Economic burden of low physical activity and high sedentary behaviour in Finland

Päivi Kolu, Jaana T Kari, Jani Raitanen, Harri Sievänen, Kari Tokola, Eino Havas, Jaakko Pehkonen, Tuija H Tammelin, Katja Pahkala, Nina Hutri-Kähönen, Olli T Raitakari, Tommi Vasankari, Päivi Kolu, Jaana T Kari, Jani Raitanen, Harri Sievänen, Kari Tokola, Eino Havas, Jaakko Pehkonen, Tuija H Tammelin, Katja Pahkala, Nina Hutri-Kähönen, Olli T Raitakari, Tommi Vasankari

Abstract

Background: Low physical activity and high sedentary behaviour are unquestionably relevant for public health while also increasing direct and indirect costs.

Methods: The authors examined the direct and indirect costs attributable to low physical activity and high sedentary behaviour in Finland in 2017. Costs related to major non-communicable diseases drawn from Finnish registries covered direct costs (outpatient visits, days of inpatient care, medication and institutional eldercare) and indirect costs (sickness-related absences, disability pensions, unemployment benefits, all-cause mortality and losses of income tax revenue). Prevalences of low physical activity and high sedentary behaviour (≥8 hours per 16 waking hours) were based on self-reports among adolescents or accelerometer data among adults and the elderly from three Finnish population studies: FINFIT 2017, Health 2011 and the Cardiovascular Risk in Young Finns Study. Cost calculations used adjusted population attributable fractions (PAF) and regression models. Total annual costs were obtained by multiplying PAF by the total costs of the given disease.

Results: The total costs of low physical activity in Finland in 2017 came to approximately €3.2 billion, of which direct costs accounted for €683 million and indirect ones for €2.5 billion. Costs attributable to high sedentary behaviour totalled roughly €1.5 billion.

Conclusion: The findings suggest that low physical activity and high sedentary behaviour levels create substantial societal costs. Therefore, actions intended to increase physical activity and reduce excessive sedentary behaviour throughout life may yield not only better health but also considerable savings to society.

Keywords: economics; epidemiology; health promotion; public health; sick leave.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Guthold R, Stevens GA, Riley LM, et al. . Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health 2018;6:e1077–86. 10.1016/S2214-109X(18)30357-7
    1. Husu P, Suni J, Vähä-Ypyä H, et al. . Objectively measured sedentary behavior and physical activity in a sample of Finnish adults: a cross-sectional study. BMC Public Health 2016;16. 10.1186/s12889-016-3591-y
    1. Bennie JA, Pedisic Z, Suni JH, et al. . Self-reported health-enhancing physical activity recommendation adherence among 64,380 Finnish adults. Scand J Med Sci Sports 2017;27:1842–53. 10.1111/sms.12863
    1. Lee I-M, Shiroma EJ, Lobelo F, et al. . Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012;380:219–29. 10.1016/S0140-6736(12)61031-9
    1. Stamatakis E, Ding D, Ekelund U, et al. . Sliding down the risk factor rankings: reasons for and consequences of the dramatic downgrading of physical activity in the global burden of disease 2019. Br J Sports Med 2021;55:1222–3. 10.1136/bjsports-2021-104064
    1. Piercy KL, Troiano RP, Ballard RM, et al. . The physical activity guidelines for Americans. JAMA 2018;320:2020–8. 10.1001/jama.2018.14854
    1. Heron L, O'Neill C, McAneney H, et al. . Direct healthcare costs of sedentary behaviour in the UK. J Epidemiol Community Health 2019;73:625–9. 10.1136/jech-2018-211758
    1. Ekelund U, Steene-Johannessen J, Brown WJ, et al. . Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 2016;388:1302–10. 10.1016/S0140-6736(16)30370-1
    1. Ding D, Lawson KD, Kolbe-Alexander TL, et al. . The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet 2016;388:1311–24. 10.1016/S0140-6736(16)30383-X
    1. Lechner M. Long-run labour market and health effects of individual sports activities. J Health Econ 2009;28:839–54. 10.1016/j.jhealeco.2009.05.003
    1. Rooth D-O. Work out or out of work — the labor market return to physical fitness and leisure sports activities. Labour Econ 2011;18:399–409. 10.1016/j.labeco.2010.11.006
    1. Hyytinen A, Lahtonen J. The effect of physical activity on long-term income. Soc Sci Med 2013;96:129–37. 10.1016/j.socscimed.2013.07.019
    1. Kari JT, Tammelin TH, Viinikainen J, et al. . Childhood physical activity and adulthood earnings. Med Sci Sports Exerc 2016;48:1340–6. 10.1249/MSS.0000000000000895
    1. Kavetsos G. The impact of physical activity on employment. J Socio Econ 2011;40:775–9. 10.1016/j.socec.2011.08.011
    1. Lechner M, Downward P. Heterogeneous sports participation and labour market outcomes in England. Appl Econ 2017;49:335–48. 10.1080/00036846.2016.1197369
    1. Kari JT. Lifelong physical activity and long-term labor market outcomes. Jyväskylä Studies in Business and Economics 2018;184.
    1. Aberg MAI, Pedersen NL, Torén K, et al. . Cardiovascular fitness is associated with cognition in young adulthood. Proc Natl Acad Sci U S A 2009;106:20906–11. 10.1073/pnas.0905307106
    1. Bailey R, Armour K, Kirk D, et al. . The educational benefits claimed for physical education and school sport: an academic review. Res Pap Educ 2009;24:1–27. 10.1080/02671520701809817
    1. Barron JM, Ewing BT, Waddell GR. The effects of high school athletic participation on education and labor market outcomes. Rev Econ Stat 2000;82:409–21. 10.1162/003465300558902
    1. Statistics Finland . Price index of public expenditure, 2020. Available: [Accessed 23 August 2021].
    1. Husu P, Tokola K, Vähä-Ypyä H, et al. . Physical activity, sedentary behavior, and time in bed among Finnish adults measured 24/7 by triaxial accelerometry. Journal for the Measurement of Physical Behaviour 2021;4:163–73. 10.1123/jmpb.2020-0056
    1. Einarson TR, Acs A, Ludwig C, et al. . Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol 2018;17:Art.83. 10.1186/s12933-018-0728-6
    1. Finnish Medicines Agency, Social Insurance Institution of Finland . Finnish statistics on medicines 2016, 2017. Available: [Accessed 23 August 2021].
    1. Arajärvi M, Kuronen R. Kotihoito- ja sosiaalihuollon laitos- ja asumispalvelut 2016. Finnish National Institute for health and welfare, 2017. Report 42/2017.
    1. Statistics Finland . Causes of death in 2016, 2020. Available: [Accessed 23 August 2021].
    1. Koski S, Ilanne-Parikka P, Kurkela O. Diabeteksen kustannukset: Lisäsairauksien ilmaantumisen puolittaminen toisi satojen miljoonien säästöt vuodessa [Costs of diabetes: Halving comorbidity would save millions of euros a year]. Diabetes ja lääkäri 2018;2:13–17.
    1. Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health 1998;88:15–19. 10.2105/AJPH.88.1.15
    1. Koopmanschap MA, Rutten FF. A practical guide for calculating indirect costs of disease. Pharmacoeconomics 1996;10:460–6. 10.2165/00019053-199610050-00003
    1. Finnish National Institute for Health and Welfare . Avohilmo: Perusterveydenhuollon avohoidon ICD-10—käyntisyyt, 2020. Available: [Accessed 23 August 2021].
    1. Matveinen P. Health expenditure and financing in 2017. Report 15/2019. Finnish Institute for health and welfare, 2019. Available: [Accessed 23 August 2021].
    1. Ding D, Kolbe-Alexander T, Nguyen B, et al. . The economic burden of physical inactivity: a systematic review and critical appraisal. Br J Sports Med 2017;51:1392–409. 10.1136/bjsports-2016-097385
    1. Nelson MC, Taylor K, Vella CA. Comparison of self-reported and objectively measured sedentary behavior and physical activity in undergraduate students. Meas Phys Educ Exerc Sci 2019;23:237–48. 10.1080/1091367X.2019.1610765
    1. Koski S. Diabetesbarometer. Finnish diabetes association, 2019. Available: [Accessed 23 August 2021].
    1. Finne-Soveri H, Jakovljevic D, Mäkelä M. Vaikeasti muistisairaan vanhuksen kivun hallinta toteutuu palvelutalossa huonommin kuin laitoksessa [Pain management of a severely memory-impaired elderly person is worse in an assisted living facility than an institution]. Suomen Lääkärilehti 2018;73:1137–42.
    1. Husu P, Sievänen H, Tokola K, et al. . The objectively measured physical activity, sedentary behavior and physical fitness of finns. Publications of the Ministry of Education and Culture 2018/30.
    1. George A, Stead TS, Ganti L. What's the risk: differentiating risk ratios, odds ratios, and hazard ratios? Cureus 2020;12:e10047. 10.7759/cureus.10047
    1. Smith Jervelund S, De Montgomery CJ. Nordic registry data: value, validity and future. Scand J Public Health 2020;48:1–4. 10.1177/1403494819898573
    1. Hukkanen H, Husu P, Sievänen H, et al. . Aerobic physical activity assessed with accelerometer, diary, questionnaire, and interview in a Finnish population sample. Scand J Med Sci Sports 2018;28:2196–206. 10.1111/sms.13244
    1. OCED . OECD employment outlook 2021, navigating the COVID-19 crisis and recovery. Paris, 2021. [Accessed 20 January 2022].
    1. Schuch FB, Vancampfort D, Firth J, et al. . Physical activity and incident depression: a meta-analysis of prospective cohort studies. Am J Psychiatry 2018;175:631–48. 10.1176/appi.ajp.2018.17111194
    1. Shiri R, Falah-Hassani K. Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med 2017;51:1410–8. 10.1136/bjsports-2016-097352
    1. Qu X, Zhang X, Zhai Z, et al. . Association between physical activity and risk of fracture. J Bone Miner Res 2014;29:202–11. 10.1002/jbmr.2019
    1. Beckett MW, Ardern CI, Rotondi MA. A meta-analysis of prospective studies on the role of physical activity and the prevention of Alzheimer’s disease in older adults. BMC Geriatr 2015;15:Art.9. 10.1186/s12877-015-0007-2
    1. Bjørk Petersen C, Bauman A, Grønbæk M, et al. . Total sitting time and risk of myocardial infarction, coronary heart disease and all-cause mortality in a prospective cohort of Danish adults. Int J Behav Nutr Phys Act 2014;11:Art.13:13. 10.1186/1479-5868-11-13
    1. Shen D, Mao W, Liu T, et al. . Sedentary behavior and incident cancer: a meta-analysis of prospective studies. PLoS One 2014;9:Art.e105709. 10.1371/journal.pone.0105709
    1. Zhai L, Zhang Y, Zhang D. Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med 2015;49:705–9. 10.1136/bjsports-2014-093613

Source: PubMed

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