Impact of The Lancet Physical Activity Series and the future of physical activity research

Purpose: To explore the impact of the 2012, 2016, 2021 The Lancet Physical Activity Series and provide an overview of the main results of an upcoming series.

Description: Publishing in The Lancet journal is particularly significant due to its visibility, extensive reach and considerable influence on public health and medical practice worldwide. As such, The Lancet Physical Activity Series of 2012, 2016, and 2021 provided a platform for wide dissemination of research findings on high-priority topics in the physical activity field. The overarching aim of the series was to advance the understanding and promotion of physical activity worldwide. This Symposium will include four presentations starting with a historical perspective and impact of The Lancet Physical Activity Series coupled with an overview of the three past series. Presentations 2-4 will follow with an overview of the new, forthcoming papers intended to be included in a 4th Lancet Physical Activity series. These presentations will delve into critical new topics including (a) health equity and a paradigm shift positing physical activity as not solely relevant to Non-Communicable Diseases (NCDs) but adopting a syndemics approach, (b) examining the nexus between physical activity and climate change/environmental sustainability, and (c) the importance of scaling up effective physical activity policies globally. Presentation one (Professor Pedro Hallal) will summarize key findings and contributions of the three series over the last decade and how the past series are positioned as a significant effort for advancing the science of physical activity and related fields. Presentation two (Associate Professor Deborah Salvo) will introduce the first paper of the 4th series exploring how the current age of syndemics presents interacting global crises of infectious diseases, NCDs, mental health problems, persistent health inequities, and climate change; all of which can benefit from physical activity. Presentation three (Professor Erica Hinckson) will reinforce the dual goal of bringing together the physical activity and climate agendas to address human and planetary health by urgently taking a multisectoral collaborative approach that will focus on comprehensive and holistic actions through policy change. Finally, Presentation four (Assistant Professor Andrea Ramirez Varela) will provide a critical reflection on monitoring global physical activity policies to assess progress in national and global physical activity and NCD prevention policies to guide efforts, inform decision-making, and drive actions aimed at fostering healthier populations and mitigating the prevalence of physical inactivity for the future.
This symposium will share learnings from research teams across six world regions with an emphasis on discussion, reflection and vision to guide the future of physical activity in the next decades to come.

Chair: Professor Pedro Hallal, University of Illinois at Urbana-Champaign, USA

Presenter 1: Professor Pedro Hallal. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA.

Presenter 2: Associate Professor Deborah Salvo. Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, USA.

Presenter 3: Professor Erica Hinckson, Department of Physical Activity and Nutrition, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand

Presenter 4: Assistant Professor Andrea Ramirez Varela. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA.

Discussants/moderators (panel): alphabetical order
-Professor Adrian Bauman, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney.
-Professor Harold Kohl III, Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA.
-Professor Jim Sallis, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California USA.
-Associate Professor Melody Ding. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia.
-Professor Michael Pratt. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA; Institute of Public Health, University of California San Diego. San Diego, USA.
-Professor Rodrigo Reis, Brown School, Washington University in St. Louis. St. Louis, USA.
-Professor Ulf Ekelund, Department of Sport Medicine, Norwegian School of Sport Sciences. Oslo, Norway.

Abstract 1: History and impact of The Lancet physical activity series (2012, 2016, 2021)
Background: In 2012, The Lancet introduced its inaugural series on Physical Activity (PA) during the 2012 Summer Olympic Games, shedding light on the alarming statistic that physical inactivity contributes to over 5 million global deaths annually, a figure equivalent to smoking-related deaths. Subsequent series in 2016 and 2021 emphasized the pressing need for addressing the substantial healthcare burden associated with physical inactivity, focusing on sedentary behaviour, disability, and at-risk populations.
Purpose: We explore the decade-long legacy of The Lancet PA series and leverage the insights gained to explore a new series.
Methods: Using bibliometric assessment and other methods we synthesized the accumulated knowledge and experience over the past decade and impact of the series on the physical activity and public health fields. Particularly, we explored citations, mentions, comparisons to other Lancet series, users by country and profession, and policy utilisation.
Results: The Lancet Series have profoundly impacted the physical activity and public health fields. In this presentation, we will elaborate on the nature of the impact on research, teaching and policy.
Conclusions: The legacy left by The Lancet PA series will provide the platform for a new direction in physical activity research that better informs policy and practice.
Practical implications: Lessons learnt are expected to have practical implications for public health, policy development, and international collaboration. The insights gained are well placed to inform evidence-based strategies for addressing global challenges through targeted interventions related to physical activity, and therefore contributing to the advancement of public health agendas worldwide.

Abstract 2: Reconceptualising physical activity for the age of syndemics using a global equity lens.
Background: The public health and medical communities generally recognise the importance of physical activity for preventing and controlling noncommunicable diseases (NCDs). However, its importance for addressing other major global issues is less well-recognised.
Purpose: This paper uses a global equity lens to shed light on the benefits of physical activity, above and beyond NCD prevention and control, for the age of syndemics (co-occurring pandemics and major global challenges).
Methods: Using nationally representative WHO data from 68 countries, we conducted a harmonized analysis of domain-specific physical activity for leisure, transport, and work; using equity plots and slope indices to quantify socioeconomic and gender-based inequalities. Next, we systematically scoped the literature of physical activity studies during the COVID-19 pandemic, as this recent global crisis underscored the public health relevance of physical activity for the age of syndemics.
Results: Pre-pandemic data revealed within- and between-country socioeconomic inequalities, with higher prevalence of leisure physical activity in higher-income countries and groups; and higher prevalence of utilitarian physical activity in lower-income countries and groups. Gender-based inequality data analysis is underway. The scoping reviews of COVID-19 and physical activity studies showed that (a) physical activity inequalities may have widened due to COVID-19; (b) physical activity was inversely associated with adverse COVID-19 related outcomes, underscoring the often-unrecognized importance of physical activity for infectious disease and immunity; and (c) physical activity may have buffered some of the negative mental health consequences of the COVID-19 pandemic, underscoring its mental health benefits.
Conclusions: The current age of syndemics is challenged by the global crises of infectious diseases and NCDs, mental health problems, persistent health inequalities, and climate change; all of which can benefit from physical activity.
Practical Implications: It is critical to reconceptualise physical activity as a factor with high relevance to multiple elements of modern-day syndemics.

Abstract 3: Living, moving, and playing on a sustainable and healthy planet: the urgency of combining physical activity and climate change agendas
Background: Climate change is the most dangerous self-inflicted catastrophe ever experienced by humanity, and physical inactivity is responsible for more than 5 million deaths per year worldwide.
Purpose: We have an opportunity to align and mobilise policy, research, and action toward the dual goals of mitigating climate change risks and promoting human health through physical activity.
Methods: We conceptualise the interconnection between frameworks on physical activity and climate change across ISPAH’s Strategies that Work for Physical Activity using applied systems thinking tools. We also address unintended consequences, consider inequities, and offer analytical frameworks for further research. Physical activity is in many ways reciprocally linked to climate change.
Results: Physical activity solutions can supplement the response to climate change. We propose a framework for action whereby advancing physical activity promotion can simultaneously reduce health and environmental inequities, mitigate climate change, and adapt both environment and behaviour long term for a changing climate.
Conclusions: Advancing physical activity and climate change agendas equitably must consider context and input from vulnerable populations, including low-income country residents and ancestral knowledge from indigenous peoples.
Practical implications: The dual goal of bringing together physical activity and climate agendas to address human and planetary health must be prioritised urgently, taking a multisectoral collaborative approach focusing on comprehensive and holistic actions through policy change and budget reprioritisations. These changes will require developing policy frameworks, providing financial incentives, mandating sustainable practices, and launching educational and awareness campaigns that prioritise physical activity for the dual goal of protecting the environment and individual health.

Abstract 4: Two-decade progress of national and global physical activity policy
Background: Physical activity policy has the potential to play an important role in conjoining multiple societal sectors to generate supportive environments that increase population physical activity.
Purpose: The purpose of this project was to document trends in the global status of physical activity policy.
Methods: We evaluated global physical activity policy changes from 2004 to 2023 based on policy monitoring from the Global Observatory for Physical Activity (GoPA!) in 217 countries.
Results: The data arranged by GoPA! highlights a notable increase from 2012 (year of the first The Lancet Physical Activity Series) onwards in the prevalence of national physical activity policies over the past two decades. Approximately nine in ten (89.4%) countries now have formal written policies; either a national NCD policy including physical activity or a standalone physical activity policy. A greater number of standalone policies was seen in the European region compared to other World Health Organization ((WHO) regions. Persistent gaps exist in policy and guideline availability in Africa, South-East-Asia, and low-income countries. In virtually all countries evaluation of policy implementation was poor. The majority of policies around the world were time-limited and, without action, will end before or in 2030, the year by which the WHO seeks to reduce global risk factors and wants to achieve a 15% relative reduction in physical inactivity.
Conclusions: Many advances in policy monitoring systems and tools have been made since 2012, but systematic global monitoring for physical activity policy, including implementation and evaluation, has yet to be achieved.
Practical implications: Monitoring global physical activity policies to assess progress in national and global physical activity and NCD prevention policies serves to guide efforts, inform decision-making, and drive actions aimed at fostering healthier populations and mitigating the prevalence of physical inactivity.
Funding: Global Observatory for Physical Activity (GoPA!)