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

Abstract

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

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

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

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

Protocol registration: PROSPERO # CRD42020191708 .

Keywords: Cardiovascular disease; Leisure; Mortality; Occupation; Physical activity; Sedentary behaviour.

Fig. 1

PRISMA flow diagram

Fig. 2

All-cause mortality risk associated with high vs. low LTPA among (a) low OPA group, (b) moderate OPA and (c) high OPA. Each bar represents a study/analysis. The height of each bar indicates the study quality; with higher bars assessed as higher quality with fewer biases. Bars are arranged by publication date moving from oldest to newest. * – Not based on formal statistical testing, but visual trends in the data. ¥ – data compared low LTPA to mod-high LTPA

Fig. 3

Cardiovascular mortality risk associated with the high vs. low LTPA among (a) low OPA, (b) moderate OPA and (c) high OPA. Each bar represents a study/analysis. The height of each bar indicates the study quality; with higher bars assessed as higher quality with fewer biases. Bars are arranged by publication date moving from oldest to newest. * – Not based on formal statistical testing, but visual trends in the data. ¥ – Findings for (a) and (c) are for both coronary heart disease and cardiovascular disease events, for (b) coronary heart disease is trending and cardiovascular disease events are not associated. †Among women in active occupations, findings showed protective effects among those with low body mass index, but detrimental effects among those with high body mass index

Fig. 4

Cardiovascular incidence risk associated with high vs. low LTPA among (a) low OPA (b) moderate OPA and (c) high OPA. Each bar represents a study/analysis. The height of each bar indicates the study quality; with higher bars assessed as higher quality with fewer biases. Bars are arranged by publication date moving from oldest to newest. * – Not based on formal statistical testing, but visual trends of data. ¥ – Trend of increasing risk for coronary heart disease and decreasing for cardiovascular disease. † − Findings are for both coronary heart disease and cardiovascular disease events. ‡ − Includes moderate and active OPA group (greater % active vs. moderate among men, and ~ equal distribution among women). ǂ – Findings are for men without ischemic heart disease

Fig. 5

Musculoskeletal pain risk associated with high vs. low LTPA among (a) low OPA, (b) moderate OPA and (c) high OPA. Each bar represents a study/analysis. The height of each bar indicates the study quality; with higher bars assessed as higher quality with fewer biases. Bars are arranged by publication date moving from oldest to newest. * – Null findings are for left shoulder, elbow or hand pain, whereas there were significant intervention effects for neck pain, right shoulder pain and right hand pain. ¥ – Null findings for both neck-shoulder symptoms, as well as elbow/wrist/hand symptoms using sport frequency per week. † − Findings based on risk of high vs. low trajectory for musculoskeletal pain. ‡ − Data presented for the home-based exercise intervention arm