Oona Hytti

The Effects of a Two-month Occupational Wellness Program on Employee Health

Bachelor’s Degree in Sports and Leisure Management Spring 2021

Abstract

Author(s): Hytti Oona

Title of the Publication: The Effects of a Two-month Occupational Wellness Program

Degree Title: Bachelor of Sports

Keywords: Occupational wellness, coaching, health, functional capacity

Currently, the largest concerns relate to occupational health are caused by modern lifestyle related factors such as stress, inactivity and poor nutritional habits. These are also seen in occupational settings since half of the workers in the EU region have been noted to suffer from stress and fatigue related issues. Due to this, exercise and health companies have decided to fight this problem by offering occupational wellness programs.

The purpose of the thesis was to assess the effects of a two-month occupational wellness program and to help the client to understand their products further. The study was conducted as an observational study. Data for the study was collected from physical tests, body composition measurements and a questionnaire which included closed and open-ended questions. Numerical data was described in terms of means and percentages and qualitative data was divided into main themes. Intervention included two individual nutritional and physical coaching sessions (strength training and aerobic work). In addition, all participants received an individualized weekly strength and nutritional program. All guidance was adapted to the specific needs of each participant.

Results showed significant improvements in the physical tests of shoulder mobility (right 20.8%; left 8.1%), ankle mobility (right 25.3%; left 28.8%) and squat (40.9%). In addition, participants showed positive changes in frequency of exercise, eating and lifestyle habits (self-efficacy), and positivity towards exercise. Furthermore, pain was significantly decreased for some of the participants (VAS- pain scale from 10 to 6 and from 7 to 3). In the future, these may lead to enhanced company profits, less sick days and medical costs, enhanced quality of work, increased knowledge capital, less recruitment costs and overall, positive changes in company culture.

It can be concluded, that the participants presented improvements in some wellness and functional capacity markers. Improvements in physical capabilities, knowledge and improved self-efficacy, may correlate with a more functioning workforce and individuals. It can also be suggested, that in the future companies may benefit from similar interventions by seeing enhanced self-efficacy of workers related to exercise, eating habits and improvements in physical capacities. The results of the study cannot be generalized due to the number of participants (n=6). However, despite the participation numbers, the study provided important knowledge about the target group, which can be utilized by the client. In the future, emphasis should be placed on recruiting employees who are least likely to participate to health enhancing activities. Also, it should be researched further, which components of wellness programs are the most cost-effective for companies. Individualized wellness programs should be included in companies’ developmental processes, and the effects of decreased function and wellness, should be understood since they pose a notable threat to company profits and reputation. Perhaps wellness can be seen as the investment policy of the future.

TABLE OF CONTENTS

1. INTRODUCTION	1

1	INDIVIDUAL WELLNESS	3

1.1	Health	3

1.2	Wellbeing	3

2	OCCUPATIONAL WELLNESS	6

2.1	Functional capacity	6

2.2	Work ability	6

2.3	Wellbeing at work	8

2.4	Työkykytalo	9

2.5	Current challenges	10

3	PROMOTING OCCUPATIONAL WELLNESS	13

3.1	Previous interventions	13

3.2	Benefits of occupational wellness	15

4	METHODOLOGY	18

4.1	Research questions and hypotheses	18

4.2	Study design	18

4.3	Participants	20

4.4	Project schedule	20

4.5	Physical tests	21

4.6	Questionnaire	24

4.7	Data analysis	25

5	RESULTS	27

5.1	Experienced wellness	27

5.2	Open ended questions	28

5.3	Experienced pain	30

5.4	Body composition measurements and physical tests	32

6	DISCUSSION	34

6.1	Ethical concerns	39

6.2	Conclusion	41

6.3	Professional competence & development	42

List of references	44

Appendices

1. INTRODUCTION

Currently, the state of wellbeing in workers is compromised due to different lifestyle habits. Depending on occupation, the challenges may be different, but the current way of life causes worry from overall health eventually to almost every individual. Some of the most prevalent worries are for example musculoskeletal disorders, inactivity, obesity, cardiovascular diseases, continuous stress, poor eating habits and overall, the inability to take care of oneself, in a physical or psychological manner (Koponen, Borodulin, Lundqvist, Sääksjärvi & Koskinen, 2018).

Some companies have decided to do their best to ensure that their employees feel valued, stay healthy, and that they continue to stay productive in work and in their private life. These companies have invested in the wellbeing of their employees in different ways. Some invest in vouchers that offer cultural and social events, while some have focused on the ergonomics of the workplace, or higher quality healthcare services. However, it can be argued that most of these investments offer temporary relief in a physical or psychological manner and thus, such benefits can only be seen for a short period of time. In addition, these types of work-benefits rarely enhance the self-efficacy of workers, especially as regards health. Due to this, it could be suggested that investing in preventative solutions could be a valuable additive to the current model, when dealing with occupational wellness and health.

Presenting a work wellness program for employees may offer improvements in most of the common problems that are now faced in the workplace. The positive outcomes may be seen in positive social, mental and physical development, which may provide financial savings in terms of reduced early retirements, less sick days and higher productivity (Vilsteren et al., 2015). However, wellness programs may also enhance one’s self-efficacy and confidence, which may also produce creative and motivated workers (Ammentorp et al., 2013). Furthermore, a corporation participating in activities with a common goal may also induce social bonding between the workers and provide health-oriented values that are promoted together. This offers belongingness, community and something to strive for.

The subject of workplace and occupational wellbeing has been of interest, since it concerns the overall health of an individual, group or a country. It is valuable to have knowledge in this area, since health related topics are always topical. Furthermore, a growing amount of evidence has now suggested that previously improving results concerning occupational wellness are starting to decrease (Koponen et al., 2018).

To these previously mentioned problems, the client of this thesis has committed itself to finding solutions. The aim of this thesis is to gather data from one implemented occupational wellness program offered by the client. The collected data is used to analyze the effectiveness of their current methods and may also be used for further product development.

The program lasts for two months and it includes private coaching 2 x 60 min and nutrition coaching 2 x 30 min, which are implemented in a training center. Also, an individual weekly nutrition and training program, group training 2 x 60 min and video training 3 x 45min in an online platform is included. In addition, physical tests, a questionnaire and a body composition measurements are conducted at the beginning and at the end of the program.

The client will benefit from this thesis by having measurable results from their own programs, which may be presented to future customers. In addition, they may develop their future products, when provided with data that delivers insights into effectiveness.

INDIVIDUAL WELLNESS

Individuals who emphasize self-care and self-efficacy in their daily life, may live longer, be happier and incur less costs for themselves, companies and the government (Shaw, et al., 2014). In addition, it can be stated that making people’s lives better in a physical manner, may also have substantial benefits for their emotional and social wellbeing.

Health

The term health refers to one’s ability to work, live and participate in life without any serious limiting diseases. The term health has been earlier defined as “the absence of disease” (WHO, 1948) but has later been transformed into a more holistic definition. Currently, WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Additionally, further clarifications were added in 1989 as “a resource for everyday life, not the objective of living” (WHO, 1948 as cited in Somerville, Kumaran & Anderson, 2012, 31). Correspondingly, health can be seen as a positive concept emphasizing social and personal resources, as well as physical capacities. Meaning that health is not one established, unchanging concept, since it includes many aspects of life and individuals’ experiences, and the balance between each variable will fluctuate throughout life.

In regards of specifically occupational Health, we may refer to aspects such as, safety, physical, mental and social wellbeing. Occupational health is no different than the previous definition, and it is enhanced by social wellbeing, community, motivating atmosphere and common goals and social norms which all effect individual workers health (Guidotti, 2011, 5). In this thesis, the term health refers to one’s competence to live life as they wish, and to have the functional capacity to deal with everyday life at ease.

Wellbeing

The definition of wellbeing can be looked at from many perspectives. For example, Seligma’s PERMA model (2011), includes positive emotions, engagement, relationships, accomplishments and the overall meaning of life. However, ‘flourishing scale’ by Diener et al. (2010) focuses on psychological wellbeing, purpose, engagement, social contribution, competence, self-respect, optimism and social relationships. Nevertheless, understanding of what promotes wellbeing at work, is still questioned and poorly understood (Hamling, Jarden, & Schofield, 2015). Also, most of the definitions regarding wellbeing are lacking the extent of understanding also the physical aspects, and their role in regards of overall wellbeing.

Physical fitness, health or wellbeing can be used to refer to the overall physical condition of a living organism, at a given time. As a definition, physical function refers to the respiratory, circulatory and musculoskeletal condition of an individual (THL, 2020). Good physical functioning guarantees that one is able to live at home and is capable of participating in society for example, in the form of work or hobbies. All of these can be stated to be an important part for life quality (THL, 2021.) In addition, physical health is also a foundation for occupational wellness (Otala & Ahonen, 2003, 20) and it can be seen as a precursor to psychological wellbeing (Envick, 2012).

Furthermore, social wellbeing may refer to many aspects related to human relationships, social structures and communities that one belongs to. For example, to experience social wellbeing at a workplace, individual should meet the feelings and need for connection and for safety. These may refer to healthy relationships within the work community, work colleagues or within a team. In addition, physical and psychological safety and a stable occupation and the guarantee for continuous work is important (Otala & Ahonen, 2003, 21.)

Also, psychological health is a key aspect in wellbeing. Wholesome, positive mental health refers to individuals’ psychological resources, which are hope, the ability to influence one’s own life and develop and the existence of satisfying social relationships (Koponen et al., 2018, 128). Professional knowledge and competence are also important since feelings of appreciation are usually experienced through praise and successes in the workplace. These bring safety to the work environment. At work, the greatest needs are for creativity, the willingness to develop one’s own capabilities and to have targeted career or private life goals. In addition, a person’s inner drive and “spirit” can be seen in values, motives and personal energy. These will influence commitment and excitement towards different situations in life. Finally, a person’s own wellness comes from internal values, ideals and desires. Operational changes will not have any impact, if employees are not interested in these on their own (Otala & Ahonen, 2003, 21-22).

Lastly, self-efficacy is a key term in the description of an individual’s success in changing personal habits. This term refers to one’s ability to cope in daily life. It can be seen in how a person feels, thinks and acts in different situations. Depression, anxiety and feelings of not being in control can lead to overall helplessness, which in turn can be seen as low self-efficacy. The reason why this may be a key factor is that a strong sense of self-efficacy has been linked to better health outcomes, social integration and overall, higher achievement when dealing with daily life. Individuals with a “can do” attitude and a sense of self control will mostly determine if changes in health behavior are possible, and the lack of these may make everything harder, and thus a longer lasting lifestyle change is unlikely (Schwarzer & Fuchs, 1996.) Furthermore, a correlation between self- efficacy and work performance has been noted (Stankovic & Luthans, 1998.), and therefore it can be seen as a possible predictor of job performance and health related outcomes in general.

OCCUPATIONAL WELLNESS

Occupational wellness can be described and seen in many ways. Common ideas and perceptions include a nice work atmosphere in which the employee can succeed and be proud of one’s work and use good equipment, and benefit from healthcare and competitive capabilities. Also, the possibilities for achieving goals are seen as important (Otala & Ahonen, 2003, 19.)

Occupational wellness has been attempted to be explained by many definitions. Some of the previously mentioned insights are in the depths of how we could try to understand this better. Occupational wellness means different things to different people and positions. The main questions used to be: do we feel well at our workplace and during our working hours? Nowadays this has cladly change to a wider perspective that encompasses many other aspects as well.

Functional capacity

The term functional capacity (toimintakyky), gathers together traits which allow an individual to cope and live their life as they please. This includes physical, psychological and social predispositions, which allows a person to do essential behaviors, which enables them to do all normal functions in regards of work, studying, free time activities and hobbies. Overall, a functioning individual can take care of oneself and others, in the surroundings and conditions that they live in (THL, 2019.)

Similarly, the definition of function refers to a person’s ability to cope with their daily challenges in physical, social and emotional manner. Function can also be defined and seen as independent living, self-expression and a chance to retrained close, positive relationships (Lehto, 2004, 18).

Work Ability

The term work ability is constantly changing, and it has grown to a more holistic perspective in the recent years. The previously health-based model has been transformed into multifactorial model, where work ability is promoted, and thus created by many constantly changing factors (Ilmarinen, 2009).

Health 2000 project has presented the importance of many different dimensions related to work ability. It seems that quality of life, appreciation at work and physical fitness will have an effect on individuals work ability. In addition, results from cross sectional data suggests that functional capacity, health and the characteristics of one’s work are statistically the most significant factors effecting work ability (Gould, Ilmarinen, Järvisalo & Koskinen, 2008). In addition, factors related to management, ergonomics and lifestyle have also been correlated to either decline, or improvements in work ability (Ilmarinen & Tuomi, 2004).

Work ability is part of the definition for overall function. This definition focuses on a person’s ability to cope and function within the requirements of a certain job description. The mixture of employee’s capabilities, social relationships, job community and the values of the workplace, will effect on individuals work ability. In essence, work ability consists of function and requirements of the work position and their dependency (Aro, 2004, 22-23). Similarly, Work ability consists of the compatibility and balance of a person's physical and mental resources and work. The ability to work is based on a person's physical and mental functioning, and it is also affected by attitudes and skills involved in the work. Therefore, a person's ability to work is a summation of resources and attitudes (TELA, n.d.)

Conversely, the deterioration of a person’s work ability can be seen, when the balance between requirements and individuals’ function is not congruent. In this scenario, workers performance will not reach the level of requirements (Aro, 2004, 22-23). However, work ability cannot be defined by a single definition, since as a concept, it includes countless variables and the interactions between them. The antithesis of this is the inability to work, which unfortunately can be seen in the form of early retirement or sick pensions.

Wellbeing at work

Due to the complexity of the terms used to describe a person’s wellness, wellbeing and health, this thesis topic will be differed based on the illustration (Figure 1). As described in the illustration, many components will affect a person’s occupational wellness: work itself, company operations, work community, leadership, work environment and the employee itself. It should be understood how much all of these intertwine amongst each other, however, researching and considering all these components within the thesis, is impossible. Due to this, the focus is centered on the concepts within the orange area (lifestyle, motivation, attitude, personality, hobbies and health status).

The main target of the coaching is the wellbeing of workers and this excludes most operational and leadership aspects since the intervention was aimed specifically at individual health improvements. Whether or not the focus on employee health stems from purely financial motivation, it could be assumed that morally everyone deserves a healthy life. However, for some unexplained reasons, the application of the most known health related behaviors, is still missing from most people’s lives

Figure 1. Wellbeing at work, adapted from Naumanen, 2011

Work Ability House

To further illustrate the concept of work ability, a model was invented by Professor Juhani Ilmarinen (2006). In this model (Figure 2), a person’s wellness is illustrated as a house, where the floors are stacked on top of one another, and each of them represents one important component of occupational health. The base for the whole house is health and function. It includes physical, mental and social capabilities, which form a base for the whole building. The second floor consists of professional competences. The capabilities and skills of a worker have to be maintained and upgraded, for an individual to manage their job challenges and feel competent. Third floor of the house consist of values, attitudes and motivation, which are all reflected to employee’s ability to cope and strive in their private and career life. The fourth floor includes leadership, work community and work conditions. The combination of these will reflect to the function of the work community and the requirements of the job. The roof of the house covers the whole concept of work ability. If all of the floors are in balance, the roof is going to serve its function, and it will not leak. In other words, the balance between leadership, community, attitudes, capabilities and wellness are in sync. For this to happen, the employers and employees will need to communicate efficiently, to develop and upkeep the whole community (Ilmarinen, 2009.)

Figure 2. Work ability house (Työterveyslaitos, 2014).

Current Challenges

Due to the common knowledge and substantial scientific research on health-related behaviors, we may wonder, why are so many individuals still struggling physically, or mentally. Behavioral theories, national guidelines and scientific knowledge are increasing and developed yearly, but for some reason the challenges are growing. Weather the problem is stress, obesity, cardiovascular diseases, musculoskeletal disorders or the lack of so called “good nutrition” it can be argued that the extent of available information, should technically provide an answer to many of these problems. However, nowadays most workers live a fast-paced lifestyle involving many responsibilities and stressors. Unfortunately, this leaves many individuals tired, in a cycle of not enough time, information or motivation to start making better choices for themselves.

Consequently, nearly half of the workers within the EU region have been noted to suffer from stress and fatigue related problems. It has been suggested that the focus should be placed on minimizing these risks in the future (Lindholm & Ilmarinen, 2007.) According to Fin-health study (2017), wellness has stated to plummet and in some cases it has even worsened. It can be said that emphasis on enhanced physical and mental wellbeing has to be the focus of the future for the individuals, companies and the whole country (Koponen et al., 2018.)

Furthermore, the most common problems of inactivity and other lifestyle habits resulting in health problems, are financially costly, however, this does not even comprise the social and psychological stress of an individual experiencing it. Likewise, it has been noted that musculoskeletal pain is a serious threat for work ability and long-term wellness. It is also suggested to play a role in early retirement plans amongst working people. Due to this, workers with pain may benefit from preventative measures for sustaining their work ability, and to decrease the risk for early retirement (Miranda, 2010). Additionally, musculoskeletal disorders are also one of the most expensive cost for the healthcare system in the western countries. Back pain is on the top of the list as the most common, and most costly problems. Neck- and shoulder issues are also high in the rankings, when reflected to the prevalence and expenses. The costs of only backpain have been estimated to be up to 2-3% of the gross domestic product, in the western societies (Dagenais, Caro & Haldeman, 2008.) In addition, according to WHO calculations, global lived years with disability (GLD) is currently 60 years. Meaning that every single year 60 million people will be incapacitated due to back pain (Wu et.al., 2020). In Finland, it is estimated that the yearly costs for overall musculoskeletal disorders, is approximately 3-4 billion euros (Tule ry, n.d.)

Consequently, the World Health Organization has defined goals for the future; minimizing smoking, increasing activity, bettering stress management of individuals, focusing on health enhancing nutrition and also, improving ergonomics of the workplaces. In addition, according to the occupational healthcare act (2001), employees should receive guidance, information and counselling related to their health, wellness and security in their work and life in general. Also, as wellness and function can be viewed from the perspective of an individual or a society, the better one is able to function in their daily life, the more potential resources the society may possess. From this perspective, enhancing people’s function can be seen also as investment politics for the future (Lehto 2004, 19.)

The lack of occupational wellbeing is a business risk, and it lessens the intangible assets that a company possesses. Businesses are used to assessing the risks in regards of equipment, markets and products. However, this assessment is rarely focused on occupational wellbeing. Nowadays this kind of thinking has been changed, and risks that are related to this topic, are taken more seriously. Exhausted workforce or lack of professional capabilities can become financially high-priced, and changing employees is far way complicated and costly, then a replacement of a new machine. Poor work capacity will lower the quality, customer service and may diminish the organizations chances to optimally succeed in the future (Otala & Ahonen, 2003, 65-55).

While improvements are made in many fields, the obverse of limitless health-related knowledge and medicalization is that most of the common problems have received a medical explanation, and thus, the answer is also searched from this perspective. Exercise and nutrition is replaced with blood pressure or cholesterol medications, and sorrow, after loss of a loved one is managed with antidepressants. Furthermore, small deviations from “normal” states of wellbeing are often seen as diseases, and are treated with drugs (Huttunen, 2015). However, our biggest concerns are lifestyle related, and they should be dealt as such. It should be emphasized that these problems are rarely solved with medication or passive treatments. Continuing in the current path, the cycle is going to be ever ending, and costly.

Lastly, although the current problems may seem vast, sometimes lives can be changed by simply questioning personal, or organizational values. This has led to many individuals and employees thinking about their current ways of living. The steps of realizing personal wants and needs will always be individual, but to have someone as a supporter, may help tremendously. Currently, several occupational wellness programs have been succeeding in this, and hopefully these will be developed further, to target individuals and companies who need it the most.

PROMOTING OCCUPATIONAL WELLNESS

Previously mentioned topics have led to an increase interest and need for improved occupational wellness. In the future, businesses may influence to their own possibilities on staying profitable, by keeping workers for a longer period of time and limiting the amount of expenses that could be prevented, by simply having a workforce that stays healthy.

Previous interventions

Some previous studies have presented evidence that hiring a trainer, or a coach has effectively helped individuals and organizations to strive towards better health and wellness. Whether or not support is received in a group or in an individualized setting, the guidance, social interaction and a goal to work towards, has been presented to have positive effects. Companies may support their employees by hiring a physician, exercise specialist or a psychologist who offers help in their acquired domains. By doing this, many common problems could be tackled more efficiently and hopefully, also in a preventative manner. Related literature is especially strong in the realm of musculoskeletal disorders, where the evidence supports the benefits of exercise and its potential preventative mechanisms (Luomajoki, 2018).

As example, a six-month pilot study by Moreira-Silva, Santos, Abreu & Mota (2014) studied the effects of a physical activity program in factory workers. The aim of the study was to investigate the pain-relieving effects of physical activity, especially with people suffering from musculoskeletal problems. Intervention included 15 min of physical activity three times a week with the focus on stretching a general strength. After the intervention, in was concluded that intervention seemed to reduce musculoskeletal pain in factory workers compared to the reference group, especially in the hip, neck and elbow areas (Moreira-Silva et al., 2014.)

Also, similar observations have been concluded in a systematic review by van Vilsteren et al., (2015), where effectiveness of workplace interventions was compared to usual care or clinical interventions. The review especially focused on return-to-work times. It included workers with cancer, musculoskeletal problems, and mental health issues. 14 Randomized controlled trials were included. Moderate evidence was found that workplace interventions may reduce return to work times, and high-quality evidence that workplace interventions reduce cumulative duration of sickness absence. Overall, the interventions reduced return to work times and decreased the amount of pain and increased the functional status with workers, who suffered from musculoskeletal problems. However, the effects varied amongst the interventions and no considerable difference was seen in workers with mental health problems or cancer (Vilsteren et al., 2015) Similar observations have been made in a systematic review and meta-analysis by Kuoppala, Lamminpää & Husman (2008), where occupational health promotion was suggested to be productive in terms of lessened sick days and improved overall well-being of workers. Promotion especially focusing on exercise, lifestyle and ergonomics was suggested to be effective. However, in this review most of the educational and psychological means on their own did not provide any added value or benefits (Kuoppala, Lamminpää & Husman 2008.)

Also, a four-month occupational health program was implemented during a project called ForMare, with the aim of improving seafarer’s health. This intervention consisted of a training plan, nutrition counselling and lectures. After analyzing the material, it was concluded that the work ability of the participants was improve significantly (Kailo & Murtomaa, 2015.)

Related to economics of workplace interventions, a randomized clinical trial by Song & Baicker (2019) observed the effects of employee health on 32 974 employees were individuals participated in modules of physical activity, stress reduction and other related topics. The results presented positive outcomes in higher engagement to exercise (8,6%) and better management of weight (13,6%) compared to employees who did not participate. However, no significant changes were seen in clinical markers, absenteeism or job performance after 18 months (Song & Baicker, 2019) However, exercise and good management of a healthy bodyweight may start showing its direct effects years later. This is crucial, since some of the biggest concerns currently are inactivity, obesity and musculoskeletal disorders.

Moreover, positive results have been presented by a systematic review of intervention studies, conducted by Ammentorp et al. (2013), with the aim of analyzing coaching interventions that were aimed towards improving self-care, health behaviors and health related outcomes in general. Results of the analysis presented direct health improvements in some of the included studies. Most significant changes were seen in stress, perceived health status, high goal attainment, quality of life and decreased depression and anxiety. Moreover, one of the most meaningful factors for positive health is self-efficacy, which was reported to improve significantly in one of the included studies. Furthermore, interventions were also successful in motivating participants to work systematically towards their goals in life (Ammentorp et al., 2013.)

The effects of individual programs can be questioned, since a large part of research is observational, short or lacks the width to understand humans and their wellness as a whole. The effect of a program may also be sometimes explained by the participants. Participation has been found to correlate with preexisting healthy behaviors and already low medical spending (Jones, Molitor & Reif, 2019). Meaning that sometimes people participating into wellness programs, already own a regular exercise pattern and pay attention to their nutrition and overall health. Due to this, the biggest problem may be the recruitment of people, who are the least interested in participating. Usually these are individuals who are obese, heavy smokers, drinkers or do not participate in any type of exercise and have low motivation towards all these matters.

Conversely, the positive effect should also be questioned since the aim of most occupational programs is to offer financial benefits for the investors. It should be always thought out, which are the components that offer the best returns for the companies and the participants.

Benefits of occupational wellness

Firstly, it is regulated by the law that workplaces will have to offer occupational health services to employees. After these are in order, workplaces have a lot of means, which can be used to stand out from other workplaces, such as, processes, culture, leadership and company strategy. By investing in these, a company may create added successes and future financial benefits (Otala & Ahonen, 2003, 25.)

Secondly, the whole competitiveness of a company depends on the ability to produce, innovate, be cost-effective and to offer high quality services and products. Also, customer satisfaction, viable partnerships and a satisfied workforce forms the basis for company success and growth. For a company to succeed with products and services, it also has to have a competitive advantage in the employment markets. Only a satisfied worker, is able to produce high quality with value. All of these aspects can be affected by focusing on wide range of competitive advantages, such as the wellbeing of workers (Otala & Ahonen, 2003.)

In the last century, younger people have been seen as more productive due to their age, technology skills and ability to learn quickly. However, it has been noted, how important is the transformation of knowledge from older age groups. For example, a research by Sveinby and Simons (2002) highlights, how older employees will become more co-operative as they age. Also, employees with many years of experience will handle pressure better, which may make them for example, better project leaders (Sveiby & Simons, 2002.) Similar observation have been done by Ilmarinen (2016), who highlights the importance of keeping workers for a long time, and investing especially towards older employees. This is due to the positive effects that may come with age. Such as, life and work experience, knowledge capital, good practices, understanding and managing responsibilities, reliability, realistic attitudes, interaction skills, empathy, knowing own boundaries, and being able to evaluate processes thoroughly. These observations further support the idea that investing on workers and keeping them for many years, is beneficial for companies culturally, and financially.

However, while older workers may offer a significant advantage to a workplace, it is a fact that baby boomers are getting older and reaching retirement age, which threatens the amount of workforce that is available. It is crucial to keep all employees healthy, and for them to enjoy their time at work. Nowadays This is especially important, since new job applicants will choose their jobs based on satisfaction of the current workers, and the overall reputation of a company (Otala & Ahonen, 2003, 25.) If a company is known for taking care of its employees, the possibility of it attracting a more capable workforce may be higher, and the ability to keep respectable workers, is enhanced. Also, new leadership models encourage companies to use long-term planning for production and profits, instead of using short term benefits as the first emphasis. Reputation, Societal responsibility and sustainable development will have a larger emphasis on the future, and thus, will also affect how companies are seen by applicants (Otala & Ahonen, 2003, 25).

In addition, culture, and help that is received from the company will affect individual wellness. It is possible to develop the employees’ own coping- strategies, and ways of functioning by offering support, and coaching from the workplace. Especially coping skills, and life control skills interventions have been suggested to be beneficial with improving employee wellness (Shaw et al., 2014). By placing emphasis on the previously mentioned topics, the culture of caring and wellbeing may be enhanced in the workplace. In surroundings where it is encouraged to take care of oneself and others, the normal, adverse effects which are seen in workplaces, may be seen less.

Many aspects will effect on employee’s motivations to come to work, but one of the biggest concerns and predictors for disability in the workforce, have been noted to be absences due to mental illnesses, and chronic pain (Munce, Stansfeld, Blackmore, & Stewart, 2007). It can be suggested that healthy workers will miss less work than unhealthy ones. In addition, a worker who is healthy may also be able to be mentally present, have more energy and to be more idea rich without the constant struggles with health.

Occupational wellness can be seen as a competitive advantage, which makes it possible for a company to build sustainable financial profits. Meaning that successes that are made, can also be replicated in the upcoming years (Otala & Ahonen, 2003, 51.) Furthermore, it is known that a lack of occupational wellness will increase expenses (Otala & Ahonen, 2003, 25), and research also suggests that there is a direct correlation between employee wellness and financial success of a company. By prioritizing occupational wellness, a company can save finances from absenteeism and medical costs (Baicker, Cutler & Song, 2010).

According to Finnish Institute of Occupational Health small workplace program (1995-1998), a company may save up to 1000-2500€ towards each employee, by investing in occupational wellness with different ways. Savings from this program were seen from lessened sick days and growth in production. Most effective changes were seen from developing management and workers occupational knowledge. Also, improving the atmosphere of the workplace could be seen in financial savings. Some other manners which were aiming towards improving occupational wellness, were also seen to be effective, although direct correlation with financial savings were not seen. This may have been linked to the observation that better occupational wellbeing led to better customer satisfaction, and increased spending (Huuskonen, Laitinen & Bergström, 2000.)

METHODOLOGY

Occupational wellness and its effects are still poorly understood, and thus, this thesis aims to enhance the knowledge which could be attained from this intervention. In addition, no previous interventions and their effectiveness have been studied in the client, which makes this research necessary and needed. Intervention is going to collect biometric and psychological data, in the form of a test battery and a questionnaire, which are both used to further understand the effect, which the implemented program has on the participants.

Research questions and hypotheses

The main objective of the thesis was to investigate the effectiveness of the applied occupational wellness program on the overall health and function of the participants. In addition, the data can be used to analyze the coaching and to further develop the process of interventions.

Results of the data are going to be reflected to the research questions:

1. How effective is the current method at improving customers wellness and functional capacity?

2. What are the benefits that a company may develop when investing in occupational and lifestyle interventions?

Study Design

Study was aimed to observe and compare results that are able to be attained from a two-month occupational wellness program, which included six participants. Investigation was targeted specifically towards wellness, including physical and psychological measures. Questionnaire (appendix 1) was used to collect data from subjective attitudes and perceptions, while physical tests (chapter 4.5), gave objective measures of performance and biometric data of the participants condition.

Data for the thesis was collected in two parts, before and after the program. Questionnaire was sent to the participants one day before the physical tests, and they were asked to fill the form independently at home. Results from physical tests were written down by hand and later transferred to an excel sheet for data analysis. All collected data was specifically used to analyze the difference between pre and post test results within the participants, with the aim of providing insights into the effectiveness of the program.

Intervention included to each participant private coaching 2 x 60 min and nutrition coaching 2 x 30 min which were done in the training center. Also, group training 2 x 60 min and video training 3 x 45min in an online platform was included. In addition, physical tests, a qualitative questionnaire and body composition measurements measurement were conducted at the beginning and at the end of the program.

In the first training session, participants current state was analyzed. Special attention was paid on physical capabilities and own needs and motivations towards the project. Meaning that each participant stated a goal of their own choosing, and this was used to structure all manners related to the intervention.

More specifically, training sessions started with individualized mobility, stability and activation drills, lasting approximately 10-30 minutes, which were all targeted at each participant’s current limitations. These were followed by strength training, which included movement patterns, such as, push, pull, lunge, squat, hinge and rotation. Sets, repetitionsand weights were scaled according to the participant’s participants’ strength and mobility, though often ranging from 2-4 sets and 6-15 repetitions per movement. The emphasis was placed on “clean” and safe execution, never maximal exertion. After these, the sessions ended with a cool down, which was done with a bike, cross-trainer or mobility drills (active and passive). As the sessions lasted exactly 1 hour, the amount of strength exercises stayed between 2 to 5, in addition to pre, and post training drills.

As regards nutritional counselling, the first session included learning suitable macronutrient ratios, calculating own daily expenditure, and assessing own caloric needs and future food targets. For all participants one of the stated goals was weight loss, which was also discussed in the counselling.

After the first nutrition and training session, each participant received an individualized weekly nutrition and exercise plan from the physiotherapist. Exercise plan included suggestions for weight training and endurance training. Times per week and durations were based on participants life situation, needs and own motivations. For most of the participants, plan included 2-3 times of strength training (gym or at home) and 1-2 times of low intensity cardio (i.e. walking, cycling, rowing). Same individualization principles were applied to the nutrition plan. Overall, all implemented procedures and counselling was based on individuals current physical and mental state, and also wishes that they presented during the sessions.

Participants

The data was collected from 6 participants with average age of (48.0 ± 4.2 years) and body mass (94.2 ± 12.0 kg), who are working in different kinds of work positions inside of a grocery store. Some individuals will be on their feet for the whole day, while others have slightly more variable job postures. Most impactful challenges for this focus group (n=6) are obesity, inactivity, poor eating habits and musculoskeletal disorders. Out of six participants, two were females and four were males.

Project schedule

Project planning started during summer 2020 with the client. The recruitment was immediate, as the participants already had a contract with the client. Between the planning period and the start of the intervention, previous studies and related literature were studied.

Once all participants were recruited, the data collection period was conducted between 17.8.2020- 26.10.2020, including both pre- and post-intervention tests, as well as the intervention itself. Pre-intervention tests were conducted within the first week of the intervention, and post-intervention tests were collected within the last week of the intervention. Lastly, Data analysis and writing were performed between January and May 2021.

Physical tests

The most important aspects of testing are assuring that the measurements are reliable, and that they measure variables which make a difference. These can be enhanced by making sure that the tests are taken by a person with previous experience and who has a standardized way of conducting them. For this reason, within this thesis process, the physiotherapist performed all the tests. These particular tests were chosen for this group since they are simple to perform, conduct in different settings, and they provide an easy comparison for the pre and post test results (Keskinen, Häkkinen & Kallinen, 2007, 201). In addition, the tests were chosen from widely used assessments which have been used in similar settings, which hopefully enhances the validity of the results. The following tests were chosen to measure the participants functional capacities (mobility, stability and strength).

FMS shoulder mobility screen

The test assesses the complementary rhythm of the thoracic spine, rib cage and the scapular-thoracic region during upper extremity shoulder movements. In the assessment, the participant aims to put his or hers hands together behind the thoracic spine, as close as possible. Both hands were tested and when the movement was restricted, measurement (in centimeters) was taken between the hands. Problems within this area may leave to limited mobility that is followed by poor posture and restricted movement patterns (Functional Movement Systems, 2015, p.19).

Side Bend

The test measures the mobility of lumbar and thoracic region, while doing a side bending movement. In the test, the participant stands close to a wall so that the legs are 15cm apart. Hands are placed on the sides of the thighs, where the tester marks the lowest spot with a tape. After this, the participant bends towards the side, while sliding the fingers lower and keeping the head, shoulders and hips against the wall. The lowest part of the fingers is marked again, and the distance is measured in centimeters and used as the end result (UKK, 2012). Lessened mobility in this movement pattern has been linked to poorer function of the spine. However, also too much mobility may cause problems, since in this case the spine has to be supported with more musculature, than normally (Suni & Taulaniemi, 2012, p.140-142 as cited in Blom, Honkala & Otronen.)

Forward reach

During a forward reach (flexion motion), the rhythm of the lumbo- pelvic region can be observed. This refers to the cooperation of the lumbar spine and hip joints. In the initiation of the flexion, muscles in the back will forward flex maximally. The pelvis and the hips will support the motion approximately until 90 degrees. After this, the muscles in the gluteus and hamstring region will flex to their maximum. From this on, the gravity will pull the body towards the ground. When performing the movement to the opposite direction, the rhythm will happen inversely. In the first step of the test, the distance between c7 to c1 is measured in centimeters while the participant is standing. After this, the participant bends forwards towards the ground, where the same measurement is taken again between the same region. The difference between these two measures is used as the measurement. A change in the rhythm may be seen in delayed flexion, or a full absence of it. The cause of this may be muscular imbalances or mobility restrictions in the lumbar spine (Saarikoski, 2004, as cited in Blom, Honkala & Otronen, 2016.)

Distance to wall test

Test measures the amount of dorsiflexion in the ankle region which is crucial for individual’s daily life. For example, Poor mobility in the ankle may result in delayed ankle dorsiflexion in the swing phase of the gate cycle, which may lead to higher fall risk, amongst older individuals (Kemoun, Thoumie, Boisson & Guieu, 2002). In addition, especially during exercising, poor mobility may lead to higher ground reaction forces, which in turn can lead to increased amount of knee valgus that exceeds the normal range. This is worrying especially during jumping, and squatting mechanics, since it may place a person at a higher risk for ACL- injuries. (Fong et al., 2011.) In the test, the participant performs a lunge, where the forwards knee touches the wall. After this, the foot is moved further, until the knee can only touch the wall slightly, while keeping the foot flat on the ground. From this position, the distance to wall is measured from the great toe in centimeters. The results obtained from this test have been stated to be reliable with a low measurement error, even from a novice rater (Konor, Morton & Grindstaff, 2012).

Dumbbell shoulder press

Assesses the dynamic upper body strength of an individual safely, especially if a person has not been doing any physical activity before. The test is started from a narrow standing position, where the arms are placed flexed, while holding dumbbells on the level of the shoulders. From this, the test starts, and the participant aims to do as many repetitions with the dumbbells, as possible. The test finishes, when the participant cannot perform any more repetitions with a good posture (i.e. bending to the sides or leaning back) (Finnish Institute of Occupational Health, n.d.)

Trunk lateral endurance test

Evaluates the muscular endurance of the lateral core muscles (i.e., transverse abdominis, erector spinae, quadratus lumborum and obliques). The tests involve static, isometric contractions of each side of the core to stabilize the spine. The test is started from a tandem position, where the participant is on his or her side with extended legs, lower arm is placed under the body and other, on the hips. The test procedure requires the participant to stay statically in this full side-bridge position, without lowering the hips or arms. The test is measured in seconds and it is finished, when the participant cannot hold the position anymore. The stability and endurance of the core muscles has been shown to be the biggest opponent of a healthy spine. (American Council on Exercise, 2017) Individuals who are suffering from low back pain have been suggested to fatigue more easily, compared to people with no back problems (Ito et al., 1996).

Squats

The squat test from Luomajoki’s Best of Advanced test battery, includes squatting with a weight that is half of the persons own bodyweight, where the aim is to reach at least 15 repetitions. The test will assess the motor control and the ability to produce force in a continuous manner. The test is performed with a barbell and the participant is guided to squat, as many times as they can. The test stops when the movement is not continuous and controlled (Luomajoki, 2018, 154.) The result will give information from overall control of a person’s movement patterns and it can also be easily repeated at the end of the intervention.

One leg stand (UKK)

Assesses the postural control while the support area is lessened by standing with one leg. A major health problem caused by a fall is a serious problem within the older population. In addition, people suffering from low back pain usually have impaired postural control, which both of these can be assessed with this test (Suni, Husu & Rinne, 2009, 13.) The test starts from a single leg stance position, where the participant places his or her foot, on the side of the opposite knee and the hands are placed freely on the sides. The aim is to hold this position as long as possible, without losing control. The test is finished, when the participant loses the balance and the measurement is taken in seconds (UKK, 2020.)

Sit to rise test

Sit to rise test (SRT) has been used to assess the mobility, balance and strength of individuals and, it has been recognized to correlate with all- cause mortality. Individuals who are able to sit and stand independently on and off from the ground, are more likely to live a longer and more functional life. The SRT test is started from a relaxed standing position. The participant is asked to try and sit to the ground, by using minimum support. The test is scored between 0-10, of which 5 points are from sitting down, and 5 for getting up. After each support utilization during the movement (e.g. hand, knee or side of the leg), one point is subtracted from the total (de Brito, 2014.)

Questionnaire

Since the first part of the tests will mainly measure physical traits, a questionnaire was included to further understand psychological aspects since in most cases, these are the driving factors to a person’s wellness. The questionnaire included 11 Likert items, measuring the agreement or disagreement of participants, with a five-point bipolar scale (Likert, 1932). Levels of agreement was measured from the following questions:

I have good health and enough energy to perform my job description

I exercise regularly and take care of my fitness

I have methods to recover from my workload

Physical workload of my job is at the appropriate level

I eat healthy

I find my work enjoyable

I feel, as I have important relationships and an adequate social support network

I believe I can affect my life

I have enjoyable hobbies

I have good self-knowledge (I know my strengths and weaknesses)

I am committed and motivated towards improving my own wellbeing

In addition, three open ended questions were included at the end of the questionnaire to gather more descriptive data from the participants. Open ended questions were as follows:

Describe your current eating habits (times and content of meals)

Describe your goals for during-, and after the project

How committed and motivated are you towards this project?

Lastly, a visual analog scale from 1-10 (VAS), was included to measure the pain experiences of the individuals (Breivik, 2008). In addition to the scale, a pain drawing (appendix 1) was also included which was used in the coaching sessions, to enable the participants to describe in detail their pain sensations to the coach. All these tests aimed to collect data from a wide variety of variables that may have been impacting the participants’ health, nutrition and overall lifestyle.

With the combination of the physical tests and a questionnaire, the most important areas of an individual’s wellness and health may be considered: health and functional capacity, physical strain of the work, free time activity and hobbies, life situation and motivation towards exercise (Laitakari & Asikainen, 1998, 217, as cited in Keskinen, Häkkinen & Kallinen, 2007).

Data Analysis

The aim for the thesis was to gain more understanding into the effectiveness of the implemented occupational wellness program. Hypothesis was that a positive cause and effect relationship could be seen between coaching and improvement in participants overall health and function.

Due to the complexity of analyzing an experience related to a person’s health, both quantitative and qualitative data was collected. Quantitative measures provide numerical data that can be used to categorize, rank and measure results, which are later analyzed with numerical comparisons and statistical inferences. To succeed in this, valid and reliable measures are required that would provide a generalizable result for the target population. (Newman, Benz & Ridenour, 1998, 10) However, numbers solely do not allow the investigator to find phenomena’s or explore human experiences from a wider perspective, especially if the number of participants is low.

A generic opinion of how to define qualitative research varies. However, qualitative measures commonly attempt to describe the experience and phenomenon as a whole. It aims to study individuals, groups and cultures as nearly as possible as its participants feel or live it. It can give insights into routines and problematic moments of an individuals’ lives from a naturalistic approach. (Denzin & Lincoln, 2011, 2)

Coaching should always be observed from a humanistic approach, which can be further analyzed with the combination of qualitative and quantitative measures. Qualitative data was gathered in the research by questionnaires, which included open ended questions, allowing the participants to further explain their experiences. The questionnaire also included questions, which were rated by using Likert scales. To assess the effectiveness of the program, mean values, standard deviations and paired sample t- tests were conducted to analyze the data from all Likert items and physical tests by using Microsoft Excel Software. Answers to the open-ended questions were analyzed by thematic analysis, which consisted of examining the data, coding it with open codes and dividing these into several categories. Lastly, these were merged into main themes. (Vaismoradi, Turunen & Bondas, 2013.) Based on the literature review and data collection, possible health outcomes and their connection with the intervention could be investigated.

The thesis aimed to take multiple measures to capture the full experience of the actual product and service. The importance of single variables and measures should be noted, however, they rarely provide a straight answer, especially in a topic that is this wide-ranging.

RESULTS

Questionnaires and physical tests were collected from all six participants (n=6) with the age range from 35 to 65 years (M= 48, ± 4.17 years). Two responses were excluded due to incorrect marking style in VAS-pain scale.

Experienced wellness

Participants answered to 11 Likert items related to different variables effecting their wellness. The answer possibilities were: 1) strongly disagree, 2) disagree, 3) neither agree nor disagree, 4) agree and 5) strongly agree.

Figure 3. Likert items. Levels of agreement. *= statistically significant change between Pre and Post tests (p<0.05)

Figure 3 illustrates the overall mean scores from pre and post test results. Statistically significant changes could be observed in frequency of exercise, which changed from 3 (± 1.17) to 4 (± 0.41), and improved eating habits from 3.5 (± 0.82) to 4 (± 0.63). Rest of the results did not show statistical significance related to: perceived health and energy, mental strain of work, physical strain of work, enjoyment of work, important social relationships, ability to influence own life, amount of enjoyable hobbies, self- awareness or commitment and motivation towards improving own health.

Open ended questions

Six main themes were identified from different categories that emerged from the data. Questions of nutritional habits and goals are presented in the following chapter by dividing results to before, and after the program, with the aim of describing the difference. Themes are written in bold, and related quotations have been added to further elucidate the data. Quotes have been translated from Finnish to English with the emphasis of maintaining participants way of diction.

MAIN THEMES BEFORE THE PROGRAM

Theme 1: Nutritionally poor diet and irregular eating

Before the program started, participants were explaining their habits in regards of their nutrition by stating times, and food stuffs that they are commonly consuming in their daily life. From this content, it could be interpreted that most of participants were lacking breakfast, and the length between meals was often prolonged. Additionally, some stated that they have a hard time balancing macronutrients, mealtimes or that they enjoy too much sweets.

“Sometimes I eat healthy and sometimes I have very poor eating habits”

“No breakfast, lunch at work and a snack. At home a dinner and snacking”

Theme 2: Improving physical health

When asked about ambitions regarding the project, most of the participants showed interest in improving their physical capabilities. These were mainly related to weight loss, improved mobility, energy and to the willingness to get back to an old hobby.

“Add more exercise to my life”

“Lose weight and get to a better shape”

“I want to be more mobile and have a better fitness”

Theme 3: Learning new things and finding solutions

Participants also presented interest in finding solutions to their current issues in regards of sleep, nutrition and pain or injuries. In addition, participants showed willingness to balance their lifestyle, finding enjoyment from exercise and experimenting with more healthy foods.

“I would like to have the ability to control my weight with diet”

“new, more healthy experiences with food”

“enjoyment for exercise. How to get up from the couch”

“making my knees stronger, continuing jogging”

“Fixing abdominal precipitation”

MAIN THEMES AFTER THE PROGRAM

Theme 1: Improved eating habits

Related to participants eating behaviors, it could be interpreted that the eating times, food stuffs and macronutrient ratios had changed. For example, many stated having breakfast, more eating times during the day and consuming more fruits and vegetables. In addition, participants felt that their habit of snacking had lessened, and the overall feeling related to food habits was more positive.

“same as before but snacking has finished”

“Good relationship with proteins, fats and carbohydrates. Sometimes not, if having a treat”

“I feel that the project changed my eating habits”

Theme 2: Positivity towards exercise and long-term lifestyle habits

Ambitions after the project had stayed similar. Participants indicated the willingness to continuing to exercise more and overall, to make the effort in the future for a bigger lifestyle change. Feelings of motivation had also suggested to increase, and many participants stated that they will continue with the project on their own.

“Got a boost for a bigger lifestyle change”

“I will try to train more than once a week”

“Motivation towards losing weight increased significantly”

“Few kilos were lost, project will continue”

“I will continue like this in the future”

Experienced pain

Experiences of pain were measured with the VAS-pain scale from 1-10 (n=4). In addition, precise areas of pain could be seen from the pain drawing. Two participants were excluded from this measurement due to incorrect marking style. Most marked areas of pain in the order of prevalence were: 1. Low back, 2. Hips and 3. Shoulders. The mean result for the experienced pain before the project was 5.0 (± 4.4), which was later reduced to 2.3 (± 2.9) after the intervention. Group results were not observed as statistically significant, however, notable individual decreases were seen as example, from VAS- pain scale from 10 to 6 and from 7 to 3.

Figure 4. Intensity of pain measured with VAS-pain scale.

Body composition measurements and physical tests

Pre intervention	Post intervention	Relative Change (%)
Body composition measurements
Body weight (kg)	94.2 (± 2.0)	92.4 (± 13.7)	1.9
Muscle mass (kg)	35.3 (± 4.9)	35 (± 5.5)	0.9
Fat (%)	33 (± 9.3)	32.4 (± 9.2)	1.7
Visceral fat (points)	14.3 (± 5.3)	13.7 (± 5.4)	4.7
Physical tests
Right shoulder mob. (cm)	21.7 (± 8.6)	17.2 (± 8.1)	20.8	*
Left shoulder mob. (cm)	24.7 (± 6.9)	22.7 (± 7.6)	8.1	*
Right ankle mob. (cm)	13.8 (± 3.9)	17.3 (± 3.6)	25.3	*
Left ankle mob. (cm)	13.3 (± 4)	17.2 (± 3.7)	28.8	*
Right side bend (cm)	19.3 (± 8.3)	20.3 (± 6.2)	5.2
Left side bend (cm)	17.5 (± 7.2)	18.7 (± 6.0)	6.7
Forward reach (cm)	9.0 (± 3.4)	10.3 (± 1.9)	14.8
Right shoulder press (reps.)	26.0 (± 13.2)	29.8 (± 16.1)	14.7
Left shoulder press (reps.)	21.0 (± 9.2)	23.5 (± 11.5)	11.9
Squat (reps.)	23.0 (± 9.7)	32.4 (± 13.4)	40.9	*
Single leg stance (sec.)	48.0 (± 18.9)	48.7 (± 17.7)	1.4
Right side plank (sec.)	21.8 (± 14.8)	31.3 (± 17.8)	43.7
Left side plank (sec.)	21.8 (± 11.9)	29.8 (± 20.7)	36.9
Sit to rise (points)	6.5 (± 2.0)	7.2 (± 1.5)	10.3

Four measurements were included in the body composition measurements, and nine tests were included in the physical tests.

Table 1. Results of the body composition measurements and physical tests. *= statistically significant change between pre and post tests (p<0.05)

Table 1 presents the results from the body composition measurements and physical tests. Physical measurements were taken from 9 different tests. The tests results were analyzed in repetitions, points or centimeters depending on the test scoring. Statistically significant changes were observed in shoulder mobility, ankle mobility and squat results. In addition, body weight, fat % and visceral fat were reduced from pre to post-intervention, however, none of the body composition measurements were considered statistically significant.

DISCUSSION

The purpose of the thesis was to explore how effective the implemented program was towards improving the participants’ overall wellness. The participants answered and conducted tests related to: energy, health, physical and mental strain of work, physical activity, eating habits, enjoyment of work, self-efficacy, hobbies, self-awareness and self-development. In addition, physical tests assessed the participants mobility, stability and strength. The thesis fulfilled the commission by implementing an occupational wellness intervention and assessing its effects on employee wellness. This is the first study to examine the effectiveness of this particular product and thus, it provides important new insights. In line with previous research, the results indicate that positive improvements could be seen after the occupational wellness program.

The intervention required a broad understanding of wellness behaviors and aimed to target specific problems which each participant presented. Individual sessions focused on noted problems, and the participants received coaching accordingly. This meant that participants suffering from musculoskeletal problems were trained differently to individuals who were experiencing weight problems and could train intensively.

Research found positive changes in self-rated amount of exercise, improved eating habits and positivity towards exercise. Also, improved lifestyle habits (self-efficacy) and physical improvements (shoulder mobility, ankle mobility and squat results) were observed. The results suggest that coaching did indeed correlate with improvements in the physical and mental capabilities of the participants. Short-term outcomes were likely based on changes in skills, attitudes, decision making and knowledge. However, persistent long-term outcomes and changes related to these cannot be analyzed from the data, since habits and attitudes require time to develop. However, it can be hypothesized that due to the increase in knowledge and skills, participants may show more improvements in the future.

It can be argued that the variables which improved during the intervention can affect employee wellness positively. However, the magnitude of the benefits can be questioned, since no financial analysis, return on investment or longer follow up period was included in the process. Straightforwardly, no unexpected results were seen, and almost all of the outcomes were anticipated at the beginning of the program, only their magnitude was questioned.

In line with previous literature of occupational wellness programs and their effect on improved overall wellness of participants (Kuoppala et al., 2008; Kailo & Murtomaa, 2015), the intervention seemed to increase the wellbeing of workers and their health status. In addition, similar results of higher self-rated amount of exercise have been reported in a randomized clinical trial by Song & Baicker (2019), where employees who were participating in health-related modules offered by the workplace showed positive outcomes in engagement rates for exercise and better weight management.

Additionally, improved perceptions of own capabilities and motivation towards exercise could be observed after the intervention, which may also be associated with higher self-efficacy of individuals (Stajkovic & Luthans, 1998). These results align with observations from a systematic review of intervention studies, conducted by Ammentorp et al. (2013), were improvements were seen in perceived health status, higher goal attainment, quality of life and decreased depression and anxiety (Ammentorp et al., 2013).

In addition, for many, (not all) participants pain decreased notably. To highlight examples, decreases were seen from VAS- pain scale from 10 to 6 and from 7 to 3. As the most marked areas of pain were the lower back and hips, it can also be hypothesized how much these may relate to absences, since these are the most common problems associated with sick leave and early retirement (Munce et al., 2007). Although the results from the VAS - pain scale were not seen as statistically significant, it can be argued that on an individual level, changes may affect life quality tremendously. Similar improvements have been observed in studies by Moreira-Silva et al., (2014) and Van Vilsteren et al., (2015) where individuals participating in physical activity were reported to significantly decreased their feelings of pain. This is meaningful, since a large number of visits to health care are due to pain, and it also contributes to early retirement and poorer work ability (Miranda, H., 2010).

Lastly, since the effect of a program may also be sometimes explained by the participants and their preexisting healthy behaviors (Jones et al., 2019), it is noteworthy that in this intervention the employer had chosen the participants. This means that the positive changes were less likely to be caused by pre-existing healthy behaviors and interest among the participants. However, this may also have affected the end results significantly since individual choices and the willingness to learn and act form the basis for the success and impact of the whole intervention.

The quality of research depends on the validity and reliability of the author, methods, literature and overall skills and attitudes which are included in the process. Validity refers to whether or not specifically chosen measures or observations could be attained from the study. In other words, are the measures actually measuring the result, which it is aimed at. On the other hand, reliability also measures how consistent the chosen methods are, and the odds of random errors are low. The reliability of a study is higher, if similar results could be attained when replicated with the same procedure. (Järvenpää, 2006)

Due to this, specific physical tests and questionnaire parts were chosen for the data collection from previously tested and commonly known scales and measurements, which likely increases the validity and reliability of the results. Physical tests were also chosen specifically for this population, and selected tests were easily replicable with the least amount of testing error. In addition, the same physiotherapist conducted the instructing, testing and guiding, which made it possible that similar procedure was maintained throughout the whole study.

In the construction of the questionnaire, it was ensured that the instructions were clear and that it was well-ordered, not too crowded, one single thing was asked at a time that the questions proceeded logically and were numbered consecutively, and that the answers were easy to add and process (Heikkilä, 2014). In addition, as all the tests included commonly used scales, the answers were easy to observe, analyze and replicate, which likely resulted in lower testing and analyzing errors. In addition, questionnaire and tests were also assessed and commented on by the CEO of the client company, and the thesis supervisor. After this, further clarifications and changes were made after feedback, for the optimal and clear collection of data.

As with the majority of studies, the design of the research is subject to many limitations. Firstly, answers to open ended questions were answered briefly and thus did not provide as much information as expected. In addition, the presence of the employer may have impacted the participants’ answers, due to fear of being judged or other unknown reasons. For example, the questions on work strain, stress and overall enjoyment may have received different responses in different settings. Also, the physiotherapist who conducted the tests is an employee of the company, which may produce a conflict of interest in the collected data.

Furthermore, when examining reliability, special attention was paid to accuracy, i.e. random errors when implementing the study, as well as measurements and overall procedure. Reliability and accuracy consider response rates, sample size and its quality, measurement abilities and data entry precision. Moreover, the reliability of the results is also dependent on the sample size and methods. The results of the study can be considered as random when the sample size is very small, or the dropout rate is high (Heikkilä, 2014).

In addition, the researcher should check that conceptualizations from the data match the interpretation of the subject’s perception. Also, consideration should be placed on the researcher’s own previous preconceptions. Lastly, the strength of the study will depend on whether or not similar interpretations have been made in other studies, examining the same phenomena or area of interest (Järvenpää, 2006).

Although appropriate data analysis tools, questionnaire and physical tests were used, the analysis of the thesis is also subject to limitations. For example, the results of the study were analyzed based on six participants. This means that the participation and overall amount of data was small, and that the results cannot be generalized to a larger population, which lessens the overall reliability of the results. Also, as most of the literature and overall, the whole work was conducted in English, it may have affected the perspective of the researcher and the overall interpretation of the data, as it needed to be translated. In addition, as the implemented individual sessions varied depending on the participant, it should also be noted that the methods of the study were not rigid, and thus, strict causal correlations cannot be made. However, despite the limitations, the results still provided data for assessing this particular group as intended, and it helped to further understand the process of wellness programs.

It can be concluded that the thesis supports the benefits of occupational interventions on employee wellness but raises the question of the most advantageous methods, and time durations to reach effectiveness. Also, since direct correlations with productivity are difficult to find, further research is required to determine the profitability of the application of wellness interventions for companies.

In the future, a larger sample and a control group would increase the amount of knowledge that could be attained. As a result, observations could be more generalized and other forms of professions and/or working conditions could be researched. Also, it would be interesting to conduct similar research with two different working communities to see how much culture effects the wellness of the workers.

Moreover, it would be noteworthy to research which biometric and psychological markers are the most correlated with wellness in occupational settings. This is fundamental since it may change the way occupational wellness is applied, and thus interventions could be targeted at the most significant measures and employees.

Correspondingly, this would mean that future interventions could achieve more significant changes if measures and coaching are more individualized for participants (i.e. overweight people would receive guidance emphasizing nutrition, and people suffering from pain would receive physiotherapy, encouraging coaching and psychological help, if needed).

At the societal level, it is essential to know which groups are measured and assessed in the future. The testing should be targeted amongst middle aged and elderly people, due to their significant impact on society (Husu et al., 2011). Similar ideas could be applied to occupational settings, where employees who are least likely to participate, should be included in the programs (Jones et al., 2019). This is noteworthy and necessary, since the greatest number of benefits could be accomplished by succeeding in this.

Based on related literature and thesis observations, companies should sincerely consider investing on their workers’ health and their overall wellness, as these are suggested to be one of the most significant factors affecting work capability (Gould et al., 2008). Benefits may be seen in enhanced company profits, less sick days and medical costs (Baicker et al., 2010), enhanced quality of work (Otala & Ahonen, 2003, 65-55), increased knowledge capital, and lessened recruitment costs (Ilmarinen, 2016; Sveiby & Simons, 2002) and company culture (Huuskonen et al., 2000). Lastly, individual wellness can be seen as investment politics for the future, for companies and the whole country (Lehto 2004, 19).

However, it remains the responsibility of the companies to target individuals who need it the most and to offer interventions targeted specifically at problems which can be seen in the company and job conditions. Overall, the experiment succeeded in providing new insights into the relationship between the implemented wellness program and its effect on overall wellness and health of the workers. Additionally, since the products of the client had not been researched before, the research offers knowledge which can be used to further develop products and interventions.

Ethical concerns

Ethical issues with the thesis are vast since it deals with people’s health. Due to this, all health-related information will be kept confidential with the respect of participants privacy. In addition, the names of participants or the company will not be revealed and any topics surrounding client’s organizational processes will also be kept private.

Polytechnic schools have principals in research and development which should be strictly followed. Violating common regulations can be seen for example as a research fraud or disregard for good practice. The overall reliability and credibility of the thesis and its whole process will depend on whether or not good research practices have been followed.

In addition, as a professional, ethical consideration should always be present when working. During the thesis process, responsibility of own actions, taking other people into consideration, and basing own skills and activities on ethical values was paid attention to. Acquiring all of these during the process, own and profession specific ethical principles could be followed

The Finnis Board on Research integrity (TENK) has set guidelines for responsible conduct of research (RCR guidelines) with the objective of promoting responsible conduct of research and possible violations can be dealt with fairness. In order for a research to be ethically accepted and reliable, following norms should be established. The guidelines (2012) include the following: recording, presenting and evaluating follow the principles which are endorsed by the research community, data acquisition, research and evaluation are ethically sustainable and conform to scientific criteria and are presented in an open and responsible manner. In addition, researcher credits, respects and appropriately cites other researchers works, all participating parties agree on the researcher’s rights, and that responsibilities, obligations and sources of financing and conflicts of interest are announced to all members and reported in publishing. Lastly, researcher refrain evaluation and decision making, when conflict of interest is suspected, and research organization adheres to data protection legislation.

Following the guidelines from TENK, thesis paid attention to the following: during the research process, all recorded, analyzed and presented data was used for purposes which were stated in the beginning of the process. Participants were informed comprehensively that why the data was collected and where it was going to be used. It was also made sure that participants knew that participation was voluntary and if any questions or unclear thoughts arise, they were able to contact the researcher by phone, email or in person.

Also, special attention was paid on individual experiences during the coaching process, since uncomfortable feelings, pain or fears are a valid reason to stop the research process. Especially in private coaching sessions where straightforward feedback was able to be received, it was important to listen and assess each client as a separate individual.

Data collection methods (questionnaire and physical tests) were chosen due to their simplicity and replicability. In addition, questionnaires which were distributed by email (appendix 1&2) made it possible for the participants to decide themselves, where, when and for how long they wished to answer to each question. This hopefully lessened the pressure with time or didactics. Also, privacy concerns were simple to follow with this type of data collection and it allowed an easy disposal of it.

Furthermore, literature and conclusions which were drawn from the process, were critically assessed to the best of researcher’s professional knowledge and capabilities. Also, credits to other authors and referred texts and ideas have been marked to the written work accordingly. Lastly, for the respect of client’s wishes, the thesis will not be released on platforms or distributed, since it may include business related information, which should stay private.

Conclusion

The thesis aimed to assess the effectiveness of a two-month intervention on employee health and wellness outcomes. The conclusions are based on the research questions which were:

1. How effective is the current method at improving customers wellness and functional capacity?

2. What are the benefits that a company may develop when investing in occupational health programs?

The results of the 2-month program presented improvements in physical tests, and improved self-efficacy related to exercise habits and lifestyle change. In addition, important, but non-statistically significant changes could be seen on an individual level within decrease in pain.

It can be concluded, that the participants presented improvements in some wellness and functional capacity markers. Improvements in physical capabilities, knowledge and improved self-efficacy, may correlate with a more functioning workforce and individuals. It can also be suggested, that in the future companies may benefit from similar interventions by seeing enhanced self-efficacy of workers related to exercise, eating habits and improvements in physical capacities. In addition, it can be proposed that especially overweight, heavy drinkers and non-active workers may benefit from support, which may lead to increases in personal capacity and possibly to wider lifestyle changes.

Occupational wellness will play a significant role in workplaces, since it is the basis of the overall capability of individual employees and eventually, of the whole company. Furthermore, in future interventions it is important to evaluate and assess which procedures bring the most returns, and what are the factors that a company should target.

Finally, it is beyond the scope of this study to address the questions of what are the components which form the basis for occupational wellness. However, it can be suggested that in the future, emphasis on individualized wellness programs should be included in companies’ developmental processes, and the effects of decreased function and wellness, should be understood since they pose a notable threat to company profits and reputation.

Professional competence and development

Professional and degree competences of universities of applied sciences include manners that a graduate should possess. Competences mean prerequisites which should be internalized as a graduate student. These include for example, performance potential and the ability to execute the duties which are included in the profession. Also, learning skills, ethical competences, innovation capabilities, internationalization competence and work community knowledge are the important characteristics of a graduate (Kajaanin ammattikorkeakoulu n.d.)

During the thesis process, competences in learning were developed by scheduling, planning and critically assessing information which was used. Also, work-community knowledge and capabilities were developed since the whole process required the skills of communicating, planning and co-operating with a client, study participants and clients. Fluent communication enabled the thesis to succeed in providing information which was requested by the client. Also, especially independent work and self-management skills became important during the process, since conducting research and the analysis really pushed the limits of learning skills and scientific understanding. Lastly, as the whole work was written in English, internationalization and the possibility for developing a career in other countries or cultures is more likely.

In addition to common competences of universities of applied sciences, Bachelor’s degrees include education-specific competences in physical education, health promoting physical activity and coaching, pedagogy and sport didactic skills and societal, management and entrepreneurial capacities (Liikunnanohjaaja (AMK) Liikunnan ja vapaa-ajan koulutus, 2013). Physical education skills were utilized in the formation of the questionnaire, and also during the writing process. Without previous knowledge, appropriate testing protocols and the ability to retrieve and critically assess related literature would have been challenging.

Also, as human wellbeing and health were at the center of the whole thesis process, competences and overall understanding surrounding these topics was vastly enhanced. A broader understanding of the whole topic was developed since literature from other fields was also included. This brought a wider perspective to a sports career, which may sometimes be strictly outcome and data oriented. Throughout these, competences were enhanced in the ability to assess and further develop wellness-based coaching and products. As regards societal, management and entrepreneurial capacities, I gained important knowledge and skills and feel that I participated to further understand subjects which are meaningful at a societal level (wellness and function of the workforce and individuals).

Overall, as the task of the university of applied sciences is to serve the development of small and medium-sized businesses and welfare services (Kajaanin ammattikorkeakoulu, n.d, a), it can be supposed that the thesis succeeded in this. In addition, other successes which came from the project are that it provided me an opportunity to become an employee for the client. This further supports the idea that the thesis succeeded at its purpose, and that it helped me as a student to present my own knowledge and competences in the sports field.

As already noticed, the sports and wellness sector are at their peak since their importance at the individual, company and societal level has been realized. I believe that the thesis process enhanced my capabilities to process larger concepts, and plan and implement processes and actions which are needed in projects or other important works. In the upcoming years, a larger amount of evidence will allow us to understand this area more deeply, and we will be able to assess occupational and individual wellness more thoroughly. I believe that in the future, my readiness and competences for supervisory and expert positions have been enhanced, due to my previous experiences in academic projects and schooling, and also my never-ending curiosity to understand our field further.

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Appendices

Appendix 1.

FIBACO työhyvinvointiprojektin kyselylomake

Nimi:	Ikä:

Minulla on hyvä terveys ja riittävästi energiaa suoriutua työstäni

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

täysin samaa mieltä

Liikun säännöllisesti ja pidän huolta kunnostani

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

3. Minulla on keinoja palautua työn kuormituksista

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

4. Työni fyysinen kuormittavuus on sopivalla tasolla

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

täysin samaa mieltä

syön terveellisesti

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

6. Koen työni mielekkääksi

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

7. Koen, että minulla on tärkeitä ihmissuhteita ja riittävä sosiaalinen tukiverkosto

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

8. Uskon voivani vaikuttaa elämääni

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

9. Minulla on mielekkäitä harrastuksia

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

10. Minulla on hyvä itsetuntemus (tunnen omat vahvuuteni ja heikkouteni)

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

11. Olen sitoutunut ja motivoitunut oman hyvinvoinnin kehittämiseen

täysin eri mieltä

jokseenkin eri mieltä

ei samaa eikä eri mieltä

jokseenkin samaa mieltä

5. täysin samaa mieltä

12. Kuvaile nykyisiä ruokailutottumuksia (ateriasisällöt ja ruokailuajat)

13. Kerro tavoitteistasi projektin ajalle ja sen jälkeen

14. Kuinka sitoutunut ja motivoitunut olet tähän työhyvinvointiprojektiin?

15. Arvioi kokemiesi kipujen voimakkuutta asteikolla 0-10. 0 on tila, jossa kipua ei ole lainkaan. Numero 10 edustaa pahinta mahdollista kipua.

Merkkaa piirrokseen raksilla kohdat, joissa koet kipua säännöllisesti