Abstract

PurposeSeveral recent studies have suggested a ‘physical activity paradox’ whereby leisure-time physical activity benefits health, but occupational physical activity is harmful. However, other studies imply that occupational physical activity is beneficial. Using data from a nationally representative Italian sample, we investigate if the context, or domain, of physical activity matters for mortality and coronary heart disease (CHD) events.MethodsAmong 40,220 men and women aged 40–55 at baseline, we used Cox models to compare associations of occupational, domestic and leisure-time physical activity with risk of mortality and CHD events over a follow-up period of up to 14 years. We accounted for sociodemographic factors, smoking, body mass index (BMI), physical and mental health, and educational qualifications.ResultsOccupational physical activity was not significantly associated with risk of mortality or CHD events for women, or with CHD events for men. In crude models, risk of mortality was higher for men in the highest occupational activity group, compared to the lowest (HR 1.26, 95% CI 1.01, 1.57). This attenuated with adjustment for health-related behaviours, health, and education (HR 1.03, 95% CI 0.77, 1.38). In crude models, leisure-time physical activity was significantly associated with decreased mortality and CHD risk only for men. Domestic physical activity was not associated with either outcome for either gender.ConclusionIn a large sample of middle-aged Italian workers, we found limited evidence of harmful or beneficial effects of occupational physical activity on mortality or CHD events. However, confidence intervals were wide, and results consistent with a range of effects in both directions.

Highlights

  • The World Health Organization (WHO) guidelines on physical activity state that activity ‘at work, leisure, home or during transportation’ all count towards recommended weekly amounts (Bull et al 2020)

  • One of these supported the physical activity paradox for men (Mikkola et al 2019), while the other found that premature mortality was highest for men in the third occupational physical activity (OPA) quartile (Ervasti et al 2019)

  • We investigate the relationship of OPA, leisuretime physical activity (LTPA) and Domestic physical activity (DPA) with all-cause mortality and with coronary heart disease (CHD) events, using data from follow-up of two nationally representative Italian surveys from 1999 to 2000 and 2004 to 2005

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Summary

Introduction

The World Health Organization (WHO) guidelines on physical activity state that activity ‘at work, leisure, home or during transportation’ all count towards recommended weekly amounts (Bull et al 2020). Confounding by health-related behaviours such as diet and smoking, more prevalent in manual occupational social class groups (Windsor-Shellard et al 2020), where more intense OPA is likely to be common, may contribute to an apparent physical activity paradox (Shephard 2019). Studies of OPA and mortality based on administrative data are often unable to take smoking or BMI into account, including two recent Finnish studies One of these supported the physical activity paradox for men (Mikkola et al 2019), while the other found that premature mortality was highest for men in the third OPA quartile (Ervasti et al 2019). Both processes would be expected to bias negative health effects of OPA towards the null

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