Guidance
Appendix C: The evidence
This appendix sets out the evidence statements taken from the review and the additional evidence paper and links them to the relevant recommendations (see appendix B for the key to study types and quality assessments). The evidence statements are presented here without references – these can be found in the full review (see appendix E for details). The appendix also sets out a brief summary of findings from the economic appraisal.
Evidence statement 1 indicates that the linked statement is numbered 1 in 'A review of effectiveness of workplace health promotion interventions on physical activity and what works in motivating and changing employees' health behaviour'. Evidence statement US1 indicates that the linked statement is numbered 1 in the additional evidence paper 'Summary of the US evidence as it relates to the draft workplace physical activity recommendations'.
Where a recommendation is not directly taken from the evidence statements, but is inferred from the evidence, this is indicated by IDE (inference derived from the evidence) below.
The review, additional evidence paper and economic appraisal are available on the NICE website.
Recommendation 1: evidence statements 4c, 13, IDE
Recommendation 2: evidence statements 3, 4a, 4b, 4c, 13, 15, US3, US4, US5, IDE
Recommendation 3: evidence statements 1, 2, 3, 11, 15, US1, US4, IDE
Recommendation 4: IDE
Evidence statements
Evidence statement 1
There is evidence from four studies (one [++ B] ITS; one [+ A] before and after (BA); one [- A] BA; one [- B] BA) that the use of posters and signs can increase stair (instead of lift) use. However, in two of these studies stair usage declined back to baseline levels at follow-up or by the end of the study period, suggesting that the effectiveness of these posters is short term. In addition, two studies (one [+ A] and one [- B] CBA) reported a decline in stair use/step count. Further study is required.
Evidence statement 2
There is evidence from studies in the public sector that workplace walking interventions using pedometers that focus on: facilitated goal setting,diaries and self-monitoring and walking routes can produce positive results, increasing step count. (One [+ B] and one [- B] BA; one [+ A] and one [- A] individual RCT.)
Evidence statement 3
There is evidence (one [+ A] individual RCT) from one UK public sector workplacethat a walking and cycling to work campaign, through use of written health materials distributed to employees, can increase walking to work (but not cycling to work) in economically advantaged women.
Evidence statement 4a
There is evidence from six studies (one [+ B] and one [- B] CBA; one [- A] and one [- B] BA; two [- A] cross-sectional surveys [CSS]) to suggest that workplace health screening can have a positive impact on physical activity. However, while all six studies included a health check or assessment, other components of the intervention differed (these included, for example, counselling), which makes it difficult to attribute effects to a single factor. Two studies (one [+ B] and one [- B] CBA) although reporting positive behaviour change only approached [statistical] significance.
Evidence statement 4b
There is evidence from four studies (one [- B] CBA; one [- B] BA; one [++ B] cluster RCT; one [+ B] individual RCT) that suggests workplace counselling has positive effects on physical activity. Of the two studies (one [++ B] cluster RCT; one [+ B] individual RCT) that focus solely on counselling, the first shows positive effects on increasing physical activity compared to the control. The other, while showing positive improvements, shows no difference between groups receiving counselling, counselling and fitness testing or the control group. Two other studies (one [- B] CBA; one [- B] BA) are multi-component interventions that included counselling, motivational interviewing and health screening, which makes it difficult to attribute effects to a single factor.
Evidence statement 4c
Evidence from one study ([+ B] CBA) suggests that employee-designed interventions that include written health and physical activity information, active commuting, stair climbing, led walks, fitness testing and counselling (all as required) can have a positive effect on physical activity.
Evidence statement 11
Evidence from two walking interventions studies (one [- B] BA; one [+ A] individual RCT) and one active travel intervention ([+ A] individual RCT) suggests self-directed interventions are effective.
Evidence statement 13
There is no evidence that involvement of employees in the implementation and review of the physical activity intervention influences the effectiveness of those interventions. There is evidence, however, from one study ([+ B] CBA) that involving employees in the planning stage of intervention design can have a positive effect on physical activity.
Evidence statement 15
Nine studies (three [- A] BA; one [- B] BA; one [+ A] CBA; one [+ A] individual RCT; one [+ B] and one [- A] qualitative; one [- B] individual RCT) gave details of employees' cited facilitators to the implementation of interventions that focus on: physical environment (improvements in facilities and convenience of location); incentive schemes; and flexible work practices. In three stair-walking studies, employees found the poster interventions encouraged stair walking, were a good idea and thought-provoking. No factors were cited by the employers as facilitators to the implementation of physical activity interventions.
Evidence statement US1
Two studies (BA + C) report that multi-component interventions that combine the provision of signs to encourage stair use with modifications to make stairwells more attractive can increase the frequency of stair use.
Evidence statement US3
One study (RCT + C) found that an Internet intervention could be effective at increasing moderate physical activity in the short term, however at 3 months the difference was no longer significant.
Evidence statement US4
One non-randomised trial (- C) found that sessions which focused on; the use of self-regulation skills; dispelling the myths of exercise; identifying the expected outcomes from exercise participation; and teaching how to engage in a safe, efficient, and effective exercise programme led to increased exercise levels.
Evidence statement US5
One study (cluster RCT - C) found that tailored information, as part of a broader health improvement strategy significantly increased the level of exercise of blue collar women.
Cost-effectiveness evidence
Overall, workplace physical activity counselling and fitness programmes were found to be cost effective. In addition, the introduction of a workplace physical fitness programme may be broadly beneficial to employers in that it can help reduce absenteeism.
Fieldwork findings
Fieldwork aimed to test the relevance, usefulness and the feasibility of implementing the recommendations and the findings were considered by PHIAC in developing the final recommendations. For details, go to the fieldwork section in appendix B and the fieldwork report.
Fieldwork participants were fairly positive about the recommendations and their potential to help increase physical activity levels among employees. Many participants felt they were practical and relevant.
Stakeholders and employers cited a range of factors that could limit implementation. This indicated a need to provide employers with further advice and support, particularly with regard to:
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how to get all employees involved in physical activity initiatives (including disabled people and shift workers)
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planning and assessing activities.
This could involve providing organisations (particularly small enterprises) with practical examples and case studies of good practice.