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Objectives: The aim of the present paper was, first, to analyze a four level biopsychosocial model to examine the interaction of various initial health behaviors and, second, their consequences with respect to the course of physical fitness (PF) and health of adults over the course of 18 years. Design: Longitudinal study based on medical examinations and self-ratings. Method: Path analysis along with latent growth curve analysis was based on the German study about the relationship of physical activity, fitness and health (1992–2010). Data were collected from 495 adults (243 women) with an average age of 45.03 years in 1992 (SD = 7.45). Participants were randomly selected from the official registers of local residents' registration offices in the community of Bad Schönborn. Results: For the mean PF and health levels in 1992, direct and indirect influences were shown on four levels including socioeconomic status and immigration on the first level, outcome expectations and stress coping strategies on the second level as well as eating patterns and physical activity on the third level; furthermore, the course of PF and the course of health (from 1992 until 2010) were affected by the initial behaviors (physical activity and eating patterns in 1992); finally PF and health were not related. Conclusions: Influences on four levels provided evidence for the complexity of PF and health (outcome level). Initial behaviors predicted current PF and health status, as well as their course. Thus, preventive measures should ensure that healthy behaviors are adopted early in adulthood. [Copyright &y& Elsevier]