Defining physical activity, physical inactivity and sedentary behaviour
Physical activity is defined as ‘any bodily movement produced by skeletal muscle that requires energy expenditure’ ( ). It comprises activities as diverse as work, playing in school, carrying out household chores, transport from place to place (walking or cycling), and engaging in recreational pursuits (gardening, dancing, yoga, swimming, running, team sports etc.) ( ). Exercise (also referred to as exercise training) is a subcategory of physical activity that is planned, structured, repetitive and purposive, with the goal to improve or maintain one or more components of physical fitness, performance and health. Another concept frequently discussed is that of Health-enhancing physical activity (HEPA) which is physical activity that, when added to baseline activity, produces health benefits ( ).
To understand physical activity and its health effects it is important to consider its type, duration, frequency, and intensity:
Type of physical activity includes:
- Aerobic physical activity (also called endurance or cardio activity): activity in which the body’s large muscles move in a rhythmic manner for a sustained period of time such as walking, running, swimming, rope skipping, or cycling. It improves cardiorespiratory fitness.
- Muscle-strengthening activity (strength training, resistance training, or muscular strength and endurance exercises): activity which involves contracting muscle against resistance. It increases skeletal muscle strength, power, endurance, and mass ( , ).
- Balance training includes ‘static and dynamic exercises that are designed to improve individuals' ability to withstand challenges from postural sway or destabilizing stimuli caused by self-motion, the environment, or other objects’ ( ). Examples of balance training are walking backward, standing on one leg, or using a wobble board ( ).
- Flexibility is a health-and performance-related component of physical fitness that describes the range of motion possible at a joint. Flexibility is specific to each joint and depends on a number of specific variables including, but not limited to, the tightness of specific ligaments and tendons. Flexibility exercises enhance the ability of a joint to move through its full range of motion. Static stretching, various poses of yoga, and some movements of tai chi are examples of flexibility training ( ).
The duration of physical activity refers to the length of time in which an activity is performed in one session. Generally, it is expressed in minutes for aerobic activity, seconds for flexibility exercises or in sets and repetitions for muscle-strengthening activity ( ).
Intensity of physical activity 'refers to the rate at which the activity is being performed or the magnitude of the effort required to perform an activity or exercise'. Intensity can be expressed either in absolute or relative terms:
- The absolute intensity of an activity is determined by the rate of work being performed and does not take into account the physiological capacity of the individual. For aerobic activity, absolute intensity typically is expressed as the rate of energy expenditure, for example oxygen consumption in millilitres per kilogram body weight per minute, kilocalories per minute, or metabolic equivalents (METs). One MET is the rate of energy expenditure while at rest and sitting. It is taken by convention to be an oxygen uptake of 3.5 millilitres per kilogram body weight per minute. For some activities, absolute intensity is simply expressed as the speed of the activity, or physiological response to the intensity (e.g. heart rate). For resistance activity or exercise, intensity frequently is expressed as the amount of weight lifted or moved.
- Relative intensity takes into account an individual's exercise capacity. For aerobic exercise, relative intensity is expressed as a percentage of an individual's maximum aerobic capacity (VO2 max) or VO2 reserve, or as a percentage of an individual's measured or estimated maximum heart rate. It can also be expressed as an index of how hard an individual feels they are exercising (e.g. on a 0-10 scale).
Physical inactivity is defined as not meeting the applicable physical activity recommendations6. Physical inactivity should not be confused with sedentary behaviour. Sedentary behaviour refers to any waking behaviour characterised by energy expenditure ≤ 1.5 METs, while in in a sitting, reclining or lying position ( , ). Sedentary behaviour usually encompasses screen time (such as watching TV, playing video games, e-reading, use of computer), driving a car, and reading.
Physical activity, physical inactivity and sedentary behaviour: effects on health
Recommended levels of physical activity and time spent on sedentary behaviours
The concept of Health Enhancing Physical Activity (HEPA) is widely used by various health related organisations to describe recommendations on type, duration, frequency, intensity, and total amount of physical activity for health promotion and disease prevention ( , ). Many countries in the EU have established national recommendations for physical activity ( , ). Tables 2a, 2b and 2c summarise the recommendations issued regarding physical activity in different age groups. Table 2d describes recent guidance for pregnancy and postpartum period and Table 3 includes recommendations on sedentary behaviour.
Prevalence of physical (in)activity and sedentary lifestyle
Within the EU, just under one third of adults declared spending at least 150 minutes per week being physically active in 2014; physical activity decreases with age and increases with education level ( ). Additionally, 46% of the Europeans say that they never exercise or play sport, while 14% only do so seldom ( ). The prevalence of physical inactivity has major implications for the general health of the population and the prevalence of non-communicable diseases ( ).
Generally EU citizens engage more easily in day-to-day physical activity (such as walking, cycling, climbing stairs, gardening, or dancing) than in formal organised sports ( ). The levels of physical activity differ geographically ( ), being highest in Nordic countries ( ), and lowest in southern Europe ( ). However inter-country comparison remains a challenge, as harmonised data processing and standardised physical activity assessment methods across European countries are not yet applied. An overview of self-reported time devoted to physical activity and sedentary behaviour is provided in Tables 4a and 4b respectively.
Health and economic burden related to physical inactivity
Physical inactivity is among the leading risk factors for global mortality. The most recent Global Burden of Disease Study ( ) estimates that, in the EU, low physical activity (defined as less than 8,000 MET-minutes per week ( ) accounted for almost 152,000 deaths and more than 2.1 million Disability-Adjusted Life Years (DALYs) ( ) in 2017. It has also been calculated that physical inactivity cost the EU 80.4 billion euro per year, through four major non-communicable diseases (coronary heart disease, type II diabetes, colorectal and breast cancer), and through the indirect costs of inactivity-related mood and anxiety disorders ( ). This cost could be avoided if all Europeans were to achieve an average of 20 minutes per day of simple and inexpensive activities such as walking and running ( ).
Policy recommendations on physical activity
Taking into account the importance of physical activity for public health, as well as the low levels of engagement in physical activity, a number of policy options to promote physical activity in various sectors have been proposed by various health related organisations, as summarised in Table 5.
Implemented policies addressing physical activity and sedentary behaviour
National policies and action plans are essential for the promotion of physical activity. All EU Member States have reported at least one national sports-for-all policy or action plan for promoting physical activity. As the promotion of physical activity requires action in a number of sectors, such as health, sports, education, urban planning and transport, most policies are multi-sectorial, with good coverage of the sectors recognised as important for the promotion of physical activity. Table 6 provides examples of these actions.
In 2014 the Commission launched a framework to monitor the implementation of HEPA policies by the Member States based on the EU Physical Activity Guidelines and on the EU Council Recommendation on cross sectorial promotion of HEPA (2013/C 354/01) ( ).
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