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It is never too late to start: adherence to physical activity recommendations for 11–22 years and risk of all-cause and cardiovascular disease mortality. The HUNT Study
  1. Trine Moholdt1,2,
  2. Eivind Schjelderup Skarpsno3,
  3. Børge Moe4,
  4. Tom Ivar Lund Nilsen3,5
  1. 1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
  2. 2Women's Clinic, St. Olavs Hospital, Trondheim, Norway
  3. 3Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Norway
  4. 4Department of Physical Activity and Health, Queen Maud University College of Early Childhood Education, Trondheim, Norway
  5. 5Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim, Norway
  1. Correspondence to Dr Trine Moholdt, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7491 Trondheim, Norway; trine.moholdt{at}


Objectives To examine associations between long-term (11–22 years) adherence to physical activity recommendations and mortality from all causes and from cardiovascular disease.

Design Prospective population-based study with repeated assessments of self-reported physical activity (1984–86, 1995–97 and 2006–08) and follow-up until the end of 2013.

Setting County of Nord-Trøndelag, Norway.

Participants Men and women aged ≥20 years; 32 811 who participated in 1984–86 and 1995–97; 22 058 in 1984–86 and 2006–08; 31 948 in 1995–97 and 2006–09 and 19 349 in all three examinations (1984–1986, 1995–95 and 2006–08).

Main outcome measures All-cause mortality and cardiovascular disease mortality from the national Cause of Death Registry.

Results Compared with the reference category comprising individuals who adhered to the physical activity recommendations (≥150 min of moderate intensity or ≥60 min of vigorous intensity physical activity per week) over time, individuals who remained inactive (reporting no or very little physical activity) from 1984–86 to 1995–97 had HRs (95% CI) of 1.56 (1.40 to 1.73) for all-cause mortality and 1.94 (1.62 to 2.32) for cardiovascular disease mortality. Individuals who were inactive in 1984–86 and then adhered to recommendations in 2006–08 had HRs of 1.07 (0.85 to 1.35) for all-cause mortality and 1.31 (0.87 to 1.98) for cardiovascular disease mortality. In a subsample of individuals who participated at all three time points, those who were inactive or physically active below the recommended level across three decades (1984–86, 1995–97 and 2006–2008) had an HR of 1.57 (1.22 to 2.03) for all-cause mortality and 1.72 (1.08 to 2.73) for cardiovascular disease mortality.

Conclusion Individuals who remained, or became, physically inactive had substantially greater risk of all-cause and cardiovascular disease mortality compared with those who met the physical activity recommendations throughout the lifespan.

  • exercise
  • sedentary
  • survival
  • epidemiology
  • health

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  • Contributors TM, BM and TILN designed the study. TILN and ESS analysed the data. TM, TILN, ESS and BM interpreted the data. TM drafted the manuscript. BM, ESS and TILN revised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript. All authors declare that they accept full responsibility for the conduct of the study, had access to the data and controlled the decision to publish.

  • Funding This work was supported by grants from the Norwegian Health Association and the Norwegian Fund for Post-Graduate Training in Physiotherapy.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional Committee for Ethics in Medical Research (no. 2014/1116 REK midt) and adhered to the World Medical Association’s Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data are obtained from the HUNT database.

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