The present cross-sectional study, conducted in the FCC S.A. Delegation, showed that the high intensity of OPA was significantly negatively associated with cardiovascular risk factors in males, such as BMI, WC, waist-hip ratio, and cholesterol and triglycerides levels in the blood, suggesting better cardiovascular health. However, in males, the high intensity of OPA was positively associated with tobacco consumption. In females, the high intensity of OPA was significantly positively associated with blood pressure levels, contrarily suggesting poorer cardiovascular health.
The hypothesis of the present cross-sectional study, about high intensity of OPA could be associated with a detrimental in health status, in particular, in cardiovascular health ; and it is confirmed in female employees, due to negative association with blood pressure levels. A possible explanation in females cleaners, who in present study females represented the majority of type of job, the muscle contractions during manual handling could be associated with elevated blood pressures .
In the same way, 419 female cleaners from five hotels evaluated during 18 h including work and leisure time, showed an increased systolic blood pressure and pulse pressure, thus room cleaners were also associated with increase blood pressure . Surprisingly, cleaners presented higher levels of SBP and DBP than other professional categories and considering the exposure to chemical products as a confounder factor such as chemical exposure was proposed as a key signaling mineralocorticoid a base of blood pressure control (Huang, Ye, & Zhang, 2020).
Focus on LTPA, people have the time and frequency control of the free physical activity but the OPA intensity was difficult to control, depending on each job characteristics and working day. In a prospective cohort, lower LTPA was associated with an elevated risk of cardiovascular disease mortality events . Recently, physical activity paradox has been defined as high OPA intensity increase the risk of mortality for cardiovascular events in men, whereas increasing the levels of physical activity is recommended for preventing cardiovascular events [11, 14] by LTPA as recommended to prevent cardiovascular disease .
Focus on WC, in our study population, low OPA intensity employees presented a high mean of WC, such as 98.0 cm ± 13.8 and 92.9 cm ± 13.7 in employees with high OPA intensity. Although the mean of WC, in men low OPA was 99.5 (± 13.0) cm while high OPA intensity was 96.0 (± 13.4) cm, and in women, low OPA was 85.47 (± 14.6) cm and 88.3 (± 12.9) cm, was not superior to defined cut-off points .
In a Spanish cross-sectional study, conducted with 259,014 workers, aimed to associate metabolic syndrome with occupation and gender, demonstrated that metabolic syndrome was higher in blue collars females, such as cleaners than white collars such as administrative occupation . These results were aligned with our results, due to our high OPA female population, majority cleaners (blue collar), presented higher blood pressure, one of the criteria of metabolic syndrome, than low OPA female population. While cross-sectional of Sanchez-Chaparro et al associated metabolic syndrome with occupational category, our present cross-sectional had one-step further because associated with the intensity of OPA related to the occupational category. Moreover, focus on the low intensity of OPA employees, the prevalence of overweight and obesity was higher than Spanish National data (18-65y) in 2017 . Spanish working population presented a prevalence of overweight plus obesity of 56% in males and 39% in females, lower than 82.2% and 55.6% showed in the present cross-sectional study, respectively. So, workplace weight management programs could increase the engagement of employees . However, from all results, one important aspect to consider is to design and implement different workplace interventions depending on the OPA intensity levels and gender of employees, to achieve a significant effect.
On the other hand, focusing on lifestyles, male employees with high OPA intensity presented a significantly higher prevalence and significant association of tobacco consumption compared to low OPA intensity employees. Most of the high intensity of OPA male employees of FCC S.A. Delegation developed tasks of their work outdoors, as street cleaners probably they have more access to smoke than the low OPA intensity employees.
Thus, not only to avoid smoking, a major cardiovascular risk factor, the intensity of OPA, type of job developed by employee and gender could be considered as key indicators to contemplate in the design of workplace programs to improve the cardiovascular health of employees.
Whereas for employees with low intensity of OPA, taking into account this activity could be considered as a sedentary lifestyle, acting as a major modifiable risk factor for cardiovascular disease [7, 33].The interventions to improve cardiovascular risk factors for males with high intensity of OPA should be tested because the evidence suggests that high OPA employees may not be a benefit for LTPA supporting caution should be in recommending exercise in the high intensity of OPA employees . However, in workplace interventions directed to females with high intensity of OPA, it is suggested the effectiveness of lowering SBP by a single session per day in cleaners’ females .
Therefore, from the evidence of the cardiovascular risk factors of employees, it could carry on actions to prevent cardiovascular disease at the workplace. Supporting the interventions, the workplace is a good environment to improve physical activity behaviors [36–38].
The present cross-sectional study had some limitations. Firstly, the study population included only one Delegation of one company, the FCC workers in Tarragona, whereas more participants of other FCC Delegations around all Spain could provide more information. Secondly, physical activity during the working time was assessed by International Physical Activity Questionnaire , and it was not calculated by an Actical accelerometer considered as the gold standard tool to evaluate physical activity [19, 39, 40] due to implying higher costs for the company. Thirdly, disease variables such as percentage of employees with hypertension and cholesterol were based on the diagnosis of the family physician, and workers were medicated, for this reason, the mean of variables related to medicated employees (mean of blood pressure and mean of blood cholesterol) was misleading. Fourthly, OW and OB prevalence could act as a confounder because it is associated with high cardiovascular risk factors, and males with high OPA intensity levels showed a low percentage of OW and OB and less cardiovascular risk factors than males with low intensity of OPA. Fifthly, although this study had the appropriate sample size, it would be more interesting to include different companies to obtain a sample size with a higher diversity of employees, to be possible to improve the generalizability of the results obtained. Besides, males represented the huge part, the generalizability of our findings to female is limited, and it should include a higher percentage of females in future researches.
Furthermore, the study had some strengths, it included a huge sample size of employees with different OPA intensity categories. Moreover, the data obtained related to cardiovascular risk factors assessed in the workplace, are based on blood analysis, anthropometric measures, and validated questionnaires. The present cross-sectional study is the first study that investigated the workplace population categorizing the intensity levels of the OPA in Spain.