Employers With Metabolic Syndrome and Increased Depression/Anxiety Severity Profit Most From Structured Exercise Intervention for Work Ability and Quality of Life

Abstract

Background: Major depressive disorder and anxiety disorders are associated with less productivity, earlier retirement, and more sick-days at the workplace. These associations also exist for patients with metabolic syndrome. For both, exercise is a generally recommended part of multimodal treatments. However, for individuals with metabolic syndrome, in which depression and anxiety is more prevalent and severe, evidence for the efficacy of exercise interventions is limited.

Methods: Company employees with diagnosed metabolic syndrome (n=314, age: 48 ± 8 yrs) were randomized to a 6-month exercise intervention (150 min per week) or wait-list control. Participants received individual recommendations for exercise activities by personal meetings, telephone, or via a smartphone app. Physical activities were supervised and adapted using activity monitor data transferred to a central database. Work ability (work ability index), depression severity and anxiety severity [hospital anxiety and depression scale (HADS)], and health-related quality of live [short form 36 (SF-36)] were assessed.

Results: We included 314 subjects from which 287 finished the intervention. Total work ability, depression- and anxiety severity, and the mental component score of the SF-36 improved after 6 months exercise compared to controls. After baseline stratification for normal (HADS scores 0-7) and increased depression- and anxiety scores (HADS scores 8-21) individuals with increased severity scores had similar age, body composition, blood lipids, and cardiorespiratory fitness compared to those with normal scores, but lower total work ability and component sum scores of health-related quality of life. After 6 months total work ability increased in the exercise group compared to controls with the magnitude of the observed increase being significantly greater for subjects with increased depression- and anxiety severity at baseline compared to those with normal severity scores.

Conclusions: A 6-month exercise intervention for company employees with metabolic syndrome showed strongest effects on self-perceived work ability in individuals with mild to severe depression- and anxiety severity. This suggests exercise programs offered to workers with metabolic syndrome not only reduces individual disease risk but may also reduce healthcare and employers costs arising from metabolic syndrome and mental disease conditions.

Clinical trial registration: ClinicalTrials.gov, identifier NCT03293264.

Keywords: activity devices; mental health; physical activity; productivity; telemonitoring.

Copyright © 2020 Haufe, Kahl, Kerling, Protte, Bayerle, Stenner, Rolff, Sundermeier, Eigendorf, Kück, Hanke, Keller-Varady, Ensslen, Nachbar, Lauenstein, Böthig, Terkamp, Stiesch, Hilfiker-Kleiner, Haverich and Tegtbur.

Figures

Figure 1

Health-related quality of life as assessed with the SF-36 questionnaire before and after the 6-month intervention. (A): Physical and psychosocial subscales: PF, physical functioning; RP, role physical; BP, bodily pain; GHP, general health perception; VITA, vitality; SF, social functioning; RE, role emotional; MH, mental health. (B): Changes of the physical and mental component sum scores with the 6-month intervention. Data are mean ± SEM, * or ** = significant with p < 0.05 or p < 0.01 respectively from pre to post assessments as analyzed with T-tests for paired samples.

Figure 2

Work ability (total score) as assessed with the work ability questionnaire before and after 6-month exercise training or control. Subjects are stratified according to baseline depression and anxiety severity derived from the HADS questionnaire in subgroups of normal scores (0–7 points, triangles) or mild to moderate scores (8–14 points, circles). Data are mean ± SEM. The framed p-values are given for between-group differences (exercise- versus control group) over time as analyzed with an ANCOVA model. The p-value behind the bracket is given for the interaction of time (baseline-6 months) × study group (exercise or control) × subgroup (normal scores or mild to moderate scores) as analyzed with an ANCOVA model, indicating the 6-month exercise versus control group change in the mild to moderate HADS subgroup is greater than the change in the normal HADS subgroup.