Physical Activity

Original Editor - Anna Lowe

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Definitions

Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity includes exercise as well as other activities which involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities.

Exercise, is a subcategory of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective

Physical inactivity (PI) is described as doing no or very little physical activity at work, at home, for transport or during discretionary time and not reaching physical activity guidelines deemed necessary to benefit public health (Bull et al 2004).

Sedentary behaviour refers to any waking activity characterised by an energy expenditure ≤ 1.5 metabolic equivalents and a sitting or reclining posture. In general this means that any time a person is sitting or lying down, they are engaging in sedentary behaviour. Common sedentary behaviours include TV viewing, video game playing, computer use (collective termed “screen time”), driving automobiles, and reading.

Physical activity as a public health priority

Physical inactivity has a major health effect worldwide.  It has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally. Of the deaths attributable to physical inactivity, 2.6 million are in low- and middle-income countries (LMICs). While physical inactivity is more prevalent in high- and middle-income countries, even in low-income countries it is among the top ten risk factors contributing to death.

Key facts on physical activity from The World Health Organisation (WHO, 2015)

• Insufficient physical activity is 1 of the 10 leading risk factors for death worldwide.
• Insufficient physical activity is a key risk factor for noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes.
• Physical activity has significant health benefits and contributes to prevent NCDs.
• Globally, 1 in 4 adults is not active enough.
• More than 80% of the world's adolescent population is insufficiently physically active.
• Policies to address insufficient physical activity are operational in 56% of WHO Member States.
• WHO Member States have agreed to reduce insufficient physical activity by 10% by 2025.

Benefits of Physical Activity

The benefits of physical activity are far reaching and cover both prevention and management of long term conditions.  The British Heart Foundation has published a document that summarises the research that supports the use of physical activity to:

• prevent ill health and reduce the number of people dying prematurely
• enhance mental health, quality of life and self-reported wellbeing
• delay the need for care in older adults (age 65+)
• reduce health inequalities and improve wider factors influencing health and wellbeing

Physical activity helps prevent many major non-communicable diseases (NCDs). Children and adolescents who are physically active have a better chance of being healthy adults. Along with other common risk factors like hypertension, tobacco use and unhealthy diet, physical inactivity is an important factor in the rise of NCDs, which now kill more people around the world than all other causes combined. Physical activity also improves concentration, self-esteem and school performance.

Global Strategy 

Recognising the unique opportunity that exists to formulate and implement an effective strategy for substantially reduce deaths and disease burden worldwide by improving diet and promoting physical activity, WHO has adopted, in May 2004, the "Global Strategy on Diet, Physical Activity and Health".

The Global Strategy has 4 main objectives:

1. Reduce risk factors for chronic diseases that stem from unhealthy diets and physical inactivity through public health actions.
2. Increase awareness and understanding of the influences of diet and physical activity on health an the positive impact of preventive interventions.
3. Develop, strengthen and implement global, regional, national policies and action plans to improve diets and increase physical activity that are sustainable, comprehensive and actively engage all sectors.
4. Monitor science and promote research on diet and physical activity.
   

Since this document was released in 2004 WHO have continued to work hard to develop strategies and realistic goals world wide to improve the health of the population. WHO have acknowledged that NCD account for a large percentage of premature deaths, therefore in 2012, all countries committed to achieving a 25% reduction in premature mortality from non-communicable diseases (NCDs) by 2025 (the 25x25 target).

• This document is form the NCD Alliance on the 25x25 countdown.

To achieve this target countries have estimated that if they tackle the six risk factors for developing a NCD, this will help the reduction of premature deaths as a result of NCDs. The six risk factors are:

1. Tobacco use
2. Alcohol use
3. Salt intake
4. Obesity
5. Raised blood pressure
6. Glucose levels

• This article which will give you more information on the six risk factor.

WHO release the Global Health Status Report in 2014 which included 9 Global targets to continue to try and tackle the NCD problem; within this document this included the 25x25 target. Here are the other targets:

1. A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases
2. At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context
3. A 10% relative reduction in prevalence of insufficient physical activity
4. A 30% relative reduction in mean population intake of salt/sodium
5. A 30% relative reduction in prevalence of current tobacco use
6. A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances
7. Halt the rise in diabetes and obesity
8. At least 50% of eligible people receive drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes
9. An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities

In 2018 the WHO launched a new WHO global action plan to promote physical activity (GAPPA). This plan responds to the requests by countries for updated guidance, and a framework of effective and feasible policy actions to increase physical activity at all levels. It also responds to requests for global leadership and stronger regional and national coordination, and the need for a whole-of-society response to achieve a paradigm shift in both supporting and valuing all people being regularly active, according to ability and across the life course. The action plan was developed through a worldwide consultation process involving governments and key stakeholders across multiple sectors including health, sports, transport, urban design, civil society, academia and the private sector.

• Read the GAPPA document here

Physical Activity Guidelines (PAGs)

WHO developed the "Global Recommendations on Physical Activity for Health" with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of NCDs.

WHO Europe also recommends that regular physical activity, throughout the life course, enables people to live better and longer lives. This infographic summarises the opportunities of a "life course approach" to making physical activity part of every day life: for nations, communities, individuals and especially patients with long term health conditions.

• 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)
  

Physiotherapy and Physical Activity

Physiotherapists have always had a close relationship with exercise, the profession was founded on the work of remedial gymnasts and the profession has a rich history of prescribing rehabilitative exercise. Despite this, literature on physiotherapy as promoters of physical activity, is scant.

The global physical inactivity crisis, and the epidemic of life-style related diseases (non-communicable diseases or NCDs) has created an urgent need to build on our rich history of prescribing exercise and develop our approaches for prescribing PA. Creating a more active population requires joined up thinking and action from many stakeholders; physiotherapists need to be active in engaging with individuals and communities.

Physiotherapists have a lot to offer: access to people living with long term conditions, repeat consultations, exercise facilities, credibility with patients, injury or illness often creates "teachable moments", expert knowledge, and behaviour change skills to name a few.

In the UK, all health care professionals are enabled to provide physical activity brief interventions within a framework for personalised care and population health, particularly in primary care. All UK health care organisations are also required to support health care professionals to make every contact count (MECC) for physical activity. These recommendations provide the remit for physiotherapists, (and all other health and social care professionals), to enable the WHO target of reducing physical inactivity by 10%, by 2025, a reality.

Resources

• Verhagen (2008) The physical therapist’s role in physical activity promotion
• Aweto (2013) Knowledge, attitude and practice of physiotherapists towards promotion of physically active lifestyles in patient management.
• Holm et al (2015) Does outpatient physical therapy with the aim of improving health-related physical fitness influence the level of physical activity in patients with long-term musculoskeletal conditions?
• Mulligan (2011) Promoting physical activity for people with neurological disability: perspectives and experiences of physiotherapists.
• Shirley et al (2010) Physical activity promotion in the physical therapy setting: perspectives from practitioners and students

Related Physiopedia Pages

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