European Journal of Epidemiology

, Volume 27, Issue 2, pp 91–99 | Cite as

Changes in physical activity in leisure time and the risk of myocardial infarction, ischemic heart disease, and all-cause mortality

  • Christina Bjørk PetersenEmail author
  • Morten Grønbæk
  • Jørn Wulff Helge
  • Lau Caspar Thygesen
  • Peter Schnohr
  • Janne Schurmann Tolstrup
Cardiovascular Disease


Physical activity is associated to a lower risk of mortality from all-causes and from coronary heart disease. The long-term effects of changes in physical activity on coronary heart disease are, however, less known. We examined the association between changes in leisure time physical activity and the risk of myocardial infarction (MI), ischemic heart disease (IHD), and all-cause mortality as well as changes in blood pressure in 4,487 men and 5,956 women in the Copenhagen City Heart Study. Physical activity was measured in 1976–1978 and 1981–1983 and participants were followed in nation-wide registers until 2009. Men who decreased physical activity by at least two levels and women who decreased by one level had a higher risk of MI relatively to an unchanged physical activity level (hazard ratio [HR] = 1.74, 95% confidence interval [95% CI]: 1.17–2.60 and HR = 1.30, 95% CI: 1.03–1.65). Similar associations were found for IHD although only significant in women. In all-cause mortality, men who increased physical activity had a lower risk and both men and women who reduced physical activity had a higher risk compared to an unchanged physical activity level. No association between changes in physical activity and blood pressure was observed. Findings from this prospective study suggest that changes in physical activity affect the risk of MI, IHD and all-cause mortality. A decrease in physical activity was associated to a higher risk of coronary heart disease.


Physical activity Coronary heart disease Mortality Prospective studies Denmark 



Body mass index


Myocardial infarction


Ischemic heart disease


Confidence interval


Hazard ratio


Number of participants



We thank the staff and the participants of the Copenhagen City Heart Study.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bull FC, Armstrong TP, Dixon T, Ham S, Neiman A, Pratt M. Physical inactivity. In: Lopez AD, Rodgers A, Murray CJL, Ezzati M, editors. Comparative quantification of health risks. Global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004. pp. 729–882.Google Scholar
  2. 2.
    Bauman AE. Updating the evidence that physical activity is good for health: an epidemiological review 2000–2003. J Sci Med Sport. 2004;7:6–19.PubMedCrossRefGoogle Scholar
  3. 3.
    Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989;262:2395–401.PubMedCrossRefGoogle Scholar
  4. 4.
    Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil. 2008;15:247–57.PubMedCrossRefGoogle Scholar
  5. 5.
    Paffenbarger RS Jr, Lee IM. Intensity of physical activity related to incidence of hypertension and all-cause mortality: an epidemiological view. Blood Press Monit. 1997;2:115–23.PubMedGoogle Scholar
  6. 6.
    Wannamethee SG, Shaper AG, Walker M. Changes in physical activity, mortality, and incidence of coronary heart disease in older men. Lancet. 1998;351:1603–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Blair SN, Kohl HW III, Macera CA, Gibbons LW, Paffenbarger RS Jr, Barlow CE. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273:1093–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Gregg EW, Cauley JA, Stone K, Thompson TJ, Bauer DC, Cummings SR, et al. Relationship of changes in physical activity and mortality among older women. JAMA. 2003;289:2379–86.PubMedCrossRefGoogle Scholar
  9. 9.
    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. Br J Sports Med. 2009;43:482.PubMedGoogle Scholar
  10. 10.
    Erikssen G, Liestol K, Bjornholt J, Thaulow E, Sandvik L, Erikssen J. Changes in physical fitness and changes in mortality. Lancet. 1998;352:759–62.PubMedCrossRefGoogle Scholar
  11. 11.
    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;158:639–44.PubMedCrossRefGoogle Scholar
  12. 12.
    Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med. 2000;160:1621–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Paffenbarger RS Jr, Kampert JB, Lee IM, Hyde RT, Leung RW, Wing AL. Changes in physical activity and other lifeway patterns influencing longevity. Med Sci Sports Exerc. 1994;26:857–65.PubMedGoogle Scholar
  14. 14.
    Schnohr P, Jensen G, Lange P, Scharling H, Appleyard M. The Copenhagen city heart study. Eur Heart J Supp. 2001;3:1–83.Google Scholar
  15. 15.
    Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation. 1968;38:1104–15.PubMedGoogle Scholar
  16. 16.
    Saltin B. Physiological effects of physical conditioning. In: Hansen AT, Schnohr P, Rose G, editors. Ischaemic heart disease: the strategy of postponement. Chicago: Year Book Medical Publishers and Copenhagen: FADL’s Forlag; 1977. p. 104–15.Google Scholar
  17. 17.
    StataCorp. Stata Statistical Software: Release 11. College Station 2009; TX: Stata Corp LP.Google Scholar
  18. 18.
    Lissner L, Bengtsson C, Bjorkelund C, Wedel H. Physical activity levels and changes in relation to longevity. A prospective study of Swedish women. Am J Epidemiol. 1996;143:54–62.PubMedGoogle Scholar
  19. 19.
    Wijndaele K, Healy GN, Dunstan DW, Barnett AG, Salmon J, Shaw JE, Zimmet PZ, Owen N. Increased cardiometabolic risk is associated with increased TV viewing time. Med Sci Sports Exerc. 2010;42:1511–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Kujala UM, Kaprio J, Sarna S, Koskenvuo M. Relationship of leisure-time physical activity and mortality: the Finnish twin cohort. JAMA. 1998;279:440–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Conroy MB, Cook NR, Manson JE, Buring JE, Lee IM. Past physical activity, current physical activity, and risk of coronary heart disease. Med Sci Sports Exerc. 2005;37:1251–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Hein HO, Suadicani P, Sorensen H, Gyntelberg F. Changes in physical activity level and risk of ischaemic heart disease. Scand J Med Sci Sports. 1994;4:57–64.CrossRefGoogle Scholar
  23. 23.
    Wannamethee G, Shaper AG. Physical activity and stroke in British middle aged men. BMJ. 1992;304:597–601.PubMedCrossRefGoogle Scholar
  24. 24.
    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;328:538–45.PubMedCrossRefGoogle Scholar
  25. 25.
    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;45:169–76.PubMedCrossRefGoogle Scholar
  26. 26.
    Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493–503.PubMedGoogle Scholar
  27. 27.
    Aadahl M, von Huth SL, Pisinger C, Toft UN, Glumer C, Borch-Johnsen K, et al. Five-year change in physical activity is associated with changes in cardiovascular disease risk factors: the Inter99 study. Prev Med. 2009;48:326–31.PubMedCrossRefGoogle Scholar
  28. 28.
    von Huth SL, Borch-Johnsen K, Jorgensen T. Commuting physical activity is favourably associated with biological risk factors for cardiovascular disease. Eur J Epidemiol. 2007;22:771–9.CrossRefGoogle Scholar
  29. 29.
    Shephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med. 2003;37:197–206.PubMedCrossRefGoogle Scholar
  30. 30.
    Ferrari P, Friedenreich C, Matthews CE. The role of measurement error in estimating levels of physical activity. Am J Epidemiol. 2007;166:832–40.PubMedCrossRefGoogle Scholar
  31. 31.
    Fransson E, de Faire U, Ahlbom A, et al. The risk of acute myocardial infarction—interactions of types of physical activity. Epidemiology. 2004;15:573–82.PubMedCrossRefGoogle Scholar
  32. 32.
    Hu G, Tuomilehto J, Silventoinen K, Barengo NC, Peltonen M, Jousilahti P. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47,212 middle-aged Finnish men and women. Int J Obes (Lond.). 2005;29:894–902.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Christina Bjørk Petersen
    • 1
    Email author
  • Morten Grønbæk
    • 1
  • Jørn Wulff Helge
    • 2
  • Lau Caspar Thygesen
    • 1
  • Peter Schnohr
    • 3
  • Janne Schurmann Tolstrup
    • 1
  1. 1.National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
  2. 2.Department of Biomedical Sciences, Centre of Healthy AgeingUniversity of CopenhagenCopenhagenDenmark
  3. 3.The Copenhagen City Heart Study, Epidemiological Research UnitBispebjerg University HospitalCopenhagenDenmark

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