Adherence to aerobic and muscle-strengthening activities guidelines: a systematic review and meta-analysis of 3.3 million participants across 32 countries

Br J Sports Med. 2023 Feb;57(4):225-229. doi: 10.1136/bjsports-2022-106189. Epub 2022 Nov 23.


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 32 countries were included. Overall adherence to the aerobic and MSA guidelines was 17.12% (95% CI 15.42% to 18.88%) in adults ≥18 years (n=3 346 723). Among adolescents aged 12-17 years, adherence to both guidelines was 19.74% (95% CI 14.72% to 25.31%) (n=43 278). 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.

Keywords: exercise; health promotion; meta-analysis; physical activity; public health.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Exercise Therapy*
  • Exercise*
  • Female
  • Humans
  • Life Style
  • Muscles
  • Obesity