{
  "abstract": "Background: With over 2.8 billion adults engaged in occupational physical activity globally and physical inactivity remaining the fourth leading mortality risk factor, understanding domain-specific PA effects is a public health priority.\n\nEvidence suggests domain-divergent effects: LTPA is protective; OPA may confer adverse effects. No umbrella review has compared evidence across all three PA domains for all-cause mortality.\n\nMethods: Umbrella review of systematic reviews with meta-analyses examining domain-specific PA (LTPA, OPA, transport) and all-cause mortality (PROSPERO: CRD42026142431). Five databases and Epistemonikos were searched to June 2026. Four Chinese-language databases were additionally searched. Quality was assessed via AMSTAR 2; evidence credibility was classified using the Ioannidis framework. Primary study overlap was quantified via Corrected Covered Area (CCA) analysis. CCA-informed descriptive synthesis with correlated-effects sensitivity analysis was complemented by leave-one-out and AMSTAR 2 quality-stratified sensitivity analyses.\n\nResults: Twelve systematic reviews (>300 cohort studies, >32 million participants) were included. A consistent descriptive domain-gradient emerged: LTPA showed strong protective associations (HR/RR 0.50–0.81, Ioannidis Class II, GRADE Moderate); transport PA showed moderate protection (RR 0.77–0.92, Ioannidis Class III, GRADE Moderate); OPA showed null-to-elevated-risk associations after LTPA adjustment (pooled HR 1.12, 95% CI 1.05–1.19, Ioannidis Class IV, GRADE Low), from one evidence cluster (pairwise CCA = 89%, very high study-level overlap; this does not mean 89% of participants derive from one source, but rather that the two reviews share approximately 89% of their included primary studies). CCA analysis confirmed largely independent evidence bases between domains (cross-domain CCA = 6.3%). Illustrative population attributable fraction analyses estimated that insufficient LTPA accounts for 10.2% of all-cause mortality globally, assuming causality.\n\nConclusions: This first multi-domain umbrella review reveals a consistent descriptive domain-gradient: LTPA is protective, transport PA moderately protective, and OPA shows null-to-elevated-risk after LTPA adjustment, though this derives from a single evidence cluster (CCA = 89%) and requires independent replication. Large Chinese cohorts (~0.9 million [CKB evidence reported in, n ~ 512,000 overlapping]; post-hoc exploratory finding, not from the 12 included reviews) report protective OPA associations, suggesting context-dependence. Current evidence suggests that PA domains may differ in mortality risk associations and warrant domain-specific consideration, though OPA evidence remains preliminary and requires independent replication.",
  "abstract_shown": true,
  "affiliations": [
    "School of Physical Education and Health, Guilin College"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Huachang Lin"
    },
    {
      "affs": [
        0
      ],
      "name": "Hong Zhao"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5c1b9tfqts4dm.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1934173",
  "fulltext_url": null,
  "id": "5c1b9tfqts4dm",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1934173/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2737|Physical Activity and Health"
    ]
  ],
  "openalex": "W7224101694",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1934173/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/5c1b9tfqts4dm.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:24Z",
      "native_id": "10.3389/fpubh.2026.1934173",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1934173/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Physical Activity and Health",
      "subfield": "physiology"
    }
  ],
  "title": "The physical activity paradox and all-cause mortality: an umbrella review of systematic reviews and meta-analyses",
  "title_text": "The physical activity paradox and all-cause mortality: an umbrella review of systematic reviews and meta-analyses",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:24Z",
  "url": "https://research.draconitic.com/paper/5c1b9tfqts4dm",
  "venue": "Frontiers in Public Health",
  "versions": []
}