Should workers be physically active after work? Associations of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels—An individual participant data meta-analysis Cillekens, Bart Rodríguez-Barranco, Miguel Mortality Individual Participant Data (IPD) Physical activity paradox Job demands The coordination of European Prospective Investigation into Cancer and Nutrition - Spain study (EPIC) is financially supported by the International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The EPIC cohort is supported by Health Research Fund (FIS) – Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology – ICO (Spain). The Kupio Ischemic Heart Disease Risk Factor (KIHD) study data were provided by the University of Eastern Finland. The Active Worker study was funded by The Netherlands Organisation for Health Research and Development; ZonMw (Grant No.: 531-00141-3). Funding for the SHIP study has been provided by the Federal Ministry for Education and Research (BMBF; identification codes 01 ZZ96030, 01 ZZ0103, and 01 ZZ0701). The Primary Prevention study received support from the Swedish Research Council (2018-02527 and 2019-00193). The Swiss WHO MONItoring of trends and determinants in CArdiovscular disease/Cooperative Health Research in the Region Augsburg (MONICA/KORA) study was initiated and financed by the Helmholtz Zentrum München – German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Background There is insufficient evidence to provide recommendations for leisure-time physical activity among workers across various occupational physical activity levels. This study aimed to assess the association of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels. Methods This study utilized individual participant data from 21 cohort studies, comprising both published and unpublished data. Eligibility criteria included individual-level data on leisure-time and occupational physical activity (categorized as sedentary, low, moderate, and high) along with data on all-cause and/or cardiovascular mortality. A 2-stage individual participant data meta-analysis was conducted, with separate analysis of each study using Cox proportional hazards models (Stage 1). These results were combined using random-effects models (Stage 2). Results Higher leisure-time physical activity levels were associated with lower all-cause and cardiovascular mortality risk across most occupational physical activity levels, for both males and females. Among males with sedentary work, high compared to sedentary leisure-time physical activity was associated with lower all-cause (hazard ratios (HR) = 0.77, 95% confidence interval (95%CI): 0.70–0.85) and cardiovascular mortality (HR = 0.76, 95%CI: 0.66–0.87) risk. Among males with high levels of occupational physical activity, high compared to sedentary leisure-time physical activity was associated with lower all-cause (HR = 0.84, 95%CI: 0.74–0.97) and cardiovascular mortality (HR = 0.79, 95%CI: 0.60–1.04) risk, while HRs for low and moderate levels of leisure-time physical activity ranged between 0.87 and 0.97 and were not statistically significant. Among females, most effects were similar but more imprecise, especially in the higher occupational physical activity levels. Conclusion Higher levels of leisure-time physical activity were generally associated with lower mortality risks. However, results for workers with moderate and high occupational physical activity levels, especially women, were more imprecise. Our findings suggests that workers may benefit from engaging in high levels of leisure-time physical activity, irrespective of their level of occupational physical activity. 2025-02-11T12:13:27Z 2025-02-11T12:13:27Z 2025-12 journal article B. Cillekens et al. J Sport Health Sci 2025;14100987. https://doi.org/10.1016/j.jshs.2024.100987 https://hdl.handle.net/10481/102199 10.1016/j.jshs.2024.100987 eng http://creativecommons.org/licenses/by-nc-nd/4.0/ open access Attribution-NonCommercial-NoDerivatives 4.0 Internacional Elsevier