864979

review-article2019
WHSXXX10.1177/2165079919864979Workplace Health & SafetyWorkplace Health & Safety

vol. XX ■ no. X Workplace Health & Safety

Continuing Education

Associations Between Workplace Exercise

Interventions and Job Stress Reduction
A Systematic Review
Sungwon Park, MSN, RN1 and Min Kyeong Jang, PhD, RN, KOAPN1

Abstract: Background: High job stress is positively Introduction

associated with reduced quality of life in workers, Job stress is a common and growing issue in workplace. In
detrimental effects on worker health, and increased 2015, the American Psychological Association (APA) reported
worker absenteeism and lower productivity. Exercise is that Americans had higher average stress levels than the year
a proven approach for coping with psychological stress before, and in 2017, about 61% of 3,440 American adults
in general. However, relatively few research studies have surveyed reported that their work was a substantial source of
examined the effects of workplace exercise interventions stress (APA, 2017). Job stress can be defined as a psychological
on job stress reduction. The purpose of this systematic response to either emotional or physical challenges when
review was to identify associations between workplace workers’ capabilities do not match the demands of their jobs
exercise interventions and job stress reduction among (National Institute for Occupational Safety and Health [NIOSH];
employees. Methods: A literature search was performed 1999). An earlier NIOSH report published in 2004 classified job
using five databases (i.e., CINAHL, Medline via PubMed, stress as an “anxiety, stress, and neurotic disorder.” This report
Scopus, PsycINFO, and Embase), and eligible studies stated that as of 2004, such disorders caused more than four
were written in English, and were published between times the number of days away from work than all nonfatal
January 1990 and October 2018. Studies were included injury and illness cases.
if worker participants were subjected to a workplace High job stress has been correlated with reduced worker
exercise intervention, and their job stress was measured quality of life, detrimental effects on worker health such as
before and after the intervention. To assess the quality increased risk of cardiovascular disease and mental disorders
of these studies, van Tulder’s risk of bias assessment (Calogiuri et al., 2016; Freitas, Carneseca, Paiva, & Ribeiro Paiva,
tool was applied. Findings: Eight studies were identified, 2014; LaMontagne, 2012), increased worker absenteeism (Sallon,
and six of those (75%) were found to be of relatively Katz-Eisner, Yaffe, & Bdolah-Abram, 2015; Schmidt et al., 2019),
good quality. In only two of the studies (25%) was and lower productivity (Adaramola, 2012). All these issues have
the workplace exercise program associated with a a negative effect on companies’ financial status as well
statistically significant reduction in job stress. The study (Adaramola, 2012; Sallon et al., 2015; Schmidt et al., 2019).
findings suggest that relationships between workplace However, the contributing factors of job stress are difficult to
exercise interventions and job stress reduction have not pinpoint, as they can be simultaneously related to multiple
been sufficiently evaluated in the literature. Conclusion unpredictable factors such as interpersonal problems,
and Application to Practice: Based on the limited environmental conditions, and personal issues (Bliese, Edwards,
data available, future intervention research should & Sonnentag, 2017).
focus on randomized controlled trials of interventions Exercise is one of the confirmed approaches for coping with
incorporating both exercise and multidimensional psychological stress in general (Kettunen, Vuorimaa, &
strategies to reduce job stress. Vasankari, 2015; Van Rhenen, Blonk, van der Klink, van Dijk, &
Schaufeli, 2005). In APA’s 2017 study, more than half (53%) of
Keywords: occupational stress, workplace, exercise, the adult Americans surveyed stated that they used exercise to
occupational health cope with their stress. Furthermore, several studies have

DOI: 10.1177/2165079919864979. From 1University of Illinois at Chicago. Address correspondence to: Min Kyeong Jang, PhD, RN, KOAPN, College of Nursing, University of Illinois at Chicago,
https://doi.org/

University Cancer Center, 818 South Wolcott Ave. (MC 709), Chicago, IL 60612-7350, USA; email: mjang21@uic.edu.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2019 The Author(s)

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reported significant positive effects of workplace exercise Both descriptive studies and studies of psychological stress that
interventions on the mental health of employees (Calogiuri did not specify job stress were excluded from the review.
et al., 2016; Kettunen et al., 2015). In addition, providing an The search yielded 12 articles in CINAHL; 512 in PubMed;
exercise program that reduced worker stress has demonstrated 2,834 in Scopus; 207 in PsycINFO; and 86 in Embase. After
benefits for both individuals and organizations (Stults- removal of duplicate references, 3,373 articles remained. Studies
KolehMainen & Sinha, 2014; Sun, Buys, & Wang, 2013). were then screened by title and abstract, and another 3,325
However, relatively few research studies on examining the articles were excluded. After applying the inclusion criteria to
effects of workplace exercise interventions on job stress have the remaining 48 articles, 8 articles were retained for detailed
been conducted worldwide (Axén & Follin, 2017; Calogiuri review (see Figure 1).
et al., 2016; de Freitas-Swerts, & Robazzi, 2014; Eriksen et al.,
2002; Figl-Hertlein, Horsak, Dean, Schöny, & Stamm, 2014; Data Extraction and Quality Assessment
Freitas et al., 2014; Lin, Huang, Shiu, & Yeh, 2015; Sjögren et al., Using the Matrix Method (PRISMA, 2015), data extraction
2006). Furthermore, no known data have been repeatedly was completed using a tabular matrix to record information
collected on a single exercise program over time to confirm its on a range of study details, including type of exercise
effectiveness, possibly because of limitations in human intervention and its duration. The major categories of
resources and financial support from companies to actually information recorded included study design, sample
sponsor the intervention. Consequently, given the lack of demographic characteristics, exercise intervention, job stress
information available about workplace exercise interventions’ outcome measures, and main findings. The methodological
ability to reduce job stress, the objective of this study was to quality of the eight studies was assessed using van Tulder’s
perform a systematic review to define potential associations risk of bias assessment tool, which included such bias
between workplace exercise interventions and job stress domains as selection, performance, detection, attrition, and
reduction. Based on the findings, efficient means of developing reporting. Although van Tulder recommended use of
a successful workplace exercise program were identified. randomized controlled trials (RCTs) to minimize research bias,
the author stated that the tool could be applied to quasi-
Methods experimental studies as well as RCTs (Furlan et al., 2015).
Search Strategy Notably, 65% of the eight studies reviewed were RCTs and
This comprehensive systematic review was guided by the 35% were quasi-experimental studies.
Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA; 2015) guidelines. From September 18 Results
through October 2, 2018, five databases were searched for As stated above, of the eight studies reviewed, five were
relevant literature: the Cumulative Index of Nursing and Allied RCTs (Calogiuri et al., 2016; Eriksen et al., 2002; Figl-Hertlein
Health Literature (CINAHL), Medline via Pubmed, Scopus, et al., 2014; Lin et al., 2015; Sjögren et al., 2006) and three were
Psychological Information (PsycINFO), and the Excerpta Medica quasi-experimental pilot studies (Axén & Follin, 2017; de
Database (Embase). To identify literature containing outcomes Freitas-Swerts & Robazzi, 2014; Freitas et al., 2014).
of interest, the search terms used were “occupational stress OR
job stress OR work stress,” “workplace OR job site,” “exercise Synthesis of the Studies
intervention OR workplace physical activity,” and “occupational The aims of all eight studies were to identify associations
health services” either alone or in combination. All possible between workplace exercise interventions and job stress
combinations of search terms were carefully reviewed with a reduction (Table 1). However, the studies involved
professional librarian and an expert in physical health participants with varying characteristics as well as different
interventions. The search terms were selected to include studies kinds of exercise programs and job stress outcome
of worker samples regardless of their occupation, age, or race/ measurements.
ethnicity. The eight studies included workplace exercise programs
conducted in four types of workplace settings. These included
Study Selection office (25%), postal office (12.5%), educational (25%), and
The following inclusion criteria were applied during study medical (37.5%) settings. Sample sizes in the studies ranged
selection: (a) primary research was published in English in a from 14 to 533 participants. Characteristics of the study
professional journal from January 1990 to October 2018; (b) participants varied considerably. For example, participant ages
study subjects were subjected to a workplace exercise ranged from 24 to 60 years, and mean ages varied from the
intervention, and their job stress was measured before and after 30’s (Eriksen et al., 2002; Freitas et al., 2014; Lin et al., 2015)
the intervention for comparison; and (c) in studies with multiple to the 40’s (Calogiuri et al., 2016; de Freitas-Swerts & Robazzi,
variables, data regarding the effects of a workplace exercise 2014; Sjögren et al., 2006) to the 50’s (Axén & Follin, 2017),
intervention were presented independently from data for other with one study not reporting age information (Figl-Hertlein
variables such as diet, general exercise, and physical activity. et al., 2014). In addition, all the studies included both male

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Figure 1. PRISMA flow diagram of study-selection process for systematic review.

Note. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

and female participants, with six having more females than These two intervention programs are further described in the
males (Axén & Follin, 2017; de Freitas-Swerts & Robazzi, “Workplace Exercise Interventions” section below.
2014; Eriksen et al., 2002; Freitas et al., 2014; Lin et al., 2015; Of the eight studies reviewed, six were judged to be of
Sjögren et al., 2006). good quality based on scores assigned by the two review
This review revealed that only two of eight workplace authors using van Tulder’s criteria. In summary, the two
exercise programs (Calogiuri et al., 2016; Lin et al., 2015) authors independently performed in-depth analyses of each
significantly reduced job stress. In Calogiuri et al.’s (2016) study, study to identify potential sources of bias and to select the
an intervention group engaging in outdoor exercise sessions in best option (Yes/No/Unsure) for each source on the risk of
a natural environment showed significantly lower job stress (p bias assessment tool. Initially, the two authors’ quality
< .001) than a control group performing indoor exercises. In appraisals differed for about 22% of the items across the eight
addition, in Lin et al.’s (2015) study, a yoga exercise group studies (i.e., for 23 of 104 questions). Consequently, the
showed a significant reduction in work-related stress (p < .001). authors conferred to attempt to reconcile these

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Table 1. Summary of Studies on Workplace Exercise Interventions and Job Stress Reduction

Exercise intervention Job Stress

Outcome
Reference Structure design Demographic characteristics Activity type Duration Measure Main findings

Calogiuri et al. Randomized Sample: 14 employees Indoor (control group) and Two 45-minute sessions Physical Activity Compared to the control
(2016) controlled Occupation: Mainly office employees in Norway nature (intervention group) over 2 weeks Affective group, the nature group
Workplace Health & Safety

trial, control- Age (mean/range): 49/41-57 biking and circuit-strength Scale for showed higher positive
intervention group, Gender ratio (M/F): 7/7 sequence work-related affect (p < .01). The
and pre-post test stress nature group also reported
higher positive affect at
follow-up (p = .02)

Axén and Follin Quasi-experimental Sample: Medical yoga exercises and Intervention: Two Perceived The intervention showed
(2017) pilot, control- Intervention group: 17, Control group: 15 meditation 75-minute sessions Stress Scale no significant effects on
intervention group, Occupation: Medical unit managers of five work groups weekly over 9 weeks (PSS) items stress
and pre-post test in public nursing homes and home care services in Sweden At-home practice: At for work-
Age (mean/ range): 51/42-60 least two 25-minute related stress
Gender ratio (M/F): 1/31 sessions weekly using
an instruction video

de Freitas-Swerts Quasi-experimental Sample: 30 employees Workplace exercise employing Two 15-minute sessions Workplace The intervention showed
and Robazzi pilot, only Occupation: Administrative employees for a higher education postural exercises, weekly over 10 weeks Stress Scale no significant effects on
(2014) intervention group, public institution in Brazil segmental stabilization, and work-related stress
and pre-post test Age (mean/ range): 41.7/33-50 segmental and muscular
Gender ratio (M/F): 13/17 chain stretching

Eriksen et al. Randomized Sample: Gymnastikkitiden, a Two 1-hour sessions 19 items from The intervention showed
(2002) controlled trial, Intervention group: 189 employees, Control group: 344 Norwegian aerobic fitness weekly over 12 weeks the Cooper no significant effects on
control-intervention employees model: a standardized Job Stress work-related stress
group, and pre- Occupation: Postal employees in Norway aerobic dancing program Questionnaire
post test Age (mean/ range): 38.2/37-40
Gender ratio (M/F): 203/330

Figl-Hertlein, Cluster randomized Sample: Physiotherapy involving Six 30-minute sessions Work-related The intervention showed
Horsak, Dean, pilot study using Intervention group: 26 employees, control group: 43 ergonomics and stress over 5 months behavior and no significant effects on
Schöny, and a convenience Occupation: Secondary school teachers in Austria management experience work-related stress
Stamm (2014) sampling, control- Age (mean/ range): Not reported patterns
intervention group, Gender ratio (M/F): Not reported questionnaire
and pre-post test (AVEM)

(continued)
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Table 1. (continued)

Exercise intervention Job Stress

Outcome
Reference Structure design Demographic characteristics Activity type Duration Measure Main findings

Freitas, Carneseca, Quasi-experimental Sample: 21 employees Workplace physical activity Five 10-minute sessions Job Stress The intervention showed
Paiva, and pilot, only Occupation: Palliative care unit nursing professionals in Brazil led by a physical education weekly over 3 months Scale no significant effects on
Ribeiro Paiva intervention group, Age (mean/ range): 37.4/28-47 professional work-related stress
(2014) and pre-post test Gender ratio (M/F): 1/20

Lin, Huang, Shiu, Randomized Sample: Yoga exercise One 60-minute session Chinese version The intervention showed
and Yeh (2015) controlled Intervention group: 30 employees, Control group: 30 weekly over 12 weeks of work- significant reduction in
trial, control- employees related stress work-related stress (p
intervention group, Occupation: Mental health professionals in Taiwan scale < .001)
and pre-post test Age (mean/ range): 30.92/24-38
Gender ratio (M/F): 12/48

Sjögren et al. Randomized Sample: 90 employees Light resistance training During the first 5 Items for The intervention showed
(2006) controlled Occupation: Office employees weeks, Five 6-minute “mental no significant effects on
trial, control- Age (mean/ range): 45.7/37-54 session weekly stress at work-related stress
intervention group, Gender ratio (M/F): 24/66 During the next 10 work” of
and pre-post test weeks, Seven Psychosocial
6-minute session functioning
weekly
Workplace Health & Safety

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inconsistencies. However, the authors were unable to reach Workplace Exercise Interventions
agreement on the appraisals for about 11% of the items (i.e., Of the eight studies reviewed, none used a longitudinal
for 11 of 104 questions). Specifically, the authors differed approach, and no two studies used the same exercise
about whether the various biases were well controlled in the intervention with the same duration. Thus, it was difficult to
five RCT studies conducted in the workplace, as some definitively evaluate or compare the effectiveness of the eight
bias-related information was only implicitly expressed or not exercise programs (Table 1). The two studies (Calogiuri et al.,
explained in those studies. Accordingly, following van Tulder’s 2016; Lin et al., 2015) whose exercise interventions were shown
recommendation, the authors attempted to contact the five to significantly reduce job stress employed muscle-strength
RCTs’ corresponding authors via e-mail to obtain exercise in sessions lasting 45 to 60 minutes. In Calogiuri et al.’s
clarifications; unfortunately, no response was received. (2016) study, employees performed a bike and circuit-strength
Therefore, to resolve the remaining disagreements between sequence in four 45-minute sessions over 2 weeks, and in Lin
the authors, a third reviewer was recruited to make final et al.’s (2015) study, employees engaged in yoga exercise in 12
decisions about the associated quality appraisals. Interestingly, 60-minute sessions over 12 weeks.
the two studies that showed a positive relationship between Regarding the intervention types examined, six of the studies
exercise workplace interventions and job stress reduction, used physical interventions only (Calogiuri et al., 2016; de
Calogiuri et al. (2016) and Lin et al. (2015), received the Freitas-Swerts & Robazzi, 2014; Eriksen et al., 2002; Freitas et al.,
highest and second highest quality appraisal scores, 2014; Lin et al., 2015; Sjögren et al., 2006). However, Axén and
respectively, principally because they most rigorously applied Follin (2017) employed both physical interventions (including
RCT methodologies. controlled breathing and seated exercise) and a psychological
intervention (seated meditation) to reduce job stress. In
Job Stress-Related Measurement Tools addition, Figl-Hertlein et al. (2014) employed exercise as a
Four of the eight studies used a scale designed to directly physical intervention and stress management as a psychological
measure job stress (de Freitas-Swerts & Robazzi, 2014; Eriksen intervention.
et al., 2002; Freitas et al., 2014; Lin et al., 2015). In addition, one With respect to the specific activities involved in
study used a general stress scale that included several items for interventions, Calogiuri et al. (2016), de Freitas-Swerts and
work-related stress (Axén & Follin, 2017), and three studies Robazzi (2014), and Eriksen et al. (2002) employed aerobic
used scales that measured job stress indirectly (Calogiuri et al., exercise, whereas Axén and Follin (2017) and Lin et al. (2015)
2016; Figl-Hertlein et al., 2014; Sjögren et al., 2006). used yoga in their interventions. In addition, de Freitas-Swerts
Regarding direct measurement of job stress, Freitas et al. and Robazzi (2014), Figl-Hertlein et al. (2014), and Sjögren et al.
(2014) used the Working Stress Scale (WSS). In addition, (2006) intervened with light exercises such as stretching. Freitas
Eriksen et al. (2002) used 19 items from the Cooper job stress et al. (2014) reported no information on the specific type of
questionnaire, including eight items for communication, four exercise used in their intervention.
for leadership, three for workload, and four for relocation. In The duration of the intervention sessions varied, with
Freitas et al.’s (2014) study, job stress was assessed using the exercise sessions ranging from 5 to 75 minutes. Most of the
Job Stress Scale ( JSS), which included items addressing interventions employed fewer than three sessions weekly (Axén
psychological demands, control, and social support. Finally, & Follin, 2017; Calogiuri et al., 2016; Lin et al., 2015; de
Lin et al. (2015) used the Chinese version of a work-related Freitas-Swerts & Robazzi, 2014; Eriksen et al., 2002), and the
stress scale that included 50 items addressing work duration of the overall interventions ranged from 2 weeks to 5
satisfaction, role, career development, interpersonal months. The intervention involving the most frequent workplace
relationships, and organizational structure. In contrast to those exercise had 150 sessions (Freitas et al., 2014), and the number
four studies, Axén and Follin (2017) used 14 questions of the of sessions among the eight studies ranged from 4 to 150.
Perceived Stress Scale (PSS) that addressed both work-related
and private stress. As to scales that measured job stress Discussion
indirectly, Calogiuri et al. (2016) used the Physical Activity This literature review was performed to define potential
Affective Scale, which included items such as “describe how associations between workplace exercise interventions and job
you feel generally these days” and “describe how you feel stress reduction. In most of the eight studies reviewed, no
generally right now.” Figl-Hertlein et al. (2014) used the statistically significant association was found between the
work-related behavior and experience patterns questionnaire interventions and job stress reduction. Although previous
(AVEM) scale, which included 11 subdimensions such as studies have shown statistically significant associations between
offensive coping with problems, balance and mental stability, exercise and reductions in general stress (Hewett, Pumpa,
emotional distancing, and satisfaction with work, to evaluate Smith, Fahey, & Cheema, 2018; Zheng et al., 2018), only 25% of
personal experiences of work-related stress. Finally, Sjögren the studies reviewed showed a relationship between job stress
et al. (2006) used psychosocial functioning questions that reduction and a workplace exercise intervention (Calogiuri
included items addressing mental stress at work. et al., 2016; Lin et al., 2015).

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By definition, job stress is mostly attributable to working regarding the relationship between workplace exercise
conditions, but this does not mean that it is entirely separate interventions and workers’ mental health, more such studies are
from general stress (APA, 2017). APA has conducted annual needed to evaluate the effectiveness of interventions intended
surveys on stress, mostly in the general population, for more to reduce job stress in particular.
than 10 years, and money and work have consistently been the In addition, in the eight studies reviewed, the frequency and
top two stressors identified. In addition, both individual and duration of the interventions were too varied to meaningfully
situational factors may intensify the effects of job stress (APA, compare the interventions’ designs. Of the two studies that
2017). For example, family issues such as work–family conflicts identified a significant relationship between a workplace
were shown to increase job stress (Lu et al., 2017). Although exercise intervention and job stress reduction, Calogiuri et al.
Axén and Follin (2017) used the PSS, which can assess both (2016) and Lin et al. (2015) both examined interventions
work-related and private stress, the relationship between job conducted once per week for less than 6 months. Specifically,
stress and private stress was unclear in their study because Calogiuri et al. (2016) performed their 45-minute sessions for 2
these types of stress were not measured separately. Therefore, weeks, and Lin et al. (2015) conducted their 60-minute sessions
future job stress studies should identify the origin of stress by for 3 months. To obtain meaningful health benefits, the Office
separately assessing job and personal stress. of Disease Prevention and Health Promotion (ODPHP) has
In addition, it is difficult to evaluate the continuous effect of recommended that adults do at least 150 to 300 minutes of
workplace exercise interventions on job stress for two central moderate-intensity or 75 to 150 minutes of vigorous-intensity
reasons—the small number of exercise intervention studies aerobic physical activity weekly or should do an equivalent
conducted to date and the lack of longitudinal studies. The combination of moderate- and vigorous-intensity aerobic activity
findings of this study were based on eight studies reviewed (ODPHP, 2018). What is more, the aerobic activity should occur
following the Matrix Method (PRISMA, 2015). Bliese et al.’s throughout the week. However, these criteria may not be
(2017) review of stress reduction studies pointed out the suitable for every employee because individual exercise needs
difficulties of evaluating the validity of exercise interventions are likely to differ due to employees’ varying behaviors outside
because of the relatively small number of studies conducted. the workplace. Based on the fact that these and other studies
Moreover, these authors stated that relatively few intervention found that exercise sessions lasting 45 to 60 minutes resulted in
studies focusing on job stress reduction had been performed improved mental health in employees (Calogiuri et al., 2016; de
from 1917 to 2017, even though coping with work stress had Vries et al., 2017; Lin et al., 2015), it is reasonable to assume that
been extensively considered from a theoretical viewpoint. In an exercise time of less than 10 minutes would be ineffective.
addition, a longitudinal study or multiple studies of the same However, the minimum time required for an effective workplace
research design would be required to obtain valid outcome exercise session has not been established (Freitas et al., 2014;
measurements for a given exercise intervention. However, none Sjögren et al., 2006).
of the studies included in this review employed a longitudinal On the whole, the findings of this study have important
research design, which reflects a notable research gap in the implications for future research on job stress reduction. First,
literature. Moreover, replication studies are also lacking, making few studies have examined potential associations between
researchers skeptical about the extent to which the results workplace exercise interventions and job stress reduction, and
found in the literature are reliable and valid. thus there is a clear need for additional research to identify
Although Calogiuri et al.’s (2016) and Lin et al.’s (2015) effective interventions for employees. Second, only 25% of the
studies found statistically significant correlations between interventions examined in this study had a significant positive
workplace exercise interventions and job stress reduction, they effect on job stress reduction among employees. Despite the
were not longitudinal studies. By way of comparison, at least small number of studies available, this finding argues that
two studies have employed longitudinal designs to examine approaches other than physical exercise alone should be
means of coping with general stress within the workplace and explored in future research. For example, Huang, Li, Huang,
thus have achieved reasonable causality in their findings as well and Tang (2015) found that their mindfulness-based intervention
as reduced risk of bias (Herr et al., 2018; Rodríguez, Kozusznik, was effective not only for reducing job stress but also for
Peiró, & Tordera, 2018). In Rodríguez et al.’s (2018) study of alleviating employees’ perceived stress and fatigue. In addition,
three approaches for coping with stress, an organizational in evaluating a conceptually similar intervention, Reingold
approach was found to be most effective in reducing employee (2015) stated that a mindfulness-based stress reduction program
stress within 6 months. In addition, Herr et al.’s (2018) study was successful in reducing employees’ emotional distress. In
showed that a continuous intervention for work stress led to studying a different, macroscopic approach, Tsutsumi, Nagami,
prevention of mental health issues, including excessive stress, in Yoshikawa, Kogi, and Kawakami (2009) found that a
employees. In addition, de Vries, van Hooff, Geurts, and participatory intervention in which researchers and employees
Kompier’s (2017) longitudinal study showed that an exercise worked together to identify means of altering the workplace to
intervention significantly reduced work-related fatigue and achieve stress reduction was also effective in reducing
enhanced well-being in employees. Given the demonstrated employees’ emotional distress. Moreover, in Sun et al.’s (2013)
value of longitudinal studies in obtaining significant findings study, a comprehensive Health Promotion Enterprise Program

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Workplace Health & Safety Mon 2019

that involved both “improving the quality of organizational care made it difficult to determine why the interventions studied
and implementing health promotion activities for employees at were or were not effective. Given these issues and the relatively
the individual level” had a positive effect on reduction of job small number of relevant studies available, further research is
stress in employees (p. 409). Based on these studies, future needed to understand why particular workplace exercise
intervention research and development efforts should focus on interventions are ineffective and to identify interventions that
multidimensional strategies. For example, physical exercise will meet employees’ job stress reduction needs.
could be combined with mindfulness promotion as a strategy
for combatting workplace stress. As another example, Implications for Occupational Health Nursing
organizational interventions combining elements of work Practice
environment improvement and employee physical exercise Based on the data available in the eight studies reviewed, as
could be designed and tested. With research attention to both of well as exploration of other studies cited herein, the authors
these promising areas, more effective approaches for reducing recommend that occupational health nurses who plan to
job stress can be identified for implementation in workplaces. In implement job stress management interventions include muscle-
addition, future studies focusing on job stress reduction should strengthening exercise lasting 45 to 60 minutes at least once per
apply a particular research design and exercise intervention to week. In addition, the authors recommend that occupational
different employee populations to expand the generalizability of health nurses consider using multidimensional approaches
any significant relationships identified. combining exercise with, for example, a mindfulness-based
intervention or an organizational-level program involving strong
Limitations employer engagement.
Some limitations of this study should be acknowledged.
First, the quality appraisal scores assigned using van Tulder’s Conclusion
criteria were observed to be relatively low for non-RCT
studies, which may be attributable to the fact that van Tulder’s Based on the review findings, the relationships between
bias domains primarily focus on the RCT research design. workplace exercise interventions and job stress reduction
When the RCT research design is applied in a clinical setting, have not been sufficiently evaluated in the literature. In
both the experimental and control groups tend to be well addition, the studies reporting significant positive associations
blinded, and potential biases tend to be well controlled. between them were unexpectedly small in number, as only
However, when an RCT is performed in a workplace setting, two of eight studies reviewed showed such a relationship.
true randomization is difficult. In addition, the 13 specific Based on the studies included in this review, future research
sources of bias covered by van Tulder’s criteria were often should include RCTs of exercise interventions that incorporate
ambiguously addressed in the eight study articles, resulting in multidimensional strategies to reduce job stress. Specifically,
differing quality appraisal interpretations by the two authors. future occupational health nursing studies should investigate
For example, for two of the studies reviewed, the authors the effectiveness of combinations of workplace exercise
disagreed about whether randomization was acceptable or not programs and psychological or organizational-level
because the interventions showed a dropout rate of about interventions.
50%; van Tulder (Furlan et al., 2015) implied that a 30%
dropout rate indicated unacceptable quality (Figl-Hertlein In Summary
et al., 2014; Freitas et al., 2014). As another example, the item The purpose of this study was to identify associations
asking “Are other sources of potential bias unlikely?” called between workplace exercise interventions and job stress
for subjective judgments on the parts of the authors that again reduction.
resulted in differing quality appraisals. For these two reasons
in particular, a third reviewer was needed to resolve differing •• A systematic review was performed of eight articles
author opinions. Therefore, although use of van Tulder’s meeting inclusion criteria, and only two of the studies
criteria generally supported objective evaluation of the eight (25%) involved a workplace exercise program that
studies, the risk of bias assessment tool may be more achieved a statistically significant reduction in job stress.
appropriate for studies conducted in clinical settings. Finally, •• Both of those studies were RCTs. One intervention
limiting the review to articles published in English may have included a strength sequence involving activities such as
excluded relevant studies in other languages. Given that the biking, and the other incorporated yoga exercise with
review findings are based on only eight studies, additional meditation. These studies received the highest and
reviews of non-English publications might be useful. second highest quality appraisal scores based on van
As for the eight studies themselves, none gathered qualitative Tulder’s criteria.
feedback from participating employees, and the six studies that •• Results of this systematic review indicate that future
found no significant correlation between workplace exercise practice should focus on RCTs of exercise interventions
interventions and job stress reduction provided no explanation incorporating a mindfulness-based intervention to
of the deficiencies of their interventions. Both of these factors maximize the effect of reducing job stress.

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Acknowledgments school teachers: A cluster randomised pilot study. Physiotherapy, 100,

20-26. doi:10.1016/j.physio.2013.03.003
The authors thank Dr. Shannon N. Zenk of the University of Freitas, A. R., Carneseca, E. C., Paiva, C. E., & Ribeiro Paiva, B. S.
Illinois at Chicago (UIC) for her guidance during the (2014). Impact of a physical activity program on the anxiety,
preparation of this article. They also thank Mr. Jon Mann of UIC depression, occupational stress and burnout syndrome of nursing
for his strong editorial contributions to the article and Dr. professionals. Revista Latino-Americana de Enfermagem, 22, 332-336.
Patricia Hershberger of UIC for her sound instruction in doi:10.1590/0104-1169.3307.2420
literature review methodology. Furlan, A. D., Malmivaara, A., Chou, R., Maher, C. G., Deyo, R. A., Schoene,
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Declaration of Conflicting Interests 1660-1673. doi:10.1097/BRS.0000000000001061
The author(s) declared no potential conflicts of interest with Herr, R. M., Barrech, A., Riedel, N., Gündel, H., Angerer, P., & Li, J.
respect to the research, authorship, and/or publication of this (2018). Long-term effectiveness of stress management at work:
article. Effects of the changes in perceived stress reactivity on mental health
and sleep problems seven years later. International Journal of
Environmental Research and Public Health, 15, 255. doi:10.3390/
Funding ijerph15020255
The author(s) received no financial support for the research, Hewett, Z., Pumpa, K. L., Smith, C. A., Fahey, P. P., & Cheema, B. S.
authorship, and/or publication of this article. (2018). Effect of a 16-week Bikram yoga program on perceived stress,
self-efficacy and health-related quality of life in stressed and sedentary
adults: A randomised controlled trial. Journal of Science and Medicine
ORCID iD in Sport, 21, 352-357. doi:10.1017/j.jsams.2017.08.006
Sungwon Park https://orcid.org/0000-0003-0251-5772 Huang, S. L., Li, R. H., Huang, F. Y., & Tang, F. C. (2015). The potential for
mindfulness-based intervention in workplace mental health promotion:
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cross-over design. Scandinavian Journal of Medicine & Science in Author Biographies
Sports, 16, 381-390. doi:10.1111/j.1600-0838.2005.00516.x
Sungwon Park, MSN, is a PhD nursing student at the University of
Stults-KolehMainen, M. A., & Sinha, R. (2014). The effects of stress on Illinois at Chicago. She studies occupational and environmental
physical activity and exercise. Sports Medicine, 44, 81-121. doi:10.1007/
s40279-013-0090-5
health nursing with an emphasis on job stress reduction.
Sun, J., Buys, N., & Wang, X. (2013). Effectiveness of a workplace-based
intervention program to promote mental health among employees in Min Kyeong Jang, PhD, is a postdoctoral research associate at
privately owned enterprises in China. Population Health Management, both the University of Illinois Cancer Center and the University of
16, 406-414. doi:10.1089/pop.2012.0113 Illinois at Chicago.

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