Regular physical activity is widely recognised as one of the simplest ways to improve health, yet millions of people around the world do not have equal opportunities to exercise. A recent global analysis suggests that access to safe and voluntary physical activity is strongly shaped by income, gender and living conditions, and these inequalities may have far-reaching consequences for health.
The research, titled “Physical activity for public health in the 21st century” and published in the journal Nature Medicine, highlights how socioeconomic disparities influence who gets to exercise for leisure and who remains physically inactive. By analysing data from various countries alongside evidence from previous studies, researchers argue that unequal access to physical activity is an overlooked public health challenge that requires urgent attention.
Physical inactivity is a major global health risk
The researchers emphasise that physical inactivity is already a significant global health problem. Estimates suggest it contributes to around 7.2 per cent of all deaths worldwide, which amounts to more than five million deaths each year.
Exercise is commonly associated with preventing obesity and heart disease, yet its benefits extend far beyond cardiometabolic health. Evidence shows that regular movement can strengthen immune responses, support mental wellbeing and improve survival outcomes in several diseases.
However, while health campaigns often focus on encouraging individuals to be more active, the study highlights that not everyone has the same opportunity to exercise.
Exercise remains a privilege for many
One of the key findings of the analysis is the stark inequality in choice-based physical activity, which includes activities such as jogging, sports or gym workouts.
Researchers analysed global surveillance data from the World Health Organization’s STEPS surveys collected between 2008 and 2019 across 68 countries. They examined physical activity across three categories:
Leisure activity: exercise or sport done voluntarily
Active transport: walking or cycling for commuting
Occupational activity: physical labour performed as part of work
The results revealed a striking gap between the most advantaged and disadvantaged groups. Wealthy men living in high-income countries had the highest levels of leisure-time exercise, while women in low-income countries had the lowest participation rates.
Overall, the difference in leisure activity between these groups was estimated at around 40 percentage points, highlighting how wealth and gender shape opportunities for exercise.
When movement is driven by necessity
Another important insight from the study is that not all physical activity occurs under healthy or voluntary conditions.
In high-income countries, more than 30 per cent of physical activity typically comes from leisure exercise such as sport or recreational workouts. In contrast, in low-income countries only around 10 per cent of activity is leisure-based, while most movement comes from work or transport needs.
This means many people remain active because they must walk long distances or perform manual labour, rather than because they have safe spaces or time to exercise.
Researchers argue that such activity may not always provide the same well-being benefits because it often occurs in environments that lack safety, rest or adequate favorable conditions.
Health benefits of staying active
The review also highlights the broader health effects of regular physical activity. Evidence from multiple studies shows that people who remain active tend to experience:
Lower risk of severe infectious disease outcomes
Better mental health and reduced risk of depression
Lower risk of several cancers
Improved survival after a cancer diagnosis
For instance, analyses of pandemic data involving 1.8 million adults found that physically active individuals had lower risks of Covid-19 hospitalisation, severe illness and death compared with inactive individuals.
Similarly, people who meet recommended exercise guidelines appear to have about a 25 per cent lower risk of developing depression, according to the study.
These findings reinforce the idea that regular movement supports overall health, not just weight management.
Bridging the global exercise gap
To address global disparities, researchers propose shifting the public health conversation from simply encouraging exercise to ensuring ‘physical activity security.’
This concept focuses on ensuring that everyone has safe, affordable and enjoyable opportunities to move intentionally, regardless of income, gender or location. It also encourages policymakers to recognise a lack of physical activity as a social and environmental issue rather than an individual choice.
Improving access to parks, safe walking paths, recreational spaces and active transport infrastructure could help reduce these inequalities.
The study suggests that promoting physical activity cannot rely solely on motivating individuals. Instead, creating environments where movement is safe, accessible and equitable may be the key to unlocking its full health benefits for populations worldwide.
This report is for informational purposes only and is not a substitute for professional medical advice.
