The effect of leisure time physical activity and sedentary behaviour on the health of workers with different occupational physical activity demands: a systematic review

Background Although it is generally accepted that physical activity reduces the risk for chronic non-communicable disease and mortality, accumulating evidence suggests that occupational physical activity (OPA) may not confer the same health benefits as leisure time physical activity (LTPA). It is also unclear if workers in high OPA jobs benefit from LTPA the same way as those in sedentary jobs. Our objective was to determine whether LTPA and leisure time sedentary behaviour (LTSB) confer the same health effects across occupations with different levels of OPA. Methods Searches were run in Medline, Embase, PsycINFO, ProQuest Public Health and Scopus from inception to June 9, 2020. Prospective or experimental studies which examined the effects of LTPA or LTSB on all-cause and cardiovascular mortality and cardiovascular disease, musculoskeletal pain, diabetes, metabolic syndrome, arrhythmias and depression among adult workers grouped by OPA (low OPA/sitters, standers, moderate OPA/intermittent movers, high OPA/heavy labourers) were eligible. Results were synthesized using narrative syntheses and harvest plots, and certainty of evidence assessed with GRADE. Results The review includes 38 papers. Across all outcomes, except cardiovascular mortality, metabolic syndrome and atrial fibrillation, greater LTPA was consistently protective among low OPA, but conferred less protection among moderate and high OPA. For cardiovascular mortality and metabolic syndrome, higher levels of LTPA were generally associated with similar risk reductions among all OPA groups. Few studies examined effects in standers and none examined effects of LTSB across OPA groups. Conclusions Evidence suggests that LTPA is beneficial for all workers, but with larger risk reductions among those with low compared to high OPA jobs. This suggests that, in our attempts to improve the health of workers through LTPA, tailored interventions for different occupational groups may be required. More high-quality studies are needed to establish recommended levels of LTPA/LTSB for different OPA groups. Protocol registration PROSPERO #CRD42020191708. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01166-z.

mortality; there was a minimum of five years of follow-up; and for prospective studies, the analysis adjusted for reverse causality by removing at least the first two years of follow-up.

Supplemental table 1. Search strategies
Ovid MEDLINE(R) ALL (1946 to June 09, 2020) # Searches 1 *occupational health/ or *occupational diseases/ or *job description/ 2 ((occupation* or worker* or working or employe* or personnel or job or jobs or professional? or "at work") adj4 (physical* or labo?r or sit or sitting)).ti,kw,kf. or ((occupation* or worker* or working or employe* or personnel or job or jobs or professional? or "at work") adj4 (physical* or labo?r or sit or sitting)).ab.
18 or/15-17 19 14 and 18 20 (child* or preschool* or pre school* or kindergarten* or toddler* or adolescent* or p?ediatric or school age or ((primary or elementary or middle or high) adj1 school*)).ti. Embase 1941 to June 10 2020 # Searches 1 *occupational health/ or *occupational diseases/ 2 ((occupation* or worker* or working or employe* or personnel or job or jobs or professional? or "at work") adj4 (physical* or labo?r or sit or sitting)).ti,kw. or ((occupation* or worker* or working or employe* or personnel or job or jobs or professional? or "at work") adj4 (physical* or labo?r or sit or sitting)).ab.

17
(intervention* or randomi?ed or (controlled adj2 (study or trial)) or case control* or retrospective 1 exp occupational health/ or exp working conditions/ 2 ((occupation* or worker* or working or employe* or personnel or job or jobs or professional? or "at work") adj4 (physical* or labo?r or sit or sitting)).ti,id. or ((occupation* or worker* or working or employe* or personnel or job or jobs or professional? or "at work") adj4 (physical* or labo?r or sit or sitting)).ab.

3
(active adj3 (travel* or transportation or commut* or transport)).ti,id. or (active adj3 (travel* or transportation or commut* or transport)).ab. /freq=2 4 (((car or cars or vehicle? or bus or buses or subway? or streetcar? or "passive transport") adj4 commut*) or passive transport* or ((drive or driving) adj3 time)).ti,id. or (((car or cars or vehicle? or bus or buses or subway? or streetcar? or "passive transport") adj4 commut*) or passive transport* or ((drive or driving) adj3 time)).ab. /freq=2 5 or/1-4 6 exp exercise/ or physical activity/ or physical fitness/ or running/ or walking/ or swimming/ or exp sports/ or yoga/ or physical education/ or activity level/ 7 ("physical activit*" or walk* or pedestrian* or bicycl* or cycling or cyclist* or biking or bike* or "active lifestyle*" or "aerobic fitness" or "aerobic exercise*" or (running not "running water") or runner* or jog* or swim* or skate or skating or sport* or hockey or basketball or soccer or football or baseball or ski or skiing or volleyball or tennis or badminton or softball or squash or yoga or athlet* or (physical* adj2 (activit* or active or exercise*)) or ((promot* or encourag* or increas*) adj3 (play* or exercise*)) or ((exercise* or fitness or aerobic*) adj2 (regimen* or training or intervention* or program* or class* or course* or train*)) or mvpa).ti,id.

19 not 20
Proquest Public Health (June 11, 2020) ((mesh.exact.explode("cohort studies") OR mesh.exact.explode(case-control studies") OR mesh.exact.explode("clinical trial") OR mesh.exact("Observational study") OR mesh.exact("Randomized controlled trials as Topic") OR mesh.exact("double blind method") OR mesh.exact("single blind method") OR noft((cohort or followup or "follow up" or observational or longitudinal or prospective) NEAR/2 (study or studies)) OR noft(intervention* or randomised or randomized or (controlled NEAR/2 (study or trial)) or "case control*" or retrospective)) AND (((MJMESH.EXACT("Yoga") OR MJMESH. EXACT ) OR ti,if("physical activity" or "physical activities" or walk or walked or walks or walking or pedestrian or pedestrians or bicycle or bicycling or bicycles or bicycled or cycling or cyclist or cyclists or biking or bike or bikes or biked or "active lifestyle" or "active lifestyles" or "aerobic fitness" or "aerobic exercise" or "aerobic exercises" or (running not "running water") or runner or runners or jog or jogging or joggers or jogged or jogs or swim or swimming or swims or swam or skate or skating or skates or skated or sport or sports or hockey or basketball or soccer or football or baseball or ski or skis or skied or skiing or volleyball or tennis or badminton or softball or squash or yoga or athlete or athletes or athletics or ((physical or physically) NEAR/2 (activity or activities or active or exercise or exercises or exercised or exercising)) or (active NEAR/3 (travel or travels or traveled or traveling or transportation or commute or commuting or commuter or commuters or transport)) or ((promote or promoting or promoted or promotes or encourage or encouraged or encourages or encouraging or increase or increases or increased or increasing) NEAR/3 (play or playing or played or plays or exercise or exercises or exercised or exercising)) or ((exercise or exercises or exercised or exercising or fitness or aerobic or aerobics) NEAR/2 (regimen or regimens or training or intervention or interventions or program or programs or programming or programmed or class or classes or course or courses or train or training or trains or trained)) or mvpa)) OR (MESH.EXACT("Sedentary Lifestyle") OR ti,if(sedentar* or stationary) OR ti,if(physical inactivity or ((no or little or none or few or infrequent) NEAR/4 (exercis* or activit*))) OR ti,if(sitting or sit or sits or seated or recline* or reclining or lying or "lie down" or "lay down" or "laying down" or deskbound or (bound NEAR/1 (desk* or chair*))) OR ti,if((screen* NEAR/2 (time or watch* or view*)) OR (video* NEAR/2 (stream* or watch* or time or view*)) OR television* or tv or "t.v." or computer* or laptop* or tablet* or ((brows* or surf* or use* or using) NEAR/2 (internet or web or net))))) AND (MJMESH.EXACT("occupational health") OR MJMESH.EXACT("occupational diseases") OR MJMESH.EXACT("job description") OR ti,if((occupation or occupational or occupations or worker or workers or working or employed or employee or employees or personnel or job or jobs or professional or professionals or "at work") NEAR/4 (physical or physically or labor or labour or sit or sitting)) OR ti,if(active NEAR/3 (travel or travels or traveled or travelling or transportation or commute or commuted or commuting or commutes or transport or transports or transported or transporting)) OR ti,if(((car or cars or vehicle or vehicles or bus or buses or subway or subways or streetcar or streetcars or "passive transport") NEAR/4 (commute or commuted or commuting or commutes)) or "passive transport*" or ((drive or driving) NEAR/3 time))))) NOT ti(child* or preschool* or "pre school*" or kindergarten* or toddler* or adolescent* or pediatric or paediatric or "school age" or ((primary or elementary or middle or high) NEAR/1 school*)) training OR trains OR trained ) ) OR mvpa ) ) OR ( TITLE ( sedentar* OR stationary OR "physical inactivity" OR ( ( no OR little OR none OR few OR infrequent ) W/4 ( exercis* OR activit* ) ) OR sitting OR sit OR sits OR seated OR recline* OR reclining OR lying OR "lie down" OR "lay down" OR "laying down" OR deskbound OR ( bound W/1 ( desk* OR chair* ) ) OR ( screen* W/2 ( time OR watch* OR view* ) ) OR ( video* W/2 ( stream* OR watch* OR time OR view* ) ) OR television* OR tv OR "t.v." OR computer* OR laptop* OR tablet* OR ( ( brows* OR surf* OR use* OR using ) W/2 ( internet OR web OR net ) ) ) ) ) AND ( TITLE-ABS-KEY ( ( ( cohort OR followup OR "follow up" OR observational OR longitudinal OR prospective ) near/2 ( study OR studies ) ) OR intervention* OR randomised OR randomized OR ( controlled W/2 ( study OR trial ) ) OR "case control*" OR retrospective ) ) AND NOT TITLE ( child* OR preschool* OR "pre school*" OR kindergarten* OR toddler* OR adolescent* OR pediatric OR paediatric OR "school age" OR ( ( primary OR elementary OR middle OR high ) near/1 AND school* ) ) 13 Supplemental The higher the frequency of strenuous PA, the lower the risk of depression.
Workers with a sedentary job who engaged in strenuous PA at least 1-2 x per week were at a significantly lower risk of depression than those who engaged in strenuous PA < 1 x month.
No significant association between strenuous PA and a lower risk of depression in workers with a non-sedentary job. Workers with a sedentary job who engaged in strenuous PA once to twice a week, but not at a higher frequency, were at a reduced risk of future depression.
In contrast, the relation between strenuous PA (1-2 times per week) and a reduced risk of future depression was not found in workers with a non-sedentary job. an increased coronary event incidence, although the fully adjusted association was no longer significant when combined with high OPA while it became borderline significant in combination with low physical job demands.

CVD & IHD Incidence
In men with low OPA, there appears to be an independent protective effect of moderate to high LTPA with CHD. No beneficial association of LTPA was observed in workers exposed to high OPA. Ferrario, 2018 *CHD events Low, medium, high OPA

Model: Cox proportional hazards
Covariates: age, cohort type, education, BMI, total cholesterol, HDL, SBP, smoking, diabetes, alcohol Among men, moderate or high levels of LTPA were strongly associated with a reduced risk of CHD among men with low OPA, but the protective effect of LTPA was not seen among those with a more physically active work.
Among women, LTPA was associated with a reduced risk of CHD at all levels of OPA.
In addition, commuting PA had a moderate inverse association with CHD risk.
Men with high levels of all three types of PA had a lower ageadjusted risk of CHD as compared with the least active men.
In women, the risk reduction was even larger.
Exclusion of the participants who died during the first 2 years of follow-up did not appreciably change the results (data not shown). The associations of CHD with the combined measure of either the cumulative or the most recent OPA and LTPA were significant (p = .0007 for the interaction between LTPA and cumulative OPA; p = .005 for the interaction between LTPA and most recent OPA).
increased risk of CHD. Highest increased risk of CHD was among women who performed moderate to high OPA and low LTPA. Being in the group that watched the most television was not statistically associated with higher all-cause mortality.