The current findings should be replicated using cohort data from various global regions

Evidence is restricted to studies from mainly Scandinavian and western European countries

Make use of existing cohort data to longitudinally study health effects of occupational physical activity

Device-based methods of (occupational and leisure-time) physical activity should be used

Occupational and leisure-time physical activity is typically assessed by questionnaires with relatively low validity, prone to random error and bias

Rather crude categories for physical activity created for analyses may have led to misclassification

Consider various characteristics of physical activity, including nature, frequency, intensity, duration, accumulation, breaks, postures, cardiovascular and biomechanical loading

Prevent physical activity misclassification by not using crude categories and by not using arbitrary sample distributions for cut-points (eg, tertiles or quartiles). Existing cohort studies could be re-analysed using such methods

Confounding and effect modification should be addressed more extensively

The possibility of residual confounding, with differences in the way confounding factors were considered and how these factors were measured

Some evidence suggested effect modification, for example, by gender or cardiovascular disease

Adjust for relevant confounding factors or conduct stratified analyses, using individual participant data, or re-analysing existing cohort data

Males and females should be analysed separately to explore gender differences

Alternative research designs should be applied to get a better understanding of the causality of the association

Causality of the association of occupational physical activity and health outcomes is not well understood

Controlled experimental studies are the preferred design option, but they may be difficult to conduct.

Alternative research designs could therefore be considered.10 For example, negative control studies could be used. Alternatively, a natural experiment of an occupational group making a transition from highly physically demanding work to robotised physically inactive work could be analysed