Physical Activity

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Introduction

Physical activity is a key preventive measure against non-communicable diseases (NCDs), yet approximately 31% of adults do not meet recommended levels of physical activity. Promoting physical activity is, therefore, an increasingly important part of practice at both the individual and population levels. This article defines core concepts such as physical activity, exercise, and sport, examines the health benefits of maintaining an active lifestyle, and discusses global physical activity strategies.

Physical Activity Terminology

While everyday conversation often treats physical activity, exercise, and sport as synonyms, physiotherapists must communicate precisely when discussing these concepts with clients.

Physical activity (PA) is defined by the World Health Organization (WHO) as "any bodily movement produced by skeletal muscles that requires energy expenditure." This broad category includes exercise and other bodily movements performed during work, play, domestic chores, recreational pursuits, and active travel.

Exercise is a planned, structured, and repetitive subcategory of physical activity. It is purposefully designed to improve or maintain specific components of physical fitness. This usually means improving muscular strength and endurance, cardiovascular health, flexibility, and body composition (the balance between fat and muscle mass).

Sport is a subset of physical activity defined by competitive rules and an organised structure. It also has a social dimension that can foster cooperation, community, and a shared sense of identity.

Physical activity exists on a spectrum, from little or no activity at one end to regularly meeting or exceeding recommended levels at the other. Many people fall in between: active to some degree, but not enough to meet the guidelines.

Types of Physical Activity

Physiotherapists prescribe physical activity across four main categories: aerobic activity, muscle-strengthening activity, flexibility and mobility activities, and balance and coordination activities.

Aerobic Activity

Often referred to as endurance or cardiovascular activity, aerobic activity involves continuous, rhythmic movements that increase ventilation and heart rate. Examples include swimming, dancing, cycling, jogging, and walking. These exercises are primarily designed to improve metabolic function, manage weight, and support cardiovascular health.

Muscle-strengthening Activities

Muscle-strengthening activities are any movement performed against resistance. Examples include bodyweight exercises, weightlifting, resistance band training, and heavy manual labour like digging or carrying loads. These movements improve bone density, muscle mass, metabolic rate, and overall functional capacity.

Flexibility and Mobility Activities

Flexibility and mobility activities focus on improving joint range of motion and enhancing tissue extensibility. These activities incorporate practices such as structured stretching routines, yoga, and Pilates to help reduce muscular stiffness and support better overall movement quality.

Balance and Coordination Activities

Balance and coordination activities include static and dynamic tasks, such as Tai Chi or walking on uneven surfaces. For older people and those living with neurological conditions, these exercises are an important fall-prevention strategy.

Physical Inactivity

Physical inactivity (PI) is described as doing too little physical activity to meet the levels recommended for health.

Sedentary Behaviour

Sedentary behaviour is distinct from physical inactivity. It refers to any waking behaviour with an energy expenditure of less than or equal to 1.5 metabolic equivalents. Time spent sitting or lying down while awake counts as sedentary behaviour. Common sedentary behaviours include watching TV, playing video games, using a computer, driving, and reading.

Sedentary behaviour is an independent risk factor for heart disease, some cancers, and type 2 diabetes, even for people who meet recommended levels of physical activity. Everyone can benefit from reducing sedentary behaviour, including people living with chronic conditions or disability.

Benefits of Physical Activity

Physical activity offers health benefits at all stages of life. In children and adolescents, regular physical activity improves physical fitness and bone health. It also helps to promote healthy body composition, supports mental health and cognitive performance, and can improve concentration, self-esteem, and school performance. For adults and older people, an active lifestyle can lower the risk of all-cause mortality, cardiovascular disease, hypertension, certain cancers, and type 2 diabetes. It also helps prevent falls in older people and enhances psychological well-being and cognitive function.

Specific Findings

People with the highest levels of aerobic activity have approximately 10–20% lower risk across several cancer types, including breast, colorectal, and bladder cancers. Post-diagnosis physical activity is associated with a 37% lower cancer-specific mortality in several cancers, compared with the least active patients.

Meeting physical activity guidelines is associated with a lower risk of depression. A 2024 meta-analysis of 218 randomised controlled trials found that several forms of exercise, such as walking, jogging, yoga, strength training, and Tai Chi, were associated with meaningful reductions in depressive symptoms.

A meta-analysis of over 1.8 million adults found that physically active individuals had an 11% lower risk of COVID-19 infection, a 36% lower risk of hospitalisation, and a 43% lower risk of COVID-19 mortality compared to those who were inactive.

WHO's Physical Activity Guidelines

For health and wellbeing, the WHO recommends at least 150 to 300 minutes of moderate-intensity aerobic activity per week (or 75 to 150 minutes of vigorous-intensity activity, or an equivalent combination) for all adults. All adults should do muscle-strengthening activity on at least two days a week. Older adults (aged 65 years and older) should also do multicomponent activity that emphasises functional balance and strength on at least three days a week, to enhance functional capacity and help prevent falls. For children and adolescents (aged 5–17), the WHO recommends an average of 60 minutes per day of moderate-to-vigorous aerobic activity. Physical activity can be incorporated into work, sport and leisure or transport (walking, wheeling and cycling), as well as everyday and household tasks.

Physical Activity Barriers and Enablers

Physical activity prescription requires a clinical assessment of barriers and enablers.

Barriers to Physical Activity

Barriers to physical activity are multifactorial and should be acknowledged.

Psychosocial barriers concern a person's beliefs, feelings, and past experiences around movement. To explore these, you might ask:

• Does the client have low self-efficacy or negative body image?
• Is there a history of adverse experiences with physical activity (e.g. humiliation, injury, or exclusion)?
• Are there signs of anxiety or depression related to movement or social judgement?

Cultural barriers concern the values, norms, and social risks that shape how a person relates to physical activity. To explore these, you might ask:

• Are there concerns regarding exercising in public spaces?
• Does the client feel that prioritising personal health conflicts with family or professional values?
• How do dietary norms, or views on body size and physical effort, influence the client's activity?

Practical barriers include the structural and logistical constraints on being active. To explore these, you might ask:

• Are there constraints related to cost, time, childcare, or working hours?
• Is transportation or access to safe, usable spaces limited?

Physical barriers concern the bodily and health-related factors that limit activity. To explore these, you might ask:

• Do comorbidities, pain, or fatigue affect the client's activity levels?
• Has the client become significantly deconditioned?

If you would like to learn more about external and internal barriers to physical activity, see: Barriers to Physical Activity

Self-Determination Theory

Enablers to Physical Activity

Physiotherapists can support clients by building on what helps them to stay active and leveraging behaviour-change strategies.

Environmental modification: Assess walkability and safety. Where city-wide changes aren't possible, identify small, targeted environmental improvements.

Active design: Encourage environmental "nudges" such as taking the stairs, standing desks, or walking during calls to accumulate incidental activity.

Motivation: Use Self-Determination Theory to prioritise intrinsic motivation (meaningful, enjoyable movement) over extrinsic pressure (see image).

Social support: Involve partners or groups to increase accountability and enjoyment.

Goal setting: Establish incremental, functional goals tied to the client’s personal values, such as returning to work or playing with grandchildren.

Global Physical Activity Strategy

Physiotherapy is increasingly expected to think beyond the individual to population health. Understanding population-level patterns is part of that shift.

Globally, physical inactivity is a major risk factor for NCDs, alongside tobacco use, poor nutrition, and hypertension. Because NCDs are now the leading cause of death worldwide, this contribution is substantial: physical inactivity is estimated to account for 7.2% of all-cause deaths.

According to Salvo et al., there are three domains of physical activity: choice-driven active leisure, necessity-driven active transport, and active labour. This distinction is important. In low- and lower middle-income countries, less than 10% of physical activity comes from active leisure, while in high-income countries it accounts for over 30%. Many people are physically "busy" but not physically secure; they are moving out of necessity rather than genuine choice, often in unsafe conditions.

A 40-percentage-point gap exists in active leisure between the most privileged groups, such as wealthy men in high-income countries, and the most disadvantaged, which include poor women in low-income countries. Gender alone accounts for roughly a 15-percentage-point gap in active leisure, consistent across income levels. Those disparities widen when multiple disadvantages intersect.

These findings inform how physiotherapists understand and approach physical activity:

• Physical activity is shaped by structural and social factors, not just individual behaviour, so promotion is more realistic when it takes a person's circumstance into account. More broadly, physical activity promotion needs to address structural inequalities.
• A person's access to safe spaces, transport, and time can matter as much as the activity itself. These must be considered in activity prescription. More broadly, safe, active transport and accessible green spaces are as much a public health intervention as clinical exercise prescription.
• Messaging about the benefit of physical activity should be culturally sensitive and tailored to the person rather than a one-size-fits-all approach. More broadly, there is a need to avoid universal approaches that reflect predominantly high-income country research.

Physiotherapy and Physical Activity

Addressing global physical inactivity and the rise of lifestyle-related NCDs calls for physiotherapy to adapt how it prescribes physical activity, and for collaboration at both community and individual levels. Physiotherapists are well placed to contribute: research shows they generally consider health promotion part of their role, and their regular contact with people living with long-term conditions (through repeat consultations and access to exercise facilities) can make injury or illness a "teachable moment" for promoting physical activity. This role can extend beyond the clinic, with physiotherapists connecting patients with community-based physical activity programmes or supporting community initiatives.

Resources

• World Health Organization: Global Status report on physical activity 2022
• Knowledge, attitude and practice of physiotherapists towards promotion of physically active lifestyles in patient management.

Related Physiopedia Pages

• Physical Activity in Long-term MSK Conditions
• Brief Interventions for PA
• Barriers to Physical Activity

Example Physical Activity Guidelines

• The UK Physical Activity Guidelines.
• Canadian Physical Activity Guidelines (Early Years 0-4)
• Canadian Physical Activity Guidelines (Children and Youth 5-17 yrs)
• Summary of Canadian Physical Activity Guidelines (adults 18-64 yrs).
• Summary of Canadian Physical Activity Guidelines (older adults > 65 yrs)