The Prevalence and Focus of Workplace Fitness Programs in Denmark: Results of a National Survey

Abstract

Purpose: This study describes the prevalence of physical activity
programs at Danish workplaces with one-hundred or more employees

Design: Cross-sectional

Setting: Denmark

Subjects: All private and public workplaces of the designated
size (n=2422).

Measures: A two-phase research model was used. Phase 1 consisted
of telephone interviews involving all workplaces. Phase 2 was conducted
using a structured, self-administered questionnaire which elicited more
detailed descriptions of workplaces identified as promoting physical activity
(n=449). Response rates were 92% and 69% in Phases 1 and 2 respectively.

Data Analysis: Data were analyzed using StatView statistical
software.

Results: 18.6% of all workplaces (n=2422) offer employees opportunities
for physical activity on a regular basis. Analysis of the data from workplaces
included in Phase 2 (n=449) showed the following: The most frequently
cited motive for providing opportunities for physical activity is to promote
social contact between employees.
63% of the workplaces have instructors for the activities on offer, while
39% mention that some form of assessment is linked to the offer of physical
activity. 50% of the programs have been implemented within the last ten
years.

Conclusions: The results indicate that the concept of physical
activity as part of everyday working life has acquired real momentum in
Denmark in recent decades, but nevertheless is still at an early stage.

Physical activity at the workplace—a historical outline

Physical activity at the workplace is not a recent phenomenon in Denmark.
Traditional company sports began more than half a century ago and were
organized in a national association. The primary aim of this association
over the years has been to organize competitions and tournaments among
various firms and companies. However, only recently has physical activity
received much attention as a catalyst for health and well being among
employees, or as a building block in corporate culture.

Thus, marked promotion of physical activity at the workplace first emerged
in 1987 when the Danish government presented the Government Preventive
Program, influenced by WHO’s strategy Health for All—Year
2000 (Ministry of Health, 1989). In the subsequent action plans, it is
the relationship between physical activity and the prevention of specific
illnesses that has been the constant theme—although the 1990s saw
a change of emphasis, with concepts like well being and social determinants
of health coming to the fore. This latter trend is reflected partly in
a variety of educational initiatives dealing with the promotion of physical
activity and fitness, and partly in official governmental guidelines for
the implementation of physical activity at workplaces from 1997 onwards
(National Board of Health, 1997). The overall development has been borne
out through the publication and promotion of the ambitious 2002 government
strategy entitled Healthy throughout life – a follow-up on The Danish
Government Programme on Public Health and Health Promotion 1999-2008 published
in 1999 (Ministry of Health, 1999. Government of Denmark, 2002).

In continuation of these political and health policy trends, this article
presents one of few comprehensive overviews of physical activity programs
at Danish workplaces. The results obtained and experiences gained from
this survey should be used to promote the continued implementation of
workplace fitness programs in particular and of workplace health promotion
in general. Furthermore, this article seeks to make a contribution to
the collection of fundamental knowledge and facts which is needed in order
to make possible international comparative research into minor or major
aspects of health promotion.

Methods

Design

The results presented in this paper are from an exploratory survey which
was conducted with the aim of systematically collecting background data
on a subject of which relatively little is currently known, namely health
promotion and physical activity at the workplace in Denmark. It was decided
to collate a limited amount of information from a large number of survey
returns concerning key variables related to both structural and human
resources.

The aims of the national survey were thus:

  • To determine the number of Danish workplaces offering physical activity
    to employees on a regular basis
  • To identify trends underlying the programs offered
  • To determine who is responsible for these programs
  • To describe how and where programs are made available
  • To document who meets the costs of establishing and running programs.

Sample

The sample included all private and public workplaces in Denmark with
one-hundred or more employees. Statistics Denmark provided information
as regards the name, addresses, and telephone numbers of each workplace,
the type of workplace, and the number of employees. The data were arranged
geographically, listed by municipality. Statistics Denmark updates information
on roughly ½ million Danish workplaces every sixth month, and supplies
information requested within ten days. The basic data can be regarded
as extremely reliable, because of the close co-operation between Statistics
Denmark and the Danish taxation authorities.

The grounds for selecting one-hundred employees as the lower limit were:

  1. The lower limit was chosen in the light of the time and resources
    available for the study. 2,422 Danish workplaces were registered as
    having one-hundred or more employees. This was considered to be a practicable
    number of workplaces to investigate, given the above mentioned conditions.
  2. Experiences gained from a pilot project carried out some years ago,
    concerning the extent of opportunities for physical activity at workplaces
    in a selected region of Denmark, indicated one-hundred employees as
    a suitable threshold value. The pilot study investigated all workplaces
    with at least twenty employees. It was found that only one of the workplaces
    offering physical activity on a formal, planned and regular basis had
    less than one-hundred employees (Berggren & Skovgaard, 1995). This
    finding is somewhat different from results presented in other research
    studies where physical activity, defined in much the same way as mentioned
    above, is frequently cited as a current health promotion initiative
    at workplaces employing less than one-hundred people (Wilson et al.,
    1999).

Measures

Collection of data was divided into two phases:

Phase 1: Selection via telephone contact
The 2,422 workplaces were contacted over the telephone. The use of a protocol
assisted interview system made it possible to discriminate between a group
of workplaces that were to take part in the later survey and a group that
did not live up to a criterion concerning workplace promotion of physical
activity.

Workplace promotion of physical activity was defined for the respondents
as: activities which lay outside the auspices of the three national Danish
sports associations and offered employees at least thirty minutes of physical
activity once a week or more frequently.

Furthermore, it was a requirement that respondents could answer ‘yes’
to one or both of the following sub-criteria:

  1. The ongoing initiatives regarding physical activity takes place solely
    or partial at the workplace;
  2. Workplace management bears some of the running expenses in connection
    with the activities.

The protocol assisted interview system included a standardized interview
guide. This gave a detailed definition of the term workplace promotion
of physical activity. There was a set of instructions related to the interview
guide which stipulated a specific order in which questions were to be
asked. This meant that the sub-criteria were mentioned last. The interview
protocol required that if the initial contact person (typically someone
in the secretariat) was unable to provide the information requested, this
person should be asked to transfer the request to another contact person
(usually someone in the personnel or administrative department).

The telephone interviews were conducted by qualified personnel with experience
in working on questionnaire-based projects. Before the work started there
were two preparatory meetings in which the interview protocol was reviewed,
commented upon, and revised.

Of the initial 2,422 workplaces listed, it proved impossible to get in
touch with 163. A further twenty workplaces either could not or refused
to participate in the survey. There was thus no information available
for a total of 183 workplaces. Ninety-two percent of the companies in
the sample were reached in Phase I, and this was judged to be acceptable.

Phase 2: Detailed questionnaire survey
This part of the survey covered all workplaces that fulfilled the requirements
set out in the definition of workplace promotion of physical activity.

All workplaces that fulfilled these conditions agreed to take part in
the subsequent survey, based on a structured, self administered questionnaire,
which was to be answered in writing and returned in an enclosed addressed
reply envelope. The questionnaire had a total of thirty-two questions
with multiple choice response categories, frequently with the possibility
of adding further comments in marked sections.

The questionnaire form was sent to a named contact person at the workplace
who was selected as being a knowledgeable and appropriate informant in
this context.

Of the 449 workplaces that received the questionnaire (corresponding
to 18.6% of all Danish workplaces with at least one-hundred employees),
310 (69%) responded. An analysis of the non-respondents showed no systematic
and consistent pattern when respondent and non-respondent groups were
compared with respect to:

  • Number of employees
  • Whether the workplace was in the private or public sector
  • Type of workplace
  • Geographical location (postal code)

Analysis

This article is mostly based on the information collected by means of
the questionnaire survey. The internal missing response rate, i.e. the
proportion of a given questions to which no response was made on the survey
forms returned, never exceeded 3% and followed no systematic pattern.
The internal missing responses are therefore considered to have only minor
effect on the reliability of the survey results.
The data from the forms were entered into a database by a firm specializing
in this type of work.
The data entered were then checked for errors against the original questionnaire
forms.
Descriptive data analysis was carried out using the StatView statistical
software package.

Results

General data—the size of workplaces
18.6% of all Danish workplaces with at least one-hundred employees offer
regular physical activity as previously defined. A comparison with the
results from the pilot study cited above suggests that a large increase
in the number of Danish workplaces offering physical activity has taken
place over a short period of time. The national survey also shows that
roughly half of the workplaces have begun to offer opportunities for physical
activity within the last decade. It is also noteworthy that in only one
in five states were making such an offer before 1980.

As shown in table I (part A), nearly half (48%) of the Danish workplaces
offering regular physical activity have 100-199 employees, while about
a third of the workplaces (32%) lie within the 200 499 range. The somewhat
smaller figure for larger workplaces (those with five-hundred or more
employees) that offer opportunities for physical activity corresponds
quite closely to the overall number of such larger workplaces existing
in Denmark. Indeed, Table I suggests that as a rule, the proportion of
Danish workplaces, which fall within a given size group, tends to tally
with the share of workplaces offering physical activity within the same
size group.

From the outset, it was assumed that physical activity programs at the
workplace would be more prevalent among smaller and medium sized workplaces.
This expectation was based on the conjecture that it would perhaps be
easier to agree on perspectives and aims of physical activity at smaller
and medium-sized workplaces. The findings described above do not support
such an assumption.

Who initiates physical activity at the workplace, and why?
At almost half the workplaces investigated (44%) it was the employees
who had taken the initiative. If one includes joint initiatives between
employees and employer, the involvement of employees grows to 79%. The
initiative came from management alone in only 19% of workplaces.

Table I suggests that within the last decade a shift has taken place
in the primary reasons given for introducing physical activity at Danish
workplaces. Surveys conducted at selected workplaces in the early and
mid 1990s pointed to a clear emphasis on such aims as ‘to reduce
absence due to illness’ and ‘to increase efficiency’
(Andersen, Berggren, & Lüders, 1996). The national survey, on
the other hand, shows that the three most frequently cited aims are:

  • To promote social contact between employees
  • To accommodate employee requirements
  • To contribute to the overall work environment

Activities offered

The national survey shows that the three most frequently offered activities
at Danish workplaces are weight training, cardiovascular exercise using
fitness equipment (e.g. steppers, treadmills, ellipticals, and rowers),
and various kinds of aerobics.

Table II shows that while almost 80% of all workplaces state that weight
training is offered, this figure falls to 70% if the requirement is for
both weight training and cardiovascular exercise using fitness equipment
to be offered. The fall becomes even more dramatic if activities such
as aerobic dance and general gymnastics are included as well.

It is noteworthy that just over 10% of all workplaces have such wide
ranges of activities on offer that they include all the four types of
activity mentioned above.

Establishing and running activities

Financially, the provision of physical activity at the workplace involves
both employers and employees. Table II shows that meeting the costs incurred
in establishing the facilities for physical activity involves the employer
to a considerable extent. In 35% of cases this is done in cooperation
with the employees. In roughly one out of ten cases the economic burden
of establishing the activities is the sole concern of the employees.

The employer is also involved in the running costs, as just over 30%
of companies state that the employer covers the annual running costs,
while another 40% report that the users and the employer share these costs.

In 20% of cases it is the employees alone who cover the running costs,
while in a small proportion of workplaces (6%) the running costs are financed
in some other way, for example through grants from unions or foundations.

Access to facilities for physical activity

Workplaces were asked to what extent they offer physical activity within
and outside working hours. It is a motivating factor for the employees
that the workplace offers such facilities during working hours. Furthermore,
the use of working hours for physical activity implies that the workplace
takes the task of activating employees seriously.

Sixty-two percent of the workplaces investigated stated that physical
activity is only offered outside working hours. Thus, at most of the investigated
workplaces the willingness to invest in employees’ physical activity
by reducing the hours spent working is not present. It is, however, notable
that 32% of workplaces state that such activity is available both within
and outside working hours.

In almost 90% of workplaces the offer is predominantly taken up immediately
after work. To some extent, this might be because it can be awkward to
return to the workplace once one has started on domestic or other commitments.

Who provides instruction?

The survey shows that 63% of workplaces provide instructors in connection
with some of the activities on offer. It transpires, however, that in
only 32% of cases are all activities conducted under some form of guidance.
The activity that most typically lacks such guidance is the use of weight
training equipment.

Only two out of five instructors state that they have some form of relevant
formal training for the job. Furthermore, the survey reveals that the
majority of those who have had such training acquired their knowledge
through weekend or other short courses.

Family

Just over 40% of the workplaces state that members of employees’
families also have access to the activities. A slightly higher proportion
(43%) does not admit other members of the family or partners. The difference
in the size of these two groups is, however, so small that it cannot be
said that there is any clear tendency for workplaces to either give or
deny family members access to physical activity facilities.

Evaluation

Thirty-nine percent of the workplaces state that some form of evaluation
is linked to the offer of physical activity, but it is only very few (11%)
of these that can be said to conduct a systematic, regular assessment
of their activities. This is not, however, a distinctively Danish phenomenon,
but rather an indication of a general trend whereby the majority of health
promotion programs are not subject to evaluation. Useful evaluation demands
adequate resources: the availability of time, money, and regular staff
or consultants skilled in carrying out evaluation activities. Company
budgets rarely allow room for such ideal provisions (Chapman, 1999).

Discussion

Summary

This study constitutes one of the first Scandinavian attempts at a national
survey of workplace promotion of physical activity. In general, the data
presented in this article should be seen as an attempt to provide the
fundamental information and analysis that is needed for cross-national
comparisons on health promotion topics.

Just under 19% of all Danish workplaces with at least one-hundred employees
make regular provision for physical activity. The results suggest that
the size of the workplace appears to have no independent effect on the
extent to which opportunities for physical activity are provided. Interestingly
enough, four-fifths of the programs currently in operation began during
the last twenty years. It is also worth mentioning that in around 40%
of cases, employees and employers both contribute to establishment and
running costs for the programs. Furthermore, it should be noted that the
majority of workplace exercise programs only offer a limited range of
activity types, and make no provision for systematic evaluation of the
programs through user surveys, measurement of results, etc. This last
finding is to be viewed in light of the fact that the three most frequently
named goals of the provision of opportunities for physical activity are
related to the well-being of employees and general working conditions.

Limitations

This study has a number of limitations.

First, there has been no previous attempt to measure the extent and nature
of the provision of opportunities for physical activity at Danish workplaces.
In 1997, 2002, and 2005 the National Board of Health commissioned inventories
on health promotion activities and strategies at Danish workplaces (National
Board of Health, 2006). The reports coming out of this work also deal
with physical activity. However, the National Board of Health applies
a much broader definition of workplace promotion of physical activity
than the one used in the present study. The various dataset are therefore
non-comparable and dynamic studies of development over time are not possible.

Second, the data collecting process was designed with the analysis of
aggregated data in mind. It is therefore not possible to use the data
to evaluate exactly how the various physical activity programs operate
and why they have been set up as they are, or to determine whether there
are typical decision-making and amendment processes which lead to the
establishment, revision, and abandonment of physical exercise programs.

Third, although the survey instruments used standard items, estimates
of reliability and validity are not available. However, for Phase 1 of
the survey, the protocol assisted interview system was developed by a
working group comprising people who all had previous experience with questionnaire-based
projects. The questionnaire used in Phase 2 was constructed on the basis
of a form used in the mentioned pilot study concerning a respondent group
very similar to that in the national survey.

Implications

Official action programs promoted by Danish Government at central, regional,
and local levels, and networks such as the WHO project Healthy Cities,
have frequently stressed the need to offer physical activity as part of
general strategies related to workplace health promotion (Ratzan, Filerman,
& LeSar, 2000. Danish Healthy Cities Network, 2004). Recently, focus
on this area has increased due to new legislative initiatives that obligates
municipal authorities to be the driving force in prevention and health
promotion matters. The workplace has been pointed out as an obvious setting
through which to reach the adult population (National Centre for Workplace
Health Promotion, 2005).

Initiatives such as the ones mentioned have included only brief comments
related to the problem of adherence to and compliance with workplace exercise
programs, and to the role of instructors in this perspective. In contrast
to the situation in many other western countries, there are no Danish
guidelines or rules that regulate and promote the trainer/instructor dimension
of the field of fitness and physical activity at the workplace. Partly
for this reason, most Danish workplaces offering physical activity have
still not fully accepted the consequences of the relationship between
the earlier stated reasons for implementing workplace fitness programs
(cf. Table 1, part B) and the central role of the instructor when what
is expected is both improvement in the physical condition of individuals
and a general improvement to the overall work environment. The results
presented indicate that only a small proportion of workplaces ensure that
their instructors have or obtain relevant pedagogical experience and theoretical
knowledge.

This state of affairs can be linked to the survey finding that only about
10% of all workplaces have multi-range fitness programs that include more
than three types of activity (Table II). Greater variation and breadth
in developing and implementing workplace physical activity schemes could
very likely influence the number of participants and the pattern of employee
exercise adherence and compliance. In general, careful planning and making
exercise a more pleasurable part of the work environment appear to have
at least a short-term positive effect on exercise adherence (Blue et al.,
1995. Andreasen & Møller-Jørgensen, 2005). However,
for many longterm adherence to exercise programs is a greater challenge.
As Chen et al. (2005) point out “The biggest challenge of a work-site
fitness program is to sustain long-term interest and enthusiasm”.
This conclusion could be applied to both the individual and organizational
level (Atlantis et al., 2006). Workplaces wanting to support such long
term efforts must be prepared to invest many types of resources (eg. human,
financial, organizational) (Nurminen E, 2002). Another challenge is engaging
the more sedentary part of the workforce. In general participation rates
in workplace health promotion programs are not that impressive and those
who do take part tend to the employees whose general health and health
behavior profile is better than average (Healthy People 2010, online documents
A).

It is important to stress that though this survey shows that only approximately
20% of Danish workplaces with one-hundred or more employees offer exercise
programs, compared to, for example, the situation in the United States,
where the corresponding figure is about 50% (Healthy People 2010, online
documents B), this is not to be taken as a precise indication of the overall
physical activity level in the Danish adolescent and adult population
as a whole. Thirty-seven percent of men and 23% of women in Denmark over
the age of 15 are members of one or more sport associations and 72% of
the total adult population state that they engage in leisure time sport
activities on a regular basis (Fridberg, 2000, Larsen, 2003). Moreover,
while about 80% of the Danish adult population is moderately active at
least four hours a week this is the case for roughly 40% of the same group
in the United States (Kjøller & Rasmussen, 2002. US Department
of Health and Human Services, 1999).

At the same time, it must be noted that about half of the Danish adult
population is not physically active in a degree that complies with the
primary public recommendation of minimum thirty minutes of moderate-intensity
physical activity per day (National Board of Health, 2002: Jørgensen
and Rosenlund, 2005). This dismal figure corresponds quite well with the
WHO estimate that at least 60% of the global population fails to achieve
the recommendation of at least thirty minutes moderate intensity physical
activity daily (WHO, 2003, WHO, 2004).

Lastly, it must be pointed out that the vast majority of Danish workplaces
have hitherto not considered workplace exercise promotion as a task in
which they played any major role. Only with the stronger political signals
of the last ten to twenty years, concerning the workplace as an important
setting for health promotion and disease prevention, has it been possible
to see much movement and shift of perspective regarding the area of workplace
physical activity among the many decision-makers of importance in this
nexus.

Perspectives: Implications for practitioners and researchers within sports-
and health promotion science

The survey data and other information presented in this article indicates
that workplace fitness programs in Denmark have been gaining ground, especially
in the last ten to twenty years. Combined with other research suggesting
that the Danish labor market as a whole is putting more and more energy
into the general field of health promotion, there seems to be support
for the assumption that the amount of work available for health promotion
practitioners is on the increase and that workplaces are interested in
using health activities as a means of promoting their employees’
well being. If this assumption is correct, future effort should ensure
that:

  • the personnel engaged in physical activity and health promotion at
    workplaces should receive better training and education in exercise
    and health related issues. With a view to encourage development of educational
    programs and tailored personnel engaged in workplace health promotion,
    national guidelines should be considered in order to increase the standards
    for the education of health promotion and/or exercise professionals
    in workplace settings. Countries such as the US, Germany, and the UK
    offer suitable models for established standards for exercise professionals.
    A future objective could be to implement a common reference system in
    the EU to promote good practice as regards Workplace promotion of physical
    activity. An effective starting point is the general quality criteria
    for workplace health promotion developed by the European Network for
    Workplace Health Promotion (ENWHP).
  • the many separate initiatives concerning health promotion, including
    physical activity, must be linked to general efforts made by public
    authorities to improve workplace health and safety.

 


Basic information concerning workplace fitness
programs I
Total sample (n=2,422)*
Part A
Number of employees 100-199 200-499 500-999 1000+ Unknown
Variable
Percentage of all Danish workplaces (100+ employees) 52 33 11 3 1
Percentage of all Danish workplaces (100+ employees) with fitness
programs
48 32 12 5 3
Part B
Most frequently mentioned reasons for implementing physical
activity at the workplace
Variable %
To promote social contact among employees 28
To meet employee requirements 18
To contribute to the work environment 14

* While the total sample size was 2,422 workplaces, the
number responses to questions included in this table ranged from 2,349
in Part A and 2,400 in Part B.


Basic information concerning workplace fitness
programs II
Total sample (n=310)*
Range of activities on offer
Establishing
Programs
Running
Programs
Variable: Variable: Variable:
activities included in workplace fitness programs who covers the preliminary expenses? who covers the annual running
expenses?
n % n % n %
1i 239 78 employees 37 12 employees 62 20
1+2ii 214 70 employer 127 42 employer 102 34
1+2+3iii 86 28 employee/employer 105 35 employee/employer 121 40
1+2+3+4 iv 34 11 others 32 11 others 19 6

* While the total sample size was 310 workplaces, the number
responses to questions included in this table ranged from 301 to 306.

iWeight training
iiWeight- and cardiovascular exercise training
iiiWeight- and cardiovascular exercise training and aerobics
iv Weight- and cardiovascular exercise training, aerobics,
and general gymnastics


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