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Original research
Leisure-time and occupational physical activity and health outcomes in cardiovascular disease
  1. Nadia E Bonekamp1,
  2. Frank L J Visseren1,
  3. Ynte Ruigrok2,
  4. Maarten J M Cramer3,
  5. Gert Jan de Borst4,
  6. Anne M May5,
  7. Charlotte Koopal1
  8. on behalf of the UCC-SMART Study group
    1. 1Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
    2. 2University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
    3. 3Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
    4. 4Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
    5. 5Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
    1. Correspondence to Dr Frank L J Visseren, Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, PO Box 85500, 3508 GA, The Netherlands; F.L.J.Visseren{at}umcutrecht.nl

    Abstract

    Objective In healthy populations, leisure-time physical activity (LTPA) improves health outcomes, while, paradoxically, occupational physical activity (OPA) is associated with detrimental health effects. This study aimed to investigate the associations of LTPA and OPA with mortality, cardiovascular events and type 2 diabetes (T2D) in patients with cardiovascular disease (CVD).

    Methods In 7058 outpatients with CVD (age 61±10 years, 75% male) from the prospective Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort, Cox models were used to quantify the associations between self-reported LTPA and OPA and all-cause mortality, cardiovascular events and T2D.

    Results Over 8.6 years (IQR: 4.6–12.5) of follow-up, 1088 vascular events, 1254 deaths and 447 incident T2D cases occurred. The top LTPA quarter had a lower risk of all-cause mortality (HR 0.63, 95% CI 0.54 to 0.74), recurrent cardiovascular events (HR 0.72, 95% CI 0.60 to 0.84) and incident T2D (HR 0.71, 95% CI 0.55 to 0.93), compared with the lowest quarter. The continuous LTPA associations were reverse J-shaped for all-cause mortality and vascular events and linear for T2D. OPA (heavy manual vs sedentary) showed a trend towards an increased risk of all-cause mortality (HR 1.08, 95% CI 0.86 to 1.35), cardiovascular events (HR 1.15, 95% CI 0.91 to 1.45) and T2D (HR 1.04, 95% CI 0.72 to 1.50). The detrimental effects of higher OPA were more pronounced in men, never-smokers, people with higher education and active employment.

    Conclusions In patients with CVD, LTPA was associated with lower risk of all-cause mortality, recurrent cardiovascular events and incident T2D. In contrast, OPA seemed to increase the risk of these outcomes. These findings support the existence of a physical activity paradox in patients with CVD.

    • diabetes mellitus
    • epidemiology
    • stroke
    • coronary artery disease
    • peripheral vascular diseases

    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • Collaborators On behalf of the UCC-SMART Study group.

    • Contributors NEB was responsible for designing the work, performing data analyses, interpreting the results and drafting the manuscript. YR, MJMC, GJdB and AMM were responsible for revising the manuscript. CK was responsible for designing the work, interpreting the results and revising the manuscript. FLJV was responsible for designing the work, interpreting the results and revising the manuscript, and is the manuscript’s guarantor.

    • Funding The UCC-SMART Study was financially supported by a grant from the University Medical Center Utrecht, the Netherlands. The research presented in this paper was supported by a grant from the Regio Deal Foodvalley (162135).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.