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Exercise and incidence of myocardial infarction, stroke, hypertension, type 2 diabetes and site-specific cancers: prospective cohort study of 257 854 adults in South Korea
  1. Youngwon Kim1,2,
  2. Stephen Sharp2,
  3. Semi Hwang1,3,
  4. Sun Ha Jee4
  1. 1 School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
  2. 2 MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
  3. 3 Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
  4. 4 Epidemiology, Graduate School of Public Health, Yonsei University, Seoul, South Korea
  1. Correspondence to Dr Sun Ha Jee; jsunha{at}


Objective The objective of this study was to examine the longitudinal associations of exercise frequency with the incidence of myocardial infarction, stroke, hypertension, type 2 diabetes and 10 different cancer outcomes.

Design A prospective cohort study.

Setting Physical examination data linked with the entire South Korean population’s health insurance system: from 2002 to 2015.

Participants 257 854 South Korean adults who provided up to 7 repeat measures of exercise (defined as exercises causing sweat) and confounders.

Primary outcome measures Each disease incidence was defined using both fatal and non-fatal health records (a median follow-up period of 13 years).

Results Compared with no exercise category, the middle categories of exercise frequency (3–4 or 5–6 times/week) showed the lowest risk of myocardial infarction (HR 0.79; 95% CI 0.70 to 0.90), stroke (HR 0.80; 95% CI 0.73 to 0.89), hypertension (HR 0.86; 95% CI 0.85 to 0.88), type 2 diabetes (HR 0.87; 95% CI 0.84 to 0.89), stomach (HR 0.87; 95% CI 0.79 to 0.96), lung (HR 0.80; 95% CI 0.71 to 0.91), liver (HR 0.85; 95% CI 0.75 to 0.98) and head and neck cancers (HR 0.76; 95% CI 0.63 to 0.93; for 1–2 times/week), exhibiting J-shaped associations. There was, in general, little evidence of effect modification by body mass index, smoking, alcohol consumption, family history of disease and sex in these associations.

Conclusions Moderate levels of sweat-inducing exercise showed the lowest risk of myocardial infarction, stroke, hypertension, type 2 diabetes, stomach, lung, liver and head and neck cancers. Public health and lifestyle interventions should, therefore, promote moderate levels of sweat-causing exercise as a behavioural prevention strategy for non-communicable diseases in a wider population of East Asians.

  • exercise
  • non-communicable disease
  • cohort
  • epidemiology
  • cardiovascular disease
  • hypertension

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  • Contributors YK designed this study, performed statistical analysis and drafted an initial version of the manuscript. SS, S-mH and SHJ all contributed to conceptualising the study idea and developing the analytical plans, and provided assistance with statistical analysis. All authors critically reviewed, approved the final version of the manuscript and agreed to be responsible for all facets of this work.

  • Funding This work was supported by the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (Grant 1631020 to SHJ), The Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Grant HI14C2686 to SHJ) and the Medical Research Council (Grant MC_UU_12015/1 to SS). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval This research was approved by the Institutional Review Board (4-2017-0051) of the Yonsei University’s Severance Hospital in Republic of Korea.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data sharing is not applicable because no informed consent for data sharing was obtained from the participants.

  • Patient consent for publication Not required.

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