The Swedish National March Cohort

In September 1997, the Swedish Cancer Society organized a four-day national fund-raising event, the National March, in almost 3,600 cities and villages around the country. In conjunction with this event, we established the Swedish National March Cohort (SNMC).

Project description

Participants in the march were expected to be particularly motivated to provide valid information. They were invited to fill out a 32-page questionnaire, and three pages of this questionnaire were devoted to physical activity, the main focus of the project. Both previously validated and newly developed questions were used in order to estimate energy expenditure and to distinguish between constant low-level activity and short-term peak activity. We used a new rating scale for self-reports of time spent on different intensity levels of physical activity (and inactivity) during a typical day, allowing estimation of total energy expenditure on an interval scale level. This scale has been shown to be both valid and reliable. Seven pages contained questions about diet, using a 63-item validated semi-quantitative food frequency questionnaire that allows estimation of total energy intake and calorie adjustment. Supplementary questions were asked about intake of fried food, detailed pattern of alcohol intake, dietary supplements and use of health food preparations. Two pages had questions about anthropometrical measures, including height, weight (birth weight, current weight, and weight fluctuations), waist and hip measures (allowing calculations of BMI, lean body mass, waist-hip ratio). Further, three pages were allocated to questions about various background and possibly confounding factors such as country of birth, environment during childhood and adolescence, birthplace of parents, own education, type of employment. Two pages were about smoking (including passive smoking) and snuff dipping habits. One page was dedicated to vaccination history, two pages to medical history, two pages to pharmacological history. Two pages were about sun and UV exposure, possible use of sunbeds, and type of complexion. Five pages were spent on questions concerning the psychosocial history, including validated sets of questions about demands and autonomy at work, life events, self-perceived health, social support, as well as duration and quality of sleep. Sleep disturbances were assessed using a modified version of the Karolinska Sleep Questionnaire (KSQ), a widely used tool to assess quality and restorative function of sleep. One page was about the use of mobile telephones. Two pages were devoted to questions specific for women (age at menarche, parity, infertility, menstruation, menopause, use of oral contraceptives and hormone replacement therapy). Due to the open nature of the National March, the total number of individuals who in reality were given a questionnaire could not be assessed. In total, 43,880 men and women completed the questionnaire.


Essentially complete follow-up has since been attained through multiple record linkages, done approximately biannually, using the individually unique national registration numbers (NRNs) to insure exact linkages. We have linked the cohort to Statistics Swedens Register of the Total Population and Population Changes to obtain dates of death, relocations (with information about the new place of residence) and emigration, if any. Data from the Patient Register (covering all inhospital care and more recently also hospital-provided outpatient care), Cancer Register, and Causes of Death Register held by the National Board of Health and Welfare, have permitted accurate tracking of health and vital status of all cohort members. Another complete update (through 2009 in total 12 years of follow-up) was completed by the end of 2011. Follow-up of the cohort participants is updated through linkage with the cancer and patient registers till the end of 2016; information on mortality is however available till March 2018.

Project leaders and research group

Weimin Ye

C8 Department of Medical Epidemiology and Biostatistics

Ylva Trolle Lagerros

Affiliated to research
K2 Department of Medicine, Solna

Rino Bellocco

Lecturer senior
C8 Department of Medical Epidemiology and Biostatistics

Justine Debelius

Affiliated to research
C1 Department of Microbiology, Tumor and Cell Biology

Olof Nyren

Affiliated to research
C8 Department of Medical Epidemiology and Biostatistics

Hans-Olov Adami

Professor Emeritus/Emerita
C8 Department of Medical Epidemiology and Biostatistics
K8 Department of Clinical Neuroscience

Essi Hantikainen

Institute for Biomedicine

Eurac Research, Bozen, Italy

Mauro Serafini

Faculty of BioSciences and Technology for Food, Agriculture and Environment Functional Food and Metabolic Stress Prevention Laboratory Teramo University

Questionnaire and Data dictionary


Dietary antioxidants and the risk of Parkinson Disease: The Swedish National March Cohort.
Hantikainen E, Lagerros YT, Ye W, Serafini M, Adami HO, Bellocco R, et al
Neurology 2021 Jan.

Prospective associations between physical activity and clinician diagnosed major depressive disorder in adults: A 13-year cohort study.
Hallgren M, Nguyen TT, Lundin A, Vancampfort D, Stubbs B, Schuch F, et al
Prev Med 2019 Jan;118():38-43

Dietary non-enzymatic antioxidant capacity and the risk of myocardial infarction: the Swedish National March Cohort.
Hantikainen E, Grotta A, Serafini M, Trolle Lagerros Y, Nyren O, Ye W, et al
Int J Epidemiol 2018 12;47(6):1947-1955

Associations of physical activity with anxiety symptoms and disorders: Findings from the Swedish National March Cohort.
Hallgren M, Nguyen TT, Herring MP, McDowell CP, Gordon BR, Stubbs B, et al
Gen Hosp Psychiatry ;58():45-50

Cross-sectional and prospective relationships of passive and mentally active sedentary behaviours and physical activity with depression.
Hallgren M, Nguyen TT, Owen N, Stubbs B, Vancampfort D, Lundin A, et al
Br J Psychiatry 2019 Mar;():1-7

Passive and mentally-active sedentary behaviors and incident major depressive disorder: A 13-year cohort study.
Hallgren M, Owen N, Stubbs B, Zeebari Z, Vancampfort D, Schuch F, et al
J Affect Disord 2018 12;241():579-585

Sleep duration and mortality - Does weekend sleep matter?
Åkerstedt T, Ghilotti F, Grotta A, Zhao H, Adami HO, Trolle-Lagerros Y, et al
J Sleep Res 2019 Feb;28(1):e12712

Body mass index, sitting time, and risk of Parkinson disease.
Roos E, Grotta A, Yang F, Bellocco R, Ye W, Adami HO, et al
Neurology 2018 Apr;90(16):e1413-e1417

Physical activity and the risk of hip fracture in the elderly: a prospective cohort study.
Lagerros YT, Hantikainen E, Michaëlsson K, Ye W, Adami HO, Bellocco R
Eur. J. Epidemiol. 2017 11;32(11):983-991

Sleep duration, mortality and the influence of age.
Åkerstedt T, Ghilotti F, Grotta A, Bellavia A, Lagerros YT, Bellocco R
Eur. J. Epidemiol. 2017 10;32(10):881-891

Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies.
Araghi M, Rosaria Galanti M, Lundberg M, Lager A, Engström G, Alfredsson L, et al
Int. J. Cancer 2017 08;141(4):687-693

Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts.
Araghi M, Galanti MR, Lundberg M, Liu Z, Ye W, Lager A, et al
Scand J Public Health 2017 Dec;45(8):741-748

Moist smokeless tobacco (Snus) use and risk of Parkinson's disease.
Yang F, Pedersen NL, Ye W, Liu Z, Norberg M, Forsgren L, et al
Int J Epidemiol 2017 06;46(3):872-880

Dietary antioxidant capacity and risk for stroke in a prospective cohort study of Swedish men and women.
Colarusso L, Serafini M, Lagerros YT, Nyren O, La Vecchia C, Rossi M, et al
Nutrition 2017 Jan;33():234-239

Cohort Profile: The Swedish National March Cohort.
Trolle Lagerros Y, Hantikainen E, Mariosa D, Ye W, Adami HO, Grotta A, et al
Int J Epidemiol 2017 06;46(3):795-795e

Prospective study of dietary Non Enzymatic Antioxidant Capacity on the risk of hip fracture in the elderly.
Hantikainen E, Grotta A, Ye W, Adami HO, Surkan PJ, Serafini M, et al
Bone 2016 09;90():31-6

A prospective cohort study of the combined effects of physical activity and anthropometric measures on the risk of post-menopausal breast cancer.
Bellocco R, Marrone G, Ye W, Nyrén O, Adami HO, Mariosa D, et al
Eur. J. Epidemiol. 2016 04;31(4):395-404

Physical activity and body mass index as predictors of prostate cancer risk.
Grotta A, Bottai M, Adami HO, Adams SA, Akre O, Blair SN, et al
World J Urol 2015 Oct;33(10):1495-502

Insufficient Sleep and Risk of Prostate Cancer in a Large Swedish Cohort.
Markt SC, Grotta A, Nyren O, Adami HO, Mucci LA, Valdimarsdottir UA, et al
Sleep 2015 Sep;38(9):1405-10

Physical activity and risk of Parkinson's disease in the Swedish National March Cohort.
Yang F, Trolle Lagerros Y, Bellocco R, Adami HO, Fang F, Pedersen NL, et al
Brain 2015 Feb;138(Pt 2):269-75

Use of Scandinavian moist smokeless tobacco (snus) and the risk of atrial fibrillation.
Hergens MP, Galanti R, Hansson J, Fredlund P, Ahlbom A, Alfredsson L, et al
Epidemiology 2014 Nov;25(6):872-6

Habitual sleep patterns and the distribution of body mass index: cross-sectional findings among Swedish men and women.
Westerlund A, Bottai M, Adami HO, Bellocco R, Nyrén O, Åkerstedt T, et al
Sleep Med. 2014 Oct;15(10):1196-203

Dose-response relationship of total and leisure time physical activity to risk of heart failure: a prospective cohort study.
Andersen K, Mariosa D, Adami HO, Held C, Ingelsson E, Lagerros YT, et al
Circ Heart Fail 2014 Sep;7(5):701-8

Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival.
Hansson J, Galanti MR, Hergens MP, Fredlund P, Ahlbom A, Alfredsson L, et al
J. Intern. Med. 2014 Jul;276(1):87-95

Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies.
Hansson J, Galanti MR, Hergens MP, Fredlund P, Ahlbom A, Alfredsson L, et al
Eur. J. Epidemiol. 2012 Oct;27(10):771-9

Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort.
Bellocco R, Jia C, Ye W, Lagerros YT
Eur. J. Epidemiol. 2010 Nov;25(11):777-88

Measures of physical activity and their correlates: the Swedish National March Cohort.
Lagerros YT, Bellocco R, Adami HO, Nyrén O
Eur. J. Epidemiol. 2009 ;24(4):161-9

Press releases

Passive sedentary behaviours increase the risk of depression in adults (The Mental Elf, Aug 2020)

Can sleeping in at the weekend prolong your life? (Corriere della serra, May 2018 in Italian)

Sleeping in on the weekends can compensate for lack of sleep during the week, study suggests (Washington Post, May 2018)

Sleep duration and mortality – Does weekend sleep matter? (Wiley online, May 2018)

An hour of daily exercise may decrease heart failure risk (KI website, Aug 2014)

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