EXPERT REACTION: Global report shows about 9 in 10 Aussie and Kiwi teens are not doing enough physical activity

Embargoed until: Publicly released:

The first ever global report looking at trends in physical activity among 11-17 year olds has found that 89 per cent of young Australians and Kiwis do not meet current recommendations of at least one hour of physical activity per day. Australia was one of the worst performers in the global report, ranking 140 out of 146 countries. NZ fared only slightly better at position 138. There was also a difference between the sexes, with 91 per cent of girls not meeting the targets in Australia, compared to 87 per cent of boys. Overall the global report found that there has been little if any improvement since 2001 and that globally around 8 in 10 teens did not do enough physical activity.

Journal/conference: Lancet Child & Adolescent Health

DOI: 10.1016/S2352-4642(19)30323-2

Organisation/s: The University of Western Australia, World Health Organization, Imperial College London, UK

Funder: This study was funded by the World Health Organization. It was conducted by researchers from WHO, Imperial College London, and the University of Western Australia.

Media Release

From: World Health Organization

New WHO-led study says majority of adolescents worldwide are not sufficiently physically active, putting their current and future health at risk

GENEVA ¦ 22 November, 2019: The first ever global trends for adolescent insufficient physical activity show that urgent action is needed to increase physical activity levels in girls and boys aged 11 to 17 years. The study, published in The Lancet Child & Adolescent Health journal and produced by researchers from the World Health Organization (WHO), finds that more than 80% of school-going adolescents globally did not meet current recommendations of at least one hour of physical activity per day – including 85% of girls and 78% of boys.

The study – which is based on data reported by 1.6 million 11 to 17-year-old students – finds that across all 146 countries studied between 2001-2016 girls were less active than boys in all but four (Tonga, Samoa, Afghanistan and Zambia).

The difference in the proportion of boys and girls meeting the recommendations was greater than 10 percentage points in almost one in three countries in 2016 (29%, 43 of 146 countries), with the biggest gaps seen in the United States of America and Ireland (more than 15 percentage points). Most countries in the study (73%, 107 of 146) saw this gender gap widen between 2001-2016.

Young people’s health compromised by insufficient physical activity

The authors say that levels of insufficient physical activity in adolescents continue to be extremely high, compromising their current and future health. “Urgent policy action to increase physical activity is needed now, particularly to promote and retain girls’ participation in physical activity,” says study author Dr Regina Guthold, WHO.

The health benefits of a physically active lifestyle during adolescence include improved cardiorespiratory and muscular fitness, bone and cardiometabolic health, and positive effects on weight. There is also growing evidence that physical activity has a positive impact on cognitive development and socializing. Current evidence suggests that many of these benefits continue into adulthood.

To achieve these benefits, the WHO recommends for adolescents to do moderate or vigorous physical activity for an hour or more each day.

The authors estimated how many 11- to 17-year-olds do not meet this recommendation by analysing data collected through school-based surveys on physical activity levels. The assessment included all types of physical activity, such as time spent in active play, recreation and sports, active domestic chores, walking and cycling or other types of active transportation, physical education and planned exercise.

To improve levels of physical activity among adolescents, the study recommends that:

-          Urgent scaling up is needed of known effective policies and programmes to increase physical activity in adolescents;

-          Multisectoral action is needed to offer opportunities for young people to be active, involving education, urban planning, road safety and others;

The highest levels of society, including national, city and local leaders, should promote the importance of physical activity for the health and well-being of all people, including adolescents.

“The study highlights that young people have the right to play and should be provided with the opportunities to realise their right to physical and mental health and wellbeing,” says co-author Dr Fiona Bull, WHO. “Strong political will and action can address the fact that four in every five adolescents do not experience the enjoyment and social, physical, and mental health benefits of regular physical activity. Policy makers and stakeholders should be encouraged to act now for the health of this and future young generations.”

Physical activity trends show slight improvement for boys, none for girls

The new study estimated for the first time how trends changed between 2001-2016 – applying the trends from 73 countries who did repeat surveys during that period to all 146 countries.

Globally, the prevalence of insufficient physical activity slightly decreased in boys between 2001 and 2016 (from 80% to 78%), but there was no change over time in girls (remaining around 85%).

The countries showing the greatest decreases in boys being insufficiently active were Bangladesh (from 73% to 63%), Singapore (78% to 70%), Thailand (78% to 70%), Benin (79% to 71%), Ireland (71% to 64%), and the USA (71% to 64%). However, among girls, changes were small, ranging from a 2 percentage-point decrease in Singapore (85% to 83%) to a 1 percentage-point increase in Afghanistan (87% to 88%).

The authors note that if these trends continue, the global target of a 15% relative reduction in insufficient physical activity – which would lead to a global prevalence of less than 70% by 2030 – will not be achieved. This target was agreed to by all countries at the World Health Assembly in 2018.

In 2016, Philippines was the country with the highest prevalence of insufficient activity among boys (93%), whereas South Korea showed highest levels among girls (97%) and both genders combined (94%). Bangladesh was the country with the lowest prevalence of insufficient physical activity among boys, girls, and both genders combined (63%, 69% and 66%, respectively).

Some of the lowest levels of insufficient activity in boys were found in Bangladesh, India and the USA. The authors note that the lower levels of insufficient physical activity in Bangladesh and India (where 63% and 72% of boys were insufficiently active in 2016, respectively) may be explained by the strong focus on national sports like cricket. However, the US rates (64%) may be driven by good physical education in schools, pervasive media coverage of sports, and good availability of sports clubs (such as ice hockey, American football, basketball, or baseball).

For girls, the lowest levels of insufficient activity were seen in Bangladesh and India, and are potentially explained by societal factors, such as increased domestic chores in the home for girls.

Insufficient activity among adolescents a major concern

“The trend of girls being less active than boys is concerning,” said study co-author

Ms Leanne Riley, WHO. “More opportunities to meet the needs and interests of girls are needed to attract and sustain their participation in physical activity through adolescence and into adulthood.”

To increase physical activity for young people, governments need to identify and address the many causes and inequities – social, economic, cultural, technological, and environmental – that can perpetuate the differences between boys and girls, the authors said.

“Countries must develop or update their policies and allocate the necessary resources to increase physical activity,” says Dr Bull. “Policies should increase all forms of physical activity, including through physical education that develops physical literacy, more sports, active play and recreation opportunities – as well as providing safe environments so young people can walk and cycle independently. Comprehensive action requires engagement with multiple sectors and stakeholders, including schools, families, sport and recreation providers, urban planners, and city and community leaders.”

Editors notes

This study was funded by the World Health Organization. It was conducted by researchers from WHO, Imperial College London, and the University of Western Australia.

The authors note some limitations, including that the study only included information from school-going adolescents, due to lack of data for adolescents out of school. School-going adolescents may vary from others of the same age, as adolescents in school may be more likely to come from advantaged backgrounds that may be more focussed on high achievement in other academic disciplines, rather than physical education and sport. Further, while the study covered 81% of the school-going adolescent population, this coverage varied by country income, ranging from 36% in low-income to 86% in high-income countries.

The study used self-reported data only, which may be subject to bias. Data from wearable devices were not used as they could not be compared to self-reported data from surveys.

Attachments:

  • The Lancet
    Web page
    Please link to the article in online versions of your report (the URL will go live after the embargo ends).
  • World Health Organization
    Web page
    WHO Physical activity fact sheet

Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Professor Ken Nosaka is Director of Exercise and Sports Science in the School of Medical and Health Sciences at Edith Cowan University

Physical activities are essential for children growth and health; thus, it is shocking that about 80 per cent of children aged 11-17 years old are insufficiently physically active globally, and 89 per cent of young Australians and Kiwis do not perform physical activities at least one hour a day.

If only 11 per cent of the children meet the recommendation, the first question is whether the recommendation is valid, and the second question is whether it is possible for every child to accumulate 60 minutes or more of moderate to vigorous physical activity per day.

Theoretically, children have a time to do physical activities at school and before and/or after school, thus having 60 minutes of physical activities in total every day does not appear to be very difficult, if their time is not occupied by other activities (e.g., computer games).

It is interesting to know more why many children are physically inactive. Instead of a 15 per cent relative reduction of global prevalence of insufficient physical activity by 2030 among adolescents and adults, we need to think how ALL children can meet the recommendation.

We need a strategy to increase physical activities in the school, and implement 'exercises' in their daily activities, since it is highly possible to have 5-10 minutes of exercise every one hour or so throughout a day.

Last updated: 21 Nov 2019 12:27pm
Declared conflicts of interest:
None declared.
Dr David Mizrahi is a Clinical Research Officer & Accredited Exercise Physiologist, from the Prince of Wales Clinical School at The University of New South Wales (UNSW)

The fact that the majority of Australian children do not achieve recommended guidelines and we rank so low globally shows there is a serious problem throughout our communities.

We know that physical activity is a modifiable risk factor for developing cardiovascular disease, metabolic and psychological conditions as well as many cancers. It is certainly a behaviour in our control to mitigate these risks.

We also know that inactive children are more likely to become inactive adults, so it is vital to develop these behaviours as early as possible. This is clearly a global issue with the rise in technology use (phones, apps, gaming consoles) and the reduction in incidental activity such as bike riding, walking to school and playing during school lunch-times are contributing to this trend.

Efforts are needed by governments and communities to promote healthy lifestyles in schools and homes from a young age. With the increased technological age we live in, the use of fitness trackers and apps may be useful in monitoring and self-motivating people to become more active to strive towards recommended guidelines and improve the health outlook of growing Australians.

Last updated: 21 Nov 2019 12:26pm
Declared conflicts of interest:
None declared.
Dr Filippe Oliveira works at the Department of Obstetrics and Gynaecology – Monash University, and The Ritchie Centre – Hudson Institute of Medical Research

Gathering and reporting data of 1.6 million teenagers across 146 countries is not an easy task. Even though the study was based on pre-existing self-reported surveys, the data should prompt discussion especially about long-term impacts of physical inactivity early in life. The low levels of physical activity in adolescents are a major concern for their current health.

However, we may be facing an even bigger problem. Physical activity exhibited during adolescence can track through to adulthood. There is strong evidence to support the association between low levels of physical activity and increased risk of health conditions such as cardiovascular diseases, type 2 diabetes mellitus, certain forms of cancer and depression in adulthood.

Alarmingly, increased risk of health complications in reproductive age may also affect possible pregnancies and babies in the future. One way to tackle this problem is by focusing on the development and implementation of health literacy programs for adolescents and their parents. Equipping people to use evidence in regards to physical activity will facilitate improved health not only for our generation but also for the next ones.

Last updated: 21 Nov 2019 12:25pm
Declared conflicts of interest:
None declared.
Alfred Deakin Professor Jo Salmon is Co-Director of the Institute for Physical Activity and Nutrition, as well as is from the School of Exercise and Nutrition Sciences at Deakin University

This research highlights the current levels of physical inactivity among teenagers globally, and for the first time shows how physical activity levels have changed over the last 15 years. It is well known that boys are generally more active than girls. However, this study shows that there have been no changes in the percentage of girls meeting physical activity guidelines of 60 minutes a day, while there was a 2 per cent decrease in the percentage of boys not meeting guidelines. 

A major concern of the findings was that out of 25 high income Western countries, Australia had the highest number of teenagers (9 out of 10) not meeting physical activity guidelines. Italy and France were rated second and third respectively behind Australia.

Against the global trends, teenage Australian boys had bigger increases in inactivity between 2011 and 2016 (84 per cent to 87 per cent respectively), whereas girls were stable over time at 91 per cent. However, there are still fewer girls than boys meeting activity guidelines.

In spite of significant Australian government funds spent on youth sport over the last 10 years ($100s of millions), this has made very little difference to overall physical activity levels. Now is the time for the Australian government to develop a National Physical Activity Action Plan or framework and invest in evidence-based solutions to increase the number of teenagers in this country engaging in enough physical activity for their current and future health.

Last updated: 21 Nov 2019 12:24pm
Declared conflicts of interest:
None declared.
Dr Jodie Cochrane Wilkie is a Senior Lecturer from the School of Medical and Health Sciences at Edith Cowan University (ECU)

The finding that 9 out of 10 Australian adolescents are not meeting physical activity guidelines is alarming but not surprising. Research and trends reported over many years in Australia have shown similar findings.

What is disappointing is that, although in most countries the percentage of insufficient physical activity in boys has decreased, in Australia it actually increased from 2001 to 2016 (from 83.5 per cent to 86.8 per cent). While at the same time the percentage of insufficient physical activity in girls has remained undesirably high (being 91.4 per cent in 2016).

With Australia being one of the worst performers in the report, ranking 140 out of 146 countries urgent action is needed.

Other reports (including the Global Matrix 3.0 developed by the Active Healthy Kids Global Alliance) have shown that Australia is good in measures of physical activity participation in organised sport and schools but showed less positive results in measures of overall physical activity, active transport, screen time, government strategies and investment and physical fitness for children and adolescents.

We also know that compared to 30 years ago our children do not have the same level of fundamental movement skill competency, fitness and strength. If children are unable to perform skills well, such as catching, throwing, kicking, jumping and running, or do not have the required strength, then they are more likely to have low self-esteem and not want to participate in sport. This then leads to inactivity in adolescents and this inactivity continues through to adulthood. There are strong links between physical activity and physical health and mental health, so it is crucial that Australia works on this. 

Another important thing to note is that worldwide and within Australia girls are less active than boys. Therefore, Australia needs to focus on increasing physical activity in children and adolescents, particularly in girls. Social marketing campaigns and also community-based interventions have shown to be effective at doing this, but countries that are doing well have demonstrated that physical activity is driven by culture and society, where being active is not just a choice, but a way of life. More needs to be done in this area, to give children the skills, abilities and confidence when young and continue to develop physical activity in adolescents so we can have young people that are physically and mentally well and adults with less health problems in the future. 

Additionally, the research was based on survey data, mainly undertaken in schools and it represents a limited, representative number of adolescents for each country. It would be ideal to use data collected via wearable devices such as accelerometers or pedometers. However, the researchers do acknowledge this and the limitations of the research. There was no clear pattern of physical activity according to country income group.

Last updated: 21 Nov 2019 12:23pm
Declared conflicts of interest:
None declared.
Associate Professor Rebecca Braham is a researcher in Human Sciences (Sport Science, Exercise and Health) at The University of Western Australia

This is a very important piece of work highlighting the issue around adolescents and physical activity. This large scale global research study using over 1.6 million students, has shown that trends of insufficient physical activity amongst 11-17 year-olds remains high and relatively stable over a 15 year period.

This is concerning because we know that the best predictors of level of physical activity in adulthood, is your activity in adolescents.

On a positive note, when a group identifies as insufficiently active, it means that they are participating in activity but just not enough to meet recommendations so the opportunity for intervention and improvement is there but we just need to find the right strategies and pathways to engage this group.

The disproportionate representation of females over males being insufficiently active is highlighted in this work and something that we are trying to better understand through the program of work that we have commenced at UWA.

Last updated: 21 Nov 2019 12:20pm
Declared conflicts of interest:
None declared.
Associate Professor Carol Maher is a NHMRC Career Development Fellow, from the Alliance for Research in Exercise, Nutrition and Activity (ARENA), and the School of Health Sciences & Sansom Institute for Health Research, at The University of South Australia (UniSA)

Physical activity is important throughout the lifespan,  both for physical health, and mental health. Teens that are physically active have better cardiovascular fitness, stronger bones and muscles, better posture, and less depression and anxiety. As a society, we should be equipping kids and teens with good physical activity skills and habits, since it helps set the norms for their physical activity habits and attitudes that can track with them through the rest of their lives.

This extremely large study brings together data from 1.6 million adolescents aged 11-17 from 146 countries around the world. It is the best global estimate of physical activity levels of teens from around the globe ever produced. It allows us to compare physical activity levels between countries, between boys and girls, and across time (from 2001 – 2016).

The majority of teens around the world aren’t getting enough physical activity – 81 per cent were categorised as insufficiently active (based on them failing to meet the World Health Organization’s guideline of 60 minutes of physical activity on 5 days a week).

The study confirmed the pattern that we always tend to see – that boys are more active than girls.
Australia didn’t fare well – out of 146 countries in the study, we were ranked 140th for our adolescents’ activity levels. 89 per cent of our adolescents fail to meet physical activity guidelines (compared with 81 per cent of adolescents globally). We were the lowest ranked of all of the “western” countries that we would usually compare ourselves to, and consider ourselves similar to.

In contrast to the global data, Australian teens became slightly less physically active across the study period (the % meeting guidelines went from 13 per cent to 11 per cent from 2001 to 2016), whereas the global data showed a small improvement over time. 

Australians tend to have an image of being beach loving, fit and healthy, but these results show it’s not the reality. At first, I was shocked when I saw Australia’s position in the list. However, we also rate badly on a global scale when it comes to overweight and obesity rates. So, the overall pattern makes sense. This really needs to be a wake-up call to Australians and to our governments.

As parents, we want to set our kids up for a happy and health life, and an important part of this is making physical activity a part of every day. Screens and mobile devices are a major challenge. A lot of kids love their screen time, and will spend many hours a day on screens if unchecked. We really need to be limiting screen time to free up time to be active and do other things.

At a society level, we need to look at how we can get kids more active in schools – particular older kids and teens – who often start to opt out of sport and PE. In Australia, we have excellent footpaths and great weather which should be conducive to active transport like walking and cycling.

However, our culture has become increasingly car-centric. In particular, encouraging young people to cycle would be a great way to boost their independence and physical activity levels at the same time. Governments are working to create safe cycling routes but they are inconsistent and incomplete – more should be done to make cycling a safe and normal option.

Last updated: 21 Nov 2019 12:19pm
Declared conflicts of interest:
None declared.
Dr David Chapman is a Post-doctoral fellow at the Translational Airways Group and Molecular Biosciences Team at The University of Technology Sydney (UTS)

Obesity substantially alters the way in which the lung functions. Therefore, the recent findings that 89 per cent of Australians aged between 11 and 17 years don’t meet recommendations for physical activity raises many questions for future lung health in Australia.

Obesity is known to promote the development of asthma, increase the severity of the asthma and reduce the efficacy of common asthma therapies.

Furthermore, the lung continues to grow throughout adolescence, and it appears that lung development is abnormal in obese children and adolescents compared to their normal weight peers. The consequences of obesity-related changes in lung development are not clear, but it may predispose them to lung disease in later life.

On the other hand, exercise has several beneficial effects for people with asthma, such as improved asthma control, reduced lung inflammation and improvements in airway hyper-sensitivity (asthma is characterised by airways that are hyper-sensitive to inhaled allergens leading to airway narrowing and asthma attacks).

Last updated: 21 Nov 2019 12:18pm
Declared conflicts of interest:
None declared.
Professor Richard (Dick) Telford AM is from the Research Institute for Sport and Exercise at the University of Canberra

This Lancet published summary of global findings showing Australian teenagers ranking close to last, i.e. 140 out of 146 in terms of meeting the recommended moderate physical activity level of an hour a day is highly concerning.

We have to believe this finding, because it is consistent with previous studies in Australian children, where the sedentary nature of our teenagers is becoming worldly infamous.

The alarming nature of this finding is enhanced by a very recently published carefully measured study in a typical cohort of Australian teenagers (Telford et al see below) which clearly identified physical inactivity as the most significant characteristic of the overweight and obese children.

The fatter children in general did not eat more than their lean counterparts but were decisively less active. So, with World Health Organization identifying physical inactivity as a major risk factor for physical and mental illness, we have a double whammy with the physical inactivity of our children in that it appears to play a vital role in balancing kilojoules in and out.

Last updated: 21 Nov 2019 12:17pm
Declared conflicts of interest:
None declared.

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