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Do highly physically active workers die early? A systematic review with meta-analysis of data from 193 696 participants
  1. Pieter Coenen1,2,
  2. Maaike A Huysmans1,
  3. Andreas Holtermann3,4,
  4. Niklas Krause5,
  5. Willem van Mechelen1,6,7,8,
  6. Leon M Straker2,
  7. Allard J van der Beek1
  1. 1 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre (VUmc), Amsterdam, The Netherlands
  2. 2 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  3. 3 National Research Centre for the Working Environment, Copenhagen, Denmark
  4. 4 Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  5. 5 Department of Environmental Health Sciences and Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, USA
  6. 6 School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
  7. 7 Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  8. 8 School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Pieter Coenen, Department of Public and Occupational Health Amsterdam, Public Health Research Institute, VU University Medical Center (VUmc), Amsterdam 1081 BT, The Netherlands; P.coenen{at}


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.

  • physical activity
  • meta-analysis

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  • Contributors PC and MAH conducted the literature screening and data extraction of all included papers. All authors (PC, MAH, AH, NK, WvM, LMS and AJvdB) analysed the data and reviewed the manuscript for important intellectual content. AJvdB is the study guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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