Physical activity

Facts

• Appropriate regular physical activity is a major component in preventing the growing global burden of chronic disease.
• At least 60% of the global population fails to achieve the minimum recommendation of 30 minutes moderate intensity physical activity daily.
• The risk of getting a cardiovascular disease increases by 1.5 times in people who do not follow minimum physical activity recommendations.
• Inactivity greatly contributes to medical costs - by an estimated $75 billion in the USA in 2000 alone.
• Increasing physical activity is a societal, not just an individual problem, and demands a population-based, multi-sectoral, multi-disciplinary, and culturally relevant approach.

Appropriate regular daily physical activity is a major component in preventing chronic disease, along with a healthy diet and not smoking. For individuals, it is a powerful means of preventing chronic diseases; for nations, it can provide a cost-effective way of improving public health across the population. Available experience and scientific evidence show that regular physical activity provides people, both male and female, of all ages and conditions - including disabilities - with a wide range of physical, social and mental health benefits. Physical activity interacts positively with strategies to improve diet, discourage the use of tobacco, alcohol and drugs, helps reduce violence, enhances functional capacity and promotes social interaction and integration.

Extent of the problem

Physical inactivity is estimated to cause 2 million deaths worldwide annually. Globally, it is estimated to cause about 10-16% of cases each of breast cancer, colon cancers, and diabetes, and about 22% of ischaemic heart disease. Estimated attributable fractions are similar in men and women. Opportunities for people to be physically active exist in the four major domains of their day.

These are:

• At work (whether or not the work involves manual labour)
• For transport (walking or cycling to work, to shop etc)
• During domestic duties (housework, gathering fuel etc)
• In leisure time (sports and recreational activities)

The global estimate for the prevalence of physical inactivity among adults is 17%. Estimates for prevalence of some, but insufficient, activity (<2.5 hours per week of moderate activity) ranged from 31% to 51%, with a global average of 41% across the sub-regions. WHR 2002 used a number of direct and indirect data sources and a range of survey instruments and methodologies to estimate activity levels in these four domains. The most data was available for leisure time activity, with less direct data available on occupational activity, and little direct data available for activity related to transport and domestic tasks. In addition, the WHR 2002 data only estimates the prevalence of physical inactivity among people aged 15 years and over, which suggests the total figures could be higher. Physical activity declines with age, falling off from adolescence, and physical activity and physical education is declining in schools worldwide. Inactivity is generally higher amongst girls and women.

Why is regular physical activity necessary?

Physical inactivity, along with other key risk factors, is a significant contributor to the global burden of chronic disease. Regular physical activity reduces the risk of heart disease, stroke, breast, and colon cancers. These benefits are mediated through a number of mechanisms. In general, physical activity improves glucose metabolism, reduces body fat and lowers blood pressure; these are the main ways in which it is thought to reduce the risk of CVD and diabetes. It can also help manage and mitigate the effects of these diseases. Physical activity may also reduce the risk of colon cancer by its effects on prostaglandins, reduced intestinal transit time, and higher antioxidant levels.

Physical activity is associated with a lower risk of breast cancer, which may be the result of effects on hormonal metabolism. Participation in physical activity can also improve musculoskeletal health, control body weight, and reduce symptoms of depression. The possible beneficial effects on musculoskeletal conditions such as and lower back pain, osteoporosis and falls, as well as on obesity, depression, anxiety and stress, have been well reported in a number of studies. Beyond the direct medical benefits, increasing physical activity through an integrated programme, which takes into account transportation and urban planning policy, makes other broader contributions, increasing social inter-action throughout the life course, providing recreational enjoyment, and reducing violence, urban traffic congestion and pollution.

Physical activity also has economic benefits, especially in terms of reduced health care costs, increased productivity, and healthier physical and social environments. Data from developed countries indicate that the direct costs of inactivity are enormous. The costs associated with inactivity and obesity accounted for some 9.4% of the national USA health expenditure in 1995. Physically active individuals in the USA save an estimated $500 per year in health care costs according to 1998 data. Inactivity alone may have contributed as much as $75 billion to US medical costs in the year 2000. In Canada, physical inactivity accounts for about 6% of total health care costs.

What can we do about it?

While different amounts are needed for various outcomes, the optimal combination of type, frequency and intensity for different populations is not known. There is, however, clear consensus in recommending at least 30 minutes daily of moderate intensity activity. Increased benefits come from doing more, especially more vigorous activities, and these are highly recommended for youth to support healthy bones and muscles. Physical activity does not necessarily mean running a strenuous marathon or playing competitive sports. Rather, for many people, it is about walking the children to school, or taking a brisk stroll in the park. It means taking the stairs, instead of the elevator, or getting off the bus two stops early.

Currently 60% of the world's population is estimated to not get enough physical activity to achieve even this modest recommendation, with adults in developed countries most likely to be inactive. Patterns of physical activity acquired during childhood and adolescence are more likely to be maintained throughout the life span, providing the basis for active and healthy life. Unhealthy lifestyles - including sedentary behaviour, poor diet and substance abuse, adopted at a young age, are likely to persist. Physical activity is not merely about individual behaviour. Multi-sectoral policies and initiatives are needed to create environments that help people to be physically active.

These should be:

• Population-based collective actions, involving various stakeholders, including public and private sector groups and NGOs.
• These should involve multiple sectors - especially health, sport, education, transport and culture and recreation ministries, as well as urban planners and local governments/municipalities.
• They should be culturally relevant and partnership-based.
• They should promote physical activity in all life settings.
• They should make use of major sport, health and cultural events.

Action is underway

• The WHO's development of a Global Strategy on Diet, Physical Activity and Health reflects Member States' increasing recognition that physical activity must be considered alongside diet, in combating the growing chronic disease burden.
• WHO dedicated World No Tobacco Day 2002 to "Tobacco Free Sports: Play it Clean".
• WHO and other agencies are actively collaborating with sports bodies in programmes such as Sports for All, aimed at increasing access to sport across population groups.
• A special focus is being placed upon partnership-based action to promote physical activity and sport among both boys and girls, in and out of schools.

"Move for health"

Following the successful World Health Day 2002, Member States have agreed to celebrate "Move for Health" Day annually to promote physical activity as essential for health and well-being. Move for Health Day will be linked to a larger ongoing process to promote physical activity worldwide throughout the year in the context of an integrated approach to the prevention of chronic diseases, health promotion and socio-economic development. This aims to increase regular physical activity practices in the population amongst men and women of all ages and conditions, in all domains (leisure, transport, work) and settings (school, community, home and workplace).

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