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Towards a better understanding of the ‘physical activity paradox’: the need for a research agenda
  1. Pieter Coenen1,
  2. Maaike A Huysmans1,
  3. Andreas Holtermann2,3,
  4. Niklas Krause4,
  5. Willem van Mechelen1,
  6. Leon M Straker5,
  7. Allard J van der Beek1
  1. 1 Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, 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 Department of Environmental Health Sciences and Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
  5. 5 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Dr Pieter Coenen, Department of Public and Occupational Health, VU University Medical Centre, 1081 HV Amsterdam, Netherlands; p.coenen{at}

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Several studies have suggested that a ‘physical activity (PA) paradox’ may exist—that is, the well documented beneficial health effects of leisure-time physical activity (LTPA) are not found for occupational physical activity (OPA). A BJSM editorial has outlined potential explanations for such a paradox.1 A recent systematic review has provided some empirical evidence that men, but not women, engaging in high (compared with low) level OPA have an 18% (95% CI 5% to 34%) increased risk of all-cause mortality.2 Nonetheless, the existence of this paradox has been questioned in a discussion paper by Professor Roy Shephard.3 Below we expand on three limitations this discussion paper raised and suggest a research agenda for generating more conclusive evidence regarding this paradox.

Cohort study origin

The current evidence originated from certain regions including Scandinavia, Spain, Iran and Israel. It was suggested that this restricted geographical representation weakens the evidence. However, relatively good working conditions in western European and Scandinavian countries could attenuate the negative health effects of OPA. Studies from countries with higher work demands and/or higher environmental temperatures are likely to provide evidence for even larger negative health effects. Apart from physical work demands, other factors (eg, LTPA or socioeconomical gradients) may also vary between countries and may have an impact on the association between OPA and health. The restricted origin of evidence also raises the possibility …

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  • Correction notice This article has been corrected since it published Online First. The funding statement has been corrected.

  • Contributors All authors (PC, MH, AH, NK, WvM, LS and AvdB) reviewed the manuscript for important intellectual content. AvdB is the study guarantor.

  • Funding This study has been funded by The Netherlands Organisation for Health Research and Development; ZonMw (grant #: 531-00141-3). The funding body played no role in the development of this protocol.

  • Competing interests For the avoidance of doubt, WvM wishes to declare that he is a non-executive board member of Arbo Unie B.V. WvM and AvdB are director-shareholders of Vrije University Medical Center (VUmc) spin-off company Evalua Nederland B.V. Both Arbo Unie and Evalua operate in the Dutch occupational healthcare market. There are no conflicts of interest reported by the other authors.

  • Patient consent for publication Not required.

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