Cardiorespiratory Fitness in Occupational Groups-Trends over 20 Years and Future Forecasts

Cardiorespiratory fitness in midlife and subsequent incident depression, long-term sickness absence, and disability pension due to depression in 330,247 men and women

OBJECTIVE

Specific information for whom and when cardiorespiratory fitness (CRF) is associated with depression risk is lacking. We aimed to study the association between adulthood CRF and incident depression, long-term sickness absence, and disability pension due to depression, as well as examine moderation of sex, age, education, and occupation on associations.

METHODS

A large prospective cohort study follows participants over time with Swedish occupational health screenings data. The study includes 330,247 individuals (aged 16-79 years, 46% women) without a depression diagnosis at baseline. CRF was estimated from a submaximal cycle test.

RESULTS

CRF was associated beneficially from low to higher levels with incident depression and long-term sickness absence due to depression. Further, CRF at high levels (≥46 ml/min/kg) was associated with a decreased risk of receiving disability pension due to depression. The associations remained after adjustment for age and sex, but not lifestyle-related factors and co-morbidity. Participants with moderate and high CRF had 16% and 21%, respectively, lower risk for incident depression, and participants with high CRF had 11% lower risk for long-term sickness absence due to depression. Associations between higher CRF and the outcomes were mainly evident in men, younger participants, and individuals with low education.

CONCLUSION

In a large sample of adults without a depression diagnosis at baseline, higher CRF was shown to be beneficially related to the risk of incident depression and, to some extent, long-term sickness absence due to depression. If causal, targeted interventions focusing on increasing CRF in these sub-groups should be prioritized.

Global status of cardiorespiratory fitness and physical activity - Are we improving or getting worse?

Despite heightened recognition of the importance of cardiorespiratory fitness (CRF) to cardiovascular (CV) health, along with updated international consensus guidelines for physical activity (PA) and sedentary behavior (SB), significant proportions of the global adult population are physically inactive, and do not meet the threshold for CRF. Physical inactivity is considered a surrogate for low CRF given that the former is defined as not reaching the recommended minimum level of PA per week to derive a health benefit. Physical inactivity remains a major global public health problem despite decades of work by various United Nations agencies, and members of the international community to improve PA levels. Given the common coupling between physical inactivity and poor health status, it is reasonable to suggest that for a significant proportion of the global population, CRF is compromised by physical inactivity. This poses a longer-term risk to morbidity and mortality. Here we provide an indicative summary of the global status of CRF and PA and reference the implications for global health. We briefly reference opportunities moving forward, including reinforcement of the importance of engaging in movement from an early age, discouraging SB, and taking a life course approach to optimise healthy living for all.

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

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

The impact of cardiorespiratory fitness and physical workload on disability pension-a cohort study of Swedish men

OBJECTIVE

Understanding the impact of physical capacity in combination with high physical workload could be beneficial for the prevention of health-related exits from work. Therefore, the aim of this study was to investigate the separate and combined effects of low cardiorespiratory fitness and high physical workload on disability pension (DP) due to any cause, musculoskeletal disorders (MSD), and cardiovascular diseases (CVD).

METHODS

A total of 279 353 men born between 1951 and 1961 were followed regarding DP between 2006 and 2020, ages 45-64. Cardiorespiratory fitness was assessed during military conscription, using an ergometer bicycle test. Physical workload was based on a job-exposure matrix (JEM) linked to occupational title in 2005. Cox regression models estimated separate and combined associations with DP.

RESULTS

Low cardiorespiratory fitness and high physical workload were associated with increased risk of DP. For all cause DP, the fully adjusted hazard ratio and 95% confidence interval for those with low cardiorespiratory fitness was 1.38 (1.32-1.46) and for those with high physical workload 1.48 (1.39-1.57). For all cause and MSD DP, but not for CVD DP, the combination of low cardiorespiratory fitness and high physical workload resulted in higher risks than when adding the effect of the single exposures.

CONCLUSION

Both low cardiorespiratory fitness in youth and later exposure to high physical workload were associated with an increased risk of DP, where workers with the combination of both low cardiorespiratory fitness and a high physical workload had the highest risks (all-cause and MSD DP).

Long Term Cardiovascular Health Effects of Intelligent Physical Exercise Training Among Office Workers-A 2 Year Follow up of a Randomized Controlled Trial

OBJECTIVE

The aim of the study is to assess long-term effects of intelligent physical exercise training (IPET) on cardiorespiratory fitness (VO 2max ) and cardiometabolic measures.

METHODS

Office workers were randomized to a control group (CG, n = 194) or a training group (TG, n = 193). The TG received 1-hour weekly IPET during paid working hours for 2 years and recommendations to perform 30-minute leisure time physical activity 6 d/wk (LPA).

RESULTS

Training group compared with CG demonstrated a significantly larger increase in VO 2max of 0.13 ± 0.06 L/min and improved cardiometabolic measures at 1-year follow-up that were maintained at 2-year follow-up, with larger increases in VO 2max among high-adherence participants.

CONCLUSIONS

Intelligent physical exercise training and LPA showed the potential for long-term improved VO 2max and cardiometabolic measures. These findings emphasize the effectiveness of integrating IPET during paid working hours, and the significance of adherence to training was underlined.

What Can One Minute of the Day Tell about Physical Activity?

High cardiorespiratory fitness (CRF) allows individuals to perform daily activities and operate at a higher intensity level. This study investigates the connection between the CRF and peak intensity of physical activity (PA) in absolute and relative terms. A total of 3587 participants (1447 men, 51.9 ± 13.0 years; 2140 women, 50.0 ± 13.0 years) provided substantial accelerometer wear time, and their CRF was estimated via the 6 min walking test. Participants were divided into CRF thirds by age group and sex. Daily one-minute peak intensities were captured in both absolute terms and relative to individual CRF levels. In absolute terms, the highest CRF third had the highest intensity value for men (6.4 ± 1.7 MET; 5.9 ± 1.4 MET; 5.3 ± 1.0 MET) and for women (6.4 ± 1.6 MET; 5.9 ± 1.3 MET; 5.4 ± 1.1 MET). In relative terms, the highest CRF third utilized the least aerobic capacity for men (49 ± 14%; 51 ± 13%; 56 ± 14%) and for women (52 ± 13%; 54 ± 12%; 62 ± 15%). One minute of daily activity offers valuable insights into an individual's CRF and the effort demanded during PA. Fitter individuals can sustain higher PA intensity levels in absolute terms, whereas individuals with lower CRF utilize a greater fraction of their aerobic capacity. Consequently, heightened CRF not only allows for enhanced intensity levels but also safeguards against strenuous PA during daily routines.

Physical Work Demands of Maintenance Workers on Onshore Petroleum Facilities in Norway: An Observational Study Utilizing Wearable Sensor Technology

OBJECTIVES

High physical work demands can cause musculoskeletal disorders and sick leave in petroleum workers. However, our knowledge of their physical work demands is scarce and based on self-report. The objective of our study is to work towards closing this knowledge gap by assessing the physical work demands of onshore petroleum maintenance workers using body-worn sensors.

METHODS

A total of 46 of 69 eligible maintenance workers (37 mechanics and 9 process technicians) from three onshore petroleum facilities in Norway filled in a questionnaire and diary and wore five accelerometers and a heart rate sensor for up to six consecutive workdays. Work-related physical activity and postures were classified using rule-based modelling in a modified version of the validated Acti4 software.

RESULTS

The onshore maintenance petroleum workers were working an average of 10 h a day and spent on average this time with 48% (SD = 16.5) sitting, 1% (SD = 2.8) lying down, 39% (SD = 16.2) in light physical activity, and 9% (SD = 3.8) in moderate to vigorous physical activity. During work hours while at feet, we found arm elevation ≥60° to be 11% (SD = 7.1) (68 min), and forward bending of the trunk ≥60° to be 2% (SD = 2.2) (14 min). The workers spent 2% (SD = 2.5) (12 minu) of the workhours kneeling. We observed a high inter-individual variation for all these work exposures. Moreover, 26% (12) of the workers conducted static standing for >30% of the workday, and 17% (8) spent more than half of the work hours >33% of their estimated maximal cardiovascular capacity.

CONCLUSIONS

While onshore maintenance petroleum workers on average spend about half of the workday sitting or lying down, the remaining worktime is spent with a rather high duration of arm elevation and forward bending. Quite high fraction of the workers spends much of the workhours in static standing and kneeling. We see a substantial variation in these work exposures between the workers. The findings indicate a need for preventive measures in how work is organized and performed.

Accelerometer-Measured Physical Behavior and Cardiorespiratory Fitness as Indicators of Work Ability

Work ability (WA) reflects an individual's resources, work demands, and related environment. Self-reports have shown that higher physical activity (PA) is associated with better WA. This study investigated associations of accelerometer-measured (24/7) physical behavior and cardiorespiratory fitness (CRF) with WA. In the FinFit2017-population-based study, the physical behavior of 20-69-year-old working Finns was measured in terms of PA, standing, and sedentariness using validated MAD-APE algorithms based on raw triaxial accelerometer data. During waking hours, the accelerometer was hip-worn, while during the time in bed (TIB), it was worn on the non-dominant wrist. CRF was measured with a 6 min walk test. WA was assessed by four questions excerpted from the Work Ability Index (WAI), called the short WAI (sWAI). Participants (n = 1668, mean age 46.6, SD = 10.9, 57% women) scored on average 23.3 on the sWAI (range 6-27), with a higher value indicating a better WA. More minutes in standing (p = 0.001) and in moderate (p = 0.004) and vigorous PA (p < 0.001) as well as a higher step number (p < 0.001) and better CRF (p < 0.001) were associated with a higher sWAI value. More time spent lying down (p < 0.001) and in high-movement (p < 0.001) and total TIB (p = 0.001) was associated with a lower sWAI. Detailed analysis of 24/7 physical behavior can be utilized in identifying individual-related indicators of WA.

Relationships between psychosocial well-being and leisure time physical activity among 160.000 young Finnish men: a cross-sectional study during 2015-2021

Evidence on the relationship between psychosocial well-being and physical activity (PA) is insufficient, especially in young adults between 18 and 29 years. Identifying protective factors for psychosocial well-being as well as factors that may promote PA behaviour in this specific age group is crucial.The aim of the present study was to explore the association between self-reported leisure time physical activity (LTPA) and a number of measures of psychosocial well-being in a large sample of Finnish young men. The sample used for this study is based on registers of the Finnish Defence Forces and consist of questionnaire-based data collected from 159,776 young healthy men (18-29 years, mean age 19 years) who started their military service during the period from 2015 to 2021. Sum scores were calculated for self-esteem and prosocial behaviour. Physical activity, number of friends and the relationship with the parents were each measured with a single question. Unadjusted and adjusted (education, financial situation of the family, family structure) logistic regression models were calculated.A multinominal logistic regression analysis showed that a higher level of LTPA was associated with a higher level of both prosocial behaviour (OR 6.12, 95% CI 5.88-6.36) and self-esteem (OR 4.41 95% CI 4.28-4.54). Further, LTPA had a positive relationship with good social relations, both with peers and parents. The odds ratio for participation in any LTPA weekly was higher (OR 2.74; CI 2.27-3.20) among those who had a close and trustworthy relationship with their parents compared to those men with more challenging relationships with their parents (OR 1.77; CI 1.46-2.14). An inactive lifestyle (PA less than once a week) seemed to be most common among men with no friends. About one third (31%) of men with no friends reported to engage in LTPA less than once a week, while only 10% of men with very many good friends reported to engage in similarly inactive LTPA behaviour.LTPA seems to be positively associated with self-esteem, prosocial behaviour and good social relations among young adult men. Actions aimed at promoting LTPA may have a positive impact on psychosocial well-being among young men, or vice versa. The relationship between PA and psychosocial well-being is complex and interrelated.

Correlates of cardiorespiratory fitness in a population-based sample of middle-aged adults: cross-sectional analyses in the SCAPIS study

OBJECTIVES

This study aimed to identify main sex-specific correlates of cardiorespiratory fitness (CRF) in a population-based, urban sample of Swedish adults.

DESIGN

Cross-sectional.

SETTING

Multi-site study at university hospitals, data from the Gothenburg site.

PARTICIPANTS

A total of 5308 participants (51% women, aged 50-64 years) with a valid estimated VO₂max, from submaximal cycle test, in the Swedish CArdioPulmonary bioImage Study (SCAPIS), were included.

PRIMARY AND SECONDARY OUTCOMES

A wide range of correlates were examined including (a) sociodemographic and lifestyle behaviours, (b) perceived health, anthropometrics and chronic conditions and (c) self-reported as well as accelerometer-derived physical activity and sedentary behaviours. Both continuous levels of estimated VO₂max as well as odds ratios (OR) and confidence intervals (CI)s of low VO₂max (lowest sex-specific tertile) were reported.

RESULTS

In multivariable regression analyses, higher age, being born abroad, short education, high waist circumference, poor perceived health, high accelerometer-derived time in sedentary and low in vigorous physical activity, as well as being passive commuter, correlated independently and significantly with low VO₂max in both men and women (OR range 1.31-9.58). Additionally in men, financial strain and being an ex-smoker are associated with higher odds for low VO₂max (OR 2.15; 95% CI 1.33 to 3.48 and OR 1.40; 95% CI 1.09 to 1.80), while constant stress with lower odds (OR 0.61; 95% CI 0.43 to 0.85). Additionally in women, being a regular smoker is associated with lower odds for low VO₂max (OR 0.64; 95% CI 0.45 to 0.92).

CONCLUSIONS

The present study provides important reference material on CRF and correlates of CRF in a general middle-aged population, which can be valuable for future research, clinical practice and public health work. If relations are causal, increased knowledge about specific subgroups will aid in the development of appropriate, targeted interventions.

Psychosocial job stressors and risk of suicidal behavior - an observational study among Swedish men

OBJECTIVE

This study aimed to explore the relationship between psychosocial job stressors and suicidal behavior (fatal and non-fatal) among Swedish men while controlling for potential confounders.

METHODS

Population-based Swedish longitudinal cohort study of male conscripts without previous self-harm (N=1 483 310) enlisting 1968-2002. Conscription examinations included measures of IQ, stress resilience and psychiatric diagnoses. Job demand-control (JDC) exposure was assessed using the Swedish Job Exposure Matrix linked to specific occupations. Suicidal behavior among men aged 30-64 was identified in the National Hospital Register (non-fatal self-harm) and Swedish Cause of Death Register (suicide) during follow-up 2002-2014. Cox regression models were used to estimate associations between JDC category and suicidal behavior.

RESULTS

In fully adjusted models, passive jobs (low demand-low control) showed the highest risk of suicidal behavior [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.25-1.43] compared to those with low strain (low demand-high control), followed by high strain (high demand-low control) (HR 1.12, 95% Cl 1.03-1.22). A lower risk of suicidal behavior was found in the active category, where levels of both demand and control are high (HR 0.64, 95% Cl 0.60-0.70). Separate analyses for suicide as outcome revealed a lower risk of suicide in persons with active jobs (high demands-high control). The passive category showed a higher risk for suicide, but the association did not remain after adjustment for stress resilience and IQ.

CONCLUSIONS

These results show that psychosocial job stressors among men are associated with risk for suicidal behavior. Improving job control has the potential to decrease suicidal behavior for this group.

Cardiorespiratory fitness is associated with sickness absence and work ability

Background

Physical activity may sustain the physical aspect of work ability despite health problems such as musculoskeletal disorders and anxiety, which are the most prevalent work-related health problem in Europe.

Aims

To evaluate the association of Finnish municipal workers’ accelerometer-measured physical activity, sedentary behaviour, and cardiorespiratory and muscular fitness with their sickness absence levels, perceived work ability and health-related quality of life.

Methods

In connection with a randomized controlled trial recruiting 185 municipal workers, the authors performed baseline data analysis utilizing quantile regression to examine relationships between the outcome variables (all-cause sickness absence for 6 months, perceived work ability and health-related quality of life) and cardiorespiratory fitness, muscular fitness, and physical activity, and sedentary behaviour. All results were adjusted for age, sex and education level.

Results

The median duration of all-cause sickness absence over the preceding 6 months was lowest among participants with high cardiorespiratory fitness relative to the lowest tertile (2.0 versus 6.0 days; P < 0.05), and the highest perceived work ability was found among those with high or moderate cardiorespiratory fitness as compared to the lowest tertile (8.0 versus 7.0; P < 0.001). Moderate-to-vigorous physical activity correlated positively with the physical component of health-related quality of life (P < 0.01) and with a high cardiorespiratory-fitness level (P < 0.05).

Conclusions

High cardiorespiratory fitness was associated with decreased all-cause sickness absence days and improved work ability among municipal workers.

The objectively measured physical work demands and physical capacity of offshore wind technicians: An observational field study

We aimed to assess the physical capacity and physical work demands of wind service technicians (WT) in different field conditions (onshore and offshore workdays). We recruited 27 male WTs (mean age of 31 years (SD: ±7), VO₂max of 46 mL O2/kg/min (SD: ±7)) and assessed their physical work demands for a total of 110 workdays using heart rate monitors and accelerometers at five body placements. On average, each day, sitting was the most recorded activity (43%), followed by standing (19%), lying (13%) moving (9%), walking (8%) and high intensity physical activities (1%). Additionally, 1 minute was spent on vertical climbing, 20 minutes on work with forward bent trunk, 13 minutes on work with elevated arms and 6 minutes kneeling. The average cardiovascular load was 22% and 4 minutes per day were spent at high cardiovascular intensities. We found significantly higher demands on offshore compared with onshore workdays.

The effect of two multi-component behavior change interventions on cognitive functions

Background

We previously reported the effects of two cluster-randomized 6-month multi-component workplace interventions, targeting reducing sedentary behavior or increasing physical activity among office workers, on movement behaviors and cardiorespiratory fitness. The primary aim of this study was to investigate the effects of these interventions on cognitive functions compared to a wait-list control group. The secondary aims were to examine if changes in cognition were related to change in cardiorespiratory fitness or movement behaviors and if age, sex, or cardiorespiratory fitness moderated these associations.

Methods

Both interventions encompassed multi-components acting on the individual, environmental, and organizational levels and aimed to change physical activity patterns to improve mental health and cognitive function. Out of 263 included participants, 139 (mean age 43 years, 76% females) completed a neuropsychological test battery and wore accelerometers at baseline and 6-month follow-up. The intervention effect (aim 1) on cognitive composite scores (i.e., Executive Functions, Episodic Memory, Processing Speed, and Global Cognition) was investigated. Additionally, associations between changes in movement behaviors and cardiorespiratory fitness, and changes in cognition were examined (aim 2). Moreover, age, sex, and cardiorespiratory fitness level were investigated as possible moderators of change associations (aim 3).

Results

Overall, cognitive performance improved from baseline to follow-up, but the change did not differ between the intervention groups and the control group. Changes in cardiorespiratory fitness or any movement behavior category did not predict changes in cognitive functions. The association between changes in time in bed and changes in both Executive Function and Global Cognition were moderated by age, such that a more positive relation was seen with increasing age. A less positive association was seen between changes in sedentary behavior and Processing Speed for men vs. women, whereas higher cardiorespiratory fitness was related to a more positive association between changes in moderate-intensity physical activity and Global Cognition.

Conclusion

The lack of an intervention effect on cognitive functions was expected since the intervention did not change movement behavior or fitness. Age, sex, and cardiorespiratory fitness level might moderate the relationships between movement behaviors and cognitive functions changes.

Trial registration

ISRCTN92968402. Registered 09/04/2018.