Physically Demanding Work Is Not Enough to Stay Healthy: Leisure-Time Physical Activity Is Key for Type 2 Diabetes Risk Reduction

Researchers have found that engaging in moderate to vigorous physical activity during leisure time, regardless of occupational physical activity, is associated with a reduced risk of type 2 diabetes. A combination of sedentary leisure-time activity and demanding occupational activity may increase the risk. Findings from a novel study, appearing in the American Journal of Preventive Medicine, published by Elsevier, add to the body of knowledge that simple lifestyle changes, like recreational physical activity, can make a big difference and can contribute to the global prevention of type 2 diabetes.

The prevalence of type 2 diabetes has more than doubled worldwide over the past decade, making it a major public health burden and a societal challenge.

First author Anna Stage, MSc, Center for Clinical Research and Prevention, Frederiksberg and Bispebjerg Hospital, Denmark, says, "The World Health Organization (WHO) states that physical activity contributes to preventing and managing noncommunicable diseases such as cardiovascular diseases and type 2 diabetes. The current WHO physical activity guidelines do not distinguish in which domains (e.g., work or leisure time) the recommended physical activity takes place. Our findings revealed that while leisure-time physical activity demonstrated a significant protective effect on type 2 diabetes incidence regardless of occupational physical activity level, no similar benefits were observed for occupational physical activity, suggesting that the 'Physical Activity Health Paradox,' which refers to the contrasting associations of physical activity during leisure time and occupational physical activity with cardiovascular disease, may also apply to type 2 diabetes. Currently the evidence is inconsistent and scarce."

This register-based study utilized data from 5,866 working adults aged 30-60 in the Inter99 cohort in Denmark. Assessment of type 2 diabetes status and date of diagnosis were based on the Danish Diabetes Register covering prevalent and incident diabetes from January 1, 1996 to June 30, 2020. In addition to undergoing a physical examination, participants answered a questionnaire about their levels of occupational physical activity and leisure-time physical activity. Data were analyzed in 2024, taking relevant variables into account.

The main findings of the research are:

• Strenuous physical activity at work could be associated with incident type 2 diabetes, however, this was not a statistically significant finding.

• Physical activity during leisure time with moderate to vigorous intensity was associated with a significantly lower risk of type 2 diabetes.

• Sedentary leisure-time activity, such as watching TV or reading, combined with a job that requires any kind of physical activity, was significantly associated with an increased risk of type 2 diabetes.

• Moderate to vigorous intensity physical activity during leisure time combined with any level of occupational physical activity was protective for incident type 2 diabetes.

Stage points out, "It is noteworthy that the WHO recommendations on physical activity do not distinguish between work and leisure time, hence sending a potentially misleading message that daily physical activity accrued during work hours is sufficient to comply with current activity guidelines. However, our findings along with those of others underscore that leisure-time, not occupational, moderate to vigorous physical activity seems to reduce the risk of incident type 2 diabetes, other noncommunicable diseases, and all-cause mortality."

Notes for editors

The article is “The Physical Activity Health Paradox in Type 2 Diabetes,” by Anna Stage, Rasmus Wibaek, Pernille F. Rønn, Kirsten Schroll Bjørnsbo, Charlotte Brøns, Karen Allesøe, Andreas Holtermann, Allan A. Vaag, Allan Linneberg, and Mette Aadahl (https://doi.org/10.1016/j.amepre.2024.11.018). It appears in the American Journal of Preventive Medicine, Volume 68, Issue 3 (March 2025), published by Elsevier.

The article is openly available at https://www.ajpmonline.org/article/S0749-3797(24)00413-6/fulltext.

Full text of this article is also available to credentialed journalists upon request; contact Astrid Engelen at +31 6 14395474 or [email protected]. Journalists wishing to interview the authors should contact Anna Stage at [email protected].

This work was supported by a research grant from the Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation (Grant number NNF17SA0031406).

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

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