Article Text

How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies
  1. Bart Cillekens1,
  2. Matthias Lang1,
  3. Willem van Mechelen1,
  4. Evert Verhagen1,
  5. Maaike A Huysmans1,
  6. Andreas Holtermann2,3,
  7. Allard J van der Beek1,
  8. Pieter Coenen1
  1. 1 Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
  2. 2 National Research Centre for the Working Environment, Copenhagen, Denmark
  3. 3 Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Dr Pieter Coenen, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre (VUmc) Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; p.coenen{at}


Objective Physical activity (PA) has substantial benefits across a range of health outcomes. There is uncertainty about the PA-specific health effects, and in particular, the occupational domain. In this umbrella review, we synthesised available evidence on the associations between occupational PA (OPA) and health-related outcomes (including cancer, all-cause mortality and cardiovascular disease). This work informed the development of WHO’s guidelines on PA and sedentary behaviour (2020).

Design Umbrella review of systematic reviews.

Data source We performed a literature search in PubMed, Web of Science, Embase, CINAHL and Sportdiscuss from database inception to 2 December 2019.

Eligibility criteria for selecting studies We included systematic reviews if they contained a quantitative assessment of OPA and its relationship with at least one health-related outcome.

Results We summarised the evidence of 17 reviews covering 23 unique health-related outcomes. We graded most evidence as low or very low, or moderate quality. We found health benefits for those engaging in high versus low OPA for multiple cancer outcomes (including colon and prostate), ischaemic stroke, coronary heart disease and mental health (ie, mental well-being and life satisfaction). High OPA was associated with unfavourable health outcomes for all-cause mortality in men, mental ill health (ie, depression and anxiety), osteoarthritis, and sleep quality and duration.

Conclusions We found favourable associations for most health-related outcomes with high OPA levels, but we also found some evidence for unfavourable associations due to high OPA levels. At this point, there is a need for better quality evidence to provide a unequivocal statement on the health effects of OPA.

  • physical activity
  • review
  • health

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials


  • Twitter @Evertverhagen, @profHoltermann

  • Contributors BC and ML conducted the literature screening and data extraction of all included reviews. All authors (BC, ML, WvM, EV, MH, AH, AJvdB, PC) reviewed the manuscript for important intellectual content. PC was the study guarantor.

  • Funding This paper was based on a report that was commissioned and funded by WHO. This research was furthermore funded by The Netherlands Organisation for Health Research and Development; ZonMw (grant #: 531-00141-3).

  • 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 AJvdB are director and advisor, respectively, of Evalua Nederland B.V. Both Arbo Unie and Evalua Nederland operate in the Dutch occupational healthcare market.

  • Patient consent for publication Not required.

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

  • 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.