Fewer than 20% of adults and adolescents around the world meet WHO’s physical activity guidelines, according to researchers.

The guidelines from 2020 recommend that children and adolescents complete 60 minutes of moderate-to-vigorous aerobic physical activity every day, and muscle-strengthening activities (MSA) 3 days per week. For adults and older adults, the guidelines call for 150 to 300 minutes of moderate physical activity or 75 to 150 minutes of vigorous intensity per week and MSA 2 days per week.

In a systematic review and meta-analysis, Antonio Garcia-Hermoso, PhD, head of the children and youth physical activity unit at Navarrabiomed, which is affiliated with the Public University of Navarra, and colleagues sought to estimate the proportion of the global population that was meeting WHO’s recommendations.

“Our study provides an accurate estimate of the prevalence of physical activity at the population level, which is an important modifiable chronic disease risk factor,” Garcia-Hermoso and colleagues wrote in the British Journal of Sports Medicine. “Adults engaging in aerobic and MSA at recommended levels showed important reductions in the risk of all-cause and cause-specific mortality in addition to a lower risk for multimorbidity (eg, cardiovascular risk and type 2 diabetes).”

The researchers searched five databases and identified 21 studies that included approximately 3.4 million people from 31 countries.

Overall, they found that the prevalence of adherence to the guidelines was 17.15% (95%, CI 15.44%-18.94%) among adults. The prevalence of adherence was slightly higher among teens, at 19.45% (95% CI, 16.34%-22.75%)

They additionally noted that adherence was lower among adults with low or medium education levels, those who were older, women, people who had underweight or obesity and those who self-rated their health as poor or moderate (P < 0.001), “although the prevalence remained very low in all cases.”

The researchers also analyzed prevalence by geographic location. Compared with those from Northern European countries like Iceland, Sweden, Denmark and the Netherlands, the United States and Southern and Central European countries like Malta, Cyprus, Croatia, Romania and Poland had lower prevalence of meeting guidelines.

Garcia-Hermoso and colleagues wrote that they were “unable to identify the key causes of the geographical differences” but offered a few possible explanations, like the different tools used to measure physical activity or “adoption of different exercise promotion policies between countries.”

“The Netherlands, one of the countries with higher prevalence, adopted the physical activity guidelines in 2017, and aimed for 75% of the Dutch population to adhere to them,” the researchers wrote. “The government launched several national policies or action plans for the promotion of physical activity for health through the collaboration between central government, the sports sector, municipalities, businesses, care providers and civil society organizations.”

Additionally, “wealth inequalities across countries, which likely impact an individual’s access to fitness facilities or the availability of free time to engage in aerobic and MSA, could also explain some of these differences.”

Garcia-Hermoso and colleagues concluded that “only one out of five adolescents and adults met the recommended combined aerobic and MSA guidelines,” and “large-scale public health interventions promoting both types of exercise are needed to reduce the associated burden of noncommunicable diseases.”

“These low prevalence levels are concerning from a public health perspective and emphasize the need to provide large-scale physical activity interventions that must be supported by long-term political commitment and paired with coordinated and sustained dissemination and communication strategies across sectors,” they wrote.