Researchers from UTHealth Houston reported on Mar. 9 that global physical activity levels have stayed low over the past two decades, even though most countries have developed policies to address the issue. The findings were published in Nature Health and led by Andrea Ramirez Varela, MD, PhD, MPH, assistant professor at UTHealth Houston School of Public Health.
The study highlights a gap between policy development and real-world outcomes. While 92% of countries now have at least one policy document addressing physical activity—and 35% have a dedicated policy—one in three adults worldwide still do not meet World Health Organization guidelines for weekly exercise.
Ramirez Varela and her team analyzed data from interviews, peer-reviewed research, and policy documents spanning 218 countries between 2004 and 2025. They aimed to understand why increased policy attention has not translated into higher physical activity rates. "What we see in other modifiable risk factors for chronic diseases – like smoking, alcohol, nutrition – they have a lot of prioritization, and there is a lot of activity around putting them first. For physical activity, it has been different," Ramirez Varela said. "We wanted to really understand why after all this apparent improvement in policy development, there was no change or the translation of this into the real world."
The researchers suggest that countries should take a more proactive approach to defining and framing physical activity as both an individual and population-level benefit. "There is no consensus if physical activity is an outcome or a means to achieve other outcomes," Ramirez Varela said. She added that embedding physical activity into city design and education could help create environments where people are more likely to be active: "Physical activity should be embedded in the way we design our cities, helping create communities where people want to live and move more... It also belongs in education. Physical activity spans multiple sectors, yet the conversation has largely been focused on health."
The team also recommended building stronger leadership networks to promote physical activity across sectors. Drawing parallels with tobacco regulation progress over recent decades, Ramirez Varela said: "Almost thirty years ago, smoking was far less regulated... We can build that same level of policy commitment for physical activity. The fact that it is not fully in place today simply means the work is ahead of us."
This research was published alongside two other population-level studies on physical activity co-authored by Ramirez Varela. Her work builds on more than twenty years of research first published in The Lancet in 2012 with follow-up studies released in 2016 and 2021.
