Higher Adult Physical Activity Tied to Less Nursing Care in Older Age

Older Norwegians who reported higher levels of leisure-time physical activity in adulthood used less municipal home health nursing and fewer long-term institutional care services in later life, according to a long-running population study published in BMC Health Services Research. The analysis drew on the Trøndelag Health Study, known as HUNT, which has surveyed residents of central Norway for decades. Researchers linked self-reported activity levels from three survey waves, HUNT1, HUNT3 and HUNT4, to national care registries covering home nursing and institutional stays between 2007 and 2022.

Using multiple Cox proportional hazard models, they estimated the time until participants first used these services, comparing people with different activity histories. The study included 15,737 people who took part in both HUNT1 and HUNT3, of whom 9,318 also joined HUNT4. For 8,882 participants aged 65 or older at HUNT3, the researchers could calculate minutes per week of moderate-intensity activity from questionnaire answers about frequency, duration and intensity.

Only 42.7 percent of that group met the nationally recommended threshold of at least 150 minutes of moderate activity per week. In the broader frequency analysis, which included all 15,737 participants, 43.4 percent reported increasing their weekly physical activity frequency between their first and last HUNT survey. Women made up 53 percent of the moderate-intensity sample and 55.7 percent of the full cohort.

During follow-up, 40.8 percent of the participants who took part in all three surveys received home health nursing care, and 16.3 percent experienced long-term institutional stays. Among those who did not return for HUNT4, the corresponding proportions were markedly higher, at 76.5 percent and 41.8 percent. The researchers observed a potential dose-response pattern, with higher activity levels associated with progressively lower utilisation of both services, although not every comparison reached statistical significance.

The authors report that individuals with higher levels of leisure-time physical activity had lower use of home health nursing and long-term institutional stays overall. The study's design shapes how the results should be read. Physical activity was measured through questionnaire responses about frequency, duration and intensity, and the analysis was observational, so it identifies associations rather than proving that activity caused the reduced care use.

Participation was also uneven: people who dropped out between surveys showed far higher rates of care utilisation than those who remained, which may affect how the findings generalise. The study population was limited to one Norwegian region, and the service outcomes examined were specifically municipal home health nursing and long-term institutional stays, services that account for a significant share of healthcare spending for older adults in Norway. The researchers combined two national data sources to capture care use.

Time-series of home health nursing and long-term institutional stays came from the Individual-based Statistics for Nursing and Care Services, known as IPLOS, merged with the Norwegian Registry for Primary Health Care. The HUNT surveys asked participants how often, how long and how intensely they engaged in physical activity, which allowed the calculation of minutes per week of moderate-intensity activity as well as an assessment of weekly activity frequency on a low-to-high scale. This dual measurement meant the researchers could examine both the volume of activity and changes in activity frequency over time, including the 43.4 percent of participants who increased their frequency between their first and last survey.

Because most participants in the study fell short of the recommended 150 minutes of weekly moderate activity, the researchers argue that understanding what enables people to stay active throughout adult life could support healthier ageing and reduce future demand for these services. Physical activity is already a central element of public health frameworks aimed at maintaining functional ability through ageing, and this study adds service-utilisation data to that evidence base. The findings suggest that sustained leisure-time physical activity across adulthood is associated with lower reliance on home-based and institutional care in older age, though the dose-response relationship was not consistent across all comparisons.

As home health nursing and long-term institutional stays represent a substantial portion of municipal healthcare expenditure in Norway, the association, if confirmed by further research, could carry meaningful implications for how ageing populations plan and fund long-term care.

Subject of Research: Associations between adult physical activity and later use of municipal home and long-term healthcare services in the HUNT study

Article Title: Associations between physical activity in adulthood and utilisation of municipal home and long-term healthcare services in older age: the HUNT study

Article References: Angelsen, A., Nakrem, S., Strand, B. H., & Strand, L. B. (2026). Associations between physical activity in adulthood and utilisation of municipal home and long-term healthcare services in older age: the HUNT study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15538-3

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15538-3

Keywords: physical activity, ageing, home health nursing, long-term care, HUNT study, Norway, cohort study, healthcare utilisation, public health, epidemiology, Associations, between