European Journal of Epidemiology

, Volume 25, Issue 11, pp 777–788 | Cite as

Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort

  • Rino Bellocco
  • Chongqi Jia
  • Weimin Ye
  • Ylva Trolle Lagerros


The health benefits of physical activity (PA) have been well documented. However, there is less research investigating whether or not these health benefits might differ among males and females or among subjects characterized by different levels of body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC). Baseline total PA, BMI, WHR and waist circumference were measured in 14,585 men and 26,144 women who participated in the Swedish National March. Their effects on all-cause mortality were analyzed with a follow-up time of almost 10 years. Sedentary men with a BMI ≥ 30 had a 98% (95% CI: 30–201%) increased risk of mortality compared to normal weight men with a high level of total PA. The same trend was observed for sedentary men with high WHR or waist circumference, compared to lean and highly active men. Sedentary women with a waist circumference of 88 cm or more had almost doubled, i.e. 97% (95% CI: 35–189%) increased mortality risk compared to physically active women with a waist circumference below 80 cm. BMI in men, but waist circumference in women better forecast all-cause mortality. We found no substantial effect modification between different measures of adiposity and physical activity—physical inactivity and obesity seem to increase total mortality risk independently and additively.


Body mass index Cohort studies Epidemiology Exercise Mortality Waist-hip ratio 



Body mass index


Confidence interval


Hazard ratio


International classification of disease


Interquartile range


Metabolic energy turnover


Physical activity


Physical activity level


Subpopulation treatment effect pattern plot


Waist circumference


Waist-to-hip ratio



This work was supported by the companies ICA AB and Ericsson. We would like to thank Statistics Sweden for scanning the questionnaires. We also would like to express sincere gratitude to the Swedish Cancer Society and volunteers who worked with the National March.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Rino Bellocco
    • 1
    • 2
  • Chongqi Jia
    • 1
    • 3
  • Weimin Ye
    • 1
  • Ylva Trolle Lagerros
    • 4
  1. 1.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  2. 2.Department of StatisticsUniversity of Milano-BicoccaMilanItaly
  3. 3.Department of Epidemiology and Health StatisticsShandong UniversityShandongPeople’s Republic of China
  4. 4.Department of MedicineUnit of Clinical Epidemiology, Karolinska InstitutetStockholmSweden

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