The first objective of this study is to reconstruct levels and types of physical activity and associated sexual and social differences using human skeletal remains from the predominately 19th century Dutch cemetery of Middenbeemster. For most individuals, life in the Beemster centred around dairy farming and was heavily based on manual labor, with a purported higher class of wealthier individuals performing less manual labor. Two skeletal markers of activity are examined in the upper limb of late young adult and middle-aged adults of both sexes (26–49 years, n = 69): osteoarthritis (OA) and entheseal changes (EC). Results support the hypothesis that the majority of the population engaged in high levels of physical activity; however, a group with a clearly lower or different pattern of activity, possibly representing a higher, less active class, was not discernible. This may be due to a low number of less active individuals in the analysed sample and/or the heterogeneity of occupations and activities. A gendered division of labour was evident in the EC data with males having more pronounced muscle attachments in almost all sites, especially the biceps brachii, used primarily in lifting. Females had more pronounced triceps brachii, which may be due to activities that required pushing or pulling with the elbow in a flexed position. The prevalence and severity of OA did not differ between the sexes. While this could be interpreted to indicate men and women engaged in a similar level of strenuous activity, hormonal and anatomical differences limit the strength of the comparison. The second objective of this study is to evaluate the concordance of OA and EC as activity markers. The correlation between OA and EC is very low, illustrating their variable and complex etiologies. Etiological factors need further research for OA and EC to become more reliable activity markers. Copyright © 2014 John Wiley & Sons, Ltd.