1. Introduction
Due to the demographic change, altered working conditions and a prolonged working lifetime, the importance for occupational health promotion (OHP) has increased. The objective of OHP is the maintenance and promotion of the employees’ health, efficiency and productivity. Companies profit from OHP by increased economic and competitive ability, employees by positive effects on health and well-being [
1].
In all European countries, musculoskeletal disorders are the most common cause of sick leave [
2,
3]. The results of different German health insurance reports show that musculoskeletal disorders have been one of the main reasons for an inability to work in recent years. Between 2011 and 2013, these disorders accounted for 21.3%–23.4% of sick leave days [
4,
5,
6,
7].
Due to the fact that distinct cause-and-effect relationships are still missing, there is consensus that specific occupational factors increase the risk of work related musculoskeletal disorders. Such factors comprise biomechanical overload [
8], repetitive activities [
9], lifting and carrying heavy stocks, positioning, ecological and psychosocial factors [
10,
11,
12] as well as whole-body vibration [
13]. From a biomechanical point of view, unfavourable body positions in combination with heavy weight lead to high stresses and strains of the musculoskeletal system [
12]. Although underlying cause-and-effect relationships are not yet clarified [
14], relationships between work-related musculoskeletal disorders in the shoulder and neck region and working on a computer [
15], long sitting durations and less physical activity at the workplace [
16] can be established.
It is also worth mentioning that some musculoskeletal disorders including back or muscle pain may also be related to stress and work overload. Mental stresses like pressure of time, high intensity of labour, monotonous operational procedures as well as aspects of work organization may contribute to the onset of musculoskeletal disorders [
17,
18].
Nowadays, stress-related diseases like burnout are additional causes for absence from work that lead to an ever-increasing number of sick days. In Germany, sick leave owing to psychological disorders or mental distress increased from 6.6% to 13.1% between 2001 and 2010 [
3].
Changes in work life, lifestyle and the increase in sick leave underline the importance of OHP-programs that focus on physical activity, mental well-being and a healthy work-life-balance or, rather, “life domain balance” [
3]. Workplace health promotion programs (WHPP) can help achieve this life-domain balance. One specific challenge for companies engaged in health promotion is how to motivate employees to exercise and create a more active lifestyle in general. Committees of professional organizations like the World Health Organization (WHO) and the American College of Sports Medicine (ACSM) recommend at least 150–180 min of physical activity per week as well as 30 min of moderate activity during everyday life on five days a week [
19].
Research history of WHPP with the goal of increasing physical activity and fitness has shown that the interventions have become increasingly specific and therefore the success of these programs has risen. Hence, a first review by Dishman et al. [
20] failed to report benefits of increasing physical activity and fitness levels. Marshall [
21] reported the success of those programs that considered aspects like the inclusion of the needs of the employees, the implementation of theories of behaviour change and a company network and potential trainers. This confirmed the findings of Proper et al. [
22] who stated that the quality of implementation and its process is of particular importance for the success of workplace health promotion programs. A review by Taylor, Conner and Lawton [
23] also pointed in this direction and underlined the importance of theory based programs. Beside the aspect of improved physical activity and fitness, other aspects of these health promotion programs also seem to be important. For example, Proper et al. [
24] and Malik et al. [
25] proposed that on site physical activity programs can support job satisfaction and reduce employee turnover. There is empirical proof that systematic interventions are able to improve physical and psychological health irrespective of age group. Andersen et al. [
26] could demonstrate the effectiveness of specific weight training to reduce shoulder and neck pain in office workers. Oesch et al. [
27] and van Tulder et al. [
28] could provide evidence that work related weight training is effective in reducing work related musculoskeletal disorders. Besides weight training, several studies point out that ergonomic training, knowledge transfer [
29] and stretching [
30] are important instruments to prevent work related musculoskeletal disorders. Recent reviews focused on increasing productivity [
31] and reducing obesity [
32], but failed to provide evidence.
Long-term implementation of these programs seems to be difficult, so positive effects are often observed immediately after intervention but sustainability has not been shown [
33]. Rongen et al. [
34] showed in a meta-analysis that the effectivity of interventions depends on the specific characteristics and design of the program. Interventions that take place on site of the workplace and in small groups are more effective.
Following Healy et al. [
35], interventions comprising both prevention of negative behaviour and conditions (e.g., work environment, work organization) are more effective. This finding is in line with the demands of New Public Health, that social influencing factors of health and disease should be taken into account to a greater extent and that interventions should be multidimensional as opposed to single behavioural prevention [
36].
For initializing long-term behaviour modification and maintaining motivation of the employee, it is essential to emphasize the self-determination of the individual [
37]. Accordingly, employees should be engaged in the planning and implementation of occupational health promotion programs. Wickström [
38] recommends a “combined approach” for the successful implementation of occupational health promotion programs:
The program ties in with the companies’ structures of the working conditions;
The program considers the companies’ organizational and social environment;
The program integrates the employees in the assessment of working health risks (participatory approach).
In addition, an effective health promotion program should include strengthening the degree of autonomy of the individual actions (e.g., by enhancement of decision-making authority) and realization of self-determination and personal responsibility [
39].
The extension of safety at work through ergonomics, biomechanical assessment and movement instructions has proved to be a successful approach for companies [
40]. Therefore, companies need programs that consider and integrate the specific demands, stresses and workloads of the employees to maintain and strengthen physical and psychological resources [
41]. Consequently, multidimensional assessments for conducting interventions are needed to achieve positive health effects in companies.
According to this theoretical framework, the BASE program (
Figure 1) was designed as a prevention program to avoid and reduce work-related musculoskeletal diseases and mental stresses. BASE is a German acronym, consisting of B = “Bedarfsbestimmung” (requirements); A = “Arbeitsplatzorganisation” (organisation of work); S = “Schulung des belastungsverträglichen Alltagshandelns” (coaching preventive behaviour at work); E = “Eigenverantwortung und Selbstwirksamkeit” (self-responsibility and self-efficacy).
It comprises aspects of health protection, ergonomics, exercise and self-efficacy. A complex assessment identifies daily workloads, musculoskeletal discomforts, psychological stresses and general health states. Moreover, the companies’ infrastructure for health promotion as well as the organizational and social environment of the business (e.g., working hours, breaks, communication) are taken into consideration [
10].
BASE is characterized by integration of the employees in each step of the assessment and implementation of the program. Specific wishes and barriers for health promotion programs are recorded to reach highest-possible participation quota. This extensive assessment leads to practical and goal-oriented recommendations and interventions. These are executed onsite in real workplace situations and involve the introduction of a first-hand experience in behaviour change. Kinesic behaviour during work is discussed and cognitively reflected upon with the workers to enhance the employee’s acceptance and self-efficacy for health promotion. This can result in long-term health promoting behaviour [
10].
The training concept of BASE differs from conventional interventions for implementing an ergonomic and kinesic behaviour with a modified methodical format:
Daily activities are analysed within the initial assessment of requirements by observation of the workplace and/or video analyses. This helps to create functional load/exposure profiles and identify recurring movements of high load factor.
Based on the results of these analyses, adequate movement tasks are generated to train the coping with the usual demands of work. The introduction of a first-hand experience in behaviour change involves the movement experiences (titled the “AHA”-experience). This AHA experience is comprised of three components: (1) body awareness; (2) recognition of dysfunctional movements; and (3) understanding positive and negative behaviour in day-to-day working tasks. This serves as the initial step in preparing for the necessary change in automated movement behaviour.
The movement experiences are reflected on and internalized by discussion targeting the adaption of ergonomic motor execution to suit individual physical working conditions.
An explanation is provided about why the changed motor execution leads to reduced stresses and strains and how it can be implemented in day-to-day work. These considerations are made together by the exercise instructors and the employees.
The employees get the opportunity to put the new movement perceptions into practice by repeated solving of different movement tasks which they may encounter at work.
The principles of ergonomic motor behaviour are tested and reflected in different labour situations to facilitate a transfer to different actions in day-to-day work.
In contrast to previous interventions, this approach is based on an initial movement experience to spark the employees’ interest in the underlying theoretical background. This also helps to provide a better rapport with the employees from the onset.
Since 2007, BASE has been implemented in 13 companies. The main research goals focussed on the implementation process, the feasibility of the intervention in different application fields and the acceptance of the whole program. This article presents the evaluation of the BASE program in three different application fields (logistic, industrial and office workers).
For all application fields, three stages will be reported:
Implementation of the BASE concept (stage one)
Evaluation of the outcome effects of the interventions (stage two)
Lasting effects and enhancing of health promotion (stage three)
Our hypothesises were, that (1) the implementation process of the program will influence the outcome effects; and (2) the whole approach will be able to gain lasting effects because of the integration of the multidimensional aspects of the WHPP.