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Muscular Strength Can Optimize Survival Outcomes in Certain Cancer Patients

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IPCS has been a strong proponent of maintaining a healthy muscle mass not only to prevent soft tissue injuries but to prevent costly medical claims as well.

The Journal of American Medical Association – Oncology, published on April 5, 2018, has presented even more critical information on the importance of maintaining a healthy and strong muscle mass. The article is written by Caan, BJ and others entitled, “Association of Muscle and Adiposity Measured by Computed Tomography with Survival in Patients with Nonmetastatic Breast Cancer”.

In this study, approximately 3,300 females with nonmetastatic breast cancer were tracked over a 6-year period. Caan measured the amount of muscle mass (sarcopenia vs non-sarcopenic), muscle quality and fatness (below the skin, within muscle, visceral-around internal organs) and several other body compositions including body mass index (BMI).

Findings:

Women who were non-sarcopenic (high amount of muscle mass) with the lowest total fatness (in the bottom one-third ranking for fatness), had a 41% increase in survivability when compared to women who were sarcopenic (low levels of muscle mass) and in the highest one-third for fatness. Measures found that muscle quality was not a factor.

Furthermore, women with a body mass index of 35 and higher and sarcopenic, were at increased risk of mortality. An association with BMI’s less than 35 and being sarcopenic did not exist.

Implications:

  1. Women with nonmetastatic breast cancer could benefit from treatment involving strength training.
  2. As a deterrent to nonmetastatic breast cancer, and perhaps other kinds of cancers (supported by current research), maintaining a strong and healthy muscle mass through employee health plans decreases a person’s risk of cancer and may increase the survivability of individuals who may get cancer.
  3. BMI certainly has a role in measuring body size and fatness but perhaps the greater emphasis should be placed on individuals with a BMI of 35 and greater.

Musculo-Skeletal Wellness

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The health of a worker’s musculo-skeletal system is not getting any better. In fact it is getting worse with no signs of improvement.

Mary Catherine Person, President of Healthscope Benefits, a large privately held TPA considers musculo-skeletal health as one of their top three health issues regarding cost and frequency of claims.

Recently, Jennifer Saddy, Director, Workers Compensation, Corporate Insurance & Risk Management for American Airlines has stated in December 2017 that shoulder injuries are now American Airlines number one injury in terms of frequency and cost of claim. The shoulder claim has replaced the low back claim as their number one claim.

Why is this? IPCS has reported that compared to 10 years ago the absolute shoulder strength of the new hire worker is 18% weaker today and knee strength is 23% weaker. Ironically, the luggage carried by passengers today does not weigh 20% less.

Wellness programs, to be effective, must also include musculo-skeletel wellness. Biometric screens to objectively evaluate and track muscular strength, based on a substantial database to correlate the strength to risk for disease and injury, is critical.

Maintaining a healthy muscle mass will reduce the frequency and cost of medical and injury claims.

IPCS EEO Opinion Letter

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IPCS is pleased to announce that its EEO law firm, Kastner, Westman & Wilkins, has completed its

review of the IPCS technology as it relates to EEO and ADA matters and has written an updated opinion

letter dated July 3, 2017, which can be viewed by clicking on this link: KWW EEO Letter 2017

 

The past couple of years IPCS has received many inquiries about testing the incumbent workforce.

Please note that footnote number 1 on this letter clearly states that the attached letter is

specific to new hires (and has application to return to work testing) but does not apply to testing

the incumbent workforce.  IPCS plans on addressing incumbent testing later this year.

 

Please review the letter  and please feel free to share it with your associates. Further,

IPCS would like you be aware of the fact that on June 6, 2017, the authors of this letter,

attorneys’ John McKenzie and Julie Trout, conducted a webcast on IPCS’ behalf on the legal aspects

of setting up a new hire physical capability screening program. Below is a link to that webcast.

Please feel free to access it and share it as well.  The webcast is 20 minutes.

 

https://ipcs.webex.com/ipcs/lsr.php?RCID=c3e3672314c330990113f27d93a6e18e

 

When you click on the link, click Playback and then allow a short time for the recording to begin

since it has to buffer.  Below is the first slide that was accidently left off the recording.

 

 

Webcast Questions: How to Legally Set Up New Hire Screening Programs

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We had a wonderful response to our last webinar and such great questions that came in that were not able to be addressed due to time constraints. So, we’ve put together a blog post that provides answers to those questions which have been answered by two EEO experts from the law firm of Kastner, Westman and Wilkins, John McKenzie and Julie Trout, who made the webcast presentation.

The IPCS Webcast and the following questions and answers are for informational purposes only and not for the purposes of providing legal advice.

 

Question 1: Can you elaborate on the 4/5’s rule? What efforts does a company need to make in the event the 80% is not achieved? Are they obligated to meet the 80% mark or just have to show that they recognize this and are making efforts achieve. I think the jobs we have are a disproportionate number of males pass vs. females.”

Answer: According to Uniform Guidelines, a selection rate for any race, sex, or ethnic group that is less than 4/5 (or 80%) of the selection rate for the group with the highest selection rate will generally be considered evidence of adverse impact.  If the 80% is not achieved , use of the selection procedure that has adverse impact is considered discriminatory unless the employer ensures that the procedure has been validated in accordance with the Uniform Guidelines. This does not require that the 80% mark be achieved, but does require the employer to comply with the requirements detailed by the Uniform Guidelines regarding validation studies.

 

Question 2: Can you elaborate on the validation types you noted in the presentation? What does our process need to be when writing the job description/analysis regarding who should review and how it should be signed off on by the company. Additionally, who and how many company reps should go through the IPCS test prior to initiating testing?

Answer: The Uniform Guidelines contain very detailed requirements for the different types of validation studies, which are set forth at 29 C.F.R. § 1607.01 et seq. (an unofficial version of which is available at http://www.gpo.gov/fdsys/pkg/CFR-2016-title29-vol4/xml/CFR-2016-title29-vol4-part1607.xml ). The job analysis process should be thorough, and should include a review of the items discussed during the webcast, including: which job behaviors or outcomes are critical or important; proportion of time spent on respective behaviors; level of difficulty of behaviors; frequency of performance; and consequences of error. The job analysis should include review by those who are most familiar with the job, which may include the employee(s) in the job itself, as well as the supervisor of the position. There are no specific requirements for how to sign off on a job analysis, but it should be reviewed and approved by those who have adequate familiarity with the position, as well as property authority from the employer. The Uniform Guidelines do not contain any requirements that a particular number or type of company representatives go through a selection procedure prior to initiating testing.

 

Question 3: Validation Study: “I’ve relied on IPCS to provide support regarding the legal foundation for the testing based on the ratings applicable to our physical demand assessments. Today’s webcast seemed to suggest each employer should conduct their own validation study. Does the research IPCS does and the requirement to provide a physical demand assessment eliminate the need for the validation study?”

Answer: While the research by IPCS can be used to support a validation study, it does not eliminate the need for a validation study. Generally speaking, a validation study must be specifically tailored to a particular job for a particular employer in order to meet the requirements of the EEOC’s Uniform Guidelines on Employee Selection Procedures (“Uniform Guidelines”). In some circumstances, evidence of validity from other studies may be used, but an employer must still comply with the strict requirements of the Uniform Guidelines when documenting the validity of the test for each job for which the test is used.

 

Question 4: When you institute post offer testing and want to do it for incumbents, could you establish a policy that states something like “we are going to test you but for the first year or two we will only tell you  what areas you need to improve upon”, then how can you improve overall performance and safety/fitness of your employee base?

Answer: As we explained during the webcast, under the Americans with Disabilities Act (“ADA”), medical testing of current employees may only be done under very limited circumstances. Generally speaking, across the board testing of current employees, even with a policy such as the one described above, would not comply with the ADA’s restrictions and would therefore be unlawful. If an employer would like to improve the overall performance, safety, and/or fitness of its employee base, it may implement performance improvement techniques, including performance measurement and ratings systems, safety programs, including safety reporting mechanisms or incentives, as well as voluntary health programs where employees have the choice of whether or not to participate.

 

Question 5: As long as the policy is consistent to all people you can test your population-yes?

Answer: As we explained during the webcast, and as detailed above, generally speaking, across the board medical testing of current employees would not comply with the ADA’s restrictions and would therefore be unlawful, even if the policy was consistent for all employees.

 

Question 6: Please comment on essential duties and safety sensitivity.

Answer: When performing a thorough job analysis, employers should identify the various duties of a particular position, and the specifically identify which of those duties are essential for that position. According to the EEOC (see http://www.eeoc.gov/facts/ada17.html ), an employer should consider the following factors in determining whether a particular duty is essential:

  • whether the reason the position exists is to perform that function
  • the number of other employees available to perform the function or among whom the performance of the function can be distributed, and
  • the degree of expertise or skill required to perform the function

If an employer considers a particular position ‘safety sensitive,’ it should have specific reasons and evidence to support that conclusion, such as an explanation of the potential consequences of unsafe performance of the position.

First Longitudinal Study to Show a 30% Reduction in Type II Diabetes and Cardiovascular Disease for Those Who Do Strength Training Exercises

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Over the years I have been a strong proponent of incorporating muscle strength training into lifestyle activities, not only to prevent osteoporosis, loss of muscle as we age, better joint stability and better overall functionality, but also to reduce the risk of certain diseases such as Type II diabetes and cardiovascular disease.

Many refereed publications support the importance of muscle strength training to reduce Type II diabetes and cardiovascular disease. A recent article published in the Medicine & Science in Sports & Exercise in January 20171 takes the research to a new level in that this research tracked 35,754 females ages 47-98 years over 10 years (longitudinally 2000-2014) to measure the effects of strength training on the risk of getting Type II diabetes or cardiovascular disease. The findings show that women who participated in strength training exercises compared to those who did not had a decrease in the rate of developing Type II diabetes by approximately 30% and for developing cardiovascular disease by about 17%. If aerobic physical activity was added to the analysis in addition to strength training, an additional risk reduction was realized.

The study looked at various levels of strength training in terms of time (minutes) per week and showed that any level of strength training generated reduction in risk for Type II diabetes and cardiovascular disease.

One additional benefit identified in the study was that any level of strength training also led to a lower body mass index (BMI), healthier dietary patterns and lower likelihood of being a smoker.

It should be noted that many studies show similar results for man but the MSSE study was the first longitudinal study.

Bottom line, with the increase in Type II diabetes and metabolic syndrome (includes cardiovascular risk), changes need to be made to our lifestyle choices if we elect to be healthy. Adding strength training to our weekly activities has so many health benefits besides the reduction in Type II diabetes and cardiovascular disease. Getting involved with strength training exercises does not necessarily mean joining a fitness center. Many strength activities can be done in your own home.

 

1Shiroma, EJ, et.al. Strength Training and the Risk of Type 2 Diabetes and Cardiovascular Disease. Med. Sci. Sports Exerc., Vol 49, pp.40-46, 2017

Physically Active Workers Are Healthier as Measured by Lower Medical, Pharmacy and Workers’ Compensation Costs

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In an article that appeared in the December 2016 Journal of Occupational and Environmental Medicine authored by Dr. Caretto and others entitled “Association Between Exercise Frequency and Health Care Costs Among Employees at a Large University and Academic Medical Center”, the research clearly shows a strong association between the level of physical activity and medical/pharmacy costs. Bottom line is that individuals that complete at least 30-minutes of aerobic exercise 4-5 times per week have the lowest medical and pharmacy costs. They are healthier individuals.

Individuals with a Body Mass Index (BMI) of 35 or more had the greatest costs associated with medical and pharmacy claims. However, if an obese person exercises 4-5 times per week, they have lower medical/pharmacy costs compared to other obese individuals within the same obese category. Individuals with Body Mass Indexes less than 30 had the lowest medical and pharmacy costs. Individuals across all Body Mass Index groups who exercised 0-1 time per week had the highest medical/pharmacy costs.

Why is this important to know? In a recent blog, I wrote about the first increase in the annual deaths due to heart disease and stroke in 2015 since 1969. The research mentioned above speaks to the issue of obesity as a co-morbidity as well as physical inactivity and the impact of these two factors on increasing the risk for heart disease, cerebrovascular disease, diabetes and hypertension. There is also a strong association with obesity/physical inactivity with risk for injury.

Within the research article stated above, the critical factor resulting in higher medical/pharmacy costs and therefore poorer health was physical inactivity. Ironically, as a country, we are moving the wrong direction- more sedentary activity than physical activity. This will only lead to more deaths, healthcare and workers’ compensation costs until the time comes when physical activity is put back into our daily routines.

It is difficult for industry to provide activity sessions in the workplace. Perhaps the best action that industry can take is to offer incentives built into the employees’ health plan to become more physically active. Legally, offer lower deductibles for those who are more physically active as supported by healthier biometric measures including physical strength.

IPCS is working with several clients who have done this and they are now realizing significant savings in medical, pharmacy and workers’ compensation costs.

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For the First Time Since 1969, Deaths Caused by Heart Disease Have Increased!

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Some disturbing news was released by the Centers For Disease Control and Prevention (CDC) and reported in the Wall Street Journal, December 8, 2016, showing that deaths caused by heart disease in the U.S. increased by 0.9% in 2015 and death by stroke increased 3%. This is the first increase since 1969.  These two statistics also resulted in the first time in many years a decrease by one-tenth of a percentage point in life expectancy.

It appears that obesity and diabetes are the two main contributing factors to the increase in death due to heart disease. As we become more automated both at work and at home, the level of physical activity each American has each day diminishes unless a deliberate effort is made to remain physically active.  The largest organ in the body is muscle and muscle is made to work.  Sedentary lifestyles (low levels of physical activity) increases risk for diabetes, obesity and loss of muscular strength.  The heart too is a muscle and it too responds favorably to physical activity.

The IPCS database shows that obesity (as measured by a Body Mass Index – BMI – of 30 or more) over the past 3-years has leveled off at 41% of each year’s pool of new hire applicants. However, the bad news is that the IPCS data shows that the obese are becoming more obese.  Since 2006 through 2015, the percentage of morbid (BMI 40-49.9) and extreme morbid (BMI 50 and more) increased from 4.6% to 7.6% which, statistically, is a 65% increase.

The IPCS data also shows that the new hire applicant from 2006 to 2015 weighs 13 pounds more, has 18% less absolute shoulder strength and 23% less absolute knee strength. This puts the applicant at greater risk for injury and disease.  There is a number of research studies that clearly shows low muscular strength can increase the risk for the Metabolic Syndrome, Diabetes and Cardiovascular Disease.

I have stated this many times – fifty years of research by the American College of Sports Medicine clearly show that physically active individuals are healthier individuals. Maintaining a strong and healthy muscle mass is critical to good health.  The IPCS PCE is a good tool to measure muscular strength as it relates to disease and safety.

Medical and Pharmacy Costs for New Hire Nurses Following a Physical Strength Evaluation Screening in a Large Health System

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“Nurses often encounter situations that require lifting patients, often using awkward body positions. Hiring nurses with strength suitable for these jobs decreases nurses’ risk for illness and injury and would be expected to result in more appropriate and lower health care, pharmacy, and disability costs.”  To read more from the published article written by Paul Terpeluk, DO, MPH, Bruce Rogen, MD, MPH, and Thomas Gilliam, PhD, please click on the following link.

Clev Clinic Research Article

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Pre-employment Testing

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Throughout America, employers face multiple challenges to maintaining and growing their companies in the face of a range of demographic and health challenges.  They increasingly recognize they cannot afford to assume physical competence of every applicant, nor acceptance of conventional retirement age to keep their workforce stable in health and physical capability.  Click on the following link to learn how one of our client’s is proactively dealing with these challenges.

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Incumbent PCE Testing – Can It Be Done?

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In the early part of 2015, IPCS asked our EEO law firm, Kastner Westman and Wilkins, LLC (KWW) to research and review court cases that could be used to justify incumbent physical capability evaluations (PCE). We asked our law firm to undertake this task because many of our clients and prospective clients asked if the incumbent worker can be re-evaluated on some fixed time period. Most of the questions focused on the new hire going forward.

As the write-up states, every company and each job classification must be reviewed on a case-by-case basis. It does appear that PCE for the incumbent worker can be done as long as job relatedness can be demonstrated and workplace safety is a concern and thereby consistent with business necessity.

The document attached below was reviewed and approved by KWW regarding incumbent PCE.

Incumbent Testing Can It Be Done

What is Obesity Costing Your Company?

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A new study published in October 2015 in the Journal of Occupational and Environmental Medicine2 shows that a severe obese worker will cost a company $4,631 and a morbid obese worker will cost a company $9,161 more per year in medical cost compared to a normal weight worker. This study researched about 72,000 workers in the United States. Click the following link to read more! What Is Obesity Costing Your Company-2015

Take Good Care…

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We’re approaching the half year mark and time is sure flying by. I hope you are not forgetting to take care of yourself! There is only one person responsible for your health and well-being and that is you! You decide what food you eat and what you drink. You decide whether you sit and watch TV or go for a walk or a bike ride.

Your health requires your attention 24-7. Keeping physically fit and eating healthfully requires you to be attentive to these matters most of the time. Yes, you can jump off the health bandwagon periodically as long as you have the will-power to get back on. This becomes even more important the older you become.

As I have discussed in previous articles, it does not take much to lose muscle when it is not used. Put a cast on your arm for six weeks and when it is removed you don’t really like what you see. The muscle has shriveled up or atrophied. More importantly, the loss of strength occurs more quickly than the loss of muscle mass. Sadly, recent research shows that low muscle strength is associated with an increase in cardiovascular disease, Type II diabetes and metabolic syndrome. Metabolic syndrome is associated with three of the following: high triglycerides, low high-density lipoprotein, high body mass index with a high waist circumference, high glucose and high blood pressure.

Obviously a healthy diet and being physically active can have a positive impact on reducing the above risks. But not all physical activity will result in increasing muscular strength. It is important to select activities that focus on increasing your muscle strength.

This is a good time of year for most of the country to get involved with physical activities that would improve strength. Most outdoor chores would increase your strength or at least maintain your level of strength. As I mentioned earlier, going for a bike ride will certainly help to strengthen that legs as would hiking. It is important to try to select activities that are good for the entire body – upper body, lower body and core (trunk and abdominal areas).

Use this summer to get back into shape by exercising more and eating healthfully. It does take time to improve your physical fitness and to increase your strength but 8-12 weeks would be a great start to creating new habits. Remember to drink plenty of water (zero calories) and avoid other beverages that contain added sugar or caffeine. Sports drinks can be good if you’re involved in vigorous activity for more than an hour, but water is still your best choice.

Have fun and be well this summer!

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The Value of Stretching

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Stretching is important for everyone. It makes no difference if you exercise regularly or do no exercise. Within our muscles there is connective tissue and there is connective tissue that surrounds our muscle in some instances. One of the properties of connective tissue is its elasticity. Some people at a young age can touch their toes and others can’t. This is because the elasticity within connective tissue will vary from person to person.

But no matter who you are, one of the impacts of aging is the loss of elasticity within the connective tissue. Some who are in their 50’s and 60’s know what this is. It is not just a matter of losing your ability to touch your toes but it is a functional issue. It is more difficult to do your job, do your daily chores and tie your shoes because it is more difficult to bend (low back is tighter as well as the back of the thighs or the hamstrings). Getting down on the floor and then getting back up is more difficult because of the loss of elasticity in the connective tissue in addition to the loss of strength.

The good news is that stretching on a regular basis will slow the loss of elasticity of the connective tissue. Stretching can be done by everyone and should be done daily if possible. Stretching, either on a mat or from a chair, should be done in a slow sustained manner where every stretch is held 15-20 seconds and then slowly released. Ideally each stretch should be done 2-3 times. Remember never to bounce or move too quickly when stretching.

We have covered basic stretches for all parts of the body in several of last year’s newsletters, and there is a wealth of information on reputable websites that detail instructions for additional ways to stretch.

Most people who exercise regularly know the value of stretching but many do not stretch following their workout routine. They merely head to the locker room, shower, get dressed and leave. This is a big mistake. Following a workout routine, the muscles are warm and this is an ideal time to stretch which adds to the “cool down” following a workout. Among other things, stretching following a workout helps alleviate muscle stiffness and soreness and increases your range of motion.

The next time you have a few extra minutes to spare consider adding some stretching to your day!

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Oh Boy…Another New Year’s Resolution!

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2015 is here! Many of you made New Year’s resolutions which is good! Most resolutions involve exercise, healthy eating and weight loss – all admirable resolutions. Unfortunately, many resolutions involve extremes and last for maybe one or two months. Let me explain. You finally decide to exercise after not doing much in the form of physical activity for five years. You have a sedentary job and once you get home you do not do much to expend calories. But you want to make a change so you join a fitness center, join a number of exercise classes and start working out for an hour a day. That kind of resolution will last maybe 30 days because it is drastically different from what you have been doing for the last 5 years. A better resolution would be to find a friend and start walking together, 20 minutes a day, 5 days a week. Gradually increase the time you walk as you become more conditioned. Eventually you can work your way up to that gym membership and classes. Another extreme resolution involves your diet. You decide that 2015 will be the year that you eat healthfully because the last 5 years you survived on pizza, chips, soft drinks and an occasional beer. Going cold turkey to change eating habits from unhealthy to healthy can be difficult to do. A better resolution tied into an exercise resolution would be to slowly change your diet by adding a piece of fruit or raw vegetables to your diet each day. Slowly wean yourself off the pizza and replace it with a meal of chicken or fish. Replace soda with water and 2% milk with a lower fat version or skim. Begin to include healthier snacks daily like a piece of fruit or yogurt. Replace chips with pretzels if you really need that crunchy snack. This process may take several months but it will keep your resolution intact. I hope you have selected a healthy resolution that you can keep for the entire year. If it is exercise and if you have not been active for a while, take time to learn how to exercise correctly, how to select shoes to help support your exercise routine and dress appropriately. Remember to stay hydrated by drinking water, not only during your workout, but throughout your day.  Learn how to prepare foods more healthfully, avoiding fried foods and add more fresh vegetables and fruits to your diet. Start by buying healthier snacks and discard the unhealthy items lurking in your cupboards…if those unhealthy foods aren’t there, you can’t eat them! A healthy diet and regular exercise will provide benefits that will pleasantly surprise you. You will sleep better, have more energy and be healthier overall!

Strength-The New Vital Sign of Personal Health

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Last year at this time I wrote about strength as the new vital sign of your personal health. A few of the advantages of maintaining a healthy and strong muscle mass are as follows:

  • Helps to maintain or even achieve a healthy body weight
  • Allows individuals to be functional no matter what their age – climbing stairs, getting out of a chair, lifting and carrying bags of groceries
  • Protects the joints from injury
  • Allows more functionality for those individuals with arthritic conditions
  • Protects the bones and greatly reduces the probability of osteoporosis in both women and men
  • Healthy muscle mass means you are a physically active individual which leads to numerous health benefits

The benefits of a healthy muscle mass are tremendous. Why would you not want a healthy muscle mass? We all age every day and as we do muscle becomes even more important. As part of the aging process we lose about 30% of our muscle mass from age 30 to age 55. After age 55 it can steadily get worse, but loss of muscle mass does not need to happen. If you work to keep or increase your muscle mass through a variety of physical activities, the loss of muscle will be greatly reduced to about 5%.

Muscle as a health risk factor does not get much attention because the loss of muscle is not necessarily life threatening. You won’t die from lack of muscle but you just won’t be able to move! And once you’ve lost muscle mass you have entered into a vicious  life cycle which is very unhealthy. Those individuals who are physically inactive are less healthy than those individuals who are physically active.

Muscular strength is a health risk factor that is relatively simple to improve. Start small and add simple strength building activities to your daily routine that improve your strength such as basic calisthenics, like push-ups, or simple weight lifting exercises like biceps curls, chest presses or even squats.

A year is a long time and lack of physical activity during that year will act as a catalyst to losing muscle- not a wise or healthy choice. Don’t let another year go by without focusing on achieving a healthy muscle mass and building a stronger, healthier you!

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