Surveillance of global physical activity: progress, evidence, and future directions
Authors: Ding Ding
Journal: The Lancet Global Health (2018)

Physical inactivity is a global pandemic, contributing to substantial disease1Lee IM Shiroma EJ Lobelo F Puska P Blair SN Katzmarzyk PT Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.Lancet. 2012; 380: 219-229Summary Full Text Full Text PDF PubMed Scopus (4995) Google Scholar and economic2Ding D Lawson KD Kolbe-Alexander TL et al.The economic burden of physical inactivity: a global analysis of major non-communicable diseases.Lancet. 2016; 388: 1311-1324Summary Full Text Full Text PDF PubMed Scopus (1094) Google Scholar burden worldwide. To tackle the rising challenges of non-communicable diseases attributable to physical inactivity, WHO has launched a global action plan to reduce physical inactivity by a relative 10% by 2025, and 15% by 2030.3WHOThe global action plan on physical activity 2018–2030.http://www.who.int/ncds/prevention/physical-activity/gappa/action-planDate: 2018Date accessed: July 26, 2018Google Scholar Surveillance of physical activity is essential for monitoring progress towards benchmarks, setting priorities, and informing policy. Validated and standardised questionnaires, such as the International Physical Activity Questionnaire and the Global Physical Activity Questionnaire, are instrumental in tracking the prevalence of physical activity worldwide, enabling comparisons of prevalence and trends across countries and regions. Through the WHO Stepwise Approach to Chronic Disease Risk Surveillance (STEPS) initiative, the number of countries with standardised surveillance of physical activity has increased from around 20 at the turn of the century, to 122 in 2008, and 146 in 2010.4Bauman A Bull F Chey T et al.The international prevalence study on physical activity: results from 20 countries.Int J Behav Nutr Phys Act. 2009; 6: 21Crossref PubMed Scopus (629) Google Scholar, 5Hallal PC Andersen LB Bull FC Guthold R Haskell W Ekelund U Global physical activity levels: surveillance progress, pitfalls, and prospects.Lancet. 2012; 380: 247-257Summary Full Text Full Text PDF PubMed Scopus (3497) Google Scholar, 6Sallis JF Bull F Guthold R et al.Progress in physical activity over the Olympic quadrennium.Lancet. 2016; 388: 1325-1336Summary Full Text Full Text PDF PubMed Scopus (559) Google Scholar However, limitations remain, such as data gaps in low-income and middle-income countries, and differential reporting bias. The study by Guthold and colleagues7Guthold R Stevens GA Riley LM Bull FC Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants.Lancet Glob Health. 2018; (published online Sept 4.)http://dx.doi.org/10.1016/S2214-109X(18)30357-7Summary Full Text Full Text PDF PubMed Scopus (1820) Google Scholar in The Lancet Global Health provides the most comprehensive global estimates of the prevalence and trends of physical activity to date. This study included 358 surveys from 168 countries totalling 1·9 million people, a substantial increase from the most recent study using data from 146 countries in 2010.6Sallis JF Bull F Guthold R et al.Progress in physical activity over the Olympic quadrennium.Lancet. 2016; 388: 1325-1336Summary Full Text Full Text PDF PubMed Scopus (559) Google Scholar A major methodological improvement from previous estimates is the statistical adjustment to survey data to improve the comparability of prevalence across countries and over time. These adjustments include converting prevalence to reflect the change in physical activity recommendations, standardising estimates from surveys using the International Physical Activity Questionnaire and the Global Physical Activity Questionnaire, and extrapolating data from restricted geographical areas and age groups to overall national estimates. This study also included 65 countries with at least two comparable surveys to derive trends, which was identified as a gap by previous research.6Sallis JF Bull F Guthold R et al.Progress in physical activity over the Olympic quadrennium.Lancet. 2016; 388: 1325-1336Summary Full Text Full Text PDF PubMed Scopus (559) Google Scholar Based on data from countries representing 96% of the world's population, this study found that 27·5% of adults are insufficiently active. The prevalence of physical activity has changed little over time, with a substantial gender gap (women are less active than men) in most countries. There is a strong gradient by national income with the prevalence of insufficient physical activity being more than twice as high in high-income countries as in low-income countries. Overall, physical activity levels vary significantly across countries and regions. Findings from this study have important implications for policy. First, the lack of change in global physical activity prevalence suggests that WHO member states are not on track to meet the global action plan targets. Governments need to better implement policy and mobilise resources to ensure that promotion of physical activity is a public health priority. Second, the gender gap in physical activity, particularly in central Asia, the Middle East and north Africa, and south Asia reveals a health equity issue, in which women face more environmental, social, and cultural barriers to participation in physical activity, particularly in their leisure time.8Mielke GI da Silva ICM Kolbe-Alexander TL Brown WJ Shifting the physical inactivity curve worldwide by closing the gender gap.Sports Med. 2018; 48: 481-489Crossref PubMed Scopus (69) Google Scholar The global physical activity target is unattainable without substantial improvement in women's physical activity levels. What is needed are progressive, large-scale, multilevel interventions, especially targeting women, that create safe and culturally acceptable opportunities for physical activity and empower women to participate in physical activity. Finally, although high-income countries have a higher prevalence of insufficient physical activity, low-income and middle-income countries still bear the larger share of the global disease burden of physical inactivity.2Ding D Lawson KD Kolbe-Alexander TL et al.The economic burden of physical inactivity: a global analysis of major non-communicable diseases.Lancet. 2016; 388: 1311-1324Summary Full Text Full Text PDF PubMed Scopus (1094) Google Scholar Furthermore, economic development and urbanisation lead to lifestyle and epidemiological transitions, characterised by increasing prevalence of physical inactivity and subsequent burdens of chronic diseases, as reported in China9Ng SW Norton EC Popkin BM Why have physical activity levels declined among Chinese adults? Findings from the 1991–2006 China Health and Nutrition Surveys.Soc Sci Med. 2009; 68: 1305-1314Crossref PubMed Scopus (288) Google Scholar and Brazil.10Hallal PC Cordeira K Knuth AG Mielke GI Victora CG Ten-year trends in total physical activity practice in Brazilian adults: 2002–2012.J Phys Act Health. 2014; 11: 1525-1530Crossref PubMed Scopus (20) Google Scholar Although declines in occupational and domestic physical activity are inevitable, it is essential to incentivise 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 programmes at scale that could yield economic, environmental, and social benefits while promoting physical activity. Progress in surveillance of physical activity over the past two decades has been fundamental to the development, implementation, and evaluation of programmes at the local, national, and global levels. The next steps in surveillance should incorporate standardised objective measures, such as those derived from accelerometers, involve emerging technologies and innovative data sources, such as smartphone apps,11Althoff T Sosič R Hicks JL King AC Delp SL Leskovec J Large-scale physical activity data reveal worldwide activity inequality.Nature. 2017; 547: 336Crossref PubMed Scopus (504) Google Scholar and adopt measures for other critical elements of health-enhancing physical activity, such as adhering to the muscle strengthening and balance components of physical activity guidelines.12Milton K Ramirez Varela A Strain T Cavill N Foster C Mutrie N A review of global surveillance on the muscle strengthening and balance elements of physical activity recommendations.JFSJ. 2018; 3: 114-124Google Scholar Comprehensive physical activity surveillance should also include indicators for macro-level determinants of physical activity, such as governmental support, national policy, and infrastructure for physical activity.13Breda J Jakovljevic J Rathmes G et al.Promoting health-enhancing physical activity in Europe: Current state of surveillance, policy development and implementation.Health Policy. 2018; 122: 519-527Crossref PubMed Scopus (68) Google Scholar Global monitoring systems, such as the Global Observatory for Physical Activity, represent additional progress towards comprehensive, consolidated, and policy-focused surveillance systems that inform and support actions for tackling the pandemic of physical inactivity. I am supported by a Future Leader Fellowship from Heart Foundation Australia and a Sydney Research Accelerator Fellowship from the University of Sydney. I declare no competing interests. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participantsIf 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. Full-Text PDF Open Access