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Can socioeconomic health differences be explained by physical activity at work and during leisure time? Rationale and protocol of the active worker individual participant meta-analysis
  1. Pieter Coenen1,
  2. Maaike A Huysmans1,
  3. Andreas Holtermann2,
  4. Richard Troiano3,
  5. Paul Jarle Mork4,
  6. Steinar Krokstad4,
  7. Els Clays5,
  8. Willem van Mechelen1,
  9. Allard J van der Beek1
  1. 1 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  2. 2 National Research Centre for the Working Environment, Copenhagen, Denmark
  3. 3 Risk Factor Assessment Branch, Division of Cancer Control and Population Sciences, US National Cancer Institute, Rockville, Maryland, USA
  4. 4 Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
  5. 5 Department of Public Health, Ghent University, Ghent, Belgium
  1. Correspondence to Dr Pieter Coenen; p.coenen{at}


Introduction Socioeconomic health differences have often been described, but remain insufficiently understood. Recent evidence suggests that workers who are high (compared with low) physically active at work are less healthy. Moreover, workers who are highly physically active at work are predominantly physically inactive during leisure time. These observations suggest that workers with a lower socioeconomic status may be exposed to negative health consequences of occupational physical activity and may only benefit to a limited extent from health benefits of leisure-time physical activity. Physical activity may therefore be an important driver of socioeconomic health differences. We describe the rationale and protocol of the active worker study, an individual participant data meta-analysis aimed at exploring socioeconomic health differences by differential doses of physical activity at work and leisure time.

Methods and analysis Using database and scoping searches (we searched in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews from database inception to 14 September 2017), we have identified 49 published and unpublished prospective studies in which the association of occupational and leisure-time physical activity with cardiovascular or all-cause mortality was assessed. Principal investigators of these studies will be invited to participate in the active worker consortium, after which data will be retrieved. After data merging and harmonising, we will perform multilevel survival analysis assessing the combined association of occupational and leisure-time physical activity with mortality. We will also test the mediating effect of physical activity on the association of socioeconomic status and mortality (ie, socioeconomic health differences).

Discussion The Medical Ethical Committee of the VU University Medical Center has declared, according to Dutch legislation, that the ‘Dutch Medical Research Involving Human Subjects Act’ does not apply to the current study. As such, no ethics approval is required. We intent to publish outcomes of the active worker Study in scientific peer-reviewed journals.

PROSPERO registration number CRD42018085228.

  • occupational physical activity
  • leisure-time physical activity
  • socio-economic health differences
  • cardiovascular mortality
  • all-cause mortality
  • individual participant meta-analysis

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  • Contributors PC has drafted the current manuscript. All authors (PC, MAH, AH, RT, PJM, SK, EC, WVM and AJvdB) were involved in the design of this study, acquisition of research funding for this project and reviewed the manuscript for important intellectual content. AJvdB is the study guarantor.

  • Funding This study has been funded by The Netherlands Organisation for Health Research and Development; ZonMw (grant #: 531-00141-3).

  • Disclaimer The funding body played no role in the development of this protocol.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval According to Dutch legislation, the Medical Ethical Committee of the VU University Medical Center has declared that the Medical Research Involving Human Subjects Act does not apply to the current study. As such no ethics approval is required for the current study.

  • Provenance and peer review Not commissioned; externally peer reviewed.