The World Health Organization (WHO) has published new global estimates on physical activity levels among adults in The Lancet Global Health.

Background Information:

The WHO defines adequate physical activity as

• 150 minutes of moderate-intensity physical activity per week, OR
• 75 minutes of vigorous-intensity physical activity per week, OR
• any equivalent combination of the two.

Established benefits of adequate physical activity include:

• lower risk of cardiovascular disease, hypertension, diabetes, breast and colon cancer;
• positive effects on mental health;
• delaying the onset of dementia;
• aiding in maintenance of healthy weight

Member states of WHO have 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.

The Global Physical Activity Questionnaire (GPAQ) was developed by the WHO to facilitate assessment of physical activity in four domains:

• leisure-time
• work
• household
• transport

GPAQ is a self-reported tool, and responses are converted into Metabolic Equivalents of Task (METs). An individual is considered to have adequate physical activity if at least 600 METs per week are achieved.

Key Messages:

Methods

The authors included studies that involving adults over 18 years of age that fulfilled the following criteria:

1. the survey questionnaire explicitly included physical activity across four domains (leisure-time, work, household, transport)
2. data were representative of a national/ subnational population, and collected through random sampling with a sample size of at least 200
3. prevalence of insufficient physical activity was reported by age and sex, according to current or previous WHO recommendations.

The total sample was 1.9 million subjects, representing 96% of world population.

Results

Globally, more than a quarter of adults (27·5%, 95% UI 25·0–32·2) were insufficiently physically active in 2016 (table 2).

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, and of more than 8 percentage points in 2016:

2001                  Men: 25.5% (23.1-33.0)        Women: 31.5% (27.9-37.8)

2016                  Men: 23.4% (21.1-30.7)        Women: 31.7% (28.6-39.0)

Between 2001 and 2016, the prevalence of physical inactivity increased by more than 5 percentage points in high-income Western countries and in Latin America and Caribbean, whereas east and southeast Asia had a
decrease of more than 5 percentage points:

High-income Western countries        2001: 30.9% (26.4-38.1)     2016: 36.8% (34.6-38.4)

Latin America & Caribbean                2001: 33.4% (29.1-38.6)     2016: 39.1% (37.8-40.6)

East, Southeast Asia                              2001: 25.7% (20.6-29.4)     2016: 17.3% (15.8-22.1)

Across all regions, with the exception of east and southeast Asia, women were less active than men in 2016 (table 2). 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 (table 2). 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 (table 2). The lowest levels of physical activity in men (<20%) in 2016 were in Oceania, east and southeast Asia, and sub-Saharan Africa (table 2).

Figure 1. Country-specific prevalence of insufficient physical activity in men in 2016

Figure 2. Country-specific prevalence of insufficient physical activity in women in 2016

The prevalence of insufficient physical activity in high-income countries was more than double the prevalence in low-income countries in 2016 (table 2). 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 (table 2).

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%

1. Kuwait,
2. American Samoa,
3. Saudi Arabia, and
4. Iraq

whereas the prevalence was lower than 10% in seven countries

1. Uganda,
2. Mozambique,
3. Lesotho,
4. Tanzania,
5. Niue,
6. Vanuatu, and
7. 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:

1. Barbados,
2. Bahamas,
3. Saint Lucia,
4. Palau,
5. Iraq,
6. Bangladesh,
7. Trinidad and Tobago,
8. Iran, and
9. Saudi Arabia.

National policy needs to be implemented to encourage non-motorised modes of transportation, such as walking and cycling, and to promote participation in active recreation and sports in leisure time. Such policies are particularly important in countries with rapid urbanisation.  Effective policies include

• improved provision of cycling and walking infrastructure,
• improving road safety, and
• creating more opportunities for physical activity in public open spaces and parks, in workplaces, and in other local community settings.

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.

Conclusions

Globally, in 2016, more than a quarter (28%) 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.

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.

Useful Links:

Link to the WHO news release:

http://www.who.int/ncds/prevention/physical-activity/lancet-global-health-insufficient-physical-activity-2001-2016/en/

Link to the article in The Lancet Global Health (English) [PDF]:

https://www.thelancet.com/action/showPdf?pii=S2214-109X%2818%2930357-7

Link to WHO page ‘Let’s Be Active’:

http://www.who.int/ncds/prevention/physical-activity/gappa

Link to previous article on Global Action Plan on Physical Activity (GAPPA):

https://communitymedicine4asses.com/2018/06/05/global-action-plan-on-physical-activity/