Only records for patrollers, lift operators, and snowsport instructors were examined. The number of claims in each category was recorded for each year and a 5-year average was calculated. In addition, a request was sent out through the industry safety association for resorts that had not participated in the study to share their injury data for comparative purposes. Four resorts submitted summary data listing the number of injuries in each category for all patrollers, instructors, and lift operators working at each of the resorts during the two seasons over which the study was conducted.
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There was no limitation on these areas implementing their own safety programs. Since the areas ranged in size, number of employees, and employee work exposure and it was not possible to establish whether the same criteria for classification of injuries were used at all areas, the comparisons between injury rates were made as relative change over time within each resort. A worksite health and wellness program designed to build healthy eating and drinking behaviors within the lifestyle and resources of a young snowsport resort worker and to establish neutral postures and stability at the lumbar spine, knee, and shoulder was offered to all employees at the five test resorts.
During fall staff training, a short presentation 30 minutes—1 hour open to all staff described the findings of the first year of the study, and briefly described the nutrition and proprioceptive program. In addition, each of the five participating snowsport areas selected 15 new volunteers five in each job category of lift operators, patrollers, and instructors to receive printed materials and attend half-hour workshops on nutrition and proprioception.
The nutrition workshop covered the three basic types of foodstuffs carbohydrates, proteins, and fats and their digestion times. The main points of focus were on how to maintain euhydration and to consume small low-fat, complex carbohydrate, and lean protein snacks every hours during the workday to stabilize blood sugar.
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Glycogen replenishment was also recommended following high-activity days. Strategies for shopping, cooking, and packing of healthy meals on a budget and while living at a snowsport resort were also provided. Discussion on limiting alcohol and other recreational substance use was encouraged. The proprioception workshop focused on learning how to position one's body into a posture with the spine and pelvis in neutral position.
Participants then learned to stabilize this neutral posture while standing in ski or snowboard boots , sitting as on a chairlift , or moving while performing work tasks, carrying a pack, skiing, or riding. Simple proprioceptive drills to help increase stability at the lumbar spine, hip, knee, and shoulder were presented and participants were encouraged to utilize the drills regularly. The increase in functional movement stability was stressed from the perspective of enhanced performance as well as a decrease in the risk of injury.
Although only 15 workers at each resort attended the workshops and were provided with the printed materials, the workshop participants were encouraged to share the information within their departments. Supervisors from each outdoor department were also invited to share in the more detailed information and were provided with strategies to support the program on a biweekly basis throughout the season.
In addition, all workers had access to a Facebook page for the program with regular postings on tips, recipes, exercises, fun activities, and other engaging platforms to support the program focal points of quality nutrition, hydration, fitness and proprioception, and a healthy lifestyle. After testing for normalcy and equal variances, injury rate comparisons were made using analysis of variance ANOVA , followed by paired historical or independent between areas t -tests with the Bonferroni correction for significant differences.
All tests were run using Minitab Demographic information is presented in Table 1 data from year 1 ; the majority of participants were between the ages of 20 and 40 years range 18—76 years , nonsmokers, and, except for instructors, predominantly males. A very high proportion of participants reported having a history of injuries of the lower back, knee, or shoulder, as well as chronic pain at one or more of these joints Table 2 —data from year 1.
Patrollers reported injuries of the shoulder and back most frequently, instructors reported injuries of the knee as the most prevalent, and lift operators reported the highest frequency of injuries to be in the knee and back. Demographic information for the 75 study participants collected during the first season at five snowsport resorts in Western Canada.
Data collected at five snowsport resorts in Western Canada during the first season of the study. Functional movement analysis results for 75 snowsport resort employees. Data collected during the first season at five resorts in Western Canada. Scores are a unitless number representing the number of movement criteria displayed during the test. A higher score indicates a lower ability to stabilize the lower back, hip, knee, or shoulder joints during loaded movement. Excluding the first glucose sample of the day to account for the fasting condition had very little impact on the results; therefore all samples were included in the statistical analysis.
Simple reaction time is given in milliseconds Figure 4 , with a lower score indicating a faster reaction time. The results of the two complex reaction time tests are presented as normalized for accuracy of response with a higher score indicating a faster and more accurate response. Figure 5 shows the results for the numerical memory task, Figure 6 the visual pattern recognition task. A historical examination for time of day of injury was also made for the five participating resorts.
Data for all patrollers, lift operators, and instructors working at five snowsport resorts in Western Canada.
A summary of the diet records is presented in Table 4 data from year 1 along with the DRI for comparison. In contrast, the daily intake of fruits and vegetables was lower than that recommended by the Canadian Food Guide leading to suboptimal intakes of a number of important nutrients including total fiber, vitamins A, D, and E, magnesium, and potassium. In addition, female lift operators and instructors had inadequate intakes of folate, calcium, and iron.
Dietary intake as reported from two- or three-day diet records for 75 patrollers, instructors, and lift operators at five ski resorts in Western Canada during the first year of the study. Highly significant reductions in medical aid and lost time claims were observed for all employees in the three test job classifications of patroller, lift operator, and instructor, at all five resorts where the nutrition and proprioceptive program was provided Figure 8.
Two resorts achieved zero Lost Time claims in these departments for the season. Overall, recordable incidents in these three job classifications were reduced by The prior to data include up to five years of historical records for all workers in the three job categories. The primary outcome of this investigation was a large reduction in the number of recordable incidents in patrollers, instructors, and lift operators working at five snowsport resorts in Western Canada during a season where a nutritional and proprioceptive training program was used Figure 8.
This observation is strengthened by the overall increase in claims for the three test job classifications in four other snowsport resorts located in the same geographical region, that did not use the educational program, over the same time frame. These findings support previous reports that stabilizing blood glucose levels can significantly impact measures of vigilance including reaction time, cognition, memory, and decision making [ 3 , 7 — 11 , 14 , 27 — 29 ].
Although the number of incidences of true hypoglycemia blood glucose levels in the 3.
However, in studies with physicians [ 14 ] or truck drivers [ 28 ] where we compared the results of a day of self-selected diet with a day of imposed feeding, the stabilization of blood glucose did correlate with an improvement in scores on every parameter measured including reaction time, memory, accuracy, and decision making of a magnitude equivalent to the norms for two age group levels [ 14 ]. Given that the dietary records of the ski resort employees tested during the first season indicated that overall, the consumptions of saturated fats and sugars were well in excess of the DRI, it is not surprising that a culturally specific educational program that provided quality information on the performance benefits of stabilizing blood sugar by consuming small frequent meals composed of complex carbohydrates and lean proteins, fresh fruits, and vegetables would have a beneficial effect.
The primary outcome measure of reduced injuries in the ski areas that provided nutritional training whether the comparison was made to a five-year average, the previous season, the timing of injuries to late morning or afternoon, or to other ski resorts over the same season demonstrates a strong argument for the role of blood glucose variability in the etiology of workplace injuries and accidents in this population.
The possibility that some of the improvements in psychomotor vigilance in the previous studies and the reduction in injury rates observed in the current study were due to maintaining euhydration cannot be excluded. The dietary recommendations utilized in the educational program delivered at the start of the second season emphasized the need for ski resort workers to carry water with them during the day and to consume small amounts on a frequent basis.
This level of intake was sufficient to maintain euhydration, and both of these studies showed enhanced psychomotor vigilance with restoring hydration as part of the treatment. In addition to stabilizing blood sugar and maintaining hydration levels, the very positive outcome of reduced injuries in patrollers, lift operators, and instructors working at the five test resorts using the training program in the second season was likely due to the inclusion of proprioceptive exercise that was specific to the movement challenges faced by these workers, but which were simple to use and could be incorporated into the workday.
Although as for the nutritional training we have no direct evidence of altered behavior in those undergoing the training, given the frequency of reported previous injuries Table 2 along with the poor performance at the functional movement tests Table 3 , it would seem likely that correcting dysfunctional movement patterns may have been a contributing factor to the reduction in injury rates in the five test ski resorts.
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Altered movement strategies can also have an effect on peripheral joints. There is evidence associating abnormal scapular positions and motions with a variety of shoulder pathologies [ 32 , 33 ] and poor stabilization of the hip with increased potential for serious injury at the knee [ 20 , 34 ]. The supposition that correcting these altered movement patterns can help reduce subsequent injuries is supported by a large body of evidence linking the positive benefits of regular proprioceptive exercises in reducing sport injuries [ 20 , 35 — 38 ].
Many of these studies have looked at using balance, plyometric, and agility components to reestablish recruitment patterns and improve joint stability following soft tissue injury [ 35 , 37 , 38 ].
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Proprioceptive receptors in muscle, tendon, and joint capsules are responsible for coordinating muscular contraction so that a joint is stabilized as applied forces increase [ 39 ]. Unfortunately these small proprioceptive nerve endings are easily damaged, resulting in a slowing of the stabilization response or even contraction of the wrong muscles [ 41 ]. Fatigue [ 42 , 43 ], trauma, edema, and bruising [ 44 ] will all reduce the speed of response such that the pattern of muscle recruitment is slowed and less likely result in stabilization of a joint prior to the development of peak force, leaving the joint susceptible to injury.
Fortunately, research has also shown that proprioceptive training can increase the speed of recruitment, restoring the protective reflex [ 36 ]. On the basis of these findings, it would seem that the scarcity of application of proprioceptive drills combined with education and training of movement strategies in occupational injury prevention programs is unfortunate, as these techniques are likely to have a pronounced effect on improving the performance of daily work tasks and reducing the likelihood of injury.
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The findings of the current study suggest that this would seem to be an area worthy of further investigation. As with most applied research, there are some methodological considerations regarding the findings of the current study. Due to the nature of the worksite environment and the culture of the subject group there were many uncontrolled variables including but not limited to weather, exposure to moderate altitude, snow conditions, equipment, work hours, extracurricular activities, and a seasonal work force. Employee turnover prevented retesting of subjects or followup to determine the effect of employee training on behavior.
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In addition, each resort had its own procedure for classifying and recording injury events, making it difficult to compare results between areas. These factors notwithstanding, the objective observations in the significant reduction in the number of injuries sustained in all five resorts that utilized the nutritional and movement training program speak strongly in favor of the positive effect of a culturally and contextually specific health and wellness program in reducing injuries in patrollers, instructors, and lift operators working at snowsport resorts.
The study findings indicate that providing these young workers with quality information in a format that is meaningful to them was effective in decreasing occupational injuries in spite of the inability to ensure that all employees complied or were even exposed to the training in an ideal manner. The integration of occupational injury prevention and worksite health promotion is becoming an area of focus, as medical and insurance costs continue to rise. The components of the program utilized in the current study are in compliance with the recommendations for an integrated worker health program as outlined by CDC NIOSH's Total Worker Health Program [ 45 ], and the study outcomes provide further support for the effectiveness of worksite-based injury prevention programs that integrate health- and wellness-based lifestyle education with injury prevention.
Given the high rates of injury common at snowsport resorts and the escalating costs of these injuries, combined with limited recourses available for employee training and the fact that compliance with healthy lifestyle behavioral change programs is often poor, the inclusion of this type of low-cost, highly effective, workplace intervention is highly recommended. The findings of the current investigation provide evidence that integrated worksite health and wellness programs that encourage healthy eating patterns to stabilize blood glucose levels and maintain euhydration, combined with increased postural awareness and joint stability exercise, can help to significantly reduce occupational injury rates in ski resort workers.
The difficulties of conducting research in a workplace setting notwithstanding, further investigations into these types of injury prevention programs are warranted. There is no conflict of interest associated with this work. The author has never had a commercial interest at any time in the past, or has any agreement to do so in the future, with any of the manufacturers of materials or instrumentation used in this study.
The training program developed in this study will be used for educational purposes. Each of the participating ski resorts provided complementary lift tickets, meals, and accommodation during the data collection as well as covering travel expenses for the research staff. This season 3 resorts are continuing to implement the program and collect injury data. These resorts have covered the research expenses associated with delivery of the injury prevention program. National Center for Biotechnology Information , U. Journal List Biomed Res Int v.