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The Physical Activity Paradox: Highly physical work increases early death risk

DiggingMen with highly physical jobs appear to have a significantly higher risk of early death compared with men who have largely inactive jobs, suggests a Dutch systematic review. There is evidence of a physical activity paradox, with beneficial health outcomes associated with leisure time physical activity, but detrimental health outcomes for people engaging in high level occupational physical activity.

Physical activity is generally considered to be an important preventive behaviour for non-communicable diseases while physical inactivity has been estimated to account for around 7% of the global health burden.

Accordingly, international guidelines encourage people to engage in up to 30 minutes of at least moderate intensity physical activity daily, but such guidelines do not distinguish between occupational, leisure time and transportation related activity.

Recent research has suggested that there is evidence of a physical activity paradox, with beneficial health outcomes associated with leisure time physical activity, but detrimental health outcomes for people engaging in high level occupational physical activity.

An international team of researchers led by Dr Pieter Coenen from the VU University Medical Centre in Amsterdam, The Netherlands, decided to carry out a systematic review of evidence regarding the association between occupational physical activity and all-cause mortality.

They searched existing studies that had assessed the association of occupational physical activity with all-cause mortality and identified 17 studies from which pooled data on 193,696 participants were used in a meta-analysis.

The various studies collectively covered the period from 1960 to 2010.

This analysis showed that men with high level occupational physical activity had an 18% higher risk of early death compared with men engaging in low level occupational physical activity. This was still the case even when levels of leisure time physical activity were taken into account.

No such association was observed among women. Indeed, the opposite seemed to be the case for females.

The authors described the new study as the first to find evidence consistent with the physical activity paradox in this systematic review with meta-analysis of studies with a large number of participants.

The researchers concluded: “The results of this review indicate detrimental health consequences associated with high level occupational physical activity in men, even when adjusting for relevant factors (such as leisure time physical activity).

“This evidence indicates that physical activity guidelines should differentiate between occupational and leisure time physical activity.”

Abstract
Objective: Recent evidence suggests the existence of a physical activity paradox, with beneficial health outcomes associated with leisure time physical activity, but detrimental health outcomes for those engaging in high level occupational physical activity. This is the first quantitative systematic review of evidence regarding the association between occupational physical activity and all-cause mortality.
Design: Systematic review with meta-analysis.
Data source: A literature search was performed in electronic databases PubMed, Embase, CINAHL, PsycINFO and Cochrane.
Eligibility criteria for selecting studies: We screened for peer reviewed articles from prospective studies assessing the association of occupational physical activity with all-cause mortality. A meta-analysis assessed the association of high (compared with low) level occupational physical activity with all-cause mortality, estimating pooled hazard ratios (HR) (with 95% CI).
Results: 2490 unique articles were screened and 33 (from 26 studies) were included. Data from 17 studies (with 193 696 participants) were used in a meta-analysis, showing that men with high level occupational physical activity had an 18% increased risk of early mortality compared with those engaging in low level occupational physical activity (HR 1.18, 95% CI 1.05 to 1.34). No such association was observed among women, for whom instead a tendency for an inverse association was found (HR 0.90, 95% CI 0.80 to 1.01).
Conclusions: The results of this review indicate detrimental health consequences associated with high level occupational physical activity in men, even when adjusting for relevant factors (such as leisure time physical activity). These findings suggest that research and physical activity guidelines may differentiate between occupational and leisure time physical activity.

Authors
Pieter Coenen, Maaike A Huysmans, Andreas Holtermann, Niklas Krause, Willem van Mechelen, Leon M Straker, Allard J van der Beek

[link url="https://www.bmj.com/company/newsroom/high-levels-of-workplace-exercise-linked-to-early-death/"]BMJ material[/link]
[link url="http://bjsm.bmj.com/content/early/2018/04/17/bjsports-2017-098540"]British Journal of Sports Medicine abstract[/link]

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