A multicomponent structured health behaviour intervention to improve physical activity in long-distance HGV drivers: the SHIFT cluster RCT

Stacy A Clemes* (Corresponding Author), Veronica Varela-Mato, Danielle H Bodicoat, Cassandra L Brookes, Yu-Ling Chen, Edward Cox, Charlotte L Edwardson, Laura J Gray, Amber Guest, Vicki Johnson, Fehmidah Munir, Nicola J Paine, Gerry Richardson, Katharina Ruettger, Mohsen Sayyah, Aron Sherry, Ana Suazo Di Paola, Jacqui Troughton, Simon Walker, Thomas YatesJames King

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background
Long-distance heavy goods vehicle drivers are exposed to a multitude of risk factors associated with their occupation. The working environment of heavy goods vehicle drivers provides limited opportunities for a healthy lifestyle, and, consequently, heavy goods vehicle drivers exhibit higher than nationally representative rates of obesity and obesity-related comorbidities, and are underserved in terms of health promotion initiatives.

Objective
The aim of this trial was to test the effectiveness and cost-effectiveness of the multicomponent Structured Health Intervention For Truckers (SHIFT) programme, compared with usual care, at both 6 months and 16–18 months.

Design
A two-arm cluster randomised controlled trial, including a cost-effectiveness analysis and process evaluation.

Setting
Transport depots throughout the Midlands region of the UK.

Participants
Heavy goods vehicle drivers.

Intervention
The 6-month SHIFT programme included a group-based interactive 6-hour education session, health coach support and equipment provision [including a Fitbit® (Fitbit Inc., San Francisco, CA, US) and resistance bands/balls to facilitate a ‘cab workout’]. Clusters were randomised following baseline measurements to either the SHIFT arm or the control arm.

Main outcome measures
Outcome measures were assessed at baseline, with follow-up assessments occurring at both 6 months and 16–18 months. The primary outcome was device-measured physical activity, expressed as mean steps per day, at 6-month follow-up. Secondary outcomes included device-measured sitting, standing, stepping, physical activity and sleep time (on any day, workdays and non-workdays), along with adiposity, biochemical measures, diet, blood pressure, psychophysiological reactivity, cognitive function, functional fitness, mental well-being, musculoskeletal symptoms and work-related psychosocial variables. Cost-effectiveness and process evaluation data were collected.

Results
A total of 382 participants (mean ± standard deviation age: 48.4 ± 9.4 years; mean ± standard deviation body mass index: 30.4 kg/m2 ± 5.1 kg/m2; 99% male) were recruited across 25 clusters. Participants were randomised (at the cluster level) to either the SHIFT arm (12 clusters, n = 183) or the control arm (13 clusters, n = 199). At 6 months, 209 (54.7%) participants provided primary outcome data. Significant differences in mean daily steps were found between arms, with participants in the SHIFT arm accumulating 1008 more steps per day than participants in the control arm (95% confidence interval 145 to 1871 steps; p = 0.022), which was largely driven by the maintenance of physical activity levels in the SHIFT arm and a decline in physical activity levels in the control arm. Favourable differences at 6 months were also seen in the SHIFT arm, relative to the control arm, in time spent sitting, standing and stepping, and time in moderate or vigorous activity. No differences between arms were observed at 16–18 months’ follow-up. No differences were observed between arms in the other secondary outcomes at either follow-up (i.e. 6 months and 16–18 months). The process evaluation demonstrated that the intervention was well received by participants and that the intervention reportedly had a positive impact on their health behaviours. The average total cost of delivering the SHIFT programme was £369.57 per driver, and resulting quality-adjusted life-years were similar across trial arms (SHIFT arm: 1.22, 95% confidence interval 1.19 to 1.25; control arm: 1.25, 95% confidence interval 1.22 to 1.27).

Limitations
A higher (31.4%) than anticipated loss to follow-up was experienced at 6 months, with fewer (54.7%) participants providing valid primary outcome data at 6 months. The COVID-19 pandemic presents a major confounding factor, which limits our ability to draw firm conclusions regarding the sustainability of the SHIFT programme.

Conclusion
The SHIFT programme had a degree of success in positively impacting physical activity levels and reducing sitting time in heavy goods vehicle drivers at 6-months; however, these differences were not maintained at 16–18 months.

Future work
Further work involving stakeholder engagement is needed to refine the content of the programme, based on current findings, followed by the translation of the SHIFT programme into a scalable driver training resource.
Original languageEnglish
Number of pages210
JournalPublic Health Research
Volume10
Issue number12
Early online date1 Nov 2022
DOIs
Publication statusPublished - Dec 2022

Bibliographical note

This project was funded by the National Institute for Health and Care Research (NIHR) Public HealthResearch programme (reference 15/190/42). The study was also supported by the NIHR LeicesterBiomedical Research Centre which is a partnership between University Hospitals of Leicester NHSTrust, Loughborough University, and the University of Leicester. Funding to cover intervention costs(e.g. Fitbits, cab workout equipment) was provided by the Higher Education Innovation Fund, viathe Loughborough University Enterprise Projects Group. The Colt Foundation provided funding fora PhD studentship, awarded to Amber Guest (reference JD/618), which covered Amber Guest’s timeand contributions to this project.

Data Availability Statement

All data requests should be submitted to the corresponding author for consideration. Access to available anonymised data may be granted following review

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