Adherence to aerobic and muscle-strengthening activities guidelines: a systematic review and meta-analysis of 3.3 million participants across 32 countries
Open accessAbstract
Objective: To estimate the global prevalence of meeting the WHO guidelines for both aerobic and muscle-strengthening activities (MSA) in populations aged ≥5 years, and whenever possible to explore this prevalence according to sociodemographic and lifestyle factors. Design: A systematic review and meta-analysis. Data sources: Five databases were systematically searched for studies published from inception to September 2022. Eligibility criteria for selecting studies: Articles with representative samples aged ≥5 years reporting the prevalence of meeting both aerobic and MSA guidelines were included. Results: Twenty-one studies comprising 3 390 001 individuals from 32 countries were included. Overall adherence to the aerobic and MSA guidelines was 17.12% (95% CI 15.42% to 18.88%) in adults ≥18 years (n=3 346 723). Among adolescents aged 12–17 years, adherence to both guidelines was 19.74% (95% CI 14.72% to 25.31%) (n=43 278). No studies reported data for children aged 5–11 years. Women, older age, low/medium education levels, underweight or obesity, and poor and moderate self-rated health were associated with lower adherence to the physical activity guidelines (p<0.001) among adults, although the prevalence remained very low in all cases. Subgroup analyses were not conducted with children and adolescents due to a lack of studies. Conclusions: Only one out of five adolescents and adults met the recommended combined aerobic and MSA guidelines. Large-scale public health interventions promoting both types of exercise are needed to reduce the associated burden of non-communicable diseases. PROSPERO registration number: CRD42022338422.
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Only 17% of adults in the general population follow the World Health Organization physical activity guidelines.
“adherence to the World Health Organization recommendations for adults in the general population remains notably low at just 17% (51).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [51]
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Cites
The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n71 · Cited by 108,283 · see citing works
World Health Organization 2020 guidelines on physical activity and sedentary behaviour
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., et al. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-102955 · Cited by 11,657 · see citing works
The Physical Activity Guidelines for Americans
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018) · JAMA · doi:10.1001/jama.2018.14854 · Cited by 9,755 · see citing works
Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I.-M., Nieman, D. C., & Swain, D. P. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318213fefb · Cited by 9,319 · see citing works
Global physical activity levels: surveillance progress, pitfalls, and prospects
Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60646-1 · Cited by 5,711 · see citing works
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30357-7 · Cited by 4,819 · see citing works
HASKELL, W. L., LEE, I.-M., PATE, R. R., POWELL, K. E., BLAIR, S. N., FRANKLIN, B. A., MACERA, C. A., HEATH, G. W., THOMPSON, P. D., & BAUMAN, A. (2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3180616b27 · Cited by 4,616 · see citing works
Correlates of physical activity: why are some people physically active and others not?
Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., & Martin, B. W. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60735-1 · Cited by 4,151 · see citing works
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2020) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(19)30323-2 · Cited by 4,033 · see citing works
Hoy, D., Brooks, P., Woolf, A., Blyth, F., March, L., Bain, C., Baker, P., Smith, E., & Buchbinder, R. (2012) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.11.014 · Cited by 2,555 · see citing works
Barendregt, J. J., Doi, S. A., Lee, Y. Y., Norman, R. E., & Vos, T. (2013) · Journal of Epidemiology and Community Health · doi:10.1136/jech-2013-203104 · Cited by 2,169 · see citing works
Metaprop: a Stata command to perform meta-analysis of binomial data
Nyaga, V. N., Arbyn, M., & Aerts, M. (2014) · Archives of Public Health · doi:10.1186/2049-3258-72-39 · Cited by 2,139 · see citing works
International exercise recommendations in older adults (ICFSR): Expert consensus guidelines
Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., Aubertin-Leheudre, M., Bernabei, R., Cadore, E. L., Cesari, M., et al. (2021) · The Journal of nutrition, health and aging · doi:10.1007/s12603-021-1665-8 · Cited by 1,247 · see citing works
Self-citationU.S. Disparities in Health: Descriptions, Causes, and Mechanisms
Adler, N. E., & Rehkopf, D. H. (2008) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.29.020907.090852 · Cited by 1,212 · see citing works
A new improved graphical and quantitative method for detecting bias in meta-analysis
Furuya-Kanamori, L., Barendregt, J. J., & Doi, S. A. R. (2018) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000141 · Cited by 1,160 · see citing works
Test-retest reliability of four physical activity measures used in population surveys
Brown, W. J., Trost, S. G., Bauman, A. E., Mummery, K. W., & Owen, N. G. (2004) · Journal of science and medicine in sport · doi:10.1016/s1440-2440(04)80010-0 · Cited by 515 · see citing works
Momma, H., Kawakami, R., Honda, T., & Sawada, S. S. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-105061 · Cited by 265 · see citing works
Stamatakis, E., Lee, I. M., Bennie, J., Freeston, J., Hamer, M., O’Donovan, G., Ding, D., Bauman, A., & Mavros, Y. (2018) · American Journal of Epidemiology · doi:10.1093/aje/kwx345 · Cited by 198 · see citing works
Bennie, J. A., Pedisic, Z., van Uffelen, J. G. Z., Gale, J., Banting, L. K., Vergeer, I., Stamatakis, E., Bauman, A. E., & Biddle, S. J. H. (2015) · BMC Public Health · doi:10.1186/s12889-016-2736-3 · Cited by 177 · see citing works
Whitfield, G. P., Carlson, S. A., Ussery, E. N., Fulton, J. E., Galuska, D. A., & Petersen, R. (2019) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6823a1 · Cited by 177 · see citing works
Lee, S. W., Lee, J., Moon, S. Y., Jin, H. Y., Yang, J. M., Ogino, S., Song, M., Hong, S. H., Ghayda, R. A., Kronbichler, A., et al. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104203 · Cited by 174 · see citing works
Meat plants—a new front line in the covid-19 pandemic
Middleton, J., Reintjes, R., & Lopes, H. (2020) · BMJ · doi:10.1136/bmj.m2716 · Cited by 163 · see citing works
Ding, D., Mutrie, N., Bauman, A. E., Pratt, M., Hallal, P. R. C., & Powell, K. E. (2020) · The Lancet · doi:10.1016/s0140-6736(20)32229-7 · Cited by 147 · see citing works
Meeting the 2008 Physical Activity Guidelines for Americans Among U.S. Youth
Song, M., Carroll, D. D., & Fulton, J. E. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.11.016 · Cited by 84 · see citing works
Bennie, J. A., Pedišić, Ž., Suni, J. H., Tokola, K., Husu, P., Biddle, S., & Vasankari, T. J. (2017) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12863 · Cited by 64 · see citing works
Physical Activity Levels of High School Students—United States, 2010
Fulton, J. E., Carroll, D. D., Galuska, D. A., Lee, S. M., Eaton, D. K., Brener, N. D., & Song, M. (2011) · JAMA · doi:10.1001/jama.306.4.367 · Cited by 52 · see citing works
Muscle Strengthening, Aerobic Exercise, and Obesity: A Pooled Analysis of 1.7 Million US Adults
Bennie, J. A., Cocker, K. A. D., Pavey, T., Stamatakis, E. A., Biddle, S., & Ding, D. (2019) · Obesity · doi:10.1002/oby.22673 · Cited by 49 · see citing works
Dankel, S. J., Loenneke, J. P., & Loprinzi, P. D. (2016) · American Journal of Health Promotion · doi:10.4278/ajhp.150520-quan-894 · Cited by 43 · see citing works
Cocker, K. A. D., Teychenne, M. J., White, R. L., & Bennie, J. A. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106192 · Cited by 31 · see citing works
Adhering to the 2017 Dutch Physical Activity Guidelines: A Trend over Time 2001–2018
Duijvestijn, M., van den Berg, S. W., & Wendel‐Vos, W. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17030681 · Cited by 30 · see citing works
Chen, T. J., Watson, K. B., Michael, S. L., & Carlson, S. A. (2021) · Journal of Physical Activity and Health · doi:10.1123/jpah.2021-0263 · Cited by 28 · see citing works
Bennie, J. A., Ding, D., Khan, A., Stamatakis, E. A., Biddle, S., & Kim, J. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318817899 · Cited by 27 · see citing works
Bennie, J. A., Cocker, K. A. D., & Tittlbach, S. A. (2021) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13922 · Cited by 27 · see citing works
Wennman, H., & Borodulin, K. (2021) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.13840 · Cited by 26 · see citing works
SANDERCOCK, G. R. H., Moran, J., & Cohen, D. D. (2022) · PLoS ONE · doi:10.1371/journal.pone.0267277 · Cited by 22 · see citing works
Sung, H., Kim, G., Ma, X., Choe, H., Han, Y., Yoon, J., Ryu, Y., & Kim, Y. S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095213 · Cited by 18 · see citing works
Bennie, J. A., & Wiesner, G. (2021) · Journal of Physical Activity and Health · doi:10.1123/jpah.2021-0349 · Cited by 9 · see citing works
Lackinger, C., & Dorner, T. E. (2015) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-015-0350-0 · Cited by 7 · see citing works
Dorner, T. E., Lackinger, C., Haider, S., & Stein, K. V. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189910 · Cited by 4 · see citing works
Mode of Physical Activity Participation in US Adults: A Regional Perspective
Churilla, J. R., Johnson, T. M., & Richardson, M. R. (2022) · Southern Medical Journal · doi:10.14423/smj.0000000000001350 · Cited by 2 · see citing works
Detecting and describing heterogeneity in meta-analysis
Hardy, R. J., & Thompson, S. G. (1998) · Statistics in Medicine · doi:10.1002/(sici)1097-0258(19980430)17:8
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- Zhao M, Veeranki SP, Magnussen CG, et al. Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. BMJ 2020;370:1-10. on September 11, 2023 by guest. Protected by copyright. http://bjsm.bmj.com/ Br J Sports Med: first published as 10.1136/bjsports-2022-106189 on 23 November 2022. Downloaded from Review · DOI · Paper page
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Self-citationBehm, D. G., Granacher, U., Warneke, K., Aragão-Santos, J. C., Da Silva-Grigoletto, M. E., & Konrad, A. (2024) · Sports Medicine · doi:10.1007/s40279-023-01949-3 · Cited by 45 · see citing works
“Garcia-Hermoso et al. [29] reported that adherence to these guidelines was 17.1%, 13.6%, and 19.5% in young and middle-aged adults, older adults, and adolescents, respectively.”
BackgroundInfluentialÁlvarez-Bustos, A., Laosa, O., Marzetti, E., Carnicero, J. A., Castro-Rodriguez, M., Landi, F., Sinclair, A. J., & Rodriguez-Mañas, L. (2024) · Age and Ageing · doi:10.1093/ageing/afad253 · Cited by 10 · see citing works
The Benefits of Exercise Training in Combination With Weight Loss Therapies
Jiang, B. C., & Villareal, D. T. (2025) · Diabetes · doi:10.2337/dbi25-0001 · Cited by 9 · see citing works
- Authors
- Garcia-Hermoso, A., López-Gil, J. F., Ramírez-Vélez, R., Alonso-Martínez, A. M., Izquierdo, M., & Ezzatvar, Y.
- Affiliations
- Universidad Pública de Navarra (UPNA) (ES)
- Universitat de València (ES)
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2022-11-23
- Volume
- 57
- Issue
- 4
- Pages
- 225-229
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W4309822129
- Cited by
- 154
- References
- 42
- Citations by year
- 2026: 32 · 2025: 40 · 2024: 58 · 2023: 23 · 2021: 1
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Life-span and Life-course Studies › Sports and Physical Education Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- physical activity guidelines adherence, aerobic exercise, muscle-strengthening activity, physical activity prevalence, WHO guidelines, sociodemographic factors, self-rated health, obesity, sex differences, adolescents, adults, non-communicable diseases
- MeSH terms
- Adolescent, Adult, Child, Exercise Therapy, Female, Humans, Life Style, Muscles, Obesity, Exercise
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