An ecological analysis of physical activity domain and associations with morbidity and mortality

Background:

It is widely recognized that higher levels of physical activity are associated with lower rates of all-cause mortality and morbidity. It is unclear whether these benefits vary by the context in which physical activity is accumulated, such as during occupational versus non-occupational activities. Recent research has shown that small increases in non-occupational physical activity provide a large protection against a range of non-communicable diseases.

Purpose:

We sought to explore whether this context-dependent variation is consistent across populations with varying occupational norms.

Methods:

We conducted a sex-stratified ecological analysis of self-reported physical activity and its association with the prevalence of diabetes, obesity, smoking, CVD mortality, and all-cause mortality in 67 countries. World Health Organization data on travel, work, and leisure physical activity were used to derive an estimate of total occupational and non-occupational physical activity. We used Poisson regression to model associations between physical activity and diabetes, obesity, smoking, and all-cause mortality.

Results:

In pooled analyses, we found moderate inverse associations between physical activity in all time domains for diabetes, obesity, and smoking. Differential associations were observed by sex. In men, we found an inverse association between physical activity in all time domains with smoking and obesity. In women, we found a positive association with smoking.

Conclusions:

Our findings for diabetes and obesity support the current literature on the relationship between physical activity and metabolic disease. We acknowledge the limitations of ecological fallacy and large heterogeneity in the diagnosis and classification of events between countries. Thus, our findings warrant an individual-level analysis to investigate the association between physical activity domain, diabetes, and other cardiometabolic risk factors.

Practical implications:

These findings suggest differential effects of physical activity patterns in different populations. Further research would inform precision prevention strategies tailored to populations beyond europe.