Worksite health promotion programs with environmental changes: a systematic review.

BACKGROUND It is now widely believed that health promotion strategies should go beyond education or communication to achieve significant behavioral changes among the target population. Environmental modifications are thought to be an important addition to a worksite health promotion program (WHPP). This review aimed to systematically assess the effectiveness of WHPPs with environmental modifications, on physical activity, dietary intake, and health risk indicators. METHODS Online searches were performed for articles published up to January 2004 using the following inclusion criteria: (1) (randomized) controlled trial (RCT/CT); (2) intervention should include environmental modifications; (3) main outcome must include physical activity, dietary intake, and health risk indicators; and (4) healthy working population. Methodologic quality was assessed using a checklist derived from the methodologic guidelines for systematic reviews (Cochrane Back Review Group), and conclusions on the effectiveness were based on a rating system of five levels of evidence. RESULTS Thirteen relevant, mostly multicenter, trials were included. All studies aimed to stimulate healthy dietary intake, and three trials focused on physical activity. Follow-up measurements of most studies took place after an average 1-year period. Methodologic quality of most included trials was rated as poor. However, strong evidence was found for an effect on dietary intake, inconclusive evidence for an effect on physical activity, and no evidence for an effect on health risk indicators. CONCLUSIONS It is difficult to draw general conclusions based on the small number of studies included in this review. However, evidence exists that WHPPs that include environmental modifications can influence dietary intake. More controlled studies of high methodologic quality need to be initiated that investigate the effects of environmental interventions on dietary intake and especially on physical activity in an occupational setting.