The Paradoxical Health Effects of Occupational Versus Leisure-Time Physical Activity

Generally, physical activity (PA) is conceived as among the best investments for a long healthy life and is therefore widely encouraged for the general population. For example, recent PA guidelines for adults recommend at least 150 min a week of moderate-intensity PA or at least 75 min a week of vigorous-intensity PA, without specifying the domain of PA. However, the epidemiological evidence for beneficial health effects and lower mortality associated with higher levels of PA is mostly limited to PA occurring during leisure time (LTPA). In contrast, emerging evidence has shown that high levels of occupational PA (OPA) increase the risk for adverse health outcomes and mortality from cardiovascular diseases and all causes. The observation of differential health effects of OPA and LTPA is referred to as the “PA health paradox.” Up to now, all PA public health guidelines have ignored this paradox, not distinguishing OPA and LTPA. This is unfortunate as OPA of various types and intensities is a fundamental requirement for working people. Most adults spend more than half of their time awake at work, and lower socioeconomic groups are predominantly physically active as part of their work. In-depth knowledge of the PA paradox is therefore fundamental for understanding the physical determinants of the socioeconomic health inequalities in working populations. In this chapter, we give an introduction and historical perspective to the PA health paradox, provide an overview of the current epidemiological evidence for the PA paradox, and reflect on the implications of the PA health paradox for future research, health promotion, and disease prevention.