Last April 9th was published in the European Heart Journal by the European Society of Cardiology (ESC) a first study showing that leisure time physical activity and occupational physical activity have opposite, and independent, associations with cardiovascular disease risk and longevity[1]. The World Health Organization (WHO) recommends physical activity during both recreation and work to improve health.[2]

This study included 104,046 women and men aged 20–100 years from the Copenhagen General Population Study with baseline measurements in 2003–2014. Participants completed questionnaires about activity during leisure and employment and were categorized as low, moderate, high, or very high activity for each.

During a median follow-up of 10 years, there were 9,846 (9.5%) deaths from all causes and 7,913 (7.6%) major adverse cardiovascular events (MACE, defined as fatal and nonfatal myocardial infarction, fatal and non-fatal stroke, and other coronary death).

Compared to low leisure time physical activity, after adjustment for age, sex, lifestyle, health, and education, moderate, high, and very high activity were associated with 26%, 41%, and 40% reduced risks of death, respectively. In contrast, compared to low work activity, high and very high activity were associated with 13% and 27% increased risks of death, respectively.

Professor Holtermann said that many people with manual jobs believe they get fit and healthy by their physical activity at work and therefore can relax when they get home. Unfortunately, the results of this study suggest that this is not the case. And while these workers could benefit from leisure physical activity, after walking 10,000 steps while cleaning or standing seven hours in a production line, people tend to feel tired so that’s a barrier.

Professor Holtermann’s vision is to re-organise occupational activity so that it mimics the beneficial aspects of leisure exercise. Several approaches are being piloted, such as rotating between workstations on a production line so that employees do a “healthy mixture” of sitting, standing, and lifting during a shift. In another study, childcare workers play games together with children, instead of observing, so that both get their heart rate up and increase fitness. “We are trying to vary the tasks, give recovery time, or raise heart rate so there is a fitness and health benefit,” he said.

Professor Holtermann concluded: “Societies need adults with sufficient health and fitness to work longer since the retirement age is increasing. We need to find ways to make active work good for health.”

Low or no physical activity is one of the behavioural risk factors identified by the YOUNG50 project for the Cardiovascular diseases.

The YOUNG50 project, through its Cardio50 screening programme, aims to affect cardiovascular risk factors, given to eight major CVD risk factors, fall into two groups:

  • behavioral risk factors (diet, low physical activity, smoking, alcohol use);
  • medical risk factors (high systolic blood pressure, high total cholesterol, high fasting plasma glucose, and high body mass index (BMI).



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[1] Holtermann A, Schnohr P, Nordestgaard BG, Marott JL. The physical activity paradox in cardiovascular disease and all-cause mortality: the contemporary Copenhagen General Population Study with 104 046 adults. Eur Heart J. 2021.
[2] WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020.