Effects of a workplace physical activity intervention on health-related quality of life

Irina Diaz de Leon, MSc, Institutt for grunnskolelærerutdanning, idrett og spesialpedagogikk, Universitetet i Stavanger.

Sindre M. Dyrstad, professor, Institutt for grunnskolelærerutdanning, idrett og spesialpedagogikk, Universitetet i Stavanger.

Denne vitenskapelige artikkelen er fagfellevurdert etter Fysioterapeutens retningslinjer, og ble akseptert 19. mai 2026. Studien materialet bygger på er godkjent av Datatilsynet, gjennom Sikt, med referansenummer 410022 . Ingen interessekonflikter oppgitt.

Abstract

Purpose: To reduce health‑related work absence many workplaces offer physical activity initiatives, which often are developed and led by physiotherapists. However, the effectiveness of such interventions on employee health outcomes in Norway often remains unknown due to a lack of published findings. Health-related quality of life (HRQoL) provides a relevant multidimensional outcome for evaluating effectiveness of workplace interventions. The purpose of this study was to evaluate the effect of a 10-week structured physical activity intervention on HRQoL among employees in the public sector.

Methods: A randomized controlled trial over 10 weeks was conducted, with HRQoL measured using the RAND-36 survey at baseline and post-intervention (n = 35).

Results: Participants in the intervention group experienced significant improvements with moderate effect sizes (r = .36-.41) compared to the control group in four HRQoL domains: Vitality, Mental Health, Social Functioning, and Role Physical (p< .05). No significant changes were observed in Physical Functioning or Bodily Pain.

Conclusion: Participation in the intervention led to improvements in several dimensions of HRQoL. These findings suggest that even a short-term workplace PA intervention can enhance both physical and mental aspects of employee well-being.

Keywords: Health-related quality of life, physical activity, workplace intervention. 

Sammendrag

Arbeidsplassbasert fysisk aktivitet: Effekter på helserelatert livskvalitet

Hensikt: For å redusere helserelatert sykefravær tilbyr mange arbeidsplasser kurs med fokus på fysisk aktivitet, som ofte utvikles og ledes av fysioterapeuter. Effekten av slike tiltak på ansattes helseutfall i Norge er imidlertid ofte ukjent på grunn av mangel på publiserte funn. Helserelatert livskvalitet (HRQoL) utgjør et relevant, multidimensjonalt utfallsmål for å evaluere effekten av arbeidsplassintervensjoner. Målet med denne studien var å undersøke effekten av en 10‑ukers strukturert fysisk aktivitetsintervensjon på HRQoL blant ansatte i offentlig sektor.

Metode: Det ble gjennomført en randomisert kontrollert studie over 10 uker, der HRQoL ble målt med RAND-36 ved baseline og etter intervensjonen (n = 35).

Resultater: Deltakerne i intervensjonsgruppen opplevde signifikante forbedringer med moderate effektstørrelser (r = .36–.41) sammenlignet med kontrollgruppen innen fire HRQoL-domener: Vitalitet, Mental helse, Sosial fungering og Rolle fysisk (p < .05). Det ble ikke observert signifikante endringer i Fysisk funksjon eller Kroppslig smerte.

Konklusjon: Deltakelse i intervensjonen førte til forbedringer innen flere dimensjoner av HRQoL. Funnene tyder på at selv en kortvarig fysisk aktivitetsintervensjon på arbeidsplassen kan styrke både fysiske og mentale aspekter ved ansattes velvære.

Nøkkelord: Helserelatert livskvalitet, fysisk aktivitet, arbeidsplassintervensjon.  

Introduction

Norway has one of the highest sickness absence rates in Europe despite a generally healthy population and high life expectancy (1, 2). In recent years, health-related work absence has remained persistently high, representing a substantial challenge for employees, employers, and society. Musculoskeletal disorders (MSDs) and mental health disorders (MHDs) are among the largest contributors to sickness absence in Norway (3).

MSDs, including back, neck, and shoulder pain, are commonly associated with prolonged sitting, repetitive movements, and limited physical variation during the workday. These risk factors are particularly prevalent in office-based occupations, which have become increasingly common in modern working life (4). MHDs, such as stress, anxiety, depression, and sleep disturbances, have also increased in recent years and now account for a substantial proportion of sickness absence, especially among younger employees (5).

Although both MSDs and MHDs are influenced by factors outside the workplace, certain work conditions such as high workloads, low control over tasks, job insecurity, and a lack of support from colleagues and supervisors can contribute to stress, burnout, anxiety, and depression (6).

Workplace-based health promotion initiatives are offered as a means of improving employee well-being and preventing health-related work absence. Physical activity is well documented to positively affect physical and mental health, and the workplace represents a convenient and accessible setting for such interventions, as employees can participate as part of their regular working hours (7, 8). As a result, some workplaces offer PA initiatives during working hours.

Evidence regarding the effectiveness of workplace PA interventions on employee health outcomes remains limited. Existing research has primarily focused on specific outcomes such as musculoskeletal pain, stress, or biomedical indicators, while broader evaluations of overall health impact are less common. Given that workplace PA interventions often aim to enhance general health and well-being rather than treat specific conditions, outcome measures that capture multiple dimensions of health are needed (9).

Health-related quality of life (HRQoL) is a multidimensional construct that reflects individuals’ perceived physical, mental, and social functioning in daily life (10). As such, HRQoL provides a relevant framework for evaluating the effectiveness of workplace PA interventions with broad health-promoting aims. However, relatively few studies have examined the effects of workplace PA interventions on HRQoL, and this gap appears particularly pronounced in the Norwegian context.

To the best of current knowledge, only three relevant studies have included HRQoL as an outcome in Norwegian workplace PA interventions, two of which were conducted more than 20 years ago (11-13).

In a large randomized controlled trial involving employees from multiple sectors, Eriksen reported no statistically significant improvements in standardized HRQoL outcomes following a 12-week physical exercise and stress-management program, despite participants reporting subjective benefits such as increased fitness and reduced discomfort (11). Similarly, Brox and Frøystein found no significant effects on HRQoL after a six-month, once-weekly workplace exercise intervention among nursing-home employees, although leisure-time physical activity increased (12). In contrast, a more recent cluster-randomized study by Barene and Krustrup reported improvements in HRQoL-related outcomes, including vitality, emotional well-being, and self-reported health, particularly following a group-based dance intervention delivered over 40 weeks (13). Taken together, Norwegian evidence is limited and mixed, indicating that workplace PA interventions do not consistently lead to measurable improvements in HRQoL. However, HRQoL may capture meaningful changes in employees’ perceived and experienced health, underscoring its relevance as a standardized, multidimensional outcome in workplace health research. (11–13).

The present study examined a structured, workplace-based PA intervention offered to employees of Stavanger Municipality. The intervention consisted of a 10-week program and combined supervised exercise with complementary health-promoting activities, including educational input, guided recovery exercises, and opportunities for reflection. The overall aim of the intervention was to improve physical and mental health and strengthening workplace well-being to prevent sickness absence. The intervention was delivered by one physiotherapist and one nurse, both with exercise experience. HRQoL was used to evaluate the broader health impact of the intervention. 

Aim of the study

The aim of this study was to evaluate the effectiveness of a structured 10-week workplace physical activity intervention on HRQoL among employees in Stavanger Municipality.

Materials and methods

A randomized controlled trial was used to evaluate changes in HRQoL following participation in the workplace intervention.

The exercise intervention was open to all municipal employees aged 18 years or older who could benefit from regular physical activity to improve health and work functioning. Participation criteria were intentionally broad and included employees who were physically inactive, on short-term sick leave, had irregular work attendance, musculoskeletal discomfort, mild mental health challenges, or had not engaged in regular exercise for an extended period. Information about the exercise intervention and the registration process was conveyed through line managers, as the exercise sessions were conducted during working hours.

Participants who did not sign the written informed consent or had incomplete HRQoL data at baseline or post-test were excluded from the study but were still allowed to participate in the exercise program.

Forty-eight participants were enrolled and randomized to either an intervention group (n = 30) or a control group (n = 18) using a 3:2 allocation ratio, reflecting program capacity constraints. Allocation was stratified by workplace to enable colleagues to participate together and reduce the risk of dropout. Participants represented 20 different workplaces in the municipality. Following exclusions related to missing consent or incomplete post-tests, 35 participants were included in the final analyses (intervention n = 22; control n = 13).

The intervention was delivered twice weekly over a 10-week period. Most sessions lasted 60 minutes, with three extended sessions of 90 minutes that included additional time for guided reflection on physical activity experiences, conducted in small groups. Each session followed a standardized structure consisting of warm-up, circuit-based strength and conditioning exercises, and cool-down stretching. Exercises were adapted to individual fitness levels. Mean attendance during the 10 weeks intervention was 86%, with 17-21 of the 22 participants attending each session. Participant progression was supported through individualized guidance and motivational feedback and was reflected in a gradual increase in exercise intensity, including heavier weights and improved technique. Participants were additionally encouraged to engage in self-organized physical activity at least once per week. The control group continued their usual routines during the same period and was offered participation in the next exercise intervention.

HRQoL was assessed using the Norwegian version of the RAND-36 Health Survey (14) at baseline and immediately post-intervention. Domain scores were calculated using the standard 0–100 scoring method, with higher scores indicating better perceived health. Due to incomplete item data, the Role Emotional and General Health domains were excluded from all analyses.

Data were collected electronically using Nettskjema.no. Statistical analyses were conducted in IBM SPSS Statistics version 29. Data were inspected for completeness and distributional properties. As assumptions of normality were not met, within-group changes were analysed using Wilcoxon signed-rank tests, and between-group differences in change scores were analysed using Mann–Whitney U tests. Effect sizes (Rosenthal’s r) were calculated as r = Z/√N. Values around 0.1 indicate a small effect, 0.3 a medium effect, and 0.5 or above a large effect. Statistical significance was set at p < 0.05.

All participants received written study information and provided informed consent. Data handling complied with Norwegian data protection regulations, and the project was approved by SIKT (ref nr: 410022).

Results

Changes in RAND-36 domain scores from baseline to post-intervention are presented in Table 1.

Within-group analyses showed statistically significant improvements in the intervention group for three of the six analysed RAND-36 domains: Vitality, Mental Health, and Social Functioning (p < .05). No statistically significant changes were observed in the domains of Physical Functioning, Role Physical, or Bodily Pain. The control group showed no statistically significant pre–post changes across any of the analysed domains.

Between-group analyses demonstrated statistically significant differences in change scores favouring the intervention group for four of the six domains: Role Physical, Vitality, Mental Health, and Social Functioning (p < .05), with moderate effect sizes (r = .36-.41). No significant between-group differences were observed for Physical Functioning or Bodily Pain, as changes in these domains were small and similar between groups. 

Discussion

This study examined the effects of a 10-week workplace-based physical activity intervention on HRQoL among employees in Stavanger Municipality. The main finding was that participation in the intervention resulted in significant improvements in four of the six assessed domains compared with the control group: Vitality, Mental Health, Social Functioning, and Role Physical. Effect sizes for these domains were moderate, indicating that the observed differences were not only statistically significant but also of practical relevance. The pattern of findings suggests that the intervention primarily influenced psychosocial aspects of HRQoL. Improvements in Vitality and Mental Health indicate enhanced energy levels, reduced fatigue, and improved psychological well-being, while gains in Social Functioning suggest greater ease in social interactions and daily participation. These domains are closely related to how individuals experience and manage everyday demands, both at work and outside the workplace. In contrast, no significant effects were observed for Physical Functioning or Bodily Pain. This may partly reflect high baseline levels of physical functioning in the study sample, leaving limited room for improvement, as well as the fact that the intervention was not specifically designed to target pain reduction.

The Role Physical domain measures how physical health interferes with work or other daily roles. It showed a large mean improvement within the intervention group but did not reach statistical significance in within-group analyses, likely due to substantial variability in responses. However, the significant between-group difference suggests that the intervention reduced the extent to which physical health interfered with participants’ daily roles compared with the control group.

Taken together, the results indicate that the intervention had its most consistent effects on domains related to perceived energy, mental well-being, social functioning, and role performance. These are dimensions that are important for overall health and should receive greater emphasis when motivating individuals to become more physically active. Often, too much emphasis is placed on weight reduction as the primary motivational factor for increasing physical activity, despite evidence showing that weight loss is an inconsistent and often modest outcome of exercise interventions (15,16). Earlier Norwegian studies have reported limited HRQoL effects (11,12) which may be related to higher baseline scores, lower intervention frequency, or differences in program structure. The twice-weekly format and group-based delivery may therefore have contributed to the observed psychosocial benefits.

A strength of this study is the randomized controlled design, which supports internal validity and strengthens confidence in the observed HRQoL differences between groups. In addition, the intervention was evaluated in a real-world workplace setting, enhancing the practical relevance of the findings. The use of HRQoL as a primary outcome addresses a gap in Norwegian workplace physical activity research by enabling a multidimensional assessment of employee health.

The study also has limitations. Given the small sample size, the generalizability is limited. The study may also be underpowered for certain RAND‑36 domains, and non‑significant results may therefore reflect type II errors rather than true absence of effects. Furthermore, two RAND-36 domains (Role Emotional and General Health) were excluded due to incomplete data, reducing the comprehensiveness of the HRQoL assessment. Finally, HRQoL was measured only immediately post-intervention, and the durability of observed effects remains unknown.

Conclusion

Participation in the 10-week workplace physical activity intervention significantly increased four of six dimensions of HRQoL: Vitality, Mental Health, Social Functioning, and Role Physical. No significant effects were observed for Physical Functioning or Bodily Pain. These findings suggest that short-term workplace physical activity interventions may enhance employees’ psychosocial well-being.

The use of HRQoL as an outcome measure allowed for a broader evaluation of intervention effects beyond physical performance and weight loss alone. Future studies should examine the long-term sustainability of these improvements and explore which intervention components are most important for enhancing psychosocial well-being in diverse workplace settings.

Acknowledgements

The authors would like to thank Astrid Grøttå Ree (physiotherapist) and Maren Mykletun (nurse), who supervised and conducted the training programme on behalf of the Occupational Health Service of Stavanger Municipality.

References

1. Raleigh V. Trends in life expectancy in EU and other OECD countries: Why are improvements slowing? OECD Health Working Papers No. 108. Paris: OECD Publishing; 2019. Available from: https://doi.org/10.1787/223159ab-en

2. Hemmings P, Prinz C. Sickness and disability systems: comparing outcomes and policies in Norway with those in Sweden, the Netherlands and Switzerland. OECD Economics Department Working Papers No. 1601. Paris: OECD Publishing; 2020. Available from: https://doi.org/10.1787/c768699b-en

3. Moberg LL, Aldridge A. Utviklingen i legemeldt sykefravær året 2024. Oslo: Arbeids- og velferdsdirektoratet (NAV); 2025. Available from: https://www.nav.no/_/attachment/inline/929bb61f-d99c-4edd-881b-dc2439acabc0:5ba00cbca51fa6ec9cbc5e256a198b5f13aa7fcb/%C3%85rsnotat%20sykefrav%C3%A6r%20%C3%A5ret%202024.pdf

4. Blaschke S, Carl J, Pelster K, Mess F. Promoting physical activity-related health competence to increase leisure-time physical activity and health-related quality of life in German private sector office workers. BMC Public Health. 2023;23(1):470. https://doi.org/10.1186/s12889-023-15391-7

5. Moberg LL. Utvikling i sykefravær med psykiske lidelser. Oslo: Arbeids- og velferdsdirektoratet (NAV); 2024 Oct 1. Available from: https://www.nav.no/_/attachment/inline/7491e2c1-caf3-43e4-8902-f288bba45dd4:de93b016fb52c466038c23937d4336170d42e175/Utvikling%20i%20sykefrav%C3%A6r%20med%20psykiske%20lidelser.pdf

6. Knardahl S, Sterud T, Nielsen MB, Nordby K-C. Arbeidsplassen og sykefravær – arbeidsforhold av betydning for sykefravær. Tidsskr Velferdsforsk. 2016;14(2):179–199. https://doi.org/10.18261/issn.2464-3076-2016-02-05

7.  Singh B, Olds T, Curtis R, Dumuid D, Virgara R, Watson A, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med. 2023;57(18):1203–1209. https://doi.org/10.1136/bjsports-2022-106195

8. Tersa-Miralles C, Bravo C, Bellon F, Pastells-Peiró R, Rubinat Arnaldo E, Rubí-Carnacea F. Effectiveness of workplace exercise interventions in the treatment of musculoskeletal disorders in office workers: a systematic review. BMJ Open. 2022;12(1): e054288. https://doi.org/10.1136/bmjopen-2021-05428

9. Schaller A, Stassen G, Baulig L, Lange M. Physical activity interventions in workplace health promotion: objectives, related outcomes, and consideration of the setting—a scoping review of reviews. Front Public Health. 2024;12:1353119. https://doi.org/10.3389/fpubh.2024.1353119

10. Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med. 2001;33(5):350–357. https://doi.org/10.3109/07853890109002089

11. Brox JI, Frøystein O. Health-related quality of life and sickness absence in community nursing home employees: randomized controlled trial of physical exercise. Occup Med (Lond). 2005;55(7):558–563. https://doi.org/10.1093/occmed/kqi153

12. Eriksen HR. Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme. Occup Med (Lond). 2002;52(7):383–391. https://doi.org/10.1093/occmed/52.7.383

13. Barene S, Krustrup P. Football and zumba training in female hospital staff: effects after 12 and 40 weeks on self-reported health status, emotional wellbeing, general self-efficacy and sleep problems. Int J Environ Res Public Health. 2022;19(3):1685. https://doi.org/10.3390/ijerph19031685

14. Folkehelseinstituttet. Norsk RAND-36 helseskjema. Oslo: Folkehelseinstituttet; [date unknown; cited 2026 Feb 13]. Available from: https://www.fhi.no/globalassets/dokumenterfiler/skjema/brukererfaring/norsk-rand-36.pdf

15. Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2013;56(4):441–447. https://doi.org/10.1016/j.pcad.2013.09.012

16. Thorogood A, Mottillo S, Shimony A, Filion KB, Joseph L, Genest J, et al. Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials. Am J Med. 2011;124(8):747–755. https://doi.org/10.1016/j.amjmed.2011.02.037

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