Test battery has been designed to test the physical readiness, psychological state of stress and to assess biological blood markers for stress. The participants underwent testing on the first day of the intervention and then 30, 60 and 90 days after starting the intervention.
Physical readiness evaluation. Participants’ cardiovascular fitness levels were measured using the Rockport Fitness Walking Test.10 Participant’s level of flexibility has been measured with a standardized Sit and Reach Test. Level of muscular strength has been measured by the Sit up test.
Rockport test (Vo2max test)
Participants’ cardiovascular fitness levels were measured using the Rockport Fitness Walking Test (RFWT).10 The RFWT is a 1.600 meter (m) walk test in which participants are instructed to walk the distance as quickly as possible. Results of several studies support the use of the RFWT as a reliable and valid instrument for adults with intellectual disabilities (ID). The test-retest reliability of the RFWT (r = 0.99) was established for 19 adult males with ID.10 Each participant underwent an aerobic power testing at our first meeting.
Muscle flexibility test. Participant’s level of flexibility has been measured with a standardized Sit and Reach Test. The test measures flexibility of the lower back and hamstrings. It requires a box of about 30 cm width and height. The participants are required to sit on the floor with legs straight ahead and knees flat against the floor. Feet should be placed flat against the box, leaning forward slowly as far as possible keeping the fingertips level with each other and the legs flat reaching forward towards the box. The furthest point to where participants can reach after a second attempt is marked as the flexibility level based on the standardized categories.
Muscle strength test. Level of muscular strength has been measured by the Sit up test, where the participants were required to follow a tempo of 20 per minute. Abdominal muscle strength and endurance is important for core stability and back support. This sit up test measures the strength and endurance of the abdominals and hip-flexor muscles. The participants were lying on a cushioned floor with their knees bent at approximately right angles, with feet flat on the ground. Hands were resting on their thighs. The participants were required to squeeze the stomach, push their back flat and raise high enough for the hands to slide along the thighs to touch the tops of the knees. Then they returned to the starting position and repeated the steps.
Psychological evaluation. 24alife stress profile with the help of questionnaires: personal hardiness, somatic anxiety, cognitive anxiety, self-confidence, coping strategies, well-being, general (un)health, burn out, environment. The questionnaires we were using were as follows.
General Health Questionnaire (GHQ) is a 12-item version or GHQ-12,11,12 a self-reported instrument of psychological components of health. The GHQ-12 focuses on breaks in normal function (rather than upon lifelong traits) and concerns itself with two major classes of phenomena: inability to continue to carry out one's normal ``healthy'' functions and the appearance of new phenomena of a distressing nature.
Modified Fatigue Impact Scale (MFIS)13 is a well validated 21-item questionnaire assessing several aspects of fatigue and activity. The scale was developed for clinical population particularly for the patients with multiple sclerosis, however it has been used in a healthy population for research purposes. Higher scores indicate a higher degree of fatigue. The scale can be interpreted in subscales of physical fatigue, cognitive fatigue, psychosocial fatigue, and the overall score of the fatigue scale. The MFIS contains 9 “physical” items, 10 “cognitive” items, and 2 “psychosocial” items. The maximum possible score is 84, with higher scores indicating a greater impact on quality of life. The original intention was to use the total score to reflect a global (unidimensional) score when reporting fatigue.
State-Trait Anxiety Inventory (STAI – X) measures anxiety as a stable personality trait, a persons’ disposition to be nervous instead of the more prominent use of the term assessing an emotional state characterized by subjective feelings of tension, apprehension, nervousness and worry, and by activation or arousal of the autonomic nervous system.14,15 Form X of the STAI contains 20 state anxiety items and 20 trait anxiety items. The state anxiety items are each rated on a 4-point intensity scale, from 1 for “not at all” to 4 for “very much so.” The trait anxiety items are rated on a 4-point frequency scale (from “almost never” to “almost always”). Respondents are asked to indicate how they generally feel. Scoring is reversed for anxiety-absent items (e.g., “I feel calm”). STAI was developed as a unidimensional self-report measure. 10 items are positively worded, and 10 items are negatively worded. Score range is 20–80 and higher scores indicate greater levels of anxiety. Test-retest reliability tends to be high for Trait and low for State, as expected. Test-retest for STAI Trait ranges from 0.73 to 0.86 over periods of 1 hour to 104 days. Alpha coefficients for both tests range from 0.83 to 0.95. STAI State and STAI Trait correlate between 0.59 and 0.75. The State Anxiety Scale is intended to measure transient levels of anxiety and, as such, is not expected to have high test-retest relationships. The Trait Anxiety Scale measure is positional anxiety and has been shown to be relatively stable over time.
Satisfaction with Life Scale (SWLS).16 The satisfaction with life was obtained by assessing global cognitive judgment of participants’ view of their life on a 5-item scale. There is a 7-point scale from “strongly disagree” to “strongly agree” and a score range is 5–35. A score of 20 represents the neutral point on the scale. Scores between 31 and 35 indicate extremely satisfied, 26 − 30 indicates satisfied, 21–25 indicates slightly satisfied, 15–19 indicates slightly dissatisfied, 10 − 14 dissatisfied, and 5–9 extremely dissatisfied. The scale has strong internal reliability and moderate temporal stability. Diener et al  report coefficient alphas of 0.79 to 0.89 and a 2-month test—retest stability coefficient of 0.64 to 0.82.
Maslow Burnout Inventory (MBI). The MBI was created in 1996 by Maslach, Jackson and Leiter.17 The MBI is the most well-known measure of teacher burnout and has been used in more than 90% of empirical studies on the subject.18,19 The three main components of burnout measured by the 22 questions on the MBI include: emotional exhaustion, depersonalization and personal accomplishment. Each of these three scores is measured using questions answered with a 7-point frequency scale and the answers range from 0 (“never”) to 6 (“everyday”). “Depersonalization” occurs when a teacher isolates himself from others. This variable is measured with five items on the survey that ask for the frequency with which they experience negative feelings towards other teachers and administrators. “Personal accomplishment” is the self-evaluation of the efficacy of the teacher’s own work. Eight items on the survey test the teacher’s feelings of personal accomplishment. “Emotional exhaustion” measures fatigue, frustration, and stress. Nine questions on the survey are used to create a score for this component. Since they are measured by frequency, the personal accomplishment scores were reverse-coded to match the consistency of the results.20 The average of each of the twenty-two questions yields a burnout score for individual participants.
Biological stress marker evaluation. Biological stress markers have been repeatedly evaluated and participants have been tested for the blood pressure, resting heart rate and weight. Blood tests of biochemistry and hormonal levels have been performed at the beginning and at the end of evaluation. Blood samples (EDTA tubes, 3 mL) were collected during the morning hours; plasma and cell fractions were processed on the same day of collection. Plasma aliquots were stored at -80 °C until use.
Automated Software Program. The participants have been asked to actively participate and follow the automated software-based program (24alife app), which has been designed by the experts from the fields of psychology, medicine, sports science and nutrition to holistically approach forming healthy lifestyle habits. The intervention program was a mobile app guide with daily reminders and tasks, designed to guide individual through healthy lifestyle for 3 months. Based on user’s initial state, which was specified testing battery, the algorithm behind the software dedicated the intensity of the automated program. Each participant got a personalized ratio of psychological relaxation exercises (autogenic training, breathing exercises, hypnosis), sports training exercises (endurance training, interval training, strength training), nutrition advice and reminders (eating diary, reminder to drink enough fluids), and reminders to track their bodily response to stress (BP). The technology ensured that the physical training was safe by tracking the HR zone with alerts on how to adjust the tempo of training.
Personalized motivation. Alongside the automated solution, the participants attended 4 thematic workshops led by field experts. Workshops entitled ‘’Coping with stress’’, ‘’Safe exercising’’, ‘’Do not feed stress’’ and ‘’Motivation to keep healthy habits’’ have been organized at the end of each month to educate subjects about stress and motivate participants to be more aware of the negative consequences of stress. Every week the employees joined one-hour group workout led by sports professional. The participants were asked for a feedback on satisfaction with the automated program every two weeks.