Regular physical activity is a known protective factor for the prevention and management of noncommunicable diseases such as cardiovascular disease, type-2 diabetes, breast and colon cancer (1–3). Physical activity also has benefits for mental health (4), delays the onset of dementia (5), and can contribute to the maintenance of healthy weight (1) and general well-being (6).
Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure (1) and can be performed at a variety of intensities, as part of work, domestic chores, transportation or during leisure time, or when participating in exercise or sports activities. At the low end of the intensity range, sedentary behaviour is defined as any waking behaviour while in a sitting, reclining or lying posture with low energy expenditure (7). Emerging new evidence indicates that high levels of sedentary behaviour are associated with cardiovascular disease and type-2 diabetes as well as cardiovascular, cancer and all-cause mortality (8–10).
Physical inactivity is defined as not meeting the 2010 Global recommendations on physical activity for health (1) and is a leading contributor to global mortality. It is estimated that between four and five million deaths per year could be averted if the global population was more active (2, 11). Global estimates of physical inactivity indicate that in 2016, 27.5% of adults (12) and 81% of adolescents (13) did not meet the 2010 WHO recommendations (1), and trend data show limited global improvement during the past decade. The data also highlight that women are less active than men in most countries and that there are significant differences in levels of physical activity within and between countries and regions. These differences can be explained by inequities in access to opportunities to be physically active, further amplifying inequalities in health.
Currently, there are no global estimates of sedentary behaviour, but technological innovation and the transition towards more sedentary occupations and recreation, and the increasing use of personal motorized transportation are contributing to changing patterns of physical activity and increased sedentary behaviour across the world. The Global action plan on physical activity 2018–2030 (14) sets out 4 strategic objectives and 20 policy actions to achieve a 15% relative reduction in the global prevalence of physical inactivity in adults and adolescents by 2030.
In 2010, WHO published the Global recommendations on physical activity for health (1), the first population-based public health guidelines for children and adolescents, adults and older adults. In 2018, the World Health Assembly, in resolution WHA71.6, 1 called for WHO to update the 2010 recommendations.
In 2019, WHO published Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age (15). The guidelines were called for by the Commission on Ending Childhood Obesity (recommendation 4.12) (16), and address the omission of this younger age group in the 2010 Global recommendations on physical activity for health (1).
The 2020 WHO Guidelines on physical activity and sedentary behaviour, replace the 2010 guidelines and are based on the most recent advances in the evidence for the selected behaviours and associated health consequences. They will form part of the overall set of global recommendations on physical activity and sedentary behaviour.
OTHER KEY WHO GUIDELINES
The importance of physical activity for health is recognized in other WHO guidelines. The WHO Package of essential noncommunicable disease interventions for primary health care in low-resource settings (17) provides a protocol for the clinical management of hypertension, type-2 diabetes, raised cardiovascular risk, asthma, and chronic obstructive pulmonary disease, and includes counselling to progressively increase physical activity to moderate levels (such as brisk walking) and at least 150 minutes per week, in line with the 2010 global recommendations. Recent WHO guidance in Risk reduction of cognitive decline and dementia (18) states that physical activity should be recommended to adults with normal cognition (strong recommendation) and those with mild cognitive impairment (conditional recommendation) to reduce the risk of cognitive decline. WHO Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity (19) recommend multimodal exercises to prevent falls, and exercises for older adults with declining mobility. WHO recommendations on antenatal care for a positive pregnancy experience (20) recommend counselling on healthy eating and being physically active during pregnancy to stay healthy and to prevent excessive weight gain, but do not address the wider health benefits of physical activity during pregnancy and the postpartum period.
The existing WHO guidelines, combined with these updated guidelines, provide an increasingly comprehensive set of global guidance on the contribution of physical activity and sedentary behaviours to the prevention and management of key diseases and to the promotion of health and well-being across the life course.
RATIONALE AND PURPOSE
The past 10 years has seen a significant increase in the body of evidence on the health impact of different types, amounts and durations of physical activity, as well as on the impact of sedentary behaviours and its interrelationship with levels of physical activity and health. In addition, the evidence base for physical activity in subpopulations, such as pregnant women and those living with chronic conditions and/or disability now permits the examination of the relationship between physical activity and health outcomes in these groups.
In the Global action plan on physical activity 2018–2030 (14), action 4.1 calls for WHO to develop and disseminate global recommendations for physical activity and sedentary behaviours in children under 5 years of age, young people, adults, older adults and specific subpopulations, such as pregnant women, people living with chronic conditions and disability. Updating and broadening the scope of the guidelines, as requested by the World Health Assembly, ensures that population groups not included in the 2010 recommendations are provided with specific recommendations for physical activity. This aligns with the key principles and goals of the global action plan on physical activity, namely to reduce inequalities and to support all people to be more physically active every day.
The overarching purpose of these guidelines is to provide evidence-based public health recommendations on how much and what type of physical activity children and adolescents, adults, older adults and subpopulations such as pregnant women and those living with chronic conditions or disability, should do for significant health benefits and mitigation of health risks. The guidelines also provide evidence-based recommendations on the associations between sedentary behaviour and health outcomes.
The guidelines have been developed for children and adolescents (aged 5–17 years), adults (aged 18–64 years), older adults (aged 65 years and above), and include for the first time specific recommendations on physical activity for subpopulations such as pregnant women and those living with chronic conditions or disability. Recommendations are made for each specific age group and subpopulation, to provide those working with particular communities easy access to the relevant information. Providing separate recommendations for subpopulations, especially people living with chronic conditions or with disability, highlights the importance of including these subpopulations in policy and planning of physical activity and sedentary behaviour interventions.
These guidelines do not address sleep as a behaviour. Sleep is an important health-related issue and an emerging topic within population health science. However, it was deemed beyond the scope of the mandate to include sleep in the updated recommendations. Nonetheless, the importance of sleep is recognized and was included as an important health outcome when considering the impact of physical activity and sedentary behaviour.
TARGET AUDIENCE
This document reports the process and summarizes the evidence-base reviewed to develop the recommendations. The primary audiences are:
Policy-makers in ministries of health, education, youth, sport and/or social or family welfare, working in high as well as low- and middle-income countries, who formulate country-specific guidelines, and who plan health, education, workplace, residential or community-based intervention programmes across the life course.
Government officials who develop national, subregional or municipal plans to increase physical activity and reduce sedentary behaviours in population groups through guidance documents.
Persons working in nongovernmental organizations, education and workplace organizations or research.
Persons working in health services and those providing advice and guidance, such as community, family, primary or tertiary nurses or doctors, or allied health and exercise professionals working beyond the health sector. These guidelines can inform the content of their advice on these topics, if national guidance is not available.
The recommendations on physical activity and sedentary behaviour contained within the guidelines should be used to inform pre-service training and professional development courses for health-care workers, physical activity specialists and education professionals.
Derivative products are needed that convey these guidelines to specific end-users, stakeholders in sectors outside of health, and the wider community, that use tailored communications to meet the specific needs of each audience.
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WHA71.6 WHO Global Action Plan on Physical Activity 2018–2030.
