Jerry Öhlin

With an aging workforce and longer working lives, staying in physically demanding occupations is increasingly challenging, and the factors influencing perceived exertion are still poorly understood. Also, self-rated exertion may not correlate strongly with physiological measurements of physical strain at work, such as heart rate. Our study aimed to describe the physical strain experienced by senior workers in manual occupations using Borg's Rating of Perceived Exertion (RPE) scale and to explore associations between personal variables such as heart rate during work, age, physical fitness, and RPE ratings. We recruited workers aged 50 yr or older in manual occupations and collected data using questionnaires, physical examinations, field heart rate monitoring, and RPE ratings during work. Field heart rate monitoring was conducted using a chest band with a pulse sensor that transmitted data to a mobile application, and the first 6 h of recordings were used in subsequent analyses. Subjects were asked to simultaneously complete a diary at the end of each shift, rating the overall physical exertion for that day using the RPE scale, ranging from 6 (rest) to 20 (maximal physical exertion). Correlation between variables was determined using Spearman's rank correlation coefficient (r). A linear mixed model was used to investigate associations between personal variables and RPE ratings. The sample consisted of 126 subjects, aged 50 to 67 yr, of whom 76 (60.3%) were females. The participants were employed as construction workers, kitchen workers, cleaners, or assistant nurses. They rated perceived physical exertion on the RPE scale once daily in one to three workdays, resulting in a total of 250 workdays. The mean (SD) RPE rating was 12.1 (2.1). When stratified by sex, the mean (SD) RPE rating was 12.1 (2.2) among females and 12.0 (1.8) among males (P = 0.669). When stratified by occupational group, the mean (SD) was 11.9 (1.9) for construction workers, 12.1 (2.0) for kitchen workers, 12.4 (1.6) for cleaners, and 11.8 (2.8) for assistant nurses (P = 0.139 to 0.815). In total, 298 heart rate (HR) recordings were obtained during work with a mean (SD) HR of 89.4 (11.4) beats/min (range 54 to 125). There was a significant bivariate correlation between the RPE ratings and mean HR for the entire study population (r = 0.14; P = 0.025) as well as in the group of construction workers (r = 0.23; P = 0.042), but not for any other occupational groups (r = 0.04 to 0.25; P = 0.096 to 0.752). In the linear mixed model, using the RPE ratings as the dependent variable, the statistically significant (P < 0.05) estimated coefficients (SE) were as follows: mean heart rate (beats/min), 0.03 (0.01); very poor sleep quality, 3.38 (0.93); and high psychological stress, 2.62 (0.71). Age, body mass index, theoretical maximum oxygen consumption, and chronic pain ratings were not significantly associated with the RPE ratings. We conclude that senior workers in manual occupations reported that their work was somewhat hard in terms of physical exertion. Our study also indicates associations between mean heart rate, sleep quality, psychological stress, and RPE ratings.

The relationship between occupational physical activity and cardiovascular disease has gained increased research interest in recent decades. Studies show conflicting results, with some indicating that occupational physical activity increases, decreases, or have no association with cardiovascular disease risk. This editorial briefly discusses reasons for these discrepancies, methodological considerations and possible consequences for retirement.

Background: Contrary to leisure-time physical activity, high levels of occupational physical activity (OPA) have been linked to cardiovascular disease and mortality. Many occupations in the construction industry are known to have high levels of OPA. Aims: This study investigated OPA and stroke mortality risk among 299 382 Swedish male construction workers. Methods: OPA was derived from job titles and categorized as low, medium or high, and stroke mortality was ascertained via the Swedish National Cause of Death Register. The average follow-up was 24 years resulting in a total of 6.9 million person-years, during which 4606 participants died from stroke. Relative risks were estimated with robust Poisson regressions and adjusted for age, calendar year, body mass index and smoking. Results: The relative risk for overall stroke mortality was higher in the medium and high OPA groups compared to the low OPA group [1.15 (1.04, 1.27) and 1.13 (1.04, 1.23), respectively], with no clear dose–response association. Age-stratified analyses showed that higher OPA increased stroke mortality risk in participants between 70 and 89 years. Participants with high versus low OPA had a higher risk of ischaemic stroke mortality [1.15 (1.01, 1.31)]. Conclusions: Construction workers with high OPA have a slight increase in overall stroke mortality, mainly after retirement.

Objectives The aim included investigation of the associations between sedentary (SED), low-intensity physical activity (LIPA), moderate-to-vigorous intensity PA (MVPA) and the prevalence of subclinical atherosclerosis in both coronaries and carotids and the estimated difference in prevalence by theoretical reallocation of time in different PA behaviours. Design Cross-sectional. Setting Multisite study at university hospitals. Participants A total of 22 670 participants without cardiovascular disease (51% women, 57.4 years, SD 4.3) from the population-based Swedish CArdioPulmonary bioImage study were included. SED, LIPA and MVPA were assessed by hip-worn accelerometer. Primary and secondary outcomes Any and significant subclinical coronary atherosclerosis (CA), Coronary Artery Calcium Score (CACS) and carotid atherosclerosis (CarA) were derived from imaging data from coronary CT angiography and carotid ultrasound. Results High daily SED (>70% ≈10.5 hours/day) associated with a higher OR 1.44 (95% CI 1.09 to 1.91), for significant CA, and with lower OR 0.77 (95% CI 0.63 to 0.95), for significant CarA. High LIPA (>55% ≈8 hours/day) associated with lower OR for significant CA 0.70 (95% CI 0.51 to 0.96), and CACS, 0.71 (95% CI 0.51 to 0.97), but with higher OR for CarA 1.41 (95% CI 1.12 to 1.76). MVPA above reference level, >2% ≈20 min/day, associated with lower OR for significant CA (OR range 0.61–0.67), CACS (OR range 0.71–0.75) and CarA (OR range 0.72–0.79). Theoretical replacement of 30 min of SED into an equal amount of MVPA associated with lower OR for significant CA, especially in participants with high SED 0.84 (95% CI 0.76 to 0.96) or low MVPA 0.51 (0.36 to 0.73). Conclusions MVPA was associated with a lower risk for significant atherosclerosis in both coronaries and carotids, while the association varied in strength and direction for SED and LIPA, respectively. If causal, clinical implications include avoiding high levels of daily SED and low levels of MVPA to reduce the risk of developing significant subclinical atherosclerosis.

Objective: This study investigated the association between occupational physical activity (OPA) and resting blood pressure in a cohort of Swedish construction workers. Methods: The final sample included 241,176 male construction workers. Occupations with low OPA were foremen and white-collar workers. The most frequent occupations in the medium OPA group were electricians, pipe workers, and machine operators, and in the high OPA group woodworkers, concrete workers, and painters. Results: Mixed effects models showed higher systolic and lower diastolic blood pressure with higher OPA, but the associations varied depending on the year of participation and participant age as shown by significant interaction terms (OPA*age, OPA*calendar year, age*calendar year). Age-stratified linear regression analyses showed a pattern of slightly higher systolic (1.49, 95% confidence interval: 1.08–1.90 mmHg) and lower diastolic (0.89, 95% confidence interval: 0.65–1.13 mmHg) blood pressure when comparing low with high OPA, but not among the oldest age groups. Conclusion: Despite a rather large contrast in OPA, the differences in systolic and diastolic blood pressure according to OPA were small.

Introduction: Low physical activity (PA) is a potential risk factor for dementia and cognitive impairment. However, few studies have focused on very old people (aged ≥80 years), the age group with highest prevalence of dementia. The aim was to investigate if PA associated with subsequent dementia, cognitive function, and gait speed (GS), in very old people. Methods: A population-based survey was conducted in 1999 and followed-up between 2016 and 2019 in participants ≥80 years. Altogether 541 individuals (56.2% women), 64.9 ± 4.2 years of age at baseline participated. Self-rated baseline PA was categorized into low, medium, or high. Cognitive function was assessed with the Mini-Mental State Examination (MMSE), executive function with the Frontal Assessment Battery (FAB), and GS (in meters/second) was measured over 2.4 m at follow-up. Results: During a mean of 19.0 ± 1.1 years, 175 (32.3%) developed dementia. Low or medium PA compared to high PA did not associate with subsequent dementia, and PA did not associate with future cognitive function (MMSE). PA associated with executive function (FAB) (unstandardized beta [95% confidence interval]) (0.67 [0.07–1.27]), but not after adjustments. PA associated with subsequent GS in the unadjusted model and after adjustment for age, sex, smoking, and education (0.06 [0.02–0.09], and 0.04 [0.01–0.08], respectively), but not after adding adjustment for hypertension, obesity, and glucose intolerance. Conclusion: No support was found for the hypothesis that low PA is a potential risk factor for dementia in very high age. However, PA and executive function were associated in unadjusted analyses which indicate that PA may be important for at least one aspect of cognitive function. The association between PA and GS around 2 decades later seems attenuated by cardiometabolic risk factors. Future investigations regarding PA, dementia, and cognitive decline may consider cardiometabolic risk factors such as hypertension, obesity, and glucose intolerance, and include repeated measures of PA over the life course.

Improving dementia screening procedures beyond simple assessment of current cognitive performance is timely given the ongoing phenomenon of population aging. A slow or declining gait speed (GS) is a potential early indicator of cognitive decline scarcely investigated in very old people. Here, we investigated the 5-year associations of baseline GS, change in GS, and cognitive function with subsequent dementia development in people aged 85 years and older (n = 296) without dementia at baseline. Declining and a slow baseline GS were associated with higher odds of dementia development after adjusting for confounders (e.g., age, sex, and dependency in activities of daily living) and missing GS values at follow-up. The GS decline was associated with cognitive decline in participants who developed dementia. The results support the potential of GS tests to predict future cognitive decline among community- and nursing home-dwelling very old people.

Background: Cognition has been related with gait speed in older adults; however, studies involving the oldest age group, where many have mobility disability and cognitive impairment, are few. The aim was to investigate the association between global cognitive function and gait speed in a representative sample of very old people, and whether the association was affected by dementia, and walking aid use. Method: This cross-sectional study included 1317 participants, mean age 89.4 years, and 68% women, from the Umeå85+/Gerontological Regional Database. Self-paced gait speed was measured over 2.4 m, with or without walking aids, and global cognitive function with the Mini-Mental State Examination (MMSE). The association between cognition and gait speed was analyzed using multiple linear regression and stratified according to dementia. The influence of missing gait speed values was explored using multiple imputation. An interaction analysis was performed to investigate the influence of walking aid use. Results: In comprehensively adjusted analyses, MMSE associated with gait speed (unstandardized β (β) 0.011 m/s, 95% Confidence Interval [CI] = 0.009, 0.013, p < 0.001) in the total sample. No association was found in people with dementia (β 0.003 m/s, 95%CI = 0.000, 0.006, p = 0.058), until missing gait speed values were compensated for by multiple imputation (β 0.007 m/s, 95% [CI] = 0.002, 0.011, p = 0.002). In interaction analysis the use of walking aids attenuated the association between cognition and gait speed (β − 0.019 m/s, 95%CI = − 0.024, − 0.013, p < 0.001). Conclusion: Global cognitive function appears to associate with gait speed in very old people. However, in people with dementia selection bias was indicated since unless missing gait speed values were accounted for no association was observed. Walking aid use attenuated cognitive load, which may not apply to walking in daily activities, and requires further investigation.