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Physical activity lowers cardiovascular risk – Always and everywhere?

Comment by Nicolle Kränkel, EACPR Exercise, Basic and Translational Research Section

High occupational physical activity and risk of ischaemic heart disease in women: The interplay with physical activity during leisure time
Karen Allesøe et al.
European Journal of Preventive Cardiology December 2015;22 (12): 1601-1608


Spending long periods sitting  during leisure time is acknowledged to increase cardiovascular risk. Vice versa, higher leisure time physical activity (PA) improves a number of cardio-metabolic parameters and is associated with lower cardiovascular mortality. Several recent studies, however, indicate that high PA at work does not lessen cardiovascular risk in the same way, and can not substitute for leisure time PA [1, 2, 3].

Allesoe et al. investigated the impact of occupational and leisure time PA on the risk to develop ischaemic heart disease (IHD) in female 12.093 nurses over a duration of 14 years [1]. The authors observed an inverse relation between leisure time PA and IHD risk, but a U-shaped association between occupational PA intensity and IHD risk [1]. In combination, nurses with “sedendary” classification in both, work and leisure time had a 3-fold higher hazard ratio (HR 3.31 or 2.81) than participants with moderate work PA and vigorous leisure time PA (HR 1). A similarly high risk (HR 3.30 or 2.65) was reported for nurses who were sedentary during leisure time, but with high PA at work. In line with this finding, recent studies from Belgium and Israel also report higher hazard ratios for various outcomes for the groups with the highest PA levels at work [2, 3].  Hence, strenuous PA at work does not compensate for low activity during leisure  time and might even confer additional risk.

How can the U-shaped relation between occupational PA level and risk be explained? Covariate analyses imply additional lifestyle factors, including smoking and alcohol consumption [1, 2], as well as  mental stress to influence IHD risk in the group with the highest occupational PA: In the study by Allesoe et al., nurses with high occupational PA were also more likely to work non-day shifts and more often felt that they had a high work pressure and less job influence [1]. High leisure time PA was able to lessen IHD risk under these conditions. Leisure time PA might therefore also provide an opportunity for mental regeneration in persons with jobs requiring high physical activity, but also mental stress or dissatisfaction.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


1    Allesøe K, Holtermann A, Aadahl M, Thomsen JF, Hundrup YA, Søgaard K. High occupational physical activity and risk of ischaemic heart disease in women: The interplay with physical activity during leisure time. Eur J Prev Cardiol. 2015;22(12):1601-8.
doi: 10.1177/2047487314554866.
2    Harari G, Green MS, Zelber-Sagi S. Combined association of occupational and leisure-time physical activity with all-cause and coronary heart disease mortality among a cohort of men followed-up for 22 years. Occup Environ Med. 2015;72(9):617-24.
doi: 10.1136/oemed-2014-102613.
3    Clays E, Lidegaard M, De Bacquer D, Van Herck K, De Backer G, Kittel F, de Smet P, Holtermann A. The combined relationship of occupational and leisure-time physical activity with all-cause mortality among men, accounting for physical fitness. Am J Epidemiol. 2014;179(5):559-66.
doi: 10.1093/aje/kwt294.    

Notes to editor

Nicolle Kränkel, Charité – Universitätsmedizin Berlin, Berlin Germany