Shiftwork and Health: optimal timing of meals and physical activity

Lead Research Organisation: Liverpool John Moores University
Department Name: Sport and Exercise Sciences

Abstract

Many people now work at unusual hours of the day. Shift-work is no longer restricted to heavy industry but is now more common in E-commerce and telesales occupations to meet the need for 24-hour services. Shift-work is associated with greater health problems (e.g. chronic fatigue, gastro-intestinal and cardiovascular problems) than normal 9am-5pm day-work. It is unclear whether these problems are due to disturbances of the body clock and/or a decreased opportunity to adopt the desired amount and timing of lifestyle and social factors. With more than 20 years experience in researching this area, the possession of new facilities in our shift-work simulation unit, as well as a history of field-based research, the Chronobiology Research Group at Liverpool John Moores University will address these gaps in knowledge. We will explore such questions as, how does shift-work interfere with physical activity and eating habits? How does prior exercise influence metabolic responses and performance during a night-shift? What are the longer-term acceptability and the health consequences of a physical activity/dietary intervention programme? A qualitative component to the project ensures that shift-workers inform the research process throughout. Research findings will be disseminated, as they emerge, to employers and individual shift-workers.

Technical Summary

About 20% of the European workforce comprises shiftworkers in order to ensure that society?s needs for 24-hour services, process industries and emergency cover are met. We aim to explore the gap in health equality between shiftworkers and dayworkers and focus on the NPRI key research areas of ?diet and nutrition? and ?physical activity?. We will identify the most appropriate timing and composition of such interventions for reducing shiftworkers? problems (chronic fatigue, gastro-intestinal and cardiovascular disorders). The major novel methodological angle to this project is the combination of quantitative and qualitative research strategies. Two research assistants will complete three research phases;

(i) A survey of shiftworkers? dietary and physical activity habits.
Fifteen hundred participants will be sampled in a stratified random fashion. Confidence intervals will be calculated for the binary and Likert scale type responses, which will be compared between shiftwork factors. Qualitative data will also be collected through unstructured interviews with shiftworkers and their families.

(ii) Four controlled experimental interventions on participants living in our shiftwork simulation unit.
Twenty shiftworkers will be recruited for each of the 4 experiments. The exact interventions will be informed by the results of phase (i), but will involve the timing of physical activity (activity taken either before or after the workshift), the intensity of activity (either a relatively short 30-min bout of intense exercise or a relatively long 1-hour bout of moderate exercise), the timing of meals (the main meal of the day taken either before or after the workshift) and the content of food intake during a shift (food that matches typical content during daywork and food that matches typical content during nightwork). Likert scale ?acceptability? responses will be compared between repeated simulated shifts and between the various interventions.

(iii) A field-based intervention study on health outcomes over an 18-month period.
One hundred participants will be recruited for each of two intervention groups and a control group. The primary outcome measures to be investigated in this phase are cardiovascular health measures, frequency data relevant to the incidence of gastro-intestinal and menstrual cycle disorders over the study period and subjective scales to measure fatigue and sleep disturbance. Qualitative data will be generated (through interviews and focus groups) that are relevant to social and family conflict issues.

When this project is complete, employers and health promotion experts would gain ergonomic data to guide shift-work arrangements and promote optimum work-life balance of their employees.

Publications

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Atkinson G (2008) Exercise, energy balance and the shift worker. in Sports medicine (Auckland, N.Z.)

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Atkinson G (2007) Relationships between sleep, physical activity and human health in Physiology & Behavior

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Harriss DJ (2009) Lifestyle factors and colorectal cancer risk (2): a systematic review and meta-analysis of associations with leisure-time physical activity. in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

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Harriss DJ (2009) Lifestyle factors and colorectal cancer risk (1): systematic review and meta-analysis of associations with body mass index. in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

 
Description Institute of Health Research, Liverpool John Moores University, Research Fund (2009/10)
Amount £5,000 (GBP)
Organisation Liverpool John Moores University 
Department Institute for Health Research
Sector Academic/University
Country United Kingdom
Start 04/2009 
End 04/2010
 
Description Physiological Society Symposium Grant
Amount £4,000 (GBP)
Organisation Physiological Society 
Sector Learned Society
Country United Kingdom
Start 06/2010 
End 06/2010
 
Description Physiological Society Travel Grant
Amount £600 (GBP)
Organisation Physiological Society 
Sector Learned Society
Country United Kingdom
Start 11/2008 
End 12/2008
 
Description RCUK National Science Week Event
Amount £1,700 (GBP)
Organisation Research Councils UK (RCUK) 
Sector Public
Country United Kingdom
Start 10/2007 
End 10/2007
 
Description Royal Society International Travel Grant
Amount £4,000 (GBP)
Organisation The Royal Society 
Sector Academic/University
Country United Kingdom
Start 10/2009 
End 10/2009
 
Title Model of factors affecting energy balance during shiftwork 
Description In publication 18620467, the first ever model was presented to summariase all the behavioural and biological factors that can potentially affect energy expenditure and intake during shiftwork. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2008 
Provided To Others? Yes  
Impact Cited by two subsequent research groups 
 
Description Civil Aviation Authority 
Organisation Department of Transport
Department Civil Aviation Authority (CAA)
Country United Kingdom 
Sector Public 
PI Contribution Ongoing discussions about lifestyle and aircabin personnel. We are inputting into the CAA website for information on jet-lag and work schedules.
Collaborator Contribution Dissemination of information via CAA website (to be live in Spring 2012). Significant impact
Impact None at present
Start Year 2011
 
Description Dept General Practice, Cardiff University 
Organisation Cardiff University
Department Department of General Practice
Country United Kingdom 
Sector Academic/University 
PI Contribution Academics from this Department delivered the traiing packages to the research staff for the motivational interviewing techniques used in the phase three intevention study.
Collaborator Contribution Academics from this Department delivered the traiing packages to the research staff for the motivational interviewing techniques used in the phase three intevention study.
Impact This colaboration was crucial for the implementation of our intervention study on shiftworkers.
Start Year 2008
 
Description Dept of Sport and Exercise Science, University of Chester 
Organisation University of Chester
Department Department of Sport and Exercise Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution An academic developed the primary physical activity survey that was used in our first phase of the project. He also supplied data on dayworkers for comparison purposes to our shift-workers.
Collaborator Contribution An academic developed the primary physical activity survey that was used in our first phase of the project. He also supplied data on dayworkers for comparison purposes to our shift-workers.
Impact A manucript is currently under preparation in which shift-workers physical activity is compared to the dayworkers data collected by this academic
Start Year 2008
 
Description Greater Manchester Police 
Organisation Greater Manchester Police
Country United Kingdom 
Sector Public 
PI Contribution Within the second year of the project, this scientific collaboration replaced Merseyside Police as our most significant source of research participants (see comments in main report), especially for the phase 3 intervention study.
Collaborator Contribution Within the second year of the project, this scientific collaboration replaced Merseyside Police as our most significant source of research participants (see comments in main report), especially for the phase 3 intervention study.
Impact The PI and another member of the team were consulted for the introduction of new shift schedules to the cohort of 600 workers.
Start Year 2007
 
Description University of Teesside 
Organisation Teesside University
Country United Kingdom 
Sector Academic/University 
PI Contribution An academic collaborated as the blinded statistician for purposes of allocation of participants to study groups and statistical analysis in our phase three RCT.
Collaborator Contribution An academic collaborated as the blinded statistician for purposes of allocation of participants to study groups and statistical analysis in our phase three RCT.Blinded statistician for RCT
Impact A manuscript is currently in preparation of the phase three RCT which adhered to CONSORT guidelines and so a blinded participant aloocator/statistician was required.
 
Description University of Teesside 
Organisation Teesside University
Country United Kingdom 
Sector Academic/University 
PI Contribution An academic collaborated as the blinded statistician for purposes of allocation of participants to study groups and statistical analysis in our phase three RCT.
Collaborator Contribution An academic collaborated as the blinded statistician for purposes of allocation of participants to study groups and statistical analysis in our phase three RCT.Blinded statistician for RCT
Impact A manuscript is currently in preparation of the phase three RCT which adhered to CONSORT guidelines and so a blinded participant aloocator/statistician was required.
 
Description Wits School of Physiology 
Organisation University of the Witwatersrand
Department School of Physiology Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution In the third year of the project, Royal Society funding (£5,000) was obtained to develop this collaboration. Dr. Bentley is an expert on sleep and has contributed to the phase 2 work on exercise and daytime sleep quality.
Collaborator Contribution In the third year of the project, Royal Society funding (£5,000) was obtained to develop this collaboration. Dr. Bentley is an expert on sleep and has contributed to the phase 2 work on exercise and daytime sleep quality.
Impact Royal Society funding (travel grant) was obtained. A manuscript on daytime sleep quality and exercise is currently being prepared in collaboration with Dr. Alison Bentley.
Start Year 2009
 
Title Shiftwork MI intervention 
Description Motivational Interviewing techniques were incorporated into a lifestyle intervention for shiftworkers.The nature of this shiftwork (participants needed to be contacted at various times of the day and night) meant that the contact interviews were face-to-face, telephone and internet-based. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Early clinical assessment
Year Development Stage Completed 2009
Development Status On hold
Impact The intervention was successful in lowering weight gain over a three-month period. 
 
Description BASES Newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The PI lead an article specifially on the NPRI which appeared in the British Association of Sport and Exercise Sciences Newsletter.

The Newsletter is disseminated to approximately 1000 academics and health professionals
Year(s) Of Engagement Activity 2006
 
Description BBC Horizon 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The PI was interviewed for the BBC Horizon programme "The Secret Life of your Bodyclock".

This Horizon programme received excellent reviews in the press, e.g. The Times: http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/tv_and_radio/article5798104.ece
Year(s) Of Engagement Activity 2009
 
Description CallNorthWest event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Fullick, S. Shift Work and Health: Optimal Timing of Physical Activity. Presented at CallNorthWest Customer Management Conference (University of Lancashire, 9th June, 2009).

Recognition from governing body
Year(s) Of Engagement Activity 2009
 
Description Firefit 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Industry/Business
Results and Impact J. Waterhouse: Invited speaker on "Rhythms and shiftwork" at the annual Firefit conference (Loughborough, 5th July 2007).

Recognition from governing body
Year(s) Of Engagement Activity 2008
 
Description RCUK National Science Week Event 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Funding (approx £1700) was gained from Research Councils UK to organise a National Science Week event entitled 'How to keep in time with your body clock'. With this event held on the 15th March 2007, we brought to life our popular science book, 'Keeping in time with your body clock', through a public open day of demonstrations, practical activities and a 'shiftworkers forum' held at RISES. Between 10am and 3.30pm, over 150 people participated in our laboratory-based tour of activities which included: • How does the body clock work? • Are you a Lark or an Owl? • What causes jet lag? • Coping with shiftwork • Measurement of sleep stages • Sleep disorders • The best times of day to exercise • The menstrual cycle and women health • Seasonal variations (including seasonal affective disorder)

Over 30 academics, shiftworkers and occupational health specialists came together for the 'shiftworkers forum'. Following Jim Waterhouse's introduction to the problems of working at unusual hours, participants questioned him about specific coping strategies. One-to-one discussions continued over refreshments, which ended the day. The event was publicised on the University's website and the local press (The 'Liverpool Echo').
Year(s) Of Engagement Activity 2007