WORKPLACE

WELLNESS: KEEPING
FIT AT WORK
Lohindren V. Adorable, MD, FPARM
Chairman, Department of Rehabilitation Medicine, Vicente Sotto Memorial Medical Center
Dean, College of Rehabilitative Sciences, Southwestern University
Head, Medical Education Unit, University of Cebu School of Medicine
Medical Director, Sacred Heart Hospital
?
SITUATIONER

NCDs/Chronic Diseases account for:

2005
60% of deaths = 35,000,000
80% of deaths in low and middle income countries
48% of disease burden (DALY)

2020
73% of deaths
60% of disease burden
- WHO
SITUATIONER
TEN LEADING CAUSES OF DEATH
1900 1987 2005
1. TB Heart Disease Heart Disease
2. Pneumonia Cancer Cancer
3. Diarrhea Stroke Stroke
4. Heart disease Injuries COPDs
5. Liver disease Bronchitis/ Emphysema Accidents
6. Injuries Pneumonia/Influenzae Diabetes
7. Stroke Diabetes Alzheimer’s Disease
8. Cancer Suicide Pneumonia/Influenzae
9. Bronchitis Chronic liver disease Kidney disease
10. Diphtheria Arteriosclerosis Septicemia
- WHO
 SITUATIONER
7 out of 10 leading causes of mortality are diseases of:
 the heart
 vascular system
 malignant neoplasms
 accidents
 COPDs
 DM
 kidney diseases seen as ESRD due to HPN and DM

2 out 10 leading causes of morbidity

 hypertension
 diseases of the heart
- FHSIS
SITUATIONER
RISK FACTORS FOR CAD

Risk Factor Defining Level

• Abdominal obesity; waist
circumference
Men >102cm (>40 in)
Women >88cm (>35 in)
• Triglycerides >150 mg/dl
• HDL Cholesterol
Men <40mg/dl
Women <50mg/dl
• Blood pressure >130/>85 mmHg
• Fasting blood glucose >110mg/dl
• Cigarette smoking
• Sedentary lifestyle
• Family history, race, age
SITUATIONER
90% of Filipinos has one or more of these 6 prevalent risk factors
Physical inactivity……60.5%
Smoking………………34.8%
Hypertension………….22.5% (SBP>140 or DBP>90)
Hypercholesterolemia ..8.5% (TC>240)
Obesity………………..4.9% (BMI>30)
Diabetes………………4.6%

- NNHeS, FNRI
How much do you sit?
The Effects of Prolonged Sitting
Back and Neck problems
Spinal disc bulging
Decreased lung function
Increased Blood Pressure
Decreased circulation
Deep Vein Thrombosis

Diabetes + Insulin resistance

Raised cholesterol

Up to 90% decrease in enzyme activity

More stuff that is yet to be proven

 The major causes of back
+ neck pain in the office environment

Extended or repetitive computer use

Inappropriate workspace set-up

Lifting and handling

Worksafe
Extended or repetitive computer use
The effects of sitting on the body
The opposite of sitting and how to use it

Inappropriate workspace set-up

The science of ergonomics – OH+S

Lifting and handling

Core muscles and how to use them
 Some facts and figures
A typical serious back injury can result in 4-weeks off work

25% of serious back injuries result in 12 weeks + off work

20% of serious compensation claims

are due to back/neck pain
Over 20% of injuries that occur in many
office environments are back or neck related
WELLNESS
a state of good health
often achieved
through healthy
lifestyle choices
- Edlin and Golanty, 2010
 PREVENTION
 Primary preventing a target problem or
condition in an individual or in a community at
risk
 Secondary decreasing the duration and
severity of disease
 Tertiary decreasing the degree of disability
and promoting rehabilitation for individuals with
chronic or irreversible diseases
- Kisner and Colby, 2007
PREVENTION THROUGH FITNESS
Fitness
“The ability to meet
the needs of our
daily requirements
without undue
fatigue, with surplus
left over for leisure
pursuits and
emergencies."
Total Fitness
"a state of
complete
physical,
mental, social
and spiritual
well-being"
that far
surpasses just
being free of
illness and
health.
Total Fitness is achieved by:
1.participation in regular exercise or
physical activity
2.proper nutrition choices and lifestyle
3.developing the ability to handle
stress
4.improving one's social and inter-
personal abilities
5.spending time to reconnect with your
religious or spiritual self
 LDL and triglycerides reduced 3-5%
 HDL increased by 4.6%
 SBP and DBP reduced by 3.7-4.3mmHg
 Reduction of glycosylated hemoglobin up to 1%
 Weight loss and subsequent weight maintenance enhanced
 Rates of smoking cessation and maintenance of abstinence
improved
PRINCIPLES

Overloading
Specificity
Individualized
variation
Reversibility
EXERCISE
PRESCRIPTION

 Type of
exercise
 Intensity
 Duration
 Frequency
TYPE OF EXERCISE
 Aerobics – strengthens CVS; cycling,
swimming, jogging, skipping, brisk
walking
 Low intensity – bone mineralization,
flexibility, weight control; stretching,
calisthenics
 NORMAL RESPONSE TO
EXERCISE
 Increased heart rate
 Increased breathing rate
 Mild to moderate sweating, depending on your
exercise level
 Feeling or hearing your heart beat
 Muscle aches and tenderness that might last a
day or two as you get started
 ABNORMAL RESPONSE TO
EXERCISE
 Severe shortness of breath
 Wheezing, coughing, or other difficulty in breathing
 Cramps, severe pain or muscle aches
 Excessive perspiration
 Chest discomfort, pain, pressure or tightness felt in the
chest and possibly extending to your left arm or neck
 Light-headedness, dizziness, fainting
 Severe, prolonged fatigue, or exhaustion after exercise
 Nausea
RECOMMENDED EXERCISE

Start slowly with two-three repetitions of each exercise you choose.

RECOMMENDED EXERCISE
(STRENGTHENING)
 Finger squeeze
 Shoulder shrug
 Arm circles
 Shoulder touch
 Leg flexion-extension
 Side leg lift
 Alternate leg lunges
RECOMMENDED EXERCISE
(STRENGTHENING)
 Calf raises
 Leg extension
 Squat
 Toe raises
 Ankle circles
 Abdominal strengthening
 Sit-up
RECOMMENDED EXERCISE (FLEXIBILITY)
 Neck circles
 Flexed leg back stretch
 Side bends
 Trunk rotation
 Back arch
 Overhead stretch
 Achilles stretch
 Shin and quadriceps stretch
 Hip and thigh stretch
WALKING
PROGRAM
Week Distance, km Minutes
1 ½ -
2 ½ -
3 ¾ -
4 1 -
5 1 -
6 1 -
7 1 20
8 2½ 30
9 3¼ 40
10 3¼ 40
11 4 50
12 4½ 60
WALKING PROGRAM

The Talk Test: If one is not able to comfortably carry on a

conversation while walking, then one should rest.

5-10 minutes after activity the pulse rate should come to pre-
activity level. Unusual tiredness one hour after exercise
means one has to slow down the pace.
 INTENSI
TY
AHA
Karvonen
BORG RPE
Talk test
 DURATION

20-30 minutes
Proper warm up and cool down
 FREQUENCY

Daily
At least 3x a week
The Opposite of Sitting
LetsOpposite
The look atofSitting
Sitting
Knees bent Knees straight
Hips bent forward Hips straight
Spine rounded Spine arched
Shoulders rounded Shoulders back
Head forward Head back
 A recipe for better postural health

It is primarily PROLONGED sitting that causes many of the

problems - so get up and move every 30 minutes.
Reduce your Weekly Sitting Number by 20% in the next 2-weeks

Try to take a lunch break and walk – for at least 20 minutes

Incorporate the “Opposite of sitting” into your everyday

habits. EG: 10 reps in standing x 5/day
20 reps in lying x 2/day
10-20 minutes prone lying
 Core crash
• Lose your pelvic floor
• Breath holding
• Loss of neutral Spine
• Bulging abdomen
 Take away menu
Get up and move every 30 minutes
Reduce sitting by 20%
Take a lunch break and exercise
Use the “Opposite of sitting” everyday
10 reps in standing x 5/day;
20 reps in lying x 2/day
10-20 minutes prone lying /day
Any concerns seek help
Learn to activate your core muscles
– get help if needed
Good core control = good lifting technique
Look at your workspace ergonomically – ask OH+S
PROPER BODY MECHANICS
PROPER BODY MECHANICS
f

f1

d1
Levers in the Body

=
PROPER BODY MECHANICS
Criticize the technique
Lifting Technique
• Same as for Core
control
• Lift pelvic floor
• Breathe normally
• Maintain neutral Spine
• Flatten abdomen
Guidelines for Lifting

 Stoop or squat to lift any object that is

below the level of your hips.
 Widen your feet to increase your base of
support and improve your balance and
stability.
 Move close to the object before you lift;
keep it close to your body as you lift or
carry it.
Guidelines for Lifting

 Keep the lumbar curve in your lower back as

you lift; do not flatten your lower back when
you lift.
 Mentally plan the lift; be certain you can
safely lift the object without assistance, have
sufficient space to perform the lift, and test
the weight of the object before you lift it.
Guidelines for Lifting

 Do not lift and twist your back at the same

time; pivot on your feet when you need to
turn.
 Do not lift quickly or with a jerky motion.
 Move the object by pushing, pulling, sliding,
or rolling rather than lifting it when
possible; pushing is better than pulling.
Guidelines for Lifting

 Avoid repetitive, sustained lifting; do not

lift heavy objects without assistance.
 Use care when removing groceries, tools,
and so on from the trunk of the car; do not
bend at the waist and lift; bend your hips
and knees slightly, and move the object
close to you before lifting it.
Guidelines for Pulling/Pushing
 Crouch and face the object squarely.
 Use your arms and legs to push or pull;
push with your arms partially bent.
 Push or pull in a straight line; your force
should be parallel to the floor.
 Be certain there are no objects in your path
and doorways are wide enough for the
object to pass through.
Guidelines for Reaching
 Stand on footstool or ladder to reach an
object that is above the head or to place an
object above the head.
 Move the object close to you before lowering
or raising it.
 Hold the object close to your body as you
step down from or onto the footstool.
 Do not simultaneously reach and twist your
body.
Guidelines for Carrying
 Carry all objects by holding them close to
your body; the best position is in front of
your body at the level of your waist or
midchest.
 If you carry an object in one hand, alternate
carrying it in one hand and then in the
other; do not twist your back when moving
the object from one hand to another.
Guidelines for Carrying
 Balance the load whenever possible.
 Some bulky or heavy objects can be carried
on your shoulders, especially if you must
carry them for a substantial distance.
 Avoid carrying or balancing a small child on
one hip; use an infant carrier or hold the
child close to your chest.
CONSERVE!
 These are general principles.
Ergonomics
For specific issues speak to your OH+S person

SCREEN
- directly in front
- top of the screen at about eye level
- angled up slightly towards eyes
- keep at arms length
- easy to raise a monitor that is too low
- if monitor too high, raise seat (need footrests) + raise keyboard

CHAIR
Arm Rests: - shoulders relaxed (not raised)
- elbows supported
Back Rests: - support to maintain neutral spine
- maintain upright position (core)
Seat Height: - feet resting comfortably on the floor
- no pressure under the thighs
- use a foot rest if the seat must be raised
Desk layout
PROPER BODY MECHANICS
PROPER NUTRITION CHOICES
FOOD
PYRAMID
RECOMMENDED DAILY
ALLOWANCE

A Lot A Little
10g of sugars 2g of sugars
20g of fat 3g of fat
5g of saturates 1g of saturates
3g of fibre 0.5g of fibre
0.5g of sodium 0.1g of sodium
RECOMMENDED DAILY
ALLOWANCE

Nutrient - Men Nutrient - Women

Energy = 2,500kcal Energy = 2,000kcal
Sugars = 70g Sugars = 50g
Fat = 95g Fat = 70g
of which saturates = 30g of which saturates = 20g
Fibre = 20g Fibre = 16g
Sodium = 2.5g Sodium = 2g
DEVELOPING THE ABILITY TO HANDLE
STRESS
SIGNS OF STRESS

 Muscle tension & bracing habits

 Aggressiveness
 Disrupted breathing
 Cold, sweaty hands
 Negative self-talk
 Tension headaches
WAYS TO RELIEVE STRESS
 Determine how real the actual stressor is by assessing
the worst possible outcome, then determine the
manageability of this outcome. Accept it if necessary;
change it if possible.
 Take 2-3 breaths, exhale through your mouth; let jaw
and shoulders fall while you are exhaling.
 Imagine a wave of warm flowing down your arms and
legs with each breath you exhale.
WAYS TO RELIEVE STRESS
 Verbalize a positive self-statement
 Get enough sleep
 Exercise
 Nurture the healthy, social relationships with others important in

your life; renewing or forming new friendships.

 Temporary avoidance of the problem or distraction
 Pray or seek guidance from your religious beliefs and leaders
WAYS TO RELIEVE STRESS

Grant me the serenity to accept the

things I cannot change, the courage
to change the things I can, and the
wisdom to know the difference.

If you can live with the worst

possible outcome, then it is not
worth worrying about.
IMPROVING ONE'S
SOCIAL AND INTER-
PERSONAL ABILITIES
SPENDING TIME TO RECONNECT
WITH YOUR RELIGIOUS OR
SPIRITUAL SELF
“What HR can do?

Create a fitness
program!
“If they can ….
Why can’t we???”

Thank