The effectiveness of the Structured Health Intervention For Truckers (SHIFT): a cluster randomised controlled trial (RCT)

Abstract

Background Long distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent ‘Structured Health Intervention For Truckers’ (SHIFT), compared to usual care, at 6- and 16–18-month follow-up. Methods We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16–18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit® and resistance bands/balls to facilitate a ‘cab workout’). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population. Results Three hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m2, 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145–1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (− 24 mins/day, 95% CI: − 43 to − 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3–11). Differences were not maintained at 16–18 months. No differences were observed between groups in the other secondary outcomes at either follow-up. Conclusions The SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group. Trial registration ISRCTN10483894 (date registered: 01/03/2017)

Drivers with and without Obesity Respond Differently to a Multi-Component Health Intervention in Heavy Goods Vehicle Drivers

“…This study used data collected from participants taking part in the wider SHIFT RCT [ 15 ]. The full protocol of this cluster RCT, and the main findings of the effectiveness trial, have been published elsewhere [ 14 , 15 ]. Measurements and procedures relevant to the present analyses are described below.…”

“…The generated event files were processed using the Processing PAL software ( , version 1.3, University of Leicester, (Leicester, UK)). The full protocol for the data processing has been described elsewhere [ 15 , 30 ]. Participants had to provide at least one valid day of data at both time points to be included in the physical activity analysis of this study.…”

“…The Educators introduced and practised the “cab workout” with drivers within the education session involving light-intensity resistance exercises. Personnel from the company co-delivering the education sessions also acted as local champions and provided ongoing health coach support, along with members of the research team via a text messaging service [ 15 ].…”

“…We therefore designed the Structured Health Intervention for Truckers (SHIFT), a multi-component, theory-driven, health behaviour change intervention seeking to increase physical activity, reduce sitting time and enhance cardiometabolic health in this occupational group [ 14 ]. SHIFT has recently been evaluated using a cluster randomised controlled trial (RCT), with 25 transport depots in the UK [ 15 ]. Baseline data from the RCT showed that 88% of drivers had overweight or obesity, a prevalence higher than that seen in European drivers [ 4 , 16 , 17 ] and within the general UK (age-matched) population [ 18 ].…”

“…At 6-months, a favourable difference in physical activity was apparent between study groups, but this was primarily driven by a decrease in physical activity within the control group. The intervention had no impact on cardiometabolic or anthropometric outcomes [ 15 ].…”