Sedentary behaviours, physical activity and cardiovascular health amongst bus and lorry drivers

Prolonged time sitting has been linked to an increased risk of cardiovascular diseases (CVD), cardiovascular mortality (CVM), all-cause mortality, diabetes and some cancers. Workers in occupations where there is no alternative to sitting can best be defined as compulsory sedentary workers , which involve bus and lorry drivers amongst others. Limited research is available on the health behaviours and health profiles of individuals working within these occupations. This thesis adopts a mixed methods approach and fits within the MRC framework for the development of complex interventions to specifically investigate bus and lorry drivers sedentary behaviours and physical activity levels in association with their cardiovascular health. Chapter 3 describes a pilot study, which results showed bus drivers accumulate 12 hours sitting on workdays and presented higher than the recommended ranges for BMI, body fat, waist circumference and blood pressure. Chapter 4 explores the validity of using an ActiGraph accelerometer compared to the activPAL to assess bus drivers sedentary behaviours. Results highlight that compared to the activPAL, the ActiGraph underestimates sedentary time during workdays (151minutes/day) and working hours (172min/day). Chapter 5 phenotypes UK lorry drivers sedentary behaviours and non-sedentary behaviours during workdays and non-workdays and examines lorry drivers markers of cardiovascular health. Lorry drivers accumulate 13 hours sitting on workdays and 8 hours on non-workdays and presented an ill-cardiovascular profile. Chapter 6 examines the effects of an intervention designed to promote PA and reduce sedentary time on a range of cardiovascular risk factors in a sample of lorry drivers. Chapter 7 presents a process evaluation of the Structured Health Intervention for Truckers (SHIFT) programme described in Chapter 6. This thesis highlights that bus and lorry drivers accumulate the highest amount of sitting time reported up to date, together with high levels of physical inactivity and an ill-cardiovascular profile. However, positive changes in cardiovascular risk factors were observed when drivers increased their daily average of step counts. Overall, these results emphasise that targeting bus and lorry drivers health behaviours should be a public health priority

Cross-sectional surveillance study to phenotype lorry drivers’ sedentary behaviours, physical activity and cardio-metabolic health

Objectives Elevated risk factors for a number of chronic diseases have been identified in lorry drivers. Unhealthy lifestyle behaviours such as a lack of physical activity (PA) and high levels of sedentary behaviour (sitting) likely contribute to this elevated risk. This study behaviourally phenotyped UK lorry drivers’ sedentary and non-sedentary behaviours during workdays and non-workdays and examined markers of drivers cardio-metabolic health.Setting A transport company from the East Midlands, UK. Participants A sample of 159 male heavy goods vehicle drivers (91% white European; (median (range)) age: 50 (24, 67) years) completed the health assessments. 87 (age: 50.0 (25.0, 65.0); body mass index (BMI): 27.7 (19.6, 43.4) kg/m2) provided objective information on sedentary and non-sedentary time.Outcomes Participants self-reported their sociodemographic information. Primary outcomes: sedentary behaviour and PA, assessed over 7 days using an activPAL3 inclinometer. Cardio-metabolic markers included: blood pressure (BP), heart rate, waist circumference (WC), hip circumference, body composition and fasted capillary blood glucose, triglycerides, high-density lipopreotein cholesterol, low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels. These cardio-metabolic markers were treated as secondary outcomes.Results Lorry drivers presented an unhealthy cardio-metabolic health profile (median (IQR) systolic BP: 129 (108.5, 164) mm Hg; diastolic BP: 81 (63, 104) mm Hg; BMI: 29 (20, 47) kg/m2; WC: 102 (77.5, 146.5) cm; LDL-C: 3 (1, 6) mmol/L; TC: 4.9 (3, 7.5) mmol/L). 84% were overweight or obese, 43% had type 2 diabetes or prediabetes and 34% had the metabolic syndrome. The subsample of lorry drivers with objective postural data (n=87) accumulated 13 hours/day and 8 hours/day of sedentary behaviour on workdays and non-workdays (p<0.001), respectively. On average, drivers accrued 12 min/day on workdays and 6 min/day on non-workdays of moderate-to-vigorous PA (MVPA).Conclusion Lorry drivers demonstrate a high-risk cardio-metabolic profile and are highly sedentary and physically inactive. Interventions to reduce sitting and increase MVPA during breaks and leisure time to improve cardio-metabolic health are urgently needed. Educational programmes to raise awareness about diet and exercise are recommended.%U http://bmjopen.bmj.com/content/bmjopen/7/6/e013162.full.pd

Attenuated cardiovascular reactivity is related to higher anxiety and fatigue symptoms in truck drivers

ACKNOWLEDGEMENTS The authors would like to thank all the truck drivers who participated in this study. The data presented in this paper were collected as part of the baseline measures from the “Structured Health Intervention For Truckers (SHIFT)” randomized controlled trial, which is funded by the NIHR Public Health Research Programme (reference: NIHR PHR 15/190/42). SAC, JAK, AS and NJP are supported by the NIHR Leicester Biomedical Research Centre—Lifestyle theme. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The first author (AG) has received funding for their PhD Studentship from the Colt Foundation (reference: JD/618). The Colt Foundation had no role in study design; election, synthesis, and interpretation of data; writing of the report; or the decision to submit the manuscript for publicationPeer reviewedPublisher PD

Exploration of associations between the FTO rs9939609 genotype, fasting and postprandial appetite-related hormones and perceived appetite in healthy men and women

Background: The fat mass and obesity-associated gene (FTO) rs9939609 A-allele has been associated with obesity risk. Although the exact mechanisms involved remain unknown, the FTO rs9939609 A-allele has been associated with an impaired postprandial suppression of appetite. Objectives: To explore the influence of FTO rs9939609 genotype on fasting and postprandial appetite-related hormones and perceived appetite in a heterogeneous sample of men and women. Design: 112 healthy men and women aged 18-50-years-old completed three laboratory visits for the assessment of FTO rs9939609 genotype, body composition, aerobic fitness, resting metabolic rate, visceral adipose tissue, liver fat, fasting leptin, and fasting and postprandial acylated ghrelin, total PYY, insulin, glucose and perceived appetite. Participants wore accelerometers for seven consecutive days for the assessment of physical activity and sedentary behaviour. Multivariable general linear models quantified differences between FTO rs9939609 groups for fasting and postprandial appetite outcomes, with and without the addition of a priori selected physiological and behavioural covariates. Sex-specific univariable Pearson's correlation coefficients were quantified between the appetite-related outcomes and individual characteristics. Results: 95% confidence intervals for mean differences between FTO rs9939609 groups overlapped zero in unadjusted and adjusted general linear models for all fasting (P ≥ 0.28) and postprandial (P ≥ 0.19) appetite-related outcomes. Eta2 values for explained variance attributable to FTO rs9939609 were <5% for all outcomes. An exploratory correlation matrix indicated that associations between fasting and postprandial acylated ghrelin, total PYY and general or abdominal adiposity were also small (r = −0.23 to 0.15, P ≥ 0.09). Fasting leptin, glucose and insulin and postprandial insulin concentrations were associated with adiposity outcomes (r = 0.29 to 0.81, P ≤ 0.033). Conclusions: Associations between the FTO rs9939609 genotype and fasting or postprandial appetite-related outcomes were weak in healthy men and women

Time in Nature Associated with Decreased Fatigue in UK Truck Drivers

Funding: The data presented in this paper were collected as part of the ‘Structured Health Interven- tion For Truckers (SHIFT)’ randomised controlled trial. This research was funded by the National Institute for Health Research (NIHR) Public Health Research Programme (reference: NIHR PHR 15/190/42). Funding Acquisition, S.A.C., J.A.K., V.V-M. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Acknowledgments: SAC: JAK, AS and NJP are supported by the NIHR Leicester Biomedical Re- search Centre—Lifestyle theme. AG has received funding for their PhD Studentship from the Colt Foundation (reference: JD/618).Peer reviewedPublisher PD

Influence of hyper-energetic, high-fat feeding on circulating hepatokines in healthy men: a randomised crossover study [Abstract]

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The structured health intervention for truckers (SHIFT) cluster randomised controlled trial : a mixed methods process evaluation

Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme (reference: NIHR PHR 15/190/42). The study was also supported by the NIHR Leicester Biomedical Research Centre which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University, and the University of Leicester. Laura Gray is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding to cover intervention costs (Fitbits, cab workout equipment) was provided by the Higher Education Innovation Fund, via the Loughborough University Enterprise Projects Group. The Colt Foundation provided funding for a PhD Studentship, awarded to Amber Guest (reference: JD/618), which covered Amber’s time and contributions to this project. None of the funding bodies had any role in study design; election, synthesis, and interpretation of data; writing of the report; or the decision to submit the manuscript for publication. Acknowledgements We gratefully acknowledge the support provided by senior Health and Safety personnel and Transport Managers at our partner logistics company in facilitating this research. We also thank all participants for taking part. We are grateful to the independent members of the Trial Steering Committee for their continued support and advice throughout the trial: Dr. Derrick Bennett, Prof Emma McIntosh, Prof Petra Wark and Mr. Paul Gardiner.Peer reviewedPublisher PD

Drivers with and without Obesity Respond Differently to a Multi-Component Health Intervention in Heavy Goods Vehicle Drivers

Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme (reference: NIHR PHR 15/190/42). The study was also supported by the NIHR Leicester Biomedical Research Centre which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University and the University of Leicester. Laura Gray is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding to cover the intervention costs (Fitbits and cab workout equipment) was provided by the Higher Education Innovation Fund, via the Loughborough University Enterprise Projects Group. The Colt Foundation provided funding for a PhD Studentship, awarded to Amber Guest (reference: JD/618), which covered Amber’s time and contributions to this project. The funders played no role in study design, data collection, data analysis, data interpretation or in the preparation of this manuscript.Peer reviewedPublisher PD

Using intervention mapping to develop evidence-based toolkits that provide mental wellbeing support to workers and their managers whilst on long-term sick leave and following return-to-work

Background Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome. Purpose To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experience for workers on long-term sick leave. Methods This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits – one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned. Results Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed. Conclusion Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial

Corrigendum: Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol (Front. Public Health, (2021), 9, (625640), 10.3389/fpubh.2021.625640)

In the published article, there were errors regarding the affiliations of several authors. For “Joseph Ollier”, instead of having affiliation “1,2”, they should have “1”. For “Olivia Clare Keller”, instead of having affiliations “1,2,15”, they should have “1,15”. For “Lorainne Tudor Car”, instead of having affiliations “3,27”, they should have “4,27”. For “Alicia Salamanca-Sanabria” instead of having affiliation “3”, they should have “4”. For “Jacqueline Louise Mair”, instead of having affiliation “3”, they should have “4”. For “Tobias Kowatsch”, instead of having affiliation(s) “1,2,15,28”, they should have “1,4,15”. In the published article, there was also an error in affiliation “29”. Instead of “Center for Digital Health, Berlin Institute of Health and Charité, Berlin, Germany”, it should be “Center for Digital Health, Berlin Institute of Health at Charité, Berlin, Germany”. There was also an error in affiliation “4”. Instead of “Future Health Technologies Programme, Singapore-Eidgenössische Technische Hochschule (ETH) Centre at Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore”, it should be “Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore”. Additionally, there was an error in affiliation “23” instead of “Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland” it should be “Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland”. The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated