WIXLIB

Six policy actions outline themultiple settings in whichan increase in programmesand opportunities canhelp people of all agesand abilities to engage inregular physical activity asindividuals, families andcommunities.Five policy actions outline theinvestments needed to strengthenthe systems necessary to implementeffective and coordinatedinternational, national andsubnational action to increasephysical activity and reducesedentary behaviour. These actionsaddress governance, leadership,multisectoral partnerships,workforce capabilities, advocacy,information systems andfinancing mechanismsacross all relevant sectors.10

ImplementationMonitoring and reportingProgress towards the 2030 global targets willNational implementation of a “systems-based”be monitored using the two existing indicators:approach will require each country to identifythe prevalence of insufficient physical activitya strategic combination of policy responses foramong persons aged 18 years and over, andimplementation over the short term (2–3 years),among adolescents (aged 11–17 years).medium term (3–6 years), and longer-term(7–12 years). Policy actions should be selectedAll countries are encouraged to strengthenaccording to country context and tailoredreporting of disaggregated data to reflect theto meet the needs of different subnationaldual priorities of this action plan: to decreasejurisdictions and subpopulations. Prioritizationoverall level of physical inactivity; and to reduceand feasibility will vary according to context;within-country disparities and levels of physicaltherefore it is recommended that each countryinactivity in the least active populations, asassess their own current situation to identifyidentified by each country.existing policy which can be strengthened, aswell as policy opportunities and gaps.A new global monitoring framework willCross-governmentandsupport countries and monitor progress onmultisectoralpolicy implementation.partnerships, as well meaningful communityengagement, will be needed to achieve acoordinated, whole-of-system response whichProgresscan deliver multiple benefits for health, theimpact will be presented to the World Healthenvironment and the economy.Assembly in 2021, 2026, and 2030.Implementation of this action plan shouldbe guided by the principle of proportionaluniversality with the greatest efforts directedtowards the least active populations.11reportsonimplementationand

Backgroundcommitted to investing in health in the resolution,“Transforming our world: the 2030 Agenda forSustainable Development”1 (hereafter referred toRegular physical activity is a well-establishedas “the 2030 Agenda”), and to ensuring universalprotective factor for the prevention andhealth coverage and reducing health inequitiestreatment of the leading noncommunicablefor people of all ages. Policy actions aimed atdiseasesdisease,increasing physical activity for all people, of allstroke, diabetes and breast and colon cancerages and abilities, are consistent with valuing(1). It also contributes to the prevention ofhealth as a universal right and an essentialother important NCD risk factors such asresource for everyday living, and not merelyhypertension, overweight and obesity, and isthe absence of disease or infirmity. Further, theassociated with improved mental health (2,multiple benefits from increasing population3), delay in the onset of dementia (4) andlevels of physical activity through, for example,improved quality of life and well-being (5).walking, cycling, active recreation, sports and(NCDs),namelyheartplay, are interconnected with, and contributeIn 2015, at the seventieth session of the Unitedto, achieving the shared goals, political prioritiesNations (UN) General Assembly, all countriesand ambition of the 2030 Agenda.See: United Nations Sustainable Development Knowledge Platform ansformingourworld, accessed April 2018).112

Mandatea whole-of-society paradigm shift in respectto both supporting and valuing all peoplebeing regularly active, according to abilityIn 2013, the World Health Assembly endorsedand across the life course.a global action plan on the prevention andcontrol of NCDs (6), and agreed a set of nineglobal voluntary targets, which include a 25%Development processreduction of premature mortality from NCDsand a 10% relative reduction in the prevalenceof insufficient physical activity by 2025 (7).TheglobalactionplanA recent review of global progress towardsthrough a worldwide consultation processthese targets concluded that progress hasand involved establishing a WHO internalbeen slow and uneven across high-, middle-,steeringand low-income countries (8). Although thedepartments across relevant clusters and2013 NCD global action plan provided Worldrepresentatives from WHO Regional Offices,Health Organization (WHO) Member Statesas well as with guidance from a multisectoralwith a set of broad policy recommendations toand a multidisciplinary global expert advisoryincrease physical activity (9), implementationgroup which met during July 2017. Followingand engagement with the necessary sectorspublication of Draft 1 of the action plan,outside of health has remained a significantsix regional consultations were conductedchallenge to progress in most countries.with Member States, as well as eight ars, information sessions with UnitedAt its 140th session in 2017, the WHO ExecutiveNations agencies and permanent missions,Board agreed to endorse a proposal for theawareness-raisingSecretariat to prepare an action plan on physicalprofessional society media and a seven-weekactivity to be submitted for considerationperiod of open online public consultation.throughsocialandby the Board at its 142nd session. It wasrequested to build upon existing NCD (6)The process engaged with 83 Member Statesand physical activity strategies (10, 11),(including representatives from ministriesguidelines (1), policy recommendations (12)of health, education, sports, transport andand other relevant commitments endorsedplanning) as well as international sportsby the World Health Assembly, and to linkassociations,with the Sustainable Development Goalsorganizations, institutes of public health, civil(SDGs) set for 2030. Accordingly, this Globalsociety and professional organizations acrossAction Plan on Physical Activity 2018–2030health, transport, urban planning and sports,(hereafter referred to as the “action plan” orthe research and academic community, and“global action plan”) provides a frameworkthe private sector. A total of 125 writtenfor action, and proposes a set of specificsubmissions were received from interestedpolicy actions to guide Member States tostakeholders. Input from all the increasedphysicalpreparation of Draft 2. Following discussion ofactivity. It also acknowledges the requests ofDraft 2 at the 142nd session of the ExecutiveMember States for stronger global, regionalBoard, comments and suggestions informedand national coordination, and the need forthe development of this final action sportmedicinedraftingand

Physical activity is defined as any bodilythe type and frequency of physical activity formovement produced by skeletal muscle thatoptimal health benefits for youth, adults andrequires energy expenditure (1). It can beolder adults (1).undertaken in many different ways: walking,cycling, sports and active forms of recreationSedentary(such as dance, yoga, tai chi). Physical activitywaking behaviour characterized by an energycan also be undertaken as part of work (lifting,expenditurecarrying or other active tasks), and as part ofsuch as sitting, reclining or lying down (13).paid or unpaid domestic tasks around the homeRecent evidence indicates that high levels(cleaning, carrying and care duties). Whileof continuous sedentary behaviour (such assome activities are done by choice and cansitting for long periods of time) are associatedprovide enjoyment, other work or domestic-withrelated physical activities may be necessary,cardiometabolic morbidity, as well as overallor even mandatory, and may not providemortality (14). Reducing sedentary behaviourthe same mental or social health benefitsthrough the promotion of incidental physicalcompared with, for example, active recreation.activityHowever, all forms of physical activity canstairs, short walks) can support individuals toprovide health benefits if undertaken regularlyincrease incrementally their levels of physicaland of sufficient duration and intensity. Inactivity towards achieving the recommended2010, WHO produced recommendations onlevels for optimal health.14behaviour1.5 equivalents,metabolismstanding,andclimbing

Although achieving the recommended levelsof physical activity for optimal health forthe general population carries low levels ofGlobally, 23% of adults and81% of adolescents (aged 11–17years) do not meet the WHOglobal recommendations onphysical activity for health.2risk, there are higher risks associated withparticipation in certain types of physicalactivity and for some subpopulation groups.Notable activities with higher risk of injuryinclude contact sports (such as rugby, icehockey) and walking and cycling, whereroad safety and or personal violence maypresent higher risks in some contexts. WHOrecommendations on physical activity provideguidance on risk reduction (1) and this actiondevelopment, owing to the influence of changingplan recommends policy actions to addresspatterns of transportation, use of technology,the wider socioenvironmental risks such asurbanization and cultural values (16).road safety for cycling.Differences in levels of physical activity arealso explained by significant inequities in theCurrent levelsof physical inactivityopportunities for physical activity by genderand social position, within as well as betweencountries (15). Girls, women, older adults, peopleof low socioeconomic position, people withThe most recent available global comparativedisabilities and chronic diseases, marginalizedestimates from 2010 indicate that worldwide,populations,23% of adults and 81% of adolescents (agedinhabitants of rural communities often have11–17 years) do not meet the WHO globalless access to safe, accessible, affordable andrecommendations on physical activity forappropriate spaces and places in which to behealth (6). Notably, the prevalence of inactivityphysically active. Addressing these disparities invariesparticipation is a policy priority and eopleandtheprinciple of this global action plan.countries, and can be as high as 80% in someadult subpopulations. Physical inactivity inadults is highest in the Eastern Mediterranean,Updated global comparable estimates onthe Americas, Europe and Western Pacificphysical inactivity in adolescents and adults areregions, and is lowest in the South-East Asiabeing prepared by WHO and will be availableRegion (15). These rates increase with economicin 2018.2The WHO global recommendation on physical activity for health for adults is 150 minutes of moderate-intensity activity (orequivalent) per week, measured as a composite of physical activity undertaken across multiple domains: for work (paid andunpaid, including domestic work); for travel (walking and cycling); and for recreation (including sports). For adolescents, therecommendation is 60 minutes of moderate- to vigorous-intensity activity daily.2These data are from 2010 (6). Updated estimates will be forthcoming in 2018 in the document "WHO country comparableestimates on physical inactivity, 2016".115

The cost of physicalinactivity to healthsystems and societyFailure to recognize and invest in physicalactivity as a priority within NCD prevention andtreatment represents a missed opportunity.Ongoing inaction will see the costs of physicalinactivity continue to rise, contributing toGlobally, physical inactivity is estimated to costfurther negative impact on health systems,INT 54 billion in direct health care, in 2013,theof which 57% is incurred by the public sectorcommunity well-being and quality of life for all.environment,economicdevelopment,and an additional INT 14 billion is attributableto lost productivity (17). Estimates from bothMultiple ways to beactive – multiple policyopportunities – multiplebenefitshigh-income, as well as low- and ��3% of national health care expenditures areattributable to physical inactivity (18). Theseestimates are recognized to be conservativedue to limitations in available data and theexclusion of costs associated with mental healthand musculoskeletal conditions. Further, theAcross its many different forms, physical activitycosts to society outside of the health system,has multiplicative health, social and economicsuch as potential environmental benefits frombenefits. Walking and cycling are key means ofincreased walking, cycling and use of publictransportation, enabling people to engage intransport, and associated reduction in use ofregular physical activity on a daily basis, but theirfossil fuel, are not yet included in a total impactrole and popularity is declining in many countries.assessment.The greatest changes are occurring in LMICswhere, for example, large numbers of people areswitching from walking and cycling to personalmotorized transport (19). Policies that improveroad safety, promote compact urban design16

and prioritize access by pedestrians, cyclistsand users of public transport to destinationsand services, particularly educational, publicPhysical activity is importantacross all ages, and should beintegrated into multiple settings.open and green and “blue” spaces,1 sports andleisure facilities, can reduce use of personalmotorized transportation, carbon emissions,traffic congestion as well as health-care costs(20), whilst also boosting the micro-economiesin local neighbourhoods and improving health,community well-being and quality of life (21,22). Given the increasingly urbanized world,with more than 70% of the global populationright for all” (28) and the 2017 Kazan Actionliving in urban centres, cities have a particularPlan endorsed at MINEPS VI (29) as well as theresponsibility and opportunity to contribute toCommission on Ending Childhood Obesity (30),this agenda through improving urban designidentified active play and recreation as importantand sustainable transport systems (23).elements of healthy growth and development in2children, including those aged less than 5 years.importantFurther, provision of quality physical educationcontributor to physical activity for people of alland supportive school environments can impartages, in addition to providing significant social,physical and health literacy for lifelong healthy,cultural and economic benefits to communitiesactive lifestyles, prevention of NCDs and mentaland nations (24, 25). While sport can be ahealth disorders as well as strengthen academiccatalyst and inspiration for participation inoutcomes. School-based policy initiatives arephysical activity (26), the sports sector is also aan essential component of endeavors to createsignificant employer and a key driver of tourisma more active society.Sportisanunderutilizedyet3and infrastructure globally. Sport and activerecreation can also contribute in emergencyPhysical activity is important across all ages,and crisis situations as part of humanitarianand should be integrated into multiple dailyprogrammes aimed at health and social needs,settings. For many adults, the workplace is aasandkey setting to be physically active and reduceintegration (27). Strengthening access to, andsedentary behaviour. The trip to and fromthe promotion of participation in, sports andwork, activity breaks, workplace programmesactive recreation, across all ages and abilities, isand incidental activity all offer opportunitiesan important element of increasing populationfor increased physical activity throughout thelevels of physical activity.working day, and can contribute to increasedwellascommunitydevelopmentproductivity and reduction in injuries andThe General Conference of UNESCO observed inabsenteeism (31). Whether working or not, olderthe International Charter of Physical Education,adults, in particular, can benefit from regularPhysical Activity and Sport that “the practicephysical activity to maintain physical, socialof physical activity and sports is a fundamentaland mental health (including prevention or“Blue space” refers to space near rivers, lakes and oceans.Such as Partnerships for Healthy Cities /, accessed April 2018).3See: The Association for Sports for All (http://www.tafisa.org/, accessed April 2018).1217

delay of dementia) (4), prevent falls and realizehealthy ageing (32). Strengthening the provisionof, and access to appropriate opportunitiesand programmes can enable all older adults toPhysical activity and thesustainable developmentgoals 2030maintain an active lifestyle according to capacity.Investment in policy actions to increaseImportantly, primary and secondary health-physical activity through, for example, moreand social-care providers can help patients ofwalking, cycling, active recreation, sport andall ages become more active and prevent theplay, can contribute to achieving many of theincreasing burden of NCDs (12), while also usingSDGs as identified in the Bangkok declarationphysical activity as a means to increase rates ofinrehabilitation and recovery (33). Strengtheningdirectly contribute to SDG3 (good health andpatient counselling on physical activity has beenwell-being) as well as other Goals, including,identified as a cost-effective intervention (12).but not limited to, SDG2.2 (ending all forms2016.1 Increasingphysicalactivitywillof malnutrition); SDGs 4.1 and 4.2 (qualityFurthermore, within health care settings, as welleducation); SDG5.1 (gender equality); SDG8as the workplace and other domains, there are(decent work and economic growth); SDG9.1opportunities for digital innovations to promote(industry, innovation and infrastructure); SDGsand support participation in physical activity and10.2 and 10.3 (reduced inequalities);

yoga, tai chi). Physical activity can also be undertaken at work and around the home. All forms of physical activity can provide health benefits if undertaken regularly and of sufficient duration and intensity. The current situation Global progress to increase physical activity has been slow, largely due to lack of awareness and investment.