Table 3

Characteristics of studies that applied an econometric approach to estimating the direct healthcare costs of physical inactivity (n=17)

First author and year of publicationCountryData sourcesDesignSamplePA categoriesTypes of costsCovariates adjustedMajor findingsPopulation-level amount* (%)†, sensitivity/uncertainty analysisTime frame‡Funding/COI
Anderson 200559 USAHeathPartners members survey (1995) linked with administrative healthcare claim data (1996–1999)Cross-sectionalMembers ≥40 years of age (n=4674)≥4×30 min/week (yes vs no)Professional and hospital claimsAge, sex, chronic disease, smoking, BMIPhysical inactivity, overweight and obesity were associated with 23% health plan charges and 27% of national healthcare chargesStatistical sensitivity analysis conducted1 year (1997)HealthPartners Center for Health Promotion/COI statement missing
Andreyeva 200635 USAHealth and Retirement StudyLongitudinalAdults aged 51–61 years and their spouses (n=7338)Any VPA versus no VPATotal healthcare costBaseline healthcare spending, socio-demographics, chronic health conditions, smoking, alcohol, BMIPA was associated with a 7.3% reduction in healthcare cost over 2 yearsStructural and statistical sensitivity analysis: 13.2% reduction when baseline health was not adjusted1 year (2004)No funding reported/COI statement missing
Aoyagi 201142 JapanNakanojo StudyCross-sectionalAll willing community residents aged ≥65 years (not severely demented or bedridden; n=5200)Quartiles based on accelerometer and pedometer
Q1=2000 steps/day and 5–10 min/day of activity at >3 METs
Insurance payments for treatment by a doctor or outpatient service of a hospital (no inpatient treatment cost)Not statedIncrease in PA of 5% of each group by a single ranking leads to 3.7% of total medical expense1 year (2009)Japan Society for the Promotion of Science/no COI declared
Brown 200843 AustraliaALSWH 2001Cross-sectionalWomen participants aged 50–55 years (n=7004)High: ≥1200 MET.min/week
Moderate: 600–<1200 MET.min/week
Low: 240–<600 MET.min/week
Very low: 40–<240 MET.min/week
None: <40 MET.min/week
Australian Medicare System (outpatient, general practitioner, specialist, and others)Area of residence, education, smoking, alcoholCosts were 26% higher in inactive than in moderately active women, and 43% higher in inactive and obese women than in healthy weight, moderately active womenPotential population-level savings: increasing from ‘none’ to ‘low’ without changing BMI: $A39.1 million, with change in BMI: $A47.1 million1 year (2001)Australian Government Department of Health and Ageing/COI statement missing
Carlson 20145 USANHIS 2004–2010, MEPS 2006–2011Cross-sectionalAdults aged ≥21 years (non-pregnant, did not respond unable to do PA; n=51 165)Active: ≥150 min MVPA/week
Insufficiently active: >0–<150 min MVPA/week
Inactive: 0 MVPA
Expenditures for all servicesAge, sex, race/ethnicity, marital status, census region, area, poverty level, health insurance, education, smoking, BMIMean annual difference in inactive adults (compared with active) was US$1437 (29.9%) and in insufficiently active US$713 (15.4%)Physical inactivity accounted for US$131 (91–172) billion (12.5%), US$117 (76–158) billion (11.1%) after adjusting for BMI; multiple structural and statistical sensitivity analyses, eg, after excluding those with difficulty walking: US$90 (58–122) billion (9.9%); and further adjusted for BMI: $79 (46–112) billion (8.7%)
Converted national estimate: $132.9 billion INT
1 year (2012)No funding reported/no COI declared
Chevan 201446 USANHIS 2006–2007, MEPS 2007–2009Cross-sectionalNon-disabled adults (did not respond unable to do PA; n=8843)(1) PA guidelines (strength and/or aerobic PA)
(2) Aerobic PA
(0; <75; 75–149, 150–299, >300 min/week)
Expenditures for all servicesAge, sex, race, income, health statusNo significant association between PA and expenditure when adjusted for covariates1 year (2012)No funding reported/No COI declared
Cho 201139 KoreaA study of 250 adultsCross-sectionalAdults aged ≥ 40 years, selected from community centres (n=250)Inactive versus acceptable versus active based on questionnaire scoreSelf-reported healthcare visits and direct expenditureNoneThe mean difference between active and inactive persons was US$14.12/month1 year (2009)Korean Government/COI statement missing
Codogno 201548 BrazilLocal municipality health offices healthcare expenditure dataCross-sectionalAdults randomly selected in five basic healthcare units in Bauru (≥50 years; n=963)Habitual PA questionnaire score quartilesOverall healthcare expenditure (all items registered in the medical records)Age, sex, smoking, blood pressure, BMIInverse association between PA and expenditurePA explained 1% of medicine and 0.7% overall expenditure (statistical sensitivity analysis conducted)1 year (2010)Brazilian Government and Brazilian Ministry of Science and Technology/no COI declared
Lin 200845 TaiwanNHIS 2001, National Health Insurance Research Database 2001Cross-sectionalAdults selected from three major regions of Taiwan (n=15 670)Exercised in the past 2 weeks (yes versus no)Healthcare claim data (inpatient and outpatient)Age, sex, ethnicity, marital status, employment status, income, education,Those who exercised had lower inpatient expenses (2079 vs 3330 NT$) but higher outpatient expenses (9738 vs 9151 NT$)1 year (2001)Taiwan’s National Science Council/COI statement missing
Min 201638 KoreaKorean National Health Insurance DatabaseRetrospective cohort40 to 69-year-old adults who had not changed PA levels during the study period (n=47 290)Continuously reported exercise that ‘worked up a sweat’ for >1 time/weekInpatient, outpatient and prescription costsAge, sex, income, area of residence, smoking, alcohol, BMI (propensity score matching)Those who were continuously inactive had 11.7% higher medical costs (8.7%–25.3% disease specific)Multiple years (2005–2010)National Research Foundation of Korea and Seoul National University Hospital/no COI declared
Musich 200344 AustraliaAHMG Insurance Claim Health Risk Appraisal data (1995–1999)Cross-sectionalAHMG members (n=19 812)≤60 min/week (at risk) versus >60 min/weekClaim charges, primarily including inpatient and some ancillary servicesNoneAt risk versus not at risk: $460 versus $A423/year (not statistically significant)2 years (1995–1999)No funding reported/COI statement missing
Peeters 201436 AustraliaALSWH and Medicare system (2001–2010)LongitudinalMiddle-aged cohort (born 1946–1951) of Australian women (n=5535–6108)(1) Active (≥40 MET-min/day)/low sitting (<8 hours/day)
(2) Active/high sitting
(3) Inactive/ low sitting
(4) Inactive/high sitting
Total Medicare cost paid by the government and out of pocketSurvey year, marital status, area of residence, education, smoking, BMI, depressive symptomsPhysical inactivity, not prolonged sitting was associated with higher costs ($A94/year)$A40 million at the national level1 year (2010)Australian Government Department of Health and Ageing and Australian National Health and Medical Research Council/no COI declared
Pratt 200040 USANMES 1987Cross-sectionalNon-pregnant participants aged ≥15 years, without physical limitations (n=20 041)≥30 min of MVPA over ≥3 days versus the rest of the sampleSelf-reported medical costs confirmed by a survey of medical providersAge, sex, lifetime smoking statusLower annual direct medical costs among those who are physically active: US$1019 versus US$1349US$29.2 billion, statistical sensitivity analysis conducted
Converted national estimate: $103.6 billion INT
1 year (1987)No funding reported/COI statement missing
Pronk 199947 USAHeathPartners members survey (1995) linked with administrative healthcare claim data (1995–1996)Cross-sectional dataMembers ≥40 years of age (n=5689)Number of active days in the prior weekHealthPartners medical claimsAge, sex, race, chronic disease, smoking, BMIAn additional day of PA led to a 4.7% decrease in median medical charges1.5 years (1995–1996)HealthPartners/COI statement missing
Wang 200441 USANMES 1987Cross-sectionalNon-pregnant adults who reported being downhearted and blue at least a little of the time (n=12 250)≥30 min of MVPA over ≥3 days versus the rest of the sampleMedical costs including hospitalisations, physician visits, medication, home careAge, sex, race, socioeconomic status, area of residence, physical limitations, smoking, body weightAmong those downhearted and blue, physical inactivity was associated with 6.1% of the expenditure (US$133 in 1987 and US$429 in 2003)Physical inactivity accounted for US$11.8 billioConverted national estimate: $37.2 billion INTn in 1987 (US$38 billion in 2003) among those who were downhearted and blue1 year (1987/2003)No funding reported/COI statement missing
Wang 200449 USANHIS 1995, MEPS 1996Cross-sectionalNon-pregnant adults without physical limitations (n=2472)≥5×30 min MPA/week or ≥3×20 min VPA versus the rest of the sampleSelf-reported medical costs confirmed by a survey of medical providersCovariates were not specified, stratified by age groups, sex, smoking status and weightActive adults and lower prevalence of CVD and lower cost per case of CVDPhysical inactivity accounted for 13.1% of medical expenditure of people with CVD1 year (1996)No funding reported/COI statement missing
Yang 201137 JapanA cohort of the National Health Insurance beneficiariesLongitudinalSeniors aged ≥70 years capable of PA, without CVD, cancer, arthritis, and cognitive dysfunction (n=483)Low: no sports+ no brisk walking + low walking
Moderate: no sports + no brisk walking + any walking
High: any sports + any brisk walking + any walking
Inpatient and outpatient costsAge, sex, hypertension, hyperlipidaemia, diabetes, liver or renal disease, smoking, drinking, BMI, physical performance, depressive symptoms, cognitive statusPer capita medical costs: low versus moderate versus high: US$875 versus US$751 versus US$723/month; when adjusted for physical performance: US$827 versus US$711 versus US$702/month (difference driven by inpatient costs)Statistical sensitivity analysis conducted5.5 years (2002–2008)Japanese Society for Promotion of Science, Japan Atherosclerosis Prevention Fund, Ministry of Health, Labour and Welfare of Japan/COI statement missing
  • *Converted national estimate: we inflated the national estimates in local currency units from the year of data to 2013 using the annual consumer prices inflation indicators from the World Bank ( and then converted to purchasing power parity (PPP) international dollars using conversion factors provided by the World Bank (

  • †Interpreted as the total amount of direct healthcare cost that was associated with physical inactivity. % interpreted as the percentage of overall healthcare cost that was spent on diseases that were attributable to physical inactivity.

  • ‡The cost estimate may be based on data from multiple years; however, the time frame here refers to the year for which the estimate is presented. For example, Anderson 200559 averaged annualised charges over a 4-year period (from 1996 to 1999) but presented the estimates in 1997 US$.

  • A, Australian dollars;  AHMG, Australian Health Management Group; ALSWH, Australian Longitudinal Study on Women’s Health; BMI, body mass index; COI, conflict of interest; CVD, cardiovascular disease; INT, International dollars; MEPS, Medical Expenditure Panel Survey; MET, metabolic equivalents; MPA, moderate physical activity; MVPA, moderate-to-vigorous physical activity; NHIS, National Health Interview Survey; NMES, National Medical Expenditure Survey; NT$, New Taiwan dollars; PA, physical activity; Q1, quartile 1; VPA, vigorous physical activity.