• epidemiology
• global health
• coronary artery disease

Physical activity is widely considered a magic bullet for the prevention of several non-communicable (eg, cardiovascular) diseases. Regular engagement in physical activity has been advocated in various guidelines such as those developed by the British Cardiovascular Society.1 Moreover, integration of physical activity recommendations in clinical practice, for example, among cardiologists, has often been argued for primary and secondary disease prevention.2 Although the merits of these initiatives appear to be apparent for many, new and emerging evidence suggests that the more the merrier or one size fits all approaches may not benefit everybody.

In their Heart manuscript, Ferrario and colleagues3 have reported on a sample of 3574 North Italian male workers from three different cohorts. From these workers, occupational and sport-related physical activity were assessed by questionnaires, and the incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) was registered during a subsequent 14-year (median) follow-up period. Associations of occupational and sport-related physical activity with CVD and CHD were modelled, taking into account relevant factors including age, education level, different domains of physical activity, body mass index, blood cholesterol, blood pressure, smoking and alcohol use and diabetes. The authors showed that, according to expectation although not statistically significant, the risk …