Are sitting occupations associated with increased all-cause, cancer, and cardiovascular disease mortality risk? A pooled analysis of seven British population cohorts

Exercise-Induced cytokines, diet, and inflammation and their role in adipose tissue metabolism

Background

Obesity poses a significant global health challenge, necessitating effective prevention and treatment strategies. Exercise and diet are recognized as pivotal interventions in combating obesity. This study reviews the literature concerning the impact of exercise-induced cytokines, dietary factors, and inflammation on adipose tissue metabolism, shedding light on potential pathways for therapeutic intervention.

Methodology

A comprehensive review of relevant literature was conducted to elucidate the role of exercise-induced cytokines, including interleukin-6 (IL-6), interleukin-15 (IL-15), brain-derived neurotrophic factor (BDNF), irisin, myostatin, fibroblast growth factor 21 (FGF21), follistatin (FST), and angiopoietin-like 4 (ANGPTL4), in adipose tissue metabolism. Various databases were systematically searched using predefined search terms to identify relevant studies. Articles selected for inclusion underwent thorough analysis to extract pertinent data on the mechanisms underlying the influence of these cytokines on adipose tissue metabolism.

Results and Discussion

Exercise-induced cytokines exert profound effects on adipose tissue metabolism, influencing energy expenditure (EE), thermogenesis, fat loss, and adipogenesis. For instance, IL-6 activates AMP-activated protein kinase (AMPK), promoting fatty acid oxidation and reducing lipogenesis. IL-15 upregulates peroxisome proliferator-activated receptor delta (PPARδ), stimulating fatty acid catabolism and suppressing lipogenesis. BDNF enhances AMPK-dependent fat oxidation, while irisin induces the browning of white adipose tissue (WAT), augmenting thermogenesis. Moreover, myostatin, FGF21, FST, and ANGPTL4 each play distinct roles in modulating adipose tissue metabolism, impacting factors such as fatty acid oxidation, adipogenesis, and lipid uptake. The elucidation of these pathways offers valuable insights into the complex interplay between exercise, cytokines, and adipose tissue metabolism, thereby informing the development of targeted obesity management strategies.

Conclusion

Understanding the mechanisms by which exercise-induced cytokines regulate adipose tissue metabolism is critical for devising effective obesity prevention and treatment modalities. Harnessing the therapeutic potential of exercise-induced cytokines, in conjunction with dietary interventions, holds promise for mitigating the global burden of obesity. Further research is warranted to delineate the precise mechanisms underlying the interactions between exercise, cytokines, and adipose tissue metabolism.

Socioeconomic gradients in 24-hour movement patterns across weekends and weekdays in a working-age sample: evidence from the 1970 British Cohort Study

BACKGROUND

Socioeconomic differences in movement behaviours may contribute to health inequalities. The aim of this descriptive study was to investigate socioeconomic patterns in device-measured 24-hour movement and assess whether patterns differ between weekdays and weekends.

METHODS

4894 individuals aged 46 years from the 1970 British Cohort Study were included. Participants wore thigh-worn accelerometers for 7 days. Movement behaviours were classified in two 24-hour compositions based on intensity and posture, respectively: (1) sleep, sedentary behaviour, light-intensity activity and moderate-vigorous activity; and (2) sleep, lying, sitting, standing, light movement, walking and combined exercise-like activity. Four socioeconomic measures were explored: education, occupation, income and deprivation index. Movement behaviours were considered compositional means on a 24-hour scale; isometric log ratios expressed per cent differences in daily time in each activity compared with the sample mean.

RESULTS

Associations were consistent across all socioeconomic measures. For example, those with a degree spent more time in exercise-like activities across weekdays (10.8%, 95% CI 7.3 to 14.7; ref: sample mean) and weekends (21.9%, 95% CI 17.2 to 26.9). Other patterns differed markedly by the day of the week. Those with no formal qualifications spent more time standing (5.1%, 95% CI 2.3 to 7.1), moving (10.8%, 95% CI 8.6 to 13.1) and walking(4.0%, 95% CI 2.2 to 6.1) during weekdays, with no differences on weekends. Conversely, those with no formal qualifications spent less time sitting during weekdays (-6.6%, 95% CI -7.8 to -4.8), yet more time lying on both weekends (8.8%, 95% CI 4.9 to 12.2) and weekdays (7.5%, 95% CI 4.0 to 11.5).

CONCLUSIONS

There were strong socioeconomic gradients in 24-hour movement behaviours, with notable differences between weekdays/weekends and behaviour type/posture. These findings emphasise the need to consider socioeconomic position, behaviour type/posture and the day of the week when researching or designing interventions targeting working-age adults.

Relationships of Total and Domain-Specific Moderate-to-Vigorous Physical Activity with All-Cause and Disease-Specific Mortality

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.

Occupational Sitting Time, Leisure Physical Activity, and All-Cause and Cardiovascular Disease Mortality

Importance

For the first time, the 2020 World Health Organization guidelines on physical activity recommended reducing sedentary behaviors owing to their health consequences. Less is known on the specific association of prolonged occupational sitting with health, especially in the context of low physical activity engagement.

Objective

To quantify health risks associated with prolonged occupational sitting and to determine whether there is a certain threshold of physical activity that may attenuate it.

Design, Setting, and Participants

This prospective cohort study included participants in a health surveillance program in Taiwan who were followed-up between 1996 and 2017. Data on occupational sitting, leisure-time physical activity (LTPA) habits, lifestyle, and metabolic parameters were collected. Data analysis was performed in December 2020.

Main Outcomes and Measures

The all-cause and cardiovascular disease (CVD) mortality associated with 3 occupational sitting volumes (mostly sitting, alternating sitting and nonsitting, and mostly nonsitting) were analyzed applying multivariable Cox regression models to calculate the hazard ratios (HRs) for all participants and by subgroups, including 5 LTPA levels and a personal activity intelligence (PAI)-oriented metric. Deaths occurring within the initial 2 years of follow-up were excluded to prevent reverse causality.

Results

The total cohort included 481 688 participants (mean [SD] age, 39.3 [12.8] years; 256 077 women [53.2%]). The study recorded 26 257 deaths during a mean (SD) follow-up period of 12.85 (5.67) years. After adjusting for sex, age, education, smoking, drinking, and body mass index, individuals who mostly sat at work had a 16% higher all-cause mortality risk (HR, 1.16; 95% CI, 1.11-1.20) and a 34% increased mortality risk from CVD (HR, 1.34; 95% CI, 1.22-1.46) compared with those who were mostly nonsitting at work. Individuals alternating sitting and nonsitting at work did not experience increased risk of all-cause mortality compared with individuals mostly nonsitting at work (HR, 1.01; 95% CI, 0.97-1.05). For individuals mostly sitting at work and engaging in low (15-29 minutes per day) or no (<15 minutes per day) LTPA, an increase in LTPA by 15 and 30 minutes per day, respectively, was associated with a reduction in mortality to a level similar to that of inactive individuals who mostly do not sit at work. In addition, individuals with a PAI score exceeding 100 experienced a notable reduction in the elevated mortality risk associated with prolonged occupational sitting.

Conclusions and Relevance

As part of modern lifestyles, prolonged occupational sitting is considered normal and has not received due attention, even though its deleterious effect on health outcomes has been demonstrated. In this study, alternating between sitting and nonsitting at work, as well as an extra 15 to 30 minutes per day of LTPA or achieving a PAI score greater than 100, attenuated the harms of prolonged occupational sitting. Emphasizing the associated harms and suggesting workplace system changes may help society to denormalize this common behavior, similar to the process of denormalizing smoking.

Effectiveness of knee pad as an additional device for wheelchairs in improving upper-limb dexterity during seated tasks: a pilot study

[Purpose] This study aimed to examine how supporting the knee from the front with a knee pad affected upper-limb dexterity while sitting. [Participants and Methods] A total of 14 healthy adult males were included in the study. As a measure of upper-limb dexterity, the number of pins was counted when the Purdue pegboard test was performed for 60 seconds. In addition, the ease of task performance was assessed using the visual analogue scale. There were two experimental conditions, with and without knee pad. The paired t-test was used to detect differences between the two conditions. A p-value of 0.05 was considered statistically significant. [Results] The Purdue pegboard test was 29.4 ± 2.5 and 27.9 ± 3.6 pins with and without knee pad, respectively. The VAS was 76.1 ± 10.3 and 62.9 ± 14.1 with and without knee pad, respectively. Both measured values were significantly higher with knee pad than without. [Conclusion] Supporting the knees from the front with knee pad improves upper-limb functionality while sitting, making it easier to perform seated tasks.

Diets, Lifestyles and Metabolic Risk Factors among Corporate Information Technology (IT) Employees in South India

(1) Information Technology (IT) Business Process Outsourcing (BPO), the largest employment sector of India, contributes to rapid economic growth. However, the work of IT employees is sedentary, and the food environments of their worksites expose them to an obesogenic environment. This study aimed to assess their metabolic and lifestyle risk factors. (2) Methods: To examine the health and nutrition status of IT employees, anthropometric, biochemical and clinical assessments were conducted among 183 employees from three IT organizations of varied operational sizes. Their health-, diet- and physical activity-related practices were assessed using a questionnaire. The prevalence of MetS was assessed. Selected biomarker levels were assessed and associated with their self-perceived stress levels. (3) Results: The median age of the employees was 30 years (26-35 years). While 44.02% of employees were overweight, 16.85% of employees were obese. About 3.89% of employees were found to be diabetic, and HDL-C levels were lower than recommended in 64.93% of employees. In all, 29.87% of the study population were considered to have metabolic syndrome since they had metabolic risk scores ≥ 3. Those with metabolic syndrome were significantly older (p = 0.000), and levels of MDA (p = 0.003), homocysteine (p = 0.001), IL-6 (p = 0.017) and IL-4 (p = 0.000) were significantly higher among them. Although the prevalence of MetS was significantly lower among those aged >30 years, the lifestyle risk factors were significantly higher among them. (4) Conclusions: The assessed parameters indicate a high risk of developing NCDs among employees in the IT industry in India. This shows the need for the modification of lifestyle and workplace food and physical activity environments.

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.

Long working hours, sedentary work, noise, night shifts and risk of ischaemic heart disease

OBJECTIVE

Ischaemic heart disease (IHD) is a leading cause of death in Western countries. The aim of this study was to examine the associations between occupational exposure to loud noise, long working hours, shift work, and sedentary work and IHD.

METHODS

This data linkage study included all New Zealanders employed and aged 20-64 years at the time of the 2013 census, followed up for incident IHD between 2013 and 2018 based on hospitalisation, prescription and death records. Occupation and number of working hours were obtained from the census, and exposure to sedentary work, loud noise and night shift work was assessed using New Zealand job exposure matrices. HRs were calculated for males and females using Cox regression adjusted for age, socioeconomic status, smoking and ethnicity.

RESULTS

From the 8 11 470 males and 7 83 207 females employed at the time of the census, 15 012 male (1.9%) and 5595 female IHD cases (0.7%) were identified. For males, there was a modestly higher risk of IHD for the highest category (>90 dBA) of noise exposure (HR 1.19; 95% CI 1.07 to 1.33), while for females exposure prevalence was too low to calculate an HR. Night shift work was associated with IHD for males (HR 1.10; 95% CI 1.05 to 1.14) and females (HR 1.25; 95% CI 1.17 to 1.34). The population attributable fractions for night shift work were 1.8% and 4.6%, respectively. No clear associations with working long hours and sedentary work were observed.

CONCLUSIONS

This study suggests that occupational exposures to high levels of noise and night shift work might be associated with IHD risk.

Office job sitting demand scale: Evidence of construct and predictive validity

Drawing on sedentary behavior and Job Demands-Resources theory, we developed a new scale for assessing office job sitting demand, conceptualized as job demand, and validated it using two independent samples. In Study 1 (N = 252), we developed the items and tested the Office Job Sitting Demand scales' factor structure through exploratory factor analysis. In Study 2 (N = 248), we tested the scales' factorial validity through confirmatory factor analysis. Indicators of measurement invariance showed no differences between participants who engage in leisure-time sport and participants who do not. Moreover, we tested convergent, discriminant, and criterion validity. We found significant positive associations with exhaustion, work pressure, and musculoskeletal complaints. The construct was unrelated to proactive vitality management and relaxation. Our results illustrate the relation between this new job demand in the workplace with employee well-being. Based on our findings, this newly developed instrument is valid and reliable and can be used to assess office job sitting demand to prevent burnout and health complaints.

Exposure to environmental occupational constraints and all-cause mortality: Results for men and women from a 20-year follow-up prospective cohort, the VISAT study. Be aware of shift-night workers!

Objective

To determine the predictive value of the large panel of occupational constraints (OC) on all-cause mortality with a 20-year follow-up, in general population of workers.

Methods

In VISAT prospective cohort study, 3,138 workers (1,605 men; 1,533 women) were recruited during the periodic work health visits conducted by occupational physicians. OC (physical, organizational, psychological and employment categories) were collected through self-questionnaires. Exposure durations of each OC were divided by tertile distribution. Cox-regression models were performed to analyze the associations between all-cause mortality and each OC first separately and simultaneously in a single model.

Results

The mortality rates were higher among exposed participants to most of OC compared to those unexposed. Being exposed and longer exposure increased the risks of all-cause mortality for exposures to carrying heavy loads, loud noise, working more than 48 h/week, starting its first job before 18 years old although these risks became non-significant after adjustments for cardiovascular risk factors. Shift work and night work confirmed a high risk of mortality whatever the adjustments and notably when the other occupational exposures were taking into account, with, respectively: HR: 1.38 (1.01-1.91) and 1.44 (1.06-1.95). After adjustments being exposed more than 13 years to a work requiring getting-up before 5:00 a.m. and more than 16 years in rotating shift work significantly increased the risk of mortality by one and a half.

Conclusion

The links between each OC and all-cause mortality and the role of individual factors were stressed. For night-shift workers, it is urgent to implement preventive strategies at the workplace.

'Just Right' job design: A conceptual framework for sustainable work in rail driving using the Goldilocks Work Paradigm

Excessive physical demand at work has traditionally been connected with adverse health outcomes, but excessive sitting is now also being recognised as an occupational hazard and emerging work-related risk. Traditional preventive occupational health and ergonomics programs are useful but limited through reliance on individual behaviour change and time-diversion from productive work. A new 'Goldilocks Work Paradigm' aims to optimise health and productivity by using movements of productive tasks. Using rail driving as a specific case of a highly sedentary and inflexible working environment, we construct a conceptual framework for designing better jobs, arguing that a theoretical amalgamation of the new Goldilocks Work Paradigm with System Thinking, Participatory Ergonomics, and a Risk Management Framework, is needed, for establishing a unified, strategic approach-a 'just right' job design model. We extend this by outlining a practical process of designing better jobs with tools that can be used to achieve it.

Status of Sedentary Time and Physical Activity of Rural Residents: A Cross-Sectional Population-Based Study in Eastern China

Background

The urbanization process may affect the lifestyle of rural residents in China. Limited information exists on the extent of sedentarism and physical activity (PA) level of rural residents in middle-income countries. This is the first survey on sedentary time (ST) and PA among rural residents in eastern China.

Methods

This cross-sectional observational study randomly samples rural adults from Zhejiang Province in eastern China (n = 1,320). Participants' ST and PA levels were determined from the International Physical Activity Questionnaire Short Form through face-to-face interviews, and the influencing factors of PA levels were assessed through multi-class logistic regression analysis.

Results

The findings showed that the daily ST of the participants ranged from 30 to 660 min, with a median of 240 min (P25, P75:120, 240 min), and 54.6% of participants were sedentary for 240 min or above. The daily ST in men, people aged 18 to 44 years, people with bachelors' degree and above, people working for government agencies or institutions, people with unmarried status, and people with an average income of &lt; 2,000 Yuan was longer than that of other respective groups (p &lt; 0.01). In contrast, the daily ST of people with hypertension or with patients with osteoporosis or osteopenia was less than that of normal people (p &lt; 0.01). Additionally, 69.4% of participants generally had a low level of PA (LPA). Compared with those living in northern Zhejiang, people living in southern Zhejiang who were aged 18–44 years, had bachelor's degree or above, were farmers, and had household incomes below 10,000 Yuan per month were more likely to engage in LPA compared to people &gt; 60 years, with high school or technical education levels or with junior college degrees, working in government agencies and institutions, and with household income above 10,000 Yuan per month (p &lt; 0.05). Furthermore, there was no correlation between ST and PA levels.

Conclusion

Most rural residents in the Zhejiang Province of eastern China had longer daily ST and a LPA. This was predominant in men, young people, highly educated people, unmarried people, and middle to high-income people. Health education programs should be targeted toward specific population groups to decrease the ST and increase PA.

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

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) 1.00, 95% confidence interval (CI) 0.87-1.15] and females (HR 0.95, 95% CI 0.82-1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88-1.49).

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.

Association of occupational sitting with cardiovascular outcomes and cardiometabolic risk factors: a systematic review with a sex-sensitive/gender-sensitive perspective

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.

Identifying opportunities and barriers for introducing a workplace nutrition and health program for employees: Findings from formative research

BACKGROUND: The work style of employees engaged in the Information Technology (IT) and Business Process Outsourcing (BPO) sector in India is dominantly sedentary exposing them to detrimental obesogenic environments with unhealthy diets, increasing the risk of non-communicable diseases (NCDs). Workplace health interventions have been reported to have the potential of reducing NCDs and related risk factors among the employees and thus reduce cost of absenteeism and improve productivity. OBJECTIVE: This formative research study aims to explore the opportunities and barriers of the development and implementation of a Workplace Health Programme (WHP). METHODS: In this study, a mixed method including qualitative and quantitative approaches were used. Focus group discussions (FGDs) were conducted with employees and senior managers in employers of IT/BPO companies of different sizes in Hyderabad, India. The food and physical activity environment in the workplaces were explored using a checklist and ground truthing approach. A Knowledge, Attitudes and Practices (KAP) questionnaire was developed to assess health, nutrition and physical activity of the employees. RESULTS: Through this formative research, the required areas for nutrition, physical activity and health education were identified. The scopes of utilising existing facilities for physical activity and modifying the food environment was explored. We noted optimistic bias among the junior employees who did not consider themselves at risk of developing NCDs. CONCLUSIONS: The identified opportunities and barriers will help in developing strategic WHPs suitable to individual workplaces. The qualitative methods, ground truthing approach, checklist and KAP tools used here can assess the company environment and employee health and nutrition status.

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 .

The physical activity paradox in cardiovascular disease and all-cause mortality: the contemporary Copenhagen General Population Study with 104 046 adults

AIMS

Leisure time physical activity associates with reduced risk of cardiovascular disease and all-cause mortality, while these relationships for occupational physical activity are unclear. We tested the hypothesis that leisure time physical activity associates with reduced major adverse cardiovascular events (MACE) and all-cause mortality risk, while occupational physical activity associates with increased risks.

METHODS AND RESULTS

We studied 104 046 women and men aged 20-100 years in the Copenhagen General Population Study with baseline measurements in 2003-2014 and median 10-year follow-up. Both leisure and occupational physical activity were based on self-report with four response categories. We observed 7913 (7.6%) MACE and 9846 (9.5%) deaths from all causes. Compared to low leisure time physical activity, multivariable adjusted (for lifestyle, health, living conditions, and socioeconomic factors) hazard ratios for MACE were 0.86 (0.78-0.96) for moderate, 0.77 (0.69-0.86) for high, and 0.85 (0.73-0.98) for very high activity; corresponding values for higher occupational physical activity were 1.04 (0.95-1.14), 1.15 (1.04-1.28), and 1.35 (1.14-1.59), respectively. For all-cause mortality, corresponding hazard ratios for higher leisure time physical activity were 0.74 (0.68-0.81), 0.59 (0.54-0.64), and 0.60 (0.52-0.69), and for higher occupational physical activity 1.06 (0.96-1.16), 1.13 (1.01-1.27), and 1.27 (1.05-1.54), respectively. Similar results were found within strata on lifestyle, health, living conditions, and socioeconomic factors, and when excluding individuals dying within the first 5 years of follow-up. Levels of the two domains of physical activity did not interact on risk of MACE (P = 0.40) or all-cause mortality (P = 0.31).

CONCLUSION

Higher leisure time physical activity associates with reduced MACE and all-cause mortality risk, while higher occupational physical activity associates with increased risks, independent of each other.

The Role of Exercise, Diet, and Cytokines in Preventing Obesity and Improving Adipose Tissue

The prevalence of obesity continues to rise worldwide despite evidence-based public health recommendations. The promise to adopt a healthy lifestyle is increasingly important for tackling this global epidemic. Calorie restriction or regular exercise or a combination of the two is accepted as an effective strategy in preventing or treating obesity. Furthermore, the benefits conferred by regular exercise to overcome obesity are attributed not only to reduced adiposity or reduced levels of circulating lipids but also to the proteins, peptides, enzymes, and metabolites that are released from contracting skeletal muscle or other organs. The secretion of these molecules called cytokines in response to exercise induces browning of white adipose tissue by increasing the expression of brown adipocyte-specific genes within the white adipose tissue, suggesting that exercise-induced cytokines may play a significant role in preventing obesity. In this review, we present research-based evidence supporting the effects of exercise and various diet interventions on preventing obesity and adipose tissue health. We also discuss the interplay between adipose tissue and the cytokines secreted from skeletal muscle and other organs that are known to affect adipose tissue and metabolism.

The Effect of Domain-Specific Sitting Time and Exercise Habits on Metabolic Syndrome in Japanese Workers: A Cross-Sectional Study

The effects of domain-specific (i.e., occupational, leisure-time on workday, and holiday) sitting time (ST), and exercise on metabolic syndrome (MetS) development are insufficiently studied. The present study aimed to examine the single and combined effects of each domain-specific ST and exercise habits on MetS. The total and domain-specific STs of 5530 participants were collected using a validated questionnaire. The multiple logistic regression analyses determined the effects of each domain-specific ST and exercise habit on MetS. Of all participants, 7.8% had MetS. Odds ratios (ORs) for MetS were significant only in the group with the longest leisure-time ST on holidays (OR, 1.43; 95% confidence interval [CI], 1.12-1.83); we found no significant associations with any other domain-specific ST after statistical adjustment for confounders. The no-habitual-exercise group clearly had a higher risk for MetS (OR, 1.44; 95% CI, 1.15-1.80). The significantly higher ORs for MetS was shown in only the combined longer total ST (OR, 1.64; 95% CI, 1.12-2.39) and holiday ST (OR, 1.83; 95% CI, 1.30-2.59) with no habitual exercise. These findings suggested that accumulated daily total ST, particularly leisure-time ST on holidays with no-habitual exercise, can increase the risk of MetS and it could possibly be mitigated by habitual exercise.

Time Spent Sitting as an Independent Risk Factor for Cardiovascular Disease

Sedentary behavior is highly prevalent despite growing evidence of adverse effects on the cardiovascular and metabolic system that are independent of the level of recreational physical activity (PA). We present results for the association between sitting time and cardiovascular disease (CVD) from selected cohort and cross-sectional studies published in or after the year 2010 according to the domains where sitting time is accumulated during the day. These include TV viewing, occupational sitting, and sitting during transportation as well as overall sitting. The outcomes considered in this review are total CVD, coronary heart disease, and stroke as well as CVD risk factors-namely, hypertension, hypercholesterolemia, and type 2 diabetes and their associated biomarkers. Finally, several current issues with regard to studying the effects of sitting time on CVD are discussed, including how sedentary behavior is assessed, isotemporal substitution modeling, examination of joint associations for sitting and PA, and benefits of breaks in sitting time. Overall, the scientific evidence supports public health recommendations that encourage adults to limit their sedentary time in order to improve their cardiovascular health.

Physical heaviness of work and sitting at work as predictors of mortality: a 26-year follow-up of the Helsinki Birth Cohort Study

OBJECTIVES

To examine the relationships of late-career physical heaviness of work and sitting at work with mortality. A national-level job exposure matrix was used to determine the occupation-specific level of physical heaviness and sitting.

DESIGN

Prospective cohort study between years 1990 and 2015.

SETTING

Community.

PARTICIPANTS

5210 men and 4725 women from the Helsinki Birth Cohort Study with an occupational code at baseline (ages 45-57 years).

PRIMARY AND SECONDARY OUTCOME MEASURES

Total, cardiovascular (International Classification of Diseases 10th Revision I00-I99), cancer (C00-C97) and external (S00-Y84) mortality.

RESULTS

The exposures, physical heaviness and sitting had a non-linear, inverse relationship. During the 26-year follow-up, 1536 men and 759 women died. Among men, physical heaviness of work was positively associated and sitting at work was negatively associated with all-cause, cardiovascular and external cause mortality but they were not associated with cancer mortality. The HRs for men in the highest quartile of physical heaviness of work compared with men in the lowest quartile were 1.54 (1.31-1.80) for all-cause mortality, 1.70 (1.30-2.23) for cardiovascular mortality and 3.18 (1.75-5.78) for external cause mortality (adjusted for age and years of education). Compared with the lowest quartile, the HRs for the highest quartile of sitting at work among men were 0.71 (0.61-0.82) for all-cause mortality, 0.59 (0.45-0.77) for cardiovascular mortality and 0.38 (0.22-0.66) for external cause mortality. In women, neither physical heaviness of work nor sitting at work was associated with mortality.

CONCLUSIONS

Men in physically heavy work at their late-work career are at higher risk of death than men in physically light work.

Moving to an "Active" Biophilic Designed Office Workplace: A Pilot Study about the Effects on Sitting Time and Sitting Habits of Office-Based Workers

Promising initial insights show that offices designed to permit physical activity (PA) may reduce workplace sitting time. Biophilic approaches are intended to introduce natural surroundings into the workplace, and preliminary data show positive effects on stress reduction and elevated productivity within the workplace. The primary aim of this pilot study was to analyze changes in workplace sitting time and self-reported habit strength concerning uninterrupted sitting and PA during work, when relocating from a traditional office setting to “active” biophilic-designed surroundings. The secondary aim was to assess possible changes in work-associated factors such as satisfaction with the office environment, work engagement, and work performance, among office staff. In a pre-post designed field study, we collected data through an online survey on health behavior at work. Twelve participants completed the survey before (one-month pre-relocation, T₁) and twice after the office relocation (three months (T₂) and seven months post-relocation (T₃)). Standing time per day during office hours increased from T₁ to T₃ by about 40 min per day (p < 0.01). Other outcomes remained unaltered. The results suggest that changing office surroundings to an active-permissive biophilic design increased standing time during working hours. Future larger-scale controlled studies are warranted to investigate the influence of office design on sitting time and work-associated factors during working hours in depth.

Physical activity levels of allied health professionals working in a large Australian metropolitan health district - an observational study

PURPOSE

The aim of this observational cross-sectional study was to determine if allied health professionals working in a large metropolitan health district were meeting the minimal physical activity (PA) recommendations and the proportion that occupational PA contributed to the recommended PA levels. A secondary aim was to determine possible relationships between self-report questionnaire measures of PA and PA measured by accelerometry.

MATERIALS AND METHODS

Allied health professionals, working in the Sydney Local Health District (SLHD) in 2016-2017, completed the Active Australia Survey (AAS), Occupational Sitting and Physical Activity Questionnaire (OSPAQ), International Physical Activity Questionnaire Long form (IPAQ-L), and wore the ActiGraph GT1M accelerometer for 7 days consecutively.

RESULTS

Based on accelerometry results, allied health professionals (N=126) spent a mean (SD) of 51 (23) minutes in moderate-to-vigorous physical activity (MVPA)/day, representing 171% of the total recommended MVPA/day, with work contributing 76% to this recommendation. Participants walked a mean of 10,077 (2,766) steps/day, meeting 100% of the recommended 10,000 steps/day, with work contributing 54% to this recommendation. Sedentary behaviors were predominant throughout the entire day and work day. Compared with the ActiGraph MVPA time measurements, AAS MVPA time showed a fair level of agreement [intraclass correlation coefficient (ICC)=0.44, P<0.01], while OSPAQ and IPAQ-L MVPA time showed no agreement (ICC=0.05, P=0.27; ICC=0.13, P=0.10, respectively).

CONCLUSION

Allied health professionals working in a large metropolitan health district met the daily PA recommendations based on accelerometry measures but tended to overreport their MVPA on self-report questionnaires.

Associations of context-specific sitting time with markers of cardiometabolic risk in Australian adults

Background

High volumes of sitting time are associated with an elevated risk of type 2 diabetes and cardiovascular disease, and with adverse cardiometabolic risk profiles. However, previous studies have predominately evaluated only total sitting or television (TV) viewing time, limiting inferences about the specific cardiometabolic health impacts of sitting accumulated in different contexts. We examined associations of sitting time in four contexts with cardiometabolic risk biomarkers in Australian adults.

Methods

Participants (n = 3429; mean ± SD age 58 ± 10 years) were adults without clinically diagnosed diabetes or cardiovascular disease from the 2011–2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multiple linear regressions examined associations of self-reported context-specific sitting time (occupational, transportation, TV-viewing and leisure-time computer use) with a clustered cardiometabolic risk score (CMR) and with individual cardiometabolic risk biomarkers (waist circumference, BMI, resting blood pressure, triglycerides, HDL- and LDL-cholesterol, and fasting and 2-h post-load plasma glucose).

Results

Higher CMR was significantly associated with greater TV-viewing and computer sitting time (b [95%CI] = 0.07 [0.04, 0.09] and 0.06 [0.03, 0.09]), and tended to be associated with higher occupational and transport sitting time (0.01 [− 0.01, 0.03] and 0.03 [− 0.00, 0.06]), after adjustment for potential confounders. Furthermore, keeping total sitting time constant, accruing sitting via TV-viewing and computer use was associated with significantly higher CMR (0.05 [0.02, 0.08] and 0.04 [0.01, 0.06]), accruing sitting in an occupational context was associated with significantly lower CMR (− 0.03 [− 0.05, − 0.01]), while no significant association was seen for transport sitting (0.00 [− 0.03, 0.04]). Results varied somewhat between the respective biomarkers; however, higher sitting time in each domain tended to be associated detrimentally with individual biomarkers except for fasting glucose (non-significant associations) and systolic blood pressure (a beneficial association was observed). Overall, associations were stronger for TV-viewing and computer use, and weaker for occupational sitting.

Conclusions

Higher context-specific sitting times tended to be detrimentally associated, albeit modestly, with CMR and several cardiometabolic risk biomarkers. There was some evidence suggesting that the context in which people sit is relevant above and beyond total sitting time. Methodological issues notwithstanding, these findings may assist in identifying priorities for sitting-reduction initiatives, in order to achieve optimal cardiometabolic health benefits.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0748-3) contains supplementary material, which is available to authorized users.

Association between physical activity, occupational sitting time and mortality in a general population: An 18-year prospective survey in Tanushimaru, Japan

AIMS

It is well known that a decline in physical activity is associated with an increase of all-cause death including cardiovascular events and cancer. Few studies have examined the association between occupational sitting time and mortality. Therefore, we investigated this issue in a general population.

METHODS

Physical activity and occupational sitting time were measured using the Baecke physical activity questionnaire in 1999. The questionnaire generated indices in three physical activity categories: work, sport and leisure-time. A total physical activity index was calculated by adding these three indices. The Baecke physical activity questionnaire was able to evaluate occupational sitting time. Hazard ratios and 95% confidence intervals (CIs) were calculated using Cox's proportional hazard regression models.

RESULTS

We enrolled a total of 1680 participants, who were followed up for 15.9 ± 3.8 years. The final follow-up rate was 93%. During the follow-up period, 397 subjects died. A significant inverse association (p < 0.0001) was found between physical activity and mortality after adjustment for age and sex. Compared with lower levels of physical activity, the adjusted hazard ratio for mortality at higher levels of physical activity was 0.85 (95% CI: 0.78-0.92). Longer occupational sitting time was also significantly associated with higher mortality (p < 0.01). The adjusted hazard ratio for mortality at longer occupational sitting time was 1.16 (95% CI: 1.05-1.27). These findings were observed in males, but not in females.

CONCLUSIONS

Our data demonstrated that higher levels of physical activity are associated with a reduced risk of cancer and cardiovascular death. Further, longer occupational sitting time is associated with increased mortality.

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.

The relationship and mechanism between education and functional health status transition among older persons in China

BACKGROUND

Despite decades of study, debates exist surrounding the relationship between education and functional health status transition among elderly populations. This study aims to add evidence to the debates using China as a case study. Specifically, this study analysed the association of education with functional health status transition and then the mechanism behind that association using the budget constraint relax hypothesis and the efficiency improvement hypothesis among elderly population in China.

METHODS

Based on data from the Chinese Longitudinal Healthy Longevity Surveys from 2008 and 2011, this study focussed on adults aged 65 years and above, with a final sample size of 12,112. A generalised structural equation model was used to analyse the relationship between education and functional health status transition and the mechanism behind that association.

RESULTS

During the three examined years, among elderly adults who were nondisabled at baseline, 53.1% stayed nondisabled, 14.6% became disabled, and 32.3% died; among those disabled in 2008, 8.1% recovered, 21.6% stayed disabled, and 70.3% died. Compared with older adults without any education, those who had attended primary schools had both lower mortality and disability, whereas those who had attended high schools and above only had a lower mortality rate. The budget constraint relax hypothesis and the efficiency improvement hypothesis explained the majority of the relationship between education and transition from non-disability to death, but hardly explained the transition from non-disability to disability. Furthermore, once a person was disabled, education had no significant relationship with functional ability recovery or mortality.

CONCLUSIONS

Attending primary school seems to provide the highest benefit to functional health status transition among older and nondisabled persons in China. Those who attended high schools and above are expected to live a longer life with disability. The mechanism between education and the onset of disability needs more discussion.

Physical activity and sedentary behavior in patients with Systemic Lupus Erythematosus

Introduction

The aim of this study was to evaluate the proportion of patients with Systemic Lupus Erythematosus (SLE) who did not met the WHO recommendations for physical activity and to evaluate the amount of time spent in sedentary behavior.

Methods

SLE patients were consecutively enrolled in a cross sectional study. The type and the time spent in physical activity and sedentary behavior were evaluated using the IPAQ short form questionnaire. The adequate physical activity was defined according to the 2010 WHO recommendations for health and the sedentary behavior according to the 2017 SBRN consensus. We also assessed quality of life using SF-36, mood disorders using BDI and HAM-H, fatigue using Facit-Fatigue and sleep disorders using PSQI scores.

Results

Physical activity was not sufficient to meet WHO recommendations in 56 of 93 SLE patients (60%). SLE patients spent a median (95% range) of 180 (0–600) minutes everyday in sedentary activities. The length of daily sedentary time was more than 6 hours in 25% of SLE patients. In multivariable analysis, the factors associated to the probability of not meeting WHO criteria was only the time of exposure to antimalarials (OR 0.88, p 0.03) and the factors related to the probability of being in the upper tertile of sedentary time (more than 270 minutes) were age (OR 1.04, p 0.02), disease activity expressed by SELENA-SLEDAI score (OR 1.2, p 0.01) and Facit-fatigue score (OR 0.94, p 0.04).

Conclusion

A relevant proportion of SLE patients were inadequately physically active. It is essential to improve the awareness of the importance of increase physical activity and reduce sedentary time. A better control of disease activity and fatigue and a prolonged use of antimalarials could help to reach this notable goal.

The Relationship Between Occupational Standing and Sitting and Incident Heart Disease Over a 12-Year Period in Ontario, Canada

While a growing body of research is examining the impacts of prolonged occupational sitting on cardiovascular and other health risk factors, relatively little work has examined the effects of occupational standing. The objectives of this paper were to examine the relationship between occupations that require predominantly sitting and those that require predominantly standing and incident heart disease. A prospective cohort study combining responses to a population health survey with administrative health-care records, linked at the individual level, was conducted in Ontario, Canada. The sample included 7,320 employed labor-market participants (50% male) working 15 hours a week or more and free of heart disease at baseline. Incident heart disease was assessed using administrative records over an approximately 12-year follow-up period (2003-2015). Models adjusted for a wide range of potential confounding factors. Occupations involving predominantly standing were associated with an approximately 2-fold risk of heart disease compared with occupations involving predominantly sitting. This association was robust to adjustment for other health, sociodemographic, and work variables. Cardiovascular risk associated with occupations that involve combinations of sitting, standing, and walking differed for men and women, with these occupations associated with lower cardiovascular risk estimates among men but elevated risk estimates among women.

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

INTRODUCTION

Development of evidence-based medicine has made a big change in diagnosis and treatment of chronic low back pain. The recent trend is assessed through a review of literature.

METHODS

The articles published in these 10 years are reviewed, and important points are examined.

RESULTS

In diagnosis, challenges for history taking and limit of imaging or clinical guidelines are revealed. In treatment, cognitive behavioral treatment and exercises are proved effective. Sleep disturbance has recently attracted attention as a factor associated with low back pain. Cost-effectiveness of diagnosis and treatment modalities has come to be emphasized.

CONCLUSIONS

Diagnosis and treatment of chronic low back pain have been significantly changing. Multidisciplinary and multidimensional approach is essential. Chronic low back pain should be treated as a total pain, not a local pain.

Self-reported actual and desired proportion of sitting, standing, walking and physically demanding tasks of office employees in the workplace setting: do they fit together?

OBJECTIVE

Occupational sitting time in white-collar workers represents a prominent contributor to overall daily sitting time, which is associated with various health risks. Workplace interventions intending to reduce sitting time during work typically focus on replacing sitting with standing. The aim was to investigate and compare actual and desired proportions of time spent sitting, standing, walking, and doing physically demanding tasks at work reported by desk-based workers. Cross-sectional data were collected from German desk-based workers (n = 614; 53.3% men; 40.9 ± 13.5 years). All were interviewed about their self-reported actual and desired level of sitting, standing, walking and physically demanding tasks at work.

RESULTS

Desk-based workers reported to sit 73.0%, stand 10.2%, walk 12.9% and do physically demanding tasks 3.9% of their working hours. However, the individuals desire to sit, stand, walk and do physically demand tasks significantly different [53.8% sit, 15.8% stand, 22.8% walk, physically demanding tasks (7.7%), p < 0.001]. The present data revealed greatest mismatch between the desk-based workers' actual and desired time for sitting and walking. Health promotion programs should offer not only options for more standing but also opportunities for more walking within the workplace setting to better match workers' desires.

Site-specific cancer mortality inequalities by employment and occupational groups: a cohort study among Belgian adults, 2001-2011

OBJECTIVE

This study probes into site-specific cancer mortality inequalities by employment and occupational group among Belgians, adjusted for other indicators of socioeconomic (SE) position.

DESIGN

This cohort study is based on record linkage between the Belgian censuses of 1991 and 2001 and register data on emigration and mortality for 01/10/2001 to 31/12/2011.

SETTING

Belgium.

PARTICIPANTS

The study population contains all Belgians within the economically active age (25-65 years) at the census of 1991.

OUTCOME MEASURES

Both absolute and relative measures were calculated. First, age-standardised mortality rates have been calculated, directly standardised to the Belgian population. Second, mortality rate ratios were calculated using Poisson's regression, adjusted for education, housing conditions, attained age, region and migrant background.

RESULTS

This study highlights inequalities in site-specific cancer mortality, both related to being employed or not and to the occupational group of the employed population. Unemployed men and women show consistently higher overall and site-specific cancer mortality compared with the employed group. Also within the employed group, inequalities are observed by occupational group. Generally manual workers and service and sales workers have higher site-specific cancer mortality rates compared with white-collar workers and agricultural and fishery workers. These inequalities are manifest for almost all preventable cancer sites, especially those cancer sites related to alcohol and smoking such as cancers of the lung, oesophagus and head and neck. Overall, occupational inequalities were less pronounced among women compared with men.

CONCLUSIONS

Important SE inequalities in site-specific cancer mortality were observed by employment and occupational group. Ensuring financial security for the unemployed is a key issue in this regard. Future studies could also take a look at other working regimes, for instance temporary employment or part-time employment and their relation to health.

Study on association of working hours and occupational physical activity with the occurrence of coronary heart disease in a Chinese population

Objective

To explore the association of working hours and occupational physical activity (OPA) with the occurrence of coronary heart disease (CHD) in a Chinese population.

Methods

A total of 595 participants (354 and 241 patients with and without CHD, respectively) aged between 24 and 65 were enrolled in our study, which was conducted at the First Affiliated Hospital of Nanjing Medical University between December 2015 and October 2016. Participant characteristics were collected from face-to-face questionnaires, and logistic regression analysis was conducted to examine the association of working hours and OPA with the occurrence of CHD.

Results

Compared with non-employed people, long working hours (especially ≥55 hours/week) contributed to the occurrence of CHD (adjusted odds ratio[OR] = 2.213, 95% confidence interval [CI]: 1.125, 4.355, P = 0.021) after multivariate adjustment in the Chinese population. With the extension of worktime, the CHD risk increased (P for the dose-response trend = 0.022). Meanwhile, even after adjusting for engagement in physical activity during leisure time, sedentary behavior at work had an adverse effect on CHD risk (adjusted OR = 2.794, 95%CI: 1.526, 5.115, P = 0.001), and a linear relationship was also found between OPA and CHD (P for the trend = 0.005).

Conclusions

Long working hours and sedentary behavior at work are associated with a high risk of CHD. In addition, prolonged working hours in sedentary occupations increases the risk of CHD, independent of engagement in leisure time physical activity.

A practical guidance for assessments of sedentary behavior at work: A PEROSH initiative

Sedentary behavior is defined as sitting or lying with low energy expenditure. Humans in industrialized societies spend an increasing amount of time in sedentary behaviors every day. This has been associated with detrimental health outcomes. Despite a growing interest in the health effects of sedentary behavior at work, associations remain unclear, plausibly due to poor and diverse methods for assessing sedentary behavior. Thus, good practice guidance for researchers and practitioners on how to assess occupational sedentary behavior are needed. The aim of this paper is to provide a practical guidance for practitioners and researchers on how to assess occupational sedentary behavior. Ambulatory systems for use in field applications (wearables) are a promising approach for sedentary behavior assessment. Many different small-size consumer wearables, with long battery life and high data storage capacity are commercially available today. However, no stand-alone commercial system is able to assess sedentary behavior in accordance with its definition. The present paper offers decision support for practitioners and researchers in selecting wearables and data collection strategies for their purpose of study on sedentary behavior. Valid and reliable assessment of occupational sedentary behavior is currently not easy. Several aspects need to be considered in the decision process on how to assess sedentary behavior. There is a need for development of a cheap and easily useable wearable for assessment of occupational sedentary behavior by researchers and practitioners.

Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence

The lifestyle factors of physical activity, sedentary behaviour, and diet are increasingly being studied for their associations with cancer. Physical activity is inversely associated with and sedentary behaviour is positively (and independently) associated with an increased risk of more than ten types of cancer, including colorectal cancer (and advanced adenomas), endometrial cancers, and breast cancer. The most consistent dietary risk factor for premalignant and invasive breast cancer is alcohol, whether consumed during early or late adult life, even at low levels. Epidemiological studies show that the inclusion of wholegrain, fibre, fruits, and vegetables within diets are associated with reduced cancer risk, with diet during early life (age <8 years) having the strongest apparent association with cancer incidence. However, randomised controlled trials of diet-related factors have not yet shown any conclusive associations between diet and cancer incidence. Obesity is a key contributory factor associated with cancer risk and mortality, including in dose-response associations in endometrial and post-menopausal breast cancer, and in degree and duration of fatty liver disease-related hepatocellular carcinoma. Obesity produces an inflammatory state, characterised by macrophages clustered around enlarged hypertrophied, dead, and dying adipocytes, forming crown-like structures. Increased concentrations of aromatase and interleukin 6 in inflamed breast tissue and an increased number of macrophages, compared with healthy tissue, are also observed in women with normal body mass index, suggesting a metabolic obesity state. Emerging randomised controlled trials of physical activity and dietary factors and mechanistic studies of immunity, inflammation, extracellular matrix mechanics, epigenetic or transcriptional regulation, protein translation, circadian disruption, and interactions of the multibiome with lifestyle factors will be crucial to advance this field.

[Occupational sedentary behaviors and physical activity at work]

Sedentary behaviors are a leading cause of preventable mortality in developed countries. We mainly have sedentary behaviors at work. Sedentary behaviors must be considered as an occupational risk, and therefore must be a major concern for managers and physicians/health researchers. Recreational physical activity only partly compensates for the negative effects of physical inactivity at work. Physical activity at work without excess (walking, standing) is beneficial. Initiatives to reduce physical inactivity and increase physical activity among employees are effective in terms of mental health, physical health, and productivity. Prevention of sedentary behaviors at work is a win-win partnership between employers and employees.

Individual, Social, and Environmental Correlates of Active Transportation Patterns in French Women

The objectives were (1) to define physical activity (PA) and sedentary behaviors (SB) patterns in daily life contexts (work, leisure, and transportation) in French working women from NutriNet-Santé web-cohort and (2) to identify pattern(s) of active transportation and their individual, social, and environmental correlates. 23,432 participants completed two questionnaires to evaluate PA and SB in daily life contexts and individual representations of residential neighborhood and transportation modes. Hierarchical cluster analysis was performed which identified 6 distinct movement behavior patterns: (i) active occupation, high sedentary leisure, (ii) sedentary occupation, low leisure, (iii) sedentary transportation, (iv) sedentary occupation and leisure, (v) active transportation, and (vi) active leisure. Multinomial logistic regressions were performed to identify correlates of the “active transportation” cluster. The perceived environmental characteristics positively associated with “active transportation” included “high availability of destinations around home,” “presence of bicycle paths,” and “low traffic.” A “positive image of walking/cycling,” the “individual feeling of being physically active,” and a “high use of active transport modes by relatives/friends” were positively related to “active transportation,” identified as a unique pattern regarding individual and environmental correlates. Identification of PA and SB context-specific patterns will help to understand movement behaviors' complexity and to design interventions to promote active transportation in specific subgroups.

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

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

Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults

BACKGROUND/AIM

Evidence for the long-term health effects of specific sport disciplines is scarce. Therefore, we examined the associations of six different types of sport/exercise with all-cause and cardiovascular disease (CVD) mortality risk in a large pooled Scottish and English population-based cohort.

METHODS

Cox proportional hazards regression was used to investigate the associations between each exposure and all-cause and CVD mortality with adjustment for potential confounders in 80 306 individuals (54% women; mean±SD age: 52±14 years).

RESULTS

Significant reductions in all-cause mortality were observed for participation in cycling (HR=0.85, 95% CI 0.76 to 0.95), swimming (HR=0.72, 95% CI 0.65 to 0.80), racquet sports (HR=0.53, 95% CI 0.40 to 0.69) and aerobics (HR=0.73, 95% CI 0.63 to 0.85). No significant associations were found for participation in football and running. A significant reduction in CVD mortality was observed for participation in swimming (HR=0.59, 95% CI 0.46 to 0.75), racquet sports (HR=0.44, 95% CI 0.24 to 0.83) and aerobics (HR=0.64, 95% CI 0.45 to 0.92), but there were no significant associations for cycling, running and football. Variable dose-response patterns between the exposure and the outcomes were found across the sport disciplines.

CONCLUSIONS

These findings demonstrate that participation in specific sports may have significant benefits for public health. Future research should aim to further strengthen the sport-specific epidemiological evidence base and understanding of how to promote greater sports participation.

Where to Sit? Type of Sitting Matters for the Framingham Cardiovascular Risk Score

Background

Current evidence on associations of type-specific sedentary behavior with cardiovascular disease (CVD) is limited to mainly screen-time sedentary behavior (SB). We aimed to study the associations of type-specific and total time spent sitting with the Framingham 10-year cardiovascular disease risk score (Framingham score) in Finnish adults.

Methods

Data comprise the National FINRISK 2007 and 2012 health examination surveys with 10,185 participants aged 25–74 years, apparently free of CVD. Participants reported average daily time spent sitting in different locations: work-related sitting, at home in front of television (TV), at home in front of computer, in a vehicle, and elsewhere. Total SB time was calculated from these context-specific self-reports. Accelerometer-based sedentary time was assessed in 988 FINRISK 2012 participants. Framingham score was calculated using information on blood pressure and its medication, cholesterol levels, age, diabetes status, and smoking. Analyses were adjusted for age, study year, education, employment status, leisure time physical activity, and body mass index.

Results

Out of several type-specific sitting behaviors, only TV sitting showed systematic associations with the Framingham score in both genders. The lowest Framingham risk was found for TV sitting from 6 minutes to less than 1 hour daily. Of other types of sitting, computer sitting was inversely associated with the Framingham risk in men only. Total self-reported sitting time did not show significant associations with the Framingham score, but instead higher objectively assessed sedentary time showed higher Framingham risk in men.

Conclusions

TV sitting showed most systematic associations with CVD risk score. This suggests that of all types of SB, reducing TV sitting should be targeted for reducing CVD risk.

Occupational physical activity in relation to risk of cardiovascular mortality: The Japan Collaborative Cohort Study for Evaluation for Cancer Risk (JACC Study)

We examined the association between patterns of occupational physical activity (OPA) and mortality from cardiovascular disease (CVD) in a Japanese population. A community-based, prospective cohort of 66,161 men and women aged 40-79years without a history of CVD or cancer at baseline (1988-1990) was followed until 2009. OPA was divided into four types: mostly sitting, sitting and standing (sitting/standing), mostly standing, and standing and walking (standing/walking). During follow-up for a median of 19.2years, 3728 deaths from CVD were registered. Compared with mostly sitting OPA, standing/walking OPA was not associated with a reduced risk of CVD mortality for all subjects, but it was associated with a 20% lower risk of CVD mortality among overweight individuals (body mass index ≥25kg/m(2)). Compared with mostly sitting OPA, mostly standing OPA was associated with an approximately 20% higher risk of CVD mortality, especially among overweight individuals or those with lower exercise (<2.5h/week). In conclusion, compared with mostly sitting OPA, standing/walking OPA is associated with lower CVD mortality among overweight individuals, while mostly standing OPA is associated with higher CVD mortality, especially in physically inactive individuals.

Too much sitting and all-cause mortality: is there a causal link?

Background

Sedentary behaviours (time spent sitting, with low energy expenditure) are associated with deleterious health outcomes, including all-cause mortality. Whether this association can be considered causal has yet to be established.

Using systematic reviews and primary studies from those reviews, we drew upon Bradford Hill’s criteria to consider the likelihood that sedentary behaviour in epidemiological studies is likely to be causally related to all-cause (premature) mortality.

Methods

Searches for systematic reviews on sedentary behaviours and all-cause mortality yielded 386 records which, when judged against eligibility criteria, left eight reviews (addressing 17 primary studies) for analysis. Exposure measures included self-reported total sitting time, TV viewing time, and screen time. Studies included comparisons of a low-sedentary reference group with several higher sedentary categories, or compared the highest versus lowest sedentary behaviour groups. We employed four Bradford Hill criteria: strength of association, consistency, temporality, and dose–response. Evidence supporting causality at the level of each systematic review and primary study was judged using a traffic light system depicting green for causal evidence, amber for mixed or inconclusive evidence, and red for no evidence for causality (either evidence of no effect or no evidence reported).

Results

The eight systematic reviews showed evidence for consistency (7 green) and temporality (6 green), and some evidence for strength of association (4 green). There was no evidence for a dose–response relationship (5 red). Five reviews were rated green overall. Twelve (67 %) of the primary studies were rated green, with evidence for strength and temporality.

Conclusions

There is reasonable evidence for a likely causal relationship between sedentary behaviour and all-cause mortality based on the epidemiological criteria of strength of association, consistency of effect, and temporality.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3307-3) contains supplementary material, which is available to authorized users.

Comparison of the Physical Activity and Sedentary Behaviour Assessment Questionnaire and the Short-Form International Physical Activity Questionnaire: An Analysis of Health Survey for England Data

Background

The Physical Activity and Sedentary Behaviour Assessment Questionnaire (PASBAQ), used within the Health Survey for England (HSE) at 5-yearly intervals, is not included annually due to funding and interview-length constraints. Policy-makers and data-users are keen to consider shorter instruments such as the Short-form International Physical Activity Questionnaire (IPAQ) for the annual survey. Both questionnaires were administered in HSE 2012, enabling comparative assessment in a random sample of 1252 adults.

Methods

Relative agreement using prevalence-adjusted bias-adjusted Kappa (PABAK) statistics was estimated for: sufficient aerobic activity (moderate-to-vigorous physical activity [MVPA] ≥150minutes/week); inactivity (MVPA<30minutes/week); and excessive sitting (≥540minutes/weekday). Cross-sectional associations with health outcomes were compared across tertiles of MVPA and tertiles of sitting time using logistic regression with tests for linear trend.

Results

Compared with PASBAQ data, IPAQ-assessed estimates of sufficient aerobic activity and inactivity were higher and lower, respectively; estimates of excessive sitting were higher. Demographic patterns in prevalence were similar. Agreement using PABAK statistics was fair-to-moderate for sufficient aerobic activity (0.32–0.49), moderate-to-substantial for inactivity (0.42–0.74), and moderate-to-substantial for excessive sitting (0.49–0.75). As with the PASBAQ, IPAQ-assessed MVPA and sitting each showed graded associations with mental well-being (women: P for trend = 0.003 and 0.004, respectively) and obesity (women: P for trend = 0.007 and 0.014, respectively).

Conclusions

Capturing habitual physical activity and sedentary behaviour through brief questionnaires is complex. Differences in prevalence estimates can reflect differences in questionnaire structure and content rather than differences in reported behaviour. Treating all IPAQ-assessed walking as moderate-intensity contributed to the differences in prevalence estimates. PASBAQ data will be used for population surveillance every 4 to 5 years. The current version of the Short-form IPAQ was included in HSE 2013–14 to enable more frequent assessment of physical activity and sedentary behaviour; a modified version with different item-ordering and additional questions on walking-pace and effort was included in HSE 2015.

Sedentary behavior and subclinical atherosclerosis in African Americans: cross-sectional analysis of the Jackson heart study

Background

Previous studies have reported conflicting results as to whether an association exists between sedentary time and cardiovascular disease (CVD) risk among African Americans. These studies, however, were limited by lack of consideration of sedentary behavior in leisure versus non-leisure settings. To elucidate this relation, we investigated the associations of television (TV) viewing time and occupational sitting with carotid intima-media thickness (CIMT), a subclinical atherosclerosis measure, in a community-based sample of African Americans.

Methods

We studied 3410 participants from the Jackson Heart Study, a single-site, community-based study of African Americans residing in Jackson, MS. CIMT was assessed by ultrasonography and represented mean far-wall thickness across right and left sides of the common carotid artery. TV viewing time, a measure of leisure sedentary behavior, and occupational sitting, a measure of non-leisure sedentary behavior, were assessed by questionnaire.

Results

In a multivariable regression model that included physical activity and CVD risk factors, longer TV viewing time (2–4 h/day and >4 h/day) was associated with greater CIMT (adjusted mean ± SE difference from referent [<2 h/day] of 0.009 ± 0.008 mm for 2–4 h/day, and 0.028 ± 0.009 mm for >4 h/day; P-trend =0.001). In contrast, more frequent occupational sitting (‘sometimes’ and ‘often/always’) was associated with lower CIMT (adjusted mean ± SE difference from referent [‘never/seldom’]:−0.021 ± 0.009 mm for ‘sometimes’, and−0.018 ± 0.008 mm for ‘often/always’; P-trend = 0.042).

Conclusions

Longer TV viewing time was associated with greater CIMT, while occupational sitting was associated with lower CIMT. These findings suggest the role of sedentary behaviors in the pathogenesis of CVD among African Americans may vary by whether individuals engage in leisure versus non-leisure sedentary behaviors.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0349-y) contains supplementary material, which is available to authorized users.