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Original research article
Differing associations for sport versus occupational physical activity and cardiovascular risk
  1. Marco Mario Ferrario1,2,3,
  2. Mattia Roncaioli3,
  3. Giovanni Veronesi1,
  4. Andreas Holtermann4,5,
  5. Els Clays6,
  6. Rossana Borchini2,
  7. Marco Cavicchiolo1,
  8. Guido Grassi7,8,
  9. Giancarlo Cesana7
  10. on behalf of The Cohorts Collaborative Study in Northern Italy (CCSNI) Research Group
    1. 1 Department of Medicine and Surgery, School of Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
    2. 2 Occupational Medicine Unit, University hospital of Varese, Varese, Italy
    3. 3 School of Occupational Medicine, University of Insubria, Varese, Italy
    4. 4 The National Research Centre for the Working Environment, Copenhagen, Denmark
    5. 5 Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
    6. 6 Department of Public Health, Ghent University, Ghent, Belgium
    7. 7 Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
    8. 8 IRCCS Multimedica, Sesto San Giovanni, Italy
    1. Correspondence to Professor Marco Mario Ferrario, Department of Medicine and Surgery, Research Centre on Epidemiology and Preventive Medicine, University of Insubria at Varese, Varese 21100, Italy; marco.ferrario{at}


    Objectives We investigate the independent and interacting long-term associations of occupational physical activity (OPA) and sport physical activity (SpPA) with the incidence of coronary heart disease (CHD) and cardiovascular diseases (CVD; CHD plus ischaemic stroke) in North Italian male workers.

    Methods 3574 employed men aged 25–64 years, free of CVD at baseline, recruited in three population-based and one factory-based cohorts, were included in the analysis. The Baecke Questionnaire was used to assess OPA and SpPA in ‘minutes per week’ of moderate or vigorous PA. We estimated the associations between different domains of PA and the endpoints, adjusting for major CVD risk factors, using Cox models.

    Results During a median follow-up of 14 years, 135 and 174 first CHD and CVD events, fatal and non-fatal, occurred. Compared with the intermediate OPA tertile, the HRs for CHD among low and high OPA workers were 1.66 (95% CI 1.06 to 2.59) and 1.18 (0.72 to 1.94), respectively (P value=0.07). Decreasing trends in CHD and CVD rates across increasing levels of SpPA were also found, with an HR for CVD of 0.68 (0.46 to 0.98) for intermediate/recommended SpPA compared with poor SpPA. We also found a statistically significant SpPA-OPA interaction, and the protective effect of SpPA was only found among sedentary workers, for both endpoints. Conversely, high OPA workers with intermediate/recommended SpPA levels had increased CHD and CVD rates compared with the poor SpPA category.

    Conclusions Our results provide further evidence on the health paradox of OPA, with higher CVD rates among workers with intense PA at work. Moreover, the protective effect on CVDs of SpPA is prominent in sedentary workers, but it attenuates and even reverses in moderate and strenuous OPA workers.

    • physical activity
    • cardiovascular diseases
    • preventive medicine
    • longitudinal studies

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    • Contributors MMF originally conceived the research question. MMF, MR and GV drafted the manuscript and MMF and GV prepared the revisions. MMF is the PI of the SEMM study. MMF and GC are co-PIs of the MONICA Brianza cohorts and GG is PI for the PAMELA study. GV was responsible for the statistical analyses. AH, MC, EC, RB, GG and GC critically revised the text, with particular reference to the introduction and to the discussion sections.

    • Funding This work and the latest activities of the Brianza, PAMELA and SEMM cohorts have been funded by the Health Administration of the Lombardia Region (grants nos. 17155/2004 and 10800/2009). The follow-up was partially supported with grants from the Italian Ministry of Health (grant 2012/597) and it was carried out in collaboration with the Department for Cardiovascular Dysmetabolic and Ageing –Associated Diseases of the Istituto Superiore di Sanità in Rome.

    • Competing interests None declared.

    • Ethics approval The MONICA-Brianza and the PAMELA studies were approved by the Ethical Committee of the University Hospital of Monza (Italy). The SEMM study was approved by the Ethical Committee of the University Hospital of Varese (Italy).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators The Cohorts Collaborative Study in Northern Italy (CCSNI) Research Group: MONICA-Brianza cohorts: PIs: Professor Marco Mario Ferrario, Professor Giancarlo Cesana; Baseline data collection: Professor R Sega, Dr M T Gussoni, Dr F Duzioni, Sig L Bolognesi; Data quality assessment: Dr G Veronesi, Dr C Fornari, Dr L Bertù. PAMELA study: PI: Professor Guido Grassi. Professor R Sega and Professor G Mancia (former PIs). Baseline data collection and follow-up activities: Professor R Sega, Dr M Bombelli. Data quality assessment: Dr R Facchetti. SEMM Study: PI: Professor Marco M Ferrario. Baseline data collection: Dr A Vivaldi. Data quality assessment: Dr G Veronesi, Dr C Fornari, Dr L Bertù. Laboratory and biobanking: Professor P Brambilla, Dr S Signorini.

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