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Li J, Zhang X, Zhang M, Wang L, Yin P, Li C, You J, Huang Z, Ng M, Wang L, Zhou M. Urban-rural differences in the association between occupational physical activity and mortality in Chinese working population: evidence from a nationwide cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101083. [PMID: 38745972 PMCID: PMC11091516 DOI: 10.1016/j.lanwpc.2024.101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/28/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
Background Despite emerging studies suggesting that occupational physical activity (OPA) might be harmful to health, the available evidence is not definitive. Most of these research studies were conducted in high-income Western countries or in urbanized setting. In China, where over one-third of the population resides in rural area, the impact of OPA on health is not well understood. The goal of this study is to investigate how the association between OPA and mortality vary by urban-rural settings. Methods Baseline data on OPA was gathered using the Global Physical Activity Questionnaire from 30,650 urban and 49,674 rural working adults as part of the 2013-2014 China Chronic Disease and Risk Factor Surveillance. Participants were followed for a median of 6.2 years, and death records were retrieved from the National Mortality Surveillance System until December 31, 2019. The multivariable Cox proportional hazard model was used to examine urban-rural differences in the association between OPA and all-cause and cardiovascular disease (CVD) mortality. Subgroup analyses were performed by sex, socioeconomic status, leisure time, transportation, and non-occupational physical activity. Findings During the study period, 1342 deaths were recorded, of which 426 were caused by CVD. In rural area, working adults engaging in occupational moderate-to-vigorous physical activity (MVPA) for ≥40 h per week, compared to those without any, had an adjusted hazard ratio of 0.60 (95% CI: 0.49-0.73) for all-cause mortality and 0.55 (95% CI: 0.37-0.83) for CVD mortality. However, no significant association was found in urban area (0.84 [0.61-1.15] for all-cause mortality, Pinteraction = 0.036; and 0.94 [0.53-1.66] for CVD mortality, Pinteraction = 0.098). The negative associations of occupational MVPA with mortality were more pronounced in women, non-smokers, and those with less non-occupational physical activities. Hypertension, heart rate, and diabetes were important contributors to the relationship between occupational MVPA and mortality. Interpretation The findings from the current study did not support the notion that high levels of OPA would induce harm. On the contrary, in rural setting, higher levels of OPA were associated with lower mortality risks. Furthermore, the observed urban-rural differences in the association between OPA and mortality underscored the need for context-specific public health guidelines on physical activities. Funding R&D Program of Beijing Municipal Education Commission (KM202210025026),National Key Research and Development Program of China (2021YFC2500201), and Young Elite Scientist Sponsorship Program by BAST (BYESS2023385).
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Affiliation(s)
- Jie Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinling You
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Marie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Kikuchi H, Inoue S, Amagasa S, Kuwahara K, Ihira H, Inoue M, Iso H, Tsugane S, Sawada N. Relationships of Total and Domain-Specific Moderate-to-Vigorous Physical Activity with All-Cause and Disease-Specific Mortality. Med Sci Sports Exerc 2024; 56:520-527. [PMID: 37882065 DOI: 10.1249/mss.0000000000003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE This study aimed to investigate the relationships of moderate-to-vigorous physical activity (MVPA) with all-cause and disease-specific mortality. We also investigated how the association between MVPA at leisure time (LT-MVPA) and health outcomes differs at different MVPA at work (WT-MVPA) levels. METHODS The 81,601 community-dwelling Japanese persons age 50-79 yr who responded to a questionnaire in 2000-2003 were followed until 2018. Cox proportional hazard model was used to examine the association of total MVPA with risks of all-cause, cancer, heart disease, stroke, and respiratory disease mortality. Then, we compared the mortality risk according to the tertile of LT-MVPA, stratified by the tertile of WT-MVPA. RESULTS During the 15.1 yr of average follow-up, 16,951 deaths were identified. Even total MVPA below the recommended volume (i.e., 0.1-1.49 MET·h·d -1 ) was associated with 11% to 24% reductions in all-cause (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.82-0.96) and heart disease mortality (HR, 0.76; 95% CI, 0.61-0.94), compared with no MVPA at all. The further reduced risks were seen in MVPA up to 10 MET·h·d -1 . The inverse association between LT-MVPA and mortality risks was more evident at lower WT-MVPA, which was also inversely associated with the risks. CONCLUSIONS Health benefits were observed at low levels of MVPA and up to 10 MET·h·d -1 , although the fine threshold for excessive MVPA was not clear. LT-MVPA had distinct health benefits especially for persons with lower WT-MVPA.
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Affiliation(s)
- Hiroyuki Kikuchi
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, JAPAN
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, JAPAN
| | | | | | - Hikaru Ihira
- Division of Cohort research, National Cancer Center Institute for Cancer Control, Tokyo, JAPAN
| | | | - Hiroyasu Iso
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, JAPAN
| | | | - Norie Sawada
- Division of Cohort research, National Cancer Center Institute for Cancer Control, Tokyo, JAPAN
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Chuang SC, Chang YH, Wu IC, Fang YH, Chan HT, Wu RC, Lee MM, Chiu CT, Chang HY, Hsiung CA, Hsu CC. Impact of physical activity on disability-free and disabled life expectancies in middle-aged and older adults: Data from the healthy aging longitudinal study in Taiwan. Geriatr Gerontol Int 2024; 24 Suppl 1:229-239. [PMID: 38169087 DOI: 10.1111/ggi.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/28/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
AIM Leisure-time physical activity (LTPA) promotes healthy aging; however, data on work-related physical activity (WPA) are inconsistent. This study was conducted to examine the disability-free life expectancy (DFLE) and disabled life expectancy (DLE) across physical activity levels, with a focus on WPA, in middle-aged and older adults. METHODS Data from 5663 community-dwelling participants aged ≥55 years and enrolled in the Healthy Aging Longitudinal Study in Taiwan were evaluated. Energy expenditures from LTPA and WPA were calculated from baseline questionnaires and categorized into sex-specific cutoffs. Disability was based on repeat measures of participants' activities of daily living and instrumental activities of daily living. Mortality was confirmed via data linkage with the Death Certificate database. DFLE and DLE were estimated from discrete-time multistate life-table models. RESULTS At age 65, women with low WPA had a DLE of 2.88 years (95% confidence interval [CI], 1.67-4.08), which was shorter than that of women without WPA (DLE, 5.24 years; 95% CI, 4.65-5.83) and with high WPA (DLE, 4.01 years; 95% CI, 2.69-5.34). DFLE and DLE were similar across WPA levels in men. DFLE tended to increase as the LTPA increased in men and women. CONCLUSION Women with low WPA had shorter DLE than did those with no or high WPA. To reduce the risks of disability associated with physical activity, public policy should advocate for older people to watch the type, amount, and intensity of their activities as these may go ignored during WPA. Geriatr Gerontol Int 2024; 24: 229-239.
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Affiliation(s)
- Shu-Chun Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Hung Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yao-Hwei Fang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Huei-Ting Chan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ray-Chin Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Marion M Lee
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
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Sagelv EH, Dalene KE, Eggen AE, Ekelund U, Fimland MS, Heitmann KA, Holtermann A, Johansen KR, Løchen ML, Morseth B, Wilsgaard T. Occupational physical activity and risk of mortality in women and men: the Tromsø Study 1986-2021. Br J Sports Med 2024; 58:81-88. [PMID: 37914386 DOI: 10.1136/bjsports-2023-107282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Associations between occupational physical activity (OPA) and mortality risks are inconclusive. We aimed to examine associations between (1) OPA separately and (2) jointly with leisure time physical activity (LTPA), and risk of all-cause, cardiovascular disease (CVD) and cancer mortality, over four decades with updated exposure and covariates every 6-8 years. METHODS Adults aged 20-65 years from the Tromsø Study surveys Tromsø3-Tromsø7 (1986-2016) were included. We categorised OPA as low (sedentary), moderate (walking work), high (walking+lifting work) or very high (heavy manual labour) and LTPA as inactive, moderate and vigorous. We used Cox/Fine and Gray regressions to examine associations, adjusted for age, body mass index, smoking, education, diet, alcohol and LTPA (aim 1 only). RESULTS Of 29 605 participants with 44 140 total observations, 4131 (14.0%) died, 1057 (25.6%) from CVD and 1660 (40.4%) from cancer, during follow-up (median: 29.1 years, 25th-75th: 16.5.1-35.3). In men, compared with low OPA, high OPA was associated with lower all-cause (HR 0.83, 95% CI 0.74 to 0.92) and CVD (subdistributed HR (SHR) 0.68, 95% CI 0.54 to 0.84) but not cancer mortality (SHR 0.99, 95% CI 0.84 to 1.19), while no association was observed for moderate or very high OPA. In joint analyses using inactive LTPA and low OPA as reference, vigorous LTPA was associated with lower all-cause mortality combined with low (HR 0.75, 95% CI 0.64 to 0.89), high (HR 0.67, 95% CI 0.54 to 0.82) and very high OPA (HR 0.74, 95% CI 0.58 to 0.94), but not with moderate OPA. In women, there were no associations between OPA, or combined OPA and LTPA, with mortality. CONCLUSION High OPA, but not moderate and very high OPA, was associated with lower all-cause and CVD mortality risk in men but not in women. Vigorous LTPA was associated with lower mortality risk in men with low, high and very high OPA, but not moderate OPA.
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Affiliation(s)
- Edvard H Sagelv
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Knut Eirik Dalene
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ulf Ekelund
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Marius Steiro Fimland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | - Kim Arne Heitmann
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Sport Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kristoffer Robin Johansen
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Fontana D, Ceron R, d'Errico A. Occupational physical activity, all-cause mortality and incidence of cardiovascular diseases: results from three Italian cohorts. Int Arch Occup Environ Health 2024; 97:81-100. [PMID: 38099982 DOI: 10.1007/s00420-023-02028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/10/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE To examine the association of exposure to Occupational Physical Activity (OPA) with all-cause mortality and incidence of cardiovascular diseases (CVD). METHODS The study population was composed of three Italian cohorts: a national cohort of employees participating in the National Health Survey 2005, followed-up until 2014 (ILS 2005), and two urban cohorts of employees resident in Turin at 2001 and 2011 censuses (TLS 2001 and TLS 2011, respectively), both followed-up until 2018. Follow-up was conducted through individual record-linkage with death registries and hospital admissions archives. Exposure to OPA was assigned through an Italian job-exposure matrix (JEM). Relative Risks of both CVD incidence and overall mortality associated with OPA quartiles (IRR) were estimated using Poisson regression models adjusted for socio-demographics and health, and in the national cohort, also for leisure time physical activity, BMI, smoking, diabetes, and hypertension. RESULTS Compared to the lowest quartile, the highest OPA quartile was associated in both genders with significantly increased mortality in TLS 2001 (IRR = 1.11 among men, IRR = 1.20 among women) and in TLS 2011 (IRR = 1.27 among men and IRR = 1.73 among women), whereas in the ILS 2005 cohort no association was found. Among women, high OPA was also associated with CVD risk in TLS 2001 and 2011 (IRR = 1.39 and IRR = 1.16 for the highest quartile, respectively), while in the ILS cohort in both genders only the third quartile showed a significantly higher risk. CONCLUSION Our results indicate that OPA does not have a beneficial effect on CVD and mortality, but rather suggest that it may produce deleterious health effects.
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Affiliation(s)
- Dario Fontana
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Turin, Italy
| | - Raffaele Ceron
- Occupational Health and Safety Unit, ASL CN1, Piedmont Region, Saluzzo, Cuneo, Italy
| | - Angelo d'Errico
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Turin, Italy.
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Mielke GI, Doust J, Chan HW, Mishra GD. Physical Activity Accumulated Across Adulthood and Resting Heart Rate at Age 41-46 Years in Women: Findings From the Menarche to Premenopause Study. J Phys Act Health 2023; 20:823-831. [PMID: 37567574 DOI: 10.1123/jpah.2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To investigate the association between physical activity accumulated from early (age 22-27 y) to mid (age 40-45 y) adulthood and resting heart rate at age 41-46 years in women. METHODS Data were from 479 participants in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. Participants reported physical activity every 3 years from age 22-27 years to 40-45 years. Linear regression models were used to investigate the associations of a cumulative physical activity score (average physical activity across 18 y; up to 7 surveys) and changes in physical activity from age 22-33 years to 34-45 years with resting heart rate at age 41-46 years. RESULTS Average resting heart rate at age 41-46 years was 75 (SD: 11) beats per minute. An inverse nonlinear dose-response association between cumulative physical activity and resting heart rate was observed. Overall, accumulation of physical activity was associated with lower resting heart rate regardless of the age when physical activity was accumulated. Women in the highest tertile of physical activity at both age 22-33 years and 34-45 years had a resting heart rate, on average, 8 beats per minute lower (95% confidence interval, -11.42 to -4.69) than those consistently in the lowest tertile of physical activity. CONCLUSION Accumulating physical activity, irrespective of timing, appears to provide cardiovascular health benefits for women before the transition to menopause.
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Affiliation(s)
- Gregore I Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
| | - Jenny Doust
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
| | - Hsiu-Wen Chan
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
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Coudevylle GR, Sinnapah S, Ginoux C, Bouchard JP. [Health care workers: the importance of adapted physical activities]. REVUE DE L'INFIRMIERE 2023; 72:39-41. [PMID: 37247988 DOI: 10.1016/j.revinf.2023.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Adapted physical activities (APA) in the workplace improve workers' health. Paradoxically, APA remains marginal in the very places where improving health is the central objective of health care workers, namely clinics and hospitals. Promoting physical activity in the workplace is a twofold challenge. Not only does PA improve the health and well-being of caregivers, but it also allows them to be more effective in their daily work with patients.
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Affiliation(s)
- Guillaume R Coudevylle
- Laboratoire Actes, EA 3596, Université des Antilles, 97159 Pointe-à-Pitre, Guadeloupe, France
| | - Stéphane Sinnapah
- Laboratoire Actes, EA 3596, Université des Antilles, 97159 Pointe-à-Pitre, Guadeloupe, France
| | | | - Jean-Pierre Bouchard
- Psychologie-criminologie-victimologie (PCV), 33000 Bordeaux, France; Centre hospitalier de Cadillac (IPJP/UMD), 33410 Cadillac, France; Statistics and Population Studies Department, Faculty of Natural Sciences, University of the Western Cape, Bellville, 7535 Cape-Town, South Africa.
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Cillekens B, Huysmans MA, Holtermann A, van Mechelen W, Straker L, Krause N, van der Beek AJ, Coenen P. 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. Scand J Work Environ Health 2023; 49:231-244. [PMID: 37000459 PMCID: PMC10621902 DOI: 10.5271/sjweh.4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 04/01/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | | | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre (VUmc), Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Cheng C, Sun XR, Chen K, Hua W, Su Y, Xu W, Wang F, Fan X, Dai Y, Liu Z, Zhang S. The mediation function of resting heart rate in how physical activity improves all-cause mortality: Continuous and automatic measurement via cardiac implantable electronic devices. Front Cardiovasc Med 2022; 9:928372. [PMID: 36225951 PMCID: PMC9548702 DOI: 10.3389/fcvm.2022.928372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physical activity (PA) and resting heart rate (RHR) are connected with all-cause mortality. Moreover, there was an inverse correlation between PA and RHR. However, the causal relationship between PA, RHR, and long-term mortality has been rarely evaluated and quantified, particularly the mediation effect of RHR in the association between PA and all-cause mortality. Objective To describe the relationship between PA and RHR when consistently measured via cardiac implantable electronic devices (CIED) and further explore the mediation effect of PA on all-cause mortality through RHR. Materials and methods Patients who underwent CIED implantation and received remote home monitoring services were included. During the first 30–60 days after CIED implantation, daily PA and RHR were continuously measured and automatically transmitted by CIED. The primary endpoint was all-cause mortality. The multiple linear regression model was used to confirm the relationship between PA and RHR. The predictive values of both PA and RHR for all-cause mortality were assessed by multivariable Cox proportional hazards models. The causal mediation model was further established to verify and quantify the mediation effect of RHR in the association between PA and all-cause mortality. Results A total of 730 patients with CIED were included. The mean daily PA and RHR were 10.7 ± 5.7% and 61.3 ± 9.1 bpm, respectively. During a mean follow-up period of 55.8 months, 187 (26.5%) death was observed. A negative linear relationship between PA and RHR was demonstrated in the multiple regression model (β = −0.260; 95% CI: −0.377 to −0.143, p < 0.001). Multivariable Cox proportional hazards analysis showed that both lower levels of PA (HR = 0.907; 95% CI: 0.878–0.936, p < 0.001) and higher RHR (HR = 1.016; 95% CI: 1.001–1.032, P = 0.031) were independent risk factors of all-cause mortality. Causal mediation analysis further confirmed and quantified the mediation function of RHR in the process of PA improving all-cause mortality (mediation proportion = 3.9%; 95% CI: 0.2–10.0%, p = 0.036). Conclusion The effects of the higher level of PA on improving life prognosis may be partially mediated through RHR among patients with CIED. It indicates that changes in the autonomic nervous function during postoperative rehabilitation exercises should get more attention.
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Affiliation(s)
- Chendi Cheng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xue Rong Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Fang Wang
- Department of Cardiology, Shanghai First People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- *Correspondence: Shu Zhang,
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Kiema-Junes H, Saarinen A, Korpelainen R, Kangas M, Ala-Mursula L, Pyky R, Hintsanen M. More Physical Activity, More Work Engagement? A Northern Finland Birth Cohort 1966 Study. J Occup Environ Med 2022; 64:541-549. [PMID: 35260539 PMCID: PMC9301987 DOI: 10.1097/jom.0000000000002530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the role of physical activity (PA) and sedentary behavior (SED) for work engagement. METHODS We used data from Northern Finland Birth Cohort 1966 Study ( n = 3046 to 4356) to analyze self-reported weekly leisure-time physical activity (LTPA), daily leisure-time sitting time (LTST) and work engagement. PA and SED 24-hour were also measured with accelerometer for 14 days. The data were analyzed using linear regression analyses. RESULTS High self-reported LTPA and sports participation were associated with higher work engagement and its subdimensions. High self-reported ST was associated with lower work engagement, vigor, and absorption. Accelerometer-measured light PA was associated with higher work engagement and vigor, and accelerometermeasured steps were linked to higher vigor. Accelerometer-measured SED was associated with lower work engagement, vigor, and dedication. CONCLUSIONS Self-reported and accelerometer-measured PA and SED may play a role in people's work engagement.
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Affiliation(s)
- Heli Kiema-Junes
- From the Unit of Psychology, Faculty of Education, University of Oulu, Oulu, Finland (Dr Kiema-Junes and Dr Hintsanen); Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Dr Saarinen); Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland; Institute of Health Sciences, University of Oulu and University of Hospital of Oulu, Oulu, Finland (Dr Korpelainen and Dr Pyky); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland (Dr Kangas); Center for Life Course Health Research, University of Oulu, Oulu, Finland (Dr Ala-Mursula)
| | - Aino Saarinen
- From the Unit of Psychology, Faculty of Education, University of Oulu, Oulu, Finland (Dr Kiema-Junes and Dr Hintsanen); Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Dr Saarinen); Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland; Institute of Health Sciences, University of Oulu and University of Hospital of Oulu, Oulu, Finland (Dr Korpelainen and Dr Pyky); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland (Dr Kangas); Center for Life Course Health Research, University of Oulu, Oulu, Finland (Dr Ala-Mursula)
| | - Raija Korpelainen
- From the Unit of Psychology, Faculty of Education, University of Oulu, Oulu, Finland (Dr Kiema-Junes and Dr Hintsanen); Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Dr Saarinen); Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland; Institute of Health Sciences, University of Oulu and University of Hospital of Oulu, Oulu, Finland (Dr Korpelainen and Dr Pyky); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland (Dr Kangas); Center for Life Course Health Research, University of Oulu, Oulu, Finland (Dr Ala-Mursula)
| | - Maarit Kangas
- From the Unit of Psychology, Faculty of Education, University of Oulu, Oulu, Finland (Dr Kiema-Junes and Dr Hintsanen); Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Dr Saarinen); Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland; Institute of Health Sciences, University of Oulu and University of Hospital of Oulu, Oulu, Finland (Dr Korpelainen and Dr Pyky); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland (Dr Kangas); Center for Life Course Health Research, University of Oulu, Oulu, Finland (Dr Ala-Mursula)
| | - Leena Ala-Mursula
- From the Unit of Psychology, Faculty of Education, University of Oulu, Oulu, Finland (Dr Kiema-Junes and Dr Hintsanen); Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Dr Saarinen); Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland; Institute of Health Sciences, University of Oulu and University of Hospital of Oulu, Oulu, Finland (Dr Korpelainen and Dr Pyky); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland (Dr Kangas); Center for Life Course Health Research, University of Oulu, Oulu, Finland (Dr Ala-Mursula)
| | - Riitta Pyky
- From the Unit of Psychology, Faculty of Education, University of Oulu, Oulu, Finland (Dr Kiema-Junes and Dr Hintsanen); Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Dr Saarinen); Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland; Institute of Health Sciences, University of Oulu and University of Hospital of Oulu, Oulu, Finland (Dr Korpelainen and Dr Pyky); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland (Dr Kangas); Center for Life Course Health Research, University of Oulu, Oulu, Finland (Dr Ala-Mursula)
| | - Mirka Hintsanen
- From the Unit of Psychology, Faculty of Education, University of Oulu, Oulu, Finland (Dr Kiema-Junes and Dr Hintsanen); Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland (Dr Saarinen); Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland; Institute of Health Sciences, University of Oulu and University of Hospital of Oulu, Oulu, Finland (Dr Korpelainen and Dr Pyky); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland (Dr Kangas); Center for Life Course Health Research, University of Oulu, Oulu, Finland (Dr Ala-Mursula)
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11
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Luo M, Gupta N, Holtermann A, Stamatakis E, Ding D. Revisiting the 'physical activity paradox' in a Chinese context: Occupational physical activity and mortality in 142,302 urban working adults from the China Kadoorie Biobank study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 23:100457. [PMID: 35602414 PMCID: PMC9120052 DOI: 10.1016/j.lanwpc.2022.100457] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Previous research suggests that while leisure-time physical activity (LTPA) is beneficial, occupational physical activity (OPA) may be detrimental to health, known as the 'physical activity paradox'. However, the current evidence is primarily based on data from Western countries. We examined the association of OPA with all-cause and cardiovascular disease mortality in working adults in urban China. METHODS This prospective longitudinal study was based on a sample of 142,302 urban working adults aged 30-79 years from the China Kadoorie Biobank study. Self-reported OPA (mainly sedentary, standing occupation, and manual work) was collected at baseline (year 2004-2008) and linked to death registries until 31st December 2016. Multivariable Cox proportional hazards models were used to examine the relationship between OPA and mortality outcomes, with further tests for effect modification by sex, educational attainment and LTPA. FINDINGS During a median follow-up of 10·2 years, 4,077 deaths occurred, of which cardiovascular disease was the primary cause for 727 deaths. Crude modelling showed that compared with the sedentary workers, manual work was associated with increased risk of all-cause mortality. However, after adjusting for socio-demographic and lifestyle variables, the association was attenuated to null (HR=1·00, 95%CI: 0·93-1·08). In subgroup analysis, higher OPA was associated with lower risk of all-cause mortality in the least educated group (HR=0·84, 95%CI: 0·75-0·95 for manual work, and HR=0·86, 95%CI: 0·75-0·99 for standing occupation), but harmful in the most educated group (HR=1·17, 95%CI: 1·01-1·36) and in those who reported regular LTPA (HR=1·20, 95%CI: 1·01-1·43). INTERPRETATION OPA was not associated with mortality risk in the overall sample. However, findings support the 'physical activity paradox' within better educated Chinese workers. FUNDING None.
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Key Words
- BMI, Body mass index
- CI, Confidence interval
- CNY, Chinese Yuan
- CVD, Cardiocascular disease
- China
- DSP, Disease Surveillance Points
- Epidemiology
- HR, Hazard ratio
- ICD, International Statistical Classification of Diseases
- IQR, Interquartile range
- LMIC
- LMICs, Low-to-middle income countries
- LTPA, Leisure-time physical activity
- Low and middle income countries
- Mortality
- OPA, Occupational physical activity
- Physical activity
- SGPALS, Saltin-Grimby Physical Activity Level Scale
- UK, United Kingdom
- USD, United States Dollars
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Affiliation(s)
- Mengyun Luo
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Nidhi Gupta
- Department of Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Andreas Holtermann
- Department of Musculoskeletal Disorders and Physical Workload, The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Emmanuel Stamatakis
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ding Ding
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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12
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Galmes-Panades AM, Abbate M, Bennasar-Veny M, López-González AA, Vicente-Herrero MT, Busquets-Cortés C, Leiva A, Yañez AM. Occupational and Leisure Physical Activity on Cardiovascular Risk and Body Composition Among Courier Workers. Biol Res Nurs 2022; 24:560-572. [PMID: 35613699 DOI: 10.1177/10998004221105535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is some controversy about the beneficial effects of occupational physical activity (OPA) on cardiovascular risk (CVR). The main aim of this study was to explore the effect of the combination of different frequencies of leisure-time physical activity (LTPA) and two types of OPA on CVR and body composition, and whether the association between physical activity (PA) and CVR was mediated by visceral adipose tissue (VAT). METHODS This cross-sectional study included data from 2516 couriers living in Spain, delivering either by motorbike or foot, and practicing LTPA never, occasionally, or regularly. Couriers were classified into six categories according to LTPA and OPA; body composition was assessed by Bioelectrical Impedance, and CVR by the Framingham equation. General linear models were performed to explore the association between different categories with each outcome (CVR and body composition) and the possible role of VAT as a mediator between PA and CVR. RESULTS Compared with the most sedentary group (motorbike couriers that never practice PA), walking couriers who practice regular PA presented the lowest CVR [β -1.58 (95% CI -2.31; -0.85)] and the lowest VAT [β -2.86 (95% CI -3.74; -1.98) followed by the motorbike couriers who practiced regular PA [β -0.51 (95% CI -1.00; -0.03) for CVR and β -2.33 (95% CI -2.91; -1.75) for VAT]. The association between PA and CVR was partially mediated by VAT. CONCLUSION The present results indicated that both OPA and LTPA are protective factors for CVR and play an important role on VAT accumulation.
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Affiliation(s)
- Aina Maria Galmes-Panades
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), 219656Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma, Spain
| | - Manuela Abbate
- Research Group on Global Health and Lifestyle (EVES), 219656Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma, Spain
| | - Miquel Bennasar-Veny
- Research Group on Global Health and Lifestyle (EVES), 219656Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma, Spain.,Nursing and Physiotherapy Department, 16745Universitat de les Illes Balears, Palma, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), 117368Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Angel Arturo López-González
- Prevention of Occupational Risks in Health Services, 88144Balearic Islands Health Service, Palma, Spain.,Escuela Universitaria ADEMA, Palma, Illes Balears, Spain.,Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), 16745Universitat de les Illes Balears, Palma, Spain
| | | | - Carla Busquets-Cortés
- Escuela Universitaria ADEMA, Palma, Illes Balears, Spain.,Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), 16745Universitat de les Illes Balears, Palma, Spain
| | - Alfonso Leiva
- Primary Care Research Unit of Mallorca, 88144Balearic Islands Health Services (IbSalut), Palma, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Palma, Spain
| | - Aina María Yañez
- Research Group on Global Health and Lifestyle (EVES), 219656Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma, Spain.,Nursing and Physiotherapy Department, 16745Universitat de les Illes Balears, Palma, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Palma, Spain
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13
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Park S, Lee JH. Associations of occupational and leisure-time physical activity with self-rated health in Korea. Prev Med 2022; 158:107022. [PMID: 35307369 DOI: 10.1016/j.ypmed.2022.107022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
Abstract
Recent findings have suggested that not all physical activity (PA) types improve health and that the health effects of occupational PA (OPA) and leisure-time PA (LTPA) can be different. However, few studies have been reported the association of OPA and LTPA with self-rated health (SRH). Therefore, we aimed to examine the association between different PA domains and general health and the impact of LTPA on the relationship between health and OPA. In total, 33440 adults from the Korea National Health and Nutrition Examination Survey 2014-2019 were analyzed in September 2021. SRH was dichotomized into "poor" and "good." Sedentary behavior (SB) was evaluated by measuring the daily sitting time. Multiple logistic regression was used to investigate the relationship of SRH with OPA, LTPA, and SB, stratified by LTPA to identify its impact on the relationship. In the fully adjusted model, OPA was found to increase the risk of poor SRH, while LTPA was found to lower the risk. In those who did not engage in LTPA, OPA and poor SRH were significantly associated. Poor SRH was not significantly associated with OPA in those who engaged in LTPA. SB was also associated with poor SRH, independent of LTPA. To improve health, it is important to promote LTPA and reduce OPA and SB. In particular, for workers with a higher level of OPA, additional LTPA should be introduced to prevent SRH from worsening.
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Affiliation(s)
- Sungjin Park
- Department of Occupational and Environmental Medicine, Incheon Nasaret International Hospital, Incheon, Republic of Korea
| | - June-Hee Lee
- Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea.
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14
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Reichel K, Prigge M, Latza U, Kurth T, Backé EM. Association of occupational sitting with cardiovascular outcomes and cardiometabolic risk factors: a systematic review with a sex-sensitive/gender-sensitive perspective. BMJ Open 2022; 12:e048017. [PMID: 35135760 PMCID: PMC8830241 DOI: 10.1136/bmjopen-2020-048017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Sedentary behaviour is a modifiable risk factor for cardiovascular health. Although long periods of sedentary behaviour take place at work, evidence of the relationship between such occupational sitting and cardiometabolic health risks remains limited. This systematic review aimed to update the evidence on the associations of occupational sitting with cardiovascular outcomes and cardiometabolic risk factors based on longitudinal studies. DESIGN Systematic review. SETTING Workplace. POPULATION Employees aged 18-65 years. PRIMARY AND SECONDARY OUTCOMES Primary outcomes were cardiovascular diseases and cardiometabolic risk markers. The secondary outcome was all-cause mortality. DATA SOURCES Ten databases, including PubMed, Web of Science and CINAHL (search January 2018, updated February 2019). DATA EXTRACTION AND SYNTHESIS Data were screened, extracted and appraised by three independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Studies were markedly heterogeneous in terms of measurement of occupational sitting, cardiometabolic risk factors and cardiovascular morbidity and mortality, so that standards were hardly identifiable and limiting the value of the evidence. The review included 27 high or acceptable quality publications. Of the eight high-quality publications from seven cohorts, three cohort studies found significant associations of occupational sitting with primary outcomes. Additionally, one study described an association with the secondary outcome. Another high-quality publication found an association between occupational sitting and ischaemic heart disease in a subgroup already at risk due to hypertension. For sex/gender analysis, 11 of the 27 high and acceptable quality publications reported sex-stratified results. Five of these found sex differences. CONCLUSIONS Evidence regarding the association of occupational sitting with cardiometabolic health risks was limited because of the lack of standardised measurements for occupational sitting. Occupational sitting combined with an overall sedentary lifestyle was associated with an elevated relative risk for several cardiometabolic outcomes. There is an urgent need for standardised measurements of occupational sitting to facilitate meta-analysis. Sex/gender aspects of this relationship require further investigation.
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Affiliation(s)
- Kathrin Reichel
- Work and Health, Federal Office for Health and Safety in the Workplace Berlin, Berlin, Germany
| | - Michaela Prigge
- Work and Health, Federal Office for Health and Safety in the Workplace Berlin, Berlin, Germany
| | - Ute Latza
- Work and Health, Federal Office for Health and Safety in the Workplace Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eva-Maria Backé
- Work and Health, Federal Office for Health and Safety in the Workplace Berlin, Berlin, Germany
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15
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Ristow B, Doubell A, Derman W, Heine M. Change in resting heart rate and risk for all-cause mortality. Eur J Prev Cardiol 2022; 29:e249-e254. [PMID: 34983058 DOI: 10.1093/eurjpc/zwab231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Brandon Ristow
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Anton Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University.,IOC Research Centre, Cape Town
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University
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16
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Abstract
Regular physical activity is a known protective factor for the prevention of non-communicable diseases such as cardiovascular disease, type 2 diabetes, breast, and colon cancer. Physical activity also has benefits for mental health, delays the onset of dementia, contributes to the maintenance of an adequate body weight and to general well-being. Research on physical activity has mainly focused on leisure and total time, and less on the activity in the workplace. The current guidelines actually recommend physical activity in any form and do not distinguish between the different areas, e.g. physical activity carried out during leisure time, at home or at work. However, new evidence suggests a contrast between the health effects of physical activity in leisure time vs. that in the workplace. In particular, while physical activity, even of high intensity in leisure time, has been associated with positive health outcomes, adverse consequences have been documented for physical activity in the workplace, both in terms of cardiovascular diseases, work absences due to illness and mortality from all causes. These contrasting effects of physical activity in leisure time compared to that in the workplace constitute the so-called 'physical activity paradox'.
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Affiliation(s)
- Pier Luigi Temporelli
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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17
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Hermassi S, Hayes LD, Salman A, Sanal-Hayes NEM, Abassi E, Al-Kuwari L, Aldous N, Musa N, Alyafei A, Bouhafs EG, Schwesig R. Physical Activity, Sedentary Behavior, and Satisfaction With Life of University Students in Qatar: Changes During Confinement Due to the COVID-19 Pandemic. Front Psychol 2021; 12:704562. [PMID: 34659019 PMCID: PMC8515034 DOI: 10.3389/fpsyg.2021.704562] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
This study explored the effects of home confinement on physical activity (PA) and satisfaction with life (SL) among university students during the COVID-19 pandemic. A total of 531 subjects participated [male: n=203; female: n=328; age: 33.1±5.2years; mass: 72.1±17.5kg; height: 1.67±0.12m; and body mass index (BMI): 25.7±5.06 kg/m2]. Online survey questions considered "before" and "during" confinement. Confinement reduced all PA intensities (ηp 2=0.09-0.45, p<0.001) and increased daily sitting time (ηp 2=0.58, p<0.001). The largest reduction was in moderate intensity PA [metabolic equivalent of task-minutes/week (MET), ηp 2=0.45, p<0.001]. SQL decreased, with the score for "I am satisfied with my life" (ηp 2=0.42, p<0.001) decreasing from 28.4±5.7 to 20.6±9.7 arbitrary units (AU). Concerning SL, the largest change was detected for "the conditions of my life are excellent" (ηp 2=0.54, p<0.001). Time changes in all variables were demonstrative of large negative changes in both sexes. The difference in change between sexes was largest in terms of magnitude for the variable "the conditions of my life are excellent" (difference between groups, Δd=0.98). In sum, COVID-19 confinement reduced PA, heightened sitting time, and reduced SL in Qatar University students. This investigation could have a significant impact in developing PA guidelines for health maintainance during COVID-19 and successive pandemics in university students.
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Affiliation(s)
- Souhail Hermassi
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
| | - Lawrence D. Hayes
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Ahmad Salman
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
| | | | - Emna Abassi
- The Movement and Sport Research Center (CeRSM), University of Paris Nanterre, Nanterre, France
| | | | - Nada Aldous
- College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Nemah Musa
- College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Amna Alyafei
- College of Arts and Sciences, Qatar University, Doha, Qatar
| | - El Ghali Bouhafs
- Department of Sports Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - René Schwesig
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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18
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Prince SA, Rasmussen CL, Biswas A, Holtermann A, Aulakh T, Merucci K, Coenen P. The effect of leisure time physical activity and sedentary behaviour on the health of workers with different occupational physical activity demands: a systematic review. Int J Behav Nutr Phys Act 2021; 18:100. [PMID: 34284795 PMCID: PMC8290554 DOI: 10.1186/s12966-021-01166-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
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 .
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Affiliation(s)
- Stephanie A Prince
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Ontario, K1A 0K9, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | | | - Aviroop Biswas
- Institute for Work & Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Tarnbir Aulakh
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | | | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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19
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Halle M, Heitkamp M. Prevention of cardiovascular disease: does 'every step counts' apply for occupational work? Eur Heart J 2021; 42:1512-1515. [PMID: 33831947 DOI: 10.1093/eurheartj/ehab105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Melanie Heitkamp
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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20
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Applying digital technology to promote active and healthy confinement lifestyle during pandemics in the elderly. Biol Sport 2020; 38:391-396. [PMID: 34475622 PMCID: PMC8329971 DOI: 10.5114/biolsport.2021.100149] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023] Open
Abstract
Although recognized as effective measures to curb the spread of the COVID19 outbreak, social distancing and home confinement have generated a mental health burden with older adults who are considered to be more vulnerable to psychosocial strains. To date, the application of digital technologies in response to COVID-19 pandemic has been narrowed to public-health needs related to containment and mitigation. However, information and communications technology (ICT)-based initiatives directed toward prediction and prevention of psychosocial support are still limited. Given the power of digital health solutions to allow easy and accurate characterization and intervention for health and disease, as well as to flatten the COVID19 incidence curves in many countries, our ECLB-COVID19 consortium is highlighting the importance of providing innovative ICT-based solutions (ICT-COVID-Companion) to improve elderly physical and mental health, thereby preventing/dampening psychosocial strain during pandemics. Based on innovative approaches (e.g., emotional/social computing, open social platform, interactive coaching, gamification, fitness-tracker, internet of things) and smart digital solutions (smartwatch/smartphone), smart companions must provide safe personalised physical, mental and psychosocial health surveillance. Additionally, by delivering personalised multi-dimension crisis-oriented health recommendations, such innovative crisis-oriented solutions would help (i) facilitate a user’s adherence to active and healthy confinement lifestyle (AHCL), (ii) achieve a rapid psychosocial recovery in case of depression issues and (iii) enhance preparedness for eventual future pandemics.
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21
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Grazzi G, Mazzoni G, Myers J, Caruso L, Sassone B, Pasanisi G, Guerzoni F, Napoli N, Pizzolato M, Zerbini V, Franchi M, Masotti S, Mandini S, Raisi A, Chiaranda G. Impact of Improvement in Walking Speed on Hospitalization and Mortality in Females with Cardiovascular Disease. J Clin Med 2020; 9:E1755. [PMID: 32517001 PMCID: PMC7357156 DOI: 10.3390/jcm9061755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention program (CR/SP) and associated with the WS maintained during a moderate 1 km treadmill-walk. Three-year mortality rates were 57%, 44%, and 29% for the slow (2.1 ± 0.4 km/h), moderate (3.1 ± 0.3 km/h), and fast (4.3 ± 0.6 km/h) walkers, respectively, with adjusted hazard ratios (HRs) of 0.78 (p = 0.24) and 0.55 (p = 0.03) for moderate and fast walkers compared to the slow walkers. In addition, hospitalization or death was examined four to six years after enrollment as a function of the change in the WS of 176 patients re-assessed during the third year after baseline. The rates of hospitalization or death were higher across tertiles of reduced WS, with 35%, 50%, and 53% for the high (1.5 ± 0.3 km/h), intermediate (0.7 ± 0.2 km/h), and low tertiles (0.2 ± 0.2 km/h). Adjusted HRs were 0.79 (p = 0.38) for the intermediate and 0.47 (p = 0.02) for the high tertile compared to the low improvement tertile. Improved walking speed was associated with a graded decrease in hospitalization or death from any cause in women undergoing CR/SP.
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Affiliation(s)
- Giovanni Grazzi
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
| | - Gianni Mazzoni
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA;
- Stanford Medical School, University of Stanford, Stanford, CA 94305, USA
| | - Lorenzo Caruso
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Biagio Sassone
- Department of Morphology, Surgery & Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Department of Emergency, Division of Cardiology, Cento SS.ma Annunziata Hospital, 44121 AUSL Ferrara, Italy
| | - Giovanni Pasanisi
- Department of Emergency, Division of Cardiology, “Delta” Hospital, AUSL Ferrara, 44121 Ferrara, Italy;
| | - Franco Guerzoni
- Health Statistics Unit, University Hospital, 44121 Ferrara, Italy; (F.G.); (N.N.)
| | - Nicola Napoli
- Health Statistics Unit, University Hospital, 44121 Ferrara, Italy; (F.G.); (N.N.)
| | - Matteo Pizzolato
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Valentina Zerbini
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Michele Franchi
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Sabrina Masotti
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Simona Mandini
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Andrea Raisi
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Giorgio Chiaranda
- General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, 40133 Bologna, Italy;
- Public Health Department, AUSL Piacenza, 29121 Piacenza, Italy
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22
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Opdal IM, Larsen LS, Hopstock LA, Schirmer H, Lorem GF. A prospective study on the effect of self-reported health and leisure time physical activity on mortality among an ageing population: results from the Tromsø study. BMC Public Health 2020; 20:575. [PMID: 32345261 PMCID: PMC7189588 DOI: 10.1186/s12889-020-08681-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background The prevailing Western ideal of ageing in place, with the option to stay at home as one ages, has led to the development of physical activity guidelines for people of advanced age to increase their quality of life and promote their functional abilities. This study investigates the effect of self-reported health and physical activity on mortality and examines how levels of age-specific physical activity affect self-reported health trajectories in an ageing cohort. Methods The sample cohort of the population-based Tromsø Study consists of 24,309 participants aged 25–97 years at baseline. This study involved a survival analysis from 1994 to 2015 and included those who completed two or more surveys (n = 12,241) between 1994 and 2008. The purpose was to examine the relationship between physical activity and self-reported health throughout life using a random coefficient model analysis. Results Being sedentary was associated with an increased risk of mortality in the ageing cohort. Subjects who reported neither light physical activity nor hard physical activity had a 57% (OR 1.57, 1.07–2.31) increased risk of all-cause death. Both hard (OR 2.77, 2.35–3.26) and light (OR 1.52, 1.32–1.76) physical activity were positively associated with self-reported health. The effect was age dependent. Vigorous physical activity was most beneficial for individuals younger than 40 years old, while moderate physical activity levels prolonged the period in which good self-reported health was likely. Conclusions Poor self-reported health and being sedentary were independently associated with an increased risk of mortality in the participants. Furthermore, physical activity prolonged the period of good self-reported health among older adults in two ways: physical activity habits from early adulthood and onwards were beneficial to self-reported health at an advanced age, and self-reported health was dependent on engagement in moderate intensity physical activity after approximately 65 years of age.
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Affiliation(s)
- Ida Marie Opdal
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Lill Sverresdatter Larsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Laila Arnesdatter Hopstock
- Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Fagerjord Lorem
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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23
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Chiesa ST, Charakida M. Physical activity and cardiovascular risk: No such thing as 'Too little, too late'. Eur J Prev Cardiol 2020; 28:e15-e16. [PMID: 33611498 DOI: 10.1177/2047487320920765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Scott T Chiesa
- Institute of Cardiovascular Science, University College London, UK
| | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
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24
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An Estimation of the Worldwide Epidemiologic Burden of Physical Inactivity-Related Ischemic Heart Disease. Cardiovasc Drugs Ther 2020; 34:133-137. [DOI: 10.1007/s10557-019-06926-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Zaccardi F, Franks PW, Dudbridge F, Davies MJ, Khunti K, Yates T. Mortality risk comparing walking pace to handgrip strength and a healthy lifestyle: A UK Biobank study. Eur J Prev Cardiol 2019; 28:704-712. [PMID: 34247229 DOI: 10.1177/2047487319885041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022]
Abstract
AIMS Brisk walking and a greater muscle strength have been associated with a longer life; whether these associations are influenced by other lifestyle behaviours, however, is less well known. METHODS Information on usual walking pace (self-defined as slow, steady/average, or brisk), dynamometer-assessed handgrip strength, lifestyle behaviours (physical activity, TV viewing, diet, alcohol intake, sleep and smoking) and body mass index was collected at baseline in 450,888 UK Biobank study participants. We estimated 10-year standardised survival for individual and combined lifestyle behaviours and body mass index across levels of walking pace and handgrip strength. RESULTS Over a median follow-up of 7.0 years, 3808 (1.6%) deaths in women and 6783 (3.2%) in men occurred. Brisk walkers had a survival advantage over slow walkers, irrespective of the degree of engagement in other lifestyle behaviours, except for smoking. Estimated 10-year survival was higher in brisk walkers who otherwise engaged in an unhealthy lifestyle compared to slow walkers who engaged in an otherwise healthy lifestyle: 97.1% (95% confidence interval: 96.9-97.3) vs 95.0% (94.6-95.4) in women; 94.8% (94.7-95.0) vs 93.7% (93.3-94.2) in men. Body mass index modified the association between walking pace and survival in men, with the largest survival benefits of brisk walking observed in underweight participants. Compared to walking pace, for handgrip strength there was more overlap in 10-year survival across lifestyle behaviours. CONCLUSION Except for smoking, brisk walkers with an otherwise unhealthy lifestyle have a lower mortality risk than slow walkers with an otherwise healthy lifestyle.
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Affiliation(s)
| | - Paul W Franks
- Department of Clinical Sciences, Lund University, Sweden.,Umeå University, Sweden
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC)-East Midlands, University of Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, UK
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