Original Scientific Paper
Different forms of physical activity and cardiovascular risk
factors among 24–64-year-old men and women in Finland
Noël C. Barengoa, Mika Kastarinend, Timo Lakkaa,b,f, Aulikki Nissinenc,e
and Jaakko Tuomilehtoe
a
Department of Public Health and General Practice, bKuopio Research Institute of Exercise Medicine,
Department of Physiology, cDepartment of Neuroscience and Neurology, University of Kuopio, Kuopio,
d
Department of Medicine, Kuopio University Hospital, Kuopio, eDepartment of Epidemiology and Health
Promotion, National Public Health Institute, Helsinki, Finland and fPennington Biomedical Research Center,
Louisiana State University, Louisiana, USA.
Received 15 November 2004 Accepted 25 August 2005
Background There is convincing evidence that regular physical activity reduces risk factors for cardiovascular diseases
(CVD) among men. However, only a few studies have been conducted among women. Most previous studies have focused
on the effects of leisure-time physical activity on cardiovascular risk factors, without considering the impact of occupational
or commuting physical activity.
Design Four independent cross-sectional surveys were carried out at 5-year intervals within the framework of the
FINMONICA studies in 1982, 1987, 1992 and 1997.
Methods An independent random sample was drawn from the national population register for each survey. The samples
were stratified by sex and 10-year age categories according to the WHO MONICA protocol. The survey consisted of a selfadministered questionnaire.
Results Not only leisure-time physical activity, but also commuting activity was directly associated with high-density
lipoprotein (HDL)-cholesterol and was inversely related to body mass index (BMI) and waist circumference among both
men and women. High occupational physical activity was related to high HDL-cholesterol levels and high total serum
cholesterol levels in both sexes and to lower BMI, waist circumference and diastolic blood pressure (DBP) in men. High
leisure-time physical activity was associated with reduced DBP among both men and women, whereas high occupational
physical activity was related to lower DBP only among men.
Conclusion Not only leisure-time physical activity but also commuting activity is associated with reduced levels of some
cardiovascular risk factors. All forms of physical activity should be promoted to reduce CVD in the population. Eur J
c 2006 The European Society of Cardiology
Cardiovasc Prev Rehabil 13:51–59 European Journal of Cardiovascular Prevention and Rehabilitation 2006, 13:51–59
Keywords: cardiovascular risk factors, commuting, leisure-time physical activity
Sponsorship: This study was supported by a grant of the Aarne ja Aili Turunen fund, the Kuopio University fund and the Finnish Heart Association. T.A.L. was a Research
Fellow of the Academy of Finland.
Introduction
Cardiovascular diseases (CVD) are the primary cause of
death across Europe [1]. Many epidemiological studies
have shown that low physical activity is a strong and
Correspondence and requests for reprints to Noël Barengo, MD, Department
of Public Health and General Practice, University of Kuopio, Finland, PL 1627,
70211 Kuopio, Finland.
Tel: + 358 50 352 0818; fax: + 358 17 162 937;
e-mail: noel.barengo@uku.fi
independent risk factor for CVD [2–4], and that regular
physical activity reduces cardiovascular and all-cause
mortality [5–9]. A sedentary lifestyle has been estimated
to be responsible for approximately a third of deaths from
coronary heart disease, colon cancer and diabetes [10].
Even though there is convincing evidence that regular
physical activity reduces risk factors for CVD among men
[6,11–15], only a few studies have been conducted among
c 2006 The European Society of Cardiology
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52 European Journal of Cardiovascular Prevention and Rehabilitation 2006, Vol 13 No 1
women [8,16–20]. Furthermore, most previous studies
have focused on the effects of leisure-time physical
activity on cardiovascular risk factors [17,21–25], without
considering the impact of other forms of physical activity.
The findings of studies assessing the relationship of
occupational physical activity or commuting activity with
cardiovascular risk factors are limited and inconsistent
[8,12,14–16,20,26–31].
Recent recommendations encourage people to practice
30 min or more of moderate-intensity physical activity on
most days of the week [32,33]. Whereas some individuals
could increase their physical activity in leisure time,
others may gain a health benefit from being more
physically active on their way to work or at work.
Therefore, it is important to understand the separate
effects of the different forms of physical activity on
cardiovascular risk factors.
The purpose of our study was to investigate separately for
men and women the association between leisure-time,
occupational and commuting physical activity on the
most common risk factors of CVD adjusted for a number
of confounding factors.
Materials and methods
Study population
Four independent cross-sectional surveys were carried out
at 5-year intervals within the framework of the FINMONICA studies in 1982, 1987, 1992 and 1997. The
FINMONICA study was the Finnish part of the multinational MONICA project initiated by the World Health
Organization (WHO) in 1982 [34]. The first two surveys
were conducted in three regions: the provinces of North
Karelia and Kuopio, which are both located in eastern
Finland and the region of Turku-Loimaa in south-western
Finland. The survey was expanded to other regions after
1987.
An independent random sample was drawn from the
national population register for each survey. The samples
were stratified by sex and 10-year age categories
according to the WHO MONICA protocol [35]. The
common age range of the four surveys was 25–64 years
and the participation rates varied between 73 and 79% in
men and between 83 and 85% in women. Informed
written consent was obtained from the participants of all
surveys. The Institutional Review Board approved the
risk factor survey in 1997.
Assessment of physical activity
Leisure-time physical activity, occupational physical
activity and commuting activity were determined by a
self-administered questionnaire. The time frame of the
activity questionnaire was a typical week. A detailed
description of the questions for physical activity is
presented elsewhere [36–38]. These questions were
similar to those used and validated in the ‘Seven
Countries Study’ [39]. In the present study, leisure-time
physical activity was defined as voluntary and purposeful
physical activity, carried out in order to improve or
maintain one or more components of physical fitness
(exercise). Leisure-time physical activity was classified as
follows: (i) high: participation in recreational sports (for
example running, jogging, skiing, gymnastics, swimming,
ball-games or heavy gardening) or in intense training or
sports competitions for at least 3 h a week; (ii) moderate:
walking, cycling or practising some other form of light
exercise (fishing, gardening and hunting) for at least 4 h
per week; and (iii) low: reading, watching TV or working
in the household without much physical activity.
Occupational physical activity was classified as follows:
(i) high: lots of walking and lifting at work, taking the
stairs or walking uphill (for example industrial work, farm
work, forestry); (ii) moderate: walking quite a lot at work
without lifting or carrying heavy objects; and (iii) low:
mostly sedentary work without much walking (for
example, working in an office).
Commuting activity was classified as follows: (i) high:
more than 30 min physical exercise (walking, cycling)
every day while getting to work and back home; (ii)
moderate: exercising between 15 and 30 min daily on the
way to work and back home; and (iii) low: exercising less
than 15 min daily on the way to work and back home.
Assessment of cardiovascular risk factors
All measurements were conducted by nurses specially
trained in the survey procedures. Blood pressure was
measured from the right arm of the subject, who was
seated for 5 min before the measurement. The fifth phase
of the Korotkoff sounds was recorded as the diastolic
blood pressure (DBP). Blood pressure was measured
twice, recorded to the nearest 2 mmHg, and the mean of
these two measurements was used in the analyses.
Height was measured to the nearest 0.5 cm. Weight was
measured with the subject wearing light clothing. Body
mass index (BMI) was calculated as weight in kilograms
divided by height in meters squared. Waist circumference
was measured in centimetres. It was measured from the
midway between the inferior margin of the last rib and
the crest of the ileum, as recommended by the WHO
[40]. Non-fasting serum total cholesterol and highdensity lipoprotein (HDL)-cholesterol concentrations
after the precipitation of beta-lipoproteins with dextran
sulphate and magnesium chloride were determined using
an enzymatic method (CHOD-PAP; Böhringer Mannheim, Germany). A new batch of dextran sulphate
sodium salt (lot no. MM 97012, Pharmacia, Sweden)
for the precipitation of apolipoprotein B-containing
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Physical activity and cardiovascular risk factors Barengo et al. 53
lipoproteins was introduced into the laboratory in May
1987. However, the HDL-cholesterol values with the
new precipitant were approximately 4.4% lower than
those measured with the old precipitant. Therefore, the
results measured before May 1987 were corrected using
the following formula: HDL-cholesterol = (((HDL old
– 1.2621)/0.3592) 0.3230) + 1.1969. After this correction, the average and standard deviation of the sample
results were the same as those measured using the new
precipitant. The correct formula was found by measuring
the HDL-cholesterol in 299 samples using both methods.
The formula to correct for these two different methods
was constructed based on the means of these methods.
All lipoprotein determinations were made in the same
central laboratory (National Public Health Institute,
Department of Biochemistry) and the laboratory data
were standardized against the WHO reference laboratory
in Prague.
Smoking habits were classified according to three
categories: never smokers, ex-smokers (those, who had
smoked regularly but had stopped smoking at least
6 months before the survey) and current smokers.
terol were further adjusted for HDL-cholesterol and
analyses with HDL-cholesterol for total cholesterol,
respectively. The correlation coefficient between leisuretime physical activity and occupational physical activity
was 0.017, between leisure-time physical activity and
commuting activity 0.047, and 0.124 between occupational physical activity and commuting activity, respectively.
For the logistic regression analysis, dichotomous variables
for SBP (cutoff 140 mmHg) and DBP (cutoff 90 mmHg),
BMI (cutoff 25 kg/m2), HDL (cutoff 1.0 for men and 1.2
for women) and total cholesterol (cutoff 5 mmol/l) as well
as waist circumference (cutoff 94 cm for men and 80 cm
for women) were constructed according to the newest
recommendations of the Third Joint Task Force of
European and other Societies on Cardiovascular Disease
Prevention in Clinical Practice [33]. The odds ratios and
the 95% confidence intervals are presented. The models
included year of survey, age, education, smoking status,
alcohol intake, total cholesterol level, BMI and the
physical activity variables.
Results
Alcohol consumption was assessed with questions on the
types, frequency, and amount of alcohol consumed during
the previous week. An alcohol index was calculated
indicating the amount of alcohol in grams per week.
Education was assessed in years and the subjects were
divided into following categories: (i) low, 0–6 years of
education; (ii) middle, 7–9 years of education; (iii) high,
more than 9 years of education.
Statistical analyses
Statistical analyses were performed using SPSS for
Windows 11.0 (SPSS Inc., Chicago, Illinois, USA). The
analyses were performed separately for men and women.
The models including waist circumference concerned
data on surveys conducted between 1987 and 1997 only.
As a result of the research design, it was not possible to
exclude subjects taking lipid-lowering drugs. General
linear models were used to compare mean systolic blood
pressure (SBP) and DBP, BMI, HDL and total cholesterol
as well as waist circumference among the three groups of
different physical activity levels. The mean values and
the 95% confidence intervals are presented. The
differences between the groups were tested for statistical
significance using the least significant difference test.
A P value of less than 0.05 was chosen as the level of
statistical significance. Two different models were constructed. Model one included the following covariates:
area and year of survey, age, education, smoking status,
alcohol intake, and two other types of physical activity.
The second model included BMI in addition to the
covariates mentioned above. Analyses with total choles-
The baseline characteristics of the study population are
presented in Table 1. The majority of men (52%) and
women (54%) reported moderate levels of leisure-time
physical activity, whereas 41% of men and 46% of women
had low occupational physical activity. Only 27% of men
and 42% of women achieved more than 15 min commuting activity daily.
Table 2 presents the risk factors for CVD among groups
with different levels of leisure-time physical activity
separately for men and women. When adjusted for age,
area and year of survey, education, smoking, alcohol
intake, total cholesterol, occupational physical activity
and commuting activity, leisure-time physical activity was
inversely associated with BMI and waist circumference in
both men and women. The association between leisuretime physical activity and waist circumference got weaker
after further adjustment for BMI; however, it remained
significant (model 2). The lowest DBP level was seen in
both sexes among individuals with high leisure-time
physical activity. The differences in DBP between the
low and the high leisure-time physical activity group
decreased by 37% in men and by 61% in women, but
remained statistically significant after adjustment for
BMI. Leisure-time physical activity was also directly
associated with HDL-cholesterol levels after adjustment
for age, area and year of survey, education, smoking,
alcohol intake, BMI (model 2), occupational physical
activity and commuting activity.
Whereas mean waist circumference and DBP among men
with high occupational physical activity was statistically
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54
European Journal of Cardiovascular Prevention and Rehabilitation 2006, Vol 13 No 1
Table 1
Baseline characteristics of men and women
Total sample size (n)
Sample size per study area (n)
North Karelia
Kuopio
Turku-Loimaa
Helsinki-Vantaa
Oulu
Men
Women
13 832
14 950
4404
3694
3765
1306
663
Mean (SD)
45.0 (11.2)
4869
3805
4075
1451
750
Mean (SD)
45.0 (11.4)
Age (years)
Education
Low
14 (1891)
Moderate
39 (5219)
High
47 (6443)
Smoking
Never
37 (4978)
Ever
25 (3384)
Current
38 (5206)
Alcohol (g/week)
76 (119)
Body mass index
< 25
36 (4955)
25–29.9
47 (6427)
Z 30
17 (2407)
Waist circumference (cm)
93.7 (11.2)
Systolic blood pressure
139.0 (17.4)
(mmHg)
Diastolic blood pressure
84.1 (11.5)
(mmHg)
Total cholesterol (mmol/l)
5.91 (1.18)
HDL-cholesterol (mmol/l)
1.28 (0.32)
Leisure-time physical activity
Low
27 (3614)
Moderate
52 (6992)
High
21 (2976)
Occupational physical activity
Low
41 (5645)
Moderate
22 (2943)
High
37 (5112)
Walking or cycling to and from work (min)
< 15
73 (9767)
15–29
14 (1864)
Z 30
13 (1678)
12 (1672)
35 (5113)
53 (7797)
69
11
20
22
49
32
19
80.6
132.12
(10196)
(1599)
(2994)
(43)
(7295)
(4840)
(2781)
(11.9)
(19.0)
79.6 (10.8)
5.78 (1.24)
1.54 (0.34)
31 (4496)
54 (7883)
15 (2224)
46 (6836)
30 (4475)
24 (3428)
58 (8246)
20 (2804)
22 (3197)
Values are means (standard deviations) or percentages (numbers of subjects).
HDL, high-density lipoprotein.
significantly lower compared with those with low
occupational physical activity even after adjustment for
BMI, no significant difference in waist circumference or
DBP between the groups was found among women after
adjustment for BMI (Table 3). Men with high occupational physical activity had a significantly lower BMI
(P < 0.05), but surprisingly women with high occupational physical activity had a higher BMI compared with
individuals with moderate or low occupational physical
activity (P < 0.05). HDL-cholesterol levels were highest
among men and women with high occupational physical
activity in both models. Men and women with high
occupational physical activity had higher total cholesterol
levels than those with moderate or low levels of
occupational physical activity.
Men and women with at least 30 min of commuting
activity daily had a significantly lower BMI, a smaller
waist circumference and higher HDL-cholesterol levels
than those with less than 15 min commuting activity daily
after adjustment for age, area and year of survey,
education, smoking, alcohol intake, BMI (model 2),
leisure-time and occupational physical activity (Table 4).
Men with high leisure-time physical activity had a 34%
lower probability and physically active women had a 50%
smaller probability of being overweight compared with
individuals with low leisure-time physical activity levels
(Table 5). Compared with men and women with low
leisure-time physical activity, those with high leisuretime physical activity had a significant lower probability
of having enlarged waist circumference (men – 67%;
women – 34%), having elevated DBP (men – 24%;
women – 21%) and having increased HDL-cholesterol
levels (men – 34%; women – 32%). Furthermore, individuals with high commuting activity showed a lower
prevalence of overweight (men and women), enlarged
waist circumference (women) and low HDL-cholesterol
(men) (Table 5).
Discussion
This is to our knowledge the first study that has analysed
separately the relationship between different forms of
daily physical activity and cardiovascular risk factors in a
large population sample of men and women and adjusting
for a number of confounding factors. Our results show
that not only leisure-time physical activity, but also
commuting activity was directly associated with HDLcholesterol and was inversely related to BMI and waist
circumference among both men and women. High
occupational physical activity was related to high HDLcholesterol and high total serum cholesterol levels in both
sexes and to lower BMI and waist circumference in men.
High leisure-time physical activity was associated with
reduced DBP among both men and women, whereas high
occupational physical activity was related to lower DBP
only among men.
An important finding of our study was that all separate
forms of physical activity were associated with a lower
BMI and a smaller waist circumference in both men and
women, except occupational physical activity among
women. Our findings are in accordance with a majority
of studies indicating an inverse association between
leisure-time physical activity and BMI [6,8,11,16,
17,22,25–27] or waist circumference [11]. Only a few
studies have reported no associations between leisuretime physical activity and BMI [16,21,26] or a significant
inverse relationship between leisure-time physical activity and waist circumference only [28,41]. Findings about
the associations between occupational physical activity
and BMI have been inconsistent. Only two studies
reported an inverse association between occupational
physical activity and BMI [31,42]. Other studies did not
find a significant relationship between occupational
physical activity and BMI in men [16,27] or women
[8,16]. In support of our results, the two studies assessing
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Table 2
Cardiovascular risk factors according to leisure-time physical activity among 25–64-year-old men and women in Finland
BMIa (kg/m2)
Men (n)
Model 1
Low
Moderate
High
Model 2e
Low
Moderate
High
Women (n)
Model 1
Low
Moderate
High
Model 2e
Low
Moderate
High
Waist circumferenceb (cm)
SBPc (mmHg)
DBPc (mmHg)
HDL-cholesterold (mmol/l)
Total cholesterold (mmol/l)
Mean
27.0
26.7*
25.8w,z
Mean
–
–
–
12 417
(95% CI)
(26.8–27.1)
(26.5–26.8)
(25.7–26.0)
(95% CI1)
–
–
–
Mean
95.4
93.6*
90.0w,z
Mean
93.9
93.4*
91.7w,z
8349
(95% CI)
(94.8–96.0)
(93.1–94.1)
(89.4–90.6)
(95% CI)
(93.6–94.2)
(93.1–93.6)
(91.4–92.0)
Mean
138.2
139.1*
138.4
Mean
137.9
138.9*
138.9w
12 044
(95% CI)
(137.4–139.0)
(138.4–139.7)
(137.6–139.2)
(95% CI)
(137.1–138.7)
(138.2–139.5)
(138.1–139.7)
Mean
84.0
84.1
82.1w,z
Mean
83.8
84.0
82.6w,z
12 044
(95% CI)
(83.5–84.6)
(83.7–84.6)
(81.6–82.7)
(95% CI)
(83.2–84.3)
(83.5–84.4)
(82.1–83.2)
Mean
1.24
1.26*
1.32w,z
Mean
1.25
1.26*
1.31w,z
12 417
(95% CI)
(1.23–1.26)
(1.25–1.27)
(1.31–1.34)
(95% CI)
(1.24–1.26)
(1.25–1.28)
(1.29–1.32)
Mean
5.93
5.92
5.69w,z
Mean
5.91
5.91
5.71w,z
12 417
(95% CI)
(5.88–5.98)
(5.88–5.96)
(5.63–5.74)
(95% CI)
(5.86–5.96)
(5.87–5.95)
(5.66–5.76)
Mean
27.1
26.0*
25.3w,z
13 297
(95% CI)
(26.9–27.3)
(25.9–26.2)
(25.1–25.5)
Mean
83.9
81.0*
78.2w,z
9233
(95% CI)
(83.3–84.4)
(80.5–81.5)
(77.5–78.9)
Mean
132.2
132.3
131.0w,z
12 863
(95% CI)
(131.4–133.0)
(131.6–133.0)
(130.1–131.9)
Mean
79.7
79.2*
78.4w,z
12 864
(95% CI)
(79.2–80.1)
(78.8–79.6)
(77.8–78.9)
Mean
1.47
1.52*
1.57w,z
13 301
(95% CI)
(1.46–1.49)
(1.51–1.53)
(1.55–1.59)
Mean
5.81
5.77*
5.70w,z
13 297
(95% CI)
(5.76–5.86)
(5.73–5.80)
(5.64–5.75)
–
–
–
–
–
–
80.8
80.3*
79.3w,z
(80.5–81.1)
(80.0–80.5)
(79.0–79.6)
131.3
132.1*
131.3z
(130.6–132.1)
(131.4–132.8)
(130.3–132.2)
79.1
79.1
78.6w,z
(78.6–79.5)
(78.7–79.5)
(78.0–79.1)
1.50
1.52*
1.56w,z
(1.49–1.51)
(1.51–1.54)
(1.54–1.58)
5.78
5.76
5.71wz
(5.73–5.82)
(5.72–5.80)
(5.65–5.76)
BMI, Body mass index; CI, confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure. aAdjusted for age, area and year of survey, education, smoking, alcohol intake, occupational physical activity and
commuting activity. bAdjusted for age, area and year of survey, education, smoking, alcohol intake, occupational physical activity and commuting activity (analysis included only the surveys between 1987 and 1997). cAdjusted for
age, area and year of survey, education, smoking, alcohol intake, occupational physical activity and commuting activity; individuals using antihypertensive drug treatment were excluded. dAdjusted for age, area and year of survey,
education, smoking, alcohol intake, total cholesterol/high-density lipoprotein (HDL)-cholesterol, occupational physical activity and commuting activity. eAdditionally adjusted for BMI. *P < 0.05 for difference between low and
moderate leisure-time physical activity; wP < 0.05 for difference between low and high leisure-time physical activity; zP < 0.05 for difference between moderate and high leisure-time physical activity.
Cardiovascular risk factors according to occupational physical activity among 25–64-year-old men and women in Finland
BMIa (kg/m2)
Men (n)
Model 1
Low
Moderate
High
Model 2e
Low
Moderate
High
Women (n)
Model 1
Low
Moderate
High
Model 2e
Low
Moderate
High
Waist circumferenceb (cm)
SBPc (mmHg)
DBPc (mmHg)
HDL-cholesterold (mmol/l)
Total cholesterold (mmol/l)
Mean
26.5
26.6
25.3w,z
12 417
(95% CI)
(26.4–26.7)
(26.4–26.8)
(25.2–26.5)
Mean
93.2
93.5
92.2w,z
8349
(95% CI)
(92.7–93.8)
(92.9–94.1)
(91.7–92.7)
Mean
138.6
138.2
138.8
12 044
(95% CI)
(137.8–139.4)
(137.3–138.0)
(138.1–139.5)
Mean
83.7
83.6
83.0w,z
12 044
(95% CI)
(83.2–84.2)
(83.1–84.2)
(82.5–83.4)
Mean
1.25
1.26
1.32w,z
12 417
(95% CI)
(1.24–1.26)
(1.25–1.28)
(1.31–1.33)
Mean
5.78
5.85*
5.90w
12 417
(95% CI)
(5.74–5.83)
(5.80–5.91)
(5.85–5.94)
–
–
–
–
–
–
93.2
93.1
92.7w,z
(93.0–93.5)
(92.8–93.4)
(92.4–92.9)
138.6
138.1
138.9z
(137.9–139.4)
(137.2–138.1)
(138.2–139.6)
83.7
83.6
83.4w
(83.2–84.2)
(83.0–84.1)
(82.6–83.5)
1.25
1.26*
1.31w,z
(1.24–1.26)
(1.25–1.28)
(1.30–1.33)
5.78
5.85*
5.90w
(5.74–5.83)
(5.80–5.90)
(5.85–5.94)
Mean
26.1
25.8*
26.6w,z
13 297
(95% CI)
(25.9–26.2)
(25.6–26.0)
(26.3–26.8)
Mean
80.9
80.2*
82.0w,z
9233
(95% CI)
(80.3–81.4)
(79.6–80.7)
(81.3–82.6)
Mean
131.4
131.2
132.8w,z
12 863
(95% CI)
(130.7–132.2)
(130.4–132.0)
(132.0–133.7)
Mean
79.1
79.1
79.1
12 864
(95% CI)
(78.6–79.5)
(78.6–79.6)
(78.6–79.6)
Mean
1.50
1.52*
1.54w
13 301
(95% CI)
(1.49–1.51)
(1.51–1.54)
(1.52–1.55)
Mean
5.77
5.69*
5.81z
13 297
(95% CI)
(5.73–5.81)
(5.65–5.74)
(5.76–5.86)
–
–
–
–
–
–
80.2
80.0
80.2
(79.9–80.4)
(79.7–80.3)
(79.9–80.5)
131.3
131.1
132.2z
(130.6–132.0)
(130.4–131.9)
(131.4–133.0)
79.0
79.1
78.7
(78.5–79.4)
(78.6–79.5)
(78.2–79.2)
1.50
1.52*
1.55wz
(1.49–1.52)
(1.51–1.54)
(1.54–1.57)
5.76
5.69*
5.79z
(5.72–5.80)
(5.65–5.74)
(5.74–5.83)
BMI, Body mass index; CI, confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure. aAdjusted for age, area and year of survey, education, smoking, alcohol intake, leisure-time physical activity and
commuting activity. bAdjusted for age, area and year of survey, education, smoking, alcohol intake, leisure-time physical activity and commuting activity (analysis included only the surveys between 1987 and 1997). cAdjusted for
age, area and year of survey, education, smoking, alcohol intake, leisure-time physical activity and commuting activity; individuals using antihypertensive drug treatment were excluded. dAdjusted for age, area and year of survey,
education, smoking, alcohol intake, total cholesterol/high-density lipoprotein (HDL)-cholesterol, leisure-time physical activity and commuting activity. eAdditionally adjusted for BMI. *P < 0.05 for difference between low and
moderate occupational physical activity; wP < 0.05 for difference between low and high occupational physical activity; zP < 0.05 for difference between moderate and high occupational physical activity.
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Physical activity and cardiovascular risk factors Barengo et al. 55
Table 3
56
Table 4
Cardiovascular risk factors according to commuting activity among 25–64-year-old men and women in Finland
Men (n)
Model 1
Low
Moderate
High
Model 2e
Low
Moderate
High
Women (n)
Model 1
Low
Moderate
High
Model 2e
Low
Moderate
High
Waist circumferenceb (cm)
SBPc (mmHg)
DBPc (mmHg)
HDL-cholesterold (mmol/l)
Total cholesterold (mmol/l)
Mean
26.8
26.4*
26.3w
12 417
(95% CI1)
(26.6–26.9)
(26.2–26.6)
(26.1–26.5)
Mean
93.7
92.7*
92.6w
8349
(95% CI)
(93.3–94.1)
(92.0–93.4)
(91.8–93.3)
Mean
139.5
137.7*
138.4w
12 044
(95% CI)
(138.9–140.0)
(136.8–138.6)
(137.5–139.4)
Mean
83.7
83.2
83.4
12 044
(95% CI)
(83.3–84.1)
(82.6–83.8)
(82.7–84.1)
Mean
1.25
1.28*
1.30w,z
12 417
(95% CI)
(1.24–1.26)
(1.26–1.29)
(1.28–1.32)
Mean
5.88
5.85
5.81w
12 417
(95% CI)
(5.84–5.91)
(5.79–5.91)
(5.75–5.87)
–
–
–
–
–
–
93.2
93.0
92.8w
(93.0–93.4)
(92.7–93.4)
(92.4–93.1)
139.2
137.7*
138.7
(138.7–139.8)
(136.8–138.6)
(137.7–139.6)
83.4
83.3
83.7
(83.1–83.8)
(82.7–83.9)
(83.0–84.3)
1.26
1.27*
1.29w,z
(1.25–1.27)
(1.26–1.29)
(1.28–1.31)
5.87
5.85
5.82
(5.83–5.90)
(5.79–5.91)
(5.75–5.88)
Mean
26.5
26.0*
25.9w
13 297
(95% CI)
(26.4–26.7)
(25.8–26.2)
(25.7–26.1)
Mean
82.1
80.7*
80.3w
9233
(95% CI)
(81.6–82.5)
(80.0–81.3)
(79.7–80.9)
Mean
132.6
131.3*
131.6w
12 863
(95% CI)
(131.9–133.2)
(130.5–132.2)
(130.7–132.4)
Mean
78.9
79.0
79.4
12 864
(95% CI)
(78.5–79.3)
(78.5–79.5)
(78.8–79.8)
Mean
1.50
1.53*
1.54w
13 301
(95% CI)
(1.49–1.51)
(1.51–1.54)
(1.52–1.55)
Mean
5.82
5.72*
5.73w
13 297
(95% CI)
(5.78–5.85)
(5.67–5.77)
(5.69–5.78)
–
–
–
–
–
–
80.4
80.1
79.9w
(80.2–80.6)
(79.8–80.4)
(79.6–80.2)
132.1
131.1*
131.5w
(131.4–132.7)
(130.3–132.0)
(130.7–132.3)
78.6
78.9
79.2w
(78.2–79.0)
(78.4–79.4)
(78.7–79.8)
1.51
1.53*
1.54w
(1.50–1.52)
(1.52–1.55)
(1.52–1.55)
5.80
5.71*
5.73w
(5.76–5.84)
(5.66–5.76)
(5.68–5.78)
BMI, Body mass index; CI, confidence interval; DBP, diastolic blood pressure; SBP, systolic blood pressure. aAdjusted for age, area and year of survey, education, smoking, alcohol intake, leisure-time physical activity and
occupational physical activity. bAdjusted for age, area and year of survey, education, smoking, alcohol intake, leisure-time physical activity and occupational physical activity (analysis included only the surveys between 1987 and
1997). cAdjusted for age, area and year of survey, education, smoking, alcohol intake, leisure-time physical activity and occupational physical activity; individuals using antihypertensive drug treatment were excluded. dAdjusted
for age, area and year of survey, education, smoking, alcohol intake, total cholesterol/high-density lipoprotein (HDL)-cholesterol, leisure-time physical activity and occupational physical activity. eAdditionally adjusted for BMI.
*P < 0.05 for difference between low and moderate commuting activity; wP < 0.05 for difference between low and high commuting activity; zP < 0.05 for difference between moderate and high commuting activity.
the effects of commuting activity and BMI or waist
circumference [11,29] found an inverse association
between commuting activity and BMI and waist circumference among men [11] and BMI in women [29].
Physical activity has been associated with reduced blood
pressure in observational studies [43,44] and clinical trials
[45–47]. However, associations between physical activity
and blood pressure have been inconsistent in crosssectional studies. Even though some studies observed an
inverse association between leisure-time physical activity
and blood pressure among both men [5,26] and women
[17,18,25,26,28], other studies could not support these
findings [9,20,21,29]. Our findings are generally in line
with the observations of Marti and co-workers [19], who
showed a lack of association between mean arterial
pressure and leisure-time physical activity. However, we
found a significantly reduced DBP among men and
women with high leisure-time physical activity. Their
study was carried out earlier among the population in
eastern Finland where a part of our study was also
conducted. Studies investigating the effect of occupational physical activity or commuting activity on blood
pressure are very rare. Whereas occupational physical
activity seemed to be associated with a lower DBP [9,14]
and SBP [14] among men, no significant association
between occupational physical activity and blood pressure
was observed among women [20]. Our results partly
support these findings showing a lower DBP in men with
high occupational physical activity. A Japanese cohort
study showed that commuting activity decreased the risk
of hypertension in Japanese men [42]. In Chinese men,
more than 60 min commuting activity was associated
with the highest mean SBP (men and women) and DBP
(men). The lowest mean blood pressure values were
found among those individuals with 31–60 min of
commuting activity [29].
It is difficult to explain why cross-sectional studies have
difficulties in showing differences in blood pressure
among physical activity groups. Most likely physical
activity reduces blood pressure by weight loss. However,
our results remained the same even when we analysed
the associations of leisure time, occupational physical
activity and commuting activity with blood pressure
separately in individuals with normal body weight and
overweight. Differences in physical activity measurements and adjustments for confounding factors may also
explain the inconsistent findings of previous studies. We
conclude that other confounding factors exist that we
could not control for, such as salt intake or stress.
Our results are in line with previous results indicating
that leisure-time physical activity has been positively
associated with HDL-cholesterol concentrations among
men [6,12,13,15,23–25,48] and women [18,20,22,25,26].
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European Journal of Cardiovascular Prevention and Rehabilitation 2006, Vol 13 No 1
BMIa (kg/m2)
Table 5
Cardiovascular risk factors according to leisure-time, occupational physical activity and commuting activity levels among 25–64-year-old men and women in Finland
BMIa (kg/m2)
Men (n)
LTPA
Low
Moderate
High
OPA
Low
Moderate
High
CA
Low
Moderate
High
12399
(95% CI)
(0.91–1.10)
(0.59–0.74)
OR
1
0.75
0.33
1
1.18
1.01
(1.06–1.31)
(0.92–1.11)
1
0.80
0.74
(0.72–0.90)
(0.66–0.83)
8349
(95% CI)
SBPc (mmHg)
(0.63–0.90)
(0.27–0.42)
OR
1
1.17
1.15
1
0.94
0.74
(0.78–1.13)
(0.62–0.88)
1
0.98
0.87
(0.79–1.21)
(0.69–1.11)
13317
10886
(95% CI1)
DBPc (mmHg)
(1.06–1.29)
(1.02–1.30)
OR
1
0.98
0.76
1
0.95
1.05
(0.76–0.96)
(0.81–1.15)
1
0.85
0.92
(0.76–0.96)
(0.81–1.04)
9233
10886
(95% CI)
HDL-cholesterold (mmol/l)
(0.88–1.09)
(0.66–0.87)
OR
1
0.90
0.66
1
1.02
0.99
(0.90–1.15)
(0.89–1.10)
1
0.99
0.96
(0.87–1.13)
(0.84–1.11)
11594
12417
(95% CI)
Total cholesterold (mmol/l)
12417
(95% CI)
(0.80–1.00)
(0.56–0.76)
OR
1
1.08
0.79
1
0.84
0.58
(0.74–0.96)
(0.52–0.66)
1
1.20
1.27
(1.06–1.35)
(1.14–1.41)
1
0.92
0.80
(0.79–1.06)
(0.68–0.94)
1
1.08
0.87
(0.95–1.23)
(0.76–1.01)
11594
13297
(0.96–1.21)
(0.69–0.89)
13298
1
0.71
0.50
(0.66–0.78)
(0.45–0.57)
1
0.89
0.66
(0.76–1.05)
(0.53–0.82)
1
1.02
0.82
(0.91–1.13)
(0.70–0.96)
1
0.95
0.79
(0.84–1.07)
(0.66–0.95)
1
0.83
0.68
(0.74–0.92)
(0.57–0.81)
1
0.99
0.87
(0.89–1.09)
(0.76–0.99)
1
0.99
1.22
(0.90–1.08)
(1.09–1.32)
1
1.03
1.01
(0.87–1.20)
(0.89–1.14)
1
1.11
1.22
(0.99–1.24)
(1.08–1.38)
1
1.03
1.05
(0.91–1.18)
(0.91–1.21)
1
0.80
0.64
(0.71–0.90)
(0.56–0.73)
1
0.89
1.10
(0.80–0.98)
(0.98–1.23)
1
0.78
0.78
(0.70–0.86)
(0.71–0.85)
1
0.90
0.69
(0.76–1.08)
(0.58–0.83)
1
0.87
0.95
(0.77–0.99)
(0.84–1.06)
1
1.01
1.11
(0.87–1.17)
(0.97–1.28)
1
0.93
0.94
(0.81–1.06)
(0.83–1.07)
1
0.87
0.94
(0.78–0.97)
(0.85–1.05)
BMI, Body mass index; CA, commuting activity; CI, confidence interval; DBP, diastolic blood pressure; HDL, high-density lipoprotein cholesterol; LTPA, leisure-time physical activity; OPA, occupational physical activity; OR, odds
ratio; SBP, systolic blood pressure. aAdjusted for age, area, year of survey, education, smoking, alcohol intake, LTPA, OPA and CA. bAdjusted for age, area, year of survey, education, smoking, BMI, alcohol intake, LTPA, OPA and
CA (analysis included only the surveys between 1987 and 1997). cAdjusted for age, area, year of survey, education, smoking, alcohol intake, BMI, LTPA, OPA and CA; individuals using antihypertensive drug treatment were
excluded. dAdjusted for age, area, year of survey, education, smoking, BMI, alcohol intake, total cholesterol/HDL-cholesterol, LTPA, OPA and CA.
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Women (n)
LTPA
Low
Moderate
High
OPA
Low
Moderate
High
CA
Low
Moderate
High
OR
1
1.00
0.66
Waist circumferenceb (cm)
58
European Journal of Cardiovascular Prevention and Rehabilitation 2006, Vol 13 No 1
In accordance with our findings, many previous studies
reported an inverse association between leisure-time
physical activity and total serum cholesterol among men
[13,17,22,24,26,49,50]. However, in contrast to our study,
they failed to show a significant association among women
[25,50]. The observations of the few studies investigating
the association between occupational physical activity
and HDL-cholesterol levels have been less consistent.
The results vary from a positive relationship [12,14] to no
relationship at all [13,15]. Walking has been shown to
affect serum lipid levels [51,52], and commuting activity
was observed to be inversely related to total serum
cholesterol among men and positively with HDLcholesterol in a cross-sectional study among Chinese
women [30].
physical activities are very difficult to conduct in large
population studies; however, the questionnaire used for
the assessment of physical activity has been successfully
used elsewhere [5,7,9,50,53], and it has been validated in
the ‘Seven Countries Study’ [39].
Several reasons may explain why the cholesterol level
among both men and women was highest in the groups
with high occupational physical activity. Individuals with
high occupational physical activity may belong to a lower
socio-economic class, and using education as an indicator
of socio-economic status may only partly reflect the socioeconomic level. Nevertheless, it is unlikely that these
results are the result of differences in socioeconomic
factors alone. Another possible reason for the observations
of our study may be differences in dietary habits among
the group with the highest occupational physical activity
compared with the group with the lowest physical
activity. The correlation coefficient between cholesterol
and education was – 0.308, indicating that dietary habits
may differ among educational levels.
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