The contribution of physical activity to good health and quality of life has been known for centuries. The ancient philosopher Plato noted: “Lack of activity destroys the good condition of every human being while movement and methodical physical exercise save it and preserve it”. The current World Health Organization (WHO) guidelines show that Plato’s notion has not lost its importance, by encouraging everyone, regardless age or ability, to engage in regular physical activity, ensuring proper physical development and maintenance of physical and mental health throughout the lifespan.1

However, only relatively recently a lack of physical activity has become a public health concern. This is largely due to the reduced requirement to be active in daily life. Vehicles, machines and technology now complete the tasks that once required physical effort.2,3 Research shows stark decline in overall physical activity levels in high income countries over the last 40 years, with medium income and even low income countries set to follow the trend.2 The WHO estimates that 35% of Europeans do not meet the recommended minimum level of activity for good health,2,4 and this is predicted to increase; not only in Europe, but in many countries worldwide.2 Our better understanding of the impact of inactivity to health,5 has led to the recognition that physical inactivity is now the fourth leading risk factor for global mortality, after high blood pressure, tobacco use, and high blood glucose, and before overweight and obesity.1 On top of that, the burden of disease caused by physical inactivity not only causes suffering for the victims, their families and friends, but also puts a huge strain on health care systems and leads to a loss of productivity due to sickness from work. In Europe, it has been estimated that physical inactivity costs between €150-300 per citizen per year.6 Physical activity is therefore considered a health promotion priority.7,8 In this light, this EUFIC review will define physical activity, address how it relates to health, present recommendations and current physical activity levels, and touch upon economic and other aspects of the global inactivity trend.

Physical activity is defined as any bodily movement, produced by skeletal muscles, that requires energy. This includes activities undertaken while working, playing, carrying out household chores, travelling and engaging in recreational pursuits. Examples of such activities are lifting, carrying, walking, cycling, climbing stairs, housework, shopping, dancing, and gardening1. The Compendium of Physical Activities is used to estimate the metabolic intensity of an activity compared to a resting state.9 These metabolic equivalents (METs) are used to classify activities as sedentary behaviour (e.g. desk work, watching television), light intensity (e.g. food shopping, slow walking) moderate intensity (e.g. lawn mowing, slow cycling) and vigorous intensity activity (e.g. fast cycling, jogging). See Annex 1 and 2 on definitions and the classification of physical activities with further details and examples. Moreover, the human body is built to move, and major systems, including the skeletal, muscular, metabolic, circulatory, digestive and endocrine systems, do not develop and function properly unless stimulated by frequent physical activity. As such, physical activity has both a preventive and therapeutic effect across several diseases and conditions and contributes to quality of life in many ways.1,10,11,12,13 See also section 5 on physical activity and health.

Since a landmark study in 195332 found that London Transport Authority bus drivers were more likely to develop heart disease than their more active bus conductor colleagues, the link between physical activity and disease has been explored extensively. There is now a large body of evidence on the importance of physical activity in disease prevention. 1,7,10,11,12,25 Inactivity contributes to premature death, the development of heart disease and stroke, obesity, type 2 diabetes, colon cancer, breast cancer, poor skeletal health and depression.1,10,11,12 A large-scale study5, estimated that, worldwide, physical inactivity causes 6% of the burden of disease from heart disease, 7% of type 2 diabetes and 10% of breast and colon cancers. Overall it was calculated that inactivity caused 5.3 million premature deaths worldwide. The authors stated that 121,000 deaths from heart disease, 14,000 deaths from breast cancer and 24,000 deaths from colon cancer could have been avoided in Europe in 2008 if everyone had been active enough to meet the current WHO recommendations.5 The effects of inactivity on the different health conditions have been observed independently from the impact on weight status, and are discussed separately within this section.