Creating Practice Opportunities

Using job requirements as the foundation for an effective warm-up program.

By Deirdre Daley, PT, DPT, Laurie J. Johnson, PT, Lisa Krefft, OTR/L, and Margot Miller, PT

Employers have been on the fast track to implement fitness and wellness programs ever since the Department of Health and Human Services (HHS) issued its final rules on employment-based wellness programs in May 2013, effective for plan years beginning on or after January 1, 2014.¹ The rules support workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health, and limit growth of health care costs to our nation. At a time when there is more competition for available jobs and an aging workforce, promoting employee health and fitness is key to a company’s success.

Private practice physical therapists have an opportunity to provide employment-based wellness programs, meeting employer and employee needs, while driving bottom line revenue for the practice.

Practices in partnership with health clubs or offering fitness programs at their facilities may identify added opportunities, but we have outlined the steps used to develop a warm-up program based on the job requirements for a national trucking company. The company’s vision was to implement a warm-up program to keep employees fit for work throughout the workday. The company reported that most soft tissue injuries were happening within the first hour of the employee’s shift. To address this, the company implemented a warm-up program based on the job requirements. Fitness and wellness programs based on job demands may also include other components in addition to warm-ups such as micro-breaks, flexibility, strengthening, conditioning, and balance.

Program Strategy

The warm-up program was an additional service for this customer. A post-offer, prework screen program and a return-to-work screen program were already in place at approximately 700 locations. The strategy for developing the warm-up program was presented to the company to facilitate their full “buy-in.” Since functional job descriptions for the jobs involved were already completed, the next step was to develop a risk assessment for each job. Possible ergonomic interventions related to identified risks were reviewed with the employer to eliminate any risks that could be addressed prior to the pilot start.

A series of job-related warm-up exercises based on the risk assessments were developed. The program needed to be appropriate for all workers, from new hires to long-term employees. Table #1, Physical Demands for Technician and Service Employee Positions, represents a sample of the physical demands, work activities, and warm-up components to consider.

Logistics and Scope

The logistics phase included developing the program components, completing the training tools and training, determining pilot length and measures, steps to rolling out the pilot, reviewing pilot outcomes, and adjusting the program as needed. Workers would be provided education about the warm-up program during orientation and through weekly safety meetings. Training for supervisors and team leads would be done via webinars.

Program Structure

Participation was designed to be group level at the beginning of each shift with supervisors and team leads trained to facilitate the program.

A training manual was developed as a reference for supervisors and team leads.
Criteria were developed so that supervisors, team leads, and employees understood contraindications to program participation.
Three 6- to 7-minute warm-up routines were developed. Having more than one routine allows for variation, options for more advanced activity, and an option for the use of props such as stools, chairs, and Thera-Bands where available. The program is voluntary and performed at the beginning of each work shift.
A critical point was for employees to understand that the program was specific to their work, the muscles they use, the positions they work in, and the flexibility needed to do their jobs.
Employees were instructed to utilize parts of the warm-up program during the workday, as they noticed fatigue setting in.
The goals of the warm-up program included:
- Reduce soft tissue injuries that were occurring early in the shift.
- Reduced muscular fatigue/discomfort.
- Improved productivity and staying on the job.
Important reminders to employees regarding the warm-up program:
- Participation is voluntary.
- It is a group activity led by a trained leader/supervisor.
- Always warm up within your “comfort zone.”
- Any activity that causes discomfort or pain should either be discontinued, repetitions of that activity decreased, or the height/angle of the arm, leg, or trunk decreased while performing that activity.
- Over time, progress to more repetitions and further reaching as comfortable.
- Stop the “warm-up” if you feel any chest pain, shortness of breath, or dizziness.

OSHA Compliance

The warm-up program was designed to be used prior to a worker’s complaint of pain or discomfort, and to be available to all employees performing the job. This meets Occupational Safety and Health Administration (OSHA) recording standards, requiring businesses to record any work-related incident that results in medical treatment beyond first aid, days away from work, restricted work activity, job transfer, loss of consciousness, or death. A key part of the OSHA guideline is what can be provided as first aid. By providing a program based on the job demands available to all employees, the likelihood is minimized that the exercise program can be interpreted as an exercise “prescription,” which may in some circumstances result in an OSHA recordable event.² This is a critical consideration in the design and implementation of any employer-based program.

Early Success

While it is too early to call the program a success, early signs are encouraging. The pilot was rolled out April 1, 2014, in one region, covering approximately 120 locations. Workers of all ages, spanning various fitness levels and various years of employment with the company, are participating; the program complements the company culture; and perceived value is high according to the program sponsor/ champion. Twenty-five locations report doing the warm-up every day; 41 locations report doing the program some of the time; 46 locations have yet to start the program. Of the locations doing the program, none have had a soft tissue injury, while three soft tissue injuries have occurred since the rollout, all from locations not on the program. The company is exploring the option to expand the program across the country. The company has also been targeting nonparticipative locations and making personal visits to explain the background and benefits of the program with terrific results reported. The company reports that in general, locations not doing the program have weaker leadership and/or managers who are not engaged.

Supportive program sponsors are key to the success of any program. Single local programs thrive from the support of an invested program sponsor. For national employers such as in this example, an invested program sponsor can assist in timing and prioritizing of sites, as well as with bringing along sites that have less desirable outcomes.

“A growing body of research suggests that nurturing employee health and wellness has a significant impact on productivity—which, as we all know, has a direct bearing on company profitability,” reports Dr. Rajiv Kumar, chief executive officer of the wellness solutions company ShapeUp in the Harvard Business Review.³ He goes on to cite a study out of Harvard that showed that for each dollar spent on wellness programs, large companies saw a return of $3.27 in reduced health costs and $2.73 in costs connected to absenteeism. This is strong support for physical therapists with specialized training in job demands analysis, ergonomics, and prevention to assist employers in developing job-related prevention programs, keeping workers at work and productive throughout the workday.

NOTES

1. Website www.dol.gov/ebsa/newsroom/fswellnessprogram.html Accessed August 2014.

2. Website www.ehow.com/info_8596882_osha-recordable-vs-osha-reportable.html Accessed 2014.

3. Website www.huffingtonpost.com/arianna-huffington/big-business-finally-lear_b_5559758.html Accessed 2014.

Deirdre Daley, PT, DPT, is the director of clinical practice at NextImage Medical/WorkWell. She can be reached at ddaley@workwell.com.

Laurie J. Johnson, PT, is an Impact editorial board member and the director of provider network and clinical implementation for NextImage Medical/WorkWell. She can be reached at ljohnson@workwell.com.

Lisa Krefft, OTR/L, is the senior director of On-Site Services at NextImage Medical/WorkWell. She can be reached at lkrefft@workwell.com.

Margot Miller, PT, is assistant managing editor of Impact magazine and the chief clinical advisor for NextImage Medical/WorkWell. She can be reached at mmiller@workwell.com.

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