European Journal of Epidemiology

, Volume 25, Issue 9, pp 619–625 | Cite as

Leisure-time physical activity, cardiovascular risk factors and mortality during a 34-year follow-up in men

  • Salla Savela
  • Pentti Koistinen
  • Reijo S. Tilvis
  • Arto Y. Strandberg
  • Kaisu H. Pitkälä
  • Veikko V. Salomaa
  • Tatu A. Miettinen
  • Timo E. Strandberg


The inverse relationship between physical activity and mortality may be confounded by socioeconomic factors, cardiovascular risk factors and inverse causality. We investigated long-term association between self-reported regular physical activity and mortality in a socioeconomically homogeneous, initially healthy middle-aged (mean age 47) male cohort (the Helsinki Businessmen Study). In 1974, the men were assessed with questionnaires, clinical and laboratory examinations. Cardiovascular disease (CVD) risk factors (including body mass index [BMI], age, cholesterol, glucose, systolic blood pressure and smoking) and details of physical activity of 782 men were available. Leisure time physical activity was collapsed into 3 categories: low (n = 148), moderate (n = 398) and high activity (n = 236). Physical activity was also briefly assessed in questionnaire surveys in 1985–1986 and in 2000. Total mortality up to 2007 was retrieved from the Central Population Register. Altogether 295 men (37.7%) died during the 34-year follow-up, and leisure-time physical activity was significantly related to mortality in a step-wise manner: 45.9% (n = 68), 37.7% (n = 150), and 32.6% (n = 77) died in the low, moderate, and high activity groups, respectively (P < 0.001). With high activity group as referent and adjusted for midlife CVD risk, perceived health and fitness at baseline, hazard ratio for total mortality was 1.21 (95% confidence interval: 0.90, 1.62), and 1.61 (95% confidence interval: 1.13, 2.30) in the moderate and low activity groups, respectively. Conclusion: During the 34-year follow-up, leisure-time physical activity in initially healthy middle-aged men had a graded association with reduced mortality that was independent of CVD risk, glucose and BMI.


Body mass index Cardiovascular risk Exercise Mortality Physical activity Social class 



Body mass index


Confidence interval


Cardiovascular disease


Hazard ratio


Standard error


Standard deviation


  1. 1.
    Johansson SE, Sundquist J. Change in lifestyle factors and their influence on health status and all-cause mortality. Int J Epidemiol. 1999;28(6):1073–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Kim S, Symons M, Popkin BM. Contrasting socioeconomic profiles related to healthier lifestyles in China and the United States. Am J Epidemiol. 2004;159(2):184–91.CrossRefPubMedGoogle Scholar
  3. 3.
    Brookhart MA, Patrick AR, Dormuth C, Avorn J, Shrank W, Cadarette SM, et al. Adherence to lipid-lowering therapy and the use of preventive health services: an investigation of the healthy user effect. Am J Epidemiol. 2007;166(3):348–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Strandberg TE, Strandberg AY, Salomaa VV, Pitkala KH, Tilvis RS, Sirola J, et al. Explaining the obesity paradox: cardiovascular risk, weight change, and mortality during long-term follow-up in men. Eur Heart J. 2009;30(14):1720–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Miettinen TA, Huttunen JK, Naukkarinen V, Strandberg T, Mattila S, Kumlin T, et al. Multifactorial primary prevention of cardiovascular diseases in middle-aged men. Risk factor changes, incidence, and mortality. JAMA. 1985;254(15):2097–102.CrossRefPubMedGoogle Scholar
  6. 6.
    Keys A, Aravanis C, Blackburn H, Van Buchem FS, Buzina R, Djordjevic BS, et al. Probability of middle-aged men developing coronary heart disease in five years. Circulation. 1972;45(4):815–28.PubMedGoogle Scholar
  7. 7.
    Hu G, Tuomilehto J, Silventoinen K, Barengo N, Jousilahti P. Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women. Eur Heart J. 2004;25(24):2212–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Barengo NC, Hu G, Lakka TA, Pekkarinen H, Nissinen A, Tuomilehto J. Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland. Eur Heart J. 2004;25(24):2204–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Pekkanen J, Marti B, Nissinen A, Tuomilehto J, Punsar S, Karvonen MJ. Reduction of premature mortality by high physical activity: a 20-year follow-up of middle-aged Finnish men. Lancet. 1987;1(8548):1473–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Manini TM, Everhart JE, Patel KV, Schoeller DA, Colbert LH, Visser M, et al. Daily activity energy expenditure and mortality among older adults. JAMA. 2006;296(2):171–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med. 1993;328(8):533–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Slattery ML, Jacobs DR Jr, Nichaman MZ. Leisure time physical activity and coronary heart disease death. The US Railroad Study. Circulation. 1989;79(2):304–11.PubMedGoogle Scholar
  13. 13.
    Byberg L, Melhus H, Gedeborg R, Sundstrom J, Ahlbom A, Zethelius B, et al. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. BMJ. 2009;338:b688.CrossRefPubMedGoogle Scholar
  14. 14.
    Chave SP, Morris JN, Moss S, Semmence AM. Vigorous exercise in leisure time and the death rate: a study of male civil servants. J Epidemiol Community Health. 1978;32(4):239–43.CrossRefPubMedGoogle Scholar
  15. 15.
    Haveman-Nies A, de Groot LP, Burema J, Cruz JA, Osler M, van Staveren WA, et al. Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study. Am J Epidemiol. 2002;156(10):962–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Sui X, LaMonte MJ, Blair SN. Cardiorespiratory fitness as a predictor of nonfatal cardiovascular events in asymptomatic women and men. Am J Epidemiol. 2007;165(12):1413–23.CrossRefPubMedGoogle Scholar
  17. 17.
    Schnohr P, Scharling H, Jensen JS. Changes in leisure-time physical activity and risk of death: an observational study of 7, 000 men and women. Am J Epidemiol. 2003;158(7):639–44.CrossRefPubMedGoogle Scholar
  18. 18.
    Paffenbarger RS Jr, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med. 1993;328(8):538–45.CrossRefPubMedGoogle Scholar
  19. 19.
    Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 1986;314(10):605–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Leon AS, Connett J, Jacobs DR Jr, Rauramaa R. Leisure-time physical activity levels and risk of coronary heart disease and death. The Multiple Risk Factor Intervention Trial. JAMA. 1987;258(17):2388–95.CrossRefPubMedGoogle Scholar
  21. 21.
    Chakravarty EF, Hubert HB, Lingala VB, Fries JF. Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Int Med. 2008;168(15):1638–46.CrossRefGoogle Scholar
  22. 22.
    Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Talbot LA, Morrell CH, Fleg JL, Metter EJ. Changes in leisure time physical activity and risk of all-cause mortality in men and women: the Baltimore Longitudinal Study of Aging. Prev Med. 2007;45(2–3):169–76.CrossRefPubMedGoogle Scholar
  24. 24.
    Hakim AA, Petrovitch H, Burchfiel CM, Ross GW, Rodriguez BL, White LR, et al. Effects of walking on mortality among nonsmoking retired men. N Engl J Med. 1998;338(2):94–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med. 2004;117(12):912–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Krueger PM, Chang VW. Being poor and coping with stress: health behaviors and the risk of death. Am J Public Health. 2008;98(5):889–96.CrossRefPubMedGoogle Scholar
  27. 27.
    Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc. 2001;33(6 Suppl):S459–71. (discussion S493-4).PubMedGoogle Scholar
  28. 28.
    Yu S, Yarnell JW, Sweetnam PM, Murray L. Caerphilly study. What level of physical activity protects against premature cardiovascular death? The Caerphilly study. Heart. 2003;89(5):502–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Salla Savela
    • 1
  • Pentti Koistinen
    • 1
  • Reijo S. Tilvis
    • 2
  • Arto Y. Strandberg
    • 2
  • Kaisu H. Pitkälä
    • 4
  • Veikko V. Salomaa
    • 3
  • Tatu A. Miettinen
    • 2
  • Timo E. Strandberg
    • 5
  1. 1.Oulu City HospitalOuluFinland
  2. 2.Department of Medicine, Geriatric ClinicUniversity of HelsinkiHelsinkiFinland
  3. 3.THL-National Public Health InstituteHelsinkiFinland
  4. 4.Unit of General PracticeHelsinki University Central HospitalHelsinkiFinland
  5. 5.Department of Health Sciences/GeriatricsUniversity of Oulu (Oulun yliopisto) and University HospitalOuluFinland

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