Getting Started with Physical Activity for Better Health

Regular physical activity is one of the best things you can do for your health. It impacts your mental state, can help you manage your weight, reduce your risk of diseases, strengthen your bones and muscles, and improve your stamina for everyday life.

It’s time to get moving in May! This month’s health observance is National Physical Fitness and Sports Month. The purpose is to raise awareness of the importance of active living and sports participation. Physical activity is a necessity for everyone. However, no matter your activity level, you can find a way to incorporate movement that works for you and get active your way.

We’re In An Inactivity Pandemic

We’ve all become comfortable with our leisurely ways. Obesity is widespread, with over 42 percent of American adults falling in that category. Being obese increases your risk of developing preventable chronic conditions like heart disease, stroke, and type 2 diabetes. Why is this happening? One factor is that we spend the majority of time in front of screens at home and work, and we sit now more than ever.

Before the COVID-19 pandemic, the Physical Activity Council determined that physical inactivity was a pandemic we must reverse. Their statistics showed that 82 million Americans were completely sedentary and that more people were dying from inactivity than smoking. This May, we can rise to the challenge and become more active by looking for ways to be more active together! So, how do you know how much activity to get?

What are Physical Activity Guidelines?

According to the CDC, less than 30 percent of adults get the recommended 150 minutes of physical activity each week. Yet, getting the appropriate amount of physical activity fosters normal growth and development in children and can make adults feel better, function better, sleep better, and reduce the risk of many chronic diseases. So let’s talk about what the guidelines recommend:

Physical activity guidelines for pre-school children

    • Pre-school children should participate in physical activity throughout the day to enhance growth and development.
    • Caregivers should encourage and participate in a variety of activity types.

Physical activity guidelines for children

    • Children and young adults aged 6-17 should participate in 60 minutes of moderate to vigorous activity per day. 
    • Physical activity should include aerobic exercise three times per week and two to three days of muscle and bone-strengthening activities.

Physical activity guidelines for adults

    • It is important for adults to minimize the amount of sitting they are doing each day.
    • Adults should participate in a minimum of 150 minutes of moderate-intensity activity per week, with the addition of muscle-strengthening activities two days per week.

Physical activity guidelines for pregnant women

    • Women who were physically active before pregnancy should still aim for two hours and 30 minutes of physical activity per week.
    • All activities should be discussed and approved by a health care provider as the pregnancy progresses and post-partum. 

Physical activity guidelines for the disabled

    • Adults with chronic conditions or disabilities should still aim for 150 minutes of activity per week plus muscle-strengthening activities, as they are able. 
    • If you cannot meet these requirements, you should seek out modified activity alternatives and be approved by your health care provider. 

Remember, these are just guidelines. If you haven’t been active before, it’s essential to start at a comfortable level that your condition or doctor allows. Then, once you build up stamina, you can continue to add more activity each time until you work up to moderate to vigorous exercise levels. Some activity is better than none. The more you do, the greater the health benefits and the better you’ll feel.

Types of Physical Activity

To get all the health benefits of physical activity, you should do a combination of aerobic, muscle, and bone-strengthening exercises.

  • Aerobic activities make you breathe harder and cause your heart to beat faster. You want to get your heart rate up 50 to 60 percent higher than its resting rate. Everyday aerobic activities include walking fast, dancing, or swimming.
  • Muscle-strengthening activities improve your strength, stability, balance, and flexibility. These activities include lifting weights or using resistance exercise bands. 
  • Bone-strengthening activities produce a force that promotes bone growth and strength through impact with the ground. These include running, jumping rope, and team sports, such as basketball and tennis.

All sorts of activities count for physical fitness! Find the combination of exercises on a schedule that works for you.

Get Active Your Way

The expression, “Rome wasn’t built in a day, ” also applies to increasing your activity levels. Start by doing what you can, and then look for ways to do more. Being active has so many health benefits, such as lowering your risk of heart disease, improving your mood by reducing stress, and helping with your weight management. 

Want some additional help and guidance? Watch our Get Active Your Way webinar. 

Picking the Right Physical Activity

The most important thing to remember is to choose an activity that you find fun. Are you an indoor or outdoor person? Do you enjoy the structure of a workout class or would you rather mix it up? Are you more social or prefer to be alone? For example, Walking is one easy and free way to add physical activity into your life.  

Go For A Walk

Physical activity doesn’t need to be complicated. Walking is a great starter exercise. It’s typically free and can be done anywhere, all you need is comfy clothes, supportive shoes, and the time to do it. Not sure where to start? In the beginning, start walking 10 minutes a day during the first couple of weeks. Then, as you increase your stamina, begin walking a little longer by trying 15 minutes and slowing increase to 30 minutes. If you have a bigger goal in mind, try a Couch to 5k program,  and go get that medal!

Try New Things

Not interested in walking? You are more likely to abandon a healthy lifestyle goal if it doesn’t suit your lifestyle. If you are unsure what activities you enjoy, then this is a great time to try a bunch of new things. Here are more tips for integrating more activity into your daily life:

  • Take the stairs instead of the elevator
  • Do yard work or chores
  • Find a workout buddy
  • Find a running group or try out biking or cycling
  • Join an exercise class or sports team
  • Dance at home or take lessons
  • Do stretches or yoga 
  • Try swimming or water aerobics
  • Do abdominal crunches, jumping jacks, push-ups, or other bodyweight exercises during tv commercial breaks
  • Try standing throughout the day
  • Visit a park, trail, or other outdoor space that encourages physical activity

If you are stuck on what types of activities to try, think back to things you enjoyed during your childhood or use your children as a way to reconnect with play. Defining what activities bring you joy is the first step. 

Finding Time for Exercise 

Now that you have some ideas of physical activities you may enjoy, it’s time to integrate them into your life. The recommendation is 150 minutes per week. That is 2 hours and 30 minutes per week. Broken up even further, that’s only 30 minutes over five days! That is completely doable, even for someone who is living a more sedentary life. Take a look at your schedule and see when you can incorporate more chunks of activity. Everyone’s schedule is different. You may be a morning person and want to take a jog while the sun rises, or you may want to take a walk on your lunch break, or you may want to lift weights or take a kickboxing class in the evening to relieve the stress of the day.

  • Find the time that works best for you.
  • Be active with friends and family. Having a support network can help you keep up with your program.
  • Talk to your health care provider about how you should spread aerobic activity out and recommended activities to try.

So, are you ready to get started building your new physically active lifestyle?

Getting Started with Exercise

There are many ways to build the right amount of activity into your life. Every little bit adds up and doing something is better than doing nothing. The key to getting started is to keep it simple and small. Define what physical activity you will do and then when and where you will complete it. 

Free Worksheet

Download our FREE Getting Started with Exercise Worksheet. It will help you identify the benefits you hope to achieve from active living as well as any potential roadblocks.

Download Worksheet

Financial Fitness: Essential to Your Employees’ Wellbeing

About half of Americans believe they are unprepared for a sudden financial need such as the purchase of a new car, appliance or furniture or a significant home repair, according to Gallup Daily tracking survey through 2015.1

So how can we get financially fit?

How do we find balance between spending and saving – between living in the present and saving for life’s unexpected financial needs? And why is this important? First let’s define financial wellbeing – it is defined as a state of being wherein you:2

  • Have control over day-to-day, month-to-month finances;
  • Have the capacity to absorb a financial shock;
  • Are on track to meet your financial goals; and
  • Have the financial freedom to make the choices that allow you to enjoy life.

Organizations that don’t implement financial wellbeing into their wellness programs are missing the  mark. In a survey conducted by the American Psychological Association, money is a somewhat or significant source of stress for 64% of Americans but especially for parents of children below the age of 18 and younger adults (77% of parents, 75% of millennials, ages 18 to 35, and 76% of Gen Xers, ages 36 to 49).3

The added financial stress has a significant impact on many Americans’ lives. Some are putting their health care needs on hold because of financial concerns.

Nearly 1 in 5 Americans say that they have either considered skipping (9 percent) or skipped (12 percent) going to a doctor when they needed health care because of financial concerns.3

Many adults are coping with health and lifestyle challenges and are beginning to recognize the connection between stress and physical and mental health.

  • Money and work remain the top two sources of very/somewhat significant stress, but in 2015, for the first time, family responsibilities emerged as the third most common stressor (54 percent).
  • The majority of adults report having at least one chronic illness (67 percent). In addition, many adults lack exercise and remain sedentary for much of the day. More than 10 percent of adults also report having a mental health-related diagnosis (13 percent for anxiety disorder and 16 percent for depression).
  • About two in five adults (39 percent) report overeating or eating unhealthy foods in the past month due to stress, compared to 33 percent in 2014.
  • Adults in urban areas have a significantly higher reported stress level on average than those in suburban and rural settings (urban: 5.6 on a 10-point scale, vs. 5.0 for suburban and 4.7 for rural).
  • Almost one-third of adults report that stress has a very strong or strong impact on their body/physical health and mental health (31 and 32 percent in 2015, compared to 25 and 28 percent in 2014, respectively).4

To help employees improve their financial fitness, organizations should provide financial education, programs, and other content into their wellness programs.

6 Ways Employees Can Improve Their Financial Wellbeing

  1. Make a simple plan to monitor and track your spending habits and to gain control over your financial decision making.
  2. Have a budget and stick to it. Set short-term and long-term goals to provide structure for your financial decision making. For example, set a spending budget for the holidays. More stuff doesn’t mean less stress.
  3. Spend some time researching before making major financial decisions to ensure you make the most-informed financial decisions.
  4. Get smart about money – Use free educational resources available at http://www.consumerfinance.gov.
  5. Don’t compare yourself to others. Compare yourself to your own standards. Don’t purchase things to keep up with the Joneses. Instead think about long-term impacts of every purchase.
  6. Avoid impulse shopping. Keep your spending under control by stopping to think about whether you need that purchase or postpone the purchase to a later date if you can.

References

  1. Gallup, Inc. “Half of Americans Unprepared for Sudden Financial Need.” http://www.gallup.com/poll/188009/half-americans-unprepared-sudden-financial-need.aspx?g_source=FINANCIAL_WELLBEING&g_medium=topic&g_campaign=tiles
  2. Consumer Financial Protection Bureau “Financial well-being: The goal of financial education.” January 2015: http://files.consumerfinance.gov/f/201501_cfpb_report_financial-well-being.pdf
  3. American Psychological Association. “Money Stress Weighs on Americans’ Health” 2015, Vol. 46, No.4 http://www.apa.org/monitor/2015/04/money-stress.aspx
  4. http://www.apa.org/news/press/releases/stress/2015/highlights.aspx

5 Ways to Spread Workplace Wellness

Wellness Programs - Blog Feature Graphic

Look around, and you’ll notice we are spending the greatest amount of our time at work; most full-time employees will spend over 2,000 hours at work every year, some even more.

This not only minimizes the amount of time we have to spend with family and do the things that make us happy, but it also makes it more difficult to fit in the required physical activity and to make healthier nutrition choices.

Healthcare Rates & Chronic Disease are on the Rise

Healthcare spending is on the rise, but so are chronic diseases such as diabetes, heart disease, heart failure, hypertension, and obesity – many of which could be prevented with a few behavior changes in our nutrition and physical activity.

According to the Organization for Economic Co-operation and Development (OECD), the United States spends far more on healthcare than any other nation. Yet, the average American’s life expectancy is only 78.3 years, which is lower than the average and the lowest among the top healthcare spending nations. Our lifestyle choices in this country are partially to blame for the rise in chronic disease.

Chronic diseases are responsible for 7 out of 10 deaths every year in the United States, and treating people with chronic diseases accounts for 86% of our nation’s healthcare costs.1

Spending more on healthcare is not making us healthier or bringing us longevity; we realize that prevention is considerably cheaper than managing any health condition and/or chronic disease. As a result, wellness is getting a lot of attention lately as we become more aware that we own our health and have complete control of our wellness.

Many businesses are adopting new approaches and beginning to implement workplace wellness programs – which are proving essential for creating and maintaining healthier, happier, hard-working employees while reducing the costs of health insurance claims, absenteeism, and receiving maximum productivity in return. Happy, healthy employees are more productive. It’s nothing short of a win-win symbiosis.

So, what is a workplace wellness program?

A successful workplace wellness program enables employees to increase control over, and improve, their health by offering healthier opportunities and empowering them to make healthier choices with ease.

The wellness program may offer risk assessments, screenings, flexibility for time to exercise, healthier snacking options in vending machines, behavior modification, educational and tobacco cessation programs, and much more. Access to a wellness program allows the employee to take care of their health regularly and reduce stress. Offering incentives may also be used to encourage employee participation and increase engagement.

Here are a few low-cost tips to get you started on spreading workplace wellness and transforming your organization into one of the best places to work:

  1. Healthy Pantry Club: Start a healthy pantry stocked with healthy choices essential to a healthy diet and productivity at work. Keep it junk-food free by stocking it with healthy snacks, fresh fruits, vegetables, and low-sugar, low-sodium drinks. A contribution box for employees to donate to keep the pantry stocked is a great way to get everyone involved.
  2. Fitness Trackers: Fitness trackers can encourage employees to increase their steps while being more active through participation in challenges that will keep them motivated and mindful of their health and nutrition choices. Office challenges are a fun way to increase steps and build camaraderie – award prizes for the top stepper, wellness champion, best effort, etc.
  3. Office Gym or Gym Memberships: Transform an unused office or space into a gym by adding yoga mats, free weights, and other fitness equipment. This helps the strapped-for-time employee fit exercise into their busy schedule. Subsidize or reimburse gym membership fees bringing fitness within reach for all employees to help create a routine they can stick with.
  4. Walking Meetings: Incorporate moving meetings to stimulate creativity and new ideas by walking around the building. Physical activity gives you energy and makes you feel more alert.
  5. Wellness Communications: Communication is the key to a successful wellness program. Get employees excited and engaged by sending wellness communications that provide ideas, strategies, short articles, tips, recipes, reminders, and more. Create awareness posters and flyers to display around the office, coordinate your content with the year’s seasons and monthly health observances.

Remember, it’s not the number of extravagant perks you offer, it’s how successful you are at fulfilling the employees’ basic human and emotional needs to foster a healthy, conscious, and happy environment that inspires employees to be their best.

References:

  1. http://www.cdc.gov/chronicdisease/
  2. https://data.oecd.org/healthres/health-spending.htm
  3. http://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATES-2014.pdf
  4. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT
  5. http://www.oecd.org/els/health-systems/health-data.htm

Can a Healthier and Safer Workforce Promote a Healthier Bottom Line for Employers?

A growing body of evidence supports the notion that focusing on the health and safety of a workforce is good business.

Engaging in a comprehensive effort to reduce the health risks of a workforce and mitigate the complications of chronic illness within these populations, can produce remarkable impacts on health care costs, productivity and performance.

An excerpt from the Journal of Occupational Occupational & Environmental Medicine:
Fabius, R; Loeppke, R; Hohn, T: et.al. “Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate Health Achievement Award Applicants”. JOEM. Volume 58: Number 1. Jan, 2016.

ABSTRACT
  • Objective: To test the hypothesis that comprehensive health and safety efforts, judged separately on their merits by the CHAA, contribute to better performance in the marketplace.
  • Methods: Stock market performance of CHAA winners tracked under 6 different scenarios using simulation and past market performance.
  • Results: The results demonstrate that a portfolio of companies recognized for excellence in workforce health or safety, or both, outperform in the marketplace. When we deconstructed the CHAA process and established portfolios among the applicants and award winners that achieved threshold scores in either health or safety as well as threshold scores in both, all significantly outperformed the S&P 500 standard index companies.
  • Conclusions: This study adds to the growing evidence that a healthy and safe workforce correlates with a company’s performance and its ability to provide “healthy” returns to shareholders.

To more objectively test this hypothesis, the stock market performance of the prior American College of Occupational and Environmental Medicine (ACOEM) Corporate Health Achievement Award (CHAA) winners were tracked under 4 different scenarios. Using simulation and past market performance, a theoretical initial $10,000 investment in publicly traded award winners was tracked from 1999 to 2012.  This portfolio of publicly traded award winning companies clearly outperformed the market. Though correlation is not the same as causation, the results consistently and significantly suggest that companies focusing on the health and safety of their workforce are yielding greater value for their investors as well. More research needs to be done to better understand the value of building these “cultures of health” in the workplace. Perhaps such efforts as this simply identify “smart” companies that outperform. But the evidence appears to be building that healthy workforces provide a competitive advantage in ways that benefit their investors.

The literature is replete with examples demonstrating that the health of employees impacts their performance and productivity. Additionally, for the majority of employers who pay for the cost of health care provided to their employees there is a direct impact on the bottom line.

Consider these statistics…
  • Over 22% of working age adults surveyed reported health-related work impairment from chronic illness in the previous 30 days. Those with impairment average 6.7 lost days. This is equivalent to $2.5 billion impaired days per year.(1)
  • In a 2003 study, it was found that illness and disability reduces total work hours by approximately 8.6%, with nearly 8.7 million Americans unable to work. The loss to the U.S. economy represented about $468 billion.(2) In 2006, over $2 trillion was spent on health care with three-fourths of that amount focused on treating chronic conditions.(3)
  • In a multi-employer study by ACOEM, IBI and Dr. Kessler of Harvard Medical School, Loeppke, et.al., reported that for every dollar of medical and pharmaceutical costs spent an employer lost an additional $2.30 of health-related productivity costs. Health-related presenteeism was shown to have a larger impact on lost productivity than absenteeism, with executives and managers suffering higher losses. Co-morbidities demonstrated the largest effects on productivity loss.(4) 
These facts led to a hypothesis…

Companies that envelope their employees and dependents in an environment that reinforces conscious and unconscious lifestyle choices as well as more effective accessing of healthcare, i.e. surround them with a “culture of health,” should be more productive and that productivity should be reflected in the price of their stock.

Testing the Hypothesis

To test the hypothesis, we turned to the American College of Occupational & Environmental Medicine’s corporate health awards (http://www.chaa.org/). The Corporate Health Achievement Award (CHAA), established in 1997, recognizes organizations with exemplary health, safety and environmental programs. Participating organizations submit a comprehensive application about their program and undergo a rigorous review by an expert panel to assess four key categories:

  1. Leadership & Management
  2. Healthy Workers
  3. Healthy Environment
  4. Healthy Organization

Awards have been given to organizations in manufacturing and service sectors, including city health departments, federal agencies and healthcare systems. Most years since inception of the award there has been at least one recipient. Most recipients have been publicly traded companies.

Since these award-winning companies are recognized for their exemplary efforts in creating a healthy workforce and since a healthy workforce generates less health care costs and improved productivity, we tested the thesis that a portfolio of these companies would outperform the marketplace.

Our results strongly support the notion that focusing on the health and safety of a workforce is good business. Engaging in a comprehensive effort to reduce the health risks of a workforce and mitigate the complications of chronic illness within these populations, can produce remarkable impacts on health care costs, productivity and performance.

The Cost of Chronic Disease

Dee Edington, Ph.D., has demonstrated that companies who do not pay any attention to elevating the health status of their workforce will see their employees developing increasing health risks and health care costs.(12) His results found that non-managed workforces acquire increased health risks and conditions resulting in increased costs over time. In fact, his research found that within non-managed populations the low risk cohort diminishes by roughly 5% while the moderate and high risk segments increase by roughly 8% and 11% respectively over a three-year period. He also demonstrated that it is possible to markedly reduce this trend through the execution of risk reduction programs at the workplace.(13)

Preventive services can stem the progression of health risks, chronic conditions and medical costs. RAND Corporation estimates one fifth of all healthcare expenditures will be devoted to treating consequences of obesity by 2020. Lowering obesity rates to 1998 levels could lead to annual productivity gains of $254 billion as well as the avoidance of $60 billion in annual treatment expenditures.

Seven chronic conditions (cancer, heart disease, hypertension, mental disorders, diabetes, pulmonary conditions and stroke) are currently costing the U.S. economy alone more than $1 trillion per year. Assuming the current trend continues to 2023, it would lead to a 42% increase in cases of the seven chronic diseases for a total of 230.7 million cases of these diseases with $4.2 trillion in treatment costs and lost economic output.

Plausible estimates of potential gains in 2023 associated with reasonable improvements in prevention, detection and treatment of just those seven conditions include:

  • Preventing 40 million fewer cases of illness
  • Cutting annual treatment costs in the U.S. by $217 billion
  • Reducing annual health-related productivity losses by $905 billion
  • Yielding more than $1 trillion in labor supply and efficiency(14)

Employers can realize similar results by implementing the best efforts in prevention, early detection and evidence based treatment for their workforce and covered lives.

A critical Meta-Analysis of 22 research studies in the scientific literature published in Health Affairs in February 2010 showed that medical and pharmacy costs fall by about $3.27 and absenteeism costs fall by about $2.73 for every $1 invested in wellness.(15)  This results in a return on investment of six to one.

Recognizing the merits of a healthy workforce even before this paper, ACOEM provided significant guidance. The College has stated that the marketplace has markedly underestimated the full impact of poor health in the workplace and on the economy. Employers would benefit by having a better understanding of the diseases and conditions that impact their employees and covered lives so that they could implement programs to mitigate their consequences. There is a connection between the health and safety and the productivity of workforces. Health care costs should be viewed as an investment in their employees rather than an expense. Health improvement strategies have proven to produce excellent returns. Comprehensive programs focus on primary, secondary as well as tertiary prevention.(16)

The workplace offers unique advantages for the implementation of health improvement initiatives. Roughly one quarter of our population is employed. When including retirees and family members this reach includes the majority of Americans. The workplace environment and the corporate culture can reinforce healthy behaviors. Powerful communication and educational assets can be leveraged. Incentives, penalties and mandates can be built into compensation and health benefits. Tenured employee relationships can promote sustainability. And finally employers possess the capability to measure the impact of health improvements on performance, productivity and business results.

The logic behind investing in workplace health is straight forward.

  • A large proportion of illness is preventable by reducing health risks. (17)
  • Health risks can be improved through workplace health programs. (18)
  • Reductions of health risks can lead to reductions in health costs. (19)
  • Worksite health programs can produce a positive ROI and VOI. (20,21,22,23,24)

Moreover, research supports a corporate-wide impact. Towers Watson has demonstrated that employers with highly effective health and productivity programs:

  • Generate 20% more revenue per employee
  • Realize a 16.1% higher market value and
  • Deliver 57% higher shareholder returns(25)

A recently published paper by Loeppke et al(26) emphasized the importance of integrating health promotion and health protection. This paper suggests that the CHAA assessment process should be realigned to follow the format of the DJSI. The CHAA’s current categories of measurement would be converted to mirror the DJSI’s categories, which include economic, environmental, and social metrics. This would result in an Integrated Health and Safety Index (IH&S Index).

Imagine a future scenario in which employers of sufficient size would be required or encouraged to publicly report on the degree to which they have achieved a culture of integrated health and safety. Those that report high Integrated Health and Safety Index scores could potentially be rewarded in the marketplace with greater investment as well as premium cost-reductions for group health and/or workers’ compensation insurance.

This would provide a major incentive for more companies to focus on the health and safety of their workforces and markedly aid in addressing many of the factors that are driving the American health care crisis—including the rise of chronic disease. If enough companies were able to improve and sustain the health status of their workforces, it could impact millions of Americans, providing a national tipping point in our effort to improve health outcomes and lower costs. The data in this paper suggest that such an effort might also contribute to investment-oriented opportunities and company differentiation in the marketplace.

Integrating health promotion (wellness) and health protection (safety) strategies creates synergy among these efforts, enhancing the overall health and well-being of the workforce, empowering employees to perform at the height of their potential and improving the organization’s bottom line.

References:

  1. Kessler et al. the Effects of Chronic Medical Conditions on Work Loss and Work Cutback. JOEM. 2001; 43(3):218-225.
  2. Berger, M, et al. Investing in Healthy Human Capital. JOEM. 2003; 45(12):1213-1225)
  3. Goetzel R. Do Prevention or Treatment Services Save Money? The Wrong Debate. Health Affairs. 2009; 28(1):37-41.
  4. Loeppke, R., et al., “Health and Productivity as a Business Strategy: A Multi-Employer Study”, JOEM, 51:4, April, 2009. pp 411-428.
  5. Peterson K W, Yarborough CM III, Ferguson EB, Matthew SJ. ACOEM Award: The American College of Occupational and Environmental Medicine’s Corporate Health Achievement Award.J Occup & Environ Med. 1996;38(10):969-972.
  6. Baldrige Award Winning Quality, 17th edition, by Mark Graham Brown, CDC Press, 2008.
  7. Malcolm Baldrige National Quality Award. [website]
  8. C. Everett Koop Award [website]
  9. Yarborough, CM. Administrative Track: What Constitutes Excellence for the Corporate Health Achievement Award. J Occup & Environ Med. 1998;40(4):381.
  10. Scope of Occupational and Environmental Health Programs and Practice. J Occup Environ Med. 1992;34:
  11. NCQA. Health Evaluation Data Information Set (HEDIS) 3.0. Washington, DC. National Commission on Quality Assurance. 1996.
  12. Edington, AJHP, May-June 2001, Vol 15, No. 5, pp-341-349. Research Overview of Natural Flow
  13. ZERO TRENDS by Dee Edington, 2009, published by the Health Management Research Center – University of Michigan
  14. Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace Wellness Program with Health Risk Factor Reduction” Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp 259–264.
  15. Devol, R et.al, 2007, An Unhealthy America: The Economic Burden of Chronic Disease. Charting a New Course to Save Lives and Increase Productivity and Economic Growth, Milken Institute
  16. Baicker, K., et.al., Workplace Wellness Programs Can Generate Savings., Health Affairs, Feb. 2010, Vol 29, No. 2. pp: 1-8
  17. ACOEM Guidance Statement, Healthy Workforce/Healthy Economy: The Role of Health, Productivity and Disability Management in Addressing the Nations’ Health Care Crisis, JOEM, 51:1, pp 114-119, January, 2009.
  18. Healthy People 2000, 2010; Amler & Dull, 1987; Breslow, 1993; McGinnis & Foege, 1993; Mokdad et al., 2004.
  19. Loeppke, et al., 2008; Wilson et al., 1996; Heaney & Goetzel, 1997; Pelletier, 1999.
  20. Edington et al., 2001; Goetzel et al., 1999
  21. Aldana SG. Financial impact of health promotion programs: A comprehensive review of the literature. Am J Health Promotion 2001;15:296-320.
  22. Loeppke R. “The Value of Health and the Power of Prevention”. Int J Workplace Health Manage. 2008; 1(2):95-108.
  23. Serxner, S., et.al., Do Employee Health Management (EHM) Programs Work? Am J Publ Health2009; 23(4):
  24.  Goetzel, R; Loeppke, R, et al. “Do Workplace Health Promotion (Wellness) Programs Work.” J Occup Environ Med. 2014; 56 (9):927-934, September, 2014.
  25. National Business Group on Health/Watson Wyatt “Staying at Work Report” 2007/2008 from Survey of 355 Large Employers
  26. Loeppke, R; Hohn, T; et.al. “Integrating Health and Safety in the Workplace: How Closely Aligning Health and Safety Strategies can Yield Measureable Benefits.” Journal of Occupational & Environmental  Medicine 2015: 57 (5): 585-597. May, 2015.