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Adherence to aerobic and muscle-strengthening activities guidelines: a systematic review and meta-analysis of 3.3 million participants across 31 countries
  1. Antonio Garcia-Hermoso1,
  2. José Francisco López-Gil2,
  3. Robinson Ramírez-Vélez1,3,
  4. Alicia María Alonso-Martínez1,3,
  5. Mikel Izquierdo1,3,
  6. Yasmin Ezzatvar4
  1. 1Navarrabiomed, Hospital Universitario de Navarra (HUN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
  2. 2Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
  3. 3CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
  4. 4Department of Nursing, Universitat de València, Valencia, Spain
  1. Correspondence to Antonio Garcia-Hermoso, Navarrabiomed, Hospital Universitario de Navarra (HUN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Navarra 31008, Spain; antonio.garciah{at}


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 31 countries were included. Overall adherence to the aerobic and MSA guidelines was 17.15% (95% CI 15.44% to 18.94%) in adults ≥18 years (n=3 337 603). Among adolescents aged 12–17 years, adherence to both guidelines was 19.45% (95% CI 16.34% to 22.75%) (n=52 398). 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.

  • exercise
  • public health
  • physical activity
  • meta-analysis
  • health promotion

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  • Contributors AG-H conceived the study, drafted the analysis plan and manuscript, and conducted statistical analyses; JFL-G reviewed the analysis plan and helped to draft the manuscript; YE assisted with data cleaning and preparation and helped to draft the manuscript; MI helped to draft the manuscript; RR-V and AMA-M helped to draft the manuscript and provided input on the analysis plan. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer AG-H had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Also, AG-H is the responsible for the data analysis.

  • Competing interests YE is an associate editor of BJSM.

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

  • 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.