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Epidemiology and Population Health

The bidirectional associations between leisure time physical activity change and body mass index gain. The Tromsø Study 1974–2016



To examine whether leisure time physical activity changes predict subsequent body mass index (BMI) changes, and conversely, whether BMI changes predict subsequent leisure time physical activity changes.


This prospective cohort study included adults attending ≥3 consecutive Tromsø Study surveys (time: T1, T2, T3) during 1974–2016 (n = 10779). If participants attended >3 surveys, we used the three most recent surveys. We computed physical activity change (assessed by the Saltin-Grimby Physical Activity Level Scale) from T1 to T2, categorized as Persistently Inactive (n = 992), Persistently Active (n = 7314), Active to Inactive (n = 1167) and Inactive to Active (n = 1306). We computed BMI change from T2 to T3, which regressed on preceding physical activity changes using analyses of covariance. The reverse association (BMI change from T1 to T2 and physical activity change from T2 to T3; n = 4385) was assessed using multinomial regression.


Average BMI increase was 0.86 kg/m2 (95% CI: 0.82–0.90) from T2 to T3. With adjustment for sex, birth year, education, smoking and BMI at T2, there was no association between physical activity change from T1 to T2 and BMI change from T2 to T3 (Persistently Inactive: 0.89 kg/m2 (95% CI: 0.77–1.00), Persistently Active: 0.85 kg/m2 (95% CI: 0.81–0.89), Active to Inactive: 0.90 kg/m2 (95% CI: 0.79–1.00), Inactive to Active 0.85 kg/m2 (95% CI: 0.75–0.95), p = 0.84). Conversely, increasing BMI was associated with Persistently Inactive (odds ratio (OR): 1.17, 95% CI: 1.08–1.27, p < 0.001) and changing from Active to Inactive (OR: 1.16, 95% CI: 1.07–1.25, p < 0.001) compared with being Persistently Active.


We found no association between leisure time physical activity changes and subsequent BMI changes, whereas BMI change predicted subsequent physical activity change. These findings indicate that BMI change predicts subsequent physical activity change at population level and not vice versa.

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Fig. 1: The study design for assessing the association between physical activity changes and future BMI changes, and conversely for assessing BMI changes and physical activity changes.
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Data availability

The data that support the findings of this study are available from the Tromsø Study but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. The data are however available from the Tromsø Study upon application to the Data and Publication Committee for the Tromsø Study:


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We would like to acknowledge Professor Bjarne Koster Jacobsen for valuable input on the study´s result and for revising working manuscript drafts.


The work of EHS is funded by Population Studies in the High North (Befolkningsundersøkelser i Nord: BiN). The remaining authors are funded by their respective positions/tenures. The funders had no role in the implementation and design of the study or in writing the manuscript.

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EHS, BM, UE, LAH designed the study, EHS carried out data analysis, OL and TW provided statistical expertise, all authors interpreted the study results, EHS drafted the manuscript, and all authors contributed with manuscript revisions and approved the final version of the manuscript.

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Correspondence to Edvard H. Sagelv.

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The authors declare no competing interests.

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All participants from Tromsø 4–7 provided written informed consent and the present study was approved by the Regional Ethics Committee for Medical Research (ref. 2016/758410).

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Sagelv, E.H., Ekelund, U., Hopstock, L.A. et al. The bidirectional associations between leisure time physical activity change and body mass index gain. The Tromsø Study 1974–2016. Int J Obes 45, 1830–1843 (2021).

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