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Systematic review
Associations of occupational and leisure-time physical activity with all-cause mortality: an individual participant data meta-analysis
  1. Pieter Coenen1,
  2. Maaike A Huysmans1,
  3. Andreas Holtermann2,3,
  4. Richard P Troiano4,
  5. Paul Jarle Mork5,
  6. Steinar Krokstad5,6,
  7. Els Clays7,
  8. Bart Cillekens1,
  9. Dirk De Bacquer7,
  10. Mette Aadahl8,
  11. Line Lund Kårhus8,
  12. Anette Sjøl9,
  13. Lars Bo Andersen10,
  14. Jussi Kauhanen11,
  15. Ari Voutilainen11,
  16. Richard M Pulsford12,
  17. Emmanuel Stamatakis13,14,
  18. Uri Goldbourt15,
  19. Annette Peters16,17,18,
  20. Barbara Thorand16,18,
  21. Annika Rosengren19,20,
  22. Lena Björck19,20,
  23. Kyle Sprow21,
  24. Kristin Franzon22,
  25. Miguel Rodriguez-Barranco23,24,25,
  26. Leila Luján-Barroso26,27,
  27. Anders Knutsson28,
  28. Lars Alfredsson29,30,
  29. Martin Bahls31,32,
  30. Till Ittermann31,33,
  31. Alexander Kluttig34,
  32. Lamiaa Hassan34,
  33. Miriam Wanner35,36,
  34. Matthias Bopp35,
  35. Jacob Louis Marott37,38,
  36. Peter Schnohr37,
  37. Børge Grønne Nordestgaard37,38,39,40,
  38. Knut Eirik Dalene41,42,
  39. Ulf Ekelund41,42,
  40. Johan Clausen43,
  41. Magnus Thorsten Jensen37,44,45,
  42. Christina Bjørk Petersen8,46,
  43. Niklas Krause47,
  44. Jos Twisk48,
  45. Willem van Mechelen1,
  46. Allard J van der Beek1
  1. 1 Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
  2. 2 National Research Centre for the Working Environment, Copenhagen, Denmark
  3. 3 Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  4. 4 U.S. Public Health Service, Arlington, VA, USA
  5. 5 Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  6. 6 Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
  7. 7 Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  8. 8 Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
  9. 9 The Capital Region of Denmark, Copenhagen, Denmark
  10. 10 Faculty of Education, Arts and Sports, Western Norwegian University of Applied Sciences, Sogndal, Norway
  11. 11 Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
  12. 12 Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
  13. 13 Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
  14. 14 School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  15. 15 Sackler Medical faculty, Tel Aviv University, Tel Aviv, Israel
  16. 16 Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
  17. 17 German Centre for Cardiovascular Research (DZHK e.V.), partner site Munich Heart Alliance, Munich, Germany
  18. 18 Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Pettenkofer School of Public Health, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
  19. 19 Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  20. 20 Department of Medicine Geriatrics and Emergency Medicine/Östra, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
  21. 21 Administration for Strategic Preparedness and Response, Washington DC, Columbia, USA
  22. 22 Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
  23. 23 Escuela Andaluza de Salud Pública (EASP), Granada, Spain
  24. 24 Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
  25. 25 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  26. 26 Unit of Nutrition and Cancer, Catalan Institute of Oncology – ICO, L’Hospitalet de Llobregat, Spain
  27. 27 Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute – IDIBELL, L’Hospitalet de Llobregat, Spain
  28. 28 Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
  29. 29 Centre for Occupational and Environmental Medicine, Stockholm, Region Stockholm, Sweden
  30. 30 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  31. 31 German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
  32. 32 Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
  33. 33 Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
  34. 34 Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
  35. 35 Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
  36. 36 Cancer Registry Zürich, Zug, Schaffhausen and Schwyz, University Hospital Zürich, Zürich, Switzerland
  37. 37 The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, Denmark
  38. 38 The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  39. 39 Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  40. 40 Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  41. 41 Department of Sport Sciences, Norwegian School of Sport Sciences, Oslo, Norway
  42. 42 Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
  43. 43 Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
  44. 44 Steno Diabetes Center Copenhagen, Herlev, Denmark
  45. 45 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  46. 46 National Institute of Public Health, University of Southern Denmark, Odense, Denmark
  47. 47 Fielding School of Public Health, Departments of Epidemiology and Environmental Health Sciences, University of California Los Angeles, Los Angeles, California, USA
  48. 48 Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
  1. Correspondence to Dr Pieter Coenen; p.coenen{at}amsterdamumc.nl

Abstract

Objective Health effects of different physical activity domains (ie, during leisure time, work and transport) are generally considered positive. Using Active Worker consortium data, we assessed independent associations of occupational and leisure-time physical activity (OPA and LTPA) with all-cause mortality.

Design Two-stage individual participant data meta-analysis.

Data source Published and unpublished cohort study data.

Eligibility criteria Working participants aged 18–65 years.

Methods After data harmonisation, we assessed associations of OPA and LTPA with all-cause mortality. In stage 1, we analysed data from each study separately using Cox survival regression, and in stage 2, we pooled individual study findings with random-effects modelling.

Results In 22 studies with up to 590 497 participants from 11 countries, during a mean follow-up of 23.1 (SD: 6.8) years, 99 743 (16%) participants died. Adjusted for LTPA, body mass index, age, smoking and education level, summary (ie, stage 2) hazard ration (HRs) and 95% confidence interval (95% CI) for low, moderate and high OPA among men (n=2 96 134) were 1.01 (0.99 to 1.03), 1.05 (1.01 to 1.10) and 1.12 (1.03 to 1.23), respectively. For women (n=2 94 364), HRs (95% CI) were 0.98 (0.92 to 1.04), 0.96 (0.92 to 1.00) and 0.97 (0.86 to 1.10), respectively. In contrast, higher levels of LTPA were inversely associated with mortality for both genders. For example, for women HR for low, moderate and high compared with sedentary LTPA were 0.85 (0.81 to 0.89), 0.78 (0.74 to 0.81) and 0.75 (0.65 to 0.88), respectively. Effects were attenuated when adjusting for income (although data on income were available from only 9 and 6 studies, for men and women, respectively).

Conclusion Our findings indicate that OPA may not result in the same beneficial health effects as LTPA.

  • Public health

Data availability statement

Data may be obtained from a third party and are not publicly available. All aggregated data are provided in this manuscript, including the supplementary files. Part of the individual participant are available on request, while other parts may be obtained from a third party and are not publicly available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bjsports-2024-108117

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. All aggregated data are provided in this manuscript, including the supplementary files. Part of the individual participant are available on request, while other parts may be obtained from a third party and are not publicly available.

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    Footnotes

    • X @profHoltermann, @richpulsford, @M_Stamatakis

    • Contributors The ‘Active Worker core team’ (authors PC, MH, AH, RPT, PJM, SK, EC, WvM and AJvdB) developed the project’s protocol, including the analysis plan. PC conducted the analyses with the help of BC, while consulting NK and JT. All other authors (DDB, MA, LLK, AS, LBA, JK, AV, RP, ES, UG, AP, BT, AR, LB, KS, KF, MR-B, LL-B, AK, LA, MB, TI, AK, LH, MW, MB, JLM, PS, BGN, KED, UE, JC, MTJ, CBP) contributed by either providing their individual participant data or analysing their data remotely using our analysis plan. AJvdB Is the study guarantor. All authors reviewed the manuscript for important intellectual content.

    • Funding The Active Worker study was funded by The Netherlands Organisation for Health Research and Development; ZonMw (grant number: 531-00141-3). Funding for the SHIP study has been provided by the Federal Ministry for Education and Research (BMBF; identification codes 01 ZZ96030, 1 ZZ0103, 01 ZZ0701). The CARLA study was founded by a grant from the Deutsche Forschungsgemeinschaft (DFG) as part of the Collaborative Research Centre 598 ‘Heart failure in the elderly—cellular mechanisms and therapy’, by an additional single funding grant from the DFG, by three grants of the Wilhelm-Roux-Programme of the Martin-Luther-University of Halle-Wittenberg (FKZ 14/41, 16/19 and 28/21), by the Federal Employment Office, by the Ministry of Education and Cultural Affairs of Saxony-Anhalt (MK-CARLA-MLU-2011) and by the Ministry of Economics, Science and Digitization of Saxony-Anhalt via the EU European Regional Development Fund (ERDF), 'Autonomy in Old Age', BIOSALSA. The Primary Prevention study received support from the Swedish Research Council [2018-02527, 2019-00193]. The MONICA/KORA Augsburg study was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. None of the above funding sources played a role in the development of the study protocol nor in the reporting of the study findings.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Author note The authors confirm that that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.