Skip to main content

Cardiovascular fitness in early adulthood and future suicidal behaviour in men followed for up to 42 years

  • M. A. I. Åberg (a1) (a2), J. Nyberg (a1), K. Torén (a3), A. Sörberg (a4), H. G. Kuhn (a1) and M. Waern (a5)...

Cardiovascular fitness influences many aspects of brain function. However, the relationship between cardiovascular fitness and suicidal behaviour is unknown. Therefore, we aimed to determine whether cardiovascular fitness at age 18 years is associated with future risk of suicide attempt/death.


We performed a population-based Swedish longitudinal cohort study of male conscripts with no previous or ongoing mental illness (n = 1 136 527). The conscription examination, which took place during 1968–2005, included the cycle ergonometric test and tests of cognitive performance. Future risk of suicide attempt/death over a 5- to 42-year follow-up period was calculated with Cox proportional hazards models controlling for several confounders including familial factors.


At least one suicide attempt was recorded for 12 563 men. Death by suicide without a prior attempt was recorded in 4814 additional individuals. In fully adjusted models low cardiovascular fitness was associated with increased risk for future attempt/death by suicide [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.64–1.94]. The HR changed only marginally after exclusion of persons who received in-patient care for depression (HR 1.76, 95% CI 1.61–1.94). Poor performance on both the cardiovascular fitness and cognitive tests was associated with a fivefold increased risk of suicide attempt or suicide death (HR 5.46, 95% CI 4.78–6.24).


Lower cardiovascular fitness at age 18 years was, after adjustment for a number of potential confounders, associated with an increased risk of attempt/death by suicide in adulthood. It remains to be clarified whether interventions designed to improve fitness in teens can influence the risk of suicidal behaviour later in life.

Corresponding author
* Address for correspondence: M. Waern, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Blå Stråket 15, Gothenburg, Sweden. (Email:
Hide All
Åberg MA, Pedersen NL, Torén K, Svartengren M, Bäckstrand B, Johnsson T, Cooper-Kuhn CM, Åberg ND, Nilsson M, Kuhn HG (2009). Cardiovascular fitness is associated with cognition in young adulthood. Proceedings of the National Academy of Sciences USA 106, 2090620911.
Åberg MA, Waern M, Nyberg J, Pedersen NL, Bergh Y, Åberg ND, Nilsson M, Kuhn HG, Torén K (2012). Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective population-based study. British Journal of Psychiatry 201, 352359.
Andres AR, Collings S, Qin P (2010). Sex-specific impact of socio-economic factors on suicide risk: a population-based case–control study in Denmark. European Journal of Public Health 20, 265270.
Babiss LA, Gangwisch JE (2009). Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediated by self-esteem and social support. Journal of Developmental and Behavioral Pediatrics 30, 376384.
Batty GD, Whitley E, Deary IJ, Gale CR, Tynelius P, Rasmussen F (2010 a). Psychosis alters association between IQ and future risk of attempted suicide: cohort study of 1,109,475 Swedish men. British Medical Journal 340, c2506.
Batty GD, Whitley E, Kivimaki M, Tynelius P, Rasmussen F (2010 b). Body mass index and attempted suicide: cohort study of 1,133,019 Swedish men. American Journal of Epidemiology 172, 890899.
Brown DR, Blanton CJ (2002). Physical activity, sports participation, and suicidal behavior among college students. Medicine and Science in Sports and Exercise 34, 10871096.
Brown J, Cooper-Kuhn CM, Kempermann G, van Praag H, Winkler J, Gage FH, Kuhn HG (2003). Enriched environment and physical activity stimulate hippocampal but not olfactory bulb neurogenesis. European Journal of Neuroscience 17, 20422046.
Bruffaerts R, Demyttenaere K, Borges G, Haro JM, Chiu WT, Hwang I, Karam EG, Kessler RC, Sampson N, Alonso J, Andrade LH, Angermeyer M, Benjet C, Bromet E, de Girolamo G, de Graaf R, Florescu S, Gureje O, Horiguchi I, Hu C, Kovess V, Levinson D, Posada-Villa J, Sagar R, Scott K, Tsang A, Vassilev SM, Williams DR, Nock MK (2010). Childhood adversities as risk factors for onset and persistence of suicidal behaviour. British Journal of Psychiatry 197, 2027.
Buckworth J, Dishman RK (2002). Exercise Psychology. Human Kinetics: Champaign, IL.
Carlstedt B (2000). Cognitive abilities – aspects of structure, process and measurement. Thesis, University of Gothenburg.
Coryell WH (2006). Clinical assessment of suicide risk in depressive disorder. CNS Spectrums 11, 455461.
de Jonge P, Roest AM (2012). Depression and cardiovascular disease: the end of simple models. British Journal of Psychiatry 201, 337338.
Dwivedi Y (2009). Brain-derived neurotrophic factor: role in depression and suicide. Journal of Neuropsychiatric Disease and Treatment 5, 433449.
Farmer ME, Locke BZ, Moscicki EK, Dannenberg AL, Larson DB, Radloff LS (1988). Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study. American Journal of Epidemiology 128, 13401351.
Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ (2012). Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Archives of General Psychiatry 69, 580587.
Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Sorensen HT, Lash TL (2010). Inflammatory bowel disease and completed suicide in Danish adults. Inflammatory Bowel Diseases 16, 21582161.
Griffin EW, Mullally S, Foley C, Warmington SA, O'Mara SM, Kelly AM (2011). Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males. Physiology and Behavior 104, 934941.
Gunnell D, Magnusson PK, Rasmussen F (2005). Low intelligence test scores in 18 year old men and risk of suicide: cohort study. British Medical Journal 330, 167.
Harvey SB, Hotopf M, Overland S, Mykletun A (2010). Physical activity and common mental disorders. British Journal of Psychiatry 197, 357364.
Hunt IM, Kapur N, Robinson J, Shaw J, Flynn S, Bailey H, Meehan J, Bickley H, Parsons R, Burns J, Amos T, Appleby L (2006). Suicide within 12 months of mental health service contact in different age and diagnostic groups. National clinical survey. British Journal of Psychiatry 188, 135142.
Jiang GX, Rasmussen F, Wasserman D (1999). Short stature and poor psychological performance: risk factors for attempted suicide among Swedish male conscripts. Acta Psychiatrica Scandinavica 100, 433440.
Kendal WS, Kendal WM (2012). Comparative risk factors for accidental and suicidal death in cancer patients. Crisis 33, 325334.
Kinoshita K, Kinoshita Y, Shimodera S, Nishida A, Inoue K, Watanabe N, Oshima N, Akechi T, Sasaki T, Inoue S, Furukawa TA, Okazaki Y (2012). Not only body weight perception but also body mass index is relevant to suicidal ideation and self-harming behavior in Japanese adolescents. Journal of Nervous and Mental Disease 200, 305309.
Kuramoto SJ, Runeson B, Stuart EA, Lichtenstein P, Wilcox HC (2013). Time to hospitalization for suicide attempt by the timing of parental suicide during offspring early development. Archives of General Psychiatry 70, 149157.
Leon AC, Friedman RA, Sweeney JA, Brown RP, Mann JJ (1990). Statistical issues in the identification of risk factors for suicidal behavior: the application of survival analysis. Psychiatry Research 31, 99108.
Magnusson PK, Rasmussen F, Lawlor DA, Tynelius P, Gunnell D (2006). Association of body mass index with suicide mortality: a prospective cohort study of more than one million men. American Journal of Epidemiology 163, 18.
Niederkrotenthaler T, Floderus B, Alexanderson K, Rasmussen F, Mittendorfer-Rutz E (2012). Exposure to parental mortality and markers of morbidity, and the risks of attempted and completed suicide in offspring: an analysis of sensitive life periods. Journal of Epidemiology and Community Health 66, 233239.
Nithianantharajah J, Hannan AJ (2009). The neurobiology of brain and cognitive reserve: mental and physical activity as modulators of brain disorders. Progress in Neurobiology 89, 369382.
Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S (2008). Suicide and suicidal behavior. Epidemiologic Reviews 30, 133154.
Nock MK, Greif Green J, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, Kessler RC (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents; results from the National Comorbidity Survey Replication Adolescent Supplement. Journal of the American Medical Association Psychiatry 70, 300310.
Nordesjö LO, Schéle R (1974). Validity of an ergometer cycle test and measures of isometric muscle strength when prediction some aspects of military performance. Swedish Journal of Defence Medicine 10, 1123.
Pahkala K, Hernelahti M, Heinonen OJ, Raittinen P, Hakanen M, Lagstrom H, Viikari JS, Ronnemaa T, Raitakari OT, Simell O (2013). Body mass index, fitness and physical activity from childhood through adolescence. British Journal of Sports Medicine 47, 7177.
Qin P (2011). The impact of psychiatric illness on suicide: differences by diagnosis of disorders and by sex and age of subjects. Journal of Psychiatric Research 45, 14451452.
Saitta P, Keehan P, Yousif J, Way BV, Grekin S, Brancaccio R (2011). An update on the presence of psychiatric comorbidities in acne patients, Part 2: Depression, anxiety, and suicide. Cutis 88, 9297.
Sörberg A, Allebeck P, Melin B, Gunnell D, Hemmingsson T (2013). Cognitive ability in early adulthood is associated with later suicide and suicide attempt: the role of risk factors over the life course. Psychological Medicine 43, 4960.
Sourander A, Klomek AB, Niemela S, Haavisto A, Gyllenberg D, Helenius H, Sillanmaki L, Ristkari T, Kumpulainen K, Tamminen T, Moilanen I, Piha J, Almqvist F, Gould MS (2009). Childhood predictors of completed and severe suicide attempts: findings from the Finnish 1981 Birth Cohort Study. Archives of General Psychiatry 66, 398406.
Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA (2002). Physical activity reduces the risk of subsequent depression for older adults. American Journal of Epidemiology 156, 328334.
Tidemalm D, Runeson B, Waern M, Frisell T, Carlström E, Lichtenstein P, Langström N (2011). Familial clustering of suicide risk: a total population study of 11.4 million individuals. Psychological Medicine 41, 25272534.
van Praag H, Kempermann G, Gage FH (1999). Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus. Nature Neuroscience 2, 266270.
Wasserman D, Wasserman J, Sokolowski M (2010). Genetics of HPA-axis, depression and suicidality. European Psychiatry 25, 278280.
Whitley E, Rasmussen F, Tynelius P, Batty GD (2010). Physical stature and method-specific attempted suicide: cohort study of one million men. Psychiatry Research 179, 116118.
WHO (2001). The World Health Report – Mental Health, New Understanding, New Hope. World Health Organization: Geneva.
Yau SY, Lau BW, So KF (2011). Adult hippocampal neurogenesis: a possible way how physical exercise counteracts stress. Cell Transplantation 20, 99111.
Yoshimasu K, Kiyohara C, Miyashita K (2008). Suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies. Environmental Health and Preventive Medicine 13, 243256.
Zetterqvist M, Lundh LG, Svedin CG (2012). A comparison of adolescents engaging in self-injurious behaviors with and without suicidal intent: self-reported experiences of adverse life events and trauma symptoms. Journal of Youth and Adolescence. Published online 5 December 2012 . doi:10.1007/s10964-012-9872-6.
Zheng H, Liu Y, Li W, Yang B, Chen D, Wang X, Jiang Z, Wang H, Wang Z, Cornelisson G, Halberg F (2006). Beneficial effects of exercise and its molecular mechanisms on depression in rats. Behavioural Brain Research 168, 4755.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Åberg Supplementary Material

 Word (39 KB)
39 KB
Supplementary Materials

Åberg Supplementary Material

 Word (48 KB)
48 KB


Altmetric attention score

Full text views

Total number of HTML views: 6
Total number of PDF views: 50 *
Loading metrics...

Abstract views

Total abstract views: 515 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd November 2017. This data will be updated every 24 hours.