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Abstract

Purpose: This study describes the prevalence of physical activity programs at Danish workplaces with one-hundred or more employees

Design: Cross-sectional

Setting: Denmark

Subjects: All private and public workplaces of the designated size (n=2422).

Measures: A two-phase research model was used. Phase 1 consisted of telephone interviews involving all workplaces. Phase 2 was conducted using a structured, self-administered questionnaire which elicited more detailed descriptions of workplaces identified as promoting physical activity (n=449). Response rates were 92% and 69% in Phases 1 and 2 respectively.

Data Analysis: Data were analyzed using StatView statistical software.

Results: 18.6% of all workplaces (n=2422) offer employees opportunities for physical activity on a regular basis. Analysis of the data from workplaces included in Phase 2 (n=449) showed the following: The most frequently cited motive for providing opportunities for physical activity is to promote social contact between employees.
63% of the workplaces have instructors for the activities on offer, while 39% mention that some form of assessment is linked to the offer of physical activity. 50% of the programs have been implemented within the last ten years.

Conclusions: The results indicate that the concept of physical activity as part of everyday working life has acquired real momentum in Denmark in recent decades, but nevertheless is still at an early stage.

Physical activity at the workplace—a historical outline

Physical activity at the workplace is not a recent phenomenon in Denmark. Traditional company sports began more than half a century ago and were organized in a national association. The primary aim of this association over the years has been to organize competitions and tournaments among various firms and companies. However, only recently has physical activity received much attention as a catalyst for health and well being among employees, or as a building block in corporate culture.

Thus, marked promotion of physical activity at the workplace first emerged in 1987 when the Danish government presented the Government Preventive Program, influenced by WHO’s strategy Health for All—Year 2000 (Ministry of Health, 1989). In the subsequent action plans, it is the relationship between physical activity and the prevention of specific illnesses that has been the constant theme—although the 1990s saw a change of emphasis, with concepts like well being and social determinants of health coming to the fore. This latter trend is reflected partly in a variety of educational initiatives dealing with the promotion of physical activity and fitness, and partly in official governmental guidelines for the implementation of physical activity at workplaces from 1997 onwards (National Board of Health, 1997). The overall development has been borne out through the publication and promotion of the ambitious 2002 government strategy entitled Healthy throughout life – a follow-up on The Danish Government Programme on Public Health and Health Promotion 1999-2008 published in 1999 (Ministry of Health, 1999. Government of Denmark, 2002).

In continuation of these political and health policy trends, this article presents one of few comprehensive overviews of physical activity programs at Danish workplaces. The results obtained and experiences gained from this survey should be used to promote the continued implementation of workplace fitness programs in particular and of workplace health promotion in general. Furthermore, this article seeks to make a contribution to the collection of fundamental knowledge and facts which is needed in order to make possible international comparative research into minor or major aspects of health promotion.

Methods

Design
The results presented in this paper are from an exploratory survey which was conducted with the aim of systematically collecting background data on a subject of which relatively little is currently known, namely health promotion and physical activity at the workplace in Denmark. It was decided to collate a limited amount of information from a large number of survey returns concerning key variables related to both structural and human resources.
The aims of the national survey were thus:

• To determine the number of Danish workplaces offering physical activity to employees on a regular basis
• To identify trends underlying the programs offered
• To determine who is responsible for these programs
• To describe how and where programs are made available
• To document who meets the costs of establishing and running programs.

Sample
The sample included all private and public workplaces in Denmark with one-hundred or more employees. Statistics Denmark provided information as regards the name, addresses, and telephone numbers of each workplace, the type of workplace, and the number of employees. The data were arranged geographically, listed by municipality. Statistics Denmark updates information on roughly ½ million Danish workplaces every sixth month, and supplies information requested within ten days. The basic data can be regarded as extremely reliable, because of the close co-operation between Statistics Denmark and the Danish taxation authorities.

The grounds for selecting one-hundred employees as the lower limit were:

1. The lower limit was chosen in the light of the time and resources available for the study. 2,422 Danish workplaces were registered as having one-hundred or more employees. This was considered to be a practicable number of workplaces to investigate, given the above mentioned conditions.
2. Experiences gained from a pilot project carried out some years ago, concerning the extent of opportunities for physical activity at workplaces in a selected region of Denmark, indicated one-hundred employees as a suitable threshold value. The pilot study investigated all workplaces with at least twenty employees. It was found that only one of the workplaces offering physical activity on a formal, planned and regular basis had less than one-hundred employees (Berggren & Skovgaard, 1995). This finding is somewhat different from results presented in other research studies where physical activity, defined in much the same way as mentioned above, is frequently cited as a current health promotion initiative at workplaces employing less than one-hundred people (Wilson et al., 1999).

Measures
Collection of data was divided into two phases:

Phase 1: Selection via telephone contact
The 2,422 workplaces were contacted over the telephone. The use of a protocol assisted interview system made it possible to discriminate between a group of workplaces that were to take part in the later survey and a group that did not live up to a criterion concerning workplace promotion of physical activity.

Workplace promotion of physical activity was defined for the respondents as: activities which lay outside the auspices of the three national Danish sports associations and offered employees at least thirty minutes of physical activity once a week or more frequently.

Furthermore, it was a requirement that respondents could answer ‘yes’ to one or both of the following sub-criteria:

1. The ongoing initiatives regarding physical activity takes place solely or partial at the workplace;
2. Workplace management bears some of the running expenses in connection with the activities.

The protocol assisted interview system included a standardized interview guide. This gave a detailed definition of the term workplace promotion of physical activity. There was a set of instructions related to the interview guide which stipulated a specific order in which questions were to be asked. This meant that the sub-criteria were mentioned last. The interview protocol required that if the initial contact person (typically someone in the secretariat) was unable to provide the information requested, this person should be asked to transfer the request to another contact person (usually someone in the personnel or administrative department).

The telephone interviews were conducted by qualified personnel with experience in working on questionnaire-based projects. Before the work started there were two preparatory meetings in which the interview protocol was reviewed, commented upon, and revised.

Of the initial 2,422 workplaces listed, it proved impossible to get in touch with 163. A further twenty workplaces either could not or refused to participate in the survey. There was thus no information available for a total of 183 workplaces. Ninety-two percent of the companies in the sample were reached in Phase I, and this was judged to be acceptable.

Phase 2: Detailed questionnaire survey
This part of the survey covered all workplaces that fulfilled the requirements set out in the definition of workplace promotion of physical activity.

All workplaces that fulfilled these conditions agreed to take part in the subsequent survey, based on a structured, self administered questionnaire, which was to be answered in writing and returned in an enclosed addressed reply envelope. The questionnaire had a total of thirty-two questions with multiple choice response categories, frequently with the possibility of adding further comments in marked sections.

The questionnaire form was sent to a named contact person at the workplace who was selected as being a knowledgeable and appropriate informant in this context.

Of the 449 workplaces that received the questionnaire (corresponding to 18.6% of all Danish workplaces with at least one-hundred employees), 310 (69%) responded. An analysis of the non-respondents showed no systematic and consistent pattern when respondent and non-respondent groups were compared with respect to:

• Number of employees
• Whether the workplace was in the private or public sector
• Type of workplace
• Geographical location (postal code)

Analysis

This article is mostly based on the information collected by means of the questionnaire survey. The internal missing response rate, i.e. the proportion of a given questions to which no response was made on the survey forms returned, never exceeded 3% and followed no systematic pattern. The internal missing responses are therefore considered to have only minor effect on the reliability of the survey results.
The data from the forms were entered into a database by a firm specializing in this type of work.
The data entered were then checked for errors against the original questionnaire forms.
Descriptive data analysis was carried out using the StatView statistical software package.

Results

General data—the size of workplaces
18.6% of all Danish workplaces with at least one-hundred employees offer regular physical activity as previously defined. A comparison with the results from the pilot study cited above suggests that a large increase in the number of Danish workplaces offering physical activity has taken place over a short period of time. The national survey also shows that roughly half of the workplaces have begun to offer opportunities for physical activity within the last decade. It is also noteworthy that in only one in five states were making such an offer before 1980.

As shown in table I (part A), nearly half (48%) of the Danish workplaces offering regular physical activity have 100-199 employees, while about a third of the workplaces (32%) lie within the 200 499 range. The somewhat smaller figure for larger workplaces (those with five-hundred or more employees) that offer opportunities for physical activity corresponds quite closely to the overall number of such larger workplaces existing in Denmark. Indeed, Table I suggests that as a rule, the proportion of Danish workplaces, which fall within a given size group, tends to tally with the share of workplaces offering physical activity within the same size group.

From the outset, it was assumed that physical activity programs at the workplace would be more prevalent among smaller and medium sized workplaces. This expectation was based on the conjecture that it would perhaps be easier to agree on perspectives and aims of physical activity at smaller and medium-sized workplaces. The findings described above do not support such an assumption.
Who initiates physical activity at the workplace, and why?
At almost half the workplaces investigated (44%) it was the employees who had taken the initiative. If one includes joint initiatives between employees and employer, the involvement of employees grows to 79%. The initiative came from management alone in only 19% of workplaces.

Table I suggests that within the last decade a shift has taken place in the primary reasons given for introducing physical activity at Danish workplaces. Surveys conducted at selected workplaces in the early and mid 1990s pointed to a clear emphasis on such aims as ‘to reduce absence due to illness’ and ‘to increase efficiency’ (Andersen, Berggren, & Lüders, 1996). The national survey, on the other hand, shows that the three most frequently cited aims are:

• To promote social contact between employees
• To accommodate employee requirements
• To contribute to the overall work environment

Activities offered
The national survey shows that the three most frequently offered activities at Danish workplaces are weight training, cardiovascular exercise using fitness equipment (e.g. steppers, treadmills, ellipticals, and rowers), and various kinds of aerobics.

Table II shows that while almost 80% of all workplaces state that weight training is offered, this figure falls to 70% if the requirement is for both weight training and cardiovascular exercise using fitness equipment to be offered. The fall becomes even more dramatic if activities such as aerobic dance and general gymnastics are included as well.

It is noteworthy that just over 10% of all workplaces have such wide ranges of activities on offer that they include all the four types of activity mentioned above.

Establishing and running activities
Financially, the provision of physical activity at the workplace involves both employers and employees. Table II shows that meeting the costs incurred in establishing the facilities for physical activity involves the employer to a considerable extent. In 35% of cases this is done in cooperation with the employees. In roughly one out of ten cases the economic burden of establishing the activities is the sole concern of the employees.

The employer is also involved in the running costs, as just over 30% of companies state that the employer covers the annual running costs, while another 40% report that the users and the employer share these costs.

In 20% of cases it is the employees alone who cover the running costs, while in a small proportion of workplaces (6%) the running costs are financed in some other way, for example through grants from unions or foundations.

Access to facilities for physical activity
Workplaces were asked to what extent they offer physical activity within and outside working hours. It is a motivating factor for the employees that the workplace offers such facilities during working hours. Furthermore, the use of working hours for physical activity implies that the workplace takes the task of activating employees seriously.

Sixty-two percent of the workplaces investigated stated that physical activity is only offered outside working hours. Thus, at most of the investigated workplaces the willingness to invest in employees’ physical activity by reducing the hours spent working is not present. It is, however, notable that 32% of workplaces state that such activity is available both within and outside working hours.

In almost 90% of workplaces the offer is predominantly taken up immediately after work. To some extent, this might be because it can be awkward to return to the workplace once one has started on domestic or other commitments.

Who provides instruction?
The survey shows that 63% of workplaces provide instructors in connection with some of the activities on offer. It transpires, however, that in only 32% of cases are all activities conducted under some form of guidance. The activity that most typically lacks such guidance is the use of weight training equipment.

Only two out of five instructors state that they have some form of relevant formal training for the job. Furthermore, the survey reveals that the majority of those who have had such training acquired their knowledge through weekend or other short courses.

Family
Just over 40% of the workplaces state that members of employees’ families also have access to the activities. A slightly higher proportion (43%) does not admit other members of the family or partners. The difference in the size of these two groups is, however, so small that it cannot be said that there is any clear tendency for workplaces to either give or deny family members access to physical activity facilities.

Evaluation
Thirty-nine percent of the workplaces state that some form of evaluation is linked to the offer of physical activity, but it is only very few (11%) of these that can be said to conduct a systematic, regular assessment of their activities. This is not, however, a distinctively Danish phenomenon, but rather an indication of a general trend whereby the majority of health promotion programs are not subject to evaluation. Useful evaluation demands adequate resources: the availability of time, money, and regular staff or consultants skilled in carrying out evaluation activities. Company budgets rarely allow room for such ideal provisions (Chapman, 1999).

Discussion

Summary
This study constitutes one of the first Scandinavian attempts at a national survey of workplace promotion of physical activity. In general, the data presented in this article should be seen as an attempt to provide the fundamental information and analysis that is needed for cross-national comparisons on health promotion topics.

Just under 19% of all Danish workplaces with at least one-hundred employees make regular provision for physical activity. The results suggest that the size of the workplace appears to have no independent effect on the extent to which opportunities for physical activity are provided. Interestingly enough, four-fifths of the programs currently in operation began during the last twenty years. It is also worth mentioning that in around 40% of cases, employees and employers both contribute to establishment and running costs for the programs. Furthermore, it should be noted that the majority of workplace exercise programs only offer a limited range of activity types, and make no provision for systematic evaluation of the programs through user surveys, measurement of results, etc. This last finding is to be viewed in light of the fact that the three most frequently named goals of the provision of opportunities for physical activity are related to the well-being of employees and general working conditions.

Limitations
This study has a number of limitations.

First, there has been no previous attempt to measure the extent and nature of the provision of opportunities for physical activity at Danish workplaces. In 1997, 2002, and 2005 the National Board of Health commissioned inventories on health promotion activities and strategies at Danish workplaces (National Board of Health, 2006). The reports coming out of this work also deal with physical activity. However, the National Board of Health applies a much broader definition of workplace promotion of physical activity than the one used in the present study. The various dataset are therefore non-comparable and dynamic studies of development over time are not possible.

Second, the data collecting process was designed with the analysis of aggregated data in mind. It is therefore not possible to use the data to evaluate exactly how the various physical activity programs operate and why they have been set up as they are, or to determine whether there are typical decision-making and amendment processes which lead to the establishment, revision, and abandonment of physical exercise programs.

Third, although the survey instruments used standard items, estimates of reliability and validity are not available. However, for Phase 1 of the survey, the protocol assisted interview system was developed by a working group comprising people who all had previous experience with questionnaire-based projects. The questionnaire used in Phase 2 was constructed on the basis of a form used in the mentioned pilot study concerning a respondent group very similar to that in the national survey.

Implications
Official action programs promoted by Danish Government at central, regional, and local levels, and networks such as the WHO project Healthy Cities, have frequently stressed the need to offer physical activity as part of general strategies related to workplace health promotion (Ratzan, Filerman, & LeSar, 2000. Danish Healthy Cities Network, 2004). Recently, focus on this area has increased due to new legislative initiatives that obligates municipal authorities to be the driving force in prevention and health promotion matters. The workplace has been pointed out as an obvious setting through which to reach the adult population (National Centre for Workplace Health Promotion, 2005).

Initiatives such as the ones mentioned have included only brief comments related to the problem of adherence to and compliance with workplace exercise programs, and to the role of instructors in this perspective. In contrast to the situation in many other western countries, there are no Danish guidelines or rules that regulate and promote the trainer/instructor dimension of the field of fitness and physical activity at the workplace. Partly for this reason, most Danish workplaces offering physical activity have still not fully accepted the consequences of the relationship between the earlier stated reasons for implementing workplace fitness programs (cf. Table 1, part B) and the central role of the instructor when what is expected is both improvement in the physical condition of individuals and a general improvement to the overall work environment. The results presented indicate that only a small proportion of workplaces ensure that their instructors have or obtain relevant pedagogical experience and theoretical knowledge.

This state of affairs can be linked to the survey finding that only about 10% of all workplaces have multi-range fitness programs that include more than three types of activity (Table II). Greater variation and breadth in developing and implementing workplace physical activity schemes could very likely influence the number of participants and the pattern of employee exercise adherence and compliance. In general, careful planning and making exercise a more pleasurable part of the work environment appear to have at least a short-term positive effect on exercise adherence (Blue et al., 1995. Andreasen & Møller-Jørgensen, 2005). However, for many longterm adherence to exercise programs is a greater challenge. As Chen et al. (2005) point out “The biggest challenge of a work-site fitness program is to sustain long-term interest and enthusiasm”. This conclusion could be applied to both the individual and organizational level (Atlantis et al., 2006). Workplaces wanting to support such long term efforts must be prepared to invest many types of resources (eg. human, financial, organizational) (Nurminen E, 2002). Another challenge is engaging the more sedentary part of the workforce. In general participation rates in workplace health promotion programs are not that impressive and those who do take part tend to the employees whose general health and health behavior profile is better than average (Healthy People 2010, online documents A).

It is important to stress that though this survey shows that only approximately 20% of Danish workplaces with one-hundred or more employees offer exercise programs, compared to, for example, the situation in the United States, where the corresponding figure is about 50% (Healthy People 2010, online documents B), this is not to be taken as a precise indication of the overall physical activity level in the Danish adolescent and adult population as a whole. Thirty-seven percent of men and 23% of women in Denmark over the age of 15 are members of one or more sport associations and 72% of the total adult population state that they engage in leisure time sport activities on a regular basis (Fridberg, 2000, Larsen, 2003). Moreover, while about 80% of the Danish adult population is moderately active at least four hours a week this is the case for roughly 40% of the same group in the United States (Kjøller & Rasmussen, 2002. US Department of Health and Human Services, 1999).

At the same time, it must be noted that about half of the Danish adult population is not physically active in a degree that complies with the primary public recommendation of minimum thirty minutes of moderate-intensity physical activity per day (National Board of Health, 2002: Jørgensen and Rosenlund, 2005). This dismal figure corresponds quite well with the WHO estimate that at least 60% of the global population fails to achieve the recommendation of at least thirty minutes moderate intensity physical activity daily (WHO, 2003, WHO, 2004).

Lastly, it must be pointed out that the vast majority of Danish workplaces have hitherto not considered workplace exercise promotion as a task in which they played any major role. Only with the stronger political signals of the last ten to twenty years, concerning the workplace as an important setting for health promotion and disease prevention, has it been possible to see much movement and shift of perspective regarding the area of workplace physical activity among the many decision-makers of importance in this nexus.

Perspectives: Implications for practitioners and researchers within sports- and health promotion science

The survey data and other information presented in this article indicates that workplace fitness programs in Denmark have been gaining ground, especially in the last ten to twenty years. Combined with other research suggesting that the Danish labor market as a whole is putting more and more energy into the general field of health promotion, there seems to be support for the assumption that the amount of work available for health promotion practitioners is on the increase and that workplaces are interested in using health activities as a means of promoting their employees’ well being. If this assumption is correct, future effort should ensure that:

• the personnel engaged in physical activity and health promotion at workplaces should receive better training and education in exercise and health related issues. With a view to encourage development of educational programs and tailored personnel engaged in workplace health promotion, national guidelines should be considered in order to increase the standards for the education of health promotion and/or exercise professionals in workplace settings. Countries such as the US, Germany, and the UK offer suitable models for established standards for exercise professionals. A future objective could be to implement a common reference system in the EU to promote good practice as regards Workplace promotion of physical activity. An effective starting point is the general quality criteria for workplace health promotion developed by the European Network for Workplace Health Promotion (ENWHP).
• the many separate initiatives concerning health promotion, including physical activity, must be linked to general efforts made by public authorities to improve workplace health and safety.

 

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Basic information concerning workplace fitness programs I
Total sample (n=2,422)*
Part A
Number of employees	100-199	200-499	500-999	1000+	Unknown
Variable
Percentage of all Danish workplaces (100+ employees)	52	33	11	3	1
Percentage of all Danish workplaces (100+ employees) with fitness programs	48	32	12	5	3
Part B Most frequently mentioned reasons for implementing physical activity at the workplace
Variable	%
To promote social contact among employees	28
To meet employee requirements	18
To contribute to the work environment	14

* While the total sample size was 2,422 workplaces, the number responses to questions included in this table ranged from 2,349 in Part A and 2,400 in Part B.

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Basic information concerning workplace fitness programs II
Total sample (n=310)*
Range of activities on offer	Establishing Programs	Running Programs
Variable:	Variable:	Variable:
activities included in workplace fitness programs	who covers the preliminary expenses?	who covers the annual running expenses?
	n	%		n	%		n	%
1i	239	78	employees	37	12	employees	62	20
1+2ii	214	70	employer	127	42	employer	102	34
1+2+3iii	86	28	employee/employer	105	35	employee/employer	121	40
1+2+3+4 iv	34	11	others	32	11	others	19	6

* While the total sample size was 310 workplaces, the number responses to questions included in this table ranged from 301 to 306.

ⁱWeight training
ⁱⁱWeight- and cardiovascular exercise training
ⁱⁱⁱWeight- and cardiovascular exercise training and aerobics
^iv Weight- and cardiovascular exercise training, aerobics, and general gymnastics

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