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Health Benefits of Work Mar 20th, 2014

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The Australasian Faculty of Occupational and Environmental Medicine (AFOEM), a Faculty of the Royal Australasian College of Physicians (RACP), is pleased to introduce the Australian and New Zealand Consensus Statement on the Health Benefits of Work. Realising the Health Benefits of Work presents compelling international and Australasian evidence that work is generally good for health and wellbeing, and that long term work absence, work disability and unemployment generally have a negative impact on health and wellbeing. Realising the health benefits of work for all Australians requires a paradigm shift in thinking and practice. It necessitates cooperation between many stakeholders, including government, employers, unions, insurance companies, legal practitioners, advocacy groups, and the medical, nursing and allied health professions.


The following are the fundamental principles of the above document in regards to the relationship between health and work:



  1. Work is generally good for health and wellbeing;

  2. Long term work absence, work disability and unemployment have a negative impact on health and wellbeing;

  3. Work is an effective means of reducing poverty and social exclusion;

  4. Work must be safe so far as is reasonably practicable.

  5. Work practices, workplace culture and work-life balance are key determinates of individual health, wellbeing and productivity;

  6. Individuals seeking to enter the workforce for the first time, seeking reemployment or attempting to return to work after a period of injury or illness, face a complex situation with many variables.Good outcomes are more likely when individuals understand the health benefits of work, and are empowered to take responsibility for their own situation; and

  7. Health professionals exert a significant influence on work absence and work disability, particularly in relation to medical sickness certification practices



Lap Banding and Obesity Mar 20th, 2014
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DIETITIANS and EXERCISE PHYSIOLOGIST  play a vital role in optimising outcomes for people undergoing bariatric procedures. Bariatric surgery provides substantial and sustained weight loss and ameliorates obesity-related chronic disease risk factors in morbidly obese patients However this comes at the risk of complications such as nutritional deficiencies, food intolerance and further operations. What nutritional factors need to be considered pre- and post-bariatric surgery and what recommendations should health professionals make?

Bariatric procedures change the gastrointestinal system and its normal functions, affecting ingestion, digestion and absorption of food and nutrients. As a result, less food and energy are consumed, malabsorption of nutrients occurs and the body uses existing fat stores leading to weight loss. The NHMRC recognises that bariatric surgery is more effective in achieving weight loss in adults with obesity than nonsurgical weight loss interventions.  Weight loss is substantial: approximately 20—30% of body weight in people with a BMI > 35. 

As a result, obesity comorbidities — such as cardiovascular disease, dyslipidaemia, hypertension, type 2 diabetes, glucose intolerance, insulin resistance, metabolic syndrome, chronic renal disease, gastro-oesophageal reflux, polycystic ovarian syndrome, non-alcohol fatty liver disease, obstructive sleep apnoea and overall mortality risks — are reduced. It is difficult to establish however whether improvements are due to the weight loss itself, or changes in hormone balance, metabolism, pressure dynamics and mechanics caused by the bariatric surgery. 

Bariatric ops

Bariatric surgery can be considered for those morbidly obese adults who have tried all other methods of weight loss and repeatedly failed, and their mortality risk from chronic diseases is greatly increased. 

The four main surgical procedures performed in Australia are: 

Laparoscopic adjustable gastric banding (LAGB),

Roux-en-Y gastric bypass (RYGB)

Sleeve gastrectomy 

Biliopancreatic diversion. 

Dietitian’s role with bariatric patients

Accredited Practising Dietitians (APDs) are well qualified to undertake:

preoperative dietary assessments, including screening for nutritional deficiencies and treatment with supplements

commencing preoperative weight loss plans using VLCDs

post-surgery dietary assessments

counselling on progression of diet consistency

continual long-term review of nutrient markers

prescribing and reinforcing supplements

encouraging mindful eating.

Exercise Physiologist's role with bariatric patients

An exercise program is also a necessary part of the postoperative routine. Along with diet compliance, exercise helps prevent weight regain and maintain weight loss.

 


 

References

http://www.medicalobserver.com.au/news/banding-to-help-the-obese


Obesity caused one in eight hospital admissions for women Mar 20th, 2014
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Obesity caused by poor lifestyle choices such as diet are the cause of one in eight hospital admissions for women over 50-years-old, according to a new study.

Researchers from the University of Oxford found that hospital admissions for women over 50 are commonly caused by issues to do with obesity or being overweight, and that these issues accounted for around 2 million days in hospital a year. 

The research was part of the Million Women Study, one of the biggest health research projects currently taking place in the UK.

 


 


101 Reasons To Exercise - Are your reasons on here? Mar 19th, 2014

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Dietitian Talk this Friday 21st March at 11.30am Mar 19th, 2014

Temika Lee's next Dietitian Talk is on Friday 21st March 2014, 11.30am at Central West Health & Rehabilitation in Geraldton. This talk is free for gym members and people who are completing Central West Health & Rehab's Diabetes Management and Chronic Disease Prevention programs.


This talk covers:



  • Healthy Eating Habits

  • Glycemic Index

  • Fat Types and Cholesterol

  • Recipe Modification Label Reading



Unhealthy fat consumption advice too ‘simplistic’ Mar 18th, 2014
logoGuidelines urging people to eat less "unhealthy" fat may be too simplistic, new research suggests. In a meta-analysis of data from 72 studies involving more than 600,000 participants from 18 countries, researchers found no overall association between saturated fat consumption and heart disease, contrary to current advice.

In addition, levels of "healthy" polyunsaturated fats such as omega 3 and omega 6 had no general effect on heart disease risk. But different specific strains of fat did have some impact. Two kinds of saturated fat found in palm oil and animal products were weakly associated with heart disease, while a dairy fat called margaric acid was significantly protective. Similarly, two types of omega-3 fatty acid found in oily fish – EPA and DHA – and the omega-6 fat arachidonic acid were linked to a lower risk of heart disease.

Popular omega-3 and omega-6 supplements appeared to have no benefit.

 



What is more important walking speed or duration? Mar 18th, 2014
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With aging of the population chronic heart failure (HF) hasbecome a major health issue throughout the world. This study aimed to assess the association between walking and other leisure time PA and Heart Failure in a large population study with repeated examination and more than 30 years follow-up with emphasis on the independent effects of speed and duration of walking. 

Conclusions: the results suggest that intensity rather than duration may be important for risk reduction with the lowest risks seen in those reporting high speeds of walking.


Do you have a Injury Management Policy? Mar 16th, 2014
reference graphicAmong other things, the Western Australian workers’ compensation system requires every employer to:

Have workers’ compensation cover for all workers (penalties apply for avoidance).

Have a documented Injury Management Policy and Injury Management System outlining the steps the employer will take if a worker is injured and the contact details of the person who will have day-to-day responsibility for the Injury Management System.

What is an injury management policy?

An injury management policy reflects an employer’s commitment to the principles of injury management and return-to-work and forms the basis for your injury management program. Your injury management policy should focus on and address injury management and returntowork issues.

What should an employer include in an injury management policy?

Ideally, your Injury Management Policy should:

reflect your commitment to the principles of effective injury management and return to work for injured/ill workers; promoting the principles of early reporting, early intervention, injury management and the return to work hierarchy as specified in the Workcover WA Return to Work and Injury Management Model.

state your commitment to the development and implementation of an Injury Management Program, which is supplemented by written procedures, readily available in the workplace, identifying the roles, rights and responsibilities of all parties.

include the right of an injured/ill worker to choose their own ‘Accredited’ Primary Treating Medical Practitioner and participate in the selection of their Accredited Workplace Rehabilitation Provider.

require return to work plans and injury management plans be developed in consultation with all parties in accordance with the Injury Management Program.

be appropriate to the nature and scale of your organisation, be written so that it is easily understood by employees and capable of being implemented in your workplace. The policy should be developed in consultation with, and endorsed by, all workplace parties with provision for input by unions if requested by workers.

be consistent with the Workers’ Compensation and Injury Management Act 1981 and the Workers’ Compensation Code of Practice (Injury Management) 2005, other supporting legislation and guidelines and your insurers Injury Management Policy; the policy should also be consistent with your health and safety policy and other management systems.

promote continuous improvement and be reviewed regularly (annually) to demonstrate your commitment to the policy and to ensure it remains consistent with the Injury Management Program Guidelines.

be explained to all new workers joining your organisation and be displayed prominently in appropriate locations so your workers can easily read it.

While inititally daunting Central West Health and Rehabilitation IMS Assessment process can assist you to meet your Workcover WA Obligations.

Contact Us for cost effective assistance.

 


 



Workplace Based Return-to-Work Programs Mar 15th, 2014
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Employers, insurers and workers’ groups have expressed a growing interest in return-to-work (RTW) interventions after injury or illness. As disability management is increasingly being integrated into employers’ and insurers’ mandates, there has been a focus on workplace-based RTW interventions. This paper is a systematic review conducted to review the effectiveness of workplacebased RTW interventions. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace;and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator.

Conclusions: This systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs. 

For more on our IMS Assessment please contact us.

 



Walking to work and adult physical activity levels Mar 15th, 2014
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One approach to increasing physical activity levels is to promote active travel i.e. walking and cycling. There is increasing evidence of the link between adult obesity levels and travel behaviour, one indicator of which is that countries with highest levels of active travel generally have the lowest obesity rates. The objective of this study was to examine the contribution to adult physical activity levels of walking to work. Total weekday physical activity was 45% higher in participants who walked to work compared to those travelling by car. 

Conclusions: Walking to work was associated with overall higher levels of physical activity in young and middle-aged adults.

 


 



Return To Work - Optimizing the Role of Stakeholders Mar 15th, 2014

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Work disability is now conceptualized as a function of organizational, jurisdictional and social influences, rather than as primarily medically determined. Return-to-work (RTW) interventions are no longer restricted to clinic-based medical interventions: insurers have become involved through case managers; employers have realized that organizational policies impact RTW outcomes; and providers have become interested in expanding their involvement to achieve better outcomes. There is growing consensus that while attending to the physical/medical aspects of the work disabled employee is important, much of the variability in RTW outcomes is accounted for by what takes place at the workplace. There is increasing evidence of greater effectiveness ofworkplace-based interventions as opposed to interventions provided outside the workplace. Organizational factors are also known to have significant impact on work disability costs. To reduce insurance or disability costs and ensure compliance with a growing number of government regulations concerning workplace safety and disability, employers have been increasingly interested in improving their disability management practices.


This study analyzes the RTW stakeholder interests and suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders’ involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions.


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Why diets often fail? Mar 11th, 2014
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Almost everyone who has tried to lose weight has tasted the bitter pill of failure. That feeling you get when, despite all your desires to be healthier, to fit into sassier clothes or to shimmy through life (and into aeroplane seats) with greater ease and comfort, you just can’t stick with your diet and exercise plans for long enough to get there.

People failing to lose weight frequently blame themselves, as does almost everyone around them. In fact, even a sizeable proportion of health professionals consider obesity to be an individual failing. But this attitude displays complete ignorance of human physiology and how it impacts weight loss. 

 



Must Dos before you dismiss an ill or injured worker Mar 11th, 2014
If you have an ill or injured worker, you might think that it is in your best interest to get them back into the workplace and working as quickly as possible - but this is not always the case. Early return to work is not always the right approach; it can agitate and extend an issue that could have been resolved in a shorter time with more rest.

The decision to return a worker to work should be based on what the worker is capable of safely doing when they return to work.

The decision about when a worker should return to work should be made with consultation between management, the worker, and after seeking professional medical advice.

What if the worker is not fit for their pre-injury duties?

If you determine (with the advice of a medical professional) that the worker will not become fit for their pre-injury duties for the foreseeable future, you will need to decide whether:



  • you can offer the worker ongoing employment in a modified role to accommodate their condition; or

  • you are going to terminate their employment.



If both parties agree to the modified duties, then a new contract of employment can be drawn up. If this is the case, you can set goals that you and the injured worker have agreed on to ensure there is a clearly communicated expectation that the injured worker will return to their pre-injury duties.

Remember, if a worker continues on modified duties for a prolonged period with no current plan to return to their pre-injury duties, it is arguable that the worker has been permanently appointed to a new role. When this occurs, the worker's old contract of employment is effectively terminated and replaced with a new one.

If this were the case, you would be unable to dismiss the worker on the basis that they are permanently unable to return to their original position, as they have been appointed to a new role.


7 things you MUST do before dismissing an ill or injured worker

Employers are generally prohibited from dismissing an employee because of incapacity due to illness or injury. However, there are certain circumstances in which you can dismiss an employee who is ill or injured.

Before you terminate an injured worker, you must ensure that you do the following things:


  1. Obtain sound medical evidence regarding the worker's incapacity.

  2. Determine, and be able to prove, that the worker is unable to perform the job they were employed to perform.

  3. Determine, and be able to prove, that there is no reasonable measure you can take to accommodate the worker's injury or illness.

  4. Do not create an expectation in the worker that you will provide them with modified duties on an ongoing basis.

  5. Give the worker an opportunity to respond to the allegation that they are unfit for their duties and to the intention to terminate their employment.

  6. Consider the worker's length of service, employment history and the impact of dismissal on them.

  7. Check that you have no obligation to provide suitable employment under the workers' compensation legislation in your jurisdiction.


 


Reference:


http://www.healthandsafetyhandbook.com.au/



Safety culture, hardiness, and musculoskeletal complaints Mar 9th, 2014
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This study explores the mechanisms linking the psychosocial characteristics of the workplace with employees’ work-related musculoskeletal complaints. Poor safety climate perceptions represent a stressor that may elicit frustration, and subsequently, increase employees’ reports of musculoskeletal discomforts. Results from an employee sample supported that when employees’ perceived safety was considered a priority, they experienced less frustration and reported fewer work-related upper body musculoskeletal symptoms. Psychological hardiness, a personality trait that is indicative of individuals’ resilience and success in managing stressful circumstances, moderated these relationships. Interestingly, employees with high hardiness were more affected by poor safety climate.

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Figure: Interaction between psychological safety climate and psychological hardiness for predicting frustration.



Diet,sleep and exercise - Lifestyle factors related to Depression Mar 9th, 2014
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Research on major depression has confirmed that it is caused by an array of biopsychosocial and lifestyle factors. Diet, exercise and sleep are three such influences that play a significant mediating role in the development, progression and treatment of this condition. This review summarises animal and human based studies on these factors and their influence on dysregulated pathways associated with depression:



  • neuro-transmitter processes,

  • immuno-inflammatory pathways,

  • hypothalamic–pituitary–adrenal(HPA)axis disturbances,

  • oxidative stress and antioxidant defence systems,

  • neuroprogression, and

  • mitochondrial disturbances



Mental health interventions, taking into account the bidirectional relationship between these lifestyle factors and major depression are likely to enhance the benefits of treatment.



Pilates Training for People With Fibromyalgia Syndrome Mar 9th, 2014
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Pilates exercises had positive effects on pain and function, especially immediately after the exercise program. Comparison of these 2 treatment groups showed superiority of Pilates over relaxation/stretching exercises in the short term for pain and function, but no statistical difference existed between groups 3 months after the end of the treatment program. This finding points to the necessity of an uninterrupted Pilates program in order to sustain the significant improvement obtained immediately after the treatment period.

pain          pain

 


Never to late to increase your activity level Mar 8th, 2014
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Previous studies have examined the effects of mid-life physical activity on healthy ageing, but not the effects of taking up activity later in life. We examined the association between physical activity and healthy ageing over 8 years of follow-up. In comparison with inactive participants, moderate, or vigorous activity at least once a week was associated with healthy ageing, after adjustment for age, sex, smoking, alcohol, marital status and wealth. Becoming active or remaining active was associated with healthy ageing in comparison with remaining inactive over follow-up. Sustained physical activity in older age is associated with improved overall health. Significant health benefits were even seen among participants who became physically active relatively late in life.

 



Why so many Australians are obese and how to fix it Mar 7th, 2014
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In 1980 just 10% of Australian adults were obese; by 2012 this figure had risen to 25%, among the highest in the world.

The food industry lobby and their friends in government would have us believe this comes down to reduced personal responsibility for what we eat and how much we move. We might, then, expect to find evidence that people are becoming less responsible. But statistics show the opposite: we are much more likely to drive more safely, drive sober, and not smoke, for example. Yet when it comes to food, something is different. Our changing food environment has undermined our capacity to be responsible in the first place.

 

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Strength Training Vs Endurance Training Mar 6th, 2014

Dr Spence's thesis summarises the results of the first prospective randomised longitudinal study which has utilised optimal contemporary imaging methods such as MRI and Doppler ultrasound to specifically address the hypothesis that distinct training modalities have different effects on cardiac and vascular structure and function. This integrative human physiology experiment provides a comprehensive morphological and functional assessment of cardiovascular changes, challenging accepted textbook dogma by providing novel information regarding changes in both the heart and arteries of humans in response to exercise. This study directly addressed the question of differential impacts of exercise modality on vascular adaptations of arteries in humans in response to a relatively prolonged training intervention period. We conclude that both endurance and resistance modalities have impacts on arterial size, function and wall thickness in vivo, which would be expected to translate to decreased cardiovascular risk.


Prevention Program - Cost-Saving to the Employer Mar 4th, 2014
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To prolong sustainable healthy working lives of construction workers, a prevention program was developed which aimed to improve the health and work ability of construction workers. The objective of this study was to analyze the cost-effectiveness and financial return from the employers’ perspective of this program.

293 workers in 15 departments were randomized to the intervention or control group (n¼7). After 12 months, the absenteeism costs were significantly lower in the intervention group than in the control group. At 12-month follow-up, no significant differences were found with respect to the primary outcomes (work ability, mental and physical health status) and secondary outcomes (musculoskeletal symptoms), meaning that the intervention was not cost-effective in comparison with the control group. The net benefit was 641 guilders ($448.00 Aust) per worker, and the intervention generated a positive financial return to the employer.

The intervention in the present study was cost-saving to the employer due to reduced sickness absenteeism costs in the intervention group compared with the control group.

 



Real Life Case Study - Metabolic Syndrome Mar 3rd, 2014

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The following Case study is taken from Exercise is Medicine e-Newsletter.

 

James is a 52 year old academic, diagnosed with Metabolic Syndrome in 2013.  He has never smoked and consumes an average of six standard drinks a week.

As a participant of a University of Queensland study, The Effect of Exercise Intensity on Metabolic Syndrome, James was prescribed supervised high intensity interval training (HIIT) for 16 weeks (3 sessions per week) on a cycle ergometer.  Each training session consisted of 4 x 4 minutes of cycling exercise at 85-95% peak heart rate (HRpeak), alternated with 3 minutes of active recovery at 50-60% HRpeak.  A 10-minute warm-up at 60-70%HRpeak and a 3-min cool-down was also conducted within each session. Throughout all training sessions, speed was maintained at 60-70 revs per minute whilst the load was adjusted to ensure that the prescribed target heart rates were met.

James has now finished the HIIT program and is continuing the program at home three times per week.  He attends a monthly HIIT session as part of the study until the 12-month testing follow-up. 

Results

After the 16-week HIIT intervention, James no longer meets the criteria for metabolic syndrome as shown on the table below.  He is no longer on cholesterol treatment.

James’ measurements against the risk factors* for Metabolic Syndrome: 

*Risk factors according to the International Diabetes Federation (IDF) criteria

The evidence behind the intervention:

High intensity interval training (HIIT) has been shown by a recent meta-analysis (including 10 randomized studies) to be superior in enhancing cardiorespiratory fitness in patients with lifestyle-induced cardiometabolic diseases (HIIT Vs. MICT; 19.4% Vs. 10.3%) (Weston et al. 2013).  Given the ability of increased cardiorespiratory fitness in attenuating traditional risk factors of cardiovascular disease (CVD) (Blair et al. 1996; Warburton et al. 2007), this finding proves to be clinically significant.  More specifically, in 2008, a pilot study by Tjonna and colleagues showed a greater improvement in cardiorespiratory fitness (HIIT Vs. MICT; 35% Vs. 16%) and a reduction in the composite number of CVD risk factors following HIIT (4x4min at 90%HRmax, 3x/week, 16 weeks) compared to an isocaloric MICT (70%HRmax, 47 mins) in 32 patients with metabolic syndrome.  Interestingly, nearly half (45%) of the patients in the HIIT group were no longer diagnosed with the metabolic syndrome after the 16-week program compared to only 38% in the MICT group, with this change only significant in the HIIT group. Furthermore, this study also revealed HIIT to have a greater impact in other physiological measures such as insulin sensitivity, mitochondrial function, and endothelial function compared to the isocaloric MICT


Physical Activity and Happiness Mar 2nd, 2014
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To investigate the associations among changes in leisure-time physical activity (LTPA) and changes in happiness over a  12 year period. 17 276 Canadians were followed from 1994 to 2009. People who were inactive at baseline were more likely to be unhappy after 2 years and 4 years of follow-up than those who were active. Leisure-time physical activity was associated with maintaining happiness and avoiding unhappiness. Changes from activity to inactivity status from one 2-years cycle to the next were associated with changes from happiness to unhappiness.

Although the same principles of physiologic adaptation to exercise apply to nonathletes, the “motivation” factor is very different. Human-centered design holds great promise for the development of prevention programs because it incorporates patient preferences and desires as the programs are being developed.

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Job Strain as a Risk Factor for Physical Inactivity Mar 2nd, 2014
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Low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time. The authors examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). The odds for physical inactivity were 26% higher for employees with high-strain jobs (low control/high demands) and 21% higher for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). This data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.


Predictors of Work Absence Following a Work Injury Feb 27th, 2014
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This study examined if the factors associated with days of absence following a work-related injury are similar for mental health versus musculoskeletal (MSK) conditions. Mental health conditions were associated with a greater number of days of absence over the 2 years following first incapacity compared to MSK conditions. Differences were observed in employment, injury and industry variables on absence from work for mental claims compared to MSK claims. Predictors of days away from work in the 2 years following an injury differ for mental health versus MSK claims.

 

 

 


World Health Organisation - Physical Activity Feb 27th, 2014

logoKey facts



  • Physical inactivity is the fourth leading risk factor for death worldwide.

  • Approximately 3.2 million people die each year due to physical inactivity.

  • Physical inactivity is a key risk factor for noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes.

  • Physical activity has significant health benefits and contributes to prevent NCDs.

  • Globally, one in three adults is not active enough.

  • Policies to address physical inactivity are operational in 56% of WHO Member States.

  • WHO Member States have agreed to reduce physical inactivity by 10% by 2025.