Promoting Health and Wellness in the Workplace: A Unique Opportunity to Establish Primary and Extended Secondary Cardiovascular Risk Reduction Programs  Ross Arena, PhD, PT, Marco Guazzi, MD, PhD, Paige D. Briggs, MBA, PMP, Lawrence P. Cahalin, PhD, PT, Jonathan Myers, PhD, Leonard A. Kaminsky, PhD, Daniel E. Forman, MD, Gerson Cipriano, PhD, PT, Audrey Borghi-Silva, PhD, PT, Abraham Samuel Babu, MPT, Carl J. Lavie, MD  Mayo Clinic Proceedings  Volume 88, Issue 6, Pages 605-617 (June 2013) DOI: 10.1016/j.mayocp.2013.03.002 Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Forward-thinking model for comprehensive worksite wellness programs focusing on cardiovascular health. *A focused risk reduction program can be performed by worksites onsite (if expertise available), by partnering with external groups, or by a combination of both. CVD = cardiovascular disease. Mayo Clinic Proceedings 2013 88, 605-617DOI: (10.1016/j.mayocp.2013.03.002) Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Incentive-based model to support compliance with worksite health and wellness practices. Worksites qualify for incremental discounts (percentage premium reduction per health goal achieved) on their health insurance premiums. The major controllable health behaviors/cardiovascular disease risk factors are as follows: (1) smoke free: also qualifies if a current smoker and enrolled in a smoking cessation class; (2) hypertension: blood pressure less than 130/85 mm Hg and if medicated takes all prescribed medication; (3) hyperlipidemia: low-density lipoprotein cholesterol level less than 100 mg/dL, high-density lipoprotien cholesterol level greater than 50 mg/dL (to convert to mmol/L, multiply by 0.0259), and triglyceride level less than 150 mg/dL (to convert to mmol/L, multiply by 0.0113) and if medicated takes all prescribed medication; (4) diabetes: fasting blood glucose level less than 100 mg/dL (to convert to mmol/L, multiply by 0.0555), or hemoglobin A1c level less than 5.6%, and if medicated takes all prescribed medication; (5) physical activity: more than 150 min/wk of moderate (or higher) intensity (objectively measured initially and documented monthly); (6) obesity: body mass index (calculated as weight in kilograms divided by height in meters squared) less than 30 and waist less than 102 cm in men and less than 88 cm in women or enrolled in a weight loss program with 5% or more body weight loss and after weight loss program completion participates in a regular physical activity program; (7) psychological health: free of anxiety and depression or if medicated takes all prescribed medication; (8) risk factor free: also qualifies if participates in regular health coaching for continued management of any risk factors; and (9) preventive medical status: has an annual flu shot, has all immunizations up-to-date, and completes all age- and sex-specific screening evaluations (colonoscopy, mammography, etc). Mayo Clinic Proceedings 2013 88, 605-617DOI: (10.1016/j.mayocp.2013.03.002) Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions