Interventions to improve physical activity and decrease sedentary behavior at the workplace: a systematic review of economic evaluations

Purpose: Insufficient physical activity (PA) and excessive sedentary behavior (SB) are major causes of at least 35 chronic diseases which result in an important worldwide economic burden. The workplace is an ideal setting to implement public health strategies aimed at improving PA and SB. As economic justification for encouraging workplace interventions are needed, we performed a critical appraisal and synthesis of health economic evaluations (HEE) of interventions aiming to improve PA and SB at the workplace.Methods: A comprehensive search filter was developed using guidelines, the PRESS checklist and published search algorithms. Six databases were searched and references of relevant articles were scanned for eligible studies. Full HEE of workplace-interventions targeting PA and/or SB were included. Methodological quality was assessed using the CHEC-list. All procedures were performed by two researchers independently, followed by a consensus meeting. Results were synthesized qualitatively.Results/findings: The search yielded 3155 references, of which 197 full-texts were assessed and 17 included in the final synthesis. The methodological quality of included HEE varied considerably: the median of fulfilled CHEC-list criteria was 63.2% (range = 36.8%-100%). Nine multicomponent health-programs, seven specific PA-interventions and one specific SB-intervention were identified. Studies were heterogeneous regarding sample size, design, intervention technique and outcome measures. From the 17 studies, significant improvements were reported in six studies for PA and in the study on SB. Typically, cost-effectiveness analyses were performed from the societal perspective and cost-benefit analyses from theemployer's perspective. However, the considered cost categories (e.g. different direct and indirect costs) varied. From nine cost-effectiveness analyses, two were considered to be cost-effective, and three others not. In four evaluations, the cost-effectiveness was uncertain. From 12 cost-benefit analyses, seven were considered to be cost-beneficial. Non-randomized trials were much more likely to report positive results than randomized trials.Conclusion: Despite some promising results of worksite interventions targeting PA and SB, their economic value remains uncertain. Further randomized trials applying sound methodologies to identify effective strategies as well as their economic consequences are needed. To enhance generalizability across countries with different health care systems, future HEE should consider the societal perspective, including all costs.