International Journal of Public Health

, Volume 62, Issue 7, pp 819–829 | Cite as

Association between long-term smoking and leisure-time physical inactivity: a cohort study among Finnish twins with a 35-year follow-up

  • Maarit PiirtolaEmail author
  • Jaakko Kaprio
  • Karri Silventoinen
  • Pia Svedberg
  • Tellervo Korhonen
  • Annina Ropponen
Original Article



To investigate longitudinal associations of smoking and a change in smoking status with leisure-time physical inactivity. In addition, to control whether familial confounding (genetics and shared environment) influences the associations.


Data were based on the population-based Finnish Adult Twin Cohort of 5254 twin individuals born in 1945–1957 (41% men) and who participated in all four surveys over a 35-year follow-up (1975–2011). Logistic and conditional logistic regression models with multiple covariates were used for analyses.


Compared to never-smokers, long-term daily smokers (1975–1990) had the highest likelihood for both long-term inactivity and to change into inactive by 2011. Recurrent smoking was associated with long-term inactivity. Instead, in comparison to persistent daily smokers, quitting smoking decreased the likelihood of becoming physically inactive at leisure time. The associations remained in the analyses which accounted for multiple covariates and/or familial confounding.


Daily smoking increases the likelihood of remaining or becoming physically inactive over the decades. Our results emphasize not only the importance of preventing smoking initiation, but also to support early smoking cessation in promotion of lifelong physical activity.


Adults Follow-up cohort study Exercise Physical inactivity Smoking Twins 


Author contributions

All authors meet the ICMJE authorship requirements as follows: (1) substantial contributions to conception and design (MP, JK, KS, PS, TK, AR) OR the acquisition of data (JK), AND the analysis and interpretation of data (all authors: MP, JK, KS, PS, TK, AR); AND (2) the drafting of the article or its critical revision for important intellectual content (all authors: MP, JK, KS, PS, TK, AR); AND (3) final approval of the version to be published (all authors: MP, JK, KS, PS, TK, AR). All authors (MP, JK, KS, PS, TK, AR) also agreed be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethical Committee of the University of Helsinki, Department of Public Health. This present analysis did not involve any contact with the study participants and only used existing epidemiological data.


This work was supported by the Academy of Finland Centre of Excellence in Complex Disease Genetics (Grants 213506 and 129680 to JK), the Academy of Finland (Grants 265240 and 263278 to JK) for data collection, and the Ministry for Education and Culture of Finland (to AR) for analyzing and reporting the results. KS was supported by the Academy of Finland (Grant 266592).

Conflict of interest

JK reports personal fees from Pfizer unrelated to the submitted work. TK reports personal fees from Pfizer for consulting on nicotine dependence but unrelated to the submitted work. None of the other authors have anything to declare.

Supplementary material

38_2017_975_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 20 kb)


  1. Aarnio M, Winter T, Peltonen J, Kujala UM, Kaprio J (2002) Stability of leisure-time physical activity during adolescence—a longitudinal study among 16-, 17- and 18-year-old Finnish youth. Scand J Med Sci Sports 12(3):179–185. doi: 10.1034/j.1600-0838.2002.00250.x CrossRefPubMedGoogle Scholar
  2. Auer R et al (2014) Change in physical activity after smoking cessation: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Addiction 109(7):1172–1183. doi: 10.1111/add.12561 CrossRefPubMedPubMedCentralGoogle Scholar
  3. Azagba S, Asbridge M (2013) Nicotine dependence matters: examining longitudinal association between smoking and physical activity among Canadian adults. Prev Med 57(5):652–657. doi: 10.1016/j.ypmed.2013.08.020 CrossRefPubMedGoogle Scholar
  4. Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW (2012) Correlates of physical activity: why are some people physically active and others not? Lancet 380(9838):258–271. doi: 10.1016/S0140-6736(12)60735-1 CrossRefPubMedGoogle Scholar
  5. Boomsma D, Busjahn A, Peltonen L (2002) Classical twin studies and beyond. Nat Rev Genet 3(11):872–882. doi: 10.1038/nrg932 CrossRefPubMedGoogle Scholar
  6. Borodulin K et al (2012) Leisure time physical activity in a 22-year follow-up among Finnish adults. Int J Behav Nutr Phys Act 9:121. doi: 10.1186/1479-5868-9-121 CrossRefPubMedPubMedCentralGoogle Scholar
  7. Borodulin K, Harald K, Jousilahti P, Laatikainen T, Männistö S, Vartiainen E (2016) Time trends in physical activity from 1982 to 2012 in Finland. Scand J Med Sci Sports 26(1):93–100. doi: 10.1111/sms.12401 CrossRefPubMedGoogle Scholar
  8. de Geus EJ, Bartels M, Kaprio J, Lightfoot JT, Thomis M (2014) Genetics of regular exercise and sedentary behaviors. Twin Res Hum Genet 17(4):262–271. doi: 10.1017/thg.2014.42 CrossRefPubMedGoogle Scholar
  9. De Moor MH, Boomsma DI, Stubbe JH, Willemsen G, de Geus EJ (2008) Testing causality in the association between regular exercise and symptoms of anxiety and depression. Arch Gen Psychiatry 65(8):897–905. doi: 10.1001/archpsyc.65.8.897 CrossRefPubMedGoogle Scholar
  10. de Vilhena e Santos DM, Katzmarzyk PT, Seabra AF, Maia JA (2012) Genetics of physical activity and physical inactivity in humans. Behav Genet 42(4):559–578. doi: 10.1007/s10519-012-9534-1 CrossRefPubMedGoogle Scholar
  11. Dumith SC, Hallal PC, Reis RS, Kohl HW 3rd (2011) Worldwide prevalence of physical inactivity and its association with human development index in 76 countries. Prev Med 53(1–2):24–28. doi: 10.1016/j.ypmed.2011.02.017 CrossRefPubMedGoogle Scholar
  12. Gold DR, Wang X, Wypij D, Speizer FE, Ware JH, Dockery DW (1996) Effects of cigarette smoking on lung function in adolescent boys and girls. N Engl J Med 335(13):931–937. doi: 10.1056/nejm199609263351304 CrossRefPubMedGoogle Scholar
  13. Higgins M et al (1991) Pulmonary function and cardiovascular risk factor relationships in black and in white young men and women. The CARDIA Study. Chest 99(2):315–322. doi: 10.1378/chest.99.2.315 CrossRefPubMedGoogle Scholar
  14. Kaczynski AT, Manske SR, Mannell RC, Grewal K (2008) Smoking and physical activity: a systematic review. Am J Health Behav 32(1):93–110. doi: 10.5555/ajhb.2008.32.1.93 CrossRefPubMedGoogle Scholar
  15. Kaprio J (2013) The Finnish Twin Cohort Study: an update. Twin Res Hum Genet 16(1):157–162. doi: 10.1017/thg.2012.142 CrossRefPubMedPubMedCentralGoogle Scholar
  16. Kaprio J, Koskenvuo M (1988) A prospective study of psychological and socioeconomic characteristics, health behavior and morbidity in cigarette smokers prior to quitting compared to persistent smokers and non-smokers. J Clin Epidemiol 41(2):139–150. doi: 10.1016/0895-4356(88)90088-1 CrossRefPubMedGoogle Scholar
  17. Koivumaa-Honkanen H, Kaprio J, Honkanen R, Viinamaki H, Koskenvuo M (2004) Life satisfaction and depression in a 15-year follow-up of healthy adults. Soc Psychiatry Psychiatr Epidemiol 39(12):994–999. doi: 10.1007/s00127-004-0833-6 CrossRefPubMedGoogle Scholar
  18. Korhonen T, Koivumaa-Honkanen H, Varjonen J, Broms U, Koskenvuo M, Kaprio J (2011) Cigarette smoking and dimensions of depressive symptoms: longitudinal analysis among Finnish male and female twins. Nicotine Tob Res 13(4):261–272. doi: 10.1093/ntr/ntq251 CrossRefPubMedGoogle Scholar
  19. Krueger H, Turner D, Krueger J, Ready AE (2014) The economic benefits of risk factor reduction in Canada: tobacco smoking, excess weight and physical inactivity. Can J Public Health 105(1):e69–e78CrossRefPubMedGoogle Scholar
  20. Kujala UM, Kaprio J, Rose RJ (2007) Physical activity in adolescence and smoking in young adulthood: a prospective twin cohort study. Addiction 102(7):1151–1157. doi: 10.1111/j.1360-0443.2007.01858.x CrossRefPubMedPubMedCentralGoogle Scholar
  21. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT (2012) Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380(9838):219–229. doi: 10.1016/S0140-6736(12)61031-9 CrossRefPubMedPubMedCentralGoogle Scholar
  22. Li MD, Cheng R, Ma JZ, Swan GE (2003) A meta-analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins. Addiction 98(1):23–31. doi: 10.1046/j.1360-0443.2003.00295.x CrossRefPubMedGoogle Scholar
  23. Lim SS et al (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2224–2260. doi: 10.1016/S0140-6736(12)61766-8 CrossRefPubMedPubMedCentralGoogle Scholar
  24. McGue M, Osler M, Christensen K (2010) Causal inference and observational research: the utility of twins. Perspect Psychol Sci 5(5):546–556. doi: 10.1177/1745691610383511 CrossRefPubMedPubMedCentralGoogle Scholar
  25. McGue M, Skytthe A, Christensen K (2014) The nature of behavioural correlates of healthy ageing: a twin study of lifestyle in mid to late life. Int J Epidemiol 43(3):775–782. doi: 10.1093/ije/dyt210 CrossRefPubMedPubMedCentralGoogle Scholar
  26. Midlöv P, Calling S, Sundquist J, Sundquist K, Johansson SE (2014) The longitudinal age and birth cohort trends of smoking in Sweden: a 24-year follow-up study. Int J Public Health 59(2):243–250. doi: 10.1007/s00038-013-0535-5 CrossRefPubMedGoogle Scholar
  27. Morris LJ, D’Este C, Sargent-Cox K, Anstey KJ (2016) Concurrent lifestyle risk factors: clusters and determinants in an Australian sample. Prev Med 84:1–5. doi: 10.1016/j.ypmed.2015.12.009 CrossRefPubMedGoogle Scholar
  28. Nagaya T, Yoshida H, Takahashi H, Kawai M (2007) Cigarette smoking weakens exercise habits in healthy men. Nicotine Tob Res 9(10):1027–1032. doi: 10.1080/14622200701591575 CrossRefPubMedGoogle Scholar
  29. Ng M et al (2014) Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 311(2):183–192. doi: 10.1001/jama.2013.284692 CrossRefPubMedGoogle Scholar
  30. Paavola M, Vartiainen E, Haukkala A (2004) Smoking, alcohol use, and physical activity: a 13-year longitudinal study ranging from adolescence into adulthood. J Adolesc Health 35(3):238–244. doi: 10.1016/j.jadohealth.2003.12.004 CrossRefPubMedGoogle Scholar
  31. Perkins KA, Rohay J, Meilahn EN, Wing RR, Matthews KA, Kuller LH (1993) Diet, alcohol, and physical activity as a function of smoking status in middle-aged women. Health Psychol 12(5):410–415. doi: 10.1037/0278-6133.12.5.410 CrossRefPubMedGoogle Scholar
  32. Piirtola M, Kaprio J, Ropponen A (2014) A study of sedentary behaviour in the older Finnish twin cohort: a cross sectional analysis. Biomed Res Int 2014:209140. doi: 10.1155/2014/209140 CrossRefPubMedPubMedCentralGoogle Scholar
  33. Piirtola M et al (2016) Leisure-time physical inactivity and association with body mass index: a Finnish Twin Study with a 35-year follow-up. Int J Epidemiol. doi: 10.1093/ije/dyw007 (Published online: March 15, 2016) Google Scholar
  34. Sarna S, Kaprio J, Sistonen P, Koskenvuo M (1978) Diagnosis of twin zygosity by mailed questionnaire. Hum Hered 28(4):241–254. doi: 10.1159/000152964 CrossRefPubMedGoogle Scholar
  35. Sedentary Behaviour Research Network (2012) Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab 37(3):540–542. doi: 10.1139/h2012-024 CrossRefGoogle Scholar
  36. Taylor AE et al (2014a) Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta-analysis: the CARTA consortium. BMJ Open 4(10):e006141. doi: 10.1136/bmjopen-2014-006141 CrossRefPubMedPubMedCentralGoogle Scholar
  37. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P (2014b) Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 348:g1151. doi: 10.1136/bmj.g1151 CrossRefPubMedPubMedCentralGoogle Scholar
  38. Waller K, Kaprio J, Kujala UM (2008) Associations between long-term physical activity, waist circumference and weight gain: a 30-year longitudinal twin study. Int J Obes (Lond) 32(2):353–361. doi: 10.1038/sj.ijo.0803692 CrossRefGoogle Scholar
  39. Wee CC, Rigotti NA., Davis RB, Phillips RS (2001) Relationship between smoking and weight control efforts among adults in the united states. Arch Intern Med 161(4):546–550CrossRefPubMedGoogle Scholar
  40. World Health Organization (2011) Global status report on noncommunicable diseases 2010. WHO Press, GenevaGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2017

Authors and Affiliations

  1. 1.Department of Public HealthUniversity of HelsinkiHelsinkiFinland
  2. 2.Department of Social Research, Population Research UnitUniversity of HelsinkiHelsinkiFinland
  3. 3.Institute for Molecular Medicine Finland (FIMM)University of HelsinkiHelsinkiFinland
  4. 4.Department of HealthNational Institute for Health and WelfareHelsinkiFinland
  5. 5.Division of Insurance Medicine, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
  6. 6.Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
  7. 7.Finnish Institute of Occupational HealthHelsinkiFinland

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