Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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



To examine the association of physical activity and body mass index (BMI), and their combined effect, with the risk of total, cardiovascular disease (CVD) and cancer mortality.


Prospective follow-up study.


In all, 22 528 men and 24 684 women aged 25–64 y at baseline having 7394 deaths during a mean follow-up of 17.7 y.


A self-administered questionnaire data on smoking, socioeconomic factors, physical activity and medical history, together with measured height, weight, blood pressure and serum cholesterol using standardized protocol.


Physically active subjects had significantly lower age-adjusted mortality from cardiovascular, cancer and all causes compared with sedentary ones. Further adjustment for smoking, systolic blood pressure, cholesterol, BMI, diabetes and education affected the results only slightly. Obese subjects (BMI≥30 kg/m2) had significantly higher cardiovascular and total mortality than the normal weight (18.5≤BMI<25 kg/m2) subjects. Part of increased mortality among obese subjects was mediated through obesity-related cardiovascular risk factors. BMI had an inverse association with cancer mortality among men and almost significant direct association among women. Total mortality was also increased among the lean (BMI<18.5 kg/m2) subjects. However, less than 0.3% of deaths were attributed to low body weight, whereas in men 5.5% and in women 17.7% of deaths were attributed to obesity.


Regular physical activity and normal weight are both important indicators for a decreased risk of mortality from all causes, CVD and cancer. Physical activity had a strong independent effect on mortality, whereas the effect of BMI was partly mediated through other obesity-related risk factors.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1


  1. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kiska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH . Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402–407.

    CAS  Article  Google Scholar 

  2. Willett WC, Dietz WH, Colditz GA . Guidelines for healthy weight. N Engl J Med 1999; 341: 427–434.

    CAS  Article  Google Scholar 

  3. Dubbert PM, Carithers T, Sumner AE, Barbour KA, Clark BL, Hall JE, Crook ED . Obesity, physical inactivity, and risk for cardiovascular disease. Am J Med Sci 2002; 324: 116–126.

    Article  Google Scholar 

  4. Jousilahti P, Tuomilehto J, Vartiainen E, Pekkanen J, Puska P . Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged men and women in eastern Finland. Circulation 1996; 93: 1372–1379.

    CAS  Article  Google Scholar 

  5. Blair SN, Cheng Y, Holder JS . Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc 2001; 33: S379–S399.

    CAS  Article  Google Scholar 

  6. Erlichman J, Kerbey AL, James WP . Physical activity and its impact on health outcomes. Paper 1: the impact of physical activity on cardiovascular disease and all-cause mortality: an historical perspective. Obes Rev 2002; 3: 257–271.

    CAS  Article  Google Scholar 

  7. Meyer HE, Sogaard AJ, Tverdal A, Selmer RM . Body mass index and mortality: the influence of physical activity and smoking. Med Sci Sports Exerc 2002; 34: 1065–1070.

    Article  Google Scholar 

  8. Fang J, Wylie-Rosett J, Cohen HW, Kaplan RC, Alderman MH . Exercise, body mass index, caloric intake, and cardiovascular mortality. Am J Prev Med 2003; 25: 283–289.

    Article  Google Scholar 

  9. Hu G, Qiao Q, Silventoinen K, Eriksson JG, Jousilahti P, Lindstrom J, Valle TT, Nissinen A, Tuomilehto J . Occupational, commuting, and leisure-time physical activity in relation to risk for type 2 diabetes in middle-aged Finnish men and women. Diabetologia 2003; 46: 322–329.

    CAS  Article  Google Scholar 

  10. Katzmarzyk PT, Janssen I, Ardern CI . Physical inactivity, excess adiposity and premature mortality. Obes Rev 2003; 4: 257–290.

    CAS  Article  Google Scholar 

  11. Hu G, Barengo NC, Tuomilehto J, Lakka TA, Nissinen A, Jousilahti P . Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland. Hypertension 2004; 43: 25–30.

    CAS  Article  Google Scholar 

  12. Hu G, Lindstrom J, Valle TT, Eriksson JG, Jousilahti P, Silventoinen K, Qiao Q, Tuomilehto J . Physical activity, body mass index, and risk of type 2 diabetes in patients with normal or impaired glucose regulation. Arch Intern Med 2004; 164: 892–896.

    Article  Google Scholar 

  13. World Health Organisation. Preventing and Managing the Global Epidemic, WHO Technical Report Series 894. World Health Organization: Geneva; 2000.

  14. Lew EA, Garfinkel L . Variations in mortality by weight among 750 000 men and women. J Chronic Dis 1979; 32: 563–576.

    CAS  Article  Google Scholar 

  15. Rissanen A, Heliovaara M, Knekt P, Aromaa A, Reunanen A, Maatela J . Weight and mortality in Finnish men. J Clin Epidemiol 1989; 42: 781–789.

    CAS  Article  Google Scholar 

  16. Lee IM, Manson JE, Hennekens CH, Paffenbarger Jr RS . Body weight and mortality. A 27-year follow-up of middle-aged men. JAMA 1993; 270: 2823–2828.

    CAS  Article  Google Scholar 

  17. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE . Body weight and mortality among women. N Engl J Med 1995; 333: 677–685.

    CAS  Article  Google Scholar 

  18. Seidell JC, Verschuren WM, van Leer EM, Kromhout D . Overweight, underweight, and mortality. A prospective study of 48 287 men and women. Arch Intern Med 1996; 156: 958–963.

    CAS  Article  Google Scholar 

  19. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath Jr CW . Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med 1999; 341: 1097–1105.

    CAS  Article  Google Scholar 

  20. Haapanen-Niemi N, Miilunpalo S, Pasanen M, Vuori I, Oja P, Malmberg J . Body mass index, physical inactivity and low level of physical fitness as determinants of all-cause and cardiovascular disease mortality—16 y follow-up of middle-aged and elderly men and women. Int J Obes Relat Metab Disord 2000; 24: 1465–1474.

    CAS  Article  Google Scholar 

  21. Sarlio-Lahteenkorva S, Silventoinen K, Jousilahti P, Hu G, Tuomilehto J . The association between thinness and socio-economic disadvantage, health indicators, and adverse health behaviour: a study of 28 000 Finnish men and women. Int J Obes Relat Metab Disord 2004; 28: 568–573.

    CAS  Article  Google Scholar 

  22. Farrell SW, Kampert JB, Kohl III HW, Barlow CE, Macera CA, Paffenbarger Jr RS, Gibbons LW, Blair SN . Influences of cardiorespiratory fitness levels and other predictors on cardiovascular disease mortality in men. Med Sci Sports Exerc 1998; 30: 899–905.

    CAS  PubMed  Google Scholar 

  23. Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger Jr RS, Blair SN . Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999; 282: 1547–1553.

    CAS  Article  Google Scholar 

  24. Farrell SW, Braun L, Barlow CE, Cheng YJ, Blair SN . The relation of body mass index, cardiorespiratory fitness, and all-cause mortality in women. Obes Res 2002; 10: 417–423.

    Article  Google Scholar 

  25. Stevens J, Cai J, Evenson KR, Thomas R . Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Am J Epidemiol 2002; 156: 832–841.

    Article  Google Scholar 

  26. Lee IM, Paffenbarger Jr RS . Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 2000; 151: 293–299.

    CAS  Article  Google Scholar 

  27. Crespo CJ, Palmieri MR, Perdomo RP, McGee DL, Smit E, Sempos CT, Min I, Sorlie PD . The relationship of physical activity and body weight with all-cause mortality: results from the Puerto Rico Heart Health Program. Ann Epidemiol 2002; 12: 543–552.

    Article  Google Scholar 

  28. Vartiainen E, Jousilahti P, Alfthan G, Sundvall J, Pietinen P, Puska P . Cardiovascular risk factor changes in Finland, 1972–1997. Int J Epidemiol 2000; 29: 49–56.

    CAS  Article  Google Scholar 

  29. Pajak A, Kuulasmaa K, Tuomilehto J, Ruokokoski E . Geographical variation in the major risk factors of coronary heart disease in men and women aged 35–64 years. The WHO MONICA Project. World Health Stat Q 1988; 41: 115–140.

    Google Scholar 

  30. WHO MONICA Project Principal Investigators. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 1988; 41: 105–114.

  31. Tuomilehto J, Hu G, Bidel S, Lindstrom J, Jousilahti P . Coffee consumption and risk of type 2 diabetes mellitus among middle-aged Finnish men and women. JAMA 2004; 291: 1213–1219.

    CAS  Article  Google Scholar 

  32. Hu G, Eriksson J, Barengo NC, Lakka TA, Valle T, Nissinen A, Jousilahti P, Tuomilehto J . Occupational, commuting, and leisure-time physical activity in relation to total and cardiovascular mortality among Finnish subjects with type 2 diabetes. Circulation 2004; 110: 666–673.

    Article  Google Scholar 

  33. 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: 1621–1628.

    CAS  Article  Google Scholar 

  34. Schnohr P, Scharling H, Jensen JS . Changes in leisure-time physical activity and risk of death: an observational study of 7000 men and women. Am J Epidemiol 2003; 158: 639–644.

    Article  Google Scholar 

  35. Keys A . Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Harvard University Press: Cambridge, MA; 1980.

    Book  Google Scholar 

  36. Spataro JA, Dyer AR, Stamler J, Shekelle RB, Greenlund K, Garside D . Measures of adiposity and coronary heart disease mortality in the Chicago Western Electric Company Study. J Clin Epidemiol 1996; 49: 849–857.

    CAS  Article  Google Scholar 

  37. Kampert JB, Blair SN, Barlow CE, Kohl III HW . Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women. Ann Epidemiol 1996; 6: 452–457.

    CAS  Article  Google Scholar 

  38. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. Physical activity and cardiovascular health. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. JAMA 1996; 276: 241–246.

  39. Fogelholm M, Kukkonen-Harjula K . Does physical activity prevent weight gain—a systematic review. Obes Rev 2000; 1: 95–111.

    CAS  Article  Google Scholar 

  40. Pan X, Li G, Hu Y, Wang J, Yang W, An Z, Hu Z, Lin J, Xiao J, Cao H, Liu P, Jiang X, Jiang Y, Wang J, Zheng H, Zhang H, Bennett P, Howard B . Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20: 537–544.

    CAS  Article  Google Scholar 

  41. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–1350.

    CAS  Article  Google Scholar 

  42. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.

    CAS  Article  Google Scholar 

Download references


This study was supported by grants from the Finnish Academy (grant numbers 46 558, 53 585, 204 274 and 205 657).

Author information

Authors and Affiliations


Corresponding author

Correspondence to G Hu.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hu, G., Tuomilehto, J., Silventoinen, K. et al. 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 29, 894–902 (2005).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • body mass index
  • cancer
  • cardiovascular disease
  • mortality
  • physical activity

This article is cited by


Quick links