University of Oulu

Jari A. Laukkanen, Setor K. Kunutsor, Cemal Ozemek, Timo Mäkikallio, Duck-chul Lee, Ulrik Wisloff, Carl J. Lavie, Cross-country skiing and running’s association with cardiovascular events and all-cause mortality: A review of the evidence, Progress in Cardiovascular Diseases, Volume 62, Issue 6, 2019, Pages 505-514, ISSN 0033-0620,

Cross-country skiing and running’s association with cardiovascular events and all-cause mortality : A review of the evidence

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Author: Laukkanen, Jari A.1,2,3; Kunutsor, Setor K.4,5; Ozemek, Cemal6;
Organizations: 1Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
2Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
3Department of Medicine, Central Finland Health Care District, Jyväskylä, Finland
4National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
5Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
6Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
7Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
8Department of Kinesiology, College of Human Sciences, Iowa State University, Ames, IA, USA
9Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
10School of Human Movement & Nutrition Sciences, University of Queensland, Australia
11Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 5.2 MB)
Persistent link:
Language: English
Published: Elsevier, 2020
Publish Date: 2020-09-07


A large body of evidence demonstrates positive, graded effects of PA on cardiovascular disease (CVD) morbidity and mortality with increasing intensity compared with lower PA intensity. Running is often designated as a high-intensity PA with substantial evidence supporting its health benefits. Cross-country skiing is among the most demanding aerobic endurance exercises and requires engaging the upper- and lower-body. Cross-country skiing is often regarded as high-intensity PA, which has been associated with significant health benefits. However, a robust body of evidence identifying the dose-response relation between cross-country skiing volume and health outcomes is sparse. Therefore, this review aims to summarize the available evidence linking cross-country skiing with CVD morbidity and all-cause mortality; postulated pathways that may elucidate the relation between these associations; outline areas of ongoing uncertainty; and the implications for primary and secondary CVD prevention. To put the findings into perspective, we also summarized the evidence linking running with CVD morbidity and all-cause mortality. Though a head-to-head comparison is not available, the evidence indicates that performing PA as cross-country skiing associates with lower mortality risk when compared with that observed in those undertaking their PA as running. Potential adverse effects of extreme high weekly doses of cross-country skiing over decades may be cardiac arrhythmias, such as atrial fibrillation. Evidence suggests that cross-country skiing may reduce the risk of CVD events and all-cause mortality via anti-inflammatory pathways, improvements in endothelial function and reduced levels of CVD risk factors, such as lipids, glucose, and blood pressure; and enhancement of cardiorespiratory fitness.

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Series: Progress in cardiovascular diseases
ISSN: 0033-0620
ISSN-E: 1873-1740
ISSN-L: 0033-0620
Volume: 62
Issue: 6
Pages: 505 - 514
DOI: 10.1016/j.pcad.2019.09.001
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3142 Public health care science, environmental and occupational health
315 Sport and fitness sciences
Copyright information: © 2019 Elsevier Inc. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license