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Paradox of occupational and leisure-time physical activity associations with cardiovascular disease
  1. Carmen C Cuthbertson1,
  2. Christopher C Moore2,
  3. Kelly R Evenson2
  1. 1 Health Education and Promotion, East Carolina University College of Health and Human Performance, Greenville, North Carolina, USA
  2. 2 Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Carmen C Cuthbertson, Health Education and Promotion, East Carolina University College of Health and Human Performance, Greenville, NC 27858, USA; cuthbertsonc22{at}

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Historical epidemiological studies showed that occupational physical activity was associated with a lower risk of coronary heart disease

For more than 70 years, research indicates that physical activity is good for heart health. Epidemiological research in this area began in the 1950s with the studies of Dr Jeremiah N Morris.1 Morris et al 1 studied how occupations with various levels of physical activity were associated with coronary heart disease (CHD). Morris et al 1 included over 31 000 men employed by the London Transport Executive and examined differences in CHD incidence and CHD death for men who were bus conductors compared with men who were drivers. This early study found that bus conductors, who climbed steps and moved around collecting fares from passengers, had a lower risk of CHD incidence and early CHD death than drivers who spent more time sitting. Morris et al 1 next conducted a similar study with men employed by the Post Office and Civil Service. Postal carriers, who mostly walked, did some stair climbing and light carrying, had a lower risk of CHD and early CHD death than sedentary postal workers, such as telephonists, executives and clerks.

Epidemiological studies transitioned to examining leisure-time physical activity with health outcomes

After these early studies on physical activity in the 1950s, there was a shift to examining leisure-time physical activity (LTPA) rather than occupational physical activity (OPA) with health outcomes. This shift occurred for multiple reasons including contemporaneous transition to jobs with fewer physical demands, better opportunity for intervention with LTPA, and because analyses could be examined for a range of socioeconomic classes.2 A substantial body of evidence indicates that LTPA of moderate-to-vigorous intensity is associated with a lower risk of all-cause mortality and cardiovascular disease (CVD).3 Many physical activity questionnaires ask about type of activity that occurs in different contexts—at work, during leisure, at home and during transport. Some studies have suggested that physical activity that occurs at work may be harmful for health, …

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  • Contributors All authors contributed to the writing of the manuscript.

  • Funding CCM and KRE are supported by the NIH (5R01CA227122): National Cancer Institute, Office of the Director, Office of Disease Prevention, and Office of Behavioral and Social Sciences Research.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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