Physical activity promotion: can a focus on disease limit successful messaging?

Abstract

We read with interest the comment by Pedro Hallal and Michael Pratt,1Hallal PC Pratt M Physical activity: moving from words to action.Lancet Glob Health. 2020; 8: e867-e868Google Scholar which offered reasons for why the promotion of physical activity globally has been unsuccessful. We note their concern about problems with mixed messaging. However, before “moving from words to action”, we encourage more reflection on the ideas used to frame the issue.1Hallal PC Pratt M Physical activity: moving from words to action.Lancet Glob Health. 2020; 8: e867-e868Google Scholar We are troubled by the authors' repetition of Chi Pang Wen and Xifeng Wu's claim that “we need to view the inactive population as abnormal”.2Wen CP Wu X Stressing harms of physical inactivity to promote exercise.Lancet. 2012; 380: 192-193Google Scholar Surely issues such as unsafe neighbourhoods, poor education systems, unhealthy workplaces, and political corruption should be the target of condemnation, rather than labelling these individuals with the stigmatising term of abnormal. People who do not meet activity thresholds deserve sympathy, not stigma. We also argue for a broader view of the concept of physical activity benefits beyond dominant disease-management justifications. Physical activity is a complex political, social, and emotional act.3Piggin J What is physical activity? A holistic definition for teachers, researchers and policy makers.Front Sports Act Living. 2020; 2: 72Google Scholar Researchers might continue to be frustrated with progress if they aim to rely on “single standardised questionnaires” or judge people as being abnormal on the basis of precise physical activity thresholds. A prospective cohort study published in 2020 by Aaron Kandola and colleagues4Kandola A Lewis G Osborn DP Stubbs B Hayes JF Depressive symptoms and objectively measured physical activity and sedentary behaviour throughout adolescence: a prospective cohort study.Lancet Psychiatry. 2020; 7: 262-271Google Scholar showed that depression scores at 18 years were lower for every additional 60 min/day of light activity done throughout adolescence. The authors observed that physical activity guidelines and interventions are dominated by physical health goals. Emphasising the mental health benefits of activity might send a more meaningful message to adolescents to promote physical activity. As such, useful solutions to the communication problem could lie outside of traditional physical health goals. Relatedly, recommendations centred on quantity or intensity of physical activity and oriented towards distal goals (rather than proximal goals) might actually hinder people's decision making about physical activity. Evidence from the Copenhagen City Heart Study,5Schnohr P O'Keefe JH Holtermann A et al.Various leisure-time physical activities associated with widely divergent life expectancies: the Copenhagen city heart study.Mayo Clin Proc. 2018; 93: 1775-1785Google Scholar in which all-cause mortality in 8577 participants followed for up to 25 years was analysed, showed that sport choices involving more social interaction were associated with the greatest longevity when compared with sedentary individuals. Thus, rather than focusing on the long-term benefits, physical activity can meet immediate human needs for interaction. The benefits of physical activity message could put more emphasis on friendship than longevity. Ambiguous or mixed messaging could indeed be a problem. Ironically, however, a far greater communication problem might be the over-emphasis on disease-related values, tests, and judgments that are imposed on people and their intentions to be physically active (often from a very young age). Any potential physiological benefits of physical activity might often have little to do with the reasons people are active. There is more to physical activity than health. We declare no competing interests. Physical activity: moving from words to actionIn 2008, an analysis of disease burden showed physical inactivity to be the cause of 5·3 million deaths worldwide, largely due to its 9% population attributable fraction for premature mortality.1 In 2016, the global prevalence of physical inactivity was 27·5%.2 The mortality estimates for physical inactivity are similar to those observed for tobacco smoking.3 However, unlike tobacco control programmes, the promotion of physical activity globally has largely been unsuccessful, due to poor coordination, ambiguous messaging, and a general absence of recognition of physical activity as a fundamental human right and public health priority. Full-Text PDF Open Access

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