Costs associated with insufficient physical activity in Germany: cross-sectional results from the baseline examination of the German national cohort (NAKO)

Sophie Gottschalk (), Hans-Helmut König, Andrea Weber, Michael F. Leitzmann, Michael J. Stein, Annette Peters, Claudia Flexeder, Lilian Krist, Stefan N. Willich, Katharina Nimptsch, Tobias Pischon, Sylvia Gastell, Karen Steindorf, Florian Herbolsheimer, Nina Ebert, Karin B. Michels, Anja Dorrn, Volker Harth, Nadia Obi, André Karch, Henning Teismann, Henry Völzke, Claudia Meinke-Franze, Leon Klimeck, Teresa L. Seum and Judith Dams
Additional contact information
Sophie Gottschalk: University Medical Center Hamburg-Eppendorf
Hans-Helmut König: University Medical Center Hamburg-Eppendorf
Michael F. Leitzmann: University of Regensburg
Michael J. Stein: University of Regensburg
Annette Peters: Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH)
Claudia Flexeder: Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH)
Lilian Krist: Charité – Universitätsmedizin Berlin
Stefan N. Willich: Charité – Universitätsmedizin Berlin
Katharina Nimptsch: Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC)
Tobias Pischon: Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC)
Sylvia Gastell: German Institute of Human Nutrition Potsdam-Rehbruecke
Karen Steindorf: German Cancer Research Center (DKFZ)
Florian Herbolsheimer: German Cancer Research Center (DKFZ)
Nina Ebert: Leibniz Center for Diabetes Research at Heinrich Heine University
Karin B. Michels: University of Freiburg
Anja Dorrn: University of Freiburg
Volker Harth: University Medical Center Hamburg-Eppendorf
Nadia Obi: University Medical Center Hamburg-Eppendorf
André Karch: University of Münster
Henning Teismann: University of Münster
Henry Völzke: University Medicine Greifswald
Claudia Meinke-Franze: University Medicine Greifswald
Leon Klimeck: German Cancer Research Center (DKFZ)
Teresa L. Seum: German Cancer Research Center (DKFZ)
Judith Dams: University Medical Center Hamburg-Eppendorf

The European Journal of Health Economics, 2025, vol. 26, issue 1, No 10, 117-128

Abstract: Abstract Background Insufficient physical activity (PA) is a leading risk factor for non-communicable diseases posing a significant economic burden to healthcare systems and societies. The study aimed to examine the differences in healthcare and indirect costs between sufficient and insufficient PA and the cost differences between PA intensity groups. Methods The cross-sectional analysis was based on data from 157,648 participants in the baseline examination of the German National Cohort (NAKO) study. Healthcare and indirect costs were calculated based on self-reported information on health-related resource use and productivity losses. PA in the domains leisure, transport, and work was assessed by the Global Physical Activity Questionnaire and categorized into sufficient/insufficient and intensity levels (very low/low/medium/high) based on PA recommendations of the World Health Organization. Two-part models adjusted for relevant covariates were used to estimate mean costs for PA groups. Results and conclusion Insufficiently active people had higher average annual healthcare costs (Δ €188, 95% CI [64, 311]) and healthcare plus indirect costs (Δ €482, 95% CI [262, 702]) compared to sufficiently active people. The difference was especially evident in the population aged 60 + years and when considering only leisure PA. An inverse association was observed between leisure PA and costs, whereas a direct association was found between PA at work and costs. Adjusting for the number of comorbidities reduced the differences between activity groups, but the trend persisted. The association between PA and costs differed in direction between PA domains. Future research may provide further insight into the temporal relationship between PA and costs.

Keywords: Physical activity; Exercise; Healthcare costs; Health expenditure; Cohort study (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1007/s10198-024-01697-9

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