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the Workplace
Effect on Cardiovascular Disease Risk Factors
by Karen White, MS, RD, LDN, and Paul H. Jacques, PhD
research Abstract
This study assessed the effectiveness of a 12-week pilot employee wellness program in reducing risk factors for coronary
heart disease. Fifty university employees with at least one cardiovascular disease risk factor participated in the program.
Interventions focused on diet, exercise, and monthly workshops. Pre- and post-intervention measurements included
weight, body composition, blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipo-
protein (HDL) cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and blood sugar. Twenty-five employees
had post-intervention measurements. A survey was administered to assess adherence. The correlation between adher-
ence and improvement in cardiovascular disease risk factors was also tested. Significant differences were observed
between pre- and post-intervention measurements of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol
ratio, triglycerides, and weight. A significant correlation existed between self-reported level of participation in the diet
aspect of the program and improvement in LDL levels. This multi-component, 12-week pilot employee wellness program
was effective in reducing cardiovascular disease risk.
N
early two-thirds of all deaths among adults in and Treatment of High Blood Cholesterol in Adults, 2001;
the United States are attributed to coronary heart National Institutes of Health, 1998; U.S. Department of
disease, cancer, stroke, and diabetes (Centers for Agriculture and U.S. Department of Health & Human Ser-
Disease Control and Prevention, 2005). Diet contributes vices, 1992, 1995; U.S. Department of Health & Human
to the development of all four (Byers et al., 2002; Grun- Services, 2000; World Health Organization, 1998; World
dy, Pasternak, Greenland, Smith, & Fuster, 1999; Hubert, Health Organization Expert Committee, 1995). In June
Feinleib, McNamara, & Castelli, 1983; Krauss et al., 2004, the American Heart Association (AHA), American
2000; Seidell, 2000; Sherwin et al., 2004; Tuomilehto et Diabetes Association (ADA), and American Cancer Soci-
al., 2001). When stroke, hypertension, and coronary heart ety (ACS) published a joint scientific statement including
disease are included in the definition of cardiovascular recommendations for treating diabetes, cancer, and heart
disease (CVD), CVD accounts for more than one-third of disease (Eyre, Kahn, & Robertson, 2004). The recom-
the deaths among American adults (Hoyert, Heron, Mur- mendations focused on four areas: diet, exercise, cigarette
phy, & Kung, 2006). smoking, and health screenings.
To improve the health of the nation and reduce mortal- Worksite health promotion programs are an effi-
ity from these diseases, the U.S. government and several cient means of improving the health of a relatively large
government agencies have published recommendations or group of individuals (Anderson, Palombo, & Earl, 1998).
guidelines regarding dietary choices, weight, and physical Worksite interventions are convenient and accessible for
activity (Fletcher et al., 1996; Joint National Committee workers and often less expensive than programs offered
on Prevention, Detection, Evaluation, and Treatment of in clinical settings (Glantz & Seewald-Klein, 1986; Pelle-
High Blood Pressure, 2004; National Cholesterol Educa- tier, 1996; Sorensen & Himmelstein, 1992). Furthermore,
tion Program Expert Panel on the Detection, Evaluation, employers who pay for health insurance have a vested in-
terest in maintaining the cardiovascular wellness of their
About the Authors employees (Guico-Pabia, Murray, Teutsch, Wertheimer,
Ms. White is a dietitian, Bird Health Center, Western Carolina University,
Cullowhee, NC. Dr. Jacques is Assistant Professor of Management, West- & Berger, 2001).
ern Carolina University, Cullowhee, NC. Many employers have developed and assessed work-
components and improvement in CVD risk factors was for 20 of them, whereas posttest levels were higher for
also tested via simple linear regression techniques (Co- 5. At the start of the program, only 23% of participants
hen & Cohen, 1983). had optimal LDL cholesterol levels (< 100 mg/dl); by the
end of the program, 32% of those re-tested had optimal
Results LDL cholesterol levels. Despite the drastic reduction in
Significant differences were observed between pre- total and LDL cholesterol levels, HDL cholesterol levels
and post-intervention measurements of total cholesterol remained essentially unchanged, leading to a significant
(p < .001), LDL cholesterol (p = .002), total cholesterol/ improvement in the total cholesterol/HDL cholesterol ra-
HDL cholesterol ratio (p = .015), triglycerides (p = .036), tio. At the start of the program, only 60% of participants
and weight (p = .01). In addition, a significant correlation had normal triglyceride levels (< 150 mg/dl) as defined
was found between self-reported level of participation in by the National Cholesterol Education Program (2001).
the diet aspect of the program and change in LDL levels However, 88% of those re-tested at the conclusion of the
(p = .018). Tables 1 and 2 display pre- and post-interven- program had normal triglyceride levels.
tion measurements. Twenty-six participants were weighed at the end of
The most noticeable improvements included a de- the program. They had lost 80 pounds combined, or an
crease in total cholesterol levels from 202 to 179 mg/dl. average of 3.2 pounds each. Sixty-two percent of those
This 23-point drop is clinically significant and correlates completing the program lost weight, for a total of 102
with significant reduction in CVD risk. Only 36.7% of pounds, or an average of 6.4 pounds each. Nine of the 25
participants had desirable cholesterol levels (< 200 mg/dl) participants who completed the program gained weight.
at the start of the program, but 72% of those re-tested had Those who gained weight gained an average of 2.2 pounds
desirable total cholesterol levels. Twelve (48%) of the 25 (range, 0.4 to 5 pounds).
participants who completed the program had normal cho- The baseline mean blood glucose level was normal
lesterol levels (total cholesterol < 200 mg/dl) at the outset. at 87 mg/dl. Systolic blood pressure and diastolic blood
A comparison of pretest cholesterol levels with posttest pressure were also normal at 122 and 79.2 mmHg, re-
levels of these 25 showed that total cholesterol dropped spectively. Statistically significant improvements were
not seen for blood sugar or blood pressure. Only three gram to initiate behaviors leading to a healthy diet and
participants had abnormal values at the beginning; none exercise.
of them changed to normal values. Despite these limitations, findings were positive and
A correlation existed between participation in the indicate the potential value of continuing this program
diet aspect of the program and change in LDL cholesterol to determine its efficacy with larger groups. Long-term
levels (p < .02). This was the only statistically significant interventions and studies investigating the link between
relationship between program components and objective employee wellness programs and health insurance claims
outcome measurements. are warranted to support expansion of such programs
throughout the United States and in countries with similar
Conclusion health care systems.
Small sample size and low program completion rate Overall, these results suggest the multi-component,
were limitations of this study. Although participants were 12-week pilot employee wellness program was effective
informed of the second testing date several times, many in reducing weight, total cholesterol, LDL cholesterol,
asked for another testing date. These requests suggested total cholesterol/HDL cholesterol ratio, and triglycer-
more than half of the participants completed the program ides. Adherence to the dietary component was linked to
but were not available for re-testing. Despite partici- reduced LDL cholesterol. Others (Anderson et al., 1998;
pants agreeing to the date and time of the posttests at the Glantz & Seewald-Klein, 1986; Pritchard et al., 2002;
programs outset, additional dates for posttest sampling Sorensen & Himmelstein, 1992) have found dietary in-
may have reduced apparent attrition rates. However, cost tervention effective. Of the worksite wellness interven-
constraints precluded adding dates and times for drawing tions mentioned at the beginning of this article, four led
posttest samples. to reductions in total cholesterol, three to reductions in
Lack of a comparison or control group was another LDL cholesterol and weight, and one to improvements
study limitation. Comparing results with those of a con- in cholesterol. Two of the interventions led to reductions
trol group would further strengthen the assumption that in blood pressure. The intervention of the current study
the wellness program was effective in reducing CVD did not, but few of the participants had elevated blood
risk. pressure.
Selection bias may have been a limitation of the Companies employing occupational health nurses
program. Individuals choosing to participate may have could coordinate similar programs. Occupational health
been motivated by factors unrelated to this specific pro- nurses could compile dietary guidelines and exercise pre-