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Physical activity health paradox: reflections on physical activity guidelines and how to fill research gap
  1. Andreas Holtermann1,2
  1. 1Department of Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Copenhagen, Denmark
  2. 2Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Andreas Holtermann, National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, Denmark; aho{at}

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Researchers, policy-makers, health professionals and the general population acknowledge the health benefits of regular physical activity.1 While adults predominantly are physically active as part of their job (ie, occupational physical activity), the evidence on physical activity and health is mainly limited to physical activity during leisure time.2

Researchers have questioned if occupational physical activity provides the same health benefits as leisure time physical activity—termed the physical activity health paradox.3 A systematic review and meta-analysis from 2018 among almost 200 000 participants found high occupational physical activity to be associated with an increased risk for all-cause mortality among men.4 After this review, large observational studies have found conflicting associations between occupational physical activity and health. One Scandinavian study found high occupational physical activity to be associated with increased mortality risk.5 Another Scandinavian study reported a beneficial association,6 while a third study from the UK found neither a beneficial nor a harmful association.7 The contrasting findings from these prospective studies demonstrate the big evidence gap on occupational physical activity and health.

Accordingly, the large prospective observational study on occupational physical activity and total and cause-specific mortality by Martinez Gomes and colleagues8 on the NIH-AARP Diet and Health Study from the USA is highly needed. It is of high scientific quality, having about 320 000 participants and 73 000 deaths, with information about history and duration in jobs with high occupational physical activity. The study observed a positive association between occupational physical activity and mortality …

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  • Contributors The author solely wrote the manuscript.

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

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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