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

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-months 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-months 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-hour 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: 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: 382 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- -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. While 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)