National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants.

BACKGROUND: Insufficient physical activity increases the risk of non-communicable diseases, poor physical and cognitive function, weight gain, and mental ill-health. Global prevalence of adult insufficient physical activity was last published for 2016, with limited trend data. We aimed to estimate the prevalence of insufficient physical activity for 197 countries and territories, from 2000 to 2022. METHODS: We collated physical activity reported by adults (aged ≥18 years) in population-based surveys. Insufficient physical activity was defined as not doing 150 minutes of moderate-intensity activity, 75 minutes of vigorous-intensity activity, or an equivalent combination per week. We used a Bayesian hierarchical model to compute estimates of insufficient physical activity by country or territory, year, age, and sex. We assessed whether countries or territories, regions, and the world would meet the global target of a 15% relative reduction of the prevalence of insufficient physical activity by 2030 if 2010-22 trends continue. FINDINGS: We included 507 surveys across 163 countries and territories. The global age-standardised prevalence of insufficient physical activity was 31·3% (95% uncertainty interval 28·6-34·0) in 2022, an increase from 23·4% (21·1-26·0) in 2000 and 26·4% (24·8-27·9) in 2010. Prevalence was increasing in 103 (52%) of 197 countries and territories and six (67%) of nine regions, and was declining in the remainder. Prevalence was 5 percentage points higher among female (33·8% [29·9-37·7]) than male (28·7% [25·0-32·6]) individuals. Insufficient physical activity increased in people aged 60 years and older in all regions and both sexes, but age patterns differed for those younger than 60 years. If 2010-22 trends continue, the global target of a 15% relative reduction between 2010 and 2030 will not be met (posterior probability <0·01); however, two regions, Oceania and sub-Saharan Africa, were on track with considerable uncertainty (posterior probabilities 0·70-0·74). INTERPRETATION: Concerted multi-sectoral efforts to reduce insufficient physical activity levels are needed to meet the 2030 target. Physical activity promotion should not exacerbate sex, age, or geographical inequalities. FUNDING: Ministry of Public Health, Qatar, and World Health Organization. TRANSLATIONS: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Ecological correlates of sport and exercise participation among Thai adolescents: A hierarchical examination of a cross-sectional population survey.

BACKGROUND: Understanding factors influencing adolescents' sport/exercise participation (S/EP) is vital to developing effective interventions, but currently, evidence from less developed countries is limited. The purpose of this study was to examine correlates of S/EP across individual, interpersonal, and environmental levels in a nationally representative sample of Thai adolescents. METHODS: Data from 4617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand. Data on S/EP (outcome variable), and psychosocial, home, and community environment covariates were collected from individual adolescents using the Thailand Physical Activity Children Survey, Student Questionnaire. School environmental data were collected at the school level using a School Built Environment Audit. Hierarchical regressions taking into account school clustering effects were applied for data analysis. RESULTS: At the individual level, age and body mass index were independently and strongly correlated with S/EP. Adolescents with high preference for physical activity (PA) (odd ratio (OR) = 1.71, p < 0.001) and at least a moderate level of self-efficacy (OR = 1.33, p = 0.001) were more likely to have high S/EP. At the interpersonal level, adolescents whose parents joined their sports/exercise at least 1-2 times/week (OR = 1.36, p = 0.003) received ≥3 types of parental support (OR = 1.43, p = 0.005) and who received siblings' (OR = 1.26, p = 0.004) and friends' (OR = 1.99, p < 0.001) support had a greater chance of high S/EP. At the environmental level, adolescents' S/EP was greater when there were at least 3-4 pieces of home sport/exercise equipment (OR = 2.77, p = 0.003), grass areas at school (OR = 1.56, p < 0.001), and at least 1-2 PA facilities in the community (OR = 1.30, p = 0.009). CONCLUSION: Multiple factors at different levels within an ecological framework influencing Thai adolescents' S/EP were generally similar to those found in developed countries, despite some differences. For those interested in promoting and supporting Thai adolescents' engagement in sports/exercise, further exploration of the influence of self-efficacy and attitude toward PA is required at the individual level; parental and peer support at the interpersonal level; and home sport equipment, school grass areas, and neighborhood PA facilities at the environment level.

The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis.

BACKGROUND: Physical inactivity is an important modifiable risk factor for non-communicable diseases (NCDs) and mental health conditions. We aimed to estimate the public health-care costs associated with these diseases because of physical inactivity, which will help policy makers to prioritise investment in policy actions to promote and enable more people to be more active. METHODS: We used a population-attributable fraction formula to estimate the direct public health-care costs of NCDs and mental health conditions for 2020-30. The disease outcomes that we included were incident cases of coronary heart disease, stroke, type 2 diabetes, hypertension, cancer (breast, colon, bladder, endometrial, oesophageal, gastric, and renal), dementia, and depression in adults aged at least 18 years. We used the most recent health and economic data evidence available for 194 countries. FINDINGS: 499·2 million new cases of preventable major NCDs would occur globally by 2030 if the prevalence of physical inactivity does not change, with direct health-care costs of INT$520 billion. The global cost of inaction on physical inactivity would reach approximately $47·6 billion per year. Although 74% of new cases of NCDs would occur in low-income and middle-countries, high-income countries would bear a larger proportion (63%) of the economic costs. The cost of treatment and management of NCDs varied-although dementia accounted for only 3% of new preventable NCDs, the disease corresponded to 22% of all costs; type 2 diabetes accounted for 2% of new preventable cases but 9% of all costs; and cancers accounted for 1% of new preventable cases but 15% of all costs. INTERPRETATION: This health and economic burden of physical inactivity is avoidable. Further investments in and implementation of known and effective policy interventions will support countries to reach the Sustainable Development Goal of reduction of NCD mortality by 2030. FUNDING: None.

Economic evaluations of fall prevention exercise programs: a systematic review.

OBJECTIVE: To investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, Web of Science, Scopus, National Institute for Health Research Economic Evaluation Database, Health Technology Assessment database, Tufts Cost-Effectiveness Analysis Registry, Research Papers in Economics and EconLit (inception to May 2022). ELIGIBILITY CRITERIA FOR STUDY SELECTION: Economic evaluations (trial-based or model-based) and costing studies investigating fall prevention exercise programmes versus no intervention or usual care for older adults living in the community or care facilities, and reporting incremental cost-effectiveness ratio (ICER) for fall-related outcomes or quality-adjusted life years (QALY, expressed as cost/QALY) and/or intervention costs. RESULTS: 31 studies were included. For community-dwelling older adults (21 economic evaluations, 6 costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of US$279 802/QALY gained and US$11 986/fall prevented (US$ in 2020). Assuming an arbitrary willingness-to-pay threshold (US$100 000/QALY), most results (17/24) were considered cost-effective (moderate certainty). The greatest value for money (lower ICER/QALY gained and fall prevented) appeared to accrue for older adults and those with high fall risk, but unsupervised exercise appeared to offer poor value for money (higher ICER/QALY). For care facilities (two economic evaluations, two costing studies), ICERs ranged from dominant (low certainty) to US$35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported. CONCLUSIONS: Most economic evaluations investigated fall prevention exercise programmes for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising. PROSPERO REGISTRATION NUMBER: PROSPERO 2020 CRD42020178023.

Impact of physical activity programs and services for older adults: a rapid review.

BACKGROUND: Knowledge of which physical activity programs are most effective for older adults in different sub-populations and contexts is limited. The objectives of this rapid review were to: 1) Overview evidence evaluating physical activity programs/services for older adults; and 2) Describe impact on physical activity, falls, intrinsic capacity (physical domain), functional ability (physical, social, and cognitive/emotional domains), and quality of life. METHODS: We conducted a rapid review of primary studies from 350 systematic reviews identified in a previous scoping review (March 2021: PEDro, MEDLINE, CINAHL, Cochrane Database). For Objective 1, we included intervention studies investigating physical activity programs/services in adults ≥ 60 years. Of these, we included good quality (≥ 6/10 PEDro scale) randomised controlled trials (RCTs) with ≥ 50 participants per group in Objective 2. RESULTS: Objective 1: Of the 1421 intervention studies identified from 8267 records, 79% were RCTs, 87% were in high income countries and 39% were good quality. Objective 2: We identified 87 large, good quality RCTs (26,861 participants). Overall activity promotion, structured exercise and recreation/sport had positive impacts (≥ 50% between-group comparisons positive) across all outcome domains. For overall activity promotion (21 intervention groups), greatest impacts were on physical activity (100% positive) and social outcomes (83% positive). Structured exercise (61 intervention groups) had particularly strong impacts on falls (91% positive), intrinsic capacity (67% positive) and physical functioning (77% positive). Recreation/sport (24 intervention groups) had particularly strong impacts on cognitive/emotional functioning (88% positive). Multicomponent exercise (39 intervention groups) had strong impacts across all outcomes, particularly physical activity (95% positive), falls (90% positive) and physical functioning (81% positive). Results for different populations and settings are presented. CONCLUSION: Evidence supporting physical activity for older adults is positive. We outline which activity types are most effective in different populations and settings.

Invest in physical activity to protect and promote health: the 2020 WHO guidelines on physical activity and sedentary behaviour.

In this editorial we discuss the new 2020 World Health Organization guidelines on physical activity and sedentary behaviour and a series of related papers that are published simultaneously in IJBNPA. The new guidelines reaffirm that physical activity is a 'best buy' for public health and should be used to support governments to increase investment in policy and research to promote and ensure physical activity opportunities are available for everyone. New recommendations on sedentary behaviour and inclusion of specific guidelines for people living with disability and/or chronic disease and pregnant and postpartum women are major developments since 2010. We discuss research priorities, as well as policy implementation and the contribution to the sustainable development agenda. The new guidelines can catalyse the paradigm shifts needed to enable equitable opportunities to be physically active for everyone, everywhere, every day.

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

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.

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.

How can global physical activity surveillance adapt to evolving physical activity guidelines? Needs, challenges and future directions.

Public health guidelines on physical activity (PA) establish national policy agendas and provide the basis for setting goals and targets. Advances in measurement and resulting new scientific findings lead to evolution of PA guidelines. PA surveillance serves to track compliance with national guidelines, usually expressed as the proportion of the population 'meeting' the main quantitative guidelines. The WHO recently completed a process to review and update the global PA guidelines. Changes to the guidelines, such as removal of a 10-min bout criterion, pose challenges for PA surveillance. We review the evolution of PA guidelines and associated surveillance methods and explore implications of the updated guidelines for changes in population surveillance and opportunities for technological approaches to PA to enhance surveillance.

Levels of domain-specific physical activity at work, in the household, for travel and for leisure among 327 789 adults from 104 countries.

OBJECTIVE: To compare the country-level absolute and relative contributions of physical activity at work and in the household, for travel, and during leisure-time to total moderate-to-vigorous physical activity (MVPA). METHODS: We used data collected between 2002 and 2019 from 327 789 participants across 104 countries and territories (n=24 low, n=34 lower-middle, n=30 upper-middle, n=16 high-income) from all six World Health Organization (WHO) regions. We calculated mean min/week of work/household, travel and leisure MVPA and compared their relative contributions to total MVPA using Global Physical Activity Questionnaire data. We compared patterns by country, sex and age group (25-44 and 45-64 years). RESULTS: Mean MVPA in work/household, travel and leisure domains across the 104 countries was 950 (IQR 618-1198), 327 (190-405) and 104 (51-131) min/week, respectively. Corresponding relative contributions to total MVPA were 52% (IQR 44%-63%), 36% (25%-45%) and 12% (4%-15%), respectively. Work/household was the highest contributor in 80 countries; travel in 23; leisure in just one. In both absolute and relative terms, low-income countries tended to show higher work/household (1233 min/week, 57%) and lower leisure MVPA levels (72 min/week, 4%). Travel MVPA duration was higher in low-income countries but there was no obvious pattern in the relative contributions. Women tended to have relatively less work/household and more travel MVPA; age groups were generally similar. CONCLUSION: In the largest domain-specific physical activity study to date, we found considerable country-level variation in how MVPA is accumulated. Such information is essential to inform national and global policy and future investments to provide opportunities to be active, accounting for country context.

Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants.

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.

Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants.

BACKGROUND: 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. METHODS: We pooled data from population-based surveys reporting the prevalence of insufficient physical activity, which included physical activity at work, at home, for transport, and during leisure time (ie, not doing at least 150 min of moderate-intensity, or 75 min of vigorous-intensity physical activity per week, or any equivalent combination of the two). We used regression models to adjust survey data to a standard definition and age groups. We estimated time trends using multilevel mixed-effects modelling. FINDINGS: We included data from 358 surveys across 168 countries, including 1·9 million participants. Global age-standardised prevalence of insufficient physical activity was 27·5% (95% uncertainty interval 25·0-32·2) in 2016, with a difference between sexes of more than 8 percentage points (23·4%, 21·1-30·7, in men vs 31·7%, 28·6-39·0, in women). Between 2001, and 2016, levels of insufficient activity were stable (28·5%, 23·9-33·9, in 2001; change not significant). The highest levels in 2016, were in women in Latin America and the Caribbean (43·7%, 42·9-46·5), south Asia (43·0%, 29·6-74·9), and high-income Western countries (42·3%, 39·1-45·4), whereas the lowest levels were in men from Oceania (12·3%, 11·2-17·7), east and southeast Asia (17·6%, 15·7-23·9), and sub-Saharan Africa (17·9%, 15·1-20·5). Prevalence in 2016 was more than twice as high in high-income countries (36·8%, 35·0-38·0) as in low-income countries (16·2%, 14·2-17·9), and insufficient activity has increased in high-income countries over time (31·6%, 27·1-37·2, in 2001). INTERPRETATION: If current trends continue, the 2025 global physical activity target (a 10% relative reduction in insufficient physical activity) will not be met. Policies to increase population levels of physical activity need to be prioritised and scaled up urgently. FUNDING: None.

"Are Thai children and youth sufficiently active? prevalence and correlates of physical activity from a nationally representative cross-sectional study".

BACKGROUND: Children and youth gain multiple health benefits from regular participation in physical activity (PA). However, in Thailand there is limited national data on children and youth's PA behaviors and recent reports suggest that Thai children and youth have low levels of PA. Furthermore, there is almost no data on the factors associated with inactivity to support the development of a Thai National PA Plan. The purpose of this paper is to investigate Thai children and youth's participation in PA and its correlates across sociodemographic characteristics and different PA domains. METHODS: This study applied a cross-sectional study design with a multi-stage stratified cluster sampling. A national representative sample of 13,255 children and youth aged 6-17 years were used for data analysis. A previously validated questionnaire was used to assess PA prevalence. Logistic regression was conducted to examine the relationships of socio-demographic factors, and participation in different PA domains with overall PA. RESULTS: Only 23.4% of Thai children and youth met recommended levels of PA and there were large gender and regional differences. PA levels generally declined with age, although the level observed in the 10-13 year group was slightly higher than other year groups. A majority of children and youth engaged in a large number of different activities across PA domains. Sex, age, BMI, geographical regions, organized sports, participation in sport and recreational activities were significant predictors of meeting the global PA guidelines, whereas participation in physical education, active transport, and the number of screen time activities had no association. Girls were less likely to achieve sufficient PA levels (OR = 0.49, 95%CI; 0.45-0.54, p < 0.001), as were obese children (OR = 0.78, 95%CI; 0.64-0.94, p = 0.01), children living in the West (OR = 0.47, 95%CI; 0.38-0.59, p < 0.001), and those who did no participation in organized sports and sport/exercise activities, or minimal participation (1-2 activities) in recreational activities (OR = 0.79, 95%CI; 0.68-0.90, p < 0.001). CONCLUSIONS: The prevalence estimate of meeting the recommended guideline of sufficient PA in Thai children and youth is low, despite the high levels of engagement in a large number of PA. The results indicate that policy and interventions aimed at increasing PA are needed with special attention required to address specific groups less likely to meet the PA guideline. Strategies to promote a large volume of participation in all possible types of PA as part of Thai children and youth's daily life should be considered.

Results From Thailand's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Physical activity (PA) is recognized as one of the core modifiable risk factors of noncommunicable diseases. However, little is known about PA in the Thai population, particularly in children. The report card (RC) project provided Thailand with an opportunity to assess PA behaviors in children. This paper summarizes the methodology, grading process, and the final grades of the Thai RC. METHODS: A school-based survey was conducted to collect data from a nationally representative sample of children aged 6 to 17 years. Survey results provided the primary source for the RC. Nine indicators were graded using the Global Matrix 2.0 framework. Grading was undertaken by a national committee comprising experts from key stakeholders. RESULTS: Grades ranged from F to B. Overall PA and Sedentary Behaviors both received the grade D-. Organized Sport Participation scored a C. Active Play scored the grade F. Active Transport and support from Family and Peers were both graded B. School, Community, and Government indicators were scored C. CONCLUSIONS: In Thai children, participation in PA and active play is very low; conversely, sedentary behaviors are high. These first data on patterns of activity for the Thailand RC will serve to guide national actions and advocacy aimed at increasing PA in children.

Updating the Evidence for Physical Activity: Summative Reviews of the Epidemiological Evidence, Prevalence, and Interventions to Promote "Active Aging".

PURPOSE OF THE STUDY: There is a global imperative to increase awareness of the emerging evidence on physical activity (PA) among older adults. "Healthy aging" has traditionally focused on preventing chronic disease, but greater efforts are required to reduce frailty and dependency and to maintain independent physical and cognitive function and mental health and well-being. DESIGN AND METHODS: This integrated review updates the epidemiological data on PA, summarizes the existing evidence-based PA guidelines, describes the global magnitude of inactivity, and finally describes the rationale for action. The first section updates the epidemiological evidence for reduced cardiometabolic risk, reduced risks of falls, the burgeoning new evidence on improved cognitive function and functional capacity, and reduced risk of depression, anxiety, and dementia. This is followed by a summary of population prevalence studies among older adults. Finally, we present a "review of reviews" of PA interventions delivered from community or population settings, followed by a consideration of interventions among the "oldest-old," where efforts are needed to increase resistance (strength) training and balance. RESULTS: This review identifies the global importance of considering "active aging" beyond the established benefits attributed to noncommunicable disease prevention alone. IMPLICATIONS: Innovative population-level efforts are required to address physical inactivity, prevent loss of muscle strength, and maintain balance in older adults. Specific investment in healthy aging requires global policy support from the World Health Organization and is implemented at the national and regional levels, in order to reduce the burden of disease and disability among older adults.

Utilization and Harmonization of Adult Accelerometry Data: Review and Expert Consensus.

PURPOSE: This study aimed to describe the scope of accelerometry data collected internationally in adults and to obtain a consensus from measurement experts regarding the optimal strategies to harmonize international accelerometry data. METHODS: In March 2014, a comprehensive review was undertaken to identify studies that collected accelerometry data in adults (sample size, n ≥ 400). In addition, 20 physical activity experts were invited to participate in a two-phase Delphi process to obtain consensus on the following: unique research opportunities available with such data, additional data required to address these opportunities, strategies for enabling comparisons between studies/countries, requirements for implementing/progressing such strategies, and value of a global repository of accelerometry data. RESULTS: The review identified accelerometry data from more than 275,000 adults from 76 studies across 36 countries. Consensus was achieved after two rounds of the Delphi process; 18 experts participated in one or both rounds. The key opportunities highlighted were the ability for cross-country/cross-population comparisons and the analytic options available with the larger heterogeneity and greater statistical power. Basic sociodemographic and anthropometric data were considered a prerequisite for this. Disclosure of monitor specifications and protocols for data collection and processing were deemed essential to enable comparison and data harmonization. There was strong consensus that standardization of data collection, processing, and analytical procedures was needed. To implement these strategies, communication and consensus among researchers, development of an online infrastructure, and methodological comparison work were required. There was consensus that a global accelerometry data repository would be beneficial and worthwhile. CONCLUSIONS: This foundational resource can lead to implementation of key priority areas and identification of future directions in physical activity epidemiology, population monitoring, and burden of disease estimates.