In which region of our country are people less likely to be physically active?
|
There's a decent chance that you, and many people in other countries, aren’t getting the recommended amount of exercise, according to a study published Wednesday in The Lancet Global Health. Show
The World Health Organization (WHO) recommends performing at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity each week to maintain health. This study, the largest and most comprehensive of its kind, is the first ever to investigate global trends in physical inactivity over time. It looked at information from 1.9 million people, from 358 population-based surveys, in 168 different countries -- representing about 96 percent of the world population -- and the results were staggering. “Countries will need to improve policy implementation to increase physical activity opportunities and encourage more people to be physically active,” Dr. Fiona Bull, the study’s senior author, said in a press release. The study’s five biggest takeaways  People work out in a gym together in this undated stock photo. STOCK PHOTO/Getty Images 1. More than 25 percent of all adults worldwide -- approximately 1.4 billion people -- are not doing enough physical activity That meets the official criteria for a “pandemic,” and this degree of global physical inactivity is likely to be a major driver for rises in the rates of cardiovascular disease, type 2 diabetes, dementia, and many cancers. Countries with the highest rates of inactivity were Kuwait, American Samoa, Saudi Arabia, and Iraq -- where more than half of all adults were insufficiently active in 2016. In the U.S., approximately 40 percent of adults were insufficiently active, which was greater than 36 percent in the U.K. and just 14 percent in China.
2. Inactivity in high-income countries is more than double that of low-income countries The average lack of activity in low-income countries was 16 percent, compared to 37 percent in high-income countries. The countries with the most favorable activity levels were Uganda and Mozambique; in each only 6 percent of adults were not meeting the physical activity guidelines. This is most likely due to high-income countries having more sedentary jobs and recreational activities, as well as methods of transportation that do not require exercise. A man doing a battle ropes exercise at the gym appears in this undated stock photo. STOCK PHOTO/Getty Images 3. Globally, there was no improvement in physical activity from 2001 to 2016 In fact, high-income Western countries got worse -- from 31 percent inactive in 2001 to 37 percent in 2016. These changes were driven most heavily by the U.S., Germany, and New Zealand. The region with the greatest improvement in activity was east and southeast Asia, from 26 percent inactive to 17 percent, attributed to increased physical activity in China, the region’s most populated country.
4. Women are less active than men in most regions of the world This was true in 159 of the 168 countries surveyed, with a difference of greater than 10 percentage points in 65 countries and greater than 20 percentage points in nine countries. This could be due to cultural norms that sometimes differentiate activity types by gender. To close the gender gap, we need to find ways to increase opportunities for women to enjoy safer, leisure-time exercise. A woman jogs in this undated stock photo. STOCK PHOTO/Getty Images 5. The WHO’s global target to reduce physical inactivity 10 percent by 2025 is not on track Most countries do have policies to tackle the issue of physical inactivity but very few have demonstrated impact. The authors of the study encourage governments to provide paths and roads that promote walking and cycling for transportation and safe spaces for active sports and recreation. Department for Prevention of Noncommunicable Diseases, WHO, Geneva, Switzerland Search for articles by this authorGretchen A Stevens Affiliations Department for Information, Evidence and Research, WHO, Geneva, Switzerland Search for articles by this authorLeanne M Riley Affiliations Department for Prevention of Noncommunicable Diseases, WHO, Geneva, Switzerland Search for articles by this authorFiona C Bull Affiliations Department for Prevention of Noncommunicable Diseases, WHO, Geneva, SwitzerlandDepartment of Sport and Exercise Science, University of Western Australia, Perth, WA, Australia Search for articles by this authorOpen AccessPublished:September 04, 2018DOI:https://doi.org/10.1016/S2214-109X(18)30357-7 Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants Previous ArticleCorrection to Lancet Glob Health 2018; 6 (suppl 2): S15 Next ArticleGlobal, regional, and national mortality trends in older children and young adolescents (5–14 years) from 1990 to 2016: an analysis of empirical data Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical activity across countries, and estimate global and regional trends. We pooled data from population-based surveys reporting the prevalence of insufficient physical activity, which included physical activity at work, at home, for transport, and during leisure time (ie, not doing at least 150 min of moderate-intensity, or 75 min of vigorous-intensity physical activity per week, or any equivalent combination of the two). We used regression models to adjust survey data to a standard definition and age groups. We estimated time trends using multilevel mixed-effects modelling. We included data from 358 surveys across 168 countries, including 1·9 million participants. Global age-standardised prevalence of insufficient physical activity was 27·5% (95% uncertainty interval 25·0–32·2) in 2016, with a difference between sexes of more than 8 percentage points (23·4%, 21·1–30·7, in men vs 31·7%, 28·6–39·0, in women). Between 2001, and 2016, levels of insufficient activity were stable (28·5%, 23·9–33·9, in 2001; change not significant). The highest levels in 2016, were in women in Latin America and the Caribbean (43·7%, 42·9–46·5), south Asia (43·0%, 29·6–74·9), and high-income Western countries (42·3%, 39·1–45·4), whereas the lowest levels were in men from Oceania (12·3%, 11·2–17·7), east and southeast Asia (17·6%, 15·7–23·9), and sub-Saharan Africa (17·9%, 15·1–20·5). Prevalence in 2016 was more than twice as high in high-income countries (36·8%, 35·0–38·0) as in low-income countries (16·2%, 14·2–17·9), and insufficient activity has increased in high-income countries over time (31·6%, 27·1–37·2, in 2001). If current trends continue, the 2025 global physical activity target (a 10% relative reduction in insufficient physical activity) will not be met. Policies to increase population levels of physical activity need to be prioritised and scaled up urgently. None. IntroductionThe health benefits of physical activity are well established and include a lower risk of cardiovascular disease, hypertension, diabetes, and breast and colon cancer. Additionally, physical activity has positive effects on mental health, delays the onset of dementia, and can help the maintenance of a healthy weight. Physical Activity Guidelines Advisory Committee report, 2008. To the Secretary of Health and Human Services. Part A: executive summary. Nutr Rev. 2009; 67: 114-120
A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults. Int J Behav Nutr Phys Act. 2010; 7: 39
WHO World Health Organization, Geneva2010
Progress in physical activity over the Olympic quadrennium. Lancet. 2016; 388: 1325-1336
ISPAH International Society for Physical Activity and Health Br J Sports Med. 2017; 51: 1389-1391
In recognition of this strong link between physical activity and major non-communicable diseases, member states of WHO agreed to a 10% relative reduction in the prevalence of insufficient physical activity by 2025, as one of the nine global targets to improve the prevention and treatment of non-communicable diseases. WHO World Health Organization, Geneva2013
The first compilation of country data to produce global and regional estimates of insufficient physical activity was undertaken in the early 2000s, as part of the Global Burden of Disease study.
Physical Inactivity. in: Ezzati M Lopez A Rodgers A Murray CJL Comparative quantification of health risks. Global and regional burden of disease attributable to selected major risk factors. World Health Organization, Geneva2004
Physical Inactivity. in: Ezzati M Lopez A Rodgers A Murray CJL Comparative quantification of health risks. Global and regional burden of disease attributable to selected major risk factors. World Health Organization, Geneva2004
International Physical Activity Questionnaire https://www.researchgate.net/file.PostFileLoader.html?id=5641f4c36143250eac8b45b7&assetKey=AS%3A294237418606593%401447163075131 Date: 2005 Date accessed: July 5, 2017
WHO http://www.who.int/ncds/surveillance/steps/GPAQ/en/ Date accessed: December 2, 2017
Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J Public Health. 2006; 14: 66-70
WHO http://www.who.int/healthinfo/survey/en/ Date accessed: December 20, 2017
Gesis https://www.gesis.org/eurobarometer-data-service/home/ Date accessed: September 30, 2017
WHO http://www.who.int/ncds/surveillance/steps/en/ Date accessed: December 22, 2017
The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: methods, challenges, and opportunities. Am J Public Health. 2016; 106: 74-78
Progress in physical activity over the Olympic quadrennium. Lancet. 2016; 388: 1325-1336
Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012; 380: 247-257
Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012; 380: 219-229
Research in contextEvidence before this studyWHO produced the first set of internationally comparable estimates on insufficient physical activity in 2008 for 122 countries. These estimates were updated for 2010, and published in the 2016 Lancet Series on Physical activity for 146 countries, showing a global prevalence of insufficient physical activity of 23·3%, with higher levels among women and older age groups. However, no compilation of global data on adult physical inactivity has been undertaken since, and no regional and global trends have previously been developed because data for trends have been considered too scarce.Added value of this studyThis study provides the most complete description of global, regional, and country levels of insufficient physical activity and, for the first time, presents regional and global trends over time. Global age-standardised prevalence of insufficient physical activity was 27·5% (95% uncertainty interval 25·0–32·2) in 2016. The prevalence has been stable since 2001.Implications of all the available evidenceProgress towards achieving the global target of a 10% relative reduction of insufficient physical activity by 2025, has been too slow. Accelerated action is needed to reverse trends in central and eastern Europe, high-income Western countries, Latin American and the Caribbean, and south Asia. Policies and programmes are also needed to achieve or maintain low levels of inactivity in other regions and in lower-income countries. Implementation of targeted evidence-based interventions presented in the Global Physical Activity Action Plan 2018–2030 will improve population health and help deliver many of the 2030 Sustainable Development Goals. However, in The Lancet Physical Activity 2016 Series, Sallis and colleagues
Progress in physical activity over the Olympic quadrennium. Lancet. 2016; 388: 1325-1336
Progress in physical activity over the Olympic quadrennium. Lancet. 2016; 388: 1325-1336
Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012; 380: 247-257
WHO http://www.who.int/gho/ncd/risk_factors/physical_activity/en/ Date accessed: October 10, 2017
MethodsStudy designWe estimated the prevalence of insufficient physical activity in adults aged 18 years and older, in 168 countries, for three World Bank income groups, The World Bank databank.worldbank.org/data/download/site-content/CLASS.xls Date: December 2016 Date accessed: May 13, 2017
NCD Risk Factor Collaboration Lancet. 2017; 390: 2627-2642
NCD Risk Factor Collaboration Lancet. 2017; 389: 37-55
WHO World Health Organization, Geneva2010
Data sourcesWe included data that fulfilled the following criteria: (1) the survey questionnaire explicitly included physical activity across four key domains—ie, for work, in the household (paid or unpaid), for transport to get to and from places (ie, walking and cycling), and during leisure time (ie, sports and active recreation); (2) data were collected through random sampling with a sample size of at least 200, and were representative of a national or defined subnational population; (3) prevalence of insufficient physical activity was reported by age and sex, according to current WHO, WHO World Health Organization, Geneva2010
Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995; 273: 402-407
Physical Activity Guidelines Advisory Committee report, 2008. To the Secretary of Health and Human Services. Part A: executive summary. Nutr Rev. 2009; 67: 114-120
Physical activity data collected using wearable devices, such as accelerometers or pedometers, were not included because of the limited comparability with self-reported data. Where available, we used individual-level data to calculate the prevalence of insufficient physical activity, taking the sampling designs into account. Where raw data were not available, we used aggregated data as reported. We included all data that met the inclusion criteria and that were provided before the end of September, 2017. We obtained data from WHO and other international surveys. WHO http://www.who.int/healthinfo/survey/en/ Date accessed: December 20, 2017
Gesis https://www.gesis.org/eurobarometer-data-service/home/ Date accessed: September 30, 2017
WHO http://www.who.int/ncds/surveillance/steps/en/ Date accessed: December 22, 2017
The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: methods, challenges, and opportunities. Am J Public Health. 2016; 106: 74-78
WHO http://www.who.int/ncds/surveillance/ncd-capacity/en/ Date accessed: July 10, 2017
Statistical analysisSurvey data were sometimes not comparable because of differences in study design. We applied four key adjustments to survey data using linear regression modelling to improve comparability (). First, we converted definitions. For surveys in which data were reported only for the former recommendation on physical activity for health,
Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995; 273: 402-407
WHO World Health Organization, Geneva2010
Second, we adjusted for over-reporting in the International Physical Activity Questionnaire. This questionnaire over-reports physical activity, leading to an underestimation of the prevalence of insufficient activity.
Addressing overreporting on the International Physical Activity Questionnaire (IPAQ) telephone survey with a population sample. Public Health Nutr. 2003; 6: 299-305
Lessons learned after 10 years of IPAQ use in Brazil and Colombia. J Phys Act Health. 2010; 7: S259-S264
Criterion-related validity of the last 7-day, short form of the International Physical Activity Questionnaire in Swedish adults. Public Health Nutr. 2006; 9: 258-265
Comparison of the 2001 BRFSS and the IPAQ Physical Activity Questionnaires. Med Sci Sports Exerc. 2006; 38: 1584-1592
Third, we adjusted data from surveys that had only urban samples. Of the 358 surveys used, 27 reported data for urban populations only. For these surveys, we estimated the prevalence in rural areas using information from surveys reporting both urban and rural prevalence. We calculated a national estimate combining the two by applying estimates of population by area of residence for the respective survey year. United Nations https://esa.un.org/unpd/wup/ Date accessed: October 13, 2017
Fourth, for surveys that did not report data for all ages older than 18 years, we estimated the data for the missing age groups using information from surveys that reported age-specific values for the entire age range. The methods used to generate final estimates of insufficient physical activity prevalence by country, year, sex, and age differed depending on the availability of data on trends over time. Of the 168 countries included, 65 had done at least two comparable surveys from different years using the same questionnaire (). For these countries, we estimated the prevalence of insufficient physical activity for each year from 2001, to 2016, using a multilevel mixed-effects linear regression model. To allow estimates to be informed by data from the same country, from other countries in the region, and other variables, this model included a random slope on year, a random intercept for each country, and fixed effects for country urbanisation, education, and location within nine previously defined regions that have been used in similar analysis for other non-communicable disease risk factors. NCD Risk Factor Collaboration Lancet. 2017; 390: 2627-2642
NCD Risk Factor Collaboration Lancet. 2017; 389: 37-55
27 countries had done several surveys with different survey coverage, or with different questionnaires, limiting comparability of these survey data. Although we adjusted for over-reporting in the International Physical Activity Questionnaire, we considered the comparison of adjusted data from the International Physical Activity Questionnaire to data from other questionnaires to be insufficient to inform country trends. Therefore, for these 27 countries, we also assumed a flat trend, whereby the trend line was based on the average prevalences across surveys for each country. To derive final estimates for the entire age range, we age-standardised resulting sex-specific and age-specific prevalence estimates using the WHO Standard Population.
Age standardization of rates: a new WHO standard. World Health Organization, Geneva2001
The World Bank databank.worldbank.org/data/download/site-content/CLASS.xls Date: December 2016 Date accessed: May 13, 2017
United Nations http://www.un.org/en/development/desa/population/publications/index.shtml Date accessed: October 13, 2017
Age standardization of rates: a new WHO standard. World Health Organization, Geneva2001
Global prevalence of vision impairment and blindness: magnitude and temporal trends, 1990–2010. Ophthalmology. 2013; 120: 2377-2384
Role of the funding sourceThere was no funding source for this study. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication. ResultsOur analysis included 358 population-based surveys done between 2001 and 2016, with 1·9 million participants from 168 countries (), representing 96% of the world's population. The availability of data across income groups and regions was spread fairly evenly, with the exception of Latin American and Caribbean countries where just more than half of countries had data (). Of the 358 surveys included, 301 were nationally representative, and 150 of 168 countries had at least one national survey (). Table 1Distribution of data across income groups and regions All countries (n=231)RegionIncome groupCentral Asia, Middle East, north Africa (n=28)Central and eastern Europe (n=20)East and southeast Asia (n=16)High-income Asia Pacific (n=3)High-income Western countries (n=36)Latin American and Caribbean (n=47)Oceania (n=22)South Asia (n=6)Sub-Saharan Africa (n=53)Low-income (n=31)Middle-income (n=109)High-income (n=75)Countries with data (%)168 (72·7%)23 (82·1%)17 (85·0%)13 (81·3%)3 (100·0%)24 (66·7%)25 (53·2%)17 (77·3%)5 (83·3%)41 (77·4%)24 (77·4%)89 (81·7%)54 (72·0%)Percentage of population covered with data95·8%90·4%98·3%97·3%100·0%99·0%87·6%94·3%98·5%89·6%81·9%96·9%96·3%Number with trend dataDefined as having used the same instrument and coverage at more than one point in time. (%)65 (28·1%)8 (28·6%)11 (55·0%)7 (43·8%)2 (66·7%)20 (55·6%)5 (10·6%)7 (31·8%)1 (16·7%)4 (7·5%)1 (3·2%)27 (24·8%)36 (48·0%)* Defined as having used the same instrument and coverage at more than one point in time.
65 of 168 countries had at least two surveys using the same questionnaire and survey coverage (, ). Availability of data meeting these two criteria was skewed towards higher-income countries, with only 3·2% of low-income countries and 48·0% of high-income countries having trend data (). Globally, more than a quarter of adults (27·5%, 95% UI 25·0–32·2) were insufficiently physically active in 2016 (). Between 2001 and 2016, levels of insufficient physical activity have decreased only marginally and insignificantly, with a global prevalence of 28·5% (23·9–33·9) in 2001. Women were less active than men, with a prevalence difference of 6 percentage points between sexes in 2001 (25·5%, 95% UI 23·1–33·0 for men, and 31·5%, 95% UI 27·9–37·8 for women), and of more than 8 percentage points in 2016 (23·4%, 21·1–30·7, for men, and 31·7%, 28·6–39·0, for women; , ). Table 2Prevalence of insufficient physical activity in 2016 Overall percentage of insufficient physical activity (95% UI)Percentage of men with insufficient physical activity (95% UI)Percentage of women with insufficient physical activity (95% UI)Country with the minimum prevalenceCountry with the maximum prevalenceCountryPrevalence (95% CI)CountryPrevalence (95% CI)All countries27·5% (25·0–32·2)23·4% (21·1–30·7)31·7% (28·6–39·0)Uganda5·5% (4·0–7·6)Kuwait67·0% (58·6–74·3)Central Asia, Middle East, and north Africa32·8% (31·0–35·2)25·9% (23·7–28·7)39·9% (37·9–42·7)Jordan11·9% (8·4–16·4)Kuwait67·0% (58·6–74·3)Central and eastern Europe23·4% (20·9–28·0)22·0% (18·6–28·8)24·7% (21·7–33·9)Moldova11·5% (8·1–16·0)Serbia39·5% (30·8–48·8)East and southeast Asia17·3% (15·8–22·1)17·6% (15·7–23·9)16·9% (14·9–25·7)Cambodia10·5% (6·9–15·7)Philippines39·7% (31·3–48·6)High-income Asia Pacific35·7% (34·4–37·0)33·0% (29·4–33·6)38·3% (37·4–42·6)South Korea35·4% (20·9–52·9)Singapore36·5% (21·7–54·3)High-income Western countries36·8% (34·6–38·4)31·2% (28·5–32·6)42·3% (39·1–45·4)Finland16·6% (12·9–21·0)Cyprus44·4% (36·8–52·1)Latin America and Caribbean39·1% (37·8–40·6)34·3% (32·5–35·5)43·7% (42·9–46·5)Dominica21·6% (16·3–28·0)Brazil47·0% (38·9–55·3)Oceania16·3% (14·3–20·7)12·3% (11·2–17·7)20·3% (18·8–28·7)Niue6·9% (4·8–9·9)American Samoa53·4% (41·4–65·0)South Asia33·0% (23·0–51·7)23·5% (14·4–54·3)43·0% (29·6–74·9)Nepal13·4% (11·2–15·6)India34·0% (22·3–47·7)Sub-Saharan Africa21·4% (19·1–23·3)17·9% (15·1–20·5)24·8% (21·8–27·2)Uganda5·5% (4·0–7·6)Mauritania41·3% (33·4–49·2)Low-income16·2% (14·2–17·9)13·4% (11·3–15·6)18·8% (15·9–21·4)Uganda5·5% (4·0–7·6)Mali40·4% (33·6–47·3)Middle-income26·0% (22·6–31·8)21·9% (18·9–31·3)30·1% (26·0–39·5)Lesotho6·3% (4·5–8·6)American Samoa53·4% (41·4–65·0)High-income36·8% (35·0–38·0)32·0% (29·8–33·1)41·6% (39·1–43·9)Finland16·6% (12·9–21·0)Kuwait67·0% (58·6–74·3)
Figure 1Trends in insufficient physical activity in men from 2001 to 2016 The shaded areas show 95% uncertainty intervals.
Figure 2Trends in insufficient physical activity in women from 2001 to 2016 The shaded areas show 95% uncertainty intervals.
Prevalence of insufficient physical activity ranged from 16·3% (95% UI 14·3–20·7) in Oceania to 39·1% (37·8–40·6) in Latin America and the Caribbean in 2016 (). Between 2001 and 2016, the prevalence of physical inactivity increased by more than 5 percentage points in high-income Western countries (from 30·9%, 26·4–38·1 in 2001, to 36·8%, 34·6–38·4, in 2016) and in Latin America and Caribbean (from 33·4%, 29·1–38·6, in 2001, to 39·1%, 37·8–40·6, in 2016), whereas east and southeast Asia had a decrease of more than 5 percentage points (from 25·7%, 20·6–29·4, in 2001, to 17·3%, 15·8–22·1, in 2016). Across all regions, with the exception of east and southeast Asia, women were less active than men in 2016 (). There was a difference between sexes of more than 10 percentage points in central Asia, Middle East and north Africa; high-income Western countries; and south Asia (). The highest levels of insufficient activity (>40%) among women in 2016 were in Latin America and the Caribbean, south Asia, and high-income Western countries (). The lowest levels of physical activity in men (<20%) in 2016 were in Oceania, east and southeast Asia, and sub-Saharan Africa (). The prevalence of insufficient physical activity in high-income countries was more than double the prevalence in low-income countries in 2016 (). The prevalence increased over time in high-income countries, from 31·6% (27·1–37·2) in 2001, to 36·8% (35·0–38·0) in 2016, whereas it was stable in low-income countries, at 16·0% (12·0–19·6) in 2001, and 16·2% (14·2–17·9) in 2016 (, ). Figure 3Trends in insufficient physical activity for three income groups from 2001 to 2016 The shaded areas show 95% uncertainty intervals.
Country-specific, age-standardised prevalence of insufficient physical activity in 2016 ranged from 5·5% (4·0–7·6) in Uganda to 67·0% (58·6–74·3) in Kuwait (). In four countries, the prevalence of insufficient physical activity was more than 50% (Kuwait, American Samoa, Saudi Arabia, and Iraq), whereas the prevalence was lower than 10% in seven countries (Uganda, Mozambique, Lesotho, Tanzania, Niue, Vanuatu, and Togo). In 55 (32·7%) of 168 countries, more than a third of the population was insufficiently physically active. In 159 of 168 countries, prevalence of insufficient physical activity was lower in men than in women, with a difference of at least 10 percentage points in 65 countries, and a difference of more than 20 percentage points in nine countries: Barbados, Bahamas, Saint Lucia, Palau, Iraq, Bangladesh, Trinidad and Tobago, Iran, and Saudi Arabia. , show country prevalence for men and women. Figure 4Country prevalence of insufficient physical activity in men in 2016
Figure 5Country prevalence of insufficient physical activity in women in 2016
Of the 65 countries with data for trends over time, 28 had decreasing levels of insufficient activity, whereas levels were increasing in 37 countries. The largest decreases (>15%) have occurred in Cook Islands, Jordan, Tokelau, Samoa, Myanmar, Solomon Islands, and Tonga, while the largest increases (>15%) occurred in Brazil, Bulgaria, Germany, Philippines, and Singapore. The average change across all of 65 countries was less than 0·01%. DiscussionOur analysis, including data from nearly 2 million participants (representing 96% of the global population), shows that globally, in 2016, more than a quarter of all adults was not getting enough physical activity. This puts more than 1·4 billion adults at risk of developing or exacerbating diseases linked to inactivity, and needs to be urgently addressed. Previous estimates
Progress in physical activity over the Olympic quadrennium. Lancet. 2016; 388: 1325-1336
WHO http://www.who.int/gho/ncd/risk_factors/physical_activity/en/ Date accessed: October 10, 2017
Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012; 380: 219-229
Prevalence of insufficient physical activity varied greatly across regions and income groups in 2016. We found the highest levels in Latin America and the Caribbean, high-income Western countries, and high-income Asia Pacific, and prevalence was more than double in high-income countries than in low-income countries in 2016. In wealthier countries, the transition towards more sedentary occupations and personal motorised transportation probably explains the higher levels of inactivity. Conversely, in lower-income countries, more activity is undertaken at work and for transport; however, these behaviours are changing rapidly.
Time use and physical activity: a shift away from movement across the globe. Obes Rev. 2012; 13: 659-680
United Nations https://esa.un.org/unpd/wup/ Date accessed: October 13, 2017
ISPAH International Society for Physical Activity and Health Br J Sports Med. 2017; 51: 1389-1391
WHO World Health Organization, Geneva2018
Land use, transport, and population health: estimating the health benefits of compact cities. Lancet. 2016; 388: 2925-2935
We also found a wide variation in country prevalence of insufficient activity both across and within regions. The prevalence of insufficient activity was lower than 10% in a few countries, and more than 50% in others. This inequality has also been confirmed by Althoff and colleagues,
Large-scale physical activity data reveal worldwide activity inequality. Nature. 2017; 547: 336-339
WHO World Health Organization, Geneva2018
Our study confirms findings
Large-scale physical activity data reveal worldwide activity inequality. Nature. 2017; 547: 336-339
Physical activity patterns among south-Asian adults: a systematic review. Int J Behav Nutr Phys Act. 2013; 10: 116
Gender-specific changes in physical activity pattern in Iran: national surveillance of risk factors of non-communicable diseases (2007–2011). Int J Public Health. 2014; 59: 231-241
Global Observatory for Physical Activity (GoPA) http://www.globalphysicalactivityobservatory.com/country-cards/ Date accessed: January 2, 2018
Gender-specific changes in physical activity pattern in Iran: national surveillance of risk factors of non-communicable diseases (2007–2011). Int J Public Health. 2014; 59: 231-241
Shifting the physical inactivity curve worldwide by closing the gender gap. Sports Med. 2018; 48: 481-489
Physical activity in 22 African countries: results from the World Health Organization STEPwise approach to chronic disease risk factor surveillance. Am J Prev Med. 2011; 41: 52-60
Shifting the physical inactivity curve worldwide by closing the gender gap. Sports Med. 2018; 48: 481-489
WHO Regional Office for the Eastern Mediterranean World Health Organization, Cairo2014
Our analysis was the first to assess trends in physical inactivity over time. The global prevalence of physical inactivity was stable between 2001 and 2016, suggesting no progress in reducing global levels to reach the 2025 global physical activity target. WHO World Health Organization, Geneva2013
BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000–14. Lancet Diabetes Endocrinol. 2016; 4: 487-497
Insights from an observational assessment of park-based physical activity in Nanchang, China. Prev Med. 2015; 2: 930-934
Progress in physical activity over the Olympic quadrennium. Lancet. 2016; 388: 1325-1336
WHO World Health Organization, Geneva2018
Our study is affected by several limitations. First, similar to all global analyses, data were not available for every country and year, and availability varied across countries and regions. Latin America and the Caribbean, high-income Western countries, Oceania, and sub-Saharan Africa had the lowest proportion of countries with data. However, within these regions, the most populous countries were more likely to have data, so that the proportion of the population with data in these regions was still high. Countries with a population of more than 10 million with no data were Bolivia, Haiti, and Peru in Latin America and the Caribbean; Angola, Burundi, Somalia, South Sudan, and Sudan in sub-Saharan Africa; Afghanistan in south Asia; Syria and Yemen in central Asia, Middle East, and North Africa; and North Korea in east and southeast Asia. Some of these countries are also classified as low-income countries, which had the lowest data availability of the income groups. The availability of data for trends in physical inactivity was clearly skewed towards high-income countries, with 48·0% of countries being covered, compared with 3·2% of low-income countries. In fact, our trend estimations for low-income countries were based on one country only, Benin, which limits the representativeness for other low-income countries. Data coverage for trends was low in sub-Saharan Africa, Latin American and the Caribbean, and south Asia, indicating that trend estimates for these regions should be interpreted with caution. Second, data quality also varied across countries and over time. 131 (37%) of the 358 surveys included data that were collected through the WHO Stepwise Approach to NCD Risk Factor Surveillance, using the Global Physical Activity Questionnaire. WHO http://www.who.int/ncds/surveillance/steps/GPAQ/en/ Date accessed: December 2, 2017
Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J Public Health. 2006; 14: 66-70
The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: methods, challenges, and opportunities. Am J Public Health. 2016; 106: 74-78
The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: methods, challenges, and opportunities. Am J Public Health. 2016; 106: 74-78
Third, we had to rely on self-reported data in our analysis despite their limitations.
Physical activity assessment in the general population; validated self-report methods. Nutr Hosp. 2015; 31: 211-218
Progress in physical activity over the Olympic quadrennium. Lancet. 2016; 388: 1325-1336
Utilization and harmonization of adult accelerometry data: review and expert consensus. Med Sci Sports Exerc. 2015; 47: 2129-2139
Finally, in some cases, our estimates are different to prevalence estimates produced by countries. There are several reasons for this difference. We adjusted our estimates for several factors when necessary. We also standardised our estimates to an artificial age structure, the WHO Standard Population.
Age standardization of rates: a new WHO standard. World Health Organization, Geneva2001
Our data show that progress towards the global target set by WHO member states to reduce physical inactivity by 10% by 2025 has been too slow and is not on track. Levels of insufficient physical activity are particularly high and still rising in high-income countries, and worldwide, women are less active than are men. A significant increase in national action is urgently needed in most countries to scale-up implementation of effective policies. The Global Action Plan on Physical Activity 2018–2030, WHO World Health Organization, Geneva2018
ISPAH International Society for Physical Activity and Health Br J Sports Med. 2017; 51: 1389-1391
Contributors RG analysed the data and wrote the first draft of the report. GAS and RG developed the methodological approach, with inputs from all other authors. All authors designed the study, and revised and approved the final report. Declaration of interests All authors are staff members of WHO. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of WHO. Acknowledgments This study received no funding. See for further acknowledgments. Supplementary Material
References
Article InfoPublication HistoryPublished: September 04, 2018 IdentificationDOI: https://doi.org/10.1016/S2214-109X(18)30357-7 Copyright© 2018 World Health Organization; licensee Elsevier Ltd. User LicenseCreative Commons Attribution IGO (CC BY 3.0 IGO) |
Creative Commons Attribution IGO (CC BY 3.0 IGO) Permitted
Elsevier's open access license policy ScienceDirectAccess this article on ScienceDirectToggle Thumbstrip Linked Articles
|
