***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This study exp and ed previous NIOSH-IRS research examining the effects of rest breaks and stretching exercises on symptoms and performance in data -entry workers . METHODS All workers spent 4 weeks with conventional breaks ( two 15 min breaks per day ) and 4 weeks with supplementary breaks ( two 15 min breaks plus four 5 min breaks per day ) . One-half were assigned at r and om to a group instructed to perform brief stretching exercises during breaks . The remainder comprised the " no stretching " ( control ) group . RESULTS 51 workers ( stretch group n = 21 ; no stretch group n = 30 ) completed the study symptom question naires . Discomfort and eyestrain were significantly lower with supplementary breaks , and supplementary breaks attenuated accumulation of discomfort and eyestrain during work sessions . Data -entry speed was significantly faster with supplementary breaks so that work output was maintained , despite replacing 20 min of work time with break time . In the stretch group , workers reported  stretching  during only 25 % of conventional breaks and 39 % of supplementary breaks , and no significant effects of stretching on discomfort or performance were observed . CONCLUSIONS These results provide further converging evidence that supplementary breaks reliably minimize discomfort and eyestrain without impairing productivity . Low compliance in performing stretches prevented valid assessment of stretching effects . Further research on stretching exercises and exercise compliance is warranted Objective : To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention ( REF ) on various health outcomes . Methods : A 1-year r and omized controlled trial was conducted with specific resistance training ( SRT ) , all-round physical exercise ( APE ) , and REF . Results : SRT and APE compared with REF showed significant reductions in systolic blood pressure ( ∼6 mm Hg ) , body fat percentage ( ∼2.2 body fat% ) , as well as shoulder and back pain ( ∼30 % reduction in duration ) . Muscle strength ( APE and SRT ) and maximal oxygen uptake ( APE ) increased approximately 10 % . Conclusions : Worksite intervention with both SRT as well as APE is recommended , since these activities compared with REF result ed in clinical ly relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms , in combination with minor increases in physical capacity INTRODUCTION Office employees are exposed to hazardous levels of sedentary work . Interventions that integrate health promotion and health protection elements are needed to advance the health of sedentary workers . This study tested an integrated intervention on occupational sedentary/physical activity behaviors , cardiometabolic disease biomarkers , musculoskeletal discomfort , and work productivity . DESIGN Two-group , RCT . Data were collected between January and August 2014 . SETTING / PARTICIPANTS Overweight/obese adults working in sedentary desk jobs were r and omized to : ( 1 ) a health protection-only group ( HPO , n=27 ) ; or ( 2 ) an integrated health protection/health promotion group ( HP/HP , n=27 ) . INTERVENTION HPO participants received an ergonomic workstation optimization intervention and three e-mails/week promoting rest breaks and posture variation . HP/HP participants received the HPO intervention plus access to a seated activity permissive workstation . MAIN OUTCOME MEASURES Occupational sedentary and physical activity behaviors ( primary outcomes ) , cardiometabolic health outcomes , musculoskeletal discomfort , and work productivity ( secondary outcomes ) were measured at baseline and post-intervention ( 16 weeks ) . RESULTS The HP/HP group increased occupational light intensity physical activity over the HPO group and used the activity permissive workstations 50 minutes/work day . Significant associations were observed between activity permissive workstation adherence and improvements in several cardiometabolic biomarkers ( weight , total fat mass , resting heart rate , body fat percentage ) and work productivity outcomes ( concentration at work , days missed because of health problems ) . CONCLUSIONS The HP/HP group increased occupational physical activity and greater activity permissive workstation adherence was associated with improved health and work productivity outcomes . These findings are important for employers interested in advancing the well-being of sedentary office workers . TRIAL REGISTRATION This study is registered at www . clinical trials.gov NCT02071420 Objective : To investigate how worksite health interventions involving a 2.5-hour reduction of weekly working hours with ( PE ) or without ( RWH ) m and atory physical exercise affects productivity . Methods : Six workplaces in dental health care were matched and r and omized to three conditions ( PE , RWH and referents ) . Employees ' ( N = 177 ) self-rated productivity  and the workplaces ' production levels ( number of patients ) were examined longitudinally . Results : Number of treated patients increased in all conditions during the intervention year . While RWH showed the largest increase in this measure , PE showed significant increases in self-rated productivity , that is , increased quantity of work and work-ability and decreased sickness absence . Conclusions : A reduction in work hours may be used for health promotion activities with sustained or improved production levels , suggesting an increased productivity since the same , or higher , production level can be achieved with lesser re sources OBJECTIVE To provide guidance on how systematic review authors , guideline developers , and health technology assessment practitioners should approach the use of the risk of bias in  nonr and omized studies of interventions ( ROBINS-I ) tool as a part of GRADE 's certainty rating process . STUDY DESIGN AND SETTING The study design and setting comprised iterative discussion s , testing in systematic review s , and presentation at GRADE working group meetings with feedback from the GRADE working group . RESULTS We describe where to start the initial assessment of a body of evidence with the use of ROBINS-I and where one would anticipate the final rating would end up . The GRADE accounted for issues that mitigate concerns about confounding and selection bias by introducing the upgrading domains : large effects , dose-effect relations , and when plausible residual confounders or other biases increase certainty . They will need to be considered in an assessment of a body of evidence when using ROBINS-I. CONCLUSIONS The use of ROBINS-I in GRADE assessment s may allow for a better comparison of evidence from r and omized controlled trials ( RCTs ) and nonr and omized studies ( NRSs ) because they are placed on a common metric for risk of bias . Challenges remain , including appropriate presentation of evidence from RCTs and NRSs for decision-making and how to optimally integrate RCTs and NRSs in an evidence assessment The aim was to determine the effect of one weekly hour of specific strength training within working hours , performed with the same total training volume but with different training frequencies and duration s , or with different levels of supervision , on compliance , muscle health and performance , behavior and work performance . In total , 573 office workers were cluster-r and omized to : 1 WS : one 60-min supervised session/week , 3 WS : three 20-min supervised sessions/week , 9 WS : nine 7-min supervised sessions/week , 3 MS : three 20-min sessions/week with minimal supervision , or REF : a reference group without training . Outcomes were diary-based compliance , total training volume , muscle performance and question naire-based health , behavior and work performance . Comparisons were made among the WS training groups and between 3 WS and 3 MS . If no difference , training groups were collapsed ( TG ) and compared with REF . Results demonstrated similar degrees of compliance , mean(range ) of 39(33 - 44)% , and total training volume , 13.266(11.977 - 15.096)kg . Musculoskeletal pain in neck and shoulders were reduced with approx . 50 % in TG , which was significant compared with REF . Only the training groups improved significantly their muscle strength 8(4 - 13)% and endurance 27(12 - 37)% , both being significant compared with REF . No change in workability , productivity or self-rated health was demonstrated . Secondary analysis showed exercise self-efficacy to be a significant predictor of compliance . Regardless of training schedule and supervision , similar degrees of compliance were shown together with reduced musculoskeletal pain and improved muscle performance . These findings provide evidence that a great degree of flexibility is legitimate for companies in planning future implementation of physical exercise programs at the workplace . Clinical Trials.gov , number NCT01027390 Background Imbalance between individual re sources and work dem and s can lead to musculoskeletal disorders and reduced work ability . The purpose of this study was to investigate the effect of workplace- versus home-based physical exercise on work ability among healthcare workers . Methods Two hundred female healthcare workers ( Age : 42.0 , BMI : 24.1 , work ability index [ WAI ] : 43.1 ) from 18 departments at three Danish hospitals participated ( Copenhagen , Denmark , Aug 2013—Jan 2014 ) . Participants were r and omly allocated at the cluster level to 10 weeks of : 1 ) workplace physical exercise ( WORK ) performed during working hours for 5x10 min per week and up to 5 group-based coaching sessions on motivation for regular physical exercise , or 2 ) home-based physical exercise ( HOME ) performed during leisure time for 5x10 min per week . Both groups received ergonomic counseling on patient h and ling and use of lifting aides . The main outcome measure was the change from baseline to 10-week follow-up in WAI . Results Significant group by time interaction was observed for WAI ( p < 0.05 ) . WAI at follow-up was 1.1 ( 0.3 to 1.8 ) higher in WORK compared with HOME corresponding to a small effect size ( Cohens’d = 0.24 ) . Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in HOME . Of the seven items of WAI , item 2 ( work ability in relation to the dem and s of the job ) and item 5 ( sickness absence during the past year ) were improved in WORK compared with HOME ( P < 0.05 ) . Conclusions Performing physical exercise together with colleagues at the workplace prevents deterioration of work ability among female healthcare workers . Trial registration number Clinical Trials.gov NCT01921764 . Registered 10 August 2013 Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Background The workplace has been identified as a priority setting to positively influence individuals ’ dietary behaviours . However , a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions . This study aim ed to conduct a cost- analysis of  workplace nutrition education and environmental dietary modification interventions from an employer ’s perspective . Methods Cost data were obtained from a workplace dietary intervention trial , the Food Choice at Work Study . Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork , Irel and . The workplaces were allocated to one of the following groups : control , nutrition education alone , environmental dietary modification alone and nutrition education and environmental dietary modification combined . A total of 850 employees were recruited across the four workplaces . For comparison purpose s , total costs were st and ardised for 500 employees per workplace . Results The combined intervention reported the highest total costs of € 31,108 . The nutrition education intervention reported total costs of € 28,529 . Total costs for the environmental dietary modification intervention were € 3689 . Total costs for the control workplace were zero . The average annual cost per employee was ; combined intervention : € 62 , nutrition education : € 57 , environmental modification : € 7 and control : € 0 . Nutritionist ’s time was the main cost contributor across all interventions , ( ranging from 53 to 75 % of total costs ) . Conclusions Within multi-component interventions , the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies . A workplace environmental modification strategy added marginal additional cost , relative to the control . Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions .Trial registration Current Controlled Trials : IS RCT N35108237 . Date of registration : The trial was retrospectively registered on 02/07/2013 Objective : This study was conducted to determine whether installation of sit-st and desks ( SSDs ) could lead to decreased sitting time during the workday among sedentary office workers . Methods : A r and omized cross-over trial was conducted from January to April , 2012 at a business in Minneapolis . 28 ( nine men , 26 full-time ) sedentary office workers took part in a 4 week intervention period which included the use of SSDs to gradually replace 50 % of sitting time with st and ing during the workday .  Physical activity was the primary outcome . Mood , energy level , fatigue , appetite , dietary intake , and productivity were explored as secondary outcomes . Results : The intervention reduced sitting time at work by 21 % ( 95 % CI 18%–25 % ) and sedentary time 
    Output:
    
The scientific evidence shows that it is possible to influence work-related outcomes , especially absenteeism , positively through health promotion efforts that include components aim ed at the workplace ’s physical work environment and organizational structure .