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Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries
  1. Peter T Katzmarzyk1,
  2. Christine Friedenreich2,3,
  3. Eric J Shiroma4,
  4. I-Min Lee5,6
  1. 1Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  2. 2Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Calgary, Alberta, Canada
  3. 3Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  4. 4Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland, USA
  5. 5Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Peter T Katzmarzyk, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; peter.katzmarzyk{at}


Objectives Physical inactivity is a risk factor for premature mortality and several non-communicable diseases. The purpose of this study was to estimate the global burden associated with physical inactivity, and to examine differences by country income and region.

Methods Population-level, prevalence-based population attributable risks (PAR) were calculated for 168 countries to estimate how much disease could be averted if physical inactivity were eliminated. We calculated PARs (percentage of cases attributable to inactivity) for all-cause mortality, cardiovascular disease mortality and non-communicable diseases including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers of the bladder, breast, colon, endometrium, oesophagus, stomach and kidney.

Results Globally, 7.2% and 7.6% of all-cause and cardiovascular disease deaths, respectively, are attributable to physical inactivity. The proportions of non-communicable diseases attributable to physical inactivity range from 1.6% for hypertension to 8.1% for dementia. There was an increasing gradient across income groups; PARs were more than double in high-income compared with low-income countries. However, 69% of total deaths and 74% of cardiovascular disease deaths associated with physical inactivity are occurring in middle-income countries, given their population size. Regional differences were also observed, with the PARs occurring in Latin America/Caribbean and high-income Western and Asia-Pacific countries, and the lowest burden occurring in Oceania and East/Southeast Asia.

Conclusion The global burden associated with physical inactivity is substantial. The relative burden is greatest in high-income countries; however, the greatest number of people (absolute burden) affected by physical inactivity are living in middle-income countries given the size of their populations.

  • physical activity
  • sedentary

Statistics from


  • Contributors PTK conceived the study, analysed the data and wrote the first draft of the article. CF helped design the study and reviewed and edited the article. EJS helped design the study, analysed the data, and reviewed and edited the article. I-ML helped design the study and reviewed and edited the article. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This work was supported, in part, by the National Institute of General Medicine Sciences of the National Institutes of Health under Award Number U54-GM104940, the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number P30-DK072476, and by the Intramural Research Programme at the National Institute on Aging (USA).

  • Disclaimer The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The study specific summary data included in this study can be obtained from the corresponding author,

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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