Physical activity includes all forms of activity, such as walking or cycling for everyday journeys, active play, work-related activity, active recreation such as working out in a gym, dancing, gardening or competitive sport (1).
Regular physical activity can reduce the risk of many chronic conditions including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions (1).
There is an approximately 30% reduction in risk for all-cause mortality, across all studies, when comparing the most active with the least active (1)
Recommended levels of physical activity
According to the four home countries' Chief Medical Officers everybody should aim to be active daily. For adults, the recommended amount is 150 minutes (2.5 hours) of moderate activity per week, in bouts of 10 minutes or more. The overall amount of activity is more important than the type, intensity or frequency, and one way to achieve this is to do 30 minutes on at least 5 days a week (1).
It is recommended that children over five should engage in at least 60 minutes (1 hour) of moderate to vigorous intensity physical activity every day. Children under five who are capable of walking unaided should be physically active for at least 180 minutes (3 hours), spread throughout the day (1).
The four CMOs say the physical activity target will only be achieved by helping people to build activity into their daily lives. They say, “for most people, the easiest and most acceptable forms of physical activity are those that can be incorporated into everyday life. Examples include walking or cycling instead of travelling by car, bus or train” (1).
NHS Health Scotland says “the creation and provision of environments that encourage and support physical activity offers the greatest potential to get the nation active” (2).
Current levels of physical activity
Physical activity levels are low in the UK. In England, 66% of men and 56% of women claim to meet the CMOs’ recommendations (3), and 62% of Scots claim to do so, (4). However, self-reporting of health behaviours is always suspect and the reality may be much lower (5): the corresponding figures for the recommendations presented in their pre-2011 form was 40% of men and 28% of women in England, 43% and 32% in Scotland, 36% and 23% in Wales (1).
The impact of monitoring methodology on these data is huge: in the CMOs’ report the recommendations are met by 24% of English girls and 32% of boys (2-15yo), in Northern Ireland (8-12yo) 10% and 19%, Wales (4-15yo) 45% and 63% and Scotland ( 2-15yo) 67% and 76% (1).
Physical activity levels decline rapidly with increasing age. In Wales the over-65s attain less than half the physical activity of 16 to 34 year olds (6).
Scale of the physical inactivity problem
Physical inactivity is one of the leading causes of death in developed countries, responsible for an estimated 22-23% of CHD, 16-17% of colon cancer, 15% of diabetes, 12-13% of strokes and 11% of breast cancer(8).
In Scotland, it is estimated that low activity contributes to around 2,500 deaths per year and costs the NHS £94 million annually. (4).
In 2010 the CMO for England called for a doubling of walking and an eight-fold increase in cycling. A study by public health economists found that within 20 years this increase would lead to savings of roughly £17 billion (in 2010 prices) for the NHS in England and Wales (7).
The cost to the NHS of physical inactivity in England is conservatively estimated at £0.9 billion (10). Aggregating non-healthcare costs such as lost productivity gives an estimated total cost of £8.2 billion per annum attributable to physical inactivity, with an additional £2.5 billion for the contribution of inactivity to the obesity problem (12).
It is worth noting that the Health Survey for England 2012 initial findings report, based on data collected before, during and after the London Olympic Games, did not detect any physical activity ‘legacy effect’ from the games (3). Scotland is currently looking closely at the impact of sport promotion activities alongside the 2014 Commonwealth Games (4): it will be interesting to see if sport campaigns do in fact lead insufficiently active people to attain the recommended levels.
Physical activity & health inequalities
In the UK there are significant inequalities in levels of physical activity in relation to age, gender, ethnicity and disability, and corresponding inequalities in health.
Compared with the general population in England, Indian, Pakistani, Bangladeshi and Chinese men and women are less likely to meet physical activity recommendations. Only 26% of Bangladeshi men and 11% of Bangladeshi women meet the recommended levels (11).
In 2009-10, male Healthy Life Expectancy in Scotland ranged from 68.5 years in the least deprived quintile to 50.0 years in the most deprived. For females, the figures were 70.5 and 52.5 years respectively (13).
People in the most deprived population quintile in Wales are less than half as likely to take exercise as the least deprived. They are half as likely again to be obese. (14).
Prevention and risk reduction
Regular moderate physical activity, including walking and cycling, can help prevent and reduce the risk of:
- Cardiovascular disease (CVD)
- Mental Health Problems
- Musculoskeletal health – osteoporosis and osteoarthritis
CVD is the largest cause of death in the UK. In 2010, 80,000 people died of Coronary Heart Disease (CHD) and 49,000 from strokes (11).
The cost of CVD to the UK economy was £19 billion in 2009 (11).
[For active people] “there is a 20% to 35% lower risk of cardiovascular disease, coronary heart disease and stroke” (1).
CVD is estimated to cost the UK economy just under £26 billion a year (11).
Macmillan says “Lack of physical activity increases the risk of bowel cancer, womb cancer and post-menopausal breast cancer. It may also increase the risk of other cancers, such as lung cancer and prostate cancer. Being physically active doesn’t necessarily mean going to the gym - regular walking, cycling or swimming can be enough“ (15).
There is an approximately 30% lower risk of colon cancer and approximately 20% lower risk of breast cancer for adults participating in daily physical activity (1).
The government’s massive trans-disciplinary Foresight study into obesity made clear the complexity of the determinants of obesity and overweight. However, the Foresight report was quite explicit: “The top five policy responses assessed as having the greatest average impact on levels of obesity across the scenarios [include] increasing walkability/cyclability of the built environment” (20).
“It is likely that for many people, 45–60 minutes of moderate-intensity physical activity a day is necessary to prevent obesity”(9).
Rates of obesity are estimated to rise, by 2035, to 47% and 36% for adult men and women respectively. By 2050, 60% males and 50% females could be obese (20).
By 2050, the NHS cost of overweight and obesity could rise to £9.7 billion, with the wider cost to society being £49.9 billion (at today's prices) (20).
The UK is facing a huge increase in the number of people with diabetes. Since 1996 the number of people diagnosed with diabetes has increased from 1.4 million to 2.9 million (16).
By 2025 it is estimated that five million people will have diabetes. Most of these cases will be Type 2 diabetes, because of our ageing population and rapidly rising numbers of overweight and obese people (16).
This type of diabetes usually appears in people over the age of 40, though in South Asian people it often appears after the age of 25. However, recently, more children are being diagnosed with the condition, some as young as seven (16).
Diabetes is associated with serious complications including heart disease, stroke, blindness, kidney disease and amputations leading to disability and premature mortality. There is also a substantial financial cost to diabetes care as well as costs to the lives of people with diabetes (16).
The prevalence of diagnosed diabetes in English men rose from 2.9% in 1994 to 7.0% in 2011, in women from 1.9% to 4.9% (17). In addition, it is estimated that 850,000 people in the UK have the disease but as yet undiagnosed (16).
People who are at least moderately active have a 30% to 40% lower risk of type 2 diabetes (1)
The CMOs say that “Physical activity has an important role to play in promoting mental health and well-being by preventing mental health problems and improving the quality of life of those experiencing mental health problems and illnesses” (1).
“Regular physical activity reduces the risk of depression and has positive benefits for mental health including reduced anxiety, and enhanced mood and self-esteem”(9).
Physical activity may improve at least some aspects of cognitive function that are important for tasks of daily living, and is also associated with a reduced risk of developing problems of cognitive impairment in old age (18).
A physically active lifestyle offers benefit in a number of areas – improved bone and muscle strength, reduced risk of falls and fractures, protection against osteoarthritis and pain relief for those who do suffer the condition.
The total cost of hospital and social care for patients with a hip fracture amounts to more than £2.3billion per annum in the UK (19).
The risk of hip fracture is lower in active people, reduced by up to 68% at the highest level of physical activity. Increases in exercise can increase spine and hip bone marrow density, and can also minimise decline in spine and hip bone density (1).
Various levels of walking are linked to a risk reduction of incident osteoarthritis ranging from 22% to 83% (1).
Physical decline in older people can be reversed relatively quickly. Among over-75s, 15 years of rejuvenation of muscle strength (27 per cent increase in leg strength) can be regained in three months (18).
A broad range of physical activities can reduce pain, stiffness and disability, and increase general mobility, gait, function, aerobic fitness and muscle strength in older adults with osteoarthritis (18).
- 1. Department of Health (2011). Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers
- 2. NHS Health Scotland (2009) Five-year review of ‘Let’s Make Scotland More Active’ – A strategy for physical activity
- 3. Health and Social Care Information Centre (2013) Health Survey for England: Is the adult population in England active enough? Initial results
- 4. The Scottish Government (2013) Scottish Health Survey 2012
- 5. Prince et al (2008) A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review, International Journal of Behavioral Nutrition and Physical Activity
- 6. Welsh Government (2013) Welsh Health Survey 2012
- 7. Jarrett et al (2012) Effect of increasing active travel in urban England and Wales on costs to the National Health Service; The Lancet 379 (9382)
- 8. World Health Organisation (2002) The World Health Report 2002 – Reducing Risks, Promoting Healthy Life
- 9. Department of Health (2005) Choosing Activity: a physical activity action plan
- 10. BHF National Centre for Physical Activity and Health (2013) Economic Costs of Physical Inactivity
- 11. British Heart Foundation (2012) Coronary Heart Disease Statistics
- 12. Department of Health (2004) At least five a week. Evidence on the impact of physical activity and its relationship to health. A Report from the Chief Medical Officer
- 13. Scottish Public Health Observatory
- 14. National Public Health Service for Wales (2004) Deprivation and Health
- 15. http://www.macmillan.org.uk/Cancerinformation/Causesriskfactors/Healthandlifestyle.aspx
- 16. Diabetes UK (2012) Diabetes in the UK 2012
- 17. Health and Social Care Information Centre (2012) Health Survey for England 2011
- 18. British Heart Foundation (2006) Active for later life
- 19. National Osteoporosis Society
- 20. Government Office for Science (2007) Foresight: Tackling obesity – Future Choices