Associations of occupational and leisure-time physical activity with all-cause mortality: an individual participant data meta-analysis
Pieter Coenen, Maaike A. Huysmans, Andreas Holtermann, Richard P. Troiano, Paul Jarle Mork, Steinar Krokstad, Els Clays, Bart Cillekens, Dirk De Bacquer, Mette Aadahl, Line Lund Kårhus, Anette Sjøl, Lars Bo Andersen, Jussi Kauhanen, Ari Voutilainen, Richard Pulsford, Emmanuel Stamatakis, Uri Goldbourt, Annette Peters, Barbara Thorand, Annika Rosengren, Lena Björck, Kyle Sprow, Kristin Franzon, Miguel Rodríguez‐Barranco, Leila Luján‐Barroso, Anders Knutsson, Lars Alfredsson, Martin Bahls, Till Ittermann, Alexander Kluttig, Lamiaa Hassan, Miriam Wanner, Matthias Bopp, Jacob Louis Marott, Peter Schnohr, Børge G. Nordestgaard, Knut Eirik Dalene, Ulf Ekelund, Johan Clausen, Magnus T. Jensen, Christina Bjørk Petersen, Niklas Krause, Jos W. R. Twisk, Willem van Mechelen, Allard J. van der Beek
Abstract
OBJECTIVE: data, we assessed independent associations of occupational and leisure-time physical activity (OPA and LTPA) with all-cause mortality. DESIGN: Two-stage individual participant data meta-analysis. DATA SOURCE: Published and unpublished cohort study data. ELIGIBILITY CRITERIA: Working participants aged 18-65 years. METHODS: After data harmonisation, we assessed associations of OPA and LTPA with all-cause mortality. In stage 1, we analysed data from each study separately using Cox survival regression, and in stage 2, we pooled individual study findings with random-effects modelling. RESULTS: In 22 studies with up to 590 497 participants from 11 countries, during a mean follow-up of 23.1 (SD: 6.8) years, 99 743 (16%) participants died. Adjusted for LTPA, body mass index, age, smoking and education level, summary (ie, stage 2) hazard ration (HRs) and 95% confidence interval (95% CI) for low, moderate and high OPA among men (n=2 96 134) were 1.01 (0.99 to 1.03), 1.05 (1.01 to 1.10) and 1.12 (1.03 to 1.23), respectively. For women (n=2 94 364), HRs (95% CI) were 0.98 (0.92 to 1.04), 0.96 (0.92 to 1.00) and 0.97 (0.86 to 1.10), respectively. In contrast, higher levels of LTPA were inversely associated with mortality for both genders. For example, for women HR for low, moderate and high compared with sedentary LTPA were 0.85 (0.81 to 0.89), 0.78 (0.74 to 0.81) and 0.75 (0.65 to 0.88), respectively. Effects were attenuated when adjusting for income (although data on income were available from only 9 and 6 studies, for men and women, respectively). CONCLUSION: Our findings indicate that OPA may not result in the same beneficial health effects as LTPA.