The physical activity paradox in cardiovascular disease and all-cause mortality: the contemporary Copenhagen General Population Study with 104 046 adults
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AIMS: Leisure time physical activity associates with reduced risk of cardiovascular disease and all-cause mortality, while these relationships for occupational physical activity are unclear. We tested the hypothesis that leisure time physical activity associates with reduced major adverse cardiovascular events (MACE) and all-cause mortality risk, while occupational physical activity associates with increased risks. METHODS AND RESULTS: We studied 104 046 women and men aged 20-100 years in the Copenhagen General Population Study with baseline measurements in 2003-2014 and median 10-year follow-up. Both leisure and occupational physical activity were based on self-report with four response categories. We observed 7913 (7.6%) MACE and 9846 (9.5%) deaths from all causes. Compared to low leisure time physical activity, multivariable adjusted (for lifestyle, health, living conditions, and socioeconomic factors) hazard ratios for MACE were 0.86 (0.78-0.96) for moderate, 0.77 (0.69-0.86) for high, and 0.85 (0.73-0.98) for very high activity; corresponding values for higher occupational physical activity were 1.04 (0.95-1.14), 1.15 (1.04-1.28), and 1.35 (1.14-1.59), respectively. For all-cause mortality, corresponding hazard ratios for higher leisure time physical activity were 0.74 (0.68-0.81), 0.59 (0.54-0.64), and 0.60 (0.52-0.69), and for higher occupational physical activity 1.06 (0.96-1.16), 1.13 (1.01-1.27), and 1.27 (1.05-1.54), respectively. Similar results were found within strata on lifestyle, health, living conditions, and socioeconomic factors, and when excluding individuals dying within the first 5 years of follow-up. Levels of the two domains of physical activity did not interact on risk of MACE (P = 0.40) or all-cause mortality (P = 0.31). CONCLUSION: Higher leisure time physical activity associates with reduced MACE and all-cause mortality risk, while higher occupational physical activity associates with increased risks, independent of each other.
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Higher levels of occupational physical activity could be associated with a higher incidence of cardiovascular disease events, the so-called physical activity paradox.
“higher levels of occupational PA (i.e.related to the job) could actually be associated with a higher incidence of CVD events-the so-called 'physical activity paradox'.45,46”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [46]
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Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation
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- Authors
- Holtermann, A., Schnohr, P., Nordestgaard, B. G., & Marott, J. L.
- Affiliations
- National Research Centre for the Working Environment (DK)
- Frederiksberg Hospital (DK)
- University of Copenhagen (DK)
- Corresponding author
- Holtermann, Andreas
- Marott, Jacob Louis
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-04-09
- Volume
- 42
- Issue
- 15
- Pages
- 1499-1511
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC8046503
- OpenAlex
- W3140647705
- Cited by
- 341
- References
- 28
- Citations by year
- 2026: 66 · 2025: 67 · 2024: 76 · 2023: 54 · 2022: 52 · 2021: 25
- FWCI
- 32.47
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Heart Journal (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc)
- Funders
- Capital Region of Copenhagen
- The Danish Heart Foundation
- The Danish Lung Association
- Velux Foundation
- Lundbeck Foundation
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- leisure-time physical activity, occupational physical activity, major adverse cardiovascular events, all-cause mortality, cardiovascular risk, physical activity domains, Copenhagen General Population Study, socioeconomic factors, lifestyle
- MeSH terms
- Adult, Cardiovascular Diseases, Female, Humans, Leisure Activities, Male, Motor Activity, Prospective Studies, Risk Factors, Exercise
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