www.thelancet.com Vol 380 July 21, 2012
passive, physical and mental life should be to assemble
the best experts in the fi eld and the best evidence to
understand what we know about the relationship
between human health and physical activity. This goal is
the purpose of our Series.
Pamela Das, Richard Horton
The Lancet, London NW1 7BY, UK
We warmly thank Pedro Hallal for devising and leading this Series, and I-Min Lee,
Adrian Bauman, Mike Pratt, Harold Kohl III, and Gregory Heath for their
contributions and support as The Lancet Series steering committee.
Physical activity: more of the same is not enough
For millennia, exercise has been recommended by
physicians and scholars. For more than 60 years, science
has shown that the health benefi ts of a physically
active lifestyle are extensive and robust. In 1953,
The Lancet published landmark papers by Jerry Morris
and colleagues on the associations between physical
activity at work and coronary heart disease.1,2 Sedentary
London Transport Authority bus drivers were at a
higher risk of cardiac events than were their more active
conductor peers. These publications laid the groundwork
for physical activity epidemiology and stimulated the
development of substantial research linking inactivity to
increased risk of many non-communicable diseases.
We now know that physical inactivity is a signifi cant
predictor of cardiovascular disease, type 2 diabetes
mellitus, obesity, some cancers, poor skeletal health,
some aspects of mental health, and overall mortality, as
well as poor quality of life. Men and women of all ages,
socioeconomic groups, and ethnicities are healthier
if they achieve the public health recommendation
of at least 150 min per week of moderate-intensity
aerobic physical activity, such as brisk walking.3
Immediate and future health benefi ts are also clearly
described for children and adolescents, for whom
at least 60 min per day of vigorous or moderate-
intensity physical activity is recommended.4,5 Muscular
strengthening physical activities are also recommended
for health improvement.3
In 2008, 63% of deaths worldwide were due to non-
communicable diseases, mainly diseases of the heart
and vascular system, diabetes mellitus, cancers, and
obstructive pulmonary disease. Physical activity was
recently considered a cornerstone for combating non-
communicable diseases by the UN.6 WHO recognises
physical inactivity as one of the leading global risk
factors for morbidity and premature mortality.7
Further, physical inactivity directly aff ects many risk
factors for morbidity and mortality including adiposity,
raised blood glucose concentrations, high blood
pressure, and a poor lipid profi le. Furthermore, people
benefi t from even modest activity. Compared with
inactive individuals, those who were active but at levels
less than recommended (about 1·5 h per week), lived
3 years longer.8
Clearly, physical activity has vast potential to
improve health throughout the world. As the scientifi c
contributions of exercise science and public health
have advanced our understanding of the health eff ects
and consequences, the specialty of physical activity
and public health has emerged. Public health practice
1 Beaglehole R, Bonita R, Horton R, et al, for The Lancet NCD Action Group and
the NCD Alliance. Priority actions for the non-communicable disease crisis.
Lancet 2011; 377: 1438–47.
Lee I-M, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, for the
Lancet Physical Activity Series Working Group. Eff ect of physical inactivity
on major non-communicable diseases worldwide: an analysis of burden of
disease and life expectancy. Lancet 2012; published online July 18. http://
WHO. Global Health Observatory Data Repository. 2011. http://apps.who.
int/ghodata (accessed June 26, 2012).
WHO. Global health risks: mortality and burden of disease attributable to
selected major risks. Geneva: World Health Organization, 2009.
July 18, 2012
Comment Download full-text
www.thelancet.com Vol 380 July 21, 2012 191
is an action-oriented discipline that seeks to move
populations towards health. After more than 60 years
of scientifi c research, technological advancements that
nudge us towards physical inactivity make it urgently
necessary to take actions. Labour-saving devices such as
motor vehicles and other transportation aids have had
the unintended consequence of reducing the minimum
daily energy expenditure necessary for living. This issue
is of particular concern in countries with low-to-middle
incomes undergoing substantial social and physical
transitions. More of the same (in terms of research
and practice) will not be enough. The global challenge
is clear: make physical activity a public health priority
throughout the world to improve health and reduce
the burden of non-communicable diseases. However, to
achieve such a goal, much work remains, as this Lancet
With the upcoming 2012 Olympic Games, sport and
physical activity will attract tremendous worldwide
attention. Publication of this Series on physical activity
and health at the same time as the Olympic Games is
not a coincidence. Although the world will be watching
elite athletes from many countries compete in sporting
events requiring tremendous training, skill, and fi tness,
most spectators will be quite inactive. The popularity of
the Olympic Games and elite sports such as professional
soccer has not been, and will not be, translated into
mass participation in exercise and physical activity
that will improve the health of the world’s population.
Although the International Olympic Committee and
the Olympic Movement have expressed concerns
about rising inactivity in young people and recognised
the importance of physical activity and sports for a
healthy lifestyle,9,10 physical inactivity continues to be a
substantial concern needing public health action.
The global challenge of making physical activity a public
health priority will not be easy to undertake, nor should
it be taken lightly. Lessons can be learned from advances
made in nutrition and tobacco control, but physical
activity should be a separate and equal concern, and
recognised as a unique specialty in public health. We trust
this Series in The Lancet will initiate travel down that road.
It is especially important to address physical activity and
non-communicable diseases in low-income and middle-
income countries. Although more than 80% of the world’s
population lives in low-income and middle-income
countries and more than 80% of the global burden
of non-communicable diseases lies here, only a small
fraction of research on physical activity has been focused
in these countries. The gap between where research is
done and where public health problems are located is
striking. Studies on the health benefi ts of physical activity,
its correlates, and strategies for eff ective promotion are
heavily concentrated in a few countries, most of which
have stable or falling rates of non-communicable diseases.
The largest increases and burden of non-communicable
diseases are now seen in low-income countries, where our
understanding of evidence-based strategies for increasing
physical activity is poor. Altering this situation must be a
priority in the next decade
*Pedro C Hallal, Adrian E Bauman, Gregory W Heath,
Harold W Kohl 3rd, I-Min Lee, Michael Pratt
Federal University of Pelotas, Pelotas 96030002, Brazil (PCH);
Prevention Research Collaboration, School of Public Health,
Sydney University, Sydney, NSW, Australia (AEB); University of
Tennessee at Chattanooga and University of Tennessee College of
Medicine, Chattanooga, TN, USA (GWH); University of Texas
Health Science Center, Houston School of Public Health, and
University of Texas at Austin Department of Kinesiology and
Health Education, Austin, TX, USA (HWK); Division of Preventive
Medicine, Brigham and Women’s Hospital, Harvard Medical
School, Boston, MA, USA (I-ML); National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, Atlanta, GA, USA (MP)
We declare that we have no confl icts of interest. The fi ndings and conclusions in
this report are those of the authors and do not necessarily represent the offi cial
position of the US Centers for Disease Control and Prevention.
1 Morris JN, Heady JA, Raffl e PA, Roberts CG, Parks JW. Coronary heart-disease
and physical activity of work. Lancet 1953; 262: 1111–20.
Morris JN, Heady JA, Raffl e PA, Roberts CG, Parks JW. Coronary heart-disease
and physical activity of work. Lancet 1953; 262: 1053–57.
Physical Activity Guidelines Advisory Committee. Physical Activity
Guidelines Advisory Committee Report, 2008. Washington, DC:
US Department of Health and Human Services, 2008.
Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health:
updated recommendation for adults from the American College of Sports
Medicine and the American Heart Association. Circulation 2007;
WHO. Global recommendations on physical activity for health. Geneva:
World Health Organization, 2011.
UN. 2011 High level meeting on prevention and control of
non-communicable diseases. General Assembly. New York, NY:
United Nations, 2011.
WHO. Physical inactivity: a global public health problem. Geneva:
World Health Organization, 2011.
Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for
reduced mortality and extended life expectancy: a prospective cohort
study. Lancet 2011; 378: 1244–53.
International Olympic Committee. The 2006 Havana Sport for All
Declaration. Havana: International Olympic Committee, 2006.
10 Mountjoy M, Andersen LB, Armstrong N, et al. International Olympic
Committee consensus statement on the health and fi tness of young people
through physical activity and sport. Br J Sports Med 2011; 45: 839–48.