Ethics approval and consent to participate
This study was approved by the Institutional Review Board (IRB) of Abu Dhabi Health Services Company (SEHA) under the application number SEHA-IRB-45 and performed in accordance with relevant guidelines and regulations including the Declaration of Helsinki. Informed consent was obtained from all the participants. This is an observational descriptive study reported following the STROBE Statement [21].
Study setting
This study was conducted by a specialized team from the Research and Innovation department at one of the largest companies in the UAE health sector. The company has been primed for its scientific innovation and advances in technology integrating a network of healthcare services and more than 25,000 employees.
Participants
Eligibility criteria
To be eligible to participate in the three months workplace wellness study, participants had to meet the following criteria: (a) employed at the company; (b) aged 18 years and older; (c) available during the study duration; (d) willing to commit to all the procedures and activities relevant to the study during its three months period; and (e) confirm participation through the informed consent form. The exclusion criteria included: (a) unsure or unable to fully commit to all the procedures and activities relevant to the study; (b) advised not to exercise by a licensed healthcare practitioner, regardless of the exercise type or intensity; (c) having a medical condition(s) that would prevent exercising, regardless of the exercise type or intensity; (d) pregnant or breastfeeding; (e) severe illnesses; (f) severe injury in the joints or the back; (g) planning major surgical procedures or other major treatment during the study period; (h) participating in any other health promotion program.
After obtaining agreement, participants were asked to complete self-reported overall health and well-being survey, give blood samples for blood biomarker assessment, and undergo body mass composition assessment, functional fitness assessment, and cardiovascular fitness assessment.
Variables, data sources, and measurements
The variables collected for the purpose of this study are clustered by outcomes. Table 1 describes, for each variable of interest, the sources of data and the details of the assessment method/measurements used.
Registered nurses and licensed nutritionists monitored the body composition assessment, by measuring the variables of interest. The functional fitness was assessed under the supervision of a certified fitness instructor and according to Cooper Health Institute methods. This outcome was chosen as it was a simple method to identify movement patterns asymmetries or deficiencies needed for everyday physical activity. Cardiovascular fitness assessment was performed under the supervision of a licensed cardiologist. The blood samples were collected by registered nurses to evaluate blood biomarkers to obtain a description of both the overall health status and the biological age [22].
Table 1: Outcome variables and measurements/data sources.
Outcomes
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Variables
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Measurements/data sources
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Socio-demographic characteristics
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Emirate, age, sex, nationality, ethnicity, marital status, number of children, education level, smoking status, physical activity
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Self-reported survey supervised
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Body composition
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Height, weight, BMI, waist circumference, body fat percentage
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Physical assessment
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Functional fitness
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Deep squat, hurdle step, in-line lunge, ankle clearing test, shoulder mobility, shoulder clearing test, active straight leg raise, trunk stability push-up, extension clearing test, rotatory stability, and flexion clearing test
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Physical assessment
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Cardiovascular fitness
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Systolic blood pressure, diastolic blood pressure, resting heart rate, one-mile Rockport walking test, walk completion heart rate, predicted VO2 max, fitness percentile/category
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Physical assessment
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Biomarkers for health status
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Total cholesterol, HDL, LDL, total cholesterol/HDL ratio, triglyceride, glucose fasting
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Phlebotomy
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Biomarkers for biological age
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Albumin, calcium, DHEAS (females), fasting glucose, GGT, HbA1c, hs-CRP, LDL, SHBG (males), testosterone (males), TIBC, triglycerides, red blood cells, RDW-CV, hematocrit, monocytes, neutrophils, MCH lymphocytes, eosinophils, basophils
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Phlebotomy
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Well-being
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Physical activity, sleep, fruit and vegetable consumption, sweets and sugary beverages consumption, water drinking, stress levels, tobacco consumption, alcohol consumption, physical examination
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Self-reported survey
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BMI: Body mass index; HDL: high-density lipoprotein; LDL: low-density lipoprotein, DHEAS: dehydroepiandrosterone sulfate; GGT: Gamma-glutamyl transferase; HbA1c: Glycated Hemoglobin; hs-CRP: high-sensitivity C-reactive protein; SHBG: sex hormone binding globulin; TIBC: total iron binding capacity; RDW-CV: red cell distribution width - coefficient of variation; MCH: Mean Corpuscular Hemoglobin.
Study size
This study included voluntary, convenience sample as employees were invited to participate in the study by online invitation. Additionally, the online invitation included a summary covering the nature of the study, the objectives of the study, the study procedures and activities, and the eligibility criteria.
Quantitative variables
Body composition
Height and weight were measured in meters (m) and kilograms (kg), respectively, using medical weighing scale with stadiometer. Waist circumference was measured in centimeter (cm) using measuring tape. The body fat percentage was measured using a handheld body fat analyzer, and body mass index (BMI) was calculated using weight in kg divided by the square of height in meters (kg/m2). BMI was classified into four categories: underweight (<18.5, healthy weight (18.5 – 24.9), overweight (25.0 – 29.9), and obesity (≥30.0).
Functional fitness
Functional fitness was evaluated using a functional movement screen (FMS) test kit, which was designed to provide a simple grading system to assess participant movement. The functional fitness test included movements, such as deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and rotatory stability. The test scoring ranged from 0–3 points, with 4 possible scores that a person could get. A score of 0 indicated pain during the movement. A score of 1 indicated inability to complete the full movement properly or inability to get into the correct position to execute the movement. A score of 2 indicated completing the movement with compensation. A score of 3 indicated the movement was optimal without compensations, with the sum creating a total score ranging from 0-21 points (a total score of 14 or lower indicated 1.5 times higher risk for injury than those with a score higher than 14). Other variables from the same outcome were dichotomous variables assuming the values of positive or negative, such as the shoulder clearing test, extension clearing test, and flexion clearing test. The ankle clearing test was also a qualitative variable assuming the category beyond, within, or behind, while the area requiring improvement assumed the category of mobility or stability.
Cardiovascular fitness
Cardiovascular fitness outcome was composed of numerical variables and a categorical variable. The numerical variables included systolic and diastolic blood pressure (BP), resting and exercise heart rate (HR), one-mile Rockport walking test, predicted VO2 max, and fitness percentile. Systolic and diastolic blood pressure (BP) was measured using mobile BP/vital signs monitor (normal values range: <120/80 mm Hg; prehypertension: 120-139/80-89 mm Hg; and hypertension: ≥140/90 mm Hg)). Resting HR and exercise HR (at completion of one-mile Rockport test) was measured (beats per minute, BPM) using HR monitor. One-mile Rockport walking test was conducted using commercial treadmill and walk completion time was measured in both minutes and seconds using a stopwatch. Participants were asked to warm-up for around 5-10 minutes before the walk. The predicted VO2 Max (mL/kg/min) was measured to predict an individual’s aerobic capacity using information, such as age (years), gender (male/female), body weight (kg), walking completion time (minute and seconds – expressed as a percentage) and exercise HR (BPM). The formula for calculating VO2 Max using the one-mile walk test was: 32.853 – (0.0769 × Weight) – (0.3877 × Age) + (6.315 × Gender) – (3.2649 × Time) – (0.1565 × HR). The fitness percentile (%) was generated from the predicted VO2 Max score, which represented the overall fitness.
Blood biomarkers for health status and biological age
Blood samples were collected through venipuncture. Per participant, 26 ml of blood was collected in vacutainer tubes to analyze biomarkers for health status and biomarkers relevant to biological aging [22]. The biomarkers for health status assessment included total cholesterol (mmol/L), HDL (mmol/L), LDL (mmol/L), total cholesterol/HDL ratio, triglyceride (mmol/L), glucose fasting (mmol/L). The biomarkers for biological age assessment included albumin (g/L), calcium (mmol/L), DHEAS (micromol/L; females), fasting glucose (mmol/L), GGT (IU/L), HbA1c (%), hs-CRP (mg/L), LDL (mmol/L), SHBG (nmol/L; males), testosterone (nmol/L; males), TIBC (micromol/L), triglycerides (mmol/L), red blood cells (x10^12/L), RDW-CV (%), hematocrit (L/L), monocytes (%), neutrophils (%), MCH (%), lymphocytes (%), eosinophils (%), basophils (%). The biological age was calculated using previously described methods [22].
Well-being
The well-being was assessed using a self-reported questionnaire, which identified possible areas of improvement to achieve total well-being. The 10-question assessment was composed of categorical variables assuming between 3 to 5 nominal categories and evaluated current habits and lifestyle behaviours, such as physical activity, sleep, fruit and vegetable consumption, sweets and sugary beverages consumption, water drinking, stress levels, tobacco consumption, alcohol consumption, and physical examination.
Statistical methods
A descriptive analysis was performed to report the demographic, social, and professional characteristics of the enrolled participants. Categorical data was described using percentages and continuous data was described using mean and standard deviation (SD), unless otherwise stated.