Physical Activity in Short Supply Worldwide, WHO Researchers Find

One in four adults worldwide—fully 1.4 billion people—don’t get enough physical activity per week, and women tend to be more inactive than men, according to a new analysis of data from 2001 to 2016.

In wealthier nations, the situation seems to be getting worse.

World Health Organization (WHO) researchers, led by Regina Guthold, PhD, combined 358 surveys that included 1.9 million participants across 168 countries. The surveys took into account physical activity at work, at home, for transport, and for leisure, and defined inactivity as < 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise each week.

“The health benefits of physical activity are well established and include a lower risk of cardiovascular disease, hypertension, diabetes, and breast and colon cancer,” the investigators note in their paper recently published online in Lancet Global Health. “Additionally, physical activity has positive effects on mental health, delays the onset of dementia, and can help the maintenance of a healthy weight.”

Five years ago, in 2013, WHO member states launched a plan to reduce physical inactivity by 10% by 2025. The current trajectory, however, suggests that progress towards this global goal has been “too slow and is not on target,” Guthold and colleagues stress. They say a “significant increase in national action is urgently needed” to shift trends, and that the WHO Global Action Plan on Physical Activity 2018-2030 will be a “catalyst” in this area.

Peter Duffy, MD (FirstHealth, Pinehurst, NC), an interventional cardiologist, told TCTMD that if anything, the results reported in the study are unusually positive, though this may come down to how individuals were surveyed and inactivity was defined. “One in three women and one in four men do not do enough physical activity to stay healthy,” he said. “I’m surprised the numbers are that high [showing] that people are doing physical activity to be honest with you.”

Most people he encounters don’t get the bare minimum “regular exercise” involving 20 minutes’ worth of moderate activity three times a week, Duffy said. “Hardly any of my patients even do that. . . . I would say maybe one out of four do.”

Warning bells about public health aren’t likely to make a dent in that, he predicted. “Most people aren’t going to pay attention to it, because they don’t think it affects them on a daily [basis].” Change will have to come at a higher level, Duffy urged, suggesting that future initiatives build on the experiences of cities that have succeeded.

The new study “is fantastic, because it points out what the problem is. But the cause of the problem is multifactorial, so it’s going to require multifactorial answers,” Duffy said.

Women Tend to Be Less Active

Overall, an estimated 27.5% of individuals were insufficiently active in 2016, with 23.4% of men and 31.7% of women falling into this group. In the United States, 40% of people were inactive, including 31.7% of men and 48.0% of women. High-income countries in general had higher proportions of inactive residents compared with low-income countries (36.8% vs 16.2%), and they were worse off than they’d been in 2001, when the prevalence of inactivity in these wealthier regions was 31.6%.

Around the world, the least active were women in Latin America and the Caribbean, South Asia, and high-income Western countries, where 43.7%, 43.0%, and 42.3% got insufficient amounts of physical activity. Most active were men in Oceania, East and Southeast Asia, and sub-Saharan Africa, reporting inactivity rates of 12.3%, 17.6%, and 17.9%, respectively.

Leveraging data from the 65 countries with more than one survey, the researchers calculated that the level of inactivity as a whole held stable between 2001 and 2016.

Our job is to be educational, not punitive and not argumentative. What we want to do is be able to present information to them and say, ‘If you want to feel better and live longer, we can help you do that.’ Peter Duffy

“In wealthier countries, the transition towards more sedentary occupations and personal motorized transportation probably explains the higher levels of inactivity. Conversely, in lower-income countries, more activity is undertaken at work and for transport; however, these behaviors are changing rapidly,” Guthold and colleagues say. They add that the implementation of effective policies will need to focus on improving cycling and walking infrastructure, as well as road safety, and creating more opportunities for physical activity in public open spaces and elsewhere.

Ding Ding, PhD (University of Sydney, Australia), writing in an accompanying editorial, agrees. “Although declines in occupational and domestic physical activity are inevitable, it is essential to incentivize transport and leisure-time physical activity in emerging economies through improving public and active transportation infrastructure, promoting social norms for physical activity through mass sports and school-level participation, and implementing sustainable programs at scale that could yield economic, environmental, and social benefits while promoting physical activity.”

Efforts to document patterns in activity are essential, she says, but they’re just the first step.

Duffy, too, noted that shifts in how people live their daily lives can explain some of the inactivity. For example, a motorized scooter program just arrived in Raleigh, NC. “So instead of walking, now you can take an electric scooter from one place to the next. I think we’re seeing that in multiple cities now. For ease, that’s a wonderful thing, but people who used to walk from the bus station to work or something like that, a quarter mile, a half mile, whatever it was, now have the ability to just take a motor scooter,” he said. “It sounds like a good idea and it works, but the repercussion of that is you’re not getting the exercise, which you don’t even really think about.”

As a culture, the United States doesn’t promote or reward exercise, Duffy added. There’s also the popular idea that medicine can undo the damage done by lack of activity, discouraging personal responsibility, he said.

To start conversations with patients, he suggested clinicians ask basic, open-ended questions: “What do you do on a daily basis? How do you spend your time? What do you do for physical activity?”

People who prioritize exercise will be able to answer in detail, Duffy said. For less-active patients, “our job is to be educational, not punitive and not argumentative. What we want to do is be able to present information to them and say, ‘If you want to feel better and live longer, we can help you do that. Here’s one of the important ways of doing that, just so you know.’”