Physical Activity

Definitions[edit | edit source]

Physical Activity[edit | edit source]

Physical Activity (PA) is defined as any bodily movement produced by contraction of skeletal muscles that require energy expenditure[1]. It 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[edit | edit source]

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[2].

Physical Inactivity[edit | edit source]

Physical Inactivity (PI) is described as doing no or very little physical activity at work, at home, for transport or during the discretionary time and not reaching physical activity guidelines deemed necessary to benefit public health (Bull et al 2004)[3].

Sedentary behaviour[edit | edit source]

Sedentary behaviour refers to any walking 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 (collectively termed “screen time”), driving automobiles, and reading[4]. Sedentary behaviour is distinct from physical inactivity. It is considered an independent predictor of metabolic risk even in instances where individuals engage in recommended levels of physical activity.[5]

Physical Activity as a Public Health Priority[edit | edit source]

Regular physical activity is known to improve health, and reduce an individual's risk of chronic diseases and death.[6][7] Physical inactivity has a major health effect worldwide[8]. 31 percent of individuals aged over 15 years are considered to be physically inactive.[9] Four to five million deaths per year could be averted if the global population was more physically active[10][1]. 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, 2020)[edit | edit source]

  1. Physical activity is good for the heart, body and mind.
  • Regular physical activity can prevent and help manage heart disease, type-2 diabetes, and cancer which cause nearly three quarters of deaths worldwide. Physical activity can also reduce symptoms of depression and anxiety, and enhance thinking, learning, and overall well-being.

2. Any amount of physical activity is better than none, and more is better.

  • For health and wellbeing, WHO recommends at least 150 to 300 minutes of moderate aerobic activity per week (or the equivalent vigorous activity) for all adults, and an average of 60 minutes of moderate aerobic physical activity per day for children and adolescents.

3. All physical activity counts.

  • Physical activity can be done as part of work, sport and leisure or transport (walking, wheeling and cycling), as well as every day and household tasks.

4. Muscle strengthening benefits everyone.

  • Older adults (aged 65 years and older) should add physical activities which emphasize balance and coordination, as well as muscle strengthening, to help prevent falls and improve health.

5. Too much sedentary behaviour can be unhealthy.

  • It can increase the risk of heart disease, cancer, and type-2 diabetes. Limiting sedentary time and being physically active is good for health.

6. Everyone can benefit from increasing physical activity and reducing sedentary behaviour, including pregnant and postpartum women and people living with chronic conditions or disability[10]

Benefits of Physical Activity[edit | edit source]

The benefits of physical activity are far-reaching and cover both the prevention and the management of long-term conditions. The British Heart Foundation[11] 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[12].

Global Strategy [edit | edit source]

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 and 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 has continued to work hard to develop strategies and realistic goals worldwide to improve the health of the population. The WHO has 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).NCD Alliance - 25x25 countdown.

To achieve these target countries have estimated that if they tackle the six risk factors for developing an 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. Hypertension
  6. Glucose levels

Article from the Lancet on the six risk factor.

WHO released the Global Health Status Report in 2014[13] 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 the prevalence of insufficient physical activity
  4. A 30% relative reduction in mean population intake of salt/sodium
  5. A 30% relative reduction in the 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 counselling (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.

Physical Activity Guidelines (PAGs)[edit | edit source]

Physical activity inforgraphic WHO Europe.png

The WHO developed the "Global Recommendations on Physical Activity for Health"[14] 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 the total amount of physical activity needed for the prevention of NCDs.

The 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 everyday life: for nations, communities, individuals and especially patients with long term health conditions.

Physiotherapy and Physical Activity[edit | edit source]

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, the 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 create "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[edit | edit source]

Related Physiopedia Pages[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 World Health Organisation. Physical Activity. Available at: [accessed 20 May 2016]
  2. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public health reports. 1985 Mar;100(2):126.
  3. Kim J, Tanabe K, Yokoyama N, Zempo H, Kuno S. Objectively measured light-intensity lifestyle activity and sedentary time are independently associated with metabolic syndrome: a cross-sectional study of Japanese adults. International Journal of Behavioral Nutrition and Physical Activity. 2013 Dec;10(1):30.
  4. González K, Fuentes J, Márquez JL. Physical inactivity, sedentary behavior and chronic diseases. Korean journal of family medicine. 2017 May 1;38(3):111-5.
  5. Panahi S, Tremblay A. Sedentariness and Health: Is Sedentary Behavior More Than Just Physical Inactivity? Front Public Health. 2018;6:258.
  6. Lacombe J, Armstrong MEG, Wright FL, Foster C. The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: a systematic reviewBMC Public Health. 2019;19(1):900.
  7. Guthold 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. The Lancet. Global Health. 2018;6(10):e1077-e1086.
  8. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The lancet. 2012 Jul 27;380(9838):219-29.
  9. Hall G, Laddu DR, Phillips SA, Lavie CJ, Arena R. A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? [published online ahead of print, 2020 Apr 8]. Prog Cardiovasc Dis. 2020;S0033-0620(20)30077-3.
  10. 10.0 10.1 WHO guidelines on physical activity and sedentary behaviour: at a glance. Geneva: World Health Organization; 2020 Available from: (last accessed 3.12.2020)
  11. British Heart Foundation National Centre for Physical Activity and Health. Making the case for physical activity. Available at:] [accessed 20 May 2016]
  12. Ericsson I, Cederberg M. Physical activity and school performance: a survey among students not qualified for upper secondary school. Physical Education and Sport Pedagogy. 2015 Jan 2;20(1):45-66.
  13. World Health Organization, World Health Organization. Management of Substance Abuse Unit. Global status report on alcohol and health, 2014. World Health Organization; 2014.
  14. World Health Organization. Global recommendations on physical activity for health. World Health Organization; 2010.