{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:18:57Z","timestamp":1793351937803,"version":"4.5.0"},"reference-count":75,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Med"],"published-print":{"date-parts":[[2026,4]]},"DOI":"10.1038\/s41591-026-04237-5","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T16:01:32Z","timestamp":1773072092000},"page":"1479-1489","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Physical activity for public health in the 21st century"],"prefix":"10.1038","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9726-0882","authenticated-orcid":false,"given":"Deborah","family":"Salvo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inacio","family":"Crochemore-Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Wendt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Tarp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Shiroma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Simpson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1083-6907","authenticated-orcid":false,"given":"I-Min","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Ekelund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7599-165X","authenticated-orcid":false,"given":"Ester","family":"Cerin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2862-2858","authenticated-orcid":false,"given":"Youssouf","family":"Keita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Bauman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro C.","family":"Hallal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ramirez Varela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8939-7715","authenticated-orcid":false,"given":"Michael","family":"Pratt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3928-7830","authenticated-orcid":false,"given":"Erica","family":"Hinckson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9850-9224","authenticated-orcid":false,"given":"Ding","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Harold W.","family":"Kohl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sallis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"4237_CR1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1136\/bjsports-2020-103640","volume":"56","author":"PT Katzmarzyk","year":"2022","unstructured":"Katzmarzyk, P. T., Friedenreich, C., Shiroma, E. J. & Lee, I.-M. Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries. Br. J. Sports Med. 56, 101\u2013106 (2022).","journal-title":"Br. J. Sports Med."},{"key":"4237_CR2","unstructured":"World Health Organization. Every move counts towards better health \u2013 says WHO. https:\/\/www.who.int\/news\/item\/25-11-2020-every-move-counts-towards-better-health-says-who (2020)."},{"key":"4237_CR3","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/S0140-6736(17)30402-6","volume":"389","author":"E Mendenhall","year":"2017","unstructured":"Mendenhall, E., Kohrt, B. A., Norris, S. A., Ndetei, D. & Prabhakaran, D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 389, 951\u2013963 (2017).","journal-title":"Lancet"},{"key":"4237_CR4","doi-asserted-by":"publisher","first-page":"3262","DOI":"10.3390\/ijerph20043262","volume":"20","author":"K Saqib","year":"2023","unstructured":"Saqib, K., Qureshi, A. S. & Butt, Z. A. COVID-19, mental health, and chronic illnesses: a syndemic perspective. Int. J. Environ. Res. Public Health 20, 3262 (2023).","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"4237_CR5","doi-asserted-by":"publisher","first-page":"100032","DOI":"10.1016\/j.ssmqr.2021.100032","volume":"2","author":"JM Wildman","year":"2022","unstructured":"Wildman, J. M., Morris, S., Pollard, T., Gibson, K. & Moffatt, S. \u2018I wouldn\u2019t survive it, as simple as that\u2019: syndemic vulnerability among people living with chronic non-communicable disease during the COVID-19 pandemic. SSM Qual. Res. Health 2, 100032 (2022).","journal-title":"SSM Qual. Res. Health"},{"key":"4237_CR6","doi-asserted-by":"publisher","first-page":"e430","DOI":"10.1016\/S2542-5196(24)00112-8","volume":"8","author":"RF Hunter","year":"2024","unstructured":"Hunter, R. F. et al. The emerging syndemic of climate change and non-communicable diseases. Lancet Planet. Health 8, e430\u2013e431 (2024).","journal-title":"Lancet Planet. Health"},{"key":"4237_CR7","unstructured":"World Health Organization. Constitution of the World Health Organization https:\/\/www.who.int\/about\/governance\/constitution (2026)."},{"key":"4237_CR8","unstructured":"World Health Organization. The Global Health Observatory: Health and Wellbeing https:\/\/www.who.int\/data\/gho\/data\/major-themes\/health-and-well-being (2026)."},{"key":"4237_CR9","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1093\/phe\/phad017","volume":"16","author":"T Schramme","year":"2023","unstructured":"Schramme, T. Health as complete well-being: the WHO definition and beyond. Public Health Ethics 16, 210\u2013218 (2023).","journal-title":"Public Health Ethics"},{"key":"4237_CR10","doi-asserted-by":"publisher","first-page":"e1232","DOI":"10.1016\/S2214-109X(24)00150-5","volume":"12","author":"Strain","year":"2024","unstructured":"Strain et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5\u00b77 million participants. Lancet Glob. Health 12, e1232\u2013e1243 (2024).","journal-title":"Lancet Glob. Health"},{"key":"4237_CR11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/S2352-4642(19)30323-2","volume":"4","author":"R Guthold","year":"2020","unstructured":"Guthold, R., Stevens, G. A., Riley, L. M. & Bull, F. C. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1\u00b76 million participants. Lancet Child Adolesc. Health 4, 23\u201335 (2020).","journal-title":"Lancet Child Adolesc. Health"},{"key":"4237_CR12","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","volume":"54","author":"F Bull","year":"2020","unstructured":"Bull, F. et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br. J. Sports Med. 54, 1451 (2020).","journal-title":"Br. J. Sports Med."},{"key":"4237_CR13","unstructured":"World Health Organization. STEPwise approach to NCD risk factor surveillance (STEPS). https:\/\/www.who.int\/teams\/noncommunicable-diseases\/surveillance\/systems-tools\/steps"},{"key":"4237_CR14","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1136\/bjsports-2020-103524","volume":"54","author":"EV Lambert","year":"2020","unstructured":"Lambert, E. V. et al. Making the case for \u2018physical activity security\u2019: the 2020 WHO guidelines on physical activity and sedentary behaviour from a Global South perspective. Br. J. Sports Med. 54, 1447\u20131448 (2020).","journal-title":"Br. J. Sports Med."},{"key":"4237_CR15","doi-asserted-by":"crossref","unstructured":"Salvo, D., J\u00e1uregui, A., Adlakha, D., Sarmiento, O. L. & Reis, R. S. When moving is the only option: the role of necessity versus choice for understanding and promoting physical activity in low- and middle-income countries. Annu. Rev. Public Health 44, 151\u2212169 (2022).","DOI":"10.1146\/annurev-publhealth-071321-042211"},{"key":"4237_CR16","first-page":"8","volume":"1989","author":"K Crenshaw","year":"1989","unstructured":"Crenshaw, K. Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. U. Chi. Legal F. 1989, 8 (1989).","journal-title":"U. Chi. Legal F."},{"key":"4237_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2021.100798","volume":"14","author":"GR Bauer","year":"2021","unstructured":"Bauer, G. R. et al. Intersectionality in quantitative research: a systematic review of its emergence and applications of theory and methods. SSM Popul. Health 14, 100798 (2021).","journal-title":"SSM Popul. Health"},{"key":"4237_CR18","doi-asserted-by":"publisher","first-page":"576777","DOI":"10.3389\/fpubh.2020.00508","volume":"8","author":"UN Yadav","year":"2020","unstructured":"Yadav, U. N., Rayamajhee, B., Mistry, S. K., Parsekar, S. S. & Mishra, S. K. A syndemic perspective on the management of non-communicable diseases amid the COVID-19 pandemic in low-and middle-income countries. Front. Public Health 8, 576777 (2020).","journal-title":"Front. Public Health"},{"key":"4237_CR19","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.3332\/ecancer.2023.1532","volume":"17","author":"M Hassan","year":"2023","unstructured":"Hassan, M. & Butt, Z. A. Applying the syndemic framework to cancer research for effective cancer control in low- and middle-income countries. Ecancermedicalscience 17, 1532 (2023).","journal-title":"Ecancermedicalscience"},{"key":"4237_CR20","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.jshs.2022.08.002","volume":"11","author":"DC Nieman","year":"2022","unstructured":"Nieman, D. C. & Sakaguchi, C. A. Physical activity lowers the risk for acute respiratory infections: time for recognition. J. Sport Health Sci. 11, 648\u2013655 (2022).","journal-title":"J. Sport Health Sci."},{"key":"4237_CR21","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.bbi.2021.07.010","volume":"97","author":"RJ Simpson","year":"2021","unstructured":"Simpson, R. J. et al. Exercise and adrenergic regulation of immunity. Brain Behav. Immun. 97, 303\u2013318 (2021).","journal-title":"Brain Behav. Immun."},{"key":"4237_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbih.2023.100600","volume":"28","author":"FL Baker","year":"2023","unstructured":"Baker, F. L. et al. Exercise mobilizes diverse antigen specific T-cells and elevates neutralizing antibodies in humans with natural immunity to SARS CoV-2. Brain Behav. Immun. Health 28, 100600 (2023).","journal-title":"Brain Behav. Immun. Health"},{"key":"4237_CR23","doi-asserted-by":"publisher","first-page":"e0268625","DOI":"10.1371\/journal.pone.0268625","volume":"17","author":"E Bohn-Goldbaum","year":"2022","unstructured":"Bohn-Goldbaum, E., Owen, K. B., Lee, V. Y. J., Booy, R. & Edwards, K. M. Physical activity and acute exercise benefit influenza vaccination response: a systematic review with individual participant data meta-analysis. PLoS ONE 17, e0268625 (2022).","journal-title":"PLoS ONE"},{"key":"4237_CR24","doi-asserted-by":"publisher","first-page":"6389","DOI":"10.1016\/j.vaccine.2012.08.022","volume":"30","author":"KM Edwards","year":"2012","unstructured":"Edwards, K. M. et al. Acute exercise enhancement of pneumococcal vaccination response: a randomised controlled trial of weaker and stronger immune response. Vaccine 30, 6389\u20136395 (2012).","journal-title":"Vaccine"},{"key":"4237_CR25","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1038\/s41577-019-0177-9","volume":"19","author":"NA Duggal","year":"2019","unstructured":"Duggal, N. A., Niemiro, G., Harridge, S. D. R., Simpson, R. J. & Lord, J. M. Can physical activity ameliorate immunosenescence and thereby reduce age-related multi-morbidity? Nat. Rev. Immunol. 19, 563\u2013572 (2019).","journal-title":"Nat. Rev. Immunol."},{"key":"4237_CR26","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.1111\/j.1532-5415.2009.02563.x","volume":"57","author":"JA Woods","year":"2009","unstructured":"Woods, J. A. et al. Cardiovascular exercise training extends influenza vaccine seroprotection in sedentary older adults: the immune function intervention trial. J. Am. Geriatr. Soc. 57, 2183\u20132191 (2009).","journal-title":"J. Am. Geriatr. Soc."},{"key":"4237_CR27","doi-asserted-by":"publisher","first-page":"2298","DOI":"10.1016\/j.vaccine.2003.11.023","volume":"22","author":"ML Kohut","year":"2004","unstructured":"Kohut, M. L. et al. Moderate exercise improves antibody response to influenza immunization in older adults. Vaccine 22, 2298\u20132306 (2004).","journal-title":"Vaccine"},{"key":"4237_CR28","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s11357-017-9982-x","volume":"39","author":"A Souquette","year":"2017","unstructured":"Souquette, A., Frere, J., Smithey, M., Sauce, D. & Thomas, P. G. A constant companion: immune recognition and response to cytomegalovirus with aging and implications for immune fitness. Geroscience 39, 293\u2013303 (2017).","journal-title":"Geroscience"},{"key":"4237_CR29","first-page":"97","volume":"12","author":"T Lowder","year":"2006","unstructured":"Lowder, T., Padgett, D. A. & Woods, J. A. Moderate exercise early after influenza virus infection reduces the Th1 inflammatory response in lungs of mice. Exerc. Immunol. Rev. 12, 97\u2013111 (2006).","journal-title":"Exerc. Immunol. Rev."},{"key":"4237_CR30","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s41232-020-00146-3","volume":"40","author":"S Hojyo","year":"2020","unstructured":"Hojyo, S. et al. How COVID-19 induces cytokine storm with high mortality. Inflamm. Regen. 40, 37 (2020).","journal-title":"Inflamm. Regen."},{"key":"4237_CR31","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1136\/bjsports-2022-105733","volume":"56","author":"Y Ezzatvar","year":"2022","unstructured":"Ezzatvar, Y., Ram\u00edrez-V\u00e9lez, R., Izquierdo, M. & Garcia-Hermoso, A. Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose\u2013response meta-analysis of data from 1 853 610 adults. Br. J. Sports Med. 56, 1188\u20131193 (2022).","journal-title":"Br. J. Sports Med."},{"key":"4237_CR32","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.amepre.2022.10.007","volume":"64","author":"DR Young","year":"2023","unstructured":"Young, D. R. et al. Associations of physical inactivity and COVID-19 outcomes among subgroups. Am. J. Prev. Med. 64, 492\u2013502 (2023).","journal-title":"Am. J. Prev. Med."},{"key":"4237_CR33","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1136\/bjsports-2021-104203","volume":"56","author":"Seung Won Lee","year":"2022","unstructured":"Won Lee, S. eung et al. Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study. Br. J. Sports Med. 56, 901 (2022).","journal-title":"Br. J. Sports Med."},{"key":"4237_CR34","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","volume":"398","author":"DF Santomauro","year":"2021","unstructured":"Santomauro, D. F. et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet 398, 1700\u20131712 (2021).","journal-title":"Lancet"},{"key":"4237_CR35","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1001\/jamapsychiatry.2022.0609","volume":"79","author":"M Pearce","year":"2022","unstructured":"Pearce, M. et al. Association between physical activity and risk of depression: a systematic review and meta-analysis. JAMA Psychiatry 79, 550\u2013559 (2022).","journal-title":"JAMA Psychiatry"},{"key":"4237_CR36","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1176\/appi.ajp.2018.17111194","volume":"175","author":"FB Schuch","year":"2018","unstructured":"Schuch, F. B. et al. Physical activity and incident depression: a meta-analysis of prospective cohort studies. Am. J. Psychiatry 175, 631\u2013648 (2018).","journal-title":"Am. J. Psychiatry"},{"key":"4237_CR37","doi-asserted-by":"publisher","first-page":"e075847","DOI":"10.1136\/bmj-2023-075847","volume":"384","author":"M Noetel","year":"2024","unstructured":"Noetel, M. et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 384, e075847 (2024).","journal-title":"BMJ"},{"key":"4237_CR38","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1017\/S0033291717002653","volume":"48","author":"AP Bailey","year":"2018","unstructured":"Bailey, A. P., Hetrick, S. E., Rosenbaum, S., Purcell, R. & Parker, A. G. Treating depression with physical activity in adolescents and young adults: a systematic review and meta-analysis of randomised controlled trials. Psychol. Med. 48, 1068\u20131083 (2018).","journal-title":"Psychol. Med."},{"key":"4237_CR39","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1016\/S0140-6736(25)01570-3","volume":"406","author":"Q Luo","year":"2025","unstructured":"Luo, Q. & Smith, D. P. Global cancer burden: progress, projections, and challenges. Lancet 406, 1536\u20131537 (2025).","journal-title":"Lancet"},{"key":"4237_CR40","doi-asserted-by":"publisher","first-page":"1252\u22121261","DOI":"10.1249\/MSS.0000000000001937","volume":"51","author":"A Mctiernan","year":"2019","unstructured":"Mctiernan, A. et al. Physical activity in cancer prevention and survival: a systematic review. Med. Sci. Sports Exerc. 51, 1252\u22121261 (2019).","journal-title":"Med. Sci. Sports Exerc."},{"key":"4237_CR41","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.3390\/cancers17091410","volume":"17","author":"J Kruk","year":"2025","unstructured":"Kruk, J. et al. Physical activity and cancer incidence and mortality: current evidence and biological mechanisms. Cancers 17, 1410 (2025).","journal-title":"Cancers"},{"key":"4237_CR42","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-021-01142-7","volume":"18","author":"W Nascimento","year":"2021","unstructured":"Nascimento, W. et al. Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies. Int. J. Behav. Nutr. Phys. Act. 18, 69 (2021).","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"4237_CR43","doi-asserted-by":"publisher","first-page":"pkz080","DOI":"10.1093\/jncics\/pkz080","volume":"4","author":"CM Friedenreich","year":"2020","unstructured":"Friedenreich, C. M., Stone, C. R., Cheung, W. Y. & Hayes, S. C. Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectr. 4, pkz080 (2020).","journal-title":"JNCI Cancer Spectr."},{"key":"4237_CR44","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1056\/NEJMoa2502760","volume":"393","author":"KS Courneya","year":"2025","unstructured":"Courneya, K. S. et al. Structured exercise after adjuvant chemotherapy for colon cancer. N. Engl. J. Med. 393, 13\u201325 (2025).","journal-title":"N. Engl. J. Med."},{"key":"4237_CR45","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-021-07988-1","volume":"21","author":"N Takemura","year":"2021","unstructured":"Takemura, N., Chan, S. L., Smith, R., Cheung, D. S. T. & Lin, C.-C. The effects of physical activity on overall survival among advanced cancer patients: a systematic review and meta-analysis. BMC Cancer 21, 242 (2021).","journal-title":"BMC Cancer"},{"key":"4237_CR46","doi-asserted-by":"crossref","unstructured":"Cadenas-S\u00e1nchez, C., Sanchez-Lastra, M. A., Tarp, J. & Ekelund, U. Occupational physical activity and incidence and mortality of 14 cancers in 404,249 adults. Nat. Commun. 16, 11052 (2025).","DOI":"10.1038\/s41467-025-65326-6"},{"key":"4237_CR47","doi-asserted-by":"publisher","first-page":"4154","DOI":"10.3390\/cancers14174154","volume":"14","author":"W Misi\u0105g","year":"2022","unstructured":"Misi\u0105g, W., Piszczyk, A., Szyma\u0144ska-Chabowska, A. & Chabowski, M. Physical activity and cancer care\u2014a review. Cancers (Basel) 14, 4154 (2022).","journal-title":"Cancers (Basel)"},{"key":"4237_CR48","doi-asserted-by":"publisher","unstructured":"Ram\u00edrez Varela, A. Low global physical activity despite two decades of policy progress. Nat. Health https:\/\/doi.org\/10.1038\/s44360-025-00044-3 (2026).","DOI":"10.1038\/s44360-025-00044-3"},{"key":"4237_CR49","doi-asserted-by":"publisher","unstructured":"Hinckson, E. et al. Benefit of physical activity initiatives for climate change mitigation and adaptation. Nat. Health https:\/\/doi.org\/10.1038\/s44360-026-00057-6 (2026).","DOI":"10.1038\/s44360-026-00057-6"},{"key":"4237_CR50","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.puhe.2021.08.009","volume":"199","author":"G Dahlgren","year":"2021","unstructured":"Dahlgren, G. & Whitehead, M. The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health 199, 20\u201324 (2021).","journal-title":"Public Health"},{"key":"4237_CR51","doi-asserted-by":"publisher","first-page":"103627","DOI":"10.1016\/j.jtrangeo.2023.103627","volume":"110","author":"C Ward","year":"2023","unstructured":"Ward, C. & Walsh, D. \u2018I just don\u2019t go nowhere:\u2019 how transportation disadvantage reinforces social exclusion. J. Transp. Geogr. 110, 103627 (2023).","journal-title":"J. Transp. Geogr."},{"key":"4237_CR52","doi-asserted-by":"crossref","unstructured":"Harms, L., Bertolini, L. & Te Br\u00f6mmelstroet, M. Spatial and social variations in cycling patterns in a mature cycling country exploring differences and trends. J. Transp. Health 1, 232\u2013242 (2014).","DOI":"10.1016\/j.jth.2014.09.012"},{"key":"4237_CR53","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-12428-7","volume":"22","author":"GI Mielke","year":"2022","unstructured":"Mielke, G. I., Malta, D. C., Nunes, B. P. & Cairney, J. All are equal, but some are more equal than others: social determinants of leisure time physical activity through the lens of intersectionality. BMC Public Health 22, 36 (2022).","journal-title":"BMC Public Health"},{"key":"4237_CR54","first-page":"691","volume":"32","author":"H Abichahine","year":"2017","unstructured":"Abichahine, H. & Veenstra, G. Inter-categorical intersectionality and leisure-based physical activity in Canada. Health Promot. Int. 32, 691\u2013701 (2017).","journal-title":"Health Promot. Int."},{"key":"4237_CR55","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1123\/jpah.2024-0135","volume":"21","author":"AG Knuth","year":"2024","unstructured":"Knuth, A. G., Leite, G. S., Dos Santos, S. F. daS. & Crochemore-Silva, I. Is it possible to decolonize the field of physical activity and health? J. Phys. Act, Health 21, 633\u2013635 (2024).","journal-title":"J. Phys. Act, Health"},{"key":"4237_CR56","unstructured":"World Bank Group. Population, total. https:\/\/data.worldbank.org\/indicator\/SP.POP.TOTL\/ (2026)."},{"key":"4237_CR57","doi-asserted-by":"publisher","first-page":"10\u221218","DOI":"10.1136\/bmjnph-2021-000375","volume":"5","author":"W Sawadogo","year":"2022","unstructured":"Sawadogo, W., Tsegaye, M., Gizaw, A. & Adera, T. Overweight and obesity as risk factors for COVID-19-associated hospitalisations and death: systematic review and meta-analysis. BMJ Nutr. Prev. Health 5, 10\u221218 (2022).","journal-title":"BMJ Nutr. Prev. Health"},{"key":"4237_CR58","doi-asserted-by":"publisher","first-page":"100674","DOI":"10.1016\/j.mhpa.2025.100674","volume":"28","author":"J Cooper","year":"2025","unstructured":"Cooper, J., Wort, G., Gillison, F. & Lambert, J. Understanding the barriers and facilitators of physical activity promotion for depression among healthcare professionals: a systematic review. Ment. Health Phys. Act. 28, 100674 (2025).","journal-title":"Ment. Health Phys. Act."},{"key":"4237_CR59","first-page":"3711","volume":"26","author":"SJ Hardcastle","year":"2018","unstructured":"Hardcastle, S. J. et al. Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: an international survey. Support. Care Cancer 26, 3711\u20133719 (2018).","journal-title":"Support. Care Cancer"},{"key":"4237_CR60","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1080\/10810730.2018.1500658","volume":"23","author":"EA Waters","year":"2018","unstructured":"Waters, E. A. & Hawkins, E. Awareness of health outcomes associated with insufficient physical activity and associations with physical activity intentions and behavior. J. Health Commun. 23, 634\u2013642 (2018).","journal-title":"J. Health Commun."},{"key":"4237_CR61","unstructured":"National Academies of Sciences, Engineering, and Medicine et al. The current \u2018system\u2019 of cancer control. in Guiding Cancer Control: A Path to Transformation Chap. 2 (National Academies Press, 2019); https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK544678\/"},{"key":"4237_CR62","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1038\/s41591-019-0644-7","volume":"25","author":"JJ Miranda","year":"2019","unstructured":"Miranda, J. J. et al. Understanding the rise of cardiometabolic diseases in low- and middle-income countries. Nat. Med. 25, 1667\u20131679 (2019).","journal-title":"Nat. Med."},{"key":"4237_CR63","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.jegh.2013.10.004","volume":"4","author":"A Batouli","year":"2014","unstructured":"Batouli, A., Jahanshahi, P., Gross, C. P., Makarov, D. V. & Yu, J. B. The global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries. J. Epidemiol. Glob. Health 4, 115\u2013124 (2014).","journal-title":"J. Epidemiol. Glob. Health"},{"key":"4237_CR64","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/S2215-0366(21)00025-0","volume":"8","author":"L Kola","year":"2021","unstructured":"Kola, L. et al. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. Lancet Psychiatry 8, 535\u2013550 (2021).","journal-title":"Lancet Psychiatry"},{"key":"4237_CR65","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1136\/bjsm.2010.079582","volume":"46","author":"A Holtermann","year":"2012","unstructured":"Holtermann, A., Hansen, J. V., Burr, H., S\u00f8gaard, K. & Sj\u00f8gaard, G. The health paradox of occupational and leisure-time physical activity. Br. J. Sports Med. 46, 291\u2013295 (2012).","journal-title":"Br. J. Sports Med."},{"key":"4237_CR66","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1093\/eurheartj\/ehab087","volume":"42","author":"A Holtermann","year":"2021","unstructured":"Holtermann, A., Schnohr, P., Nordestgaard, B. G. & Marott, J. L. The physical activity paradox in cardiovascular disease and all-cause mortality: the contemporary Copenhagen General Population Study with 104 046 adults. Eur. Heart J. 42, 1499\u20131511 (2021).","journal-title":"Eur. Heart J."},{"key":"4237_CR67","doi-asserted-by":"publisher","first-page":"104470","DOI":"10.1016\/j.ijnurstu.2023.104470","volume":"141","author":"TI Janssen","year":"2023","unstructured":"Janssen, T. I. & Voelcker-Rehage, C. Leisure-time physical activity, occupational physical activity and the physical activity paradox in healthcare workers: a systematic overview of the literature. Int. J. Nurs. Stud. 141, 104470 (2023).","journal-title":"Int. J. Nurs. Stud."},{"key":"4237_CR68","doi-asserted-by":"crossref","unstructured":"Holtermann, A., Krause, N., van der Beek, A. J. & Straker, L. The physical activity paradox: six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does. Br. J. Sports Med.52, 149\u2212150 (2018).","DOI":"10.1136\/bjsports-2017-097965"},{"key":"4237_CR69","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00155-9","volume":"6","author":"KE Dalene","year":"2021","unstructured":"Dalene, K. E., Tarp, J. & Ekelund, U. The role of occupational physical activity on longevity \u2013 authors\u2019 reply. Lancet Public Health 6, e545 (2021).","journal-title":"Lancet Public Health"},{"key":"4237_CR70","doi-asserted-by":"publisher","unstructured":"Piggin, J. What is physical activity? A holistic definition for teachers, researchers and policy makers. Front. Sports Act. Living https:\/\/doi.org\/10.3389\/fspor.2020.00072 (2020).","DOI":"10.3389\/fspor.2020.00072"},{"key":"4237_CR71","unstructured":"Global action plan on physical activity 2018\u22122030: more active people for a healthier world. https:\/\/www.who.int\/publications\/i\/item\/9789241514187 (World Health Organization, 2019)."},{"key":"4237_CR72","doi-asserted-by":"publisher","first-page":"74","DOI":"10.2105\/AJPH.2015.302962","volume":"106","author":"L Riley","year":"2016","unstructured":"Riley, L. et al. The World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance: methods, challenges, and opportunities. Am. J. Public Health 106, 74\u201378 (2016).","journal-title":"Am. J. Public Health"},{"key":"4237_CR73","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1007\/s10389-006-0024-x","volume":"14","author":"T Armstrong","year":"2006","unstructured":"Armstrong, T. & Bull, F. Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J. Public Health 14, 66\u201370 (2006).","journal-title":"J. Public Health"},{"key":"4237_CR74","unstructured":"Handbook on Health Inequality Monitoring: With a Special Focus on Low- and Middle-Income Countries. https:\/\/www.who.int\/docs\/default-source\/gho-documents\/health-equity\/handbook-on-health-inequality-monitoring\/handbook-on-health-inequality-monitoring.pdf (World Health Organization, 2013)."},{"key":"4237_CR75","unstructured":"The World Bank. World Bank country and lending groups. https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups"}],"container-title":["Nature Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41591-026-04237-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-026-04237-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-026-04237-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T14:02:59Z","timestamp":1776780179000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41591-026-04237-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":75,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["4237"],"URL":"https:\/\/doi.org\/10.1038\/s41591-026-04237-5","relation":{},"ISSN":["1078-8956","1546-170X"],"issn-type":[{"value":"1078-8956","type":"print"},{"value":"1546-170X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]},"assertion":[{"value":"14 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}