Impact of Occupational Physical Activity on Cardiometabolic Health Among Manual Workers in Anambra State

While leisure-time physical activity consistently demonstrates cardiometabolic benefits, emerging evidence suggests that high levels of occupational physical activity (OPA) may paradoxically elevate cardiovascular risk, a phenomenon termed the physical activity health paradox. This analytical cross-sectional study examined the impact of OPA on cardiometabolic health markers among manual workers in Onitsha, Anambra State, South East Nigeria. Three hundred manual workers from construction, loading, and manufacturing sectors were stratified by self-reported OPA levels using the Occupational Physical Activity Questionnaire, with 120 sedentary office workers as comparison group. Cardiometabolic outcomes measured included blood pressure, fasting glucose, total cholesterol, HDL and LDL cholesterol, and resting heart rate. Counterintuitively, workers with very high OPA demonstrated higher systolic blood pressure (mean: 141.3 mmHg), higher fasting glucose (mean: 5.9 mmol/L), and lower HDL cholesterol than moderately active workers and controls. Multivariate regression identified cumulative OPA hours, inadequate recovery time, and dietary inadequacy as independent predictors of adverse cardiometabolic profiles. These findings provide Nigerian-contextualized evidence relevant to the physical activity health paradox debate and challenge the assumption that manual work provides equivalent cardiometabolic protection to structured exercise. Recommendations include tailored cardiometabolic screening for manual workers, nutritional support programs, and recovery interval policies in manual labor industries in Anambra State. Keywords: occupational physical activity, cardiometabolic health, physical activity paradox, manual workers, Anambra State.