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Ergonomics
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Relationship between aerobic capacity, injury risk and tenure for new-hire delivery drivers
Charles K. Anderson
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Advanced Ergonomics, Inc., 7460 Warren Parkway #265 Frisco, Texas, 75034-4279, USA

Version of record first published: 21 Oct 2010

To cite this article: Charles K. Anderson (2010): Relationship between aerobic capacity, injury risk and tenure for new-hire delivery drivers, Ergonomics, 53:11, 1395-1401 To link to this article: http://dx.doi.org/10.1080/00140139.2010.524252

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Ergonomics Vol. 53, No. 11, November 2010, 13951401

Relationship between aerobic capacity, injury risk and tenure for new-hire delivery drivers
Charles K. Anderson*
Advanced Ergonomics, Inc., 7460 Warren Parkway #265 Frisco, Texas 75034-4279, USA (Received 16 November 2009; nal version received 8 September 2010) Over a 2-year study period, aerobic capacity was measured at time of hire for 1419 delivery drivers. Injury experience and tenure were then monitored for these new-hires during that same period. Number of strain injuries, time to rst strain and time to termination were regressed on aerobic capacity adjusting for tenure. Statistically signicant, monotonically changing relationships were found for all three outcome variables. A unit increase in aerobic capacity was predicted to result in a 3.7% decrease in injury rate and a 1.1% decrease in risk of termination. When age was included in the model for time to termination, aerobic capacity was no longer a signicant predictor. The ndings regarding injury experience and aerobic capacity support National Institute for Occupational Safety and Health recommendations that individuals should work at no more than 2130% of their aerobic capacity. Statement of Relevance: Knowledge of the nature of the relationship between aerobic capacity, injury experience and retention allows the ergonomist to determine whether there is a point of diminishing returns in intervention eectiveness for higher levels of aerobic capacity. Keywords: injury risk; musculoskeletal disorders; NIOSH lifting equation; personnel selection; physical work capacity

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Introduction Physical work evaluation guidelines such as the revised lifting equation published by the National Institute for Occupational Safety and Health (NIOSH) identify energy expenditure as one of the factors of concern (National Institute for Occupational Safety and Health 1981, Waters et al. 1993). The guidelines provided in the support material for the revised lifting equation translate to a recommendation that the energy expenditure for an 8-h shift should be no more than approximately 21% of aerobic capacity, as measured on a treadmill, when the work is primarily performed with the arms and 30% otherwise (Waters et al. 1993). More recently, Wu and Wang (2002) suggested energy expenditure limits of 34% of aerobic capacity for 8 h of work time and 31% for 10 h, based on subjects tolerance of cycling on an ergometer at various workloads. The energy expenditure for a given task is just one of several factors reected in the calculation of the Lifting Index in the revised NIOSH lifting equation (Waters et al. 1993). The Lifting Index itself has been validated in a number of ways (Hidalgo et al. 1995, Wang et al. 1998, Marras et al. 1999, Waters et al. 1999, Lavender et al. 2009), but there have been no studies that have provided a detailed examination of the shape of the relationship between the percentage of
*Email: chuck.anderson@advancedergonomics.com
ISSN 0014-0139 print/ISSN 1366-5847 online 2010 Taylor & Francis DOI: 10.1080/00140139.2010.524252 http://www.informaworld.com

aerobic capacity utilised on the job and occupational eld measures of worker/job mismatch. Such indications of worker/job mismatch could include increased injury rate, increased turnover and lower productivity. Knowledge of the shape of these relationships could allow the ergonomist to determine whether there is a point of diminishing returns in intervention eectiveness for higher levels of aerobic capacity. Statistically signicant relationships have been found between performance on test batteries, including a measure of aerobic capacity and subsequent injury rates for employees in warehouse jobs (Anderson and Catterall 1987, Craig et al. 1998, Anderson and Briggs 2008), reghting (Cady et al. 1979) and basic combat training (Knapik et al. 2001, 2006). These studies indicated that individuals with low tness levels had injury rates ranging from 1.4 to 9.3 times as high as individuals with higher tness levels. A number of these studies did not provide the energy expenditure for the job and all of them considered only two, or at most three, ranges of tness. Hence, from these studies it is dicult to ascertain the sensitivity of injury rate to the percentage of aerobic capacity being used. Two studies have reported on the relationship between aerobic capacity and job tenure (Knapik et al. 2006, Anderson and Briggs 2008). They found that

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C.K. Anderson Handling heights were obtained by measuring the heights at which products were stored on the delivery trucks and in representative client facilities. The majority of the manual unloading from the delivery truck occurred above waist level, which is the region in which NIOSH recommended that the threshold be 21% of aerobic capacity. The manual handling associated with rearranging product in the clients storage locations was roughly evenly mixed between above and below waist level. Energy expenditures were estimated by monitoring the heart rates of 181 experienced delivery drivers and then adjusting the heart rate responses for their individual tness levels. Each driver was monitored for an entire shift, which was typically about 10 h. Fitness level was assessed with a multi-stage sub-maximal step test protocol designed by Siconol et al. (1985). The protocol is described in more detail in the sub-section regarding predictor measures. The mean overall energy expenditure for incumbents whose heart rate was monitored was 9.86 (SD 0.45) ml/kg per min. Predictor measures The 1419 delivery driver new-hires had participated in a physical ability testing battery as part of their screening process for employment. The battery consisted of two strength tests and the multi-stage sub-maximal step test. Test administrators at clinics close to each location were trained in the test protocol by the authors sta and the test results were reviewed to assure compliance with the specied protocol. The strength tests consisted of lifting a box into which the applicant added as much weight as she/he felt she/he could safely lift and then demonstrating that lift. The amount of weight available to place in the box was limited to slightly more than the maximum weight that would be routinely lifted on the job at that location, which was where the cut-o was set. The weight made available was limited to reduce the risk of injury during the test. One implication of this strength testing protocol was that individuals strength test scores were limited to the maximum weight available for the lift. This also meant that all individuals who passed the test had virtually the same amount of weight lifted for the strength tests. Hence, strength was not used as a predictor measure in this study since there was virtually no variance in the measured value for these new-hires. Aerobic capacity was assessed with the multi-stage sub-maximal stepping protocol described by Siconol et al. (1985). The protocol involved stepping up and down on a 25.4 cm bench for 3 min, starting at a pace

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individuals with lower tness were 3438% less likely to work more than 89 weeks than more-t individuals. As with the studies of aerobic capacity and injury rate, the results presented made it dicult to evaluate the sensitivity of tenure to percentage of aerobic capacity being used, particularly for time periods other than 89 weeks. Barrick and Zimmerman (2009) noted that relationships with predictors of retention other than personality weakened over time up to 2 years after hire. Data from a large sample of delivery drivers working at a very similar average energy expenditure provided an opportunity to more nely explore the relationship between aerobic capacity and injury rate and tenure. Other potential indicators of worker/job mismatch were not archived by the company, so this study concentrated on these two outcome measures. Methods Subjects The subjects in this study were an ethnically diverse group of 1419 full-time delivery drivers who had been hired in 2007 or 2008 at locations of the parent company across the United States. Demographics are shown in Table 1. Job analysis These delivery drivers manually unloaded hundreds of units of product from a delivery truck to a two-wheel dolly or cart in the course of a series of deliveries over a given work shift. The delivery driver then transported the units for a particular delivery to a clients storage location and potentially manually handled the products again to place them in their nal position. The strength and endurance demands of this delivery driver job were analysed most recently in 2006 by collecting data regarding the weights of the product delivered, the frequency of handling various products, the handling heights and the average energy expenditure over the shift.

Table 1.

Subject demographics. Males Females 29.8 1.70 81.7 35.7 13 (5.8) (0.10) (17.4) (6.6) Overall 1419 30.9 (6.5) 1.78 (0.13) 93.0 (18.7) 38.5 (6.7)

Sample size Age (years) Height (m) Weight (kg) Aerobic capacity (ml/kg per min)

1406 31.0 (6.5) 1.78 (0.13) 93.1 (18.7) 38.6 (6.7)

Note: Values for age, height, weight and aerobic capacity are shown as mean (SD).

Ergonomics of 17 steps per min. If the heart rate at the end of the 3 min was below 65% of estimated maximum heart rate (220 minus age), the participant rested for 1 min and then stepped another 3 min at 26 steps per min. If the heart rate was still below 65% of the estimated maximum at the end of that stage, the participant rested for 1 min and then stepped another 3 min at 34 steps per min. The aerobic capacities for males were calculated using the equations provided in Siconol et al. (1985). The equations for females provided by these authors seemed to under-predict for the population of female applicants for manual materials handling jobs, so data from Harkrider (2005) were used to calculate equation coecients that represented a population of females more similar to the industrial applicant pool. Siconol et al. (1985) reported a correlation coecient of 0.79 between predicted and measured aerobic capacity for males. The equations using the data from Harkrider (2005) had a correlation coecient of 0.89 for females. A testretest reliability of 0.83 was reported by Gall and Parkhouse (2004) for the step test protocol. Outcome measures Hire dates, termination dates, reasons for termination and data from rst reports of injuries for the period of 2007 and 2008 were provided by the employer for the 1419 delivery drivers included in the study. Injury data included date of occurrence, part of body involved, type of injury (sprain, strain, contusion, etc.) and event associated with the injury (lifting, pushing, pulling, motor vehicle accident, etc.). The study focused on musculoskeletal injuries that were not vehicle-related because of their prevalence and anticipated relationship to employee physical tness level. The outcome measures were the number of strain injuries during the study period, time to rst strain and the number of days worked. The number of days to rst strain was calculated by determining the number of days between the hire date and rst strain (if any). Likewise, the number of days worked for each driver was calculated by determining the number of days between the hire date and the earlier of the termination date or end of the study period (31 December 2008). The following three categories of work status were dened for the purposes of the analysis of tenure: . Still working: Individuals who were hired and still working at the end of the study period. . Terminated potentially physical ability related: Individuals who had terminated within the study period for reasons that may have been related to physical ability to perform the job. The most common examples of such reasons included

1397 voluntary resignation, voluntary resignation with no rehire and job abandonment. . Terminated other: Individuals who had terminated within the study period for reasons unrelated to physical ability to perform the job. Examples would be workforce reductions, return to school and end of temporary or seasonal employment.

The tenure analyses were restricted to those terminations that were potentially physical ability-related because it would not be expected that physical ability would have a bearing on terminations associated with return to school, workforce reduction or end of seasonal employment. Data analysis Analyses of the relationships between aerobic capacity, injury experience and tenure were performed with a variety of methods. Poisson regression adjusting for tenure was used to develop a prediction of number of injuries from an individuals aerobic capacity. The assumption of equidispersion of the injury data was evaluated by testing the over-dispersion parameter of a negative binomial regression model against zero (Cameron and Trivedi 1998). Cox proportional hazards regression (Cox 1972) was used to study the relation between time to rst injury and aerobic capacity as well as demographic variables. The same technique was used to study the relationship with time to termination. The Cox regression approach was also used to assess whether there was a time-dependent eect of aerobic capacity on time to rst injury or time to termination. The Kaplan-Meier method (Klein and Moeschberger 1997) was used to estimate time-to-event curves for the tenure and time to rst injury outcomes. All analyses were conducted using Stata (version 10.1; StataCorp, College Station, TX, USA). Poisson regression was used for analysis of the injury data because it allowed for consideration of all of the injuries that occurred while adjusting for tenure. If the alternative method of logistic regression were used, individuals would be categorised as either having had an injury or not, thereby disregarding injuries beyond the rst one to a given new-hire and, more importantly, disregarding the length of time that the individual was employed. The disadvantage of this technique is the assumption that multiple injuries on the same individual are independent. The Cox proportional hazard regression approach evaluates the time to rst injury, ignoring multiple injuries on the same individual and days worked after the rst injury. However, the assumption of the

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C.K. Anderson

independence of injuries is avoided. It also enables the consideration of a time-dependent eect on the relationship between aerobic capacity and time to rst injury or time to termination. Results Injury experience There was a total of 318 rst reports of sprain-strain injuries to 264 of the 1419 delivery drivers in the study, within a total of 328,664 d worked. This gave an injury rate of 35.3 injuries per 100 years worked for all delivery drivers in the study. The mean number of strains per driver was 0.22 with a variance of 0.26, indicating near-equality of mean and variance (equidispersion). The injuries included in the study accounted for 63% of all rst reports of injury for delivery drivers. These injuries had an average of $5073 of incurred workers compensation cost, 10.7 d lost and 13.8 d of transitional duty. In total, 45 of the delivery drivers had more than one injury during the study period (3% of the whole sample of 1419). Analysis of the 99 injuries to these 45 delivery drivers indicated that six of the injuries may have been of the same type and to the same location of the body as a prior injury to the same person. This was probably an overestimate since there was not always specic detail about the side of the body involved in the injury and whether an injury was actually a recurrence of a prior injury. The much more typical pattern was for subsequent injuries to be to dierent body parts and often of dierent types (e.g. neck strain and cumulative trauma at the wrist). Hence, it appeared that the assumption of independence of injuries required for the Poisson regression was reasonably met. A negative binomial model was used to model the relationship between aerobic capacity and the number of injuries to determine if an adjustment for overdispersion was warranted. Using a likelihood ratio test, the over-dispersion parameter was not found to be signicantly dierent from zero (p 0.19), which corroborated the assumption that the data were equidispersed. A Poisson regression performed between number of strain injuries and aerobic capacity, adjusting for tenure yielded a statistical signicance of p 5 0.0001. Neither ethnic group nor age was a signicant predictor in the model at a 0.05 level. The sample consisted of only 13 females, so it was not possible to accurately estimate the gender eect. Figure 1 illustrates the predicted number of strains per 100 years worked and 95% condence bounds based on the model, including aerobic capacity

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Figure 1. Predicted injury rate vs. aerobic capacity. Dotted lines indicate 95% condence limits.

adjusting for tenure. A downward trend in number of injuries was found with increasing aerobic capacity. Axis values for both aerobic capacity and percentage of aerobic capacity at which working were included in the gure so as to allow comparison with the NIOSH recommendations for the threshold of aerobic capacity at which one should work. Percentage of aerobic capacity at which working was calculated by dividing the average energy expenditure on the job (9.86 ml/kg per min) by aerobic capacity. The prediction equation was: number of injuries per day worked exp0:0376 aerobic capacity 5:513 1

The coecient of 0.0376 for aerobic capacity translates into an injury rate ratio of 0.963 for a one unit increase in aerobic capacity, which would be a 3.7% decrease. For a ve-unit increase in aerobic capacity, the injury rate would decrease by about 17%. The predicted injury rate for the delivery driver with the lowest measured aerobic capacity (22.75 ml/kg per min) was close to seven times higher than the predicted injury rate for the driver with the highest measured aerobic capacity (73.85 ml/kg per min). As shown in Table 2, the least-t quartile had an actual injury rate that was two times higher than the rate for the most-t quartile. Cox proportional hazards regressions yielded the same results as the Poisson regressions. The Wald p-value for aerobic capacity was less than 0.001. Age and ethnic group were not signicant predictors. A unit increase in aerobic capacity was predicted to result in a 0.965 decrease in the hazard of injury, or around 3.5%. There was no indication that there was a signicant time-dependent eect for aerobic capacity,

Ergonomics
Table 2. Injury rates by aerobic capacity quartile. Sample size 356 353 357 353 1419 Number of strain injuries 104 81 77 56 318 Total years worked 215.4 215.9 238.3 230.2 899.8

1399

Aerobic capacity range (ml/kg per min) 22.7533.75 33.7637.79 37.8042.67 42.6873.85 Total

Injury rate per 100 years worked (95% CI) 48.3 37.5 32.3 24.3 35.3 (39.858.5) (30.246.7) (25.840.4) (18.731.6) (31.739.4)

which meant that the risk of injury associated with a change in aerobic capacity appeared to be constant for the time periods worked by the drivers in this study. Tenure

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A total of 112 drivers terminated during the study period due to reductions in force, return to school or end of seasonal employment and therefore were removed from the tenure analysis. Of the other 1307 drivers, 708 terminated during the study period (54%). The median tenure was 260 d. A univariable Cox proportional hazards regression indicated aerobic capacity was signicantly related to time to termination (p 0.048) for these 1307 drivers. Ethnic group was not related to tenure, but age was (p 0.01). A one unit increase in aerobic capacity decreased the risk of termination about 1.1%. A 1 year increase in age increased the risk of termination about 1.6%. When age was included in a multivariable model with aerobic capacity, aerobic capacity was no longer signicant (p 0.19). A linear regression of aerobic capacity on age showed a statistically signicant inverse relationship (p 5 0.001), but the explained variance was less than 8% (r2 0.077). Figure 2 illustrates the KaplanMeier plot of proportion employed vs. days worked for the four age quartiles of these 1307 drivers. There was no indication that there was a time-dependent eect for aerobic capacity. Discussion Injury risk The nding that there appeared to be a monotonically decreasing relationship between aerobic capacity and strain rate in this pre-screened group of delivery drivers suggested that higher aerobic capacity had a continuously increasing prophylactic eect on injury rate in the range studied. The roughly seven-fold ratio of predicted injury rates for the least-t compared with the most-t of the new-hire delivery drivers and the two-fold ratio in actual injury rates for the least-t quartile vs. the most-t quartile of delivery drivers were similar in magnitude to the risk ratios observed in similar studies (Cady et al. 1979, Anderson and

Figure 2. quartile.

Proportion employed vs. days worked by age

Catterall 1987, Craig et al. 1998, Knapik et al. 2001, 2006, Anderson and Briggs 2008). The increased slope of the Poisson regression equation for lower aerobic capacities suggested that injury rate would be disproportionately higher for those with aerobic capacities less than about 40 ml/kg per min. Delivery drivers with stamina below this level would be working at more than 25% of their aerobic capacity, given the overall average energy expenditure of 9.86 ml/kg per min. This supported NIOSHs recommendation of thresholds ranging from 21% to 30% of aerobic capacity as measured on a treadmill, depending on whether the lifting is being performed above or below waist level, respectively (Waters et al. 1993). Tenure The nding that there was a statistically signicant relationship between aerobic capacity and time to termination was consistent with the ndings of higher termination rates for less-t individuals reported by Knapik et al. (2006) and Anderson and Briggs (2008). There appeared to be a relatively small eect in this study, however. One possible reason for this discrepancy may have been that the delivery drivers

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C.K. Anderson capacity. This supported the NIOSH recommendation that individuals should not work at more than 2130% of their aerobic capacity, depending on the handling heights. Further research is needed to determine if new-hires who did not pass the physical ability test battery would have had an even more disproportionately higher injury rate than the least-t delivery drivers included in this study, as well as a signicantly higher termination rate. Acknowledgements
The author would like to thank Gregory Young for his assistance in data analysis and graphics development.

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had been pre-screened on aerobic capacity, so the least-t individuals were not included in the new-hire population that comprised the study group. The fact that there did not appear to be a time dependency in the relationship between aerobic capacity and tenure was inconsistent with the observation of Barrick and Zimmerman (2009), who noted that relationships with predictors of retention other than personality weakened over time up to 2 years after hire. This may have been due to the fact that the median tenure for the delivery drivers in this study was 260 d, so there may have been insucient time for a time dependency to have manifested. It was interesting to nd that age was a stronger predictor of time to termination than aerobic capacity for these delivery drivers. This suggested that there may have been age-related psychosocial issues that eclipsed physical ability in their impact on the decision to terminate. It did not appear that age was acting as a surrogate indicator of aerobic capacity since the correlation between the two was relatively moderate. The level of correlation was not surprising since the group was pre-screened on aerobic capacity (i.e. there was signicant range restriction) and there was a fairly narrow range of ages represented in the group of delivery drivers. As both Lavender and Marras (1994) and van Iddekinge and Ployhart (2008) noted, withdrawal behaviour tends to be complex, which makes measures related to it challenging to validate. For instance, the real reasons for terminating may be signicantly dierent or more complicated than the reasons reported. This made it dicult to isolate terminations that were primarily due to mismatch between physical ability and job demand. Conclusions Statistically signicant monotonic relationships were found between aerobic capacity, injury rate, time to rst injury and time to termination for new-hire delivery drivers screened on the basis of their physical ability. A unit increase in aerobic capacity was predicted to result in 3.7% decrease in injury rate and a 1.1% decrease in the risk of termination. These results support the strategy of matching individuals and jobs as a method for reducing the injury rate for delivery drivers. Age appeared to be a stronger predictor of time to termination than aerobic capacity for this group of delivery drivers screened on their physical ability, which may be an indication of the complexity of factors aecting withdrawal behaviour. There appeared to be a disproportionately higher number of injuries for those with aerobic capacities below 40 ml/kg per min, which corresponded to working at greater than about 25% of ones aerobic

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