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

Background Physical activity is a key component in public health frameworks to maintain functional ability through ageing. In Norway, healthcare services such as home health nursing and long-term institutional stays for older adults account for a significant amount of healthcare expenditures, but little is known about the association between physical activity levels through adulthood and utilisation of these services later in life. To this end, we wanted to explore an association between physical activity and the use of these specific healthcare services. Methods We used data from three waves of the Trøndelag Health Study, that surveyed physical activity levels through questions about physical activity frequency, duration and intensity (HUNT1, 3 and 4). These questions allowed the calculation of minutes per week of moderate intensity physical activity, in addition to assessment of weekly physical activity frequencies (low-high). We included all who were either ≥ 65 years in HUNT3 or took part in all three surveys. Time-series of home health nursing and long-term institutional stays was collected from the combined Individual-based Statistics for Nursing and Care Services (IPLOS) and the Norwegian Registry for Primary Health Care (NRPHC) between 2007 and 2022. Multiple Cox proportional hazard models were built to assess the association between time to healthcare utilisation and physical activity levels. Results Of the 15,737 participants who took part in HUNT1 and HUNT3, 9318 also participated in HUNT4. Moderate-intensity physical activity could be calculated for 8882 participants aged ≥ 65 years in HUNT3 (53% women), of whom 42.7% achieved the recommended ≥ 150 min per week. Physical activity frequency analysis included all 15,737 participants (55.7% women), of whom 43.4% increased their physical activity frequency between their first and last HUNT survey. Of the 9318 participants who took part in all three surveys, 40.8% received home health nursing care during follow-up, and 16.3% received long-term institutional stays. For participants who did not take part in HUNT4, the corresponding proportions were 76.5% and 41.8%. A potential dose-response relationship was seen between physical activity levels and healthcare utilisation, although not all comparisons were statistically significant. Conclusion Individuals who partake in higher levels of leisure time physical activity had lower utilisation of home health nursing and long-term institutional stays. As most of the participants in our study did not comply with the nationally recommended ≥ 150 min of moderate physical activity per week, understanding what enables physical activity throughout life could help enable healthy ageing and reduce need for healthcare. Clinical trial number Not applicable. Trial registration Not applicable.