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Occupation Correlates of Adults' Participation in Leisure-Time Physical

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Article  in  American Journal of Preventive Medicine · April 2011

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 Occupation Correlates of Adults’ Participation
in Leisure-Time Physical Activity
A Systematic Review

Megan A. Kirk, MA, Ryan E. Rhodes, PhD

Context: The rapid changes to the labor force (e.g., advances in technology, overtime hours) have
increased obesogenic behaviors (e.g., lack of physical activity, sedentariness on the job).

Purpose: The purpose of this review was to unite and appraise the existing research examining
occupation correlates of adults’ participation in leisure-time physical activity (LTPA) to establish
direction for future research targeting habitual inactivity.

Evidence acquisition: Eligible studies were searched from January 2009 to July 2010 in English
peer-reviewed journals. A total of 62 studies passed the inclusion criteria. Major fındings were
summarized based on common subtopics of occupation category/status, occupational physical
activity (OPA), work hours, psychological work demands, and LTPA.

Evidence synthesis: Included articles were published between 1984 and 2010, with sample
sizes ranging from 158 to 203,120. Occupation factors correlated with LTPA, but the magnitude
of the effect was diffıcult to determine because of heterogeneous measures. Occupation category/
status was directly associated with LTPA, with white-collar/professionals showing the highest
LTPA compared to blue-collar workers. When OPA was measured, a positive association with
LTPA was found. Work hours appeared to have a negative threshold effect on LTPA. Some
preliminary evidence found psychosocial work demands (e.g., job strain) to be negatively
correlated with LTPA levels.

Conclusions: Convincing evidence supports the premise that those employed in occupations
demanding long work hours and low OPA are at risk of inactivity. Existing research has focused
heavily on cross-sectional data and study-created self-report measures. Longitudinal evaluations
using robust research measures (e.g., accelerometry, National occupation classifıcation tool) are a
priority for future research.
(Am J Prev Med 2011;40(4):476 – 485) © 2011 American Journal of Preventive Medicine

Context One understudied potential correlate of physical ac-

tivity is occupation variables (e.g., work hours).4 –7 The

R
egular physical activity has a preventive and reha-
bilitative effect for more than 25 chronic diseases
and adverse health conditions.1,2 Unfortunately,
the majority of North American adults are not meeting
the minimum physical activity guidelines to accrue these
benefıts.1,3 Thus, continued research efforts investigating
the critical correlates of adults’ participation in physical
activity are needed to help inform targeted interventions.
From the Faculty of Education, University of Victoria, Victoria, British
Columbia, Canada
Address correspondence to: Ryan E. Rhodes, PhD, Behavioural Medi-
cine Laboratory, Faculty of Education, P.O. Box 3010 STN CSC, University
of Victoria, Victoria, British Columbia V8W 3N4, Canada. E-mail:
rhodes@uvic.ca.
0749-3797/$17.00
doi: 10.1016/j.amepre.2010.12.015
rapid changes to the labor market, including techno-
logic advances (e.g., robotics, elevators) and globaliza-
tion, have noticeably influenced the working condi-
tions of the North American labor force.8 –10 Despite
the aim of substantially enhancing global productivity,
a sizeable decrease in on-the-job energy expenditure of
even the most labor-intensive occupations has re-
sulted.7,8,10 Analysis of U.S. Census data from 1950 to
2000 indicated a large increase in the percentage of
people employed in low-activity occupations (occupa-
tional physical activity [OPA]) from 23.3% to 42.6%,11
and the number of people employed in low OPA is
almost double the number of people employed in high-
OPA jobs (58.2 million vs 30.9 million, respectively).11

476 Am J Prev Med 2011;40(4):476 – 485 © 2011 American Journal of Preventive Medicine • Published by Elsevier Inc.
 Kirk and Rhodes / Am J Prev Med 2011;40(4):476 – 485
Whether decreases in OPA lead to decreased leisure-
time physical activity (LTPA) has been understudied,
but it may be an important clue that explains the low
prevalence of physical activity.
The type of work associated with certain occupations
may also explain low LTPA (e.g., deadlines). North
Americans are working harder and longer than ever be-
fore due to increasing workloads.9,12–15 The standard
work week has expanded to include regular overtime
hours (e.g., ⱖ50 hours/week) and weekend work, and
work responsibilities/demands (e.g., multitasking) have
dramatically increased.9,12–15 Although it appears likely
that a combination of these occupation variables are con-
tributing to low levels of LTPA as a result of reduced
availability of time and fatigue, the impact of occupation
variables on physical activity participation remains
largely unexplored and warrants the need for a review of
the extant literature.
Because more than 80% of North
American adults16,17 spend the majority
of their adulthood employed in the labor See
force, it seems an important domain to related
clarify the role of occupation and LTPA. Commentary by
Therefore, the purpose of this review was Hillsdon in
to critically appraise the relationship be- this issue.
tween occupation and LTPA status to
help identify potential limitations and
to outline targets for future LTPA
interventions.
Evidence Acquisition
Inclusion Criteria
Eligible studies were from English peer-reviewed pub-
lished articles that examined a relationship between an
occupation variable and LTPA status. Studies that mea-
sured occupation category/class, work hours, mental
work demands, and OPA as independent variables were
included. Studies were limited to those examining LTPA
behavior of adults, aged 18 – 64 years, since this is the
standard age range of employment.
Exclusion Criteria
Studies were excluded from this review based on pre-
established criteria set by both reviewers. Excluded stud-
ies were those that (1) used a dichotomous employment
classifıcation (e.g., employed versus unemployed) be-
cause an occupation variable could not be determined;
(2) investigated OPA as the primary outcome measure
because the aim of the current study was to determine
how occupation affects LTPA; or (3) examined clinical
populations, because the results may deviate from the
general population as a result of the health condition.
April 2011
477
Search Strategy
Based on previous recommendations,18,19 fıve online da-
tabases were used to search for relevant literature18,19
from January 2009 to July 2010: Academic Search Pre-
mier (1982–2010, EBSCO); ISI Web of Science (1955–
2010, ISI); MEDLINE (1965–2010, EBSCO); PsycINFO
(1966 –2010, EBSCO); and PubMed (1982–2010, NCBI).
Search terms included leisure-time physical activity, phys-
ical activity, exercise AND occupation, employment,
white-collar, blue-collar, work hours, work demands (Ap-
pendixes A–C, available online at www.ajpm-online.net).
The search strategy was not restricted by language, study
design, year of publication, or population. Manual cross-
referencing of relevant articles was completed to ensure
saturation of the literature.
Screening
Citations, including the title, abstract, and full-text arti-
cle, were initially screened by one reviewer
using inclusion criteria set by both review-
ers. Potential studies for inclusion were
then discussed and agreed on. Disagree-
ments between reviewers were resolved
through discussion until 100% consensus
was reached. Studies found to be ineligible
during the full-text screening phases were
recorded along with reasons for exclusion
(Supplementary File 1 can be obtained from
corresponding author).
Risk-of-Bias Assessment
A modifıed version of Downs and Black’s (1998) 22-item
assessment tool20 was used to assess risk of bias and
methodologic quality (Appendixes A–C, available online
at www.ajpm-online.net). The current modifıed scoring
scheme was based on a maximum score of 15. Checklist
items that pertained to RCTs were excluded and all items
were scored as yes/no. Both authors independently coded
and assessed the overall methodologic quality. Discrep-
ancies were resolved through discussion until 100%
agreement in all cases was reached. High-quality studies
were those that scored 14 –15, moderate-quality studies
scored 10 –13, and low-quality studies were those that
scored below 10. Studies were deemed weak or insuffı-
cient to be appraised in the review if they scored a 6 or
less.
Data Abstraction and Analysis
A nine-item data abstraction form was developed by both
reviewers. One author extracted the data from the in-
cluded studies and the second author checked the data
(Appendixes A–C, available online at www.ajpm-online.
net). Disagreements were resolved through discussion
478 Kirk and Rhodes / Am J Prev Med 2011;40(4):476 – 485
until 100% consensus was reached. The data abstraction Table 1. Characteristics of included studies (N⫽62), n
form included the authors, year of publication, sample (%) unless otherwise indicated
characteristics, study design, the occupation measure, the
Characteristic Value
physical activity outcome measure, study outcomes, ef-
fect sizes, and quality assessment score. The major fınd- STUDY DESIGN
ings were identifıed and categorized into themes and Cross-sectional 51 (82.3)
were highlighted only if they were present in a minimum
Longitudinal 11 (17.7)
of three independent studies included in the review.21
Duration (years; M, min, max) 15.4 (4,30)
The common themes and major fındings are discussed
and synthesized in a narrative review. Qualitative ap- Independent samples 58 (93.5)
praisal of occupation category/status, OPA, work hours, Same data set 4 (6.5)
and psychological work demands with LTPA were in- Whitehall II Study (1985; n) 3
cluded. The quantitative appraisal of the studies included
U.S. National Health Interview Survey (n) 3
summarizing effect sizes when the necessary statistical
information was available. Cohen’s effect sizes (d, f) val- Australian Longitudinal Study on 2
Women’s Health (n)
ues were calculated and included in Appendix A, avail-
able online at www.ajpm-online.net. Reporting decisions Finnish North Karelia Project (n) 2
were based on (1) signifıcant/null fındings (p⬍0.05) and Sample size (M) 14 880
(2) at least a small effect size (d⫽0.20; f⫽0.10) using Sample size (min) 158
standardized predetermined criteria.22 Homogeneity
Sample size (max) 203 120
across study methods and measures was inadequate to
perform a meta-analysis.23 Quality rating (total of 15; M) 9.9
POPULATION CHARACTERISTICS
Evidence Synthesis Study location (country)
Overall, the initial literature search yielded 2092 citations. U.S. 18 (29.0)
Based on the inclusion criteria, 210 potentially relevant
Finland 10 (16.1)
articles were obtained for an in-depth review (Figure 1).
A total of 74 articles passed the eligibility criteria. Of Australia 8 (12.9)
these, 12 studies (16.2%) indicated high risk of publica- United Kingdom 6 (9.7)
tion bias and were excluded from the review (Appendixes Japan 3 (4.8)
A–C, available online at www.ajpm-online.net). Thus, a
Spain 3 (4.8)
total of 62 studies were critically appraised and summa-
Poland 2 (3.2)
rized in this review (Appendix A, available online at
www.ajpm-online.net). Sweden 2 (3.2)
Denmark 2 (3.2)

Study Characteristics Canada 2 (3.2)

Table 1 highlights the study characteristics for the 62 Germany 1 (1.6)
studies reviewed. No studies met the current criteria for Greece 1 (1.6)
high quality; 35 studies (56.5%) were identifıed as modest
Ireland 1 (1.6)
quality and 27 studies (43.5%) were identifıed as low
quality (Appendixes A–C, available online at www.ajpm- Island Nation of Mauritius 1 (1.6)
online.net). The majority of studies were cross-sectional Nigeria 1 (1.6)
(n⫽51, 82.3%) followed by longitudinal (n⫽11, 17.7%). Portugal 1 (1.6)
Participants were primarily of both genders (n⫽52,
PARTICIPANT CHARACTERISTICS
83.9%), and sample sizes ranged from 158 participants24
to 203,120 participants.25 Occupation variables were Both-gender sample 52 (83.9)
most commonly assessed using measures of occupation Male-only sample 5 (8.1)
category/status (n⫽44, 70.1%), followed by OPA (n⫽23, Female-only sample 5 (8.1)
37.1%); weekly work hours (n⫽18, 29.0%); and psycho- (continued on next page)
logical work demands (n⫽12, 19.4%). Physical activity
was most commonly assessed using self-report measures

www.ajpm-online.net
 Kirk and Rhodes / Am J Prev Med 2011;40(4):476 – 485 479
43,49,53,61,63,66
Table 1. (continued) (n⫽37, 84.1%). Six studies (13.6%) used a
validated self-report measure of physical activity, and
Characteristic Value the remaining 38 studies used study-created self-
OCCUPATION MEASURES reported measures of physical activity. Sixteen stud-
Occupation category/type 44 (70.1)
ies27,30,36,37,40,48,50,51,53–56,59,64,66,68 (36.4%) used a
standardized occupation classifıcation tool (e.g., Aus-
Standardized occupation classification 17 (38.6)
tool tralian Standard Classifıcation of Occupations) to
measure occupation category, and 28 studies (62.2%)
Study-created occupation classification 27 (61.4)
tool relied on study-created measures. Effect sizes were calcu-
lated for 17 of the studies27,33,34,36 – 40,46 – 48,50,55,57–59,70 and
Weekly work hours 18 (29.0)
indicated extreme variability.
Categories of hours (e.g., 40–45, 9 (50.0) Occupation category measures varied heavily across
45–50)
the studies, making it diffıcult to draw overall conclu-
Self-report number of hours 5 (27.8) sions. In some cases, differentiating between white-collar
Overtime (yes/no) 2 (11.1) and professional workers was not possible. Based on the
Full-time vs part-time (yes/no) 2 (11.1) heterogeneity of the occupation category/status mea-
sures, the current analysis included three subdivisions of
Occupational physical activity 23 (37.1)
occupation category/status: (1) dichotomous occupation
Objective/direct measure 2 (8.7) categories (e.g., blue-collar/manual labor versus white-
Self-report valid measure 4 (17.4) collar/non-manual labor); (2) trichotomous occupation
Other self-report measure 17 (73.9) categories (e.g., blue-collar, white-collar [e.g., secretary],
professional [e.g., supervisory]); and (3) multiple occupa-
Psychological work demands 12 (19.4)
tion categories (e.g., four or more occupation types, stan-
Karasek’s Job Content Questionnaire 7 (58.3) dardized occupation tool).
Other occupation measures (e.g., 6 (50.0)
mental workload, work ability index)
Use of multiple occupation measures 23 (37.1)
Dichotomous Occupation Categories
Thirteen studies27–29,38,42,44,52,57,60 – 62,64,68 used a dichot-
OUTCOME MEASURES (n [%])
omous occupation classifıcation measure (e.g., blue-
Self-reported physical activity measures 60 (96.8)
MLTPAQ 4 (6.7)
7-day PAR 2 (3.3)
EPAQ-2 1 (1.7)
GLTEQ 1 (1.7)
IPAQ 1 (1.7)
MAQ 1 (1.7)
Study-created self-report measure 50 (83.3)
Objective physical activity measure 2 (3.2)

EPAQ-2, EPIC-Norfolk Physical Activity Questionnaire; GLTEQ, Godin

Leisure Time Exercise Questionnaire; IPAQ, International Physical Activ-
ity Questionnaire; MAQ, Modified Activity Questionnaire; MLTPAQ, Min-
nesota Leisure Time Activity Questionnaire; PAR, Physical Activity Recall

(n⫽60; 96.8%). Only two studies (3.2%) used pedometers

to obtain a direct measure of physical activity.24,26

Occupation Category/Status and

Leisure-Time Physical Activity
A total of 44 studies27-70 (70.1%) examined a relation-
ship between occupation category/status and LTPA. Figure 1. Systematic flow chart of literature search
Of these, the majority were cross-sectional designs LTPA, leisure-time physical activity

April 2011
480 Kirk and Rhodes / Am J Prev Med 2011;40(4):476 – 485
collar versus white-collar) to assess a relationship be-
tween occupation category/status and LTPA levels. Seven
of studies27,38,42,44,60,62,68 (53.8%) found a positive asso-
ciation between occupation status and LTPA. That is,
higher LTPA levels were found among those employed in
white-collar/non-manual occupations compared to
those employed in blue-collar/manual occupations. The
remaining six studies found mixed results. Three stud-
ies52,57,64 (23.1%) found a negative relationship be-
tween occupation status and LTPA, with those employed
in blue-collar/manual positions showing higher LTPA, and
the remaining three studies28,29,61 (23.1%) found no sig-
nifıcant difference in LTPA levels based on occupation
category.
Trichotomous Occupation Categories
Eleven independent samples measured occupation category/
status using a trichotomous classifıcation tool (e.g., blue-
collar, white-collar, professional).26,31,34 –36,39,43,49 –51,63,69,70
Overall, 10 samples (90.9%) supported a positive association
with higher LTPA levels among those employed in white-
collar or professional occupations. In terms of a negative
association, the one study26 that used a direct measure of
physical activity found higher levels among those employed
in the lowest-status occupations. Six studies34,36,39,43,49,50
(46.2%) found a unique relationship between the intermediate/
middle-status occupations and LTPA. Higher LTPA lev-
els among those employed in the intermediate occupa-
tion (e.g., white-collar) were evident compared to the
lowest- (e.g., blue-collar) and highest- (e.g., professional)
grade occupations, but differences based on gender were
prominent and limited the clarity of the results.34,39,43,50
These fındings suggest that when an intermediate occu-
pation category is included in the analysis, the lowest-
and highest-status occupations may be most at risk of
lowered physical activity.
Multiple Occupation Categories
Nineteen studies30,32,33,37,40,41,45– 48,53–56,58,59,65– 67 (43.2%)
examined an association between occupation category/sta-
tus and LTPA levels by measuring multiple occupations
(e.g., four or more occupation categories). Overall, 17 of the
19 studies (89.5%) supported higher LTPA levels among
those employed in professional-type occupations (e.g., higher-
status) compared to white-/blue-collar occupations.
The fındings suggest that occupation category/status is
linked to physical activity status, but results must be
interpreted with caution because many potential mod-
erators such as gender and social roles, and confound-
ing factors such as hours of work, work demands, and
work-related physical activity were not accounted for.
Future research conducting multivariate analysis is
prudent.
Occupation Category/Status and Total
Physical Activity
Our main purpose was to understand the relationship
between occupation category and LTPA, but ten stud-
ies24,26,38,44,48,52,53,56,57,66 also investigated occupation
status and total physical activity as a secondary outcome.
LTPA was recognized to be confounded by other do-
mains of physical activity (e.g., work, household), but an
analysis of whether differences between occupation cate-
gory and total physical activity were evident was felt to be
important because of the novelty of this review. Overall,
all ten studies suggested that higher levels of total physical
activity were associated with having a lower-status occu-
pation (e.g., manual labor). According to the study26 that
used a direct measure of physical activity, the strongest
effect for achieving the recommended 10,000 steps/day
was among men working in blue-collar occupations
(d⫽1.26). In all, 80.2% of blue-collar workers compared
to only 38.2% of professionals achieved 10,000 steps/
day.26 One study53 found reverse trends based on gender,
indicating that male professionals had the lowest total
physical activity whereas female professionals had the
highest.
Occupational Physical Activity and
Leisure-Time Physical Activity
Twenty-three24 –27,29,32,41,43,44,59,60,63,66 – 68,71–78 (36.5%) st-
udies examined a relationship between OPA and LTPA.
Two studies44,72 conducted longitudinal analysis. Four stud-
ies66,67,73,77 used a validated self-report OPA measure,
and two studies24,26 used a direct measure of physical
activity. Effect sizes were calculated for 11 stud-
ies24 –27,44,63,71,73–76 and indicated extreme variability
(Cohen’s d⫽ – 0.28 to 0.80).
Fifteen studies24 –26,29,32,41,44,60,68,71–73,75,77,78 (65.2%)
found a positive association between OPA and LTPA and
suggested that those employed in physically active occu-
pations demonstrated higher levels of LTPA, but differ-
ences based on gender may have confounded the fınd-
ings. Of the remaining studies, fıve27,43,63,66,74 (26.1%)
found a negative association between OPA and LTPA,
one study found reverse trends based on gender,59 and
two studies67,76 found no signifıcant association. In terms
of methodologic quality rating, longitudinal studies in-
vestigating a relationship found higher levels of LTPA
among those working in physically demanding occupa-
tions,44,72 and both24,26 of the studies that used a direct
measure of physical activity also supported a positive
association.
www.ajpm-online.net
 Kirk and Rhodes / Am J Prev Med 2011;40(4):476 – 485
Work Hours and Leisure-Time
Physical Activity
Seventeen independent samples (27.4%) exam-
ined the relationship between work hours and
LTPA.27,34,40,41,46,47,50,56,68,75,77– 84 Two independent
samples were longitudinal.40,80,81 Only one study77 in-
cluded a valid and reliable physical activity measure.
Measures used to test an association between work
hours and LTPA were varied. For the purposes of this
analysis, fındings were summarized based on three
categories: (1) total hours of work (e.g., continuous
variable); (2) overtime work hours (e.g., ⬎40 hours/
week); and (3) work status (e.g., full-time/part-time).
Total Hours of Work
Seven studies27,40,50,56,68,79,82 examined a relationship be-
tween total work hours and LTPA levels. Six stud-
ies27,40,50,56,68,79 (85.7%) supported a negative association
between work hours and LTPA levels, and the results
indicated a negative threshold effect. That is, the negative
association between work hours and LTPA became evi-
dent at the 45–50 hours/week level and above. The stron-
gest evidence supporting an association between work
hours and physical activity comes from the three stud-
ies40,50,79 that measured a detailed breakdown of weekly
work hours (e.g., 30 – 40, 41–50, 51– 60) and examined
the impact of various categories of work hours on physi-
cal activity levels. These studies40,50,79 found a negative
association between the longest work hours (e.g., ⬎50)
and participation in LTPA. Available effect sizes ranged
between 0.2350 and 0.49,79 indicating a small to moderate
effect of long work hours on LTPA.
Overtime Hours
Three studies46,47,75 examined a relationship between
overtime hours (e.g., ⬎40 hours/week) and participation
in LTPA. None of these studies used a detailed break-
down of overtime hours; all relied on a self-reported
dichotomous “yes/no” answer to working overtime. Two
studies46,47 found a negative association between work-
ing overtime and engaging in LTPA, and one study75
found that working overtime was associated with greater
LTPA participation compared to those working regular
or part-time hours.
Full-Time Versus Part-Time Hours
34,41,46,77,78,80,81,83,84
Nine studies examined a relationship
between work status and LTPA. The fındings were equiv-
ocal, suggesting that this type of occupation measure is
inadequate. Four studies34,78,83,84 found higher levels of
LTPA among part-time workers compared to full-time
workers, four studies41,46,80,81 found no signifıcant differ-
April 2011
481
ence between full-time and part-time employment status
with respect to LTPA levels, and one study77 found full-
time employees to have higher levels of LTPA compared
to part-time employees. Overall, it appears that full-time
and part-time status as an occupation variable is an in-
complete measure because variability in full-time and
part-time hours (e.g., 15–20 hours/week vs 30 –35 hours/
week) was not accounted for, but it could have an impor-
tant impact on LTPA.
Work Demands and Leisure-Time
Physical Activity
Twelve studies27,29,39,41,43,47,60,68,74,75,82,85 (19.0%) exam-
ined a relationship between work demands and LTPA.
Eight studies27,29,39,47,60,68,75,85 used components of
Karasek’s Job Content Questionnaire,86 and four stud-
ies41,43,74,75 used study-created self-reported measures of
mental workload. In terms of Karasek’s Job Content out-
come, six studies27,29,39,47,75,85 (75%) found that a high
level of job strain was inversely related to LTPA status.
Two of the studies60,75 found that decision latitude was
positively related to levels of LTPA, suggesting that those
with higher-level decision authority, and subsequently
lower job strain, were more active during leisure.
Four41,43,74,75 of the 12 studies assessed a relationship
between perceived mental workload and levels of LTPA
and found inconclusive results.
Gender Differences
Of the 53 studies that examined both genders, only 12 of
the studies26,28,29,39,45,46,53,59,79,82– 84 (22.6%) tested for a
signifıcant difference in LTPA means between men and
women. Seven studies found men to have higher LTPA
and fıve studies found no signifıcant difference between
LTPA means based on gender. One study that assessed
physical activity across multiple domains indicated that
men had higher LTPA, but women had higher levels of
household physical activity.53 Assessment of potential
gender differences in occupation status that may influ-
ence physical activity levels across multiple domains has
been understudied, and sound conclusions about the in-
teractions of gender and occupation with LTPA cannot
be drawn at this time.
Discussion
This was the fırst known review to summarize and criti-
cally appraise the existing literature examining occupa-
tion correlates of LTPA. Overall, the fındings from this
review suggest that the relationship between occupa-
tional status and physical activity is complex.
Occupation category/status was the most common
measure used to test for an association. Overall, the fınd-
482 Kirk and Rhodes / Am J Prev Med 2011;40(4):476 – 485
ings revealed that occupation category/status was linked
to LTPA status, with the majority of studies indicating
that those employed in higher-status occupations had
higher levels of LTPA compared to those employed in
lower-status occupations. Although these results are in
line with prior research,87 the clarity of the fındings dif-
fered depending on the way occupation category was
measured. Studies that broke occupation category down
into detailed positions (e.g., National standardized tools)
were better able to identify the target occupations that
were associated with the largest decreases in LTPA.
Alternately, when total physical activity was consid-
ered, the positive trend observed between occupation
status and physical activity was reversed. The fındings
indicated that those employed in lower-status occupa-
tions (e.g., blue-collar) demonstrated higher total physi-
cal activity than professionals. These fındings support
prior research10,88 that has suggested that those employed
in higher-status positions (e.g., lawyers) are more likely to
engage in sedentary work-related behavior (e.g., sitting)
compared to those working in lower-status positions
(e.g., manual labor). This adds further complexity to the
task of understanding the relationship between occupa-
tion category and physical activity, however, because it
contradicts the relationship between occupation category
and LTPA. Overall, when total physical activity is consid-
ered, the results suggest that those employed in higher-
status occupations may not be accumulating enough
LTPA to compensate for their sedentary occupation and
are at risk of insuffıcient activity. More robust research
efforts investigating total physical activity among those
employed in various occupations would be particularly
useful to confırm these fındings.
A key fınding of this review was that occupation char-
acteristics (e.g., OPA) appeared to have a more robust
association with LTPA behavior than occupation category/
status alone. These results parallel prior research10,88 sug-
gesting that physically demanding work contributes to
higher overall physical activity. What may be partially
responsible for the higher levels of LTPA among those
working in higher-OPA positions are social– cognitive
constructs (e.g., self-effıcacy). People who are active in
their jobs may feel more capable to engage in LTPA
whereas those in low-OPA positions may feel less capable
as a result of fatigue or decreased motivation. Future
researchers are encouraged to integrate behavior-change
theories into their research (e.g., theory of planned be-
havior, social cognitive theory) and investigate the social
cognitions of both low- and high- OPA occupations to
substantiate these speculations.
Studies investigating a relationship between work
hours and LTPA appeared to have a negative threshold
effect, suggesting that decreased LTPA was evident for
those working more than 45–50 hours per week. Studies
that categorized work hours (e.g., 35– 40, 40 – 45, 45–50)
were able to more clearly identify the threshold of work
hours associated with decreased physical activity. These
fındings were somewhat expected given that an increase
in work hours would likely result in a reduced time for
LTPA participation.14 Future research examining de-
tailed categories of hours worked, including overtime,
would provide more robust evidence of an association
and help to identify the critical threshold of hours that
causes the most notable declines in LTPA.
Results were limited, but there appeared to be some
evidence showing a negative association between job
strain and LTPA. Previous literature89 –91 has suggested
that psychological stress such as work-related stressors
(e.g., heavy demands/deadlines) have implications on
physical (e.g., increased blood pressure) and psychologi-
cal (e.g., burnout) health. This reinforces the importance
of determining if a relationship between psychological
work demands and decreased physical activity exists be-
cause physical activity plays a key role in reducing the risk
of adverse health consequences (e.g., stress).
The heterogeneous measures and fındings from this
review highlight the need for focused research. Although
large-scale surveys used in the current review have excel-
lent power and sample generalizability, measurement fı-
delity is often compromised. Studies that examine one or
two distinct occupations are recommended because re-
searchers can use well-validated and detailed meas-
ures (e.g., accelerometry, International Physical Activity
Questionnaire) to better discern which occupation vari-
ables are consistently related to decreased physical activ-
ity. In addition, longitudinal change models that consider
mixed factors and test for interactions between occupa-
tion and certain sociodemographic profıles (e.g., parent-
hood) would help researchers identify when declines in
LTPA most notably occur (e.g., entering the workforce,
becoming a parent, job promotion). It is likely that health
and SES in the early years is likely to confound any rela-
tionship among current occupation, SES, and physical
activity.
Another aspect that has been underdiscussed is poten-
tial gender differences in occupation. For example, men
are more likely to be employed in blue-collar or high-
manual-labor occupations than women. Second, income
disparity between men and women may result in women
working longer hours to achieve the same income as their
male counterparts. Lastly, although men typically show
higher levels of LTPA, women may be involved in greater
physical activity that is non-occupational and non–
leisure time (e.g., housework). Unfortunately, these inci-
dental activities are not captured in questionnaires of
occupation, transportation, or leisure-time physical ac-
www.ajpm-online.net
 Kirk and Rhodes / Am J Prev Med 2011;40(4):476 – 485
tivity, but they are important considerations for future
research.
There are a number of limitations to this review that
should be considered. First, the studies were limited to
peer-reviewed published articles, which may be subject to
publication bias. Second, the summarized literature was
limited to English peer-reviewed studies. Therefore, not
all potentially relevant articles (e.g., non-English, disser-
tations) may have been included. Third, the studies in-
cluded in this review were limited to the search terms and
databases mentioned in the methods section. Although
searches were conducted based on recommended proce-
dures,19 studies not identifıed with the key search terms
used will be missing. Overall, this review highlights the
convoluted nature of the extant literature and supports
the need for continued research.
MAK is supported by the Canadian Institutes of Health Re-
search Frederick Banting and Charles Best Canada Graduate
Scholarship and a University of Victoria President’s Research
Scholarship.
RER is supported by a new investigator award from the
Canadian Institutes of Health Research, and with funds from
the Social Sciences and Humanities Research Council of Can-
ada, the Canadian Diabetes Association, and the Canadian
Cancer Society.
No fınancial disclosures were reported by the authors of this
paper.
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Appendix
Supplementary data
Supplementary data associated with this article can be found, in the
online version, at doi:10.1016/j.amepre.2010.12.015.