Abstract
The interplay of occupational and leisure time physical activity (LTPA) in affecting cardiovascular health is subject to debate. This study aimed to examine the independent and interacting associations of leisure time and occupational physical activity (OPA) with the incidence of coronary events within the BELSTRESS cohort. The study included 14,337 middle-aged men free from coronary heart disease at baseline. Standardized questionnaires and clinical examinations were used to assess socio-demographic factors, level of physical activity, job strain and classical coronary risk factors. The incidence of clinical coronary events was monitored during a mean follow-up time of 3.15 years. Results demonstrated overall a beneficial relation of LTPA and an adverse relation of physical work demands with cardiovascular health. However, an interaction effect between both physical activity types was observed, showing that men with high physical job demands who also engaged in physical activity during leisure time had an almost four times increased incidence of coronary events after adjusting for socio-demographic and classical coronary risk factors (HR 3.82; 95 % CI 1.41–10.36). Stratified analyses revealed that moderate to high physical activity during leisure time was associated with a 60 % reduced incidence rate of coronary events in men with low OPA (age adjusted HR 0.40; 95 % CI 0.21–0.76), while this protective association was not observed in workers being exposed to high physical work demands (age adjusted HR 1.67; 95 % CI 0.63–4.48). These findings suggest that recommendations regarding LTPA should be tailored according to the level of occupational physical activity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil. 2008;15:247–57.
Holtermann A, Mortensen OS, Burr H, Sogaard K, Gyntelberg F, Suadicani P. Physical demands at work, physical fitness, and 30-year ischaemic heart disease and all-cause mortality in the Copenhagen Male Study. Scand J Work Environ Health. 2010;36:357–65.
Holtermann A, Burr H, Hansen JV, Krause N, Sogaard K, Mortensen OS. Occupational physical activity and mortality among Danish workers. Int Arch Occup Environ Health. 2012;85:305–10.
Krause N, Brand RJ, Kaplan GA, Kauhanen J, Malla S, Tuomainen TP, et al. Occupational physical activity, energy expenditure and 11-year progression of carotid atherosclerosis. Scand J Work Environ Health. 2007;33:405–24.
Krause N. Physical activity and cardiovascular mortality–disentangling the roles of work, fitness, and leisure. Scand J Work Environ Health. 2010;36:349–55.
Kukkonen-Harjula K. Physical activity and cardiovascular health-work and leisure differ. Scand J Work Environ Health. 2007;33:401–4.
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423–34.
World Health Organization. Global recommendations on physical activity for health. Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data; 2010.
Holtermann A, Mortensen OS, Burr H, Sogaard K, Gyntelberg F, Suadicani P. The interplay between physical activity at work and during leisure time–risk of ischemic heart disease and all-cause mortality in middle-aged Caucasian men. Scand J Work Environ Health. 2009;35:466–74.
Holtermann A, Mortensen OS, Sogaard K, Gyntelberg F, Suadicani P. Risk factors for ischaemic heart disease mortality among men with different occupational physical demands. A 30-year prospective cohort study. BMJ Open. 2012;2:e000279.
Holtermann A, Marott JL, Gyntelberg F, Sogaard K, Suadicani P, Mortensen OS, et al. Occupational and leisure time physical activity: risk of all-cause mortality and myocardial infarction in the Copenhagen City Heart Study. A prospective cohort study. BMJ Open. 2012;2:e000556.
Hu G, Jousilahti P, Borodulin K, Barengo NC, Lakka TA, Nissinen A, et al. Occupational, commuting and leisure-time physical activity in relation to coronary heart disease among middle-aged Finnish men and women. Atherosclerosis. 2007;194:490–7.
Pelfrene E, Vlerick P, Mak R, De Smet P, De Backer G, Kornitzer M. Scale reliability and validity of the Karasek ‘job demand-control-support’ model in the Belstress-study. Work Stress. 2001;15:297–313.
Houtman I, Kornitzer M, De Smet P, Koyuncu R, De Backer G, Pelfrène E, et al. Job stress, absenteism and coronary heart disease European cooperative study (JACE Study): design of a multicenter prospective study. Eur J Public Health. 1999;9:52–7.
ILO. International Standard Classification of Occupations: ISCO-88. Geneva: International Labour Office; 1990.
Karasek R, Theorell T. Healthy work. Stress, productivity, and the reconstruction of working life. New York: Basic Books; 1990.
Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol. 1998;3:322–55.
De Bacquer D, Pelfrene E, Clays E, Mak R, Moreau M, De Smet P, et al. Perceived job stress and incidence of coronary events: three year follow-up of the BELSTRESS cohort. Am J Epidemiol. 2005;161:434–41.
Eaton CB, Medalie JH, Flocke SA, Zyzanski SJ, Yaari S, Goldbourt U. Self-reported physical activity predicts long-term coronary heart disease and all-cause mortalities. Twenty-one-year follow-up of the Israeli Ischemic Heart Disease Study. Arch Fam Med. 1995;4:323–9.
Lopes C, Santos AC, Azevedo A, Maciel MJ, Barros H. Physical activity and risk of myocardial infarction after the fourth decade of life. Rev Port Cardiol. 2005;24:1191–207.
Salonen JT, Slater JS, Tuomilehto J, Rauramaa R. Leisure time and occupational physical activity: risk of death from ischemic heart disease. Am J Epidemiol. 1988;127:87–94.
Glagov S, Zarins C, Giddens DP, Ku DN. Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. Arch Pathol Lab Med. 1988;112:1018–31.
Holtermann A, Hansen JV, Burr H, Sogaard K, Sjogaard G. The health paradox of occupational and leisure-time physical activity. Br J Sports Med. 2012;46:291–5.
Karlqvist LK, Harenstam A, Leijon O, Scheele P. Excessive physical demands in modern worklife and characteristics of work and living conditions of persons at risk. Scand J Work Environ Health. 2003;29:363–77.
Bouchard C, Blair SN, Church TS, Earnest CP, Hagberg JM, Hakkinen K, et al. Adverse metabolic response to regular exercise: is it a rare or common occurrence? PLoS ONE. 2012;7:e37887.
Acknowledgments
BELSTRESS was supported by grants from the Federal Office for Scientific, Technical, and Cultural Affairs (ST/02/007), the FWO-Vlaanderen, and the National Fund for Scientific Research (FNRS).
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Clays, E., De Bacquer, D., Janssens, H. et al. The association between leisure time physical activity and coronary heart disease among men with different physical work demands: a prospective cohort study. Eur J Epidemiol 28, 241–247 (2013). https://doi.org/10.1007/s10654-013-9764-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-013-9764-4