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      Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group

      research-article
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      The International Journal of Behavioral Nutrition and Physical Activity
      BioMed Central
      Physical activity, Sedentary behavior, Research, Recommendations

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          Abstract

          Background

          In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities.

          Methods

          The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG.

          Results

          Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities.

          Conclusions

          Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.

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          World Health Organization 2020 guidelines on physical activity and sedentary behaviour

          Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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            Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants

            Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical activity across countries, and estimate global and regional trends.
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              Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants

              Summary Background Physical activity has many health benefits for young people. In 2018, WHO launched More Active People for a Healthier World, a new global action on physical activity, including new targets of a 15% relative reduction of global prevalence of insufficient physical activity by 2030 among adolescents and adults. We describe current prevalence and trends of insufficient physical activity among school-going adolescents aged 11–17 years by country, region, and globally. Methods We did a pooled analysis of cross-sectional survey data that were collected through random sampling with a sample size of at least 100 individuals, were representative of a national or defined subnational population, and reported prevalence of of insufficient physical activity by sex in adolescents. Prevalence had to be reported for at least three of the years of age within the 10–19-year age range. We estimated the prevalence of insufficient physical activity in school-going adolescents aged 11–17 years (combined and by sex) for individual countries, for four World Bank income groups, nine regions, and globally for the years 2001–16. To derive a standard definition of insufficient physical activity and to adjust for urban-only survey coverage, we used regression models. We estimated time trends using multilevel mixed-effects modelling. Findings We used data from 298 school-based surveys from 146 countries, territories, and areas including 1·6 million students aged 11–17 years. Globally, in 2016, 81·0% (95% uncertainty interval 77·8–87·7) of students aged 11–17 years were insufficiently physically active (77·6% [76·1–80·4] of boys and 84·7% [83·0–88·2] of girls). Although prevalence of insufficient physical activity significantly decreased between 2001 and 2016 for boys (from 80·1% [78·3–81·6] in 2001), there was no significant change for girls (from 85·1% [83·1–88·0] in 2001). There was no clear pattern according to country income group: insufficient activity prevalence in 2016 was 84·9% (82·6–88·2) in low-income countries, 79·3% (77·2–87·5) in lower–middle-income countries, 83·9% (79·5–89·2) in upper–middle-income countries, and 79·4% (74·0–86·2) in high-income countries. The region with the highest prevalence of insufficient activity in 2016 was high-income Asia Pacific for both boys (89·0%, 62·8–92·2) and girls (95·6%, 73·7–97·9). The regions with the lowest prevalence were high-income western countries for boys (72·1%, 71·1–73·6), and south Asia for girls (77·5%, 72·8–89·3). In 2016, 27 countries had a prevalence of insufficient activity of 90% or more for girls, whereas this was the case for two countries for boys. Interpretation The majority of adolescents do not meet current physical activity guidelines. Urgent scaling up of implementation of known effective policies and programmes is needed to increase activity in adolescents. Investment and leadership at all levels to intervene on the multiple causes and inequities that might perpetuate the low participation in physical activity and sex differences, as well as engagement of youth themselves, will be vital to strengthen the opportunities for physical activity in all communities. Such action will improve the health of this and future young generations and support achieving the 2030 Sustainable Development Goals. Funding WHO.
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                Author and article information

                Contributors
                ldp1@gwu.edu
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                26 November 2020
                26 November 2020
                2020
                : 17
                : 143
                Affiliations
                [1 ]GRID grid.253615.6, ISNI 0000 0004 1936 9510, Department of Exercise and Nutrition Sciences, , Milken Institute School of Public Health, The George Washington University, ; Washington, DC, USA
                [2 ]Health Promotion Center, Riyadh, Kingdom of Saudi Arabia
                [3 ]GRID grid.1048.d, ISNI 0000 0004 0473 0844, Centre for Health Research, , University of Southern Queensland, ; Springfield, Australia
                [4 ]Age Institute, Helsinki, Finland
                [5 ]GRID grid.14758.3f, ISNI 0000 0001 1013 0499, Public Health Evaluation and Projection Unit, , Finnish Institute for Health and Welfare, ; Helsinki, Finland
                [6 ]GRID grid.3575.4, ISNI 0000000121633745, Physical Activity Unit, Department of Health Promotion, , World Health Organization, ; Geneva, Switzerland
                [7 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, School of Human Sciences, , The University of Western Australia, ; Perth, Australia
                [8 ]GRID grid.215654.1, ISNI 0000 0001 2151 2636, College of Health Solutions, , Arizona State University, ; Phoenix, USA
                [9 ]GRID grid.5342.0, ISNI 0000 0001 2069 7798, Department of Movement and Sports Sciences, , University of Ghent, ; Ghent, Belgium
                [10 ]GRID grid.418996.b, ISNI 0000 0004 0488 275X, UNESCO Chair, , Institute of Technology Tralee, ; Tralee, Ireland
                [11 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, Department of Pediatrics, University of Ottawa, , Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Group, ; Ontario, Canada
                [12 ]GRID grid.5214.2, ISNI 0000 0001 0669 8188, School of Health and Life Sciences, , Institute for Applied Health Research, Glasgow Caledonian University, ; Glasgow, UK
                [13 ]GRID grid.5288.7, ISNI 0000 0000 9758 5690, Departments of Medicine, and Medical Informatics & Clinical Epidemiology, , Oregon Health & Science University, ; Portland, Oregon USA
                [14 ]GRID grid.5335.0, ISNI 0000000121885934, MRC Epidemiology Unit, , School of Clinical Medicine, University of Cambridge, ; Cambridge, UK
                [15 ]GRID grid.1051.5, ISNI 0000 0000 9760 5620, Baker Heart and Diabetes Institute, ; Melbourne, VIC 3004 Australia
                [16 ]Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
                [17 ]GRID grid.412285.8, ISNI 0000 0000 8567 2092, Department of Chronic Disease and Ageing, Norwegian Institute of Public Health, , Department of Sport Medicine, Norwegian School of Sport Science, ; Oslo, Norway
                [18 ]GRID grid.5379.8, ISNI 0000000121662407, Division of Psychology and Mental Health, , University of Manchester, ; Manchester, UK
                [19 ]GRID grid.1029.a, ISNI 0000 0000 9939 5719, NICM Health Research Institute, , Western Sydney University, ; Sydney, Australia
                [20 ]GRID grid.413574.0, ISNI 0000 0001 0693 8815, Department of Cancer Epidemiology and Prevention Research, , Cancer Control Alberta, Alberta Health Services, ; Calgary, Canada
                [21 ]GRID grid.4777.3, ISNI 0000 0004 0374 7521, Centre for Public Health, , Queen’s University Belfast, ; Belfast, UK
                [22 ]GRID grid.415727.2, Department of Non-Communicable Diseases, , Ministry of Health, ; Nairobi, Kenya
                [23 ]GRID grid.5337.2, ISNI 0000 0004 1936 7603, Centre for Exercise Nutrition and Health Sciences, , School for Policy Studies, University of Bristol, ; Bristol, UK
                [24 ]GRID grid.250514.7, ISNI 0000 0001 2159 6024, Population and Public Health Sciences, , Pennington Biomedical Research Center, ; Baton Rouge, LA USA
                [25 ]GRID grid.7836.a, ISNI 0000 0004 1937 1151, Research Centre for Health through Physical Acivity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, , Faculty of Health Sciences, University of Cape Town, ; Cape Town, South Africa
                [26 ]GRID grid.7727.5, ISNI 0000 0001 2190 5763, Department of Epidemiology and Preventive Medicine, , University of Regensburg, ; Regensburg, Germany
                [27 ]GRID grid.8273.e, ISNI 0000 0001 1092 7967, Norwich Medical School, Faculty of Medicine and Health Sciences, , University of East Anglia, ; Norwich, UK
                [28 ]GRID grid.8065.b, ISNI 0000000121828067, PROFITH (PROmoting FITness and Health through physical activity) research group, Department of Physical Education and Sports, Faculty of Sport Sciences, , Research Institute of Sport and Health, University of Granada, Spain 26. Sports and Exercise Medicine Unit, Faculty of Medicine, University of Colombo, ; Colombo, Sri Lanka
                [29 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Charles Perkins Centre, University of Sydney, , School of Health Sciences, Faculty of Medicine and Health, University of Sydney, ; Sydney, Australia
                [30 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Institute for Musculoskeletal Health, , The University of Sydney, and Sydney Local Health District, ; Sydney, Australia
                [31 ]GRID grid.48336.3a, ISNI 0000 0004 1936 8075, Epidemiology and Genomics Research Program, , National Cancer Institute, ; Bethesda, USA
                [32 ]Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
                [33 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Sydney School of Public Health, , The University of Sydney, ; Sydney, Australia
                Author information
                http://orcid.org/0000-0002-3064-3977
                Article
                1042
                10.1186/s12966-020-01042-2
                7690200
                33239105
                2f94bb9e-0726-4218-820c-ed51e20e73b7
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 9 July 2020
                : 20 October 2020
                Funding
                Funded by: Public Health Agency of Canada
                Funded by: Government of Norway
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                © The Author(s) 2020

                Nutrition & Dietetics
                physical activity,sedentary behavior,research,recommendations
                Nutrition & Dietetics
                physical activity, sedentary behavior, research, recommendations

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