BACKGROUND: Little is known about the early predictors of need for care in late life. The purpose of this study was to investigate whether physical activity from midlife onward was associated with hospital and long-term care in the last year of life. METHODS: We studied a decedent population of 846 persons aged 66-98 years at death, who, on average 5.8 years prior to death, had participated in an interview about their current and earlier physical activity. Data on the use of care in the last year of life are register-based data and complete. RESULTS: Men needed on average 96 days (SD 7.0) and women 138 days (SD 6.2) of inpatient care in the last year of life. Among men, the risk for all-cause hospital care in the last year of life was higher for those who had been sedentary since midlife (adjusted incidence rate ratio [IRR] 1.98, 95% confidence interval [CI] 1.14-3.42) compared with those who had been consistently physically active, whereas use of long-term care did not correlate with physical activity history. Among women, the risk for long-term care was higher for those who had been sedentary (IRR 2.03, 95% CI 1.28-3.21) or only occasionally physically active (IRR 1.60, 95% CI 1.06-2.43), than for those who had been consistently active from midlife onward, whereas use of hospital care did not correlate with physical activity history. CONCLUSION: People who had been physically active since midlife needed less end-of-life inpatient care but patterns differed between men and women.