Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

BACKGROUND: Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers. METHODS: Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9). RESULTS: 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders. CONCLUSION: High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain. TRIAL REGISTRATION: NCT01071980

Neck pain and anxiety do not always go together

Chronic pain and psychosocial distress are generally thought to be associated in chronic musculoskeletal disorders such as non-specific neck pain. However, it is unclear whether a raised level of anxiety is necessarily a feature of longstanding, intense pain amongst patient and general population sub-groups. In a cohort of 70 self-selected female, non-specific neck pain sufferers, we observed relatively high levels of self-reported pain of 4.46 (measured on the 11 point numerical pain rating scale (NRS-101)) and a longstanding duration of symptoms (156 days/year). However, the mean anxiety scores observed (5.49), fell well below the clinically relevant threshold of 21 required by the Beck Anxiety Inventory. The cohort was stratified to further distinguish individuals with higher pain intensity (NRS>6) and longer symptom duration (>90 days). Although a highly statistically significant difference (p = 0.000) was subsequently observed with respect to pain intensity, in the resulting sub-groups, none such a difference was noted with respect to anxiety levels. Our results indicate that chronic, intense pain and anxiety do not always appear to be related. Explanations for these findings may include that anxiety is not triggered in socially functional individuals, that individual coping strategies have come into play or in some instances that a psychological disorder like alexithymia could be a confounder. More studies are needed to clarify the specific role of anxiety in chronic non-specific musculoskeletal pain before general evidence-driven clinical extrapolations can be made

Protocol for Work place adjusted Intelligent physical exercise reducing Musculoskeletal pain in Shoulder and neck (VIMS): a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Specific strength training is a promising type of physical exercise for relieving neck and shoulder pain in office workers. However, the optimal combination of frequency and exercise duration, as well as the importance of exercise supervision, is unknown. The VIMS study investigates in a cluster randomized controlled design the effectiveness of different time wise combinations of specific strength training with identical accumulated volume, and the relevance of training supervision for safe and effective training.</p> <p>Methods/design</p> <p>A cluster randomized controlled trial of 20 weeks duration where employed office workers are randomized to 1 × 60 min, 3 × 20 min, 9 × 7 min per week of specific strength training with training supervision, to 3 × 20 min per week of specific strength training with a minimal amount of training supervision, or to a reference group without training. A questionnaire will be sent to 2000 employees in jobs characterized by intensive computer work. Employees with cardiovascular disease, trauma, hypertension, or serious chronic disease will be excluded. The main outcome measure is pain in the neck and shoulders at week 20.</p> <p>Trial Registration</p> <p>The trial is registered at ClinicalTrials.gov, number NCT01027390.</p

“I don’t need a flat tummy; I just want to run fast” – self-understanding and bodily identity of women in competitive and recreational sports

Background Women who exercise intensively, whether competitive or recreational, devote a lot of time and energy into exercise, which requires high levels of ambition and motivation. The aim of the study is to investigate the self-understanding and bodily identity of different (competitive vs recreational) forms of exercise, and to investigate the role of important others (parents, siblings and social relations) for this self-understanding. Methods A qualitative study using semi-structured interviews. An interactional psychodynamic framework informed the development of the interview questions focusing on the influence of their family, peers, and the meaning of exercise for their identity. Participants were recruited via local training centers and via the Danish Athletic Sports Association. A total of twenty highly physically active female athletes were interviewed, ten of whom participated in competitions (“competitve athletes”) and ten of whom did not (“recreational athletes”). Results Self-related and social similarities and differences between competitive athletes and recreational athletes were found. Recreational athletes had supportive but not ambitious parents and used sport to reinforce their bodily self-efficacy and identity, while competitive athletes had highly engaged parents, especially fathers, and competed to externalize their identities as athletes. Correspondingly, the meaning of exercise was the activity itself, for recreational athletes, while competition was the means to the end of achievement, for competitive athletes. Conclusion All athletes are affected and triggered by their biography and their environment. The biographical tradition of sport culture must be recognized as important for the engagement in different forms of physical activity in health and competition settings. If research can make the conflicts and relations of the self visible in sports culture, this could strengthen the recognition that the overall bodily well-being of athletes is important for women’s health

The Wildman Programme—Rehabilitation and Reconnection with Nature for Men with Mental or Physical Health Problems—A Matched-Control Study

Men with health problems refuse to participate in rehabilitation programmes and drop out of healthcare offerings more often than women. Therefore, a nature-based rehabilitation programme was tailored specific to men with mental health problems, and long-term illnesses. The rehabilitation programme combines the use of nature, body, mind, and community spirit (NBMC) and is called the ‘Wildman Programme’. The presented study was designed as a matched-control study with an intervention group participating in the Wildman Programme (N = 114) compared to a control group receiving treatment as usual (N = 39). Outcomes were measured at baseline (T1), post-intervention (T2), and 6 months post-intervention (T3). The primary outcome was the participants’ quality of life measured by WHOQOL-BREF, which consists of four domains: physical health, psychological health, social relationships, and environment. The secondary outcomes were the level of stress measured by the Perceived Stress Scale (PSS), and the participants’ emotional experience in relation to nature, measured by the Perceived Restorativeness Scale (PRS). The intervention group improved significantly in the physical and psychological WHOQOL-BREF domains and in PSS at both follow-ups. The participants’ interest in using nature for restoration increased significantly as well. The only detectable difference between the control group and the intervention group was in the WHOQOL-BREF physical domain at the 6-month follow-up. For further studies, we recommend testing the effect of the Wildman Programme in an RCT study

Exercise on Prescription. Effect of attendance on participants' psychological factors in a Danish version of Exercise on Prescription: A Study Protocol

Abstract Background In many countries exercise prescriptions are used to facilitate physical activity in a sedentary population with or in risk of developing lifestyle diseases. Some studies show a positive effect of exercise prescription on specific lifestyle diseases. Others only show moderately positive or no effect on physical activity level. Furthermore, the challenge is adherence of participants to a physically active lifestyle on a long term basis after intervention. Therefore, it is essential for offering successful prescribed interventions aiming towards behaviour change to focus on psychological and social issues as well as physiological issues. The aim of this study is to assess the short and long term development of psychological conditions in two different Exercise on Prescription groups; The Treatment Perspective and The Preventive Perspective behaviour. Thus, the aim of this paper is to describe the design used. Methods/Design The Treatment Perspective involves a 16 week supervised training intervention including motivational counselling. The Preventive Perspective only involves motivational counselling. The study is an evaluation of best practice and is accomplished by the use of a combination of quantitative (collected by questionnaires) and qualitative (collected by the use of semi structured interviews) measures. Comparison of The Treatment Perspective and The Preventive Perspective are performed at baseline and after 16 months. Development within the groups is measured at 4, 10, and 16 months. Self-reported measures describe physical activity, health-related quality of life, compliance with national guidelines for physical activity, physical fitness, self-efficacy, readiness to change, decisional balance, and processes of change. To elaborate self-efficacy, readiness to change, decisional balance, and processes of change, these issues were elucidated by interviews. Discussion This study of best practice is designed to provide information about important psychological concepts in relation to behaviour change and physical activity. The study is part of a health technology assessment of Exercise on Prescription, which apart from the psychological concepts (the patient's perspective) covers the effectiveness, the organization, and the health economy.</p

Exercising alcohol patients don’t lack motivation but struggle with structures, emotions and social context - a qualitative dropout study

Background Exercise is an important component of a healthy lifestyle, the development of which is a relapse prevention strategy for those with alcohol use disorder. However, it is a challenge to create exercise interventions with a persistent behavioural change. The aim of this qualitative study was to investigate perceived barriers to participation in an exercise intervention among alcohol use disorder patients, who dropped out of the intervention program. Furthermore, this study aims to propose possibilities for a better practice of future intervention studies based on the participants’ experiences and suggestions. Methods Qualitative interviews with 17 patients who dropped out from an exercise intervention in an outpatient treatment centre about their experiences and reasons for dropping out. Social cognitive theory informed the development of the interview guides and systematic text condensation was used for analysis. Results Analysis revealed three central themes: 1) Structural barriers described as the type of exercise and the timing of the intervention, 2) Social barriers described as need for accountability and unsupportive relations, and 3) Emotional barriers described as fear, guilt and shame, and negative affect of the intervention on long term. Conclusions Future exercise interventions should include socio-psychological support during the first weeks, begin shortly after treatment initiation instead of concurrently, and focus on garnering social support for participants in both the intervention context and among their existing network in order to best reduce barriers to participation. Trial registration This study was retrospectively registered at Current Controlled Trials ISRCTN74889852 on 11 July 2013