Researchers at the MRC Epidemiology Unit are among scientists from across the world contributing to The Lancet 2021 series on physical activity.

Key findings revealed in the series include:

• Worldwide progress to improve physical activity has stalled; overall deaths associated with inactivity remain at more than 5 million people per year.
• No progress has been made to improve adolescent physical activity since 2012, with 80% still not meeting WHO activity guidelines.
• People living with disabilities (PLWD) are 16-62% less likely to meet physical activity guidelines and policymakers should do more to advance the rights of PLWD to participate in physical activity.
• Researchers found that Olympic Games remain a missed opportunity to increase physical activity in host countries; physical activity public health initiatives should be incorporated into Olympic and mass sporting event planning.
• Exercise during lockdowns was considered by many governments as an essential activity; but daily physical activity must be promoted as an essential human need beyond and independent of COVID-19.

The Lancet has launched this third Series on physical activity ahead of the delayed 2020 Tokyo Olympics and Paralympic. It extends the knowledge base from previous Series’ (2012 and 2016) on the importance of regular physical activity and sport to our health and wellbeing. In the past decade, not enough progress has been made to improve physical activity worldwide, with adolescents and people living with disabilities (PLWD) among the least likely populations to have the support needed to meet WHO’s physical activity guidelines.

Physical inactivity is linked to an increased risk of non-communicable diseases (NCDs) such as heart disease, diabetes, and some cancers. But the health benefits also include improvements in mental health, dementia and cognitive function, sleep, preventing falls, and fall-related injuries. Increasingly recognised are the co-benefits of physical activity promotion such as improved air quality and climate mitigation.

The COVID-19 pandemic has a reciprocal relationship with physical activity. Lockdowns and restrictions are likely to have decreased physical activity levels, whilst people who are physically active are less likely to experience severe symptoms and hospitalisations from COVID-19. The authors call for urgent efforts to improve physical activity levels in key populations, and recognise the potential to incorporate population health initiatives into future mass sporting events such as the Olympics.

• Read the full series at www.thelancet.com/series/physical-activity-2021

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Highlights from Unit researchers

More progress needed to improve physical activity among adolescents

Despite the growing number of young people diagnosed with non-communicable diseases (NCDs), including cardio-metabolic and mental health disorders, the authors note that research on adolescent physical activity is limited.

Global analysis shows that 80% of school-going adolescents are failing to meet the WHO recommended guidelines of 60 minutes of physical activity per day, with little progress made since 2012. In addition, 40% of adolescents never walk to school and 25% sit for more than 3 hours per day in addition to sitting at school and for homework.

The researchers also examined screen time in adolescents in 38 European countries and found that 60% of boys and 56% of girls spent two hours or more a day watching television. In addition, 51% of boys and 33% of girls spent two hours a day or more playing video games.

Lead author of the study, Dr Esther van Sluijs, from the MRC Epidemiology Unit at the University of Cambridge, UK says:

We desperately need to explore both the short- and long-term consequences physical inactivity has on adolescents, and identify effective ways of promoting increases in physical activity, especially in light of the COVID-19 pandemic. Virtual schooling and social distancing have drastically reduced physical activity and increased use of screens, and the consequences of these changes could last a lifetime.

Adolescents make up nearly one quarter of the world’s population, and by ensuring that they grow up in social and physical environments that are supportive of physical activity, we are helping to change their health right now, improve their future health, and positively influence the health of the next generation.”

• Full paper: Physical activity behaviours in adolescence: current evidence and opportunities for intervention. Esther M F van Sluijs, Ulf Ekelund, Inacio Crochemore-Silva, Regina Guthold, Amy Ha, Prof David Lubans, Adewale L Oyeyemi, Ding Ding. The Lancet, 2021  https://doi.org/10.1016/S0140-6736(21)01259-9

Scaling up urban infrastructure for physical activity in the COVID-19 pandemic and beyond

Since 2010, active transportation systems and active urban design have been recognised as among the best investments for encouraging physical activity at scale. Designing and planning activity-promoting cities can help prevent premature mortality, reduce the high costs associated with physical inactivity, and help countries achieve some of the UN Sustainable Development Goals. During the COVID-19 pandemic, there have been declines in physical activity worldwide, highlighting the need for widespread, accessible, and safe public open spaces for active recreatin and infrastructure for active transportation in cities.

Encouragingly, some cities responded to the unexpected situation arising from COVID-19 by implementing rapid, large-scale urban transformations to increase access to public open spaces and active transport infrastructure. Two examples are Sydney, Australia, and Mexico City, Mexico.

Creating active urban infrastructure is a foundation for encouraging physical activity. Transformational approaches that shift the focus away from individual responsibility and towards large-scale, systems-oriented strategies for physical activity promotion are crucial. These strategies are effective investments for physical activity promotion, and operate across multiple sectors and levels—eg, health care, education, urban planning and transport, environmental sustainability, communications, and public safety. Systems-oriented approaches must be prioritised for physical activity promotion and sustainable development.

• Full comment piece: Scaling up urban infrastructure for physical activity in the COVID-19 pandemic and beyond. Alejandra Jáuregui, Estelle Victoria Lambert, Jenna Panter, Clover Moore, Deborah Salvo. The Lancet 2021 https://doi.org/10.1016/S0140-6736(21)01599-3