¹Centre for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
²Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, United States
³Washington State Department of Labor and Industries, Tumwater, United States
⁴Section of General Internal Medicine, Department of Medicine, Boston University Chobanian Avedision School of Medicine and Boston Medical Center, Boston, United States
⁵Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
⁶Chiropractic Knowledge Hub, Odense, Denmark

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Introduction: The positive health effects of physical activity on individuals are undisputed, and the negative health consequences of physical inactivity are equally well established. The societal burden of ill health has sparked an increased focus on health-promoting initiatives, such as physical exercise at work. Not surprisingly, employers may require a solid business case before implementing workplace health-enhancing initiatives. Unfortunately, the cost-effectiveness of available workplace-based exercise programs is not well established, likely impeding implementation efforts. This scoping review aimed to descriptively summarize studies on economic evaluations of physical exercise at work from both employer and societal perspectives.

Methods: We included quantitative articles published in MEDLINE, Embase, Scopus, EBSCO, and EconLit between 2000 and 2024 that evaluated workplace-based exercise programs, defined as elements of strength training, aerobic training, or functional training alone or in conjunction with other health-enhancing initiatives. Data on population characteristics, evaluation methods, outcomes, and financial costs and benefits were systematically extracted by two reviewers. US and Danish workplace stakeholders were invited to participate in the scoping review, contributing to the definition of the interventions and outcomes, and discussing the findings.

Results: In our preliminary work, we have identified 16 articles reporting on 13 studies, including five RCTs, covering both working populations with sedentary and physically demanding work and ranging from 14 to 24,000 participants. Seven studies investigated physical exercise as a single intervention, and six studies investigated physical exercise as part of a multicomponent health intervention or wellness program. A wide range of health and economic outcomes were reported from both employer and societal perspectives, including workability, lost work time, sickness absence, medical expenditures, and premium costs. Most studies reported cost savings, but three did not find workplace-based exercise programs to decrease costs, and only a few studies were designed to estimate cost-effectiveness. Stakeholder perspectives reflected local practices and matched the heterogeneity found in the literature.

Discussion: Despite a large body of evidence pointing towards positive health effects of workplace-based physical exercise, our preliminary results indicate an important gap in the literature on the economic costs and benefits of implementing workplace physical exercise. To assist workplace decision-makers in deciding to implement physical exercise at work, more high-quality studies serving as business cases are warranted.

Conclusion: The body of literature is highly heterogeneous in terms of populations, outcomes, and results, reflective of national and legislative differences. At present, there is limited evidence pointing towards cost savings, but the cost-effectiveness of workplace-based physical exercise is largely unknown. Final results will be available at the time of the conference.