Why are we failing to promote physical activity globally?

Editorials 390 Physical inactivity is one of the most common and persistent contributors to poor health in the world. It is defined as the failure to achieve the minimum recommended physical activity, which is, for adults, 150 minutes of moderate aerobic exercise or 75 minutes of vigorous aerobic exercise per week, or an equivalent combination. 1 In 72 of the 159 countries for which data on physical inactivity were available in 2008 (i.e. 59%), 2 its population prevalence that year exceeded 30%, and in two of the regions of the World Health Organization (WHO) – the Americas and the Eastern Mediterranean – prevalence exceeded 40%. According to WHO estimates, physical inactivity is the world's fourth leading risk factor for death. 1 In 2002, physical inactivity was estimated to have led to 1.9 million deaths globally and to have accounted for 19 million disability-adjusted life years (DALYs). 3 Currently, physical inactivity is estimated to account for an annual average of around 3.2 million deaths and more than 69 million DALYs. 4 This represents an increase of 68.4% in the number of deaths and a 3.6-fold increase in the number of DALYs in just over one decade. Physical inactivity is a complex and multifactorial behaviour whose determinants vary across countries. These determinants encompass individual factors, such as age and sex, 7 as well as environmental, 8 geopolitical and economic factors. Health-related and psychosocial factors, such as the presence of a chronic disease or poor self-efficacy, affect people's ability to engage in regular physical activity. A high crime rate, dense traffic and the absence of parks or sidewalks, to give some examples, can discourage people from exercising outdoors. On the other hand, most countries with a low prevalence of physical inactivity (i.e. < 20%) 2 are African and Asian countries whose economies are largely dependent on physically demanding labour (e.g. agriculture and mining). Rates of physical inactivity throughout the world suggest that we are failing to promote regular physical activity effectively. The reason does not lie in a lack of social recognition of the importance of physical activity or in a failure to address the issue on the part of policy-makers and public health agencies. Indeed, how best to promote regular physical activity has been hotly discussed for decades, and public health authorities and WHO 2 have long waged a battle against physical inactivity through public health campaigns and various interventions that have …