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The economic burden of physical inactivity: a systematic review and critical appraisal
  1. Ding Ding1,2,
  2. Tracy Kolbe-Alexander3,4,
  3. Binh Nguyen1,
  4. Peter T Katzmarzyk5,
  5. Michael Pratt6,
  6. Kenny D Lawson2,7
  1. 1 Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
  2. 2 Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
  3. 3 Department of Human Biology, Research Unit for Exercise Science and Sports Medicine (ESSM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  4. 4 School of Health and Wellbeing, University of Southern Queensland, Ipswich, Australia
  5. 5 Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
  6. 6 Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
  7. 7 Centre for Health Research, School of Medicine, Western Sydney University, Penrith, Australia
  1. Correspondence to Dr Ding Ding, Prevention Research Collaboration, Sydney School of Public Health, (6N55) Level 6, the Charles Perkins Centre (D17), The University of Sydney, Camperdown, NSW 2006, Australia; melody.ding{at}


Objective To summarise the literature on the economic burden of physical inactivity in populations, with emphases on appraising the methodologies and providing recommendations for future studies.

Design Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42016047705).

Data sources Electronic databases for peer-reviewed and grey literature were systematically searched, followed by reference searching and consultation with experts.

Eligibility criteria Studies that examined the economic consequences of physical inactivity in a population/population-based sample, with clearly stated methodologies and at least an abstract/summary written in English.

Results Of the 40 eligible studies, 27 focused on direct healthcare costs only, 13 also estimated indirect costs and one study additionally estimated household costs. For direct costs, 23 studies used a population attributable fraction (PAF) approach with estimated healthcare costs attributable to physical inactivity ranging from 0.3% to 4.6% of national healthcare expenditure; 17 studies used an econometric approach, which tended to yield higher estimates than those using a PAF approach. For indirect costs, 10 studies used a human capital approach, two used a friction cost approach and one used a value of a statistical life approach. Overall, estimates varied substantially, even within the same country, depending on analytical approaches, time frame and other methodological considerations.

Conclusion Estimating the economic burden of physical inactivity is an area of increasing importance that requires further development. There is a marked lack of consistency in methodological approaches and transparency of reporting. Future studies could benefit from cross-disciplinary collaborations involving economists and physical activity experts, taking a societal perspective and following best practices in conducting and reporting analysis, including accounting for potential confounding, reverse causality and comorbidity, applying discounting and sensitivity analysis, and reporting assumptions, limitations and justifications for approaches taken. We have adapted the Consolidated Health Economic Evaluation Reporting Standards checklist as a guide for future estimates of the economic burden of physical inactivity and other risk factors.

  • physical activity
  • economic burden
  • economic cost
  • cost analysis
  • healthcare cost
  • health expenditure
  • systematic review

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  • Contributors DD led the conceptualisation, design and writing of this paper with critical input from KDL and other coauthors. DD, TLK-A and BN conducted independent literature search and study selection. DD conducted data extraction with TLK-A and BN independently re-entering data for quality check. DD and KDL developed the checklist. All authors critically reviewed the paper and approved the final version for submission.

  • Funding Dr Ding (APP1072223) is funded by an early career fellowship from the National Health and Medical Research Council of Australia. The funding sources had no involvement in the analysis presented here.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.