P09-08 24-Hour Physical Behavior Balance for Better Health for All: “The Sweet-Spot Hypothesis”

Background 'Sit less-move more' has been a common advice to improve health of adults. Research indicates that this advice might be health enhancing among adults with sedentary occupations but not among adults with physically active occupations such as cleaners. This may be explained by the considerable differences in 24-h physical behaviors between adults in sedentary and physically active occupations. To provide a scientific approach and encourage research on 24-h physical behaviors and health for those in physically active occupations, we recently proposed the ‘Sweet-Spot Hypothesis'. The hypothesis postulated that the ‘Sweet-Spot' of 24-h physical behaviors for better health differs between adults, depending on their occupation. Methods To exemplify such hypothesis, we tested the cross-sectional association between 24-hour time composition of physical behaviors measured using thigh-based accelerometry and self-rated health among adults engaged in white-collar (n = 136), manufacturing (n = 481) and cleaning (n = 130) occupations. Results We found that the sweet spot of 24-h physical behaviors for better health was far from ‘sit less-move more' zone among adults with physically active occupations. Specifically, among white-collar workers, 24-h physical behavior distribution associated with the best 5% of self-rated health comprised about 30% of the day spent on sedentary behavior, 45% spent actively, and 25% spent on sleep. However, among cleaners, this distribution was about 50% spent sedentary, 15% spent actively, and 35% on sleep and in manufacturing sector, this distribution was about 35% spent sedentary, 35% spent actively, and 30% spent on sleep. Conclusion The advice ‘sit less-move more' may not bring adults in physically active occupations toward their ‘Sweet-Spot' of 24-h physical behaviors for better health. To promote health for all and reduce social gradient, we see a great need for empirically testing the ‘Sweet-Spot Hypothesis' with high-quality data and strong study design. We hope that the proposal of testing ‘Sweet-Spot Hypothesis' will encourage discussion, debates, and empirical research to expand our collective knowledge about the healthy ‘24-h physical behavior balance' for all

P04-10 The Physical activity health paradox - what do we know about physiological mechanisms? (editorial)

There is strong and consistent evidence that leisure-time physical activity (LTPA) improves cardiovascular health and reduces the risk of all-cause and cardiovascular mortality. Less is known about health effects of occupational physical activity (OPA), and results are not in favor of a beneficial effect on cardiovascular health. Several large-scale prospective studies have found that high occupational physical activity (OPA) is associated with detrimental or no effects on cardiovascular health and mortality. These contrasting associations with cardiovascular morbidity and mortality for LTPA and OPA have coined ‘The Physical activity health paradox'. Although the underlying physiological mechanisms are not established, a theoretical framework was proposed by Holtermann and colleagues (2018). This framework suggests that due to the nature of OPA (i.e. low intensity, long duration, constrained postures, and limited recovery), it may not result in healthy adaptation to the same extent as LTPA, or even lead to unhealthy responses, such as elevated 24-hour heart rate and blood pressure and increased inflammation. Drawing on theoretical models and empirical findings, the aim is to summarize the literature regarding potential physiological mediators of the physical activity health paradox. This also includes a brief summary of our own research based on accelerometer measurements of physical activity with cardiovascular regulation assessed by heart rate and blood pressure in workers with low occupational class and manual work

Evaluation of an implementation strategy for Individual Placement and Support in the Netherlands: a 30-month observational study

Abstract Background Individual Placement and Support (IPS) is an evidence-based, effective approach to help people with severe mental illness (SMI) obtain and maintain competitive employment. The aim of the present study was to examine employment outcomes and associations with an organizational and a financial factor in people with SMI who participated in Individual Placement and Support using a multifaceted implementation strategy (IPS + MIS). The goal of this strategy was to improve IPS implementation by enhancing collaboration among mental health care and vocational rehabilitation stakeholders, and realizing secured IPS funding. Methods An observational cohort study including 103 participants was conducted, with a 30-month follow-up. Descriptive analyses were used to examine employment outcomes. Multivariable logistic and linear regression analyses were performed to study associations with an organizational and a financial factor: the level of experience of mental health agencies with providing IPS + MIS and the type of IPS funding (i.e. municipality funding (reference group) and the Dutch Social Security Institute: the Institute for Employee Benefits Schemes (UWV) funding). Results Forty-six percent of the participants were competitively employed at any time during the 30-month follow-up; the median number of days until competitive job obtainment and in competitive jobs was 201 and 265, respectively. The majority of all jobs obtained (81%) were categorized as ‘elementary occupations’, ‘clerical support workers’, and ‘service and sales workers’. A higher level of experience of the mental health agencies with providing IPS + MIS was found to be positively associated with job obtainment (OR = 3.83, 95% CI 1.42–10.30, p = 0.01) and the number of days worked in competitive jobs (B = 1.21, 95% CI 0.36–2.07, p = 0.01). UWV funding was found to be negatively associated with job obtainment (OR = 0.30, 95% CI 0.11–0.77, p = 0.01). No association was found for the type of IPS funding and the number of days worked in competitive jobs (B = -0.73, 95% CI -1.48–0.02, p = 0.06). Conclusions This study shows that almost half of the people who participate in IPS + MIS obtain a competitive job within 30 months. The results further suggest that both the level of experience of mental health agencies with providing IPS + MIS, and funding may play a role in employment outcomes

Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants

Objectives Emerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality. Methods A literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality. Results We screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87–1.15] and females (HR 0.95, 95% CI 0.82–1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88–1.49). Conclusions While the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing

How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies

OBJECTIVE: Physical activity (PA) has substantial benefits across a range of health outcomes. There is uncertainty about the PA-specific health effects, and in particular, the occupational domain. In this umbrella review, we synthesised available evidence on the associations between occupational PA (OPA) and health-related outcomes (including cancer, all-cause mortality and cardiovascular disease). This work informed the development of WHO's guidelines on PA and sedentary behaviour (2020). DESIGN: Umbrella review of systematic reviews. DATA SOURCE: We performed a literature search in PubMed, Web of Science, Embase, CINAHL and Sportdiscuss from database inception to 2 December 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included systematic reviews if they contained a quantitative assessment of OPA and its relationship with at least one health-related outcome. RESULTS: We summarised the evidence of 17 reviews covering 23 unique health-related outcomes. We graded most evidence as low or very low, or moderate quality. We found health benefits for those engaging in high versus low OPA for multiple cancer outcomes (including colon and prostate), ischaemic stroke, coronary heart disease and mental health (ie, mental well-being and life satisfaction). High OPA was associated with unfavourable health outcomes for all-cause mortality in men, mental ill health (ie, depression and anxiety), osteoarthritis, and sleep quality and duration. CONCLUSIONS: We found favourable associations for most health-related outcomes with high OPA levels, but we also found some evidence for unfavourable associations due to high OPA levels. At this point, there is a need for better quality evidence to provide a unequivocal statement on the health effects of OPA