Category: Facts and Research

Companies enacting policies supporting an “always on” culture believe employee performance is tied to hours worked or email response time.  Research continues to be published that contradicts this management style, including a study scheduled to be presented at this summer’s annual meeting of the Academy of Management.  The study suggests that employers “damage their employeesꞌ well-being and work-life balance and weaken their job performance when they create expectations that work-related emails should be monitored and responded to during non-work hours.”

According to the authors of the study, “An ‘always on’ culture with high expectations to monitor and respond to emails during non-work time may prevent employees from ever fully disengaging from work, leading to chronic stress and emotional exhaustion.”  Even if the amount of time to check and respond to emails is minimal, the expectation to do so creates anticipatory stress and prevents detachment from work, which is necessary for sustainable job performance.  Ironically, the ability to disengage from work improves your ability to engage while you are there.

The study recruited and surveyed 600 working adults from a business school alumni association and LinkedIn interest groups.  The participants worked in a wide variety of industries and organizations.  The study conducted two surveys.  The first survey captured amount of time dedicated to after-hours email, the degree of employer expectation to respond to these emails, psychological detachment from work, emotional exhaustion, and personal opinions on having to be connected to email 24/7.  The second survey, which was given a week later, focused on work-life balance.

The study found that detachment from work was impaired less by time spent on after-hours email.  Rather, the expectation from an employer to be constantly connected made it harder to disengage.  This lowered ability to disconnect translates into poorer work-life balance and causes emotional exhaustion, which, earlier research has shown, negatively affects job performance.

The study also showed that the “negative effects of feeling the need to respond to emails during non-work hours was greatest on employees who strongly wish to keep their work and family separate.  While these employees are generally more likely to detach from work than those who don’t care as much about work bleeding into their personal lives, the insistence on after-hours email availability upsets their ability to do so.”

Category: Wellness

A survey from TriNet revealed some interesting information about the differences that exist in paid time off (PTO) use and preferences amongst different age and income groups.  The survey sought to gauge the impact of various PTO benefits on workers’ behaviors and their job performance and found that employees consider PTO a very important part of their job satisfaction.  A whopping 89% of all employees surveyed consider PTO important to their job satisfaction and count PTO packages as an important component when evaluating a new position.  Regardless of age, gender, or generation, this means generous vacation packages are no longer just considered a bonus; many workers see them as a necessity.

Differences By Income Levels
The survey found that nearly one-third of employees mainly take time off for medical emergencies, family obligations, or personal obligations.  Employees who take time off for these reasons earn, on average, $22,000 less per year than those who mainly take time off for pleasure.  This may be due to lower income individuals having to serve as caregivers for their loved ones while higher salaried employees may be able to afford support options to assist with certain situations.  Employers must recognize that their employees need and deserve personal time off to recharge so that they can be effective at their jobs, and as such, addressing these challenges will be critical to business success.

Differences By Generations
The survey also showed that older workers expect more time off than their younger colleagues.  Specifically, baby boomers were twice as likely (26%) to say they need four weeks or more off from work than millennials (13%).  According to Tina Hawk, Director of Human Capital Services at TriNet, “baby boomers are usually making a little bit more, so they’re actually able to travel and get away from the office, and they’ve got families established.  Millennials tend to take off in short spurts.”  In regard to the ideal amount of PTO, the largest share of respondents in each age group, including baby boomers (46%), generation X (45%) and millennials (56%) cited two to three weeks of PTO as the ideal amount.

Difference By Gender
There were also gender differences identified in the survey.  Specifically, 60% of women said they never check email while on PTO, compared to only 40% of men.  The same percentages (60% vs. 40%) felt PTO was essential to their workplace happiness.  As the importance of workplace diversity continues to increase, a shift in PTO benefits may also occur.

Category: Mobile Wellness

In a classic (and modern) story of unintended consequences, Pokémon Go may have become the next best health app by accident.  Before diving deeper into why, the obvious question of “What is Pokémon Go?” needs to be answered.

In simple terms, Pokémon Go uses a phone’s GPS and clock to detect where and when a user is in the game and make Pokémon “appear” (on a phone screen).  A user’s goal is to go and catch the Pokémon.  As you move around, different and more types of Pokémon will appear depending on where a user is and what time it is.  The idea is to encourage users to travel around the real world to catch Pokémon in the game.  This combination of a game and the real world interactions is known as “augmented reality.”  The game is so popular that it’s on the verge of overtaking Twitter in terms of daily active users on Android.  Did we mention the game is a little more than a week old?

The game has become so popular that people are hunting down Pokémon on their office desks, in hospital rooms, and even in bathrooms.  One teenage girl even found a dead body while looking for Pokémon, and police in Missouri claimed that four suspected robbers lured in victims with the possibility of Pokémon.

So how is Pokémon a health app?  To hatch a new Pokémon from an egg, players have to walk one kilometer, as measured by the phone’s sensors.  Driving is out of the question, as users must stay below the 10 or 15-mile-per-hour speed limit.  For an addictive game, that means lots of walking.  One player even logged 24 miles over the course of a couple of days walking around San Francisco.  While the game has limited data due to its newness, anecdotal evidence shows that Pokémon Go could be a boon to an individual’s exercise and well-being.  Users are increasing their physical activity, getting fresh air and sunshine, and interacting with others.

Only time will tell if Pokémon Go is the best thing since sliced bread for the wellness industry.

Category: Regulatory

The Equal Employment Opportunity Commission (EEOC) published new rules on May 17, 2016 that will require employers that offer wellness programs that collect employee health information (such as through a health risk assessment or biometric screening) to provide a notice to employees informing them what information will be collected, how it will be used, who will receive it, and what will be done to keep it confidential.  Although programs like these should not be used by employers in the first place, employees will at least benefit from having more transparency into the process.  This does not prevent employers from creating onerous, near-mandatory programs that effectively force employees to participate in the program even though the information provided through the new ruling makes these individuals want to opt out of the program.  The new ruling takes effect at the beginning of the first plan year on or after January 1, 2017.

To assist employers in communicating information on health data collection and use, the EEOC provided a sample notice for employers to use.  Employers can customize the sample notice to fit their specific wellness program or create their own message so long as certain criteria are met.  For example, the employer will need to describe the type and amount of incentives to be provided in return for participating in the wellness program and the specific criteria that must be met to obtain each level of incentive.  The notice can be provided electronically and may also be incorporated into notice materials that an employer already uses to comply with the health-contingent wellness program requirements under HIPAA.

Category: Facts and Research

According to a new study from Independence Blue Cross, “enhanced” walking programs encouraged people to walk more and resulted in weight loss and improvements in mood, energy levels, and overall feelings of well-being.  Published in the American Journal of Health Promotion, the study comprised of 460 employees from six employer groups and analyzed results from standard walking programs relative to enhanced ones.  The standard program included resources such as flyers and posters for promoting the program, but employers could do as much or as little promotion as they wanted.  The enhanced walking program included incentives, coaching, feedback, competitive challenges, and monthly wellness workshops.

During the nine months of the program, participants in the enhanced walking program averaged 726 more steps per day compared with those in the standard condition.  A 1000-step increase in average daily steps was associated with significant weight loss for both men (3.8 lbs.) and women (2.1 lbs.) and reductions in body mass index (0.41 men, 0.31 women).  Higher step counts were also associated with improvements in mood, having more energy, and higher ratings of overall health.  The study concluded that “an enhanced walking program significantly increases participation rates and daily step counts, which were associated with weight loss and reductions in body mass index.”

One dynamic worth noting that is often the case in most walking or physical activity programs is the drop in engagement over time.  Since a wellness program’s impact is limited by the number of participants in the program, sustainable engagement is critical.  As highlighted in the exhibit below, both programs struggled to maintain engagement throughout the nine months.  However, the enhanced program did have significantly more engagement (40% vs. 24%) at the end of the program despite both groups starting at similar points.

Buyer Beware
Before everyone gets excited about the results, it is worth noting the shortcomings, some even noted by the researchers, of this study.  First, participants reported daily step counts rather than having these measured and verified.  As a result, there is no way to determine the validity of the steps that participants recorded, which increases measurement error and reduces the likelihood of finding statistically reliable effects of step counts on outcome measures.  Also, participants in the enhanced condition had higher average step counts at baseline.

Category: Facts and Research

Wellable has long advocated for using test messaging as a medium of communication to facilitate individuals with living a healthier life (we even wrote a free eBook about it).  Now, another study suggests text messaging could prevent heart attacks.  The results of the six-month clinical trial, which were published in the Journal of the American Medical Association (JAMA), found that patients recovering from a heart attack were more likely to maintain lower blood pressure, less body fat, and lower cholesterol levels relative to a control group when receiving text messages with suggestions about their health routines.  Patients were also more likely to be active and quit smoking when compared to the control group.

The study included 700 patients with coronary heart disease, half of which received four text messages a week generated by a computer algorithm designed to be encouraging and give helpful advice.  Examples of sample text messages include: “Have you gone for your walk today, Jane?” or “did you know 90% of people don’t eat the recommended daily intake of vegetables (5 servings a day)?”  After six months, the difference in blood pressure between patients who received messages vs. those that did not was similar to what would have been achieved using a standard blood-pressure-lowering tablet.  Body fat percentage and physical activity differences were comparable to having the patients attend a cardiac rehabilitation program.

With repeat heart attacks comprising more than a quarter of all heart attacks in the Unites States, the implications of the study are significant.  What makes this study unique from similar findings in other studies is the duration of the research period and the number of patients.  Other studies were conducted over a shorter time period and on a much smaller scale.

As discussed in other blog posts and confirmed in this study, text messaging has benefits relative to other forms of communication that makes it ideal for delivering health content.  According to Dr. Clara Chow, the lead researcher in the study, “texts allow [doctors] to give support in bite-size chunks.”  The brevity of text messages is key in ensuring recipients read the message, which is why text message open and read rates are multiples higher than other digital media, especially email.  Rather than overwhelming an individual with lots of information at the time of discharge, text messaging allowed patients in the study to slowly consume and retain this information.  This is analogous to employers replacing a monthly wellness newsletter with lots of information into small text messages throughout the month.

Category: Mobile Wellness

The digital health movement has given consumers easy ways to track and maintain positive routines when it comes to physical activity and nutrition.  Unfortunately, when it came to supporting healthy sleep habits, most consumer technologies did little more than just track the amount, and in some cases quality, of sleep.  Fitbit’s new feature, Sleep Schedule, aims to change that.  Developed in collaboration with a panel of sleep experts, the feature will help users set and meet personalized sleep goals.

According to medical experts, maintaining a consistent schedule is one of the most important things when it comes to improving your sleep.  Failing to do so gives your body jet lag, which can then impact your physical performance, mental health, and cognitive functions.  To promote consistent quality sleep, Sleep Schedule will allow users to establish sleep goals and set up consistent bedtime and wakeup targets.  Fitbit will recommend how many hours per night you need, and suggest when you should retire and wake.  At the appropriate times, Fitbit will send push notifications to your smartphone that remind you to go to bed.  Users can also set a silent wake alarm on their tracker based on a target wakeup time.

The feature provides a much needed feedback loop, helping users adhere to a schedule and hit certain goals.  It is analogous to the push notifications Fitbit sends users when they are close to their step goal for the day.  These advancements in sleep tracking, including improved quantity and quality tracking, will open up new opportunities for consumers and employers to improve personal and population health.

Consumer Wellness Strategy

Advancements like this highlight why Wellable believes so strongly in a consumer wellness strategy.  Consumer technologies, like Fitbit and others, are leading the way in regard to innovation and user experience.  Rather than disrupt or challenge their gains, employers should embrace the consumer health movement, and this goes beyond just integrating these technologies into your current wellness platform.  Check out this free eBook on what a consumer wellness strategy really means and why employers should adopt it in their wellness philosophy.

Category: Facts and Research

After our posts on the efficacy of standing desks to reduce healthcare costs and improve productivity, there has been interest in identifying appropriate ways to increase energy expenditure (calories burned) while at work.  It just so happens that a new study published in the Journal of Physical Activity and Health sought to identify ways to increase the number of calories an employee can burn in order to reduce the harmful effects of sedentary behavior.  The study focused on quantifying the amount of calories burned while sitting, standing, and walking.

The researchers, who are affiliated with the Physical Activity and Weight Management Center at the University of Pittsburgh, studied the calories burned from 74 healthy individuals that were mostly in their 20s and of normal weight.  The volunteers were randomly assigned to four groups:

  • Group 1: Asked to sit and type at a computer for 15 minutes and then stand up for 15 minutes.
  • Group 2: Asked to sit for 15 minutes and watch TV and then walk at a gentle, strolling pace on a treadmill for 15 minutes.
  • Group 3: Asked to stand for 15 minutes and then sit down for 15 minutes.
  • Group 4: Asked to walk on the treadmill for 15 minutes and then sit down for 15 minutes.

While standing, participants were asked to avoid moving or fidgeting as much as possible.

Participants burned about 20 calories while sitting for 15 minutes, regardless of whether or not they were typing or watching TV.  Surprisingly, standing only burned an extra two calories per 15 minutes compared to sitting down.  The calories burned were not impacted by what the participant did prior to sitting or standing.  Total caloric expenditure was about the same.

Despite the hype, it does not appear that standing desks are a good intervention to burn more calories.  The extra calories burned from standing all day would only offset a very light snack.

As expected, walking had a very different impact.  15 minutes of walking resulted in about three times as many calories burned as sitting or standing.  Walking for an hour would burn 130 more calories than sitting or standing for the same amount of time.

The takeaway for employers is to reconsider why they are purchasing standing desks and create ways to promote walking.  Moving the printer across the office, scheduling walking meetings, and organizing wellness challenges are just a few ways to help facilitate activity during the work day.

Category: Mobile Wellness

According to a survey conducted by Nielsen and commissioned by the Council of Accountable Physician Practices, there is a significant communications gap between how much doctors say they are prescribing technology and how patients report that interaction.  When it comes to self-tracking, 5% of consumers say their doctor has recommended an app to track activity and 4% report their doctor recommended they use a wearable to track activity.  According to physicians, 52% said they recommend patients use mobile apps to track physical activity levels and 40% recommended patients use a wearable health monitor that helps track activity.  Some of the difference could be explained by potential survey bias, if physicians who were prescribing this technology were also more likely to participate in the survey.  Nevertheless, the delta between these two reported numbers is significant and very important.


According to another survey, three-quarters (76%) of patients listened to their physician’s recommendation to use wearable devices to track their health.  With a follow through rate of 76%, the communication gap between patients and physicians results in a significant impact on individuals utilizing mobile health tools.  As an alternative, employers can provide cogent communications that utilizes quality research from physicians on the benefits of health tracking.  It probably won’t have an impact on 3 out of 4 people, but it will certainly get more users engaging with these tools.  In the meantime, the Council of Accountable Physician Practices can start making efforts to improve physician communication.

Nielsen talked to 30,007 US consumers and 626 US physicians for the poll.

Category: Facts and Research

Despite the popularity of standing desks in the office, there’s little evidence that workplace interventions like standing desks help individuals burn lots more calories or prevent or reverse the harm of sitting for hours on end.  However, a new study from Texas A&M Health Science Center School of Public Health suggests that standing desks could also boost productivity for some employees by a whopping 46%.

The study, which included employees at a call center for a pharmaceutical company over a six-month period, sought to measure productivity changes in said employees after the company purchased standing desks.  Prior to the intervention, employees spent most of their days sitting down while talking with clients on the phone about health issues.  After installing standing desks, their productivity was graded based on metrics such as whether they delivered pertinent information and whether callers decided to continue being clients.

Within a month of getting standing desks, those employees were 23% more productive than their colleagues who continued to use traditional sitting desks.  Over the next five months, the boost in productivity rose to 53%, which may be because employees got accustomed to working while standing.  The average productivity increase over the entire half-year period was 46%.  In all fairness, some individuals have criticized the study, including Alan Hedge, professor of ergonomics at Cornell University.  He notes that the group of employees who did not receive a standing desk was less productive than the group who did, even at the beginning of the study.  If you take that difference into account, there was probably a productivity boost of only about 14% or 15% associated with a standing desk.  “That difference would be completely in line with the 20-year history of other studies,” Hedge said.

A separate survey of the call center employees in the study found that, after several months of having standing desks, workers said they were spending about 70% of their day seated, whereas their peers who did not receive standing desks were spending 90% of their day sitting in a chair.

Even critics like professor Hedge agree that the study is still an argument in favor of standing desks.  It just might not be as strong an argument as the data would make you think.  So should employers invest in standing desks?  The answer is still unclear.  The current research suggests that standing desks have little to no impact on health but do improve productivity.  The potential to see productivity gains should consider the type of work employees are doing.  Call center work (talking on the phone, etc.) is more conducive to a standing desk than other types of work.  Also, in highly competitive job markets, benefits like standing desk may mean the difference in a candidate accepting a job offer, which is why standing desks are so popular in Silicon Valley.  When making this decision, employers should definitely think beyond traditional return on investment measures (ROI) and start thinking about value on investment (VOI) that takes into consideration how benefit packages impact recruitment and retention as well as other outcomes in a company.

For companies that can’t find budget to outfit traditional desks with standing ones, there are plenty of low-tech ways to work more movement into your day without buying new equipment or furniture.  For example, encouraging employees to take micro-breaks in which they move around for a minute every 20 minutes.  Similar to standing desks, micro-breaks appear to increase productivity about 15%.  If an employer does upgrade to standing desks, they should make sure employees are using them with proper form.