The physical activity paradox revisited: a prospective study on compositional accelerometer data and long-term sickness absence

Nidhi Gupta*, Sofie Dencker-Larsen, Charlotte Lund Rasmussen, Duncan McGregor, Charlotte Diana Nørregaard Rasmussen, Sannie Vester Thorsen, Marie Birk Jørgensen, Sebastien Chastin, Andreas Holtermann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)
119 Downloads (Pure)


BACKGROUND: The 'physical activity paradox' advocates that leisure physical activity (PA) promotes health while high occupational PA impairs health. However, this paradox can be explained by methodological limitations of the previous studies-self-reported PA measures, insufficient adjustment for socioeconomic confounding or not addressing the compositional nature of PA. Therefore, this study investigated if we still observe the PA paradox in relation to long-term sick absence (LTSA) after adjusting for the abovementioned limitations.

METHODS: Time spent on moderate-to-vigorous physical activity (MVPA) and remaining physical behaviors (sedentary behavior, standing, light PA and time in bed) at work and in leisure was measured for 929 workers using thigh accelerometry and expressed as isometric log-ratios (ilrs). LTSA was register-based first event of ≥6 consecutive weeks of sickness absence during 4-year follow-up. The association between ilrs and LTSA was analyzed using a Cox proportional hazards model adjusted for remaining physical behaviors and potential confounders, then separately adjusting for and stratifying by education and type of work.

RESULTS: During the follow-up, 21% of the workers experienced LTSA. In leisure, more relative MVPA time was negatively associated with LTSA (20% lower risk with 20 min more MVPA, p = 0.02). At work, more relative MVPA time was positively associated with LTSA (15% higher risk with 20 min more MVPA, p = 0.02). Results remained unchanged when further adjusted for or stratified by education and type of work.

CONCLUSION: These findings provide further support to the 'PA paradox'.

Original languageEnglish
Article number93
Number of pages9
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Publication statusPublished - 20 Jul 2020


  • accelerometry/instrumentation
  • adult
  • Denmark/epidemiology
  • exercise
  • female
  • humans
  • leisure activities
  • male
  • middle aged
  • proportional hazards models
  • prospective studies
  • sedentary behavior
  • sick Leave/statistics & numerical data
  • social class
  • wearable electronic devices
  • workplace
  • Accelerometers
  • Physical activity
  • Register-based sickness absence
  • Occupational health
  • Time-use epidemiology

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine (miscellaneous)


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