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Is there a ‘recent occupational paradox’ where highly active physically active workers die early? Or are there failures in some study methods?
  1. Roy J Shephard
  1. Faculty of Kinesiology and Physical Education, University of Toronto, Brackendale, Ontario, Canada
  1. Correspondence to Professor Roy J Shephard, Faculty of Kinesiology and Physical Education, University of Toronto, Brackendale, ON M5S, Canada; royjshep{at}

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Occupational epidemiology studies in the 1980s and 1990s demonstrated a beneficial effect of physically active employment on risks of premature death,1 with HR of ~1.50 for sedentary employees (see the online supplement for a detailed discussion). However, that accepted wisdom was disputed in a recent meta-analysis which claimed that male employees faced ‘detrimental health consequences associated with high-level occupational activity, even after adjusting for relevant factors’.2 Such a view challenges existing physical activity guidelines and poses the intriguing problem why occupational activity might be bad for men but not women.

Here the author scrutinises the choice of articles for this meta-analysis, the characteristics of apparently hazardous activity and potential confounding by covariates, focusing on the male data. Possible reasons why women do not show an occupational paradox are discussed in the online supplemental material.

Supplementary file


Choice of articles: search strategy

Articles for the meta-analysis were drawn from 13 countries, but 5 of 16 were written by the study authors, leading to some similarities in the determination of active individuals and choice of co-variates. Moreover, participants in 5 of 16 studies lived around Copenhagen, with a potential for subject overlap; the author does not believe that this was evaluated. Studies provided ~30 to 5668 male …

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  • Contributors RJS is the sole contributor.

  • 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.

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

  • Data sharing statement There are no additional unpublished data relevant to this paper.

  • Patient consent for publication Not required.