Cardiovascular disease (CVD) is a non-communicable disease that affects the function of the heart. It is the leading cause of death in men and women, killing 1 in 5 people every year (CDC, 2023). Some types of CVD include coronary heart disease, stroke, arrhythmia, and heart valve problems. Coronary artery disease (CAD) is the most prominent type of CVD, where 1 in 20 adults, aged 20 years or older, are recognized with CAD every year (CDC, 2023). CVD in general affects men and women differently. Men have a higher incidence of CVD, but women are more prone to early death after diagnosis. Women's risk factors can differ from the traditional ones, which can lead to more deaths as they have not been studied in depth (Maas & Appelman, 2010).

Physically inactive individuals have a higher risk of CVD (CDC, 2023). Inactivity diminishes the amount of endothelial cells in your arteries and thus their production of nitric oxide (Exercise and Your Arteries, 2006). A body wants more nitric oxide because it prevents white blood cells and platelets from latching onto the side of the arterial lining. This keeps the arteries free from blockages that would stop blood flow throughout the body (Physical Inactivity, 2023). The blockage of oxygenated blood flow to your brain can cause a stroke. Physical inactiveness is deemed as being sedentary for a long period of time, specifically engaging in less than 150 minutes of moderate physical activity per week (Physical Inactivity, 2023). Achieving an active lifestyle, more than 150 minutes of moderate physical activity per week, can lower the risk of CVD. This level of weekly exercise could prevent 1 in 15 cases of heart disease (CDC, 2020).

Being physically active also benefits communities from an economic and safety perspective. Physical activity encourages a walkable community, which demands a physically safe infrastructure. Investments made in sidewalks, bike paths, crosswalks, and community paths would allow for a multimodal transport system to operate safely. Pedestrians, bicyclists, and drivers would be able to operate together, safely. Individuals in a community that has such benefits tend to take less sick days (CDC, 2020). Besides physical inactivity, other risk factors that increase CVD include smoking, obesity, and diabetes.

A major social determinant of health may be a person's workplace. An individual's job and time commitment significantly impacts their daily activities. Employment provides health and societal benefits to an individual in the sense of healthcare and economic incentives. Nevertheless, there are also risks associated with the workplace environment, such as exposure to physical, biological, and physiological hazards. (Armenti et al., 2023) Construction workers are at risk for health problems by being exposed to the daily environmental and physical aspects of the job. Investment bankers are exposed to the sedentary state of their work environment. Within a workplace, excessive or non-traditional hours of work have been documented with higher rates of incidence, prevalence, and mortality (Kasl, 1996). The CDC states that 55 hours of work per week or more is linked to an increase in having CVD (Cardiovascular Disease and Occupational Factors | NIOSH | CDC, 2023). Not having control over the state of your working environment and other factors can lead to different health outcomes, cardiovascular disease included (Wilkinson & Marmot, 2003).

The role of an investment banker is to advise companies on financial growth strategies to raise capital, secure debt financing, and/or assist with mergers and acquisitions. Their work most often takes place in offices and cubicles, where they sit at desks for long periods of time analyzing data and speaking with clients, leading to sedentary behavior.

Key characteristics of investment bankers are that they are determined, intelligent and competitive (Logue & Lindvall, 1974). Their determination to complete projects leads to 80 to 100 hour work weeks, encouraging sedentary behavior (Baseren, 2020). This is immediately flagged as a higher risk of CVD, as it is more than the CDC rate of 55 hours of work per week (Cardiovascular Disease and Occupational Factors | NIOSH | CDC, 2023). Investment banking jobs consist of working on spreadsheets, researching data, taking phone calls, and answering emails throughout the day. The long hours do not allow for other activities, such as engaging in physical activities outside of the office, social gatherings, or down time. The long hours and sedentary state of this job become mentally and physically draining (Alvesson & Robertson, 2016).

An upkeep of intelligence is required to continue to perform well in this job that has many technical nuances. Physical activity increases these skills (Exercise Can Boost Your Memory and Thinking Skills, 2023). Physically active individuals tend to take less sick days, which will increase work productivity (CDC, 2020).

The important question to explore and create a solution for is how to continually increase the opportunity to be physically active throughout one’s career.

To increase physical activity in investment banks, an intervention on the community level, would be to create a competitive game that would be played among employees of various

teams. Investment bankers are competitive in nature, hence a game with incentives would increase the likelihood of players' attention. The game would increase exercise throughout the work day while working towards gaining an incentive.

The game would be set for a certain duration. There would be multiple teams, all competing to win a prize. Such incentives would include a gym membership, a Whole Foods gift card, or a bonus. During the designated time period, participants would have to complete a series of challenges, all incorporating physical activity into their work day.

Some examples of the activities performed could be scheduling a work meeting while going for a walk with a coworker. This would increase physical activity, accomplishing daily tasks and gaining points towards receiving the prize. In the office, using a standing desk for an hour or switching locations before a call would count as a challenge. Another option could be logging a certain amount of time spent at the gym, with proof. With this, the specific company could partner with a brand - FItBit or Apple Watch - to use a device to track steps or minutes of physical activity. This would act as a preventative measure against cheating.

After the end of the competition, the results from each team would be tallied to show the winning team. Incentives would then be given which would continue to stimulate physical activity.

There are limitations that come with this intervention due to the nature of investment banks. There are limited ways to reduce the hours of work, due to the current nature of the job. Because of this, it is hard to reduce the risk in terms of CDC work hour recommendation. There may be unexpected calls or unexpected hours where an employee is pulled out of a challenge. There would be rules in place to not penalize the employee, as companies would put work as first priority. Offices may also not have all equipment outlined above, such as standing desks and

wearable technology, that could be used to increase activity. For incentives, the limitations would be around what the company has the capacity to offer. If they are not willing to spend large amounts of money, a small gift card could be the prize instead of an expensive gym membership. Because of this, the intervention may have to be tailored specifically to different banks, but would have the same overall idea. This would thus decrease the potential of cardiovascular disease in employees working in investment banks due to the increase of physical activity.

The CDC has given guidelines to employers around the integration of exercise in the workplace. The CDC recommends that employers provide access to on-site walking paths and gym access, along with discounts for active commuting (CDC, 2023). Investment banks incorporating this way of incentivising their employees would align with the CDC recommendations.

Cardiovascular disease is the leading cause of death in the United States. Looking at investment bankers' physical activity, they are at risk for CVD. By implementing a competitive game in the workplace, employees will participate in hopes of winning a prize while increasing their daily exercise minutes, overall lowering their risk of CVD. Leveraging the CDC recommendations around ways employers can help their employees, physical activity can begin to be implemented into investment banks.

References

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Armenti, K., Sweeney, M. H., Lingwall, C., & Yang, L. (2023). Work: A Social Determinant of Health Worth Capturing. International Journal of Environmental Research and Public Health, 20(2), 1199. https://doi.org/10.3390/ijerph20021199

Baseren, Z. C. (2020, August 11). Working Time Regime and Use of Technology: A Case Study on Investment Bankers.

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Logue, D. E., & Lindvall, J. R. (1974). The Behavior of Investment Bankers: An Econometric Investigation. The Journal of Finance, 29(1), 203–215. https://doi.org/10.2307/2978226 Maas, A. H. E. M., & Appelman, Y. E. A. (2010). Gender differences in coronary heart disease.

Netherlands Heart Journal, 18(12), 598–602.New York University (NYU)—Profile, Rankings and Data | US News Best Colleges. (2023). Retrieved December 20, 2023, from https://www.usnews.com/best-colleges/nyu-2785 Physical inactivity. (2023). British Heart Foundation. Retrieved December 20, 2023, from https://www.bhf.org.uk/informationsupport/risk-factors/physical-inactivity

Wilkinson, R. G., & Marmot, M. (2003). Social Determinants of Health: The Solid Facts. World Health Organization.