Res Exerc Epidemiol 2014; 16(1): 1-8.
c 2014 by the Japanese Association of Exercise Epidemiology
Copyright ○【Review Article】

Physical Activity and Health at the Population Level– the Role of International Networks
Brian W. Martin1), Sonja Kahlmeier1)
1）Institute of Social and Preventive Medicine, University of Zurich, Switzerland

ABSTRACT The first countries to develop comprehensive policy approaches to population based physicalactivity promotion in the modern sense were Finland and Canada. Other parts of the worlds saw comparable
developments in countries or large metropolitan areas towards the end of the 20th century, examples are Australia,
São Paulo in Brazil and Japan. The US Surgeon General’s report on Physical Activity and Health of 1996 was ahealth policy document with important international repercussions. Around the same time, the World Healt hOrganisation (WHO) began to integrate physical activity in its Active Living Strategy and a little later in its
Global Strategy for the Prevention and Control of Non-Communicable Diseases (NCDs). In 2004, physicalactivity featured more prominently in the WHO’s Global Strategy on Diet, Physical Activity and Health. In the
2008-2013 Action Plan to WHO’s NCD strategy, physical inactivity was for the first time explicitly andprominently named as one of the four main NCD risk factors. In 2010, WHO issued the first Global
Recommendations for Physical Activity and Health, its role for global public health was confirmed in the 2011
UN High-Level Meeting on NCDs. So physical activity is a relatively new concept in international public health.
Many institutions can play an important role in physical activity promotion, but for most this is only one of theirtasks amongst others. There are a limited number of organisations that focus on physical activity and health alone:
the international physical activity promotion networks and the International Society for Physical Activity and
Health (ISPAH). Agita Mundo, the Global Physical Activity Promotion Network, the four existing regional
networks (RAFA/PANA, HEPA Europe, APPAN and AFPAN), ISPAH and its advocacy council GAPA work
together not only in the dissemination of tools and information, but also in lobbying for physical activity as animportant aspect of public health.

Physical activity and health– from the individual to the global level(Taiiku-no-Hi) as a national holiday in Japan incommemoration of the Tokyo Olympic Games in 1964
and the Sport for All movement with Congressesorganised by the International Olympic Committee(IOC) since 1986. The first countries to develop
comprehensive policy approaches to physical activity
promotion were Canada 1) and Finland 2), both in the
1970ies. In Brazil, the State of São Paulo became thesetting for the “Agita São Paulo” movement in the late
1990ies3). Examples for comprehensive developments
in other world regions were Australia since 1996 4),
Japan with its national strategy since 2000 5) and South
Africa with the development of a national physicalactivity plan since 2011 6). Though the US National
Physical Activity plan was only launched in 2010, thescientific and conceptual work in the United States
was very influential on the international level, from

The importance of physical activity for individual
fitness and health has been long recognised andincorporated in proverbs analogous to “use it or loseit” in many languages. However, its importance at the
population level has only begun to emerge over thelast half century. There have been several social
movements in society with a strong link to physicalactivity, for example the gymnastics movement incentral and northern Europe since the middle of the
19th century, the annual Health and Sports Day
Address for correspondence: Brian W. Martin; Institute ofSocial and Preventive Medicine, University of Zurich,
Seilergraben 49, Room D-03 8001 Zurich, Switzerland,brian.martin@uzh.ch1

Res Exerc Epidemiol 2014; 16(1): 1-8. http://jaee.umin.jp/REE.html

the Surgeon General’s report on Physical Activity and
Health in 1996 7) to the Advisory Committee Reportfor the 2008 Physical Activity Guideline for
Americans8).
Physical activity in international health is arelatively new phenomenon. The World HealthOrganisation (WHO) presented the “Active Living”
initiative at its 4th International Conference on Health
Promotion in Jakarta in 1997 and physical activity
was also an element in the Global Strategy for thePrevention and Control on Non-Communicable
Diseases (NCDs) adopted by the World Health
Assembly in 2000 9). Still there was little concrete
action, until Physical Activity was chosen as the topicof WHO’s World Health Day in 2002. The Global
Strategy on Diet, Physical Activity and Healthadopted by the World Health Assembly 2004 10) was
the first time physical activity entered the global
central stage of public health. The strategy explicitly
stated: “although the effects of diet and physicalactivity on health often interact, particularly in
relation to obesity, there are additional health benefits
to be gained from physical activity that are
independent of nutrition and diet (…)”. Nevertheless,at this time physical activity was still mainly
perceived in the context of the obesity discussion.
This began to change when the 2008-2013 Action Plan
to WHO’s NCD strategy prominently stated not only
four main groups of NCDs (cardiovascular diseases,
diabetes, cancers and chronic respiratory diseases),
but also four main risk factors: tobacco use, physicalinactivity, unhealthy diets and harmful use ofalcohol11). In WHO’s 2009 “Global Health Risks”
assessment, physical inactivity was ranked as the
fourth risk factor for worldwide mortality12), with four
more of the six top factors also related to it (highblood pressure, high blood glucose, overweight andobesity, high cholesterol). In the following year, WHOissued the first Global Recommendations on Physical
Activity for Health13). This prominent role wasconfirmed in the first UN high level meeting for noncommunicable diseases in autumn 2011 in New Yorkand its political declaration adopted by the General
Assembly of the United Nations 14). It seemed that now
physical activity had found its rightful place ininternational public health.

International organisations
physical activity and healthrelevantfor

From the perspective of public health, the World
Health Organisation WHO as the “directing andcoordinating authority for health within the United
Nations system” (www.who.int) is the most important
global organisation to include physical activity in its
agenda. Other ones are the International Union for
Health Promotion and Education (www.iuhpe.org) or
the International Society for Behavioural Nutrition
and Physical Activity (ISBNPA, www.isbnpa.org).
However, beside health there are other parts of society
which are of great relevance for physical activity andhealth, and also within these there are institutions very
active in this topic. The International Olympic
Committee (IOC, www.olympic.org) has already been
mentioned in this context, other examples from thefield of sports are the Association For InternationalSport for All (TAFISA, www.tafisa.net) and theInternational Sport and Culture Association (ISCA,
www.isca-web.org). For physical education, theInternational Council of Sport Science and Physical
Education (ICSSPE, www.icsspe.org) could be
mentioned. In addition there are a number of regionalorganisations with global impact in our field,
including the American Society for Sports Medicine(ACSM, www.acsm.org), particularly with its Exercise is Medicine Initiative (www.exerciseismedicine.
org), the European College of Sports Sciences (www.
sprt-science.org) or the Asian Council of Exercise
and Sports Science (www.acess.asia). A systematic
overview of institutions relevant for health-enhancing
physical activity in the European region has been
carried out recently (Figure 1)15), but no suchoverview exists at the global level.
These institutions represent only an incomplete
list of organisations relevant for health-enhancing
physical activity and health at the global level, andthere are far more of them at the regional and national
level. However, all of them have in common thatphysical activity and health is only one of their
institutional tasks and topics, and usually not the one
with the highest priority. At the global level, there are
only two organisations dealing exclusively withphysical activity and health: Agita Mundo, the Global

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Figure 1 Overview of European institutions and their role for health-enhancing physical activity15), by topic, type oforganisation and synergy with the goals of HEPA Europe (=closeness). A: NGO or Association; N: network; E: European
Commission body, W: WHO unit or platform 15). Health care organisations were not included in the analysis. No
systematic overview on the role of global institutions exists yet.
ACES: European Capitals of Sport Association; CEHAPE: Children’s Environment and Health Action Plan; CESS:
Confédération Européenne Sport et Santé; DG EAC: Directorate General Education and Culture; DG SANCO: Directorate
General for Health and Consumers; EACPR: European Association for Cardiovascular Prevention & Rehabilitation; ECF:
European Cyclists’ Federation; ECSS: European College of Sports Science; EEN: Epode European Network; EFCS:
European Federation for Company Sports; EGREPA: European Group for Research into Elderly and Physical Activity;
EGWA: European Greenways Association; EHFA: European Health and Fitness Association; EHN: European Heart
Network; ELSN: Euro Local Sport Network; ENGSO: European Non-Governmental Sports Organisation; ENSSEE:
European Network of Sport Science, Education and Employment; ENWHP: European Ne for Workplace Health Promotion;
EOC: European Olympic Committee; EPHA: European Public Health Alliance; ESFAN: European Sport for All Network;
EUFAPA: European Federation of Adapted Physical Activity; EUFIC: European Food Information Council; EUNAAPA:
European Network for Action on Ageing and Physical Activity; EUPEA: European Physical Education Association;
EUPHA: European Public Health Association; EUROPREV: European Network for Prevention and Health Promotion in
Family Medicine & General Practice; EWS: European Women and Sport; FEPA: Federation of European Pedestrian
Associations; POLIS: European Cities & Regions Networking for Innovative Transport Solutions; SHE: Schools for Healthin Europe; THE PEP: Transport, Health and Environment Pan-European Programme; THENAPA II: Thematic Network
Adapted Physical Activity.

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The international physical activity networks

Physical Activity Promotion Network, and theInternational Society for Physical Activity and Health(ISPAH). Agita Mundo was founded after the WHO’s
World Health Day celebration 2002 in São Paulo,building on the successful experiences of the Agita
São Paulo and the Agita Brazil programmes 16). Its
members are the regional physical activity promotion
networks as well as organisations and institutions
willing to contribute to its purpose, which is topromote physical activity as a healthy behaviour for
people of all ages, nations, and characteristics. ISPAH
was founded after the successful first International
Conference for Physical Activity and Public Health(ICPAPH) in Atlanta in 2006, ICPAPHs following
every two years have seen further in- creases inparticipation. ISPAH is an international professionalsociety for individual members who are interested inadvancing the science and practice of physical activity
and health. Many experts are involved in both ISPAH
and Agita Mundo (see Tables 1 and 2), and there isstrong collaboration between the physical activity
networks, ISPAH and the Society’s councils. Every
second year the Agita Mundo Network meeting takes
place in conjunction with ISPAH’s biennial
conference ICPAPH.

The main members of Agita Mundo are the regional
physical activity promotion networks which are also
represented in its Executive Board (see Table 2). The
Global Physical Activity Promotion Network also
has an advisory board consisting of distinguishedindividuals in the field of physical activity and healthwhich support the Network and its Executive Board(Table 3). Agita Mundo’s main activity is the annual
World Day for Physical Activity (www.panh.ch/worldday) with more than 1000 events in 38 countries
on five continents registered in 2013. The World Day
is coordinated by the Agita Mundo secretariat at theCentro de Estudos do Laboratório de Aptidão Fisicade São Caetano do Sul (CELAFISCS) in São Paulostate in Brazil. At the International Conference forPhysical Activity and Public Health (ICPAPH) 2014 in
Rio de Janeiro, the “Agita Mundo Award” will bepresented as the global annual recognition award foroutstanding activities in physical activity promotion.
Further activities are discussed at the annual meetingsof the network and decided on by the members of the
network.
Table 2 Executive Board of Agita Mundo, the Global
Physical Activity Promotion Network, as at early 2014.

Table 1 Executive Board of ISPAH (www.ispah.org), theInternational Society of Physical Activity and Health, as Brian Martin (E), University of Zurich, Switzerland

at early 2014.

(chairman)

 Harold W. Kohl, III, University of Texas, USA Nasser Al Rahma, Dubai Sports Council
 Adrian Bauman (AP), University of Sydney, Australia(president) Fiona Bull, University of Western Australia, Perth Eddy Engelsman (E), The Netherlands Institute for Sport(president-elect)

and Physical Activity: NISB Lars Bo Anderson, University of Southern Denmark, Shigeru Inoue, Tokyo Medical University, Japan Vicki Lambert (AF), University of Cape Town, South

Odense Adrian Bauman, University of Sydney, Australia

Africa William E. Kraus, Duke University, Durham NC, USA Victor Matsudo (R), CELAFISCS, Brazil (founder and Shigeru Inoue, Tokyo Medical University, Japan

past chairman) Vicki Lambert, University of Cape Town, South Africa

 Michael Pratt (R), Centers for Disease Control and Michael Pratt, Centers for Disease Control andPrevention: CDC, USA Jasem Ramadan, Kuwait University

Prevention CDC, USA Jasem Ramadan, Kuwait University

 Jim Whitehead (R), American College of Sports Olga Sarmiento, Universidad de los Andes, Bogotá,

Medicine: ACSM

Colombia(E): representative of HEPA Europe; (R): representative of
RAFA/PANA, (AP): representative of APPAN; (AF):representative of AFPAN.

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Table 3 Advisory Board of Agita Mundo, the Global

Table 4 Chairs, executive directors (where formally

Physical Activity Promotion Network, as at early 2014.

defined) and hosting institution for the secretariat of theregional physical activity promotion networks, as at early Hamadi Benaziza, formerly WHO

2014.

 Steven Blair, University of South Carolina, Columbia SC,
USA

Physical Activity Network of the Americas/Red de Antonio Carlos Bramante, formerly State University of

Actividad Física de las Américas, RAFA/PANA

Campinas (UNICAMP), Brazil(www.rafapana.org)

 Maria Beatriz Rocha Ferreira, State University of President: Victor Matsudo, CELAFISCS, Brazil
 Secretariat: Centro de Estudos do Laboratório de Aptidão

Campinas(UNICAMP) and Federal University of Grande
Dourados, Mato Grosso do Sul, Brazil

Fisica CELAFISCS, São Caetano do Sul SP, Brazil

 José da Silva Guedes, Santa Casa Faculty of Medical

HEPA Europe, the European Network for health-enhancing

Sciences of Sâo Paulo, Brazil

physical activity (www.euro.who.int/hepaeurope) Harold W. Kohl, III, University of Texas, USA Chair: Tommi Vasankari, UKK Institute, Tampere, Pekka Oja, formerly UKK Institute, Tampere, Finland

Finland Neville Owen, Baker IDI Heart and Diabetes Institute, Executive member of the steering committee: Sonja

Melbourne, Australia

Kahlmeier, University of Zurich, Switzerland

 Jim Sallis, University of California, San Diego, USA

 Secretariat: WHO’s Regional Office for Europe, Willem van Mechelen, VU University Medical Centre,

Copenhagen

Amsterdam, the Netherlands
 Ilkka Vuori, formerly UKK Institute, Tampere, Finland

Asia Pacific Physical Activity Network, APPAN(www.ap-pan.org)

There are currently four regional physical activity
promotion networks (Table 4). The Physical Activity
Network of the Americas/Red de Actividad Física delas Américas RAFA/PANA was founded in 2002 16)
with the objective of building a network of national
networks. It has currently more than 200 member
institutions from 19 countries. HEPA Europe, theEuropean Network for health-enhancing physicalactivity was founded in 2005, building on theexperiences and the work done by a previous
European network funded by the European Union
from 1996 to 2001 17). The network currently has morethan 130 member institutions from 30 European
countries. The Asia Pacific Physical Activity Network(APPAN) as an informal communication network wasfounded at the University of Sydney in Australia in
20064). It had up to 70 members at its peak, formed ofpolicy makers and practitioners from at least 15
countries. Given the diversity of geography, language
and culture in the region, APPAN is a challenging
network to sustain and develop. The African Physical
Activity Network (AFPAN) was founded in 2007 andhas about 200 individual and institutional members
from 13 African countries.
All regional physical activity networks provide

 Chair: Adrian Bauman, University of Sydney, Australia
 Secretariat: School of Public Health, University ofSydney, Australia
African Physical Activity Network, AFPAN(www.afpan.weebly.com)

 Chair: Antonio Prista, Universidade Pedagógica, Maputo,
Mozambique Secretariat: Sports Science Institute of South Africa,
Cape Town

access to expertise and a platform for exchange on
physical activity and health. The networks’ further
activities vary in their nature. RAFA/PANA andAFPAN include population based activities, with theAmerican network particularly citing the translation oftheory into practice as its main challenge and theAfrican network describing itself as the “functioning
African arm” of GAPA, the advocacy council of
ISPAH. APPAN has focused on joint scientificprojects and on communication on innovative
programmes and policies in the geographically vastand diverse Asia and Pacific region. One example wasa research project that reviewed best practices forphysical activity promotion; a more recent one
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assessed physical activity surveillance across theregion. The steering committee of HEPA Europe hasdeveloped an impact model for its activities which has
been confirmed by the network members. HEPA
Europe does not become directly active at the
population level, but it supports stakeholder in theirefforts to increase participation and improve theconditions for healthy lifestyles, particularly withrespect to physical activity. Theses stakeholders andpartners include the WHO, the European Commission
as the administrative arm of the European Union, butalso ministries, NGOs and professionals from health,sports, transport and other sectors.

Joint action for the promotion of healthenhancing physical activity
There is close collaboration between the physicalactivity networks, but also with ISPAH and its
different councils, particularly Global Advocacy for
Physical Activity GAPA (www.globalpa.org.uk).
GAPA has produced excellent advocacy material
which is used by the networks, including the “Toronto
Charter for Physical Activity” 18-20) and its supporting
document on the “7 Best Investments for Physical
Activity21,22) which have been translated into several
languages. The “GAPA postcard” (Figure 2) is theultimate advocacy tool for dealing with policy makers:
on its front page it sums up the seven key messages on
physical activity and health. On its back page it calls
for action and refers to the two documents mentioned
above and the Lancet Special Series on Global
Physical Inactivity published in 2012 by a group ofinternational researchers around ISPAH and thephysical activity promotion networks (www.lancet.
com/series/physical-activity).
However, collaboration goes beyond the use of
advocacy material. For example joint meetings andevents are being organised, ISPAH is the scientificpartner of the Conferences of HEPA Europe, and there
are joint projects with GAPA such as the developmentof the Health-Enhancing Physical Activity Policy Assessment Tool (HEPA PAT, www.who.int/hepapat)23).
Joint action is also necessary in global health policy.
The enthusiasm of physical activity experts after the2011 UN high level NCD meeting was great, but

Figure 2 The “GAPA postcard” with key messages forphysical activity advocacy on its front side, a call for
action and access to key resources on its backside(www.globalpa.org.uk/postcard).

dampened considerably already in December of thesame year when the first draft of WHO’s global NCD
monitoring framework had indicators on tobacco,
alcohol, diet, obesity and blood pressure – but none on
physical inactivity. In the following weeks GAPA andthe physical activity promotion networks became
active, and it was possible to gain the support ofimportant organisations such as the NCD Alliance(www.ncdalliance.org). It was a victory not only forphysical activity and health, but also for public healthin general, when the World Health Assembly in May
2013 adopted the “omnibus resolution” on NCDs 24).
This resolution included the global NCD action plan
2013-2020, the development of a global coordination
mechanism and the suggestion for a global monitoring
framework on NCDs, now with two indicators and areduction target for physical inactivity.
The role and the potential of physical activity for
population health is only beginning to be realised, and6

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it will further grow with ongoing changes in society
and technology. The international physical activity
networks unite the leading experts in the field.
Together with partner organisations from other sectors,
they can play an important role in physical activity
promotion. To achieve the necessary changes at the
population level it will be necessary to continue
collaboration between traditional partners, to forge
new alliances and to secure long term resources.

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