Social and territorial inequalities in physical activity participation in France: analysis of national population-based surveys

Purpose: Insufficient physical activity (PA) is a well-known risk factor for noncommunicable diseases. Yet studies show that the level of PA among French adults remains inadequate, and unevenly across the population. This work studies the factors associated with PA in French population to identify inequalities and adapt public health strategies.

Methods: Data come from two complementary cross-sectional population-based surveys (Esteban 2014-2016 and Health Barometer 2021). Using the RPAQ in Esteban study produced detailed data on the nature, types and domains of PA in 2678 French adults. The data collected in the Health Barometer were less detailed, but the size of this survey (n=24514 for mainland France; n=6519 for the overseas territories) allowed analysis of PA levels according to sub-national territories and detailed socio-demographic characteristics. Samples have been compared by adjusted Wald tests and design-based Pearson tests (gender-stratified, weighted and standardized data). Multivariate models (with odds ratio) identified the factors associated with PA levels.

Results: The results highlighted social and territorial inequalities in PA practice in France: residents of northeastern regions are less active, as are older people (OR=0.6), those living in large cities (OR=0.7) and those with lower levels of education (ORwomen=0.7; ORmen=0.9). The most obvious difference concerns gender, with only half of women sufficiently active (compared with 4/5 of men). This relates to the domains and characteristics of PA. Women do more low-intensity PA, linked to home and family duties, which are still highly gendered and hamper achievement of the WHO recommendations.

Conclusions: This study shows the inequalities in PA in France, and the need to target public health strategies accordingly. In addition to targeted actions, it is necessary to act at a systemic level, by making living environments more conducive to PA, for all, i.e. by increasing walkability, active mobility, and practice opportunities such as active design projects.