderate-to-vigorous physical activity (B = 1.8%), weight (B = -4.2 kg), abdominal girth (B = -3.5 cm), systolic blood pressure (B = -8.0 mmHg) and HDL cholesterol (B = 0.1 mmol/l). No changes in psychotic symptoms were observed. Changes in total activity did not mediate metabolic improvements, suggesting that multiple components of MULTI contribute to these improvements. In contrast to previously unsuccessful attempts to change lifestyle behavior in inpatients with SMI in the longer term, MULTI showed to be a feasible treatment to sustainably improve PA and metabolic health.

Less Medication Use in Inpatients With Severe Mental Illness Receiving a Multidisciplinary Lifestyle Enhancing Treatment. The MULTI Study III.

Besides having an unhealthy lifestyle contributing to premature mortality, inpatients with severe mental illness (SMI) use high dosages of medication. Previous research has shown improved health after lifestyle improvements in SMI. In addition, we aimed to retrospectively study whether a multidisciplinary lifestyle enhancing treatment (MULTI) was associated with changes in medication use after 18 months, as compared with patients that continued treatment as usual (TAU) and explored mediation by a change in physical activity. We conducted an observational study within a cohort of inpatients with SMI, who received MULTI (N = 65) or continued TAU (N = 49). Data on their somatic and psychotropic medications were collected, converted into defined daily dose (DDD), and analyzed using linear multilevel regression, correcting for baseline value and differences between groups in age, diagnosis, and illness severity. Compared with TAU, the DDD for psychotropic medication significantly decreased with MULTI (B = -0.55, P = 0.02). Changes in total activity did not mediate this association, suggesting that multiple components of MULTI contributed. Corrected between-group analyses for subgroups of medication were not possible due to lack of power and skewed distributions. Within-group data showed a decreased proportion of users as well as median DDD in both groups for almost all medications. In addition to previously reported health improvements after 18 months of MULTI, we observed a significant decrease in dose of psychotropic medication in MULTI compared to TAU. This first study evaluating a wide range of medications indicates a possible effect of lifestyle improvements on medication use in inpatients with SMI. Findings need to be confirmed in future controlled studies, however.

Correlates of sedentary time in different age groups: results from a large cross sectional Dutch survey.

BACKGROUND: Evidence shows that prolonged sitting is associated with an increased risk of mortality, independent of physical activity (PA). The aim of the study was to identify correlates of sedentary time (ST) in different age groups and day types (i.e. school-/work day versus non-school-/non-work day). METHODS: The study sample consisted of 1895 Dutch children (4-11 years), 1131 adolescents (12-17 years), 8003 adults (18-64 years) and 1569 elderly (65 years and older) who enrolled in the Dutch continuous national survey 'Injuries and Physical Activity in the Netherlands' between 2006 and 2011. Respondents estimated the number of sitting hours during a regular school-/workday and a regular non-school/non-work day. Multiple linear regression analyses on cross-sectional data were used to identify correlates of ST. RESULTS: Significant positive associations with ST were observed for: higher age (4-to-17-year-olds and elderly), male gender (adults), overweight (children), higher education (adults ≥ 30 years), urban environment (adults), chronic disease (adults ≥ 30 years), sedentary work (adults), not meeting the moderate to vigorous PA (MVPA) guideline (children and adults ≥ 30 years) and not meeting the vigorous PA (VPA) guideline (4-to-17-year-olds). Correlates of ST that significantly differed between day types were working hours and meeting the VPA guideline. More working hours were associated with more ST on school-/work days. In children and adolescents, meeting the VPA guideline was associated with less ST on non-school/non-working days only. CONCLUSIONS: This study provides new insights in the correlates of ST in different age groups and thus possibilities for interventions in these groups. Correlates of ST appear to differ between age groups and to a lesser degree between day types. This implies that interventions to reduce ST should be age specific. Longitudinal studies are needed to draw conclusions on causality of the relationship between identified correlates and ST.

Physical activity and relaxation in the work setting to reduce the need for recovery: what works for whom?

BACKGROUND: To recover from work stress, a worksite health program aimed at improving physical activity and relaxation may be valuable. However, not every program is effective for all participants, as would be expected within a "one size fits all" approach. The effectiveness of how the program is delivered may differ across individuals. The aim of this study was to identify subgroups for whom one intervention may be better suited than another by using a new method called QUalitative INteraction Trees (QUINT). METHODS: Data were used from the "Be Active & Relax" study, in which 329 office workers participated. Two delivery modes of a worksite health program were given, a social environmental intervention (group motivational interviewing delivered by team leaders) and a physical environmental intervention (environmental modifications). The main outcome was change in Need for Recovery (NFR) from baseline to 12 month follow-up. The QUINT method was used to identify subgroups that benefitted more from either type of delivery mode, by incorporating moderator variables concerning sociodemographic, health, home, and work-related characteristics of the participants. RESULTS: The mean improvement in NFR of younger office workers in the social environmental intervention group was significantly higher than younger office workers who did not receive the social environmental intervention (10.52; 95 % CI: 4.12, 16.92). Furthermore, the mean improvement in NFR of older office workers in the social environmental intervention group was significantly lower than older office workers who did not receive the social environmental intervention ( -10.65; 95 % CI: -19.35, -1.96). The results for the physical environmental intervention indicated that the mean improvement in NFR of office workers (regardless of age) who worked fewer hours overtime was significantly higher when they had received the physical environmental intervention than when they had not received this type of intervention (7.40; 95 % CI: 0.99, 13.81). Finally, for office workers who worked more hours overtime there was no effect of the physical environmental intervention. CONCLUSIONS: The results suggest that a social environmental intervention might be more beneficial for younger workers, and a physical environmental intervention might be more beneficial for employees with a few hours overtime to reduce the NFR. TRIAL REGISTRATION: NTR2553.

Longitudinal Relationship Between Sitting Time on a Working Day and Vitality, Work Performance, Presenteeism, and Sickness Absence.

OBJECTIVE: The aim of this study was to explore the longitudinal relationship between sitting time on a working day and vitality, work performance, presenteeism, and sickness absence. METHODS: At the start and end of a five-month intervention program at the workplace, as well as 10 months after the intervention, sitting time and work-related outcomes were measured using a standardized self-administered questionnaire and company records. Generalized linear mixed models were used to estimate the longitudinal relationship between sitting time and work-related outcomes, and possible interaction effects over time. RESULTS: A significant and sustainable decrease in sitting time on a working day was observed. Sitting less was significantly related to higher vitality scores, but this effect was marginal (b = -0.0006, P = 0.000). CONCLUSIONS: Our finding of significant though marginal associations between sitting time and important work-related outcomes justifies further research.

Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes.

OBJECTIVE: Evaluation of the effectiveness of a workplace health promotion program on employees' vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors' role on these outcomes. METHODS: The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used. RESULTS: Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence. CONCLUSIONS: Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes.

Objectively Measured Total and Occupational Sedentary Time in Three Work Settings.

BACKGROUND: Sedentary behaviour increases the risk for morbidity. Our primary aim is to determine the proportion and factors associated with objectively measured total and occupational sedentary time in three work settings. Secondary aim is to study the proportion of physical activity and prolonged sedentary bouts. METHODS: Data were obtained using ActiGraph accelerometers from employees of: 1) a financial service provider (n = 49 men, 31 women), 2) two research institutes (n = 30 men, 57 women), and 3) a construction company (n = 38 men). Total (over the whole day) and occupational sedentary time, physical activity and prolonged sedentary bouts (lasting ≥30 minutes) were calculated by work setting. Linear regression analyses were performed to examine general, health and work-related factors associated with sedentary time. RESULTS: The employees of the financial service provider and the research institutes spent 76-80% of their occupational time in sedentary behaviour, 18-20% in light intensity physical activity and 3-5% in moderate-to-vigorous intensity physical activity. Occupational time in prolonged sedentary bouts was 27-30%. Total time was less sedentary (64-70%), and had more light intensity physical activity (26-33%). The employees of the construction company spent 44% of their occupational time in sedentary behaviour, 49% in light, and 7% in moderate intensity physical activity, and spent 7% in sedentary bouts. Total time spent in sedentary behavior was 56%, 40% in light, and 4% in moderate intensity physical behaviour, and 12% in sedentary bouts. For women, low to intermediate education was the only factor that was negatively associated with occupational sedentary time. CONCLUSIONS: Sedentary behaviour is high among white-collar employees, especially in highly educated women. A relatively small proportion of sedentary time was accrued in sedentary bouts. It is recommended that worksite health promotion efforts should focus on reducing sedentary behaviour through improving light intensity physical activity.

Interventions to reduce sedentary behavior and increase physical activity during productive work: a systematic review.

OBJECTIVE: This review addresses the effectiveness of workplace interventions that are implemented during productive work and are intended to change workers` SB and/or PA. METHODS: We searched Scopus for articles published from 1992 until 12 March 2015. Relevant studies were evaluated using the Quality Assessment Tool for Quantitative Studies and summarized in a best-evidence synthesis. Primary outcomes were SB and PA, both at work and overall (ie, during the whole day); work performance and health-related parameters were secondary outcomes. RESULTS: The review included 40 studies describing 41 interventions organized into three categories: alternative workstations (20), interventions promoting stair use (11), and personalized behavioral interventions (10). Alternative workstations were found to decrease overall SB (strong evidence; even for treadmills separately); interventions promoting stair use were found to increase PA at work while personalized behavioral interventions increased overall PA (both with moderate evidence). There was moderate evidence to show alternative workstations influenced neither hemodynamics nor cardiorespiratory fitness and personalized behavioral interventions did not influence anthropometric measures. Evidence was either insufficient or conflicting for intervention effects on work performance and lipid and metabolic profiles. CONCLUSIONS: Current evidence suggests that some of the reviewed workplace interventions that are compatible with productive work indeed have positive effects on SB or PA at work. In addition, some of the interventions were found to influence overall SB or PA positively. Putative long-term effects remain to be established.

Are Self-report Measures Able to Define Individuals as Physically Active or Inactive?

PURPOSE: Assess the agreement between commonly used self-report methods compared with objectively measured physical activity (PA) in defining the prevalence of individuals compliant with PA recommendations. METHODS: Time spent in moderate and vigorous PA (MVPA) was measured at two time points in 1713 healthy individuals from nine European countries using individually calibrated combined heart rate and movement sensing. Participants also completed the Recent Physical Activity Questionnaire (RPAQ), short form of the International Physical Activity Questionnaire (IPAQ), and short European Prospective Investigation into Cancer and Nutrition Physical Activity Questionnaire (EPIC-PAQ). Individuals were categorized as active (e.g., reporting ≥150 min of MVPA per week) or inactive, based on the information derived from the different measures. Sensitivity and specificity analyses and Kappa statistics were performed to evaluate the ability of the three PA questionnaires to correctly categorize individuals as active or inactive. RESULTS: Prevalence estimates of being sufficiently active varied significantly (P for all <0.001) between self-report measures (IPAQ 84.2% [95% confidence interval {CI}, 82.5-85.9], RPAQ 87.6% [95% CI, 85.9-89.1], EPIC-PAQ 39.9% [95% CI, 37.5-42.1] and objective measure 48.5% [95% CI, 41.6-50.9]. All self-report methods showed low or moderate sensitivity (IPAQ 20.0%, RPAQ 18.7%, and EPIC-PAQ 69.8%) to correctly classify inactive people and the agreement between objective and self-reported PA was low (ĸ = 0.07 [95% CI, 0.02-0.12], 0.12 [95% CI, 0.06-0.18], and 0.19 [95% CI, 0.13-0.24] for IPAQ, RPAQ, and EPIC-PAQ, respectively). CONCLUSIONS: The modest agreement between self-reported and objectively measured PA suggests that population levels of PA derived from self-report should be interpreted cautiously. Implementation of objective measures in large-scale cohort studies and surveillance systems is recommended.

Physical activity and relaxation during and after work are independently associated with the need for recovery.

BACKGROUND: Research is needed to better understand the associations between during-work and after-work-hours physical activity and relaxation and need for recovery (NFR), so a study of these variables in office workers at a financial service provider was undertaken. METHODS: Self-reported baseline data of 412 employees (mean age = 41.3 y; 39.6% women) were used. Linear regression analyses were performed to test associations of physical activity, relaxation, detachment, and breaks at work with NFR. RESULTS: A lower NFR was significantly positively associated with standing, stair climbing, active lunch break, relaxation at work, detachment at work, physical detachment at work, relaxation at home, and detachment at home. In the multiple model, a lower NFR was independently positively associated with frequency of stair climbing, minutes spent in leisure activities, detachment at work, physical detachment at work, and relaxation and detachment at home (P < .05). Significant effect modification indicated that the positive association between relaxation at home and NFR was stronger with high job demands. CONCLUSION: Although prospective evidence is necessary to confirm the causal relationships, our findings suggest that engaging in stair climbing, leisure activities, (physical) detachment at work, relaxation and detachment after work is associated with a lower NFR. For future work site health promotion initiatives, interventions might be targeted at improving physical activity and relaxation.

Effectiveness of a worksite social & physical environment intervention on need for recovery, physical activity and relaxation; results of a randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of a worksite social and physical environment intervention on need for recovery (i.e., early symptoms of work-related mental and physical fatigue), physical activity and relaxation. Also, the effectiveness of the separate interventions was investigated. METHODS: In this 2 × 2 factorial design study, 412 office employees from a financial service provider participated. Participants were allocated to the combined social and physical intervention, to the social intervention only, to the physical intervention only or to the control group. The primary outcome measure was need for recovery. Secondary outcomes were work-related stress (i.e., exhaustion, detachment and relaxation), small breaks, physical activity (i.e., stair climbing, active commuting, sport activities, light/moderate/vigorous physical activity) and sedentary behavior. Outcomes were measured by questionnaires at baseline, 6 and 12 months follow-up. Multilevel analyses were performed to investigate the effects of the three interventions. RESULTS: In all intervention groups, a non-significant reduction was found in need for recovery. In the combined intervention (n = 92), exhaustion and vigorous physical activities decreased significantly, and small breaks at work and active commuting increased significantly compared to the control group. The social intervention (n = 118) showed a significant reduction in exhaustion, sedentary behavior at work and a significant increase in small breaks at work and leisure activities. In the physical intervention (n = 96), stair climbing at work and active commuting significantly increased, and sedentary behavior at work decreased significantly compared to the control group. CONCLUSION: None of the interventions was effective in improving the need for recovery. It is recommended to implement the social and physical intervention among a population with higher baseline values of need for recovery. Furthermore, the intervention itself could be improved by increasing the intensity of the intervention (for example weekly GMI-sessions), providing physical activity opportunities and exercise schemes, and by more drastic environment interventions (restructuring entire department floor). TRIAL REGISTRATION: Nederlands Trial Register NTR2553.

Predictive factors of postpartum fatigue: a prospective cohort study among working women.

OBJECTIVES: The aim of this study was to investigate which prepartum determinants contribute to the development of postpartum (PP) fatigue among working women in the Netherlands. METHODS: A prospective cohort study in 15 Dutch companies was conducted to measure different potential predictors using self-administrated questionnaires at baseline and at 30 weeks of pregnancy. Fatigue was measured at 12 (N=523) and 52 weeks (N=436) PP using the Checklist Individual Strength (CIS). A CIS score>76 was defined as fatigue. RESULTS: The prevalence of fatigue at 12 and 52 weeks PP was 24.5% and 18.1%, respectively. Fourteen predictive factors were found for fatigue (R(2)=0.37) at 12 weeks PP. Ten predictive factors were found for fatigue at 52 weeks PP (R(2)=0.36). In general, less favourable work relationships and characteristics, poorer mental health, more passive coping styles, more sleeping problems, more fatigue during pregnancy, and beliefs about child care arrangements were related to PP fatigue. At 30 weeks of pregnancy, only more fatigue (OR=3.69, p<0.001; OR=2.68, p=0.02) and poorer mental health (OR=0.50, p=0.02; OR=0.90, p=0.78) predicted fatigue both at 12 and 52 weeks PP. CONCLUSIONS: A large number of predictive factors for PP fatigue were found. These findings indicate that different aspects can contribute to being fatigued after pregnancy. Further research is needed to investigate the effect of possible interventions by employers and/or occupational physicians.

Effectiveness of a combined social and physical environmental intervention on presenteeism, absenteeism, work performance, and work engagement in office employees.

OBJECTIVE: To investigate the effectiveness of a combined social and physical environmental intervention as well as the effectiveness of both separate interventions. METHODS: In a 2 × 2 factorial design, 412 office employees were allocated to the combined social and physical environmental intervention, to the social environmental intervention only, to the physical environmental intervention only, or were part of the control group. Data on presenteeism, absenteeism, work performance, and work engagement were obtained with questionnaires at baseline, 6, and 12 months. Multilevel analyses were performed. RESULTS: The combined intervention showed a decrease in contextual performance and dedication. The social environmental intervention showed an improvement in task performance. The physical environmental intervention revealed an improvement in absorption. CONCLUSION: Although the study showed some promising results, it is not recommended to implement the current interventions.

Associations between overweight, obesity, health measures and need for recovery in office employees: a cross-sectional analysis.

BACKGROUND: With both a high need for recovery (NFR) and overweight and obesity being a potential burden for organizations (e.g. productivity loss and sickness absence), the aim of this paper was to examine the associations between overweight and obesity and several other health measures and NFR in office workers. METHODS: Baseline data of 412 office employees participating in a randomised controlled trial aimed at improving NFR in office workers were used. Associations between self-reported BMI categories (normal body weight, overweight, obesity) and several other health measures (general health, mental health, sleep quality, stress and vitality) with NFR were examined. Unadjusted and adjusted linear regression analyses were performed and adjusted for age, education and job demands. In addition, we adjusted for general health in the association between overweight and obesity and NFR. RESULTS: A significant positive association was observed between stress and NFR (B= 18.04, 95%CI:14.53-21.56). General health, mental health, sleep quality and vitality were negatively associated with NFR (p<0.001). Analyses also showed a significant positive association between obesity and NFR (B=8.77, 95%CI:0.01-17.56), but not between overweight and NFR. CONCLUSIONS: The findings suggest that self-reported stress is, and obesity may be, associated with a higher NFR. Additionally, the results imply that health measures that indicate a better health are associated with a lower NFR. TRIAL REGISTRATION: The trial is registered at the Dutch Trial Register (NTR) under trial registration number: NTR2553.

Process evaluation of a worksite social and physical environmental intervention.

OBJECTIVE: To evaluate the process of implementation of a social and physical environmental intervention and to explore differences regarding this process between both interventions. METHODS: Context, recruitment, dose delivered, fidelity, reach, dose received, satisfaction, and implementation barriers were investigated. RESULTS: Reach for the social and physical environmental interventions ranged from 45% to 76%. Mean satisfaction for the social environmental intervention was 6.0 and for the physical environmental intervention was 7.0. Generally, the results were higher for team leaders than for employees. Furthermore, the implementation of the physical intervention was better at the departments that additionally received the social intervention. CONCLUSION: Both interventions were better implemented on the level of the team leader than that of the employees. Furthermore, the combined interventions received higher evaluation scores. To increase satisfaction and participation, attention should be paid to both employees and team leaders during implementation.

Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study.

The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12 weeks postpartum among working women. A total of 548 Dutch pregnant employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12 weeks postpartum. Participants received questionnaires at 30 weeks of pregnancy and at 6 and 12 weeks postpartum with demographic, work-related, pregnancy-related, fatigue, psychosocial, PGP-related and delivery-related questions. Univariate and multiple logistic regression analyses were performed. Almost half of the women experienced pain in their pelvic girdle at 12 weeks postpartum. However, the level of pain and the degree of disability due to postpartum PGP was low. Pregnancy-related predictors for PGP at 12 weeks were history of low back pain, higher somatisation, more than 8 hours of sleep or rest per day, and uncomfortable postures at work. The pregnancy and postpartum-related predictors were: more disability at 6 weeks, having PGP at 6 weeks, higher mean pain at 6 weeks, higher somatisation during pregnancy and at 6 weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP.

The development of the Be Active & Relax "Vitality in Practice" (VIP) project and design of an RCT to reduce the need for recovery in office employees.

BACKGROUND: There is strong evidence to suggest that multiple work-related health problems are preceded by a higher need for recovery. Physical activity and relaxation are helpful in decreasing the need for recovery. This article aims to describe (1) the development and (2) the design of the evaluation of a daily physical activity and relaxation intervention to reduce the need for recovery in office employees. METHODS/DESIGN: The study population will consist of employees of a Dutch financial service provider. The intervention was systematically developed, based on parts of the Intervention Mapping (IM) protocol. Assessment of employees needs was done by combining results of face-to-face interviews, a questionnaire and focus group interviews. A set of theoretical methods and practical strategies were selected which resulted in an intervention program consisting of Group Motivational Interviewing (GMI) supported by a social media platform, and environmental modifications. The Be Active & Relax program will be evaluated in a modified 2 X 2 factorial design. The environmental modifications will be pre-stratified and GMI will be randomised on department level. The program will be evaluated, using 4 arms: (1) GMI and environmental modifications; (2) environmental modifications; (3) GMI; (4) no intervention (control group). Questionnaire data on the primary outcome (need for recovery) and secondary outcomes (daily physical activity, sedentary behaviour, relaxation/detachment, work- and health-related factors) will be gathered at baseline (T0), at 6 months (T1), and at 12 months (T2) follow-up. In addition, an economic and a process evaluation will be performed. DISCUSSION: Reducing the need for recovery is hypothesized to be beneficial for employees, employers and society. It is assumed that there will be a reduction in need for recovery after 6 months and 12 months in the intervention group, compared to the control group. Results are expected in 2013. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR2553.