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The physical activity paradox in cardiovascular disease

20 May 2021
Physical activity paradox in cardiovascular disease

Physical activity during leisure time is associated with a reduced risk of major adverse cardiovascular events (MACE) and all-cause mortality. In contrast, some research has suggested an increased risk of all-cause mortality in those with high levels of occupational physical activity.

Prof. Andreas Holtermann (National Research Centre for the Working Environment, Denmark) and his team aimed to further explore this association. They invited 256,761 individuals from the Copenhagen General Population Study to participate in their analysis. Of these, 104,046 (43%) accepted the invitation. All subjects underwent a baseline physical examination which provided information regarding height, weight, blood pressure and heart rate. Participants also provided information regarding both leisure and occupational physical activity, educational background, socioeconomic status and other health status indicators. Both leisure and occupational physical activity were categorized into one of four activity levels, ranging from sedentary to vigorous or heavy. Researchers compared the risk of MACE and all-cause mortality in those performing leisure time physical activity to those performing occupational physical activity.

After a median follow-up of 10 years, 7913 (7.6%) participants experienced MACE, and 9846 (9.5%) died. An increased risk of MACE and all-cause mortality was consistently noted in those participants with higher levels of occupational physical activity. Conversely, a decreased risk was consistently noted in participants with higher levels of leisure time physical activity. Furthermore, the group with the highest amount of leisure time physical activity and the lowest amount of occupational physical activity had the lowest risk of MACE and all-cause mortality. There was no interaction between leisure time physical activity and occupational physical activity with respect to risk of MACE (p=0.40) or all-cause mortality (p=0.31).

Researchers speculate that this paradox is due to the difference characteristics of leisure time physical activity as compared to occupational physical activity. Leisure activity tends to be of a higher intensity and shorter duration. Conversely, occupational activity tends to be of a lower intensity and longer duration, and frequently involves awkward positions or maneuvers. Given this paradox, physical activity guidelines should consider differences between occupational and leisure time physical activity when providing prescriptive advice.

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Author: Kelly Schoonderwoerd

Original article: Holtermann et al. Eur Heart J. (2021) 42: 1499-1511.

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