A 24-h assessment of physical activity and cardio-respiratory fitness among female hospital cleaners: a pilot study

Associations between occupational physical activity and left ventricular structure and function over 25 years in CARDIA

AIMS

Leisure time physical activity (LTPA) confers cardiovascular health benefits, while occupational physical activity (OPA) may have paradoxically negative health associations. This study tested the explanatory hypothesis that unfavourable cardiac remodelling may result from chronic OPA-induced cardiovascular strain.

METHODS AND RESULTS

Longitudinal associations of OPA and left ventricular (LV) structure and function were examined in 1462 participants {50.0% female, 56.4% White, aged 30.4 ± 3.4 years at baseline [Year 5 exam (1990-91)]} from the Coronary Artery Risk Development in Young Adults study. Left ventricular structure and function were measured as LV mass (LVMi), end-diastolic volume (LVEDVi), end-systolic volume (LVESVi), ejection fraction (LVEF), stroke volume (LVSVi), and e/a-wave ratio (EA ratio) via echocardiography at baseline and 25 years later. Occupational physical activity was reported at seven exams during the study period as months/year with 'vigorous job activities such as lifting, carrying, or digging' for ≥5 h/week. The 25-year OPA patterns were categorized into three trajectories: no OPA (n = 770), medium OPA (n = 410), and high OPA (n = 282). Linear regression estimated associations between OPA trajectories and echocardiogram variables at follow-up after adjusting for baseline values, individual demographic/health characteristics, and LTPA. Twenty-five-year OPA exposure was not significantly associated with LVMi, LVEDVi, LVSVi, or EA ratio (P > 0.05). However, higher LVESVi (β = 1.84, P < 0.05) and lower LVEF (β = -1.94, P < 0.05) were observed at follow-up among those in the high- vs. no-OPA trajectories.

CONCLUSION

The paradoxically adverse association of OPA with cardiovascular health was partially supported by null or adverse associations between high OPA and echocardiogram outcomes. Confirmation is needed using more precise OPA measures.

Revisiting the physical activity paradox: the role of cardiorespiratory fitness in workers with high aerobic demands

In contrast to leisure time physical activity, occupational physical activity may have adverse health effects-a phenomenon known as the "Physical activity paradox". Characteristics such as long duration, low intensity, static and restricted movement, body position and insufficient recovery are possible explanations as to why physical activity in the occupational context may "wear one out" rather than provide health benefits. We emphasise the role of low cardiorespiratory fitness as a potential contributor to the physical activity paradox, and present data suggesting that only 25% to 50% of Swedish workers in occupations with higher aerobic demands may have "sufficient" cardiorespiratory fitness to maintain good health during their employment. More research is needed to fully understand the complexity of the role of other confounding factors when examining the relationship between cardiorespiratory fitness and occupational workload. However, we believe that there is an increasing need for general awareness amongst Swedish authorities, employees and employers of the potential health consequences of low levels of cardiorespiratory fitness, especially among workers with high occupational workloads. Importantly, when developing interventions targeting the working situation and/or cardiorespiratory fitness levels among workers, researchers should actively involve the relevant population in the design of the study in order to maximize the effect of the interventions on health outcomes.

Physiological responses, trunk posture, and work pace in commercial building cleaning in Washington State: An observational field study

INTRODUCTION

This study aimed to investigate whether work pace is a critical indicator for predicting a janitor's risk of work-related musculoskeletal disorders (WMSDs).

METHOD

Field measurements were obtained from commercial building janitors as well as the determination of work pace. Physiological responses collected were heart rate, energy expenditure (calories), activity level (METs), steps, trunk posture. Data were obtained using direct measurements, along with a time study, which was performed by shadowing 13 janitors in Washington State. The measured values were summarized descriptively, and five of the most common janitorial tasks were compared. The relationships between work pace and the physiological response variables were determined by calculating the Pearson product-moment correlation coefficients.

RESULTS

The highest average percent heart rate reserve (47.4%) was reported during restroom cleaning, while the highest activity and energy expenditure levels (3.6 METs and 217.1 calories/h) were reported for mopping. The top 90% of trunk flexion angles and the highest percentage of time in trunk flexion from 20° to 60° were recorded during restroom cleaning. Restroom cleaning showed the highest correlation between all the physiological response variables and work pace. In most of the tasks, a high work pace may have increased the degree and duration of severe trunk flexion.

CONCLUSION

Overall, when several tasks were considered, the extent of physiological responses, trunk joint angles, and exposure time to awkward postures tended to increase with an increase in work pace.

PRACTICAL APPLICATIONS

This study showed the feasibility of using the work pace measured from time studies as a predictive indicator of WMSDs risks. Using this information, managers may compose a schedule that can minimize WMSDs risks while considering actual work pace deviations that may impact a janitor's ability to complete assigned tasks properly within a shift.

Re: Cillekens B, Huysmans MA, Holtermann A, van Mechelen W, Straker L, Krause N, van der Beek AJ, Coenen P. Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants. Scand J Work Environ Health. 2022;48(2):86-98. doi:10.5271/sjweh.3993

Objectives

Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality.

Methods

A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality.

Results

We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.84–1.12] and females (HR 0.97, 95% CI 0.82–1.15). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 9% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.09, 95% CI 0.82–1.43).

Conclusions

While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.

Intensity of occupational physical activity in blue-collar workers: do self-reported rating and device-worn measurements agree?

PURPOSE

High intensity occupational physical activity (OPA) seem to aggravate health and increase risk of sick leave and early retirement. Most intensity of OPA monitoring has been self-reported, e.g. by rating of perceived exertion (RPE). However, no studies have investigated the precision and risk of bias in RPE reporting during free-living OPA. This study investigated the agreement between OPA intensity in percentage of the heart rate reserve (%HRR) estimated from RPE and device-measured heart rate (HR), and potential bias factors on this agreement.

METHODS

The CR10 scale measured RPE at work. The Actiheart monitor measured HR during 24-h a day for 2-4 days. Both RPE and device-worn HR were converted to %HRR. The difference between both %HRR and their limits of agreement was determined in a Bland Altman plot. To detect bias factors, the difference between both %HRR was regressed on age, sex, cardiorespiratory fitness, occupational lifting, medication, consequences of musculoskeletal disorders and the interactions between these factors with device-work %HRR.

RESULTS

Six hundred and twenty-three participants were included in the analysis. Mean difference between RPE-based and device-worn %HRR was 54.6% (SD 19.5). The limits of agreement were wide (11.6-90.1%HRR). Age (0.48%HRR, 95% CI 0.18-0.79) occupational lifting (9.84%HRR, 95% CI 3.85-15.83) and cardiorespiratory fitness (0.41%HRR, 95% CI 0.03-0.79) significantly biased the agreement between the estimations of OPA intensity.

CONCLUSION

RPE overestimated OPA intensity, and was biased by several factors. Device-worn %HRR should be preferred when evaluating OPA intensity among workers with physically demanding jobs.

An Exploratory Study on the Physical Activity Health Paradox-Musculoskeletal Pain and Cardiovascular Load during Work and Leisure in Construction and Healthcare Workers

Using a novel approach, this exploratory study investigated whether the physical activity (PA) paradox extends to cardiovascular load and musculoskeletal pain. At baseline, 1–2 days of 24 h heart rate was assessed in 72 workers from construction and healthcare. Workers then reported pain intensity in 9 body regions (scale 0–3) every 6 months for two years. The 2 year average of musculoskeletal pain (sum of 9 pain scores; scale 0–27) was regressed on time spent during work and leisure above three thresholds of percentage heart rate reserve (%HRR), i.e., ≥20 %HRR, ≥30 %HRR, and ≥40 %HRR, using a novel ilr structure in compositional data analysis. Analyses were stratified for several important variables. Workers spending more time in physical activity at work had higher pain, while workers with more time in physical activity during leisure had less pain (i.e., the PA paradox), but none of the associations were statistically significant. Higher aerobic capacity and lower body mass index lowered the pain score among those with higher physical activity at work. This exploratory study suggests that the PA paradox may apply to musculoskeletal pain and future studies with larger sample sizes and additional exposure analyses are needed to explain why this occurs.

Cardiovascular responses to physical activity during work and leisure

OBJECTIVES

Recent evidence suggests that occupational physical activity (OPA) is associated with adverse cardiovascular health, whereas leisure time physical activity is protective. This study explored explanatory physiological mechanisms.

METHODS

Nineteen males (68% white, age=46.6±7.9 years, body mass index=27.9±5.1 kg/m²) with high self-reported OPA wore activity (ActiGraph and activPAL) and heart rate (HR) monitors for 7 days and an ambulatory blood pressure (BP) monitor on one workday and one non-workday. Mixed effects models compared cardiovascular variables (24-hour, nocturnal, waking and non-work time HR and BP) and nocturnal HR variability (HRV) on workdays versus non-workdays. Additional models examined associations of daily activity (steps, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA)) with cardiovascular variables. Workday by daily activity interactions were examined.

RESULTS

24-hour and waking HR and diastolic BP as well as non-work diastolic BP were significantly higher on workdays versus non-workdays (p<0.05 for all). However, no difference in systolic BP or nocturnal HR or BP was observed between work and non-workdays (p>0.05 for all). Low-frequency and high-frequency power indices of nocturnal HRV were lower on workdays (p<0.05 for both). Daily steps and LPA were positively associated with 24-hour and waking HR on work and non-workdays. Significant interactions suggested MVPA increases HR and lowers nocturnal HRV during workdays, with the opposite effect on non-workdays.

CONCLUSIONS

Cardiovascular load was higher on workdays versus non-workdays with no compensatory hypotensive response following workdays. Daily MVPA may differentially affect ambulatory cardiovascular load and nocturnal HRV on workdays versus non-workdays, supporting the physical activity health paradox hypothesis.

The effect of leisure time physical activity and sedentary behaviour on the health of workers with different occupational physical activity demands: a systematic review

BACKGROUND

Although it is generally accepted that physical activity reduces the risk for chronic non-communicable disease and mortality, accumulating evidence suggests that occupational physical activity (OPA) may not confer the same health benefits as leisure time physical activity (LTPA). It is also unclear if workers in high OPA jobs benefit from LTPA the same way as those in sedentary jobs. Our objective was to determine whether LTPA and leisure time sedentary behaviour (LTSB) confer the same health effects across occupations with different levels of OPA.

METHODS

Searches were run in Medline, Embase, PsycINFO, ProQuest Public Health and Scopus from inception to June 9, 2020. Prospective or experimental studies which examined the effects of LTPA or LTSB on all-cause and cardiovascular mortality and cardiovascular disease, musculoskeletal pain, diabetes, metabolic syndrome, arrhythmias and depression among adult workers grouped by OPA (low OPA/sitters, standers, moderate OPA/intermittent movers, high OPA/heavy labourers) were eligible. Results were synthesized using narrative syntheses and harvest plots, and certainty of evidence assessed with GRADE.

RESULTS

The review includes 38 papers. Across all outcomes, except cardiovascular mortality, metabolic syndrome and atrial fibrillation, greater LTPA was consistently protective among low OPA, but conferred less protection among moderate and high OPA. For cardiovascular mortality and metabolic syndrome, higher levels of LTPA were generally associated with similar risk reductions among all OPA groups. Few studies examined effects in standers and none examined effects of LTSB across OPA groups.

CONCLUSIONS

Evidence suggests that LTPA is beneficial for all workers, but with larger risk reductions among those with low compared to high OPA jobs. This suggests that, in our attempts to improve the health of workers through LTPA, tailored interventions for different occupational groups may be required. More high-quality studies are needed to establish recommended levels of LTPA/LTSB for different OPA groups.

PROTOCOL REGISTRATION

PROSPERO # CRD42020191708 .

Development and Implementation of 'Just Right' Physical Behavior in Industrial Work Based on the Goldilocks Work Principle-A Feasibility Study

The Goldilocks Work Principle expresses that productive work should be redesigned to comprise physical behaviors of different intensities in a composition promoting workers' health and fitness. This study is the first to assess the feasibility of redesigning work in an industrial setting according to the Goldilocks Work Principle. We recruited workers (n = 20) from a brewery in Denmark, and we conducted a participatory 16-week intervention including a workshop and two consultations. The workshop aimed to support the workers in modifying their work, while the consultations assisted the eventual implementation. Feasibility was evaluated as per three aspects: (1) developing modifications of work, (2) implementing these modifications, and (3) changing physical behavior and self-reported fatigue, pain and energy. The three aspects were addressed through records completed by the workers, measurements of workers' physical behavior and intensity during 'control' workdays (i.e., usual work) and 'intervention' workdays (i.e., modified work), and self-reported fatigue, pain and energy level following both types of workday. Five modifications to work were developed, and three of these five modifications were implemented. To some extent, physical behavior and intensity changed as intended during 'intervention' workdays compared to 'control' workdays. Workers were also less fatigued, had less pain, and had more energy after 'intervention' workdays. These results suggest that it is feasible to develop and implement modified work based on the Goldilocks Work Principle among industrial workers. However, we also identified several barriers to the implementation of such modifications.

The Relation between Domain-Specific Physical Behaviour and Cardiorespiratory Fitness: A Cross-Sectional Compositional Data Analysis on the Physical Activity Health Paradox Using Accelerometer-Assessed Data

In contrast to leisure time physical activity (LTPA), occupational physical activity (OPA) does not have similar beneficial health effects. These differential health effects might be explained by dissimilar effects of LTPA and OPA on cardiorespiratory fitness (CRF). This study investigated cross-sectional associations between different physical behaviours during both work and leisure time and CRF by using a Compositional Data Analysis approach. Physical behaviours were assessed by two accelerometers among 309 workers with various manual jobs. During work time, more sedentary behaviour (SB) was associated with higher CRF when compared relatively to time spent on other work behaviours, while more SB during leisure time was associated with lower CRF when compared to other leisure time behaviours. Reallocating more time to moderate-to-vigorous physical activity (MVPA) from the other behaviours within leisure time was positively associated with CRF, which was not the case for MVPA during work. The results of our study are in line with the physical activity health paradox and we call for further study on the interaction between LTPA and OPA by implementing device-worn measures in a longitudinal design. Our results highlight the need for recommendations to take into account the different effects of OPA and LTPA on CRF.

Can Childcare Work Be Designed to Promote High Intensity Physical Activity for Improved Fitness and Health? A Proof of Concept Study of the Goldilocks Principle

Childcare workers are reported to have high variation in physical activity during work hours, but also to sit for about half of the workday and have almost no high intensity physical activity (HIPA). No study has investigated if their work can be re-designed to introduce HIPA, thus promoting fitness and health according to the Goldilocks principle. This study investigated the feasibility of designing pedagogical games (‘Goldilocks-games’) intended to lead to more HIPA. Heart rate was measured in nineteen childcare workers during Goldilocks-games, and compared to measurements during a regular workday. Worker perceptions of feasibility, and researcher observations of contextual factors were also collected. The Goldilocks-games (33 min) elicited significantly more HIPA (18/33 min) compared to the most active period of equal length on a regular workday (0.5/33 min). Seventy-four-percent of the childcare workers reported that it was feasible to integrate the Goldilocks-games pedagogically, and seventy-two-percent could see themselves using them. Thus, we found it possible to re-design a work task in childcare according to the Goldilocks principle so that it leads to substantial time with HIPA. The sustainability of Goldilocks-games in childcare, and their effectiveness in improving fitness and health among childcare workers, needs to be tested in further studies.

Factors associated with musculoskeletal symptoms and heart rate variability among cleaners - cross-sectional study

BACKGROUND

The professionals who perform cleaning activity constitute a major economic sector in Brazil. Cleaners may develop health problems related to the musculoskeletal and cardiovascular systems. It is necessary to understand the working and health conditions of cleaners in Brazil. Thus, the aim of this study was to identify factors associated with musculoskeletal symptoms and heart rate variability (HRV) among cleaners.

METHODS

A cross-sectional study conducted at a public higher education institution with 45 outsourced cleaners following approval from the institutional ethics committee. The participants answered a questionnaire addressing sociodemographic, occupational and health data, the Nordic Musculoskeletal Questionnaire, the Physical Activity Questionnaire (work and leisure) and the short version of the Copenhagen Psychosocial Questionnaire. Clinical data (height, body mass, waist-to-hip ratio and blood pressure) and heart rate variability (HRV) were also collected. Logistic and linear regression models were created to identify factors associated with symptoms and HRV.

RESULTS

The sample consisted of women (100%) predominantly older than 50 years of age (44%), without a conjugal life (64%), with three or more children (59%), low educational level (58%) and who worked less than 12 months at the company (87%). Systemic arterial hypertension (23%) was the most reported health problem. The highest frequency of musculoskeletal symptoms was identified in the lower limbs (ankles/feet: 31% in the previous 12 months and 24% in the previous 7 days; knees: 31% in the previous 12 months and 20% in the previous 7 days). Moreover, the workers reported not practicing physical activity during leisure time (84%). Psychosocial aspects indicated health risks for the dimensions "influence at work" (74%), "burnout" (59%) and "stress" (52%). Associations were found between ankle/foot symptoms and body mass index, shoulder symptoms and predictability, and knee symptoms and self-rated health and burnout. HRV indices were associated with age.

CONCLUSIONS

This study outlined the profile of female cleaners and identified risk factors. The workers exhibited musculoskeletal symptoms, which were associated with the body mass index and some psychosocial factors. HRV indices were associated with age. Thus, health promotion and prevention measures should be taken to benefit this population of workers.

Domain-specific physical activity patterns and cardiorespiratory fitness among the working population: Findings from the cross-sectional German Health Interview and Examination Survey

OBJECTIVES

This study aimed to investigate associations between occupational physical activity patterns (physical work demands linked to job title) and leisure time physical activity (assessed by questionnaire) with cardiorespiratory fitness (assessed by exercise test) among men and women in the German working population.

DESIGN

Population-based cross-sectional study.

SETTING

Two-stage cluster-randomised general population sample selected from population registries of 180 nationally distributed sample points. Information was collected from 2008 to 2011.

PARTICIPANTS

1296 women and 1199 men aged 18-64 from the resident working population.

OUTCOME MEASURE

Estimated low maximal oxygen consumption ([Formula: see text]), defined as first and second sex-specific quintile, assessed by a standardised, submaximal cycle ergometer test.

RESULTS

Low estimated [Formula: see text] was strongly linked to low leisure time physical activity, but not occupational physical activity. The association of domain-specific physical activity patterns with low [Formula: see text] varied by sex: women doing no leisure time physical activity with high occupational physical activity levels were more likely to have low [Formula: see text] (OR 6.54; 95% CI 2.98 to 14.3) compared with women with ≥2 hours of leisure time physical activity and high occupational physical activity. Men with no leisure time physical activity and low occupational physical activity had the highest odds of low [Formula: see text] (OR 4.37; 95% CI 2.02 to 9.47).

CONCLUSION

There was a strong association between patterns of leisure time and occupational physical activity and cardiorespiratory fitness within the adult working population in Germany. Women doing no leisure time physical activity were likely to have poor cardiorespiratory fitness, especially if they worked in physically demanding jobs. However, further investigation is needed to understand the relationships between activity and fitness in different domains. Current guidelines do not distinguish between activity during work and leisure time, so specifying leisure time recommendations by occupational physical activity level should be considered.

Physical performances show conflicting associations in aged manual workers

Ageing is associated with a decrease in physical performance implying that aged manual workers may be unable to match the physical requirements of their jobs. In this cross-sectional study, 96 male manual workers aged 51–72 years were recruited. Outcomes included handgrip strength (HGS), fat-free mass (FFM), fat percentage, cardiorespiratory fitness (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{{\rm{V}}}$$\end{document}V˙O₂max), forced vital capacity (FVC), forced expiratory volume after 1 s (FEV₁), spinal flexibility, sit-to-stand test performance and static balance. Covariates included height, smoking habits, leisure-time physical activity and systemic inflammation from blood samples. Outcomes were also compared with general populations. Age was negatively related to FFM and FEV₁, whereas static balance (velocity of displacement) was positively associated with age. Greater HGS, but poorer \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{{\rm{V}}}$$\end{document}V˙O₂max and FEV₁/FEV ratio were found compared with general populations. Age was negatively related with physical performances although a large part of the variance in performance could be explained by factors other than age such as smoking and systemic inflammation. The manual workers had greater muscle strength but had poorer cardiorespiratory fitness and lung function when compared with general populations. Specific health interventions targeting specifically cardiorespiratory fitness, lung function, and balance may be needed to maintain physical performances among manual workers.

Movement behavior profiles and obesity: a latent profile analysis of 24-h time-use composition among Danish workers

BACKGROUND/OBJECTIVES

An element of obesity prevention is increasing total physical activity energy expenditure. However, this approach does not incorporate the balance of various movement behaviors-physical activity, sedentary behaviors and sleep-across domains of the day. We aimed to identify time-use profiles over work and leisure, termed 'movement behavior profiles' and to investigate their association with obesity.

SUBJECTS/METHODS

Eight-hundred-and-seven workers completed (a) thigh accelerometry and diaries to determine their 24-h composition of behaviors (sedentary and standing, light physical activity and moderate-to-vigorous physical activity at work and leisure, and time in bed) and (b) obesity measurements. Movement behavior profiles were determined using latent profile analyses of isometric log-ratios of the 24-h composition, and labeled according to animal movement behavior traits. Linear models were applied to determine the association between profiles and obesity.

RESULTS

Four profiles were identified, labeled as "Chimpanzees" (n = 226), "Lions" (n = 179), "Ants" (n = 244), and "Koalas" (n = 158). "Chimpanzees" work time was evenly distributed between behaviors while their leisure time was predominantly active. Compared to Chimpanzees, "Lions" were more active at work and sedentary during leisure and spent more time in bed; "Ants" were more active at work and during leisure; "Koalas" were more sedentary at work and leisure and spent similar time in bed. With "Chimpanzees" as reference, "Lions" had least favorable obesity indicators: +2.0 (95% confidence interval [CI] 0.6, 3.4) %body fat, +4.3 cm (1.4, 7.3) waist circumference and +1.0 (2.0, 0.0) Body Mass Index (BMI), followed by "Koalas" +2.0 (0.4, 3.7) %body fat, +3.1 cm (0.1, 6.0) waist circumference, and +0.8 (-0.30, 1.94) BMI. No significant differences were found between "Chimpanzees" and "Ants".

CONCLUSIONS

Movement behavior profiles across work and leisure time-use compositions are associated with obesity. Achieving adequate balance between work and leisure movement behaviors should be further investigated as a potential obesity prevention strategy.

Is high aerobic workload at work associated with leisure time physical activity and sedentary behaviour among blue-collar workers? A compositional data analysis based on accelerometer data

Objective

This study aimed to investigate the hypothesized negative association between duration of work time spent at a high relative aerobic workload and leisure time movement behaviours among blue-collar workers.

Methods

This was a cross-sectional study based on heart rate and accelerometer data from 803 blue-collar workers (447 men and 356 women). Relative aerobic workload was measured as percentage of heart rate reserve during work (%HRR). Leisure time movement behaviours were expressed in terms of leisure time spent in sedentary and active behaviours in uninterrupted bouts (i.e. <10 min, ≥10–30 min and >30 min). Compositional regression and isotemporal substitution models were used to assess the association between the predominance of work time spent at ≥40%HRR and leisure time spent in sedentary and active bouts. All analyses were stratified by sex.

Results

For men, there was no statistically significant association between the predominance of work time spent at ≥40%HRR and leisure time movement behaviours. Among women, the predominance of ≥40%HRR at work was negatively associated with relative leisure time spent in ≥10 min bouts of active behaviour (β^ = -0.21, p = 0.02) and a theoretical 15 min reallocation of work time from <40%HRR to ≥40%HRR was estimated to decrease active behaviour by 6 min during leisure time.

Conclusion

Our result highlights the need for considering work-related barriers for an active leisure time in high-risk populations. Longitudinal studies are warranted to disentangle the relationship between physically demanding work characteristics and leisure time movement behaviours in such populations.

Device-measured physical activity, sedentary behaviour and cardiometabolic health and fitness across occupational groups: a systematic review and meta-analysis

BACKGROUND

With approximately 8 hours of one's waking day spent at work, occupational tasks and environments are important influencers on an individual's physical activity (PA) and sedentary behaviours. Little research has compared device-measured physical activity, sedentary behaviour and cardiometabolic outcomes between occupational groups.

OBJECTIVE

To compare device-measured movement (sedentary time [ST], light intensity physical activity [LPA], moderate-to-vigorous intensity physical activity [MVPA], and steps) across occupations. The secondary objective was to examine whether cardiometabolic and fitness outcomes differed by occupation.

METHODS

Five bibliographic databases were searched to identify all studies which included working age, employed adults from high-income countries, and reported on device-measured movement within occupations. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses and narrative syntheses.

RESULTS

The review includes 132 unique studies with data from 15,619 participants. Working adults spent ~ 60% of their working and waking time engaged in sedentary behaviour; a very small proportion (~ 4%) of the day included MVPA. On average, workers accumulated 8124 steps/day. Office and call center workers' steps/day were among the lowest, while those of postal delivery workers were highest. Office workers had the greatest ST and the lowest time in LPA both at work and during wakeful time. However, office workers had the greatest minutes sent in MVPA during wakeful hours. Laborers had the lowest ST and spent a significantly greater proportion of their work time in LPA and MVPA. Healthcare and protective services workers had higher levels of LPA at work compared to other occupations. Workers in driving-based occupations tended to have a higher body mass index and blood pressure.

CONCLUSION

This review identifies that occupational and wakeful time PA and ST differed between occupations. Future studies are needed to assess whether patterns differ by age and sex, describe leisure-time movement and movement patterns, and the relationship with cardiometabolic health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017070448 .

Can socioeconomic health differences be explained by physical activity at work and during leisure time? Rationale and protocol of the active worker individual participant meta-analysis

INTRODUCTION

Socioeconomic health differences have often been described, but remain insufficiently understood. Recent evidence suggests that workers who are high (compared with low) physically active at work are less healthy. Moreover, workers who are highly physically active at work are predominantly physically inactive during leisure time. These observations suggest that workers with a lower socioeconomic status may be exposed to negative health consequences of occupational physical activity and may only benefit to a limited extent from health benefits of leisure-time physical activity. Physical activity may therefore be an important driver of socioeconomic health differences. We describe the rationale and protocol of the active worker study, an individual participant data meta-analysis aimed at exploring socioeconomic health differences by differential doses of physical activity at work and leisure time.

METHODS AND ANALYSIS

Using database and scoping searches (we searched in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews from database inception to 14 September 2017), we have identified 49 published and unpublished prospective studies in which the association of occupational and leisure-time physical activity with cardiovascular or all-cause mortality was assessed. Principal investigators of these studies will be invited to participate in the active worker consortium, after which data will be retrieved. After data merging and harmonising, we will perform multilevel survival analysis assessing the combined association of occupational and leisure-time physical activity with mortality. We will also test the mediating effect of physical activity on the association of socioeconomic status and mortality (ie, socioeconomic health differences).

DISCUSSION

The Medical Ethical Committee of the VU University Medical Center has declared, according to Dutch legislation, that the 'Dutch Medical Research Involving Human Subjects Act' does not apply to the current study. As such, no ethics approval is required. We intent to publish outcomes of the active worker Study in scientific peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42018085228.

Do highly physically active workers die early? A systematic review with meta-analysis of data from 193 696 participants

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.

Acute effect on ambulatory blood pressure from aerobic exercise: a randomised cross-over study among female cleaners

Purpose

High occupational physical activity (OPA) is shown to increase the risk for elevated blood pressure, cardiovascular diseases and mortality. Conversely, aerobic exercise acutely lowers the blood pressure up to 25 h post exercise. However, it is unknown if this beneficial effect also apply for workers exposed to high levels of OPA. Cleaners constitute a relevant occupational group for this investigation because of a high prevalence of OPA and cardiovascular disease. Accordingly, the objective was to investigate the acute effects on ambulatory blood pressure from a single aerobic exercise session among female cleaners.

Methods

Twenty-two female cleaners were randomised to a cross-over study with a reference and an aerobic exercise session. Differences in 24-h, work hours, leisure time, and sleep ambulatory blood pressure (ABP) were evaluated using repeated measure 2 × 2 mixed-models.

Results

After the aerobic exercise session, the 24-h systolic ambulatory blood pressure was significantly lowered by 2.4 mmHg (p < 0.01) compared to the reference session. The 24-h diastolic ABP was unaltered. During work hours, a lowered systolic ABP of 2.2 mmHg (p = 0.02) and a higher diastolic ABP of 1.5 mmHg (p = 0.03) were found after the aerobic exercise session. During leisure time, the systolic ABP was lowered by 1.7 mmHg (p = 0.04) and the diastolic ABP was unaltered. During sleep, the systolic and diastolic ABP was unaltered.

Conclusion

A single aerobic exercise session lowered 24-h systolic ABP of 2.4 mmHg. Thus, an aerobic exercise session seems to be beneficial for lowering the risk of hypertension among cleaners.

Effects of 12 months aerobic exercise intervention on work ability, need for recovery, productivity and rating of exertion among cleaners: a worksite RCT

Purpose

This study assessed the effects of a worksite aerobic exercise intervention among cleaners on: work ability, need for recovery, productivity, and rating of exertion.

Methods

In a monocentric randomised controlled trial in Denmark, 116, of 250 invited, cleaners were cluster-randomised (work location; sex; age; length of service) to aerobic exercise [N = 57, 44.9 years, 75.4% female, body mass index (BMI) 26.2], receiving 2 weekly aerobic exercise sessions during 12 months, or a reference group (N = 59, 45.7 years, 76.3% female, BMI 27.1), receiving health-promoting lectures. Self-reported data on outcomes and sociodemographic information were collected at baseline, and at 4 and 12 month follow-up. All outcomes were analysed in a linear repeated-measures 2 × 2 mixed-model by an intention-to-treat analysis approach.

Results

Drop-out was 26 and 33% at 4 and 12 months, respectively. Aerobic exercise adherence was 51% during the first 4 months. At 4 month follow-up no effects were found. At 12 month follow-up, work ability significantly increased by 0.59 on a 0–10 scale (95% CI 0.05–1.13) and need for recovery significantly decreased by − 11.0 on a 0–100 scale (95% CI − 19.8 to − 2.2) in the aerobic exercise group compared to the reference group. Productivity and rating of exertion were unaltered. Analysis stratified on age showed significant effects only among the participants aged ≤ 45 years.

Conclusions

After 12 months work ability improved and need for recovery decreased. A period of 4 months was insufficient to affect these outcomes emphasising that longer interventions may be needed to induce effects on work ability and need for recovery.

Decrease in musculoskeletal pain after 4 and 12 months of an aerobic exercise intervention: a worksite RCT among cleaners

Background: Prevalence of musculoskeletal pain is high in jobs with high physical work demands. An aerobic exercise intervention targeting cardiovascular health was evaluated for its long term side effects on musculoskeletal pain. Objective: The objective was to investigate if aerobic exercise affects level of musculoskeletal pain from baseline to 4- and 12-months follow-up. Methods: One-hundred-and-sixteen cleaners aged 18–65 years were cluster-randomized. The aerobic exercise group ( n = 57) received worksite aerobic exercise (30 min twice a week) and the reference group ( n = 59) lectures in health promotion. Strata were formed according to closest manager (total 11 strata); clusters were set within strata (total 40 clusters, 20 in each group). Musculoskeletal pain data from eight body regions was collected at baseline and after 4- and 12-months follow-up. The participants stated highest pain in the last month on a scale from 0, stating no pain, up to 10, stating worst possible pain. A repeated-measure 2 × 2 multi-adjusted mixed-models design was applied to compare the between-groups differences in an intention to treat analysis. Participants were entered as a random effect nested in clusters to account for the cluster-based randomization. Results: Clinically significant reductions (>30%, f 2 > 0.25) in the aerobic exercise group, compared to the reference group, in pain intensity in neck, shoulders, arms/wrists were found at 12-months follow-up, and a tendency ( p = 0.07, f 2 = 0.18) to an increase for the knees. At 4-months follow-up the only significant between-group change was an increase in hip pain. Conclusions: This study indicates that aerobic exercise reduces musculoskeletal pain in the upper extremities, but as an unintended side effect may increase pain in the lower extremities. Aerobic exercise interventions among workers standing or walking in the majority of the working hours should tailor exercise to only maintain the positive effect on musculoskeletal pain.

Maternal occupational physical activity and risk for orofacial clefts

OBJECTIVES

To perform a case-control study of maternal occupational physical activity and risk for orofacial clefts in Texas during 1999-2009.

METHODS

We used logistic regression to assess 14 measures of physical activity estimated from a job exposure matrix, using the maternal occupation reported on the birth certificate, among 887 children with cleft lip with or without cleft palate (CLP), 436 children with cleft palate only (CP), and 1932 controls.

RESULTS

After adjusting for several potential confounders, seven measures of physical activity (as a categorical and/or continuous variable) were significantly associated with CLP, CP, or both. Positive associations were seen for keeping balance, kneeling, standing, and walking/running (odds ratio 95% confidence interval range 1.0-1.9 for fourth versus first quartile). A significant positive trend was also seen for bending/twisting. Negative associations were seen for repetitive motion and sitting.

CONCLUSIONS

Maternal occupational physical activity may be related to the etiology of orofacial clefts.

Validity of Questionnaire and Representativeness of Objective Methods for Measurements of Mechanical Exposures in Construction and Health Care Work

Objectives

To determine the criterion validity of a questionnaire on physical exposures compared to objective measurements at construction and health care sites and to examine exposure variation over several working days.

Methods

Five hundred ninety-four construction and health care workers answered a baseline questionnaire. The daily activities (standing, moving, sitting, number of steps), postures (inclination of the arm and the trunk), and relative heart rate of 125 participants were recorded continuously over 3–4 working days. At the end of the first measurement day, the participants answered a second questionnaire (workday questionnaire).

Results

All objective activity measurements had significant correlations to their respective questions. Among health care workers, there were no correlations between postures and relative heart rate and the baseline questionnaire. The questionnaires overestimated the exposure durations. The highest explained variance in the adjusted models with self-reported variables were found for objectively measured sitting (R² = 0.559) and arm inclination > 60° (R² = 0.420). Objective measurements over several days showed a higher reliability compared to single day measurements.

Conclusions

Questionnaires cannot provide an accurate description of mechanical exposures. Objective measurements over several days are recommended in occupations with varying tasks.

Long Term Effects on Risk Factors for Cardiovascular Disease after 12-Months of Aerobic Exercise Intervention - A Worksite RCT among Cleaners

Objectives

Occupational groups exposed to high occupational physical activity have an increased risk for cardiovascular disease (CVD). This may be explained by the high relative aerobic workload. Enhanced cardiorespiratory fitness reduces the relative aerobic workload. Thus, the aim was to evaluate the 12-months effects of worksite aerobic exercise on risk factors for CVD among cleaners.

Methods

One hundred and sixteen cleaners aged 18–65 years were randomized to a group performing aerobic exercise and a reference group receiving lectures. Outcomes were collected at baseline and after 12-months. A repeated measures 2×2 multi-adjusted mixed-model design was applied to compare the between-group differences using intention-to-treat analysis.

Results

Between-group differences (p<0.05) were found favouring the aerobic exercise group: cardiorespiratory fitness 2.15 (SE 1.03) mlO₂/min/kg, aerobic workload -2.15 (SE 1.06) %HRR, resting HR -5.31 (SE 1.61) beats/min, high sensitive C-reactive protein -0.65 (SE 0.24) μg/ml. The blood pressure was unaltered. Stratified analyses on relative aerobic workload at baseline revealed that those with relative aerobic workloads ≥30% of HRR seems to impose a notable adverse effect on resting and ambulatory blood pressure.

Conclusion

This long-term worksite aerobic exercise intervention among cleaners led to several beneficial effects, but also potential adverse effects among those with high relative aerobic workloads.

Trial Registration

Controlled-Trials.com ISRCTN86682076

Heavy Physical Work: Cardiovascular Load in Male Construction Workers

This study aimed to elucidate cardiovascular loads (CVL) in construction workers during work and leisure by relative heart rate (RHR) over several days. Furthermore, we sought to evaluate the level of CVL in relation to individual factors, work ability, musculoskeletal pain and subjective general health. From a group of 255 construction workers responding to the baseline questionnaire, the CVL during work and leisure time was determined by recording RHR in 42 workers over 3–4 days. Almost 60% of the workday was spent below 20% RHR. The mean RHR during work for all participants was 16% RHR, with large differences between professions. On average, the 42 workers spent 14% of the workday at a RHR above 33%, and four subjects (10%) had a mean RHR above 33% during work. Eight (19%) of the participants had a mean length of their workday exceeding calculated maximal acceptable work time. Seven persons (17%) experienced on average one or more episode(s) of 5 min or more continuously above 33% RHR. The cardiovascular load at work was significantly associated with age and V˙O_2max, but not with work ability, musculoskeletal pain or subjective general health.

Is aerobic workload positively related to ambulatory blood pressure? A cross-sectional field study among cleaners

PURPOSE

Cardiovascular disease is prevalent among workers with high levels of occupational physical activity. The increased risk may be due to a high relative aerobic workload, possibly leading to increased blood pressure. However, studies investigating the relation between relative aerobic workload and ambulatory blood pressure (ABP) are lacking. The aim was to explore the relationship between objectively measured relative aerobic workload and ABP.

METHODS

A total of 116 cleaners aged 18-65 years were included after informed consent was obtained. A portable device (Spacelabs 90217) was mounted for 24-h measurements of ABP, and an Actiheart was mounted for 24-h heart rate measurements to calculate relative aerobic workload as percentage of relative heart rate reserve. A repeated-measure multi-adjusted mixed model was applied for analysis.

RESULTS

A fully adjusted mixed model of measurements throughout the day showed significant positive relations (p < 0.001): a 1% increase in mean relative aerobic workload was associated with an increase of 0.42 ± 0.05 mmHg (95% CI 0.32-0.52 mmHg) in systolic ABP and 0.30 ± 0.04 mmHg (95% CI 0.22-0.38 mmHg) in diastolic ABP. Correlations between relative aerobic workload and ABP were significant.

CONCLUSIONS

Because workers may have an elevated relative aerobic workload for several hours each working day, this relationship may elucidate a mechanism behind the increased risk for cardiovascular disease among workers exposed to high levels of occupational physical activity.

Aerobic exercise reduces biomarkers related to cardiovascular risk among cleaners: effects of a worksite intervention RCT

Purpose

Blue-collar workers have an increased risk of cardiovascular disease. Accordingly, elevated levels of biomarkers related to risk of cardiovascular disease, such as high-sensitive C-reactive protein, have been observed among blue-collar workers. The objective was to examine whether an aerobic exercise worksite intervention changes the level of inflammation biomarkers among cleaners.

Methods

The design was a cluster-randomized controlled trial with 4-month worksite intervention. Before the 116 cleaners aged 18–65 years were randomized, they signed an informed consent form. The reference group (n = 59) received lectures, and the aerobic exercise group (n = 57) performed worksite aerobic exercise (30 min twice a week). Levels of biomarkers (high-sensitive C-reactive protein, fibrinogen, cholesterol, low- and high-density lipoprotein cholesterol and triglyceride) were collected at baseline and after 4 months. A repeated-measure, multi-adjusted, mixed-model intention-to-treat analysis was applied to compare between-group differences. The study was registered as ISRCTN86682076.

Results

Significant (p < 0.05) between-group reductions from baseline to follow-up were found for high-sensitive C-reactive protein (−0.54 ± 0.20 µg/ml; 95 % CI −0.94, −0.14), low-density lipoprotein cholesterol (−0.32 ± 0.11 mmol/L; 95 % CI −0.54, −0.10) and the ratios of LDL/HDL (−0.30 ± 0.08; 95 % CI −0.46, −0.14), and LDL/TC cholesterol (−0.04 ± 0.02; 95 % CI −0.07, −0.01).

Conclusion

This study indicates that an aerobic exercise intervention among cleaners leads to reduced levels of high-sensitive C-reactive protein and low-density lipoprotein cholesterol, and an unaltered level of fibrinogen. The aerobic exercise seems to improve inflammatory levels and lipoprotein profile among cleaners, with no signs of cardiovascular overload.

Occupational noise and myocardial infarction: considerations on the interrelation of noise with job demands

The present analysis aims to differentiate the association of noise on myocardial infarction (MI) by job specific demands using International Standard Classification of Occupations (ISCO)-88 codes as a proxy. Data of a German case-control study were supplemented by job descriptions (indicated by ISCO-88). It was examined whether the demands in the various occupational groups modify the effect of noise. Noise and occupational groups are combined to form new exposure categories. Conditional logistic regression models were fitted to identify effects of combined job-noise categories. For the highest noise range (95-124 dB(A)) we found a significant odds-ratio (OR) of 2.18 (confidence interval [CI]_0.95 = 1.17-4.05) independent of the profession. Some interesting results were found indicating ISCO groups with possible risk. In men, noticeable effects for the exposure category between 62 dB(A) and 84 dB(A) are calculated in the group of legislators and senior officials (ISCO-group 11; OR=1.93; CI_0.95 = 0.50-7.42), the group consisting of life science and health professionals (ISCO-group 22; OR=2.18; CI_0.95 = 0.36-13.1), the group of life science and health associate professionals (ISCO-group 32; OR = 2.03; CI_0.95 = 0.50-8.24), and the group of “precision, handicraft, printing, and related trades workers” (ISCO-group 73; OR = 2.67; CI_0.95 = 0.54-13.0). In the exposure range of 85-94 dB(A), high ORs are calculated for “skilled agricultural, fishery, and forestry workers” (ISCO-group 6; OR = 4.31; CI_0.95 = 0.56-33.3). In women, there are high (nonsignificant) ORs in ISCO-group 1 (OR = 2.43; CI_0.95 = 0.12-50.0), ISCO-group 2 (OR = 1.80; CI_0.95 = 0.31-10.5), and ISCO-group 9 (OR = 2.45; CI_0.95 = 0.63-9.51) for a noise exposure between 62 dB(A) and 84 dB(A). When investigating noise at the workplace in relation to cardiovascular diseases it is important to take the specific requirements of a job into account. Thus, work tasks with high health risks can be identified that helps to develop appropriate prevention strategies.

A conceptual model for worksite intelligent physical exercise training--IPET--intervention for decreasing life style health risk indicators among employees: a randomized controlled trial

BACKGROUND

Health promotion at the work site in terms of physical activity has proven positive effects but optimization of relevant exercise training protocols and implementation for high adherence are still scanty.

METHODS/DESIGN

The aim of this paper is to present a study protocol with a conceptual model for planning the optimal individually tailored physical exercise training for each worker based on individual health check, existing guidelines and state of the art sports science training recommendations in the broad categories of cardiorespiratory fitness, muscle strength in specific body parts, and functional training including balance training. The hypotheses of this research are that individually tailored worksite-based intelligent physical exercise training, IPET, among workers with inactive job categories will: 1) Improve cardiorespiratory fitness and/or individual health risk indicators, 2) Improve muscle strength and decrease musculoskeletal disorders, 3) Succeed in regular adherence to worksite and leisure physical activity training, and 3) Reduce sickness absence and productivity losses (presenteeism) in office workers. The present RCT study enrolled almost 400 employees with sedentary jobs in the private as well as public sectors. The training interventions last 2 years with measures at baseline as well as one and two years follow-up.

DISCUSSION

If proven effective, the intelligent physical exercise training scheduled as well as the information for its practical implementation can provide meaningful scientifically based information for public health policy.

TRIAL REGISTRATION

ClinicalTrials.gov, number: NCT01366950.

Assessment of physical strain in younger and older subjects using heart rate and scalings of perceived exertion

Physical strain is usually evaluated physiologically by using the heart rate (HR) or psychologically using scaled perceived exertion (PE). In order to explore the relationship between these approaches, we compared the series of both measurements taken simultaneously during work on a bicycle ergometer. A total of 29 participants aged between 27 and 41, 42 and 56, and 57 and 71 years took part in 28 minutes of cycling with systematically increased and decreased load as well as in 7 hours of continuous cycling with low to medium exertion, interrupted by brief peak loads at high to very high exertion levels. Results revealed that, while both measurements are suitable to capture physical strain, HR is not as specific as PE. The older participants further perceived comparable physical loads as more demanding as the younger participants. With an aging workforce, results have potential implications for the organisation of work places.

PRACTITIONER SUMMARY

The organisation of work processes is a key issue in the prevention of strain and hence of interest to ergonomists. Our study suggests that workers can, independent of age, perform physical work all day as long as they work at subjectively equal, moderate intensities.