Background: Physical activity is a very important component of cardiometabolic health, yet most evidence supporting its benefits is derived from leisure-time physical activity (LTPA). In low- and middle-income settings, occupational physical activity (OPA) constitutes the dominant source of daily exertion, but its cardiometabolic implications remain insufficiently characterized. It’s clear that excessive occupational physical activity results in adverse cardiovascular activities: the physical activity health paradox, the more reason why this study becomes very important.

Objective: This study assessed the distribution of occupational physical activity levels and examined their associations with key cardiometabolic indicators: hypertension, body mass index and blood glucose among adults in Rivers State

Methods: A cross-sectional analysis was conducted among 1,116 adults aged 30–65 years using de-identified community health records. Sociodemographic data, body mass index (BMI), blood pressure, and blood glucose measurements were extracted. Occupational physical activity was classified into sedentary, moderate, and high levels using adapted public health criteria. Group differences in cardiometabolic parameters were evaluated using one-way ANOVA with Tukey post-hoc analysis.

Results: The mean age of participants was 43.30 ± 15.62 years, with females comprising 58.2% of the cohort. Sedentary occupations predominated (67.9%), while 21.1% engaged in high-intensity OPA. Hypertension was prevalent in 30.7% of participants, and 34.6% were overweight, with 20.9% obese. Mean BMI differed significantly across OPA categories (p < 0.05), with moderately active workers exhibiting the lowest BMI (24.72 kg/m²). Systolic blood pressure increased progressively with higher OPA levels, peaking in the high-activity group (138.93 mmHg; p < 0.05). No significant differences were observed for diastolic blood pressure or blood glucose.

Conclusion: Occupational physical activity demonstrated a complex, non-linear relationship with cardiometabolic health. Moderate OPA appeared most favorable, while high OPA was associated with elevated systolic blood pressure, supporting the physical activity paradox. These findings point to the need for context-specific physical activity guidelines that incorporate occupational workload, recovery, and leisure-time exercise in a population more involved in work related physical activity like in  sub-Saharan African populations.