miller Health Occupational Health and Fitness

Index

64. Results ERJ JULY 2007

John Miller conducted a Crookback Clinic for The Group in June 2007.

Participant profile

4 participants - all men.

The average age of participants was 34.

Participants completed two profiles

■ Mind and Body

■ Musculo-skeletal risk

The results are presented in graphic format, with commentary.

CONTEXT

The health assessment program conducted by Miller Health is based on the premise that the health of key body systems depends on

• physical fitness

• diet and

• an ability to manage the stress of both life and work.

Within the Australian community, there is currently an epidemic of body system dysfunctions which when translated into the workplace are associated with increased absenteeism and workers compensation, and decreased work performance and productivity.

There are very few organisations that are not affected by this epidemic.

THE PROGRAM

The assessments took an holistic look at health, based on the premise that the major systems of the body maintain healthy function when they are supported by

n	a physically active way of life

n	management of stress, including that which is generated internally and that which impacts on each individual from their external environment

n	work satisfaction, including work stress

n	a life in balance in which people have interests outside of work which distract them from being busy and miserable.

HEALTH PROFILES

The Mind and Body profile was used as a way of obtaining a snap shot of people’s health, fitness and stress levels. In the workplace it is also a good measure of the risk of absenteeism, presenteeism and workers’ compensation.

People in poor shape experience

• headaches

• poor sleep

• lack of energy and vitality

• musculo-skeletal dysfunction

• frequent colds and flu

• obesity

• anxiety ...

The aging population

We believe (barring disability) there is nothing stopping anyone of working age from being in exceptionally good physical condition – except lack of training. It's not so much that we have an aging population but a lazy population. We know this is the case because according to the principle of increased dysfunction, people are getting older younger!

Theoretically, as people get older they should be able to maintain a high level of fitness – they’ve had longer to train!

The Governments of Australia base their medical system data on the fact that as people get older they become more dysfunctional. It's a poorly researched premise. What's actually happening is that people are getting older younger! They're unfit and unhealthy. Junk medicine is not contributing to an improvement in community standards of health, on the contrary.

Whilst we can expect people over the age of 70 to start slowing down, it is not necessarily the case for people of working age. As a general rule, poor health and body system dysfunction is not so much related to age as it is to

▪ low levels of physical activity

▪ junk food diets

▪ over-consumption of alcohol

▪ smoking

▪ an inability to handle the normal stresses of life

▪ a job that does not suit their personality, intelligence strengths or interests

▪ an over-reliance on junk medicine - medicine that is pharmaceutically based and which masks

symptoms without stimulating the body's own recuperative power.

MIND AND BODY PROFILE

The Mind and Body profile provides people with a very good idea of how well the various systems of the body are functioning, particularly the

• the mind

• autonomic nervous system

• immune system

• digestive system

• circulatory system

• elimination system

• musculo-skeletal system.

On this profile, the lower the score the better.

To complete the profile, circle the number appropriate to the degree to which you experience the symptoms on the left hand side of the page. The greater the symptom, the higher the score.

	Symptom	None		Not much			A fair bit			A lot
1.	Headaches	0	1	2	3	4	5	6	7	8	9	10
2.	Migraines	0	1	2	3	4	5	6	7	8	9	10
3.	Lack of energy and vitality	0	1	2	3	4	5	6	7	8	9	10
4.	Candida - jock itch, thrush, tinea ...	0	1	2	3	4	5	6	7	8	9	10
5.	Poor sleep. If on tablets score 10	0	1	2	3	4	5	6	7	8	9	10
6.	Snoring &/or sleep apnoea.	0	1	2	3	4	5	6	7	8	9	10
7.	Crook back, sore shoulders RSI ...	0	1	2	3	4	5	6	7	8	9	10
8.	Frequent colds, flu, sinus	0	1	2	3	4	5	6	7	8	9	10
9.	Unsettled stomach, reflux	0	1	2	3	4	5	6	7	8	9	10
10.	Irritable bowel, constipation, trots ...	0	1	2	3	4	5	6	7	8	9	10
11.	Overweight - 1 point for every 2Kg	0	1	2	3	4	5	6	7	8	9	10
12.	Asthma	0	1	2	3	4	5	6	7	8	9	10
13.	Low level of aerobic fitness	0	1	2	3	4	5	6	7	8	9	10
14.	Chest pain, palpitations	0	1	2	3	4	5	6	7	8	9	10
15.	Rashes, itchiness, psoriasis, zits	0	1	2	3	4	5	6	7	8	9	10
16.	Mouth ulcers, cold sores	0	1	2	3	4	5	6	7	8	9	10
17.	Elevated blood pressure. Score 0 on pills	0	1	2	3	4	5	6	7	8	9	10
18.	Reduced libido	0	1	2	3	4	5	6	7	8	9	10
19.	Shakes, nervous ticks, mannerisms	0	1	2	3	4	5	6	7	8	9	10
20.	Grinding teeth	0	1	2	3	4	5	6	7	8	9	10
21.	Alcoholic drinks per day (2 pts/drink)	0	1	2	3	4	5	6	7	8	9	10
22.	Smoking. (1 pt/cigarette/day)	0	1	2	3	4	5	6	7	8	9	10
23.	Caffeine (1 pt/cup per day)	0	1	2	3	4	5	6	7	8	9	10
24.	Anxious about life in general	0	1	2	3	4	5	6	7	8	9	10
25.	Insecure/apprehensive about the future	0	1	2	3	4	5	6	7	8	9	10
26.	Sad or depressed (On medication, score 0)	0	1	2	3	4	5	6	7	8	9	10
27.	In wrong job for now	0	1	2	3	4	5	6	7	8	9	10
28.	Under-appreciated at work	0	1	2	3	4	5	6	7	8	9	10
29.	Under-appreciated at home	0	1	2	3	4	5	6	7	8	9	10
30.	Unhappy with family and romantic life	0	1	2	3	4	5	6	7	8	9	10

Score

The score of a normal, fit and healthy human being is less than 20

Higher scores are symptomatic of dysfunction of one or more body systems.

People with high levels of stress usually score well over 100.

For people with a score of more than 80, the ‘background noise’ of their life is becoming louder and louder. It is hard to concentrate on your work when body systems are dysfunctional.

We know a fit and healthy group when we see the majority of scores below 40. This was not the case with this group. By and large higher scores are usually a reflection of

• low levels of fitness

• an inability to deal with what life and work are serving up to people.

Remember, it is not what happens, but how we deal with what happens that determines our level of stress.

Classification of average scores:

Excellent, less than 40: Good, 41 - 50: Not bad, 51 - 60: Poor, 61 - 70: Dreadful 70+

This profile is described as poor. The average score was 80. With one exception this is not a very fit and healthy group.

SCORES ON EACH ITEM, RANKED - the higher the score the worse the problem

4 people completed the profile. We added the scores for each item. The results appear in the table below.

Rank	Symptom		Aggregate Score for 4 people	People scoring 7 or more - high risk
				Number	Percentage
1	11	Overweight	27	2	50
2	17	High blood pressure	26	1	25
3	6	Snoring	23	2	50
4	5	Poor sleep	20	1	25
5	13	Unfit	18	0	0
6	7	Musculo-skeletal dysfunction	17	0	0
7	24	Anxious	15	0	0
8	28	Under-appreciated at work	15	0	0
9	23	Caffeine	14	1	25
10	3	Lack of energy	13	1	25
11	8	Colds and flu	13	1	25
12	4	Candida	12	1	25
13	21	Alcohol	12	1	25
14	20	Grinding teeth	11	0	0
15	22	Smoking	11	1	25
16	19	Shakes	8	2	50
17	12	Asthma	7	1	25
18	25	Insecure	7	1	25
19	14	Chest Pain	6	0	0
20	18	Libido	6	0	0
21	27	Wrong job	6	0	0
22	1	Headaches	5	0	0
23	9	Crook gut	5	0	0
24	29	Under-appreciated at home	5	0	0
25	30	Unhappy family life	5	0	0
26	10	Irritable bowel	4	0	0
27	26	Depressed	4	0	0
28	2	Migraines	3	0	0
29	15	Rashes	2	0	0
30	16	Mouth ulcers	1	0	0

* Fitness related

* Diet related

* Stress related

This is a very sample of 4 and the results so we can't draw many conclusions from them.

Nevertheless the way the results are presented will provide the Organisation with an appreciation of the quality and usefulness of our reports. A useful comparison is between this report and those numbered 55-59 in the audit reports index.

Usually musculo-skeletal dysfunction comes at the top of this list, followed by a range of fitness related symptoms.

Perception

Based on people's perception the underlying issues are low levels of fitness.

Fitness

This workplace, like all others has a fitness problem. Of the top 4 items, 4 are directly related to low levels of fitness.

It's interesting that rarely do people have their aerobic fitness levels measured, when this is the key driver of poor health. We measure every thing but; blood pressure, cholesterol, blood sugar and fail to measure the key driver of metabolic health.

It would be good to conduct a measure of aerobic fitness on this group and run a program designed to inspire and motivate them to keep themselves fit and healthy.

Musculo-skeletal dysfunction

Like all organisations, the organisation has a musculo-skeletal dysfunction problem but with such a small number of participants it is difficult to quantify. Based on our experience, in excess of 30% of staff will report high rates of musculo-skeletal dysfunction. We believe the whole workforce would experience similar dysfunction to our sample group.

It is recommended that the organisation build a firewall between dysfunctions and injuries.

What this means is requiring staff at risk (and staff experiencing musculo-skeletal pain) to attend musculo-skeletal prehab sessions, in work time, to improve strength and flexibility and to get bones back into alignment - tracksuit therapy not white coat therapy.

Our survey showed that staff will overwhelmingly willing to participate in such a program.

A similar approach needs to be taken with people who've already been tipped into the workers compensation bucket. These people should attend daily rehab sessions, conducted by registered fitness practitioners that involve strength and flexibility exercises.

There is a good case for subsidizing fitness centre memberships, but only for people who go and only for people whose fitness is getting better, or has achieved an acceptable level. A lot of organisations pay by input, not output. They don't get good value for money.

Smoking

1 person smoked. That's 1 too many.

Depression

No one was depressed. This is good.

As the population becomes less physically active, eats diets high in flour and sugar and low in omega 3 fats, selenium and B group vitamins, lacks resilience, drinks too much alcohol and caffeine, has difficulty managing the internal and external conversations going on inside their head and/or live lives devoid of meaning and purpose, we can expect rates of anxiety and depression to increase.

This epidemic will, of course increase at the same rate as the epidemic of all other body system dysfunctions. The mind is just another part of the human ecosystem - an ecosystem under threat from low levels of health, fitness and wellbeing.

There is an epidemic of 'depression' in the community, and whilst not wishing to make light of the true ‘black dog’ of clinical depression, for some people the symptoms of stress, unhappiness, sadness, grief, hopelessness, disappointment, despair, vacuity, anger and anxiety are being treated as if they were the symptoms of clinical depression.

I believe it is appropriate for the Organisation to encourage those people with an unhappiness, anxiety or depression problem to make full use of the counselling services of the EAP and encourage them to do the things that unstressed people do - like keeping themselves fit, having a lunch hour outside, taking their holidays, eating wisely, not working too many hours and ‘getting a life’. There could be a high price of achievement for those who can't keep lives in balance.

It is frequently the case that those people on anti-depressants are not doing the things that unstressed people do to keep their bodies and minds in good shape.

The best book about depression I've read, and what you can do about it, and one that I recommend highly is by psychiatrist, David Servan-Schreiber, Healing Without Freud or Prozac.

Health, fitness and wellbeing

I recommend that all organisations establish a health, fitness and wellbeing section and employ registered fitness practitioners to give oversight to a systematic health, fitness and wellbeing program. Those at risk need to be given the greatest encouragement to get themselves back into good shape, in their own and company time.

These fitness practitioners would also supervise musculo-skeletal prehab and rehab programs.

MUSCULO-SKELETAL RISK FACTOR

Our musculo-skeletal risk factor profile looked at a range of parameters including mobility, strength and flexibility and whether people are training to keep themselves strong and flexible.

The musculo-skeletal risk factor profile is comprised of a mix of 7 objective and 3 subjective assessments.

• Current musculo-skeletal condition

• Abdominal strength test

• Upper body strength test

• Flexibility

• Functional mobility – the ability to sit down and stand up with ease.

• Shoulder function

• Dominant hand grip

• Non-dominant hand grip

• Flexibility training behaviour

• Strength training behaviour

A score of 70% is attainable by those who have a regular and systematic training program.

Those scoring less than 70 are not doing sufficient in the way of strength and flexibility exercises. They are therefore exposing themselves to a high risk of musculo-skeletal dysfunction. (It would be bizarre for a workplace to offer to pay the rehabilitation costs of people who were not keeping themselves strong enough or flexible enough to do their job without succumbing to musculo-skeletal dysfunction, wouldn't it?)

This risk to The Organisation is much higher than the risk we see in other organisations. This is a poor result.


Not a particularly good result. 2 people are experiencing pain and discomfort. Those scoring less the 6 need to be required attend a prehab/rehab program, for their own benefit and that of the organisation.		As a group this is not a good result. 17 sit-ups (7/10) was the pass mark. People who can't do 40 sit-ups on the trot aren't serious about protecting their trunk from dysfunction.

Generally speaking a poor result. 2 people performed poorly. 17 press-ups (7/10) was the pass mark. People who can't do 40 press-ups aren't serious about protecting the arms and shoulders from dysfunction.		This is a poor result. 2 people couldn't touch their toes at all. Too many people already have tight muscles along the back side of their body - calves, hamstrings, buttock and back. It's caused by two things - sitting down and not having a flexibility program. There is a high risk of lower back and neck dysfunction.

This is a good result. When you can't get down and up off the floor 7 times in 30 seconds you've got a mobility problem. Fix it!		One person had severe shoulder dysfunction. Fortunately itr's redeemable.

A mediocre result. I strongly recommend people use the grip strengtheners every day to improve grip strength.		A mediocre result. I strongly recommend people use the grip strengtheners every day to improve grip strength.

Its always the case, few people have a regular strength and flexibility program. The organisation needs to put in train a regular and systematic training program, on site, that includes 1. specialist prehab and rehab sessions for those at serious risk and those already dysfunctional and on compo 2. daily strength and flexibility sessions in the workplace.

Average score: 51. Not good. This graph show why people are experiencing pain. They are not in particularly good shape. Low levels of strength and flexibility. There is a strong case of the organisation to implement an obligatory strength and flexibility program for those who scored less than 60 in this profile.

Lack of strength and flexibility is something that the Organisation needs to take seriously and monitor carefully and put in place an organisation-wide strategy to improve musculo-skeletal function. By far and away a high proportion of people do not have a strength and flexibility program. As a result they are getting weaker and tighter by the week, thereby exposing themselves and the organisation to risk.

When push comes to shove and people become dysfunctional, it will be The Organisation that ends up paying the high cost of an avoidable musculo-skeletal complaint. Click here to read the article from injury to dysfunction. Click here to read about swifties and fallacies.

In our opinion musculo-skeletal dysfunction caused by lack of a regular and systematic strength and flexibility program cannot be classified as an injury. Responsibility for musculo-skeletal dysfunction needs to be sheeted home to individual employees, though it’s unlikely to happen without the establishment of a culture within the organisation that supports, values and understands strength and flexibility.

We recommend a range of strength and flexibility classes that are readily available Australia-wide: -

•	Posture and Flexibility
•	Yoga
•	Crookback Clinic
•	Tai Chi
•	Pontius Pilates

The Organisation would place itself in the forefront of OH&S practice if it took the musculo-skeletal risk seriously and moved heaven and earth to educate all staff about this risk and encourage them to take part in a regular strength and flexibility program. Maybe The Organisation and its worker's compensation insurer could invest in a pilot program to increase staff strength and flexibility!

The lack of strength and flexibility training coupled with poor abdominal strength, upper body strength, flexibility, shoulder function and grip strength is a cause for concern and needs the attention of individual staff and managers.

RECOMMENDATION

We strongly recommend that the people who are in current poor musculo-skeletal condition, and who lack abdominal strength, upper body strength, flexibility, shoulder function and functional mobility, in particular those who scored less than 60 on the profile, be obligated to attend regular, in-house strength and flexibility classes.

The pressure on the organisation's workers' compensation costs is such that to do otherwise would, in our opinion be to abrogate a responsibility for the prudent management of the organisation's finances.

See the generic list of recommendations.

STRESS RISK

Participants completed a simple stress and relaxation profile designed to assist them in making an assessment of how they were affected by stress. It is based on the habits of unstressed people.

If you do what unstressed people do you are less at risk of becoming stressed. I’m yet to see someone who said they were highly stressed or depressed who got a high score on this profile. A good score is over 70.

• How would you rate your current stress level

• Do you get a good night’s sleep?

• Do you take your holidays?

• Are you keeping yourself fit and healthy?

• Is there balance in your life?

• Do you take time off at lunch time?

• How many hours a week do you work?

• Are you good at giving back to your Self?

• Do you meditate?

• Are you happy with your family (and romantic) life?

The matter of stress always needs to be addressed by organisations as part of a personal development thrust, and aimed at all staff. If stress management type programs are to be conducted, all staff need to be involved, otherwise those at most risk and those who are currently most stressed (and too wrapped up in their own busyness) will not attend.

For those who spend long hours at work, I often wonder whether the behaviour is externally or internally driven. I suspect the latter. No body on their death bed ever said 'I wish I'd spent more time at the office.'

A few people are struggling with their family life. This is another fertile area for personal development and counseling programs. It's hard to concentrate at work when your home life is in turmoil

SCORING GUIDELINES

Excellent, scoring 8 or more

Good, scoring 7 or more

Fair, scoring 5 or 6

Poor, scoring less than 5

‘Pass mark’ on all parameters 7/10.


As a group this is a good profile. Most people are managing stress well.		This is a very good result. With one exception people are sleeping well.

Another good score. Only 2 people not taking good long holidays.		A good score. In the main people are keeping themselves fit and healthy - the foundation of stress management.

With one exception this group has it's life in balance.		A good result.

A very pleasing result.		With one exception people are doing things that give back to themselves.

Very few people meditate.		Family life satisfaction is good.

Average score: 69. This is a pleasing score. Compared with other groups we have surveyed this group is dealing with the stress of life and career well.

CAREER SATISFACTION

The parameters in the profile relate to a mix of factors influences by the participant, management and their colleagues.

• How close are you to doing the job you’d really like to be doing?

• Are you in the right job for now?

• Is work giving you life or sucking life out of you?

• Are you focused on your career options?

• Do you get good feedback from your manager?

• Do you receive an appropriate financial reward?

• Do you feel you and your work are valued and appreciated?

• Do you work for an organisation that cares about people?

• Do you enjoy the company of the people you work with?

• What’s the level of morale like in your work group?

Normally, when results on the overall career profile are less than 70/100, people agree that they’re not in the right job. Certainly those scoring less than 60 have sufficient issues relating to career management as to seriously consider going somewhere else.