Effects of Weight Reduction on Sleep and Alertness in Long-distance Truck and Bus Drivers

Aims


The work of long-distance truck and bus drivers involves long days, irregular hours and long uninterrupted periods of sitting still. These factors may lead to unhealthy lifestyle choices and thus increase the accumulation of excess weight. Individual lifestyle counseling is rarely planned for professional drivers even though their work is straining and they are often predisposed to long-term diseases. The aim of the one-year individual counseling regarding nutrition, exercise and sleep was for the drivers to achieve a 10% weight loss.

Process


The project recruited long-distance male drivers who were aged between 30 and 62 and whose waist circumference was at least 100 cm. The exclusion criteria included sleep apnoea (pauses in breathing during sleep) and diabetes requiring medication. The participants were randomly assigned to the intervention group and control group to allow more reliable investigation on the effects of lifestyle counseling. The participants in the intervention group took part in monthly counseling for a year. The control group members continued with their old lifestyles and then after 12 months they took part in lifestyle counseling for three months. The study lasted a total of 24 months. The final tests were completed in June 2012.


Methods


The drivers in the intervention group had six meetings and seven telephone sessions with a lifestyle counselor. The meetings were held as close to the drivers' home or workplace as possible. During the second year, the control group received counseling through two meetings and three telephone sessions. The aim of nutrition counseling was to help the drivers adopt the nutrition pie chart, eat regular meals and reduce their energy intake. The increase in exercise focused particularly on walking, which can also be performed in short sessions during a workday. The aim was to take 4000 extra steps five days a week with the help of a pedometer. 4000 steps is equivalent to half an hour of brisk walking. The target for sufficient sleep was at least 6 hours/day. The drivers were given a sleep hygiene manual prepared by a psychologist from the Finnish Institute of Occupational Health.

Tests


The tests were conducted at the UKK Institute at the beginning of the study as well as one year and two years after the study had finished. The drivers' height, weight and waist circumference was measured, they took part in a 2 km walk test and their balance, jump height and hand strength was tested, all of which are part of the UKK health-related fitness tests. In addition, the drivers wore an Actigraph device on their wrist for two weeks to monitor their amount of physical activity at work and in their free time as well as their duration of sleep. During this period, the drivers kept a sleep diary and assessed their daytime alertness on the questionnaire scale. Their alertness was also assessed using a reaction time test at the beginning and end of two workdays.

Schedule and funding


The project was funded by the Academy of Finland work research program between 2008 and 2011 with the aim of investigating if weight loss improves the alertness of an overweight driver.

RESULTS 1: Effects on body weight and cardiometabolic risk factors


Men with waist circumference >100 cm were randomized into a lifestyle counseling (LIFE, N=55) and a reference (REF, N=58) group. The LIFE group participated in monthly counseling on nutrition, physical activity, and sleep for 12 months aiming at 10% weight loss. After 12 months, the REF group participated in 3-month counseling. Assessments took place at 0, 12, and 24 months. Between-group differences in changes were analyzed by generalized linear modeling. Metabolic risk (Z score) was calculated from components of metabolic syndrome.
The mean body weight change after 12 months was -3.4 kg in LIFE (N=47) and 0.7 kg in REF (N=48) [net difference -4.0 kg, 95% confidence interval (95% CI) -1.9- -6.2]. Six men in LIFE reduced body weight by ≥10%. Changes in waist circumference were -4.7 cm in LIFE and -0.1 cm in REF (net -4.7 cm, 95% CI -6.6- -2.7). Metabolic risk decreased more in the LIFE than REF group (net -1.2 points, 95% CI -0.6- -2.0). After 24 months follow-up, there were no between-group differences in changes in body weight (net -0.5 kg, 95% CI -3.8-2.9) or metabolic risk score (net 0.1 points; 95% CI -0.8-1.0) compared to baseline.

Conclusions: Weight reduction and decreases in cardiometabolic risk factors were clinically meaningful after 12 months of counseling.

Original article:
Puhkala J, Kukkonen-Harjula K, Mansikkamäki K, Aittasalo M, Hublin C, Kärmeniemi P, Olkkonen S, Partinen M, Sallinen M, Tokola K, Fogelholm M. Lifestyle counseling to reduce body weight and cardiometabolic risk factors among truck and bus drivers - a randomized controlled trial. Scandinavian Journal of Work, Environment & Health 2015;41(1):54-64.

RESULTS 2: Effects on dietary patterns and physical activity


Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone-counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' logbooks.

Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants.

Conclusion: Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling.

Original article:
Puhkala J, Kukkonen-Harjula K, Aittasalo M, Mansikkamäki K, Partinen M, Hublin C, Kärmeniemi P, Sallinen M, Olkkonen S, Tokola K, Ojala A, Nygård CHå, Fogelholm M. Lifestyle counseling in overweight truck and bus drivers :effects on dietary patterns and physical activity. Preventive Medicine Reports 2016;4:435-440. doi:10.1016/j.pmedr.2016.08.012.

 

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Updated May 2018

 

 

 
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