TY - JOUR T1 - Sliding down the risk factor rankings: reasons for and consequences of the dramatic downgrading of physical activity in the Global Burden of Disease 2019 JF - British Journal of Sports Medicine JO - Br J Sports Med DO - 10.1136/bjsports-2021-104064 SP - bjsports-2021-104064 AU - Emmanuel Stamatakis AU - Ding Ding AU - Ulf Ekelund AU - Adrian E Bauman Y1 - 2021/04/29 UR - http://bjsm.bmj.com/content/early/2021/04/28/bjsports-2021-104064.abstract N2 - Published in the Lancet in 2020, the Global Burden of Disease (GBD) 2019 provided updated disease burden rankings for 87 risk factors including behavioural and metabolic risks. GBD 2019 ranked low physical activity 19th out of 20 risk factors in terms of disability-adjusted life years, down from 10th in the equivalent 2010 GBD publication.1 The number of attributable deaths has decreased from 3.2 million in 20101 to approximately 1.2 million in 20192; both estimates are substantially lower than the Lancet 2012 physical activity series estimates (5 million deaths/year).3 GBD authors2 do not comment on this remarkable demotion of physical activity’s ranking in 2019, despite the fact that it contradicts the significant progress in the field of physical activity over the last decade.4 Here, we explore this seemingly counterintuitive downgrade to alert policy makers, health professionals and researchers about the caveats of interpreting GBD data. We also offer suggestions on how to improve future physical activity GBD estimates.Physical activity is a complex multidimensional behaviour whose health effects are determined by its intensity, duration, type (eg, aerobic vs strength training) and domain.4 GBD considered a single physical activity indicator that captures only total volume. This provides a stark contrast with how GBD treated other behaviours such as diet, which was addressed by 15 different risk factor indicators, including a diet low in seafood omega-3 fatty acids intake and low milk … ER -