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Original research
Occupational physical activity and cardiovascular disease in the United States
  1. Tyler D. Quinn1,2,
  2. Patrick L. Yorio1,
  3. Peter M. Smith3,4,
  4. Yongsuk Seo1,
  5. Geoffrey P. Whitfield5,
  6. Bethany Barone Gibbs2
  1. 1National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, USA
  2. 2Health and Human Development, University of Pittsburgh School of Education, Pittsburgh, Pennsylvania, USA
  3. 3Institute for Work & Health, Toronto, Ontario, Canada
  4. 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Tyler D. Quinn, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, USA; yhh7{at}


Background Emerging evidence, predominately from European and Asian countries, describes opposing effects of occupational physical activity (OPA) and leisure-time physical activity (LTPA) on cardiovascular health. This analysis examined cardiovascular disease (CVD) prevalence associated with OPA and LTPA.

Methods This cross-sectional analysis of 2015 National Health Interview Survey data (n=16 974) employed logistic regression to estimate odds (OR) of self-reported CVD (coronary heart disease, heart attack, stroke or angina) with self-reported total occupational activity (TOA), occupational exertion (OE), occupational standing and walking (OSW) and LTPA. OPA was measured using two questions: ‘How often does your job involve…’ (1) ‘repeated lifting, pushing, pulling or bending?’ (OE) and (2) ‘standing or walking around?’ (OSW) with responses on a 5-item Likert scale (0=never, 4=always). TOA was categorised similarly after summing OE and OSW scores. LTPA was defined as 0, 1–149 or ≥150 min/week of moderate-to-vigorous activity. All models adjusted for common socioeconomic variables and additional analyses were stratified by sex, smoking status and LTPA.

Results Odds for CVD were higher when ‘always’ performing TOA (OR 1.99 95% CI 1.12 to 3.53), OE (OR 2.15, 95% CI 1.45 to 3.19) or OSW (OR 1.84, 95% CI 1.07 to 3.17) compared with ‘never’. When restricting to never-smokers, odds for CVD were higher when ‘always’ performing TOA (OR 3.00, 95% CI 1.38 to 6.51) and OE (OR 3.00, 95% CI 1.80 to 5.02) versus ‘never’.

Conclusion Associations of high OPA with CVD were equally apparent across sexes, stronger in lower LTPA levels and stronger in never-smokers. While uncontrolled confounding is still possible, even after extensive adjustment, the seemingly paradoxical adverse associations with OPA and CVD should be investigated further.

  • occupational health practice
  • epidemiology
  • fitness for work
  • cardiovascular
  • physical work

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  • Contributors TDQ, PLY, YS and BBG contributed to analytical design development, analysis and manuscript authorship. PMS and GPW contributed to critical manuscript review and authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. The authors' analyses, interpretations, and conclusions do not necessarily represent the views of the National Center for Health Statistics (NCHS), which is responsible only for the initial data.

  • Competing interests BBG discloses grant funding from the Agency for Healthcare Quality Research, the American Heart Association, the National Institutes of Health, and the Tomayko Fund.

  • Patient consent for publication Not required.

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

  • Data availability statement Public data source: NCHS, National Health Interview Survey, 2015.

  • Author note This work was authored as part of the Contributor’s official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 USC. 105, no copyright protection is available for such works under US Law.

  • 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.

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