From home to health: Telerehabilitation’s contribution to physical activity and quality of life in young adult teleworkers

Abstract

BACKGROUND:

The global implementation of full-time telework became widespread during the new normal conditions following the pandemic, resulting in reduced physical activity (PA) among teleworkers and young adults. It is vital to comprehend how telehealth interventions favorably impact PA levels and overall well-being of young adults who face increasingly blurred boundaries between work and home life.

OBJECTIVES:

The aim of this study is to examine the effect of telerehabilitation (TR) on PA levels and quality of life (QoL) in young adult teleworkers.

METHODS:

A quasi-experimental study was conducted on 82 teleworkers (54 females and 28 males). Levels of PA and QoL were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Health-Related Quality of Life (HRQOL-14) questionnaire. TR was provided to all participants for four weeks, three times a week, for 40 minutes per session. Levels of PA and QoL were evaluated at baseline and after four weeks of the intervention. Data were analyzed using descriptive and inferential statistics.

RESULTS:

After four weeks of TR, there has been a significant improvement in the scores of IPAQ and HRQOL-14 (p < 0.05). In regards to IPAQ-SF results, TR had a significant effect on the sitting or sedentary behavior of the teleworkers.

CONCLUSION:

The results showed that a short-term TR intervention improved both the level of PA and QoL in young adult teleworkers. Therefore, TR may be an effective treatment approach to improve PA and QoL and promote a healthy lifestyle in teleworkers.

1. Introduction

“Telework” is described as work performed from a remote location that enables employees or students to engage in their work activities through information and communications technologies (ICT) [1]. With the growth of high-speed Internet, “telework/ICT mobile work” can be characterized as using ICT tools including smartphones, tablets, laptops, and desktop computers for work-related purposes away from the employer’s facilities [2]. A previous study found that teleworking provides various advantages, including flexibility in time and space, work– life balance (WLB), improved work quality, and performance [3]. However, recent studies have highlighted a decline in physical activity (PA) levels among teleworkers [4–6], leading to several adverse effects such as prolonged working hours and the blurring of boundaries between personal and professional life [7]. As a result, people face challenges in balancing work and personal life, resulting in increased stress and detrimental effects on their physical and emotional well-being [8]. Working on a computer for lengthy periods, particularly at home, is also associated with a sedentary lifestyle, static and awkward posture, repetitive movements, and excessive strain on the joint positions [9].

In addition to the sedentary nature of telework, the new normal conditions also pose significant challenges and impact teleworkers’ physical activity (PA) and quality of life (QoL), leading to potential health risks and reduced well-being. Managing these critical health risks is paramount as they directly impact teleworkers’ productivity, health, and overall satisfaction with remote work [10]. PA is essential for improving all aspects of QoL and health. On the other hand, a higher QoL serves as motivation to increase PA habits. PA can create a positive health cycle by improving psychological aspects such as mood, social interactions, and cognitive performance [11]. Improved QoL is recognized as a benefit and a driving force behind PA by professionals and participants alike. There is evidence that maintaining or improving QoL and well-being are universal goals for people of all ages. Few research studies have suggested that being physically active is a strategy to improve QoL and well-being, although many studies have discussed the association between PA and QoL [12].

Various treatment approaches are available to enhance teleworkers’ PA and QoL. These encompass telerehabilitation (TR) programs, ergonomic assessment, exergame technology, telepsychology sessions-stress management programs, and education on the importance of regular breaks and movement throughout the workday [13, 14]. This comprehensive approach improves teleworkers’ PA and overall well-being. Among these approaches, TR delivers rehabilitation services at a distance with the clinical use of two-way interactive telecommunication technologies to provide consultative, preventative, diagnostic, and therapeutic services [15]. It is a healthcare system that has been proven to support physical therapy sessions more effectively than face-to-face sessions, and it can help save healthcare costs and improve the QoL of individuals seeking rehabilitation [16].

Several studies have been conducted about the efficacy of TR on the occupational health of different working populations [17–19]. Likewise, TR interventions have demonstrated their effectiveness in other populations, such as those with chronic lung disease [17], low back pain [18], and functional impairment after a stroke [19]. Like other occupations, teleworking is becoming increasingly widespread, yet research is scarce on the precise health effects of extended sedentary behavior linked with teleworking. Nevertheless, the impact of TR on increasing PA and improving QoL among teleworkers has yet to be thoroughly investigated in the Malaysian population. Hence, this study addresses a significant research gap by presenting evidence on the efficacy of TR treatments in enhancing PA levels and QoL among young adult teleworkers in Malaysia. The current study aims to address an essential research gap by investigating the effectiveness of TR in enhancing PA and improving QoL among young adult teleworkers.

2. Methods

2.1. Participants and setting

This study is a quasi-experimental study with pretest and posttest questionnaire evaluation of a single group comparing two sets of scores. The study obtained prior ethical approval from the INTI International University Research and Ethical Committee with the reference number INTI-IU/FHLS-RC/BPHTI/7NY 12021/018. Furthermore, the sample size of 82 teleworkers was determined using G-Power software, considering an effect size of 0.3, power of 80%, and an alpha error of 5% with a two-tailed test. When calculating the sample size, this study chose the effect size of 0.3 based on a recent study that demonstrated the effect of TR on disability reduction [20], which was estimated to be small based on Cohen’s d range, where 0.2 to 0.5 were considered as small effect [20, 21].

The authors assumed a dropout rate of 10%, set the sample size at 90, and chose a range of inclusion criteria to recruit young adult teleworkers of both genders between the ages of 18 and 30 years residing in the Klang Valley in Malaysia. Students, part-time workers, and individuals participating in any form of sports or with a history of fractures, hypertension, and neurological disorders were excluded from the study. Although 90 teleworkers were selected to participate using a convenience sampling method, 82 remained until the end of the study. Before starting the study, participants were fully informed about the aim, procedures, potential risks and benefits, and the voluntary nature of their participation.

2.2. Intervention

Before the intervention, participants were given pertinent details and explanations. The interviews for selecting participants were conducted synchronously using an accessible computer program (Google Meet Link) that allowed remote exercise instruction. Prior to the commencement of the intervention, participants were required to attend in person to obtain baseline demographic details and one repetition maximum (1RM). Participants were advised to wear appropriate, comfortable clothing and to prepare the following items: a yoga mat, TheraBand weight cuffs, a dumbbell, and sandbags. Contact information of the participant’s caregiver was collected for emergencies. Caregivers were informed of any potential situations that may arise during training. The therapist observed the participants throughout the 40-minute session via the online Google Meet platform. The therapist monitored the exercise intervention, addressed inquiries, evaluated treatment plans, and conducted study assessments.

The general exercise session includes a 10-minute warm-up (neck movements up to down, side to side and rotating left to right & vice versa, marching in place, backward, and forward). Flexibility exercises for the upper (neck, shoulder, trunk, elbow, and wrist joints) and lower extremities (hip, knee, and ankle) muscles involved stretching for 10 seconds on both sides [22]. The participants were instructed to perform these exercises for ten repetitions. Moreover, they were required to complete three weekly sessions of 1- 2 sets of 10 repetitions each week regarding weight-bearing and strengthening exercises. The training started at 50.0% of 1RM and gradually increased based on the patient’s weekly progress. Finally, the session concluded with a 5-minute cool-down program that included stretching exercises and a “leg shakedown” with thoracic breathing exercises. The exercise training was carried out over four weeks, three days per week, for an average of40 minutes.

2.3. Outcome assessment

Data on PA and QoL were collected using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and the Health-Related Quality of Life Scale (HRQoL-14), respectively. These questionnaires were distributed to all participants via Google Forms. In addition, participants were informed about the general objectives and methods of the study and the handling of anonymous data. Participation was entirely voluntary, and participants could leave the study anytime. Informed consent was obtained from participants before data collection.

2.4. Physical Activity (PA)

The IPAQ-SF was used to assess participants’ PA levels. The questionnaire has adequate measurement properties for monitoring PA population levels among 18- to 65-year-old adults in various settings [23]. The IPAQ-SF measures PA over the past seven days and is divided into four domains: walking, moderate physical activity (MPA), vigorous physical activity (VPA), and sitting or sedentary behavior. For each PA domain, reported frequency (days/week) and duration (in minutes) were recorded and multiplied by the corresponding IPAQ algorithm (walking - 3.3; MPA – 4.0; VPA – 8.0). As a result, the corresponding metabolic equivalent (MET) in minutes/week of each PA was estimated. Subsequently, total PA (MET-minutes/week) was calculated by adding walking, moderate, and vigorous MET-minutes/week. Furthermore, the teleworkers were categorized into three levels of PA based on the following cut-off point values: i) Low – total PA equivalent to less than 600 MET-minutes/week, ii) Moderate - total PA equivalent to at least 600 MET-minutes/week, and iii) High - total PA equivalent to at least 3000 MET-minutes/week [24, 25].

2.5. Quality of Life (QoL)

QoL was assessed using HRQoL-14. HRQoL-14 is a valid and reliable instrument studied in multiple adult population samples (CDC HRQoL-14) [26]. Participants were allowed to self-assess their general health status and how various symptoms affected their daily activities to estimate the influence of these factors on their QoL. These core questions measure the number of unhealthy days a person has had in the last 30 days (one month). Scores for physically and mentally unhealthy days were recorded, and their sum (i.e., questions 2 and 3 of HRQoL-14) provided overall unhealthy days. HRQoL-14 is divided into three modules (Healthy Days Core, Activity Limitations, and Healthy Days Symptoms module). The reliability of HRQoL-14 spans from moderate to excellent [27].

2.6. Statistical analysis

The data analysis was performed using a statistical package for social sciences software version 27.0 (SPSS 27.0). Regarding descriptive statistics, the median with the 1st and 3rd interquartile range (IQR) was used to represent the IPAQ-SF scores. Frequencies, percentages, and mean with standard deviation (SD) were used to describe the HRQoL-14 scores. A Shapiro-Wilk test was used to assess the normality of the data. Additionally, a Wilcoxon Signed Rank test was used to determine the significance between the pretest and posttest scores of IPAQ-SF and HRQOL-14. A p-value of less than 0.05 was considered significant.

3. Results

Table 1 describes the sociodemographic characteristics of teleworkers. Among the teleworkers (N = 82), most were women (65.9%) and their mean age was 25.29 years. Furthermore, 80.5% were healthy, and 56.09% worked in customer service.

Table 1.

Sociodemographic data

Characteristics		Mean±SD	n (%)
Age (year)		25.29±2.835	–
Sex	Male	–	28 (34.1)
	Female	–	54 (65.9)
Body Mass Index (BMI) (kg/m2)	Healthy (18–24.9)	20.71±2.06	66 (80.5)
	Overweight (25.0–29.9)	25.39±0.01	6 (7.3)
	Obese (30.0 and above)	34.27±3.99	10 (12.2)
Occupation	Customer service		46 (56.09)
	Virtual assistant		15 (18.29)
	Product advisors		21 (25.60)

SD = Standard Deviation, n = number, %  = percentage, BMI = Body Mass Index, kg/m² = Kilograms per meters squared.

A significant difference was observed between pre- and post-test median values for walking, moderate and vigorous MET minutes/week, and total PA (MET minutes/week) after TR (p < 0.05). In addition, TR helps to significantly reduce sitting or sedentary behavior among teleworkers (p < 0.05) (Table 2).

Table 2.

Comparison of teleworkers’ pre-test and post-test physical activity following telerehabilitation using IPAQ-SF

IPAQ	Pre-test Median (IQR)	Post-test Median (IQR)	z value (p-value)
Walking (MET minutes/week)	16.5 (0, 33)	264 (198, 396)	7.872 (0.000)*
Moderate (MET minutes/week)	0 (0, 0)	480 (360, 840)	7.648 (0.000)*
Vigorous (MET minutes/week)	0 (0, 0)	160 (0, 480)	6.054 (0.000)*
Total Physical Activity (MET minutes/week)	33 (0, 56.5)	1038 (886.5, 1435.5)	7.869 (0.000)*
Sitting or sedentary behavior (hours per day)	9 (8, 10)	7 (7, 8)	7.466 (0.000)*

MET - Metabolic equivalent of task; IQR - Interquartile range; *Significant at 0.05 level.

Concerning the level of PA, all teleworkers displayed a low level before TR. However, 87.8% showed a moderate level of PA, and 12.2% showed a low-level following TR. Notably, no teleworkers presented a high level of PA (Table 3).

Table 3.

Pre-test and post-test levels of physical activity among teleworkers

Physical Activity Level	Pre-test n (%)	Post-test n (%)
Low	82 (100)	10 (12.2)
Moderate	0 (0)	72 (87.8)
High	0 (0)	0 (0)
Total	82 (100)	82 (100)

After receiving TR, the percentage of teleworkers with “Fair” and “Good” general health status was improved. There was a significant decrease in the number of days with physical and mental health issues, as well as overall unhealthy days and days with activity limitations after TR (p < 0.05). Following TR, all teleworkers were not restricted in their activities due to impairments or health problems. Furthermore, they did not need the help of others for personal care and routine needs. A significant reduction in days of severe impairment or limited activity due to health problems was observed (p < 0.05). In addition, the TR intervention demonstrated a significant reduction in days difficult to perform usual activities such as self-care, work, or leisure due to pain. Additionally, there was a significant decrease in days “feeling sad, blue, or depressed,” “feeling worried, tense, or anxious,” and “not getting enough rest or sleep.” It also improved days of feeling “very healthy and full of energy” (Table 4).

Table 4.

Comparison of teleworkers’ pre-test and post-test quality of life following telerehabilitation using HRQoL-14

HRQoL -14		Pretest	Posttest	z value (p-value)
Healthy Days Core Module
General Health n (%)	Excellent	0 (0)	0 (0)	–
	Very Good	0 (0)	0 (0)
	Good	0 (0)	49 (59.8)
	Fair	31 (37.8)	33 (40.2)
	Poor	51 (62.2)	0 (0)
Physically unhealthy days (mean±SD)		1.44±1.17	0.44±0.611	6.986 (0.000)*
Mentally unhealthy days (mean±SD)		11.73±7.52	5.44±3.03	5.655 (0.000)*
Usual activity limitation days (mean±SD)		0.79±1.46	0 (0)	2.567 (0.010)*
Activity Limitations Module
Are you limited in anyway in any activities because of any impairment or health problem	Yes	0 (0)	0 (0)	–
	No	55 (67.1)	82 (100)
	I don’t Know	27 (32.9)	0 (0)
Days of health-related limited activity (mean±SD)		0.37±0.854	0 (0)	5.361 (0.000)*
Need others’ help for personal care n (%)	Yes	0 (0)	0 (0)	–
	No	82 (100)	82 (100)
	I do not know	0 (0)	0 (0)
Need others’ help for routine needs n (%)	Yes	0 (0)	0 (0)	–
	No	55 (67.1)	82 (100)
	I do not know	27 (32.9)	0 (0)
Healthy days symptoms module
Days of hard to perform usual activities, such as self-care, work, or recreation due to pain (mean±SD)		1.34±2.40	1.00±0.00	4.348 (0.000)*
Days of feeling sad, blue, or depressed (mean±SD)		14.04±5.16	5.93±2.57	7.651 (0.000)*
Days of feeling worried, tense, or anxious (mean±SD)		13.21±5.36	4.87±1.99	7.683 (0.000)*
Days of not getting enough rest or sleep (mean±SD)		13.05±5.65	1.55±1.29	7.882 (0.000)*
Days of feeling very healthy and full of energy (mean±SD)		4.52±3.08	12.01±3.79	7.615 (0.000)*
Overall unhealthy days (mean±SD)		13.17±7.66	5.88±2.99	6.097 (0.000)*

*Significant at 0.05 level, SD- Standard deviation.

Table 5 shows no change in the distribution of teleworkers with back or neck and vision problems. At the posttest level, no teleworkers had reported mental health problems. Most teleworkers (79.3%) refused to report their major impairment or health problem that limited their activities at the posttestlevel.

Table 5.

Comparison of teleworkers’ pre-test and post-test major impairment or health problems limiting their activities according to the HRQoL-14

Major Impairment or Health problem	Pretest n (%)	Posttest n (%)
Arthritis/Rheumatism	0 (0)	0 (0)
Back or Neck problem	11 (13.4)	11 (13.4)
Fractures, Bone/Joint injury	0 (0)	0 (0)
Walking problem	0 (0)	0 (0)
Lung/breathing problem	0 (0)	0 (0)
Hearing problem	0 (0)	0 (0)
Eye vision problem	6 (7.3)	6 (7.3)
Heart problem	0 (0)	0 (0)
Stroke problem	0 (0)	0 (0)
Hypertension/high blood pressure	0 (0)	0 (0)
Diabetes	0 (0)	0 (0)
Cancer	0 (0)	0 (0)
Depression/anxiety/emotional problem	54 (65.9)	0 (0)
Other impairment/problem	0 (0)	0 (0)
Don’t Know/not sure	5 (6.1)	0 (0)
Refused	6 (7.3)	65 (79.3)

4. Discussion

This study aimed to demonstrate the effect of TR interventions on the level of PA and QoL in young adult teleworkers. The levels of PA and QoL were measured with IPAQ-SF and HRQoL-14. The findings of this study delineate that TR is efficacious in improving the level of PA and QoL among young adult teleworkers.

Firstly, the authors uncovered the level of physical activity (PA) observed among teleworkers. Notably, following four weeks of TR, the level of walking (16.5 to 264 MET minutes/week), moderate (0 to 480 MET minutes/week), vigorous (0 to 160 MET minutes/week), and total (33 to 1038 MET minutes/week) PA significantly improved compared to its pretest score. In alignment with these findings, a recent study observed a significant improvement in the total PA following TR in systemic sclerosis (SSc) patients. It also stated that TR might enhance satisfaction, treatment compliance, and consciousness by allowing participants to actively manage illness and decision-making [28]. Another study recently observed that TR had significantly improved PA in knee osteoarthritis patients [29]. These two studies covered patients with clinical conditions; however, the current study involved teleworkers. Several studies have shown that TR programs, such as home-based exercise programs delivered via teletherapy supervision, can lead to improvements in PA, mobility, and balance [30–32]. Furthermore, the present study found that the participants spent most of their time in a sedentary position during the day, with a median of 9 hours per day at the baseline. After four weeks of remote TR, the sedentary behavior was reduced to a median of 7 hours per day. This observation is consistent with a previous report on the effect of mobile TR on metabolic health outcomes in obese patients [33]. Moreover, a recent study found significant changes only in the high PA category following a tailored short message service in females with polycystic ovary syndrome [34]. On the other hand, this study observed that all teleworkers (100%) had a low level of PA before TR, indicating that they spent most of their time sedentarily. However, 87.8% of teleworkers showed a moderate level of PA, and only 10% had a low level of PA following TR.

The second most crucial aspect of the study’s findings was a notable increase in the participants’ health-related QoL after engaging in a four-week TR session. This study observed a noteworthy improvement in general health status among teleworkers at the posttest level (Poor-0%; Fair-40.2%; Good-59.8%). It also noticed a reduction in the number of days of feeling psychological symptoms such as anxiety (13.21 to 4.87 days) and depression (14.04 to 5.93 days). These outcomes were supported by previous research on TR for acute multi-musculoskeletal disorders, which demonstrated significant enhancements in many outcomes, including a 54% reduction in anxiety, a 58% decrease in depression, and a 79% improvement in total productivity [35] and a significant improvement was observed during the initial 4-week of the intervention period [35]. Furthermore, previous studies indicated that prolonged sitting time was associated with an increased risk of cardiometabolic diseases and all-cause mortality [36,37]. An earlier study revealed an association between sedentary behavior and musculoskeletal diseases such as low back pain (LBP) in working and non-working populations [38]. Specifically, PA is associated with musculoskeletal pain in areas like the lower back, upper back, and neck [39]. In this study, there is an increase in the level of PA and a decrease in sedentary behavior among teleworkers following TR, which may have limited the progression of major health problems by altering sedentary lifestyles. Furthermore, this study found a significant decrease in the number of days with physical (1.44 to 0.44 days) and mental health issues (11.73 to 5.44 days), as well as overall unhealthy days (13.17 to 5.88 days) and days with activity limitations (0.79 to 0 days) after TR. These results indicated that TR had significantly improved QoL among teleworkers by reducing unhealthy and activity limitation days. Similarly, a previous study found that TR effectively improved QoL among SSc patients. However, it varied from the current study concerning the study population and measurement tool adopted [28]. Another recent study revealed that TR enhanced various aspects of QoL among older individuals [40]. A previous review also stated that TR could be an alternative way for the treatment of pain, physical function, and QoL in adults who have physical disabilities [41].

Moreover, TR showed a positive effect on psychological factors, resulting in an increase in the level of PA following treatment. The psychological factors contributing to this rise in PA include diminished anxiety and depression levels, better mental health, and improved resilience. TR programs reduce fear, physical and psychological distress, and disability, resulting in better QoL and pain reduction in fibromyalgia patients [42]. Furthermore, TR can impact the mental health and well-being of teleworkers. It provides an opportunity to scale mental health services and minimize the treatment gap for mental health issues [43]. It can encourage a healthy lifestyle among the general population by monitoring individuals in their homes. It is beneficial in rural areas, where residents can participate in at-home workouts made possible by technological advances in communication, such as the telephone, video conferencing, and software programs [44]. On the other hand, challenges arise in multiple domains, including clinical, technological, environmental, and regulatory aspects when implementing telerehabilitation programs [45]. A meta-analysis study reported that, for various reasons, including measurement error, self-reported levels of PA could not be validated with device-based measures of activity. To guide future research, it is critical to highlight hurdles in using such technology and assess the impact of such devices on intervention outcomes [46]. Additionally, this study demonstrated significant improvements in PA and QoL after four weeks of TR. Several factors may have contributed to these improvements. First, the convenience and accessibility of telehealth services likely facilitated greater participation and adherence to rehabilitation protocols, which spanned four weeks with three sessions per week. Second, the exercise regimens provided as an intervention in this study may have been tailored to individual needs, and progress may have resulted in optimized outcomes. Third, integrating technology-enabled monitoring and feedback mechanisms may enhance motivation and accountability and promote sustained engagement in PA. Overall, the multifaceted nature of TR likely synergized to produce the observed significant improvement in both PA levels and QoL among teleworkers.

This study is limited to a single group receiving TR without a control group, as it intended to explore only the effect of TR on teleworkers. Further research can be conducted with larger sample and a control group to generalize the results. In addition, due to the small sample size, robust, risk-adjusted regression analyses were not performed. In addition, repeated measures and follow-up assessments of the outcome variables can reveal the actual effect of TR among teleworkers in future studies. The outcomes of this study suggest that TR might be a promising prospective alternative to traditional face-to-face rehabilitative therapy for teleworkers to enhance their healthy lifestyle in the community.

5. Conclusion

This study concluded that four weeks of TR significantly improved walking, PA, MPA, VPA, and total PA and also reduced sitting or sedentary behavior in young adult teleworkers. Following TR, the general health condition of teleworkers was rated as “Fair” and “Good.” A significant reduction in being physically and mentally active and overall unhealthy days as well as activity restricted days was observed. All teleworkers were not restricted in their ability to perform their duties due to impairments or health problems. Therefore, TR could be a viable method to improve PA and quality of life levels in teleworkers, thereby achieving a healthy lifestyle and its benefits.

Ethical approval

The study obtained ethical approval from the institutional research committee with reference number INTI-IU/FHLS-RC/BPHTI/7NY12021/018.

Informed consent

All the participants were given sufficient information to make an informed decision and agreed to be a subject by providing a written concern before participating in this study.

Conflict of interest

None to report

Funding

Not applicable