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We assessed the association between physical activity, and the risk of moderate and severe lower urinary tract symptoms.A cross-sectional representative sample of 30,377 men 45 to 79 years old in central Sweden who completed a self-administered life-style questionnaire, including International Prostate Symptom Score questions, physical activity currently and recalled at age 30 years (total, work/occupation, walking/bicycling, inactivity and exercise) and demographic data. A total of 6,905 men (23%) who scored 8 or more points on International Prostate Symptom Score questions were considered to have moderate or severe lower urinary tract symptoms.After controlling for subject age, waist-to-hip ratio, diabetes, smoking and drinking status, and educational level total physical activity was significantly inversely related to moderate and severe lower urinary tract symptoms (highest vs lowest quartile OR 0.72, 95% CI 0.66 to 0.79, p trend <0.001). Men who were physically active at work as well as during leisure time were at half the risk of lower urinary tract symptoms compared to inactive men (OR 0.49, 95% CI 0.40 to 0.60). Long-term high inactivity (5 hours daily at age 30 years plus currently) was associated with a 2-fold increased risk compared with the risk in men who were more active at the 2 periods (OR 1.90, 95% CI 1.41 to 2.59).Our results suggest that physical activity in young and late adulthood may be associated with a lower risk of moderate and severe lower urinary tract symptoms.