Desk potatoes: the importance of occupational physical activity on health

Leisure-time physical activity, occupational physical activity and the physical activity paradox in healthcare workers: A systematic overview of the literature

BACKGROUND

Physical activity positively influences cardiovascular health. Results from male-dominated physically active occupations suggest that a high level of occupational physical activity may be detrimental to cardiovascular health. This observation is referred to as the physical activity paradox. Whether this phenomenon can also be observed in female-dominated occupations remains unknown.

OBJECTIVE

We aimed to provide an overview of (1) leisure-time and occupational physical activity in healthcare workers. Therefore, we reviewed studies (2) to assess the relationship between the two physical activity domains and analyzed (3) their effects on cardiovascular health outcomes in relation to the paradox.

METHODS

Five databases (CINAHAL, PubMed, Scopus, Sportdiscus, Web of Science) were systematically searched. Both authors independently screened the titles, abstracts, and full texts and assessed the quality of the studies using the National Institutes of Health's quality assessment tool for observational cohort and cross-sectional studies. All studies that assessed leisure-time and occupational physical activity in healthcare workers were included. The two authors independently rated the risk of bias using the ROBINS-E tool. The body of evidence was evaluated using the GRADE approach.

RESULTS

The review included 17 studies that assessed the leisure-time and occupational physical activity of people working in healthcare, determined the relationship between the domains (n = 7) and/or examined their effects on the cardiovascular system (n = 5). Measurements for leisure-time and occupational physical activity varied between studies. Leisure-time physical activity typically ranged between low and high intensity, with a short duration (approx. 0.8-1.5 h). Occupational physical activity was typically performed at light to moderate intensity with a very long duration (approx. 0.5-3 h). Moreover, leisure-time and occupational physical activity were almost negatively related. The few studies investigating effects on cardiovascular parameters revealed a rather unfavorable effect of occupational physical activity, while leisure-time physical activity was beneficial. The study quality was rated as fair and the risk of bias was moderate to high. The body of evidence was low.

CONCLUSIONS

This review confirmed that leisure-time and occupational physical activity of healthcare workers are opposed in their duration and intensity. Moreover, leisure-time and occupational physical activity seem to be negatively related and should be analyzed according to their relation to each other in specific occupations. Furthermore, results support the relationship between the paradox and cardiovascular parameters.

REGISTRATION

Preregistered on PROSPERO (CRD42021254572). Date of registration on PROSPERO: 19 May 2021.

TWEETABLE ABSTRACT

Does occupational physical activity adversely affect the cardiovascular health of healthcare workers in comparison to leisure-time physical activity?

Body fat and muscle in relation to heart rate variability in young-to-middle age men: a cross sectional study

BACKGROUND

While obesity is recognisably associated with changes in heart rate variability (HRV), the association between skeletal muscle mass and HRV is less clear.

AIMS

In this cross sectional study, we analysed the association of body fat (four parameters) and muscle mass (five parameters) with indicators of HRV activity.

SUBJECTS AND METHODS

Assessment of body composition and HRV was performed in n = 180 young-to-middle age healthy men exposed to high occupational physical activity, using the multi-frequency bioelectrical impedance device and the PPG-StressFlow® HRV photoplethysmography device, respectively.

RESULTS

Mean values of parameters of fat tissue were above normal/reference values. Muscle tissue indicators were higher or within the reference ranges. Fat tissue parameters were significantly higher in participants with lower parasympathetic nervous system (PNS) indicators. Weight-adjusted skeletal muscle index (wSMI) was significantly lower in men with reduced PNS parameters. Fat tissue parameters were negatively correlated with PNS parameters, while wSMI was positively correlated with PNS parameters.

CONCLUSIONS

Participants with higher fat mass and lower muscle mass had poorer parasympathetic activity. Since mean values of HRV parameters indicated mild parasympathetic dominance, we conclude that physical activity and consequently good muscle mass potentially compensated for the negative interaction between fat tissue and HRV.

Occupational and leisure time physical inactivity and the risk of type II diabetes and hypertension among Mexican adults: A prospective cohort study

There is a lack of longitudinal data linking physical inactivity and chronic diseases among Mexicans. Objective. To examine the relationship between total, leisure and occupational moderate-to-vigorous physical activity (MVPA) and incidence of type II diabetes (T2D) and hypertension in the Mexico City Diabetes Study. Study design and population. A prospective cohort study was conducted from 1989 to 2009 among 2282 men and non-pregnant women residing in six low-income neighborhoods in Mexico City. Main outcome. Incidence of T2D and hypertension. Results. After controlling for confounders, <1 MET/min/week of MVPA during leisure time was associated with higher risk of hypertension (HR 1.29, CI 95% 1.01, 1.66) and T2D (HR 1.31 CI 95% 1.00, 1.74). In addition, accumulating <1 MET/min/week of occupational MVPA was associated with higher risk of hypertension (HR 1.47, CI 95% 1.13, 1.90). Conclusion. The absence of leisure and occupational MVPA was associated with an increased risk of hypertension. However, no associations were found between occupational MVPA and T2D.

A qualitative review of existing national and international occupational safety and health policies relating to occupational sedentary behaviour

Prolonged sedentary time is now recognised as an emergent ergonomics issue. We aimed to review current occupational safety and health policies relevant to occupational sedentary behaviour. An electronic search for documents was conducted on websites of ergonomics and occupational safety and health organisations from 10 countries and six international/pan-European agencies. Additionally, 43 informants (nine countries) were contacted and an international conference workshop held. 119 documents (e.g. legislation, guidelines, codes of practice) were identified. Using a qualitative synthesis, it was observed that many jurisdictions had legal frameworks establishing a duty of care for employers, designers/manufacturers/suppliers and employees. While no occupational authority policies focusing specifically on sedentary behaviour were found, relevant aspects of existing policies were identified. We highlight implications for ergonomics research and practice and recommend the development of policy to specifically address occupational sedentary behaviour and support workplace initiatives to assess and control the risks of this emergent hazard.

Alberta's Tomorrow Project: adherence to cancer prevention recommendations pertaining to diet, physical activity and body size

Objective

To explore cross-sectional adherence to cancer prevention recommendations by adults enrolled in a prospective cohort in Alberta, Canada.

Design

Questionnaire data were used to construct a composite cancer prevention adherence score for each participant, based on selected personal recommendations published by the World Cancer Research Fund/American Institute for Cancer Research (2007). Data were self-reported on health and lifestyle, past-year physical activity and past-year FFQ. The scores accounted for physical activity, dietary supplement use, body size, and intakes of alcohol, fruit, vegetables and red meat. Tobacco exposure was also included. Scores ranged from 0 (least adherent) to 7 (most adherent).

Setting

Alberta’s Tomorrow Project; a research platform based on a prospective cohort.

Subjects

Adult men and women (n 24 988) aged 35–69 years recruited by random digit dialling and enrolled in Alberta’s Tomorrow Project between 2001 and 2009.

Results

Of the cohort, 14 % achieved adherence scores ≥5 and 60 % had scores ≤3. Overall adherence scores were higher in women (mean (sd): 3·4 (1·1)) than in men (3·0 (1·2)). The extent of overall adherence was also associated with level of education, employment status, annual household income, personal history of chronic disease, family history of chronic disease and age.

Conclusions

Reported adherence to selected personal recommendations for cancer prevention was low in this cohort of adults. In the short to medium term, these results suggest that more work is required to identify behaviours to target with cancer prevention strategies at a population level. Future work will explore the associations between adherence scores and cancer risk in this cohort.

Time to challenge public health guidelines on physical activity

There is striking evidence in support of physical activity (PA) as a very strong factor in health promotion and disease prevention. Since the mid-1990s, public health guidelines on PA have established PA recommendations to promote health and prevent several non-communicable diseases (NCDs). However, it is not clear that there is universal agreement on the validity of all aspects of these recommendations. Indeed, a growing body of evidence has accumulated over the last 20 years showing that less than 150 min/week of moderate PA, i.e. the minimum PA level currently recommended, promotes health and prevents NCDs. Moreover, when determining whether someone achieves the minimum PA recommendations, the quantities of PA undertaken are added together regardless of what domain of PA they represent, i.e. leisure-time, occupational, transport or housework. However, while convincing evidence exists to show that leisure-time and transport PA are important factors for promoting health, the evidence for occupational PA and housework is mixed. Therefore, the purpose of this article is to discuss two major issues relating to public health guidelines on PA for adults and older adults: the minimum volumes of PA required and the importance of PA domains in health promotion. A proposal on how to tackle these issues and ultimately strengthen PA recommendations is also presented.

Associations between different types of physical activity and teachers' perceived mental, physical, and work-related health

BACKGROUND

The teaching profession is characterized by high levels of stress and physical complaints, which might be improved through regular participation in physical activity (PA). However, the effect of PA on mental and physical health is not always consistent and depends on the type of PA performed. The aim of this study was to examine the mental, physical, and work-related health of Flemish secondary school teachers and identify the impact on those health variables by demographic and teaching-related factors and various types of PA.

METHODS

This study included an online survey conducted across a representative sample of secondary school teachers (n = 1066, average age 40 years; 68 percent female). Level of PA and sitting time were estimated using the International Physical Activity Questionnaire, and perceived mental health and physical health were estimated using the Short Form 36. Work-related factors such as job satisfaction, occupational stress, and absenteeism were also collected. T-tests, ANOVAs, and linear regression analyses were performed.

RESULTS

Flemish secondary school teachers have poorer perceived mental and physical health than a general healthy population. This difference is particularly evident among female teachers, who reported lower perceived health, more occupational stress, and more absent days compared to their male colleagues. Higher participation in leisure-time PA was associated with a more positive perceived health. In contrast, higher levels of occupational PA and sitting time had a negative impact on perceived health. Total amount of PA, total amount of moderate-to-vigorous PA, transportation-related PA, and PA at home were not associated to teachers' perceived health.

CONCLUSION

Because secondary school teachers' levels of perceived health are low, they are an important target group for interventions aiming to improve health. Only leisure-time PA was associated with more positive perceived health. This finding may indicate that teachers performing more exercise during leisure time, or in a more autonomous way, may be more resistant to physical and mental health problems. Future research should verify whether promoting leisure-time PA among teachers has the potential to improve their mental and physical health, and counteract the negative associations between teachers' health and their occupational PA.

Comparing the risk associated with psychosocial work conditions and health behaviours on incident hypertension over a nine-year period in Ontario, Canada

OBJECTIVES

Hypertension is an increasingly important health concern in Canada. This paper examines the risks associated with psychosocial working conditions compared to health behaviours on the risk of hypertension over a 9-year period in Ontario, Canada.

METHODS

We used data from Ontario respondents to the 2000-01 Canadian Community Health Survey linked to the Ontario Health Information Plan database covering physician services and the Canadian Institute for Health Information database for hospital admissions. We focused on labour market participants aged 35 to 60, who had not been previously diagnosed with hypertension, were not self-employed, and were working more than 10 hours per week, more than 20 weeks in the previous 12 months (N = 6,611). Subjects were followed for a nine-year period to ascertain incidence of hypertension.

RESULTS

Low job control was associated with an increased risk of hypertension among men, but not among women. The population attributable fraction associated with low job control among males was 11.8% in our fully adjusted model. There was no consistent pattern of increased risk of hypertension across different levels of health behaviours.

CONCLUSION

Primary prevention efforts to reduce the incidence of hypertension predominantly target modifiable health behaviours. Evidence from this longitudinal cohort suggests that modifiable characteristics of the work environment should also be considered in the design of cardiovascular disease prevention programs, in particular for male labour market participants.

Farming activities and carrying and lifting: the Agricultural Health Study

BACKGROUND

Heavy carrying and lifting (HCL) is a common activity among farmers that may be related to health. The aim of this study was to examine HCL as a proxy for occupational physical activity (PA) among farm residents. The secondary objective was to evaluate PA based on HCL.

METHODS

Data from 21,296 farmers and 30,951 spouses in the Agricultural Health Study examined the relationship between HCL and farm activities and individual/farm characteristics. HCL was categorized as ≥ 1 or < 1 hours per day. The association between HCL and farm activities (15 for farmers; 16 for spouses) and individual/farm characteristics was examined using adjusted logistic regression. To evaluate PA, we created a PA activity index using metabolic equivalents for HCL, and compared PA weekly averages with national guidelines.

RESULTS

In adjusted results, most farm activities were significantly associated with HCL. Based on HCL, farmers had a median of 1.5 hours and spouses 0.5 hours of vigorous or muscle-strengthening PA per day. Most farmers (94%) and about 60% of spouses meet or exceed 2008 national guidelines for vigorous or muscle-strengthening PA.

CONCLUSION

Findings suggest the HCL measure may be useful as a PA metric in future studies of occupational PA among farm residents.

Occupation correlates of adults' participation in leisure-time physical activity: a systematic review

CONTEXT

The rapid changes to the labor force (e.g., advances in technology, overtime hours) have increased obesogenic behaviors (e.g., lack of physical activity, sedentariness on the job).

PURPOSE

The purpose of this review was to unite and appraise the existing research examining occupation correlates of adults' participation in leisure-time physical activity (LTPA) to establish direction for future research targeting habitual inactivity.

EVIDENCE ACQUISITION

Eligible studies were searched from January 2009 to July 2010 in English peer-reviewed journals. A total of 62 studies passed the inclusion criteria. Major findings were summarized based on common subtopics of occupation category/status, occupational physical activity (OPA), work hours, psychological work demands, and LTPA.

EVIDENCE SYNTHESIS

Included articles were published between 1984 and 2010, with sample sizes ranging from 158 to 203,120. Occupation factors correlated with LTPA, but the magnitude of the effect was difficult to determine because of heterogeneous measures. Occupation category/status was directly associated with LTPA, with white-collar/professionals showing the highest LTPA compared to blue-collar workers. When OPA was measured, a positive association with LTPA was found. Work hours appeared to have a negative threshold effect on LTPA. Some preliminary evidence found psychosocial work demands (e.g., job strain) to be negatively correlated with LTPA levels.

CONCLUSIONS

Convincing evidence supports the premise that those employed in occupations demanding long work hours and low OPA are at risk of inactivity. Existing research has focused heavily on cross-sectional data and study-created self-report measures. Longitudinal evaluations using robust research measures (e.g., accelerometry, National occupation classification tool) are a priority for future research.

Exercise-induced energy expenditure: implications for exercise prescription and obesity

OBJECTIVE

Walking is commonly recommended to help with weight management. We measured total energy expenditure (TEE) and its components to quantify the impact of increasing exercise-induced energy expenditure (ExEE) on other components of TEE.

METHODS

Thirteen obese women underwent an 8-week walking group intervention. TEE was quantified using doubly labeled water, ExEE was quantified using heart rate monitors, daily movement was assessed by accelerometry and resting metabolic rate was measured using indirect calorimetry.

RESULTS

Four of the 13 participants achieved the target of 1500kcalwk(-1) of ExEE and all achieved 1000kcalwk(-1). The average ExEE achieved by the group across the 8 weeks was 1434+/-237kcalwk(-1). Vigorous physical activity, as assessed by accelerometry, increased during the intervention by an average of 30min per day. Non-exercise activity thermogenesis (NEAT) decreased, on average, by 175kcald(-1) (-22%) from baseline to the intervention and baseline fitness was correlated with change in NEAT.

CONCLUSIONS

Potential alterations in non-exercise activity should be considered when exercise is prescribed. The provision of appropriate education on how to self-monitor daily activity levels may improve intervention outcomes in groups who are new to exercise.

PRACTICE IMPLICATIONS

Strategies to sustain incidental and light physical activity should be offered to help empower individuals as they develop and maintain healthy and long-lasting lifestyle habits.

Utility of the RT3 triaxial accelerometer in free living: an investigation of adherence and data loss

There is strong evidence for the protective effects of physical activity on chronic health problems. Activity monitors can objectively measure free living occupational and leisure time physical activity. Utility is an important consideration when determining the most appropriate monitor for specific populations and environments. Hours of activity data collected, the reasons for activity hours not being recorded, and how these two factors might change over time when using an activity monitor in free living are rarely reported. This study investigated user perceptions, adherence to minimal wear time and loss of data when using the RT3 activity monitor in 21 healthy adults, in a variety of occupations, over three (7 day) repeated weeks of measurement in free living. An activity diary verified each day of monitoring and a utility questionnaire explored participant perceptions on the usability of the RT3. The RT3 was worn for an average of 14 h daily with 90% of participants having complete data sets. In total 6535.8 and 6092.5h of activity data were collected from the activity diary and the RT3 respectively. An estimated 443.3h (6.7%) of activity data were not recorded by the RT3. Data loss was primarily due to battery malfunction (45.2%). Non-adherence to wear time accounted for 169.5h (38.2%) of data loss, of which 14 h were due to occupational factors. The RT3 demonstrates good utility for free living activity measurement, however, technical issues and strategies to manage participant adherence require consideration with longitudinal and repeated measures studies.

Are Canadians meeting the guidelines for moderate and vigorous leisure-time physical activity?

The purpose of this study was to determine the proportion of Canadian adults (aged 18-55 years) who met the guidelines for moderate and vigorous physical activity set out in Canada's Physical Activity Guide to Healthy Active Living. Leisure-time physical activity energy expenditure from moderate- and vigorous-intensity activities was calculated using data from the National Population Health Surveys (1994-1998) and the Canadian Community Health Surveys (2001-2007). The prevalence was estimated for no leisure-time physical activity, meeting only the moderate guideline, meeting both the moderate and vigorous guidelines, and meeting the guidelines through a combination of moderate and vigorous activities. Logistic regression was used to determine the odds of meeting the guidelines by various demographic characteristics. The prevalence of no activity did not change appreciably over time, ranging from 6.5% to 10%, depending on the survey year. Reporting of no activity was more prevalent among older adults, those in lower income groups, and those with a body mass index (BMI) > or =30 kg.m-2. Overall, 65% of adults met the guidelines for physical activity in 2007, which has increased from 54% in 1994-1995. Men, younger adults, those with a higher income, and those with a lower BMI more often met the guidelines. Among all subgroups, meeting the guidelines was most often accomplished through participation in moderate-intensity activities. These findings should be considered when designing and implementing public health interventions that promote participation in daily physical activity.

Estimating leisure-time physical activity energy expenditure in the Canadian population: a comparison of 2 methods

The purpose of this study was to determine the impact of 2 different calculation methods for total leisure-time physical activity energy expenditure (LTPAEE) and LTPAEE from different intensity activities on the classification of level of physical activity in the population. Nationally representative cross-sectional data from the Canadian Community Health Survey Cycle 4.1 (2007) were used for this study (N = 64 397). LTPAEE was calculated using a metabolic equivalent (MET) value of 4.0 for all activities in the “other activity” category for method 1 (currently employed by Statistics Canada) and using activity-specific MET values for method 2. The weighted prevalence and 95% confidence intervals of active (≥3  kcal·kg–1·day–1 (kkd)), moderately active (1.5–2.9 kkd), and inactive (<1.5 kkd) were determined for each method by demographic characteristics. The agreement between the 2 methods was assessed overall, and for light, moderate, and vigorous activities. There was no difference between methods in the proportion classified as active, moderately active, or inactive for any of the subgroups studied and there was no difference in the distribution or mean LTPAEE between methods. However, assessment of the agreement showed a large number of outliers and a tendency to underestimate LTPAEE from light and vigorous activities while overestimating LTPAEE from moderate activities at the individual level. The results of this study should be considered when performing inferential statistics on the relationship between physical activity and health outcomes.