Efficacy of a workplace osteoporosis prevention intervention: a cluster randomised trial

Intervention methodologies: Subjects from workplaces assigned to the intervention group received three intensive workshops targeting behaviour change over a period of 6 weeks. The intervention design had a strong focus on behavioural strategies and was participatory in nature. Bandura’s Self–Efficacy Model was used to guide the workshop design for the intervention group. The workshop design focused on individual goal setting and on building skill sets to attain individual goals. The design avoided presentation style communication and focused on behavioural strategies such as participatory skill building through hands-on activities, goal setting exercises, peer support and problem solving discussions. Attention was placed on helping participants identify individual barriers and build their capacity to overcome them. The intervention also addressed diet and physical activity as different entities that required different behavioural strategies. Though guided by the same principles, the workshops for diet and physically activity were unique in the nature and design of their activities. Intervention strategy development for calcium intake: Our study reviewed the content of interventions that reported positive outcomes for dietary calcium intake. The intervention workshops, run by a dietician, included participatory activities such as food preparation and tasting, nutrition label reading exercises, group discussions with exchange of ideas. Emphasis was placed on using specific examples relevant to the participants' lifestyles and tastes as well incorporating local food sources into activities. In addition, we incorporated quantitative and qualitative dietary information collected at baseline to help tailor intervention strategies. The dietary records were inspected to identify the common food sources of calcium amongst the study population, as well as their consumption patterns and volumes. This information was also be used to tailor strategies that were relevant to individual participants. The workshop also addressed common barriers to consuming calcium rich foods, identified in previous research include the perception that these foods are higher in price, are mainly dairy products and are high in fat. Taste aversion, mainly to dairy, has also been highlighted as a barrier. These issues were addressed individually in different components of the workshop. Food tasting was a very effective strategy to expose subjects to a wide range of foods that can provide a substantial calcium boost. The ability to correctly read and interpret nutrition labels was identified as a necessary skill to facilitate selection of calcium rich foods. Practical sessions on reading of food labels were included in the intervention. Intervention strategy development for physical activity: Physical activity behaviour can have very different psychosocial mediators from dietary behaviour. In this study, physical activity was regarded as a unique behaviour that required a different set of intervention strategies to that for dietary calcium intake. The types of physical activity that can affect bone mineral density, risk of osteoporosis and risk of fractures are described as load bearing and resistance training exercises. The intensity of activity is also critical. Evidence indicates that only moderate to vigorous level of load-bearing physical activity can affect bone density in important sites such as the hips, a vulnerable site for osteoporotic fractures. Evidence indicates behavioural strategies to be superior to cognitive strategies and meta-analyses of physical activity interventions emphasise the importance of behavioural interventions, which include goal setting, self-monitoring, physical activity behaviour feedback, consequences, exercise prescription and cues. Our study adhered to these recommendations when designing intervention activities. In addition, emphasis was placed on providing opportunities to sample a variety of the targeted physical activities. These included take home activity samplers in many formats, including DVDs. The first workshop discussed the relationship between load bearing and resistance training exercises on bone cell formation and bone modelling. This served to communicate the key message that specific types of exercise are needed to protect and promote bone health. The third workshop was focused entirely on helping participants identify their barriers to increasing their physical activity level and to help them overcome the barriers with individually tailored strategies. The intervention for physical activity was facilitated by a physiotherapist. The aims of the intervention were to encourage participants to problem solve and develop strategies to help them increase their moderate to vigorous intensity load-bearing physical activity by 60 minutes per week. Each participant would record their weekday and weekend routine to be shared within a group. In the design of the intervention, peer support was identified as an important mediator for behaviour change and hence the emphasis on group work. This allowed participants to identify common barriers to change, develop strategies together and support one another through problem solving on common issues. Workshop participants shared a common work environment and would be able to develop workplace based strategies based on shared experience. This facilitated discussion as participants shared many ideas that were based on common experience, such as workplace stair access for opportunistic physical activity, discussion of suitable walking routes around the workplaces and sharing of information about exercise facilities near the work premises. Unique strategies were developed for this study to facilitate the attainment of the physical activity goal with minimal disruption to the participants’ routine. One important strategy was to introduce short bouts of exercise breaks (5–10 minutes) during television viewing time or work time, which many participants would regard as achievable and sustainable. Participants would devise different types of 5–10 minute exercise routines that required minimal room and could be carried out easily at home or at the workstation. Resources, such as an exercise CD and a 10-minute exercise poster with instructions and illustrations would be provided to each participant. The latter was developed specifically for this intervention. The duration of each workshop is 90 minutes/1.5 hours. The frist workshop educated about bone health and osteopososis, risk of osteoporosis and lifestyle prevention measures. The first workshop also included education on how calcium intake and physical activity can help imact on osteoporosis.. The session intorduced participants to types of dietary calcium sources and the types of physical activity that is beneficial for bone health.. The second workshop focused solely calcium intake and the third workshop focused solely on physical activity.. Records of the attendance were taken at the workshops.