Before the 2019 SARS-CoV-2 (COVID-19) pandemic, it was estimated that approximately 1 in 4 adults did not meet the World Health Organization’s (WHO) recommendations for physical activity (PA).1 This has been widely recognized as a global health problem, primarily due to the increased risks of cardiovascular disease, several types of cancer, type 2 diabetes, and a range of other chronic diseases associated with insufficient PA.2,3 Growing evidence from 2020 and 2021 has shown that the COVID-19 pandemic has had a detrimental impact on PA levels globally4,5 further exacerbating what was already a major public health issue.5–8
To tackle this problem, it is important for countries to have national policies that support a physically active lifestyle. PA research and surveillance are needed to ensure that such policies are effective and based on empirical evidence. PA surveillance, policy, and research can therefore be considered as 3 pillars underpinning PA promotion.9
The Global Observatory for Physical Activity (GoPA!)10 was established in 2012 as an independent evidence- and expert-based surveillance system to monitor and evaluate national PA surveillance, policy, and research worldwide. As such, GoPA! facilitates evidence-based PA promotion and supports global and national PA advocacy (http://www.globalphysicalactivityobservatory.com/). In 2015 GoPA! published its first report on worldwide PA surveillance, policy, and research, producing PA profiles (the Country Cards) for 139 countries.11,12 The report identified a wide range of gaps and differences in PA surveillance, policy, and research across countries, world regions, and income groups. It was estimated that one-third of the countries had periodic surveillance, one-quarter had standalone PA policies, and two-thirds had PA research outputs, thus consolidating the urgent case for periodic monitoring of these indicators.11
The second GoPA! data collection was conducted from 2019 to 2020 (referred to as “GoPA! 2020 survey”), to enable evaluation of national and global changes in the capacity for PA promotion.9 Such evaluation was needed to support global PA leadership and advocacy and to improve national capacities for PA promotion. The aim of this paper was to assess the trends in PA surveillance, policy, and research globally, based on data from the GoPA! 2015 and 2020 surveys.
Methods
Identification of Country Contacts
GoPA! country representatives, also known as “Country Contacts”, were invited to participate in GoPA!. Through their work and experience as PA researchers, policymakers, and practitioners, most Country Contacts represent academic and government sectors in the areas of PA and/or noncommunicable disease (NCD) prevention. An active search for new members is ongoing for the countries without a representative. Description of identification methods and complete list of Country Contacts can be found elsewhere.9,11
Collection and Processing of Country-Specific Data
Sample of Countries
Consistent with the protocol and standardized methodology established before the GoPA! 2015 survey,11,12 we collected data for 217 world countries/states/economies (hereafter referred to as “countries”). A full list of countries can be found elsewhere.9 The same protocol was used in the GoPA! 2020 survey to ensure comparability of results between countries and over time.11 Only countries that had their data approved by Country Contacts were included in the analysis of this paper.
For some of the analyses, countries were grouped into 6 WHO regions, including Africa (AFRO), Eastern Mediterranean (EMRO), Europe (EURO), The Americas (PAHO), South-East Asia (SEARO), and Western Pacific (WPRO).13 Countries were also grouped by their gross national income per capita into High Income (HIC), Upper Middle Income (UMIC), Lower Middle Income (LMIC), and Low Income (LIC), according to the 2020 World Bank’s classification.14 Information on total population and Gini inequality index was obtained from the World Bank14 and Our World in Data15 websites.
PA Surveillance
The GoPA! working group conducted comprehensive, systematic searches to identify national PA surveys and surveillance systems. The search for the GoPA! 2015 survey was conducted from July 2014 to September 2014, while the search for the GoPA! 2020 survey was conducted from April 2019 to August 2019. There were no language restrictions, and the team members doing the searches were fluent in English, Spanish, and Portuguese. Documents in these languages were thus included if they were relevant to the search topic. The searches included the following sources: (1) Demographic and Health Surveys (DHS) Program16; (2) the WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) Report17; (3) Google using “national survey”, “physical activity”, and a country name as search terms; (4) Google using “Non-communicable disease”, “NCD”, “risk factors”, and “national survey” as search terms; (5) Google using a country name, “national survey”, and “NCD” as search terms; (6) the World Health Survey (WHS)18; and (7) information sourced from Guthold et al1 at the WHO (only in the GoPA! 2020 survey).
PA Policy
The GoPA! working group conducted comprehensive systematized searches through WHO MiNDbank, Google, and PubMed using “physical activity”, “national policy”, and “national plan” as search terms to identify national PA plans and other PA-related policies. The search for the GoPA! 2015 survey was conducted from July 2014 to September 2014, while the search for the GoPA! 2020 survey was conducted from April to August 2019. There were no language restrictions, and the team members conducting the searches were fluent in English, Spanish, and Portuguese. Documents in these languages were thus included if they were relevant to the search topic. In addition, before the 2020 survey, the GoPA! working group developed the GoPA! Policy Inventory (version 3.0), to collect more detailed information on national PA policies directly from the Country Contacts. The development and data collection methods of the GoPA! Policy Inventory are described elsewhere.19
PA Research
The GoPA! working group conducted a systematic review of peer-reviewed articles to assess the quantity of PA research that was conducted using country-specific data and published between 1950 and 2019. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the PROSPERO database (ref: CRD42017070153). The searches were conducted from August 2017 to May 2020 in PubMed, Scopus, and Web of Science databases. Details about the literature search can be found elsewhere.9,10,12,20
The population-adjusted contribution to worldwide PA research was estimated for each country using the following formula:
Data Assessment and Approval
The GoPA! data collected through literature searches were reviewed and verified in 2015 and 2020 by representatives for 139 and 164 countries, respectively. Country Contacts could complement the information found in the literature searches with documents in the country’s native language. For the purpose of comparisons between the first and second surveys we used the data from 133 countries for which country contacts verified data in both surveys.
Scoring System
The GoPA! conceptual model for quantifying country-level capacity for PA promotion (ie, an aggregate of data on surveillance, policy, and research for PA) was used to assign a rating for each country.21 The scoring protocol and variable definitions are described in Table 1. Country Contacts revised and approved the country data, and the core research team scored and analyzed it based on the standardized scoring system presented in Table 1. More details on development of the country capacity categorization for PA promotion can be found elsewhere.21
Assessment of Country Progress in Physical Activity Surveillance, Policy, and Research Capacity
| Categories’ designation | National physical activity surveillance | National physical activity policy | Population-adjusted physical activity research contribution |
|---|---|---|---|
| Green: Improved or stayed at the highest level of the indicator | Green: Periodic physical activity surveillance (first, most recent, and next surveys were determined from the 2015 and 2020 GoPA! surveys) OR an increase in the number of surveys identified in the 2020 GoPA! survey | Green: Standalone physical activity policies in the 2015 and 2020 GoPA! surveys OR transition to a standalone policy in the 2020 GoPA! survey | Green: Physical activity research was above the global average in both 2010–2014 AND 2015–2019 periods |
| Yellow: Stayed at the same level of the indicator | Yellow: First and most recent surveys were determined, but not a plan for a next or future survey including physical activity | Yellow: NCD plans including physical activity in the 2015 and 2020 GoPA! surveys OR a standalone physical activity policy in the 2015 but not in the 2020 GoPA! survey | Yellow: Physical activity research was above the global average in 2010–2014 OR 2015–2019 periods |
| Red: Decreased or stayed at the lowest level of the indicator | Red: Only a first survey was determined from the 2015 and 2020 GoPA! surveys (not a most recent or next/future survey) OR there was no surveillance data for the 2020 GoPA! survey | Red: NCD plans including physical activity in the 2015 OR 2020 GoPA! survey (but not both) | Red: Physical activity research was below the global average in both 2010–2014 AND 2015–2019 periods |
| Black: No data available for the indicator | Black: No physical activity surveillance data | Black: No physical activity policy data | Black: No physical activity research articles |
Abbreviation: GoPA!, Global Observatory for Physical Activity; NCD, noncommunicable disease.
Data Analysis
Descriptive analyses of surveillance, policy, and research indicators were conducted for all countries in the sample and stratified by world region and income group. PA surveillance, policy, and research progress were determined based on comparisons between the first and second surveys (Table 1). The statistical analyses were conducted in STATA (version 17.0, StataCorp) and the graphs were conducted in R (version 4.1.3, R Foundation for Statistical Computing).
Results
Global Coverage
A total of 139 countries had representatives in the GoPA! 2015 survey (covering 64.1% of the countries and 84.0% of the world’s population), and 164 countries had representatives in the GoPA! 2020 survey (covering 75.6% of the countries and 98.8% of the world’s population). The number of countries with representatives in GoPA! surveys increased by 18.0% from 2015 to 2020. Of the 164 countries in 2020, 133 were also represented in 2015, while 6 countries (Bahrain, Bulgaria, Greenland, Maldives, Swaziland, and Tunisia) lost their representation (due to staff turnover of dedicated country contacts in most cases), and representatives from 31 new countries from Eastern Europe and the Caribbean and Pacific Islands contributed to the survey in 2020. In the GoPA! 2020 survey, 48 countries (29.3% of the GoPA! countries) had more than one Country Contact. The number of countries with more than one GoPA! representative has increased since 2015.
The survey participation increased from 2015 to 2020 across all income groups and most world regions except SEARO as follows: HICs (+3.3%), UMICs (+13.0%), LMICs (+20.0%), and LICs (+8.0%), AFRO (+21.3%), EMRO (+9.1%), EURO (+8.1%), PAHO (+18.2%), SEARO (−9.1%), and WPRO (+3.3%).
In both GoPA! surveys, a higher participation rate was associated with higher country income groups. Only 34.5% of LICs participated in GoPA! 2020 survey compared with 85.4% of HICs. The second set of GoPA! Country Cards including 164 countries can be found in the “second Physical Activity Almanac”,9 available at the GoPA! website (http://www.globalphysicalactivityobservatory.com/).
Status of Global PA
The GoPA! 2020 survey found that 92.1% of countries conducted at least one national survey on PA, 66.5% of countries at least 2 surveys, while only 18.3% of countries had 3 or more surveys and a plan for a future survey. The percentage of countries with periodic PA surveillance varied by region and income group, from 30.4% in EURO to 8.3% in AFRO region (Figure 1), and from 27.1% in HICs to 0.0% in LICs (Figure 2).
—Physical activity surveillance, policy, and research characteristics by world region based on the 2020 GoPA! survey. AFRO indicates Africa; EMRO, Eastern Mediterranean; EURO, Europe; GoPA!, Global Observatory for Physical Activity; NCD, noncommunicable disease; PAHO, The Americas; SEARO, South-East Asia; WPRO, Western Pacific.
Note: The lighter-colored bars show the indicators’ lowest level (ie, surveillance: no surveillance, policy: no plan, population-adjusted research: no research output). The darker-colored bars show the indicators’ highest level (ie, surveillance: 3 national surveys, policy: standalone physical activity plan, research: above average of publications). For the most accurate interpretation of this graph (full range of color) please refer to the electronic version of the manuscript.
Citation: Journal of Physical Activity and Health 20, 2; 10.1123/jpah.2022-0464
—Physical activity surveillance, policy, and research characteristics by income group based on the 2020 GoPA! survey. GoPA! indicates Global Observatory for Physical Activity; HIC, high-income country; LIC, low-income country; LMIC, lower-middle-income country; NCD, noncommunicable disease; UMIC, upper-middle-income country.
Note: The lighter-colored bars show the indicators’ lowest level (ie, surveillance: no surveillance, policy: no plan, population-adjusted research: no research output). The darker-colored bars show the indicators’ highest level (ie, surveillance: 3 national surveys, policy: standalone physical activity plan, research: above average of publications). For the most accurate interpretation of this graph (full range of color) please refer to the electronic version of the manuscript.
Citation: Journal of Physical Activity and Health 20, 2; 10.1123/jpah.2022-0464
The percentage of countries with PA policies also varied by world region (Figure 1). We found that 37.8% of the countries had a standalone PA policy, 45.1% had a PA policy embedded in their NCD prevention plan, and 17.1% did not have a PA policy. The highest percentage of countries with a standalone policy was in the EURO region (65.2%), followed by the PAHO and EMRO regions (35.7% in each). In terms of the income groups, 91.4% of HICs and only 10.0% of LICs had a PA policy, either standalone or included in an NCD policy (Figure 2). This constitutes almost a 10-fold difference between HICs and LICs in the prevalence of PA policies.
Furthermore, for 15.9% of countries, we found no PA research output. In the EURO and WPRO regions, 78.3% and 73.3% of countries, respectively, had above average contributions to the global research output. For 3 quarters of countries in the SEARO region, the contribution was below the global average. The AFRO region had the second highest (after SEARO) percentage of countries with “low” research productivity. In most HICs and UMICs, research contribution was above the global average and in most LMICs and LICs, the contribution was below the global average.
The overall capacity for PA promotion varied greatly across world regions and income groups. The highest overall capacity was found for the EURO region (all 3 indicators at the highest level), followed by the WPRO region (2 indicators at the highest level and 1 indicator at the middle level), and PAHO (2 indicators at the highest level and 1 indicator at the lowest level). The lowest overall capacity for PA promotion was found for the AFRO region, with 1 indicator at the middle level and 2 indicators at the lowest level (Figure 3).
—Estimated number of countries with low, medium, and high capacity for physical activity promotion. AFRO indicates Africa; EMRO, Eastern Mediterranean; EURO, Europe; PAHO, The Americas; SEARO, South-East Asia; WPRO, Western Pacific.
Note: The levels of the indicators, from lightest to darkest, are: Stayed at the same level of the indicator (light color), Improved or stayed at the highest level of the indicator, No data available for the indicator, and Decreased or stayed at the lowest level of the indicator (dark color). For the most accurate interpretation of this graph (full range of color) please refer to the electronic version of the manuscript.
Citation: Journal of Physical Activity and Health 20, 2; 10.1123/jpah.2022-0464
When translated into population estimates, the data suggest that 2.7 billion people (37.1%) lived in a country with periodic PA surveillance, 4.5 billion people (62.3%) in a country with at least 2 surveys, and 49.6 million people (0.7%) in a country with no surveys (Figure 4). In addition, 3.4 billion people (47.5%) lived in a country with a standalone PA policy, 3.1 billion people (43.7%) with PA included in an NCD prevention policy, and 629.4 million people (8.8%) in a country without a policy (Figure 4). For research, it was estimated that 1.7 billion people (24.1%) lived in a country with PA research productivity above the global average, 5.3 billion people (74.4%) with a productivity below the global average, and 108.7 million people (1.5%) without any PA research output (Figure 4).
—Global physical activity surveillance, policy, and research: GoPA! categories by country population, income, and region.
Note: Random noise was added to minimize countries’ overplotting according to H. Wickham22 with the countries maintaining their position based on the indicator and income group. For example, POL and ITA both have 2 national surveys (upper left) and are high-income countries; the random noise prevents them from overlapping but keeps them in their respective positions inside the cell, as determined by the indicator and their respective income group classification. AFRO indicates Africa; ARG, Argentina; BGD, Bangladesh; BRA, Brazil; CHN, China; COL, Colombia; EGY, Egypt, Arab Rep.; EMRO, Eastern Mediterranean; ESP, Spain; EURO, Europe; ETH, Ethiopia; DEU, Germany; GoPA!, Global Observatory for Physical Activity; HIC, high-income country; IND, India; IDN, Indonesia; IRN, Iran, Islamic Rep.; IRQ, Iraq; ITA, Italy; KEN, Kenya; KOR, Korea, Rep.; LIC, low-income country; LMIC, lower-middle-income country; MYS, Malaysia; MEX, Mexico; MAR, Morocco; MOZ, Mozambique; MMR, Myanmar; PAHO, The Americas; PAK, Pakistan; PER, Peru; PHL, Philippines; POL, Poland; RUS, Russian Federation; SEARO, South-East Asia; SAU, Saudi Arabia; TZA, Tanzania; THA, Thailand; TUR, Turkey; UGA, Uganda; UKR, Ukraine; UMIC, upper-middle-income country; USA, United States; VNM, Vietnam; WPRO, Western Pacific; ZAF, South Africa. Note: The regions from lightest to darkest on the color scale are: PAHO, EURO, EMRO, AFRO, SEARO, and WPRO. For the most accurate interpretation of this graph (full range of color) please refer to the electronic version of the manuscript.
Citation: Journal of Physical Activity and Health 20, 2; 10.1123/jpah.2022-0464
Trends in Global PA Based on the First and Second GoPA! Surveys
PA Surveillance
The comparison of PA indicators included 133 countries. In regard to national PA surveillance, the majority of countries improved or remained at the same level (Figure 5). The WPRO region had the highest share of countries (69.0%) where the indicator improved or stayed at the highest level, compared with the AFRO region where 15.4% of countries stayed (ie, have never had periodic surveillance) or decreased to the lowest level of the indicator (ie, previously reported any kind of surveillance but in the 2020 survey did not report current surveillance efforts or future plans). A decreased capacity was reported in 5.0%, 3.4%, and 2.6% of the EURO, WPRO, and PAHO countries, respectively (data not shown in tables).
—Progress in national physical activity surveillance, policy, and research by world region.
Note: The reference period was 2015–2020 for surveillance and policy and 2010–2019 for research. The inner circles in each radial plot accumulate a percentage, thus the first inner circle represents 20.0% and the last inner circle represents 100.0%. Each region is represented by a color, for example, the first radial plot (top left) shows that 69.0% of countries in the WPRO region (dark blue) improved or stayed at the highest surveillance level. AFRO indicates Africa; EMRO, Eastern Mediterranean; EURO, Europe; PAHO, The Americas; SEARO, South-East Asia; WPRO, Western Pacific.
Note: The regions from lightest to darkest on the color scale are: PAHO, EURO, EMRO, AFRO, SEARO, and WPRO. For the most accurate interpretation of this graph (full range of color) please refer to the electronic version of the manuscript.
Citation: Journal of Physical Activity and Health 20, 2; 10.1123/jpah.2022-0464
In terms of income groups, an equal or increased surveillance capacity was found for 49.2% of the HICs, 50.0% of UMICs, 40.7% of LMICs, and 60.0% of LICs. Twenty percent of the LICs decreased their score or stayed at the lowest level of the indicator (Figure 6).
—Progress in national physical activity surveillance, policy, and research by income group.
Note: The reference period was 2015–2020 for surveillance and policy and 2010–2019 for research. The inner circles in each radial plot accumulate a percentage, thus the first inner circle represents 20.0% and the last inner circle represents 100.0%. Each income group is represented by a color, for example, the first radial plot (top left) shows that 60.0% of the LICs (dark green) improved or stayed at the highest surveillance level. HIC indicates high-income country; LIC, low-income country; LMIC, lower-middle-income country; UMIC, upper-middle-income country.
Note: The income groups from lightest to darkest on the color scale are: HIC, UMIC, LMIC, and LIC. For the most accurate interpretation of this graph (full range of color) please refer to the electronic version of the manuscript.
Citation: Journal of Physical Activity and Health 20, 2; 10.1123/jpah.2022-0464
PA Policy
The comparison of PA policy indicators showed that most countries also improved or remained at the same level (Figure 5). EURO was the region with the highest percentage of countries (71.8%) that improved or stayed at the highest level for this indicator. AFRO was the region with the highest percentage of countries (30.8%) that stayed or decreased to the lowest level for the indicator (ie, did not report the existence of any policy or reported the existence of an NCD plan including PA in only one of the two GoPA! surveys). A decreased capacity was reported in 11.8%, 10.0%, 5.1%, and 3.4% of PAHO, EMRO, EURO, and WPRO countries, respectively (data not shown in tables).
More than half of HICs (60.0%) improved or stayed at the highest level for this indicator, while this was achieved by 38.9% of UMICs, 7.4% LMICs, and none of the LICs. Also, 20.0% of LICs decreased or stayed at the lowest level for this indicator (Figure 6).
PA Research
The comparison of PA research indicators showed that most countries in the EURO and WPRO regions (76.9% and 55.2%, respectively) improved or stayed at the highest level of the indicator, whereas 75.0% of countries in the SEARO region and 69.0% of countries in the AFRO region decreased or remained at the lowest level (Figure 5). The population-adjusted research productivity improved or stayed the same in 72.3% of HICs, 19.4% of UMICs, and 7.4% of LMICs. The population-adjusted research productivity in all LICs decreased or stayed at the lowest level for this indicator (ie, a contribution to worldwide PA research below the global average) (Figure 6).
When analyzing the changes in all 3 indicators collectively, 38.5%, 10.3%, and 5.9% of countries in the EURO, WPRO, and PAHO regions, respectively, improved or stayed at the highest level for all 3 indicators. In the SEARO and EMRO regions, 25.0% and 10.0% of the countries stayed at the same level for all 3 indicators, respectively. Twenty-three percent of countries in the AFRO region decreased or stayed at the lowest level for all 3 indicators (data not shown in tables).
Discussion
The key findings on the status and progress in PA surveillance, policy, and research based on data from the GoPA! 2015 and 2020 surveys are as follows: First, the overall capacity for PA promotion varied greatly across countries, world regions, and income groups. The highest capacity was found for EURO, followed by WPRO and PAHO regions, and the lowest was found for the AFRO region and LICs and LMICs. This translated to an estimated 145 million people or 2.0% of the world’s population living in countries with a low capacity for or no data on PA promotion. Second, although most countries benefit from some kind of PA surveillance, policy, and research, having periodic national PA surveillance, standalone policies, and high research productivity (ie, all of the 3 elements underpinning PA promotion) is very uncommon. In particular, an estimated 6.3 billion people or 88.2% of the world’s population live in countries where the capacity for PA promotion can be significantly improved; 3.1 billion of these people live in LICs and LMICs. Third, almost 70.0% of the world’s population (5.0 billion people) live in a country without periodic PA surveillance, 10.0% of the world’s population (629.4 million people) live in a country without any PA policy, and at least 75.0% of the population (5.4 billion people) live in a country with PA research productivity below the global average. Fourth, the global 5-year progress in surveillance, policy, and research indicators was modest, with LICs and the AFRO, EMRO, and SEARO regions lagging even further behind.
Many individuals live in countries that do not have adequate PA surveillance, policy, and research for facilitating PA promotion.23–25 PA is often incorrectly considered to be an individual rather than collective responsibility,26 while, in fact, political, social, economic, and built environments play key roles in shaping population PA behavior.27–32 Putting the “blame” on individuals while failing to prioritize PA in national public health agendas is malpractice and may explain why the global prevalence of PA has not improved in the last decades.1,33,34
According to our study, most countries do not have periodic PA surveillance. This finding is in accordance with the new NCD Progress Monitor 2022 report showing that fewer than 20.0% of WHO Member States conducted a STEPS survey or other comprehensive health examination survey every 5 years.35 This widespread lack of periodic PA surveillance hinders the implementation and evaluation of evidence-based PA policies. Public health initiatives to increase PA need to be clearly prioritized in national policies, and PA surveillance is of utmost importance for assessing the overall effectiveness of these interventions. Improving national surveillance must be a public health priority, to monitor prevalence and trends and to better inform the development and evaluation of national health policies.
Progress in the development of national PA policies has been slow and unequal. Standalone PA policies are seen more frequently in HICs and in the EURO region, compared with other income groups and world regions. From a health equity perspective and in accordance with the United Nations’ declaration on the prevention of NCDs,36 LMICs and LICs countries should be supported in their efforts to increase funding, implement surveillance systems25 that are consistent and sustainable, improve research and public health capacity, governance and political will related to PA promotion. Whole-of-government and systems approaches that facilitate physically active lifestyles are also needed37,38 as recommended in the WHO Global Action Plan for Physical Activity39,40 and GoPA!-like policy monitoring initiatives such as the NCD Country Capacity Survey from the WHO Global Health Observatory,41 and the Health-Enhancing Physical Activity (HEPA) monitoring framework for the European Union.42 These approaches may help countries tackle the rising burden of NCDs25 and build healthier and more resilient populations in the context of the current challenges of pandemics and climate change.43
Even though LMICs are home to more than 80.0% of the world’s population, they collectively conduct less PA research than HICs. More PA research infrastructure is urgently needed in LMICs to inform the development of contextually relevant policies and programs for this major part of the global population.39 Due to limited resources,44–46 building research capacity in LMICs is often challenging and requires coordinated efforts at individual, institutional, and national levels,47,48 and familiarity with the local context and its challenges. The academic community in HICs should help develop global capacity for PA research by sharing their expertise and resources with researchers from LMICs.
The AFRO region had the lowest capacity for PA promotion and showed limited progress between 2015 and 2020. There are several potential explanations. First, countries in this region remain focused on the prevention and management of prevalent infectious diseases such as malaria, HIV/AIDS, and tuberculosis. Infectious diseases present competing priorities for policymakers considering how to address PA promotion and the dual burden of NCDs and infectious diseases. Second, most countries in sub-Saharan Africa, where NCDs are highly prevalent and have been on the rise over the past 2 decades,49,50 are LICs or LMICs with limited resources to develop national PA surveillance, policy, and research. Third, despite the previous efforts of the African Physical Activity Network to increase PA capacity in the region, developing a viable and sustainable workforce remains a challenge for many countries.51,52
Strengths and Limitations
The key strengths of this study are: (1) analysis of PA surveillance, policy, and research indicators from two-thirds of the world’s countries verified by Country Contacts (local experts); (2) first of its kind evaluation of temporal changes in PA surveillance, policy, and research based on 2 surveys (2015 and 2020) with standardized indicators; (3) a good representation of countries from different world regions and income groups; and (4) the scoring system employed provided a straightforward measure of progress of PA surveillance, policy, and research with meaningful comparisons across world regions and income groups.
However, some limitations of the study must be taken into account while interpreting our findings. First, 53 countries were not included in the current study because they did not have GoPA! Country Contacts. Most of these 53 countries are in the AFRO and EMRO regions, and this lack of data may have affected the evaluation and comparisons between regions. Second, only the availability of reported PA policies was analyzed. It is possible that in some countries PA policies and research production exist within the gray literature or informal documents but were not reported by the Country Contact or were not picked up by the comprehensive searches. Third, other monitoring efforts use different indicators to quantify various elements of PA policy limiting comparability. For example, the HEPA monitoring framework for the European Union42 and the Active Healthy Kids Global Alliance53 are limited to the European Union countries and children, respectively. Fourth, GoPA! has yet to conduct case studies to shed light on the country-specific circumstances that contributed to the observed progress on indicators but might not have been captured by the scoring method employed. Finally, we did not assess the quality of PA surveillance, policy, and research. Having systems in place that do not include underrepresented subgroups in the population or that are not implemented with fidelity may not improve the capacity for PA promotion. Although such an analysis would provide additional important insights into the capacity for PA promotion, it was beyond the scope of the current study.
Conclusions
The overall capacity for PA promotion is remarkably unequal across world regions and income groups, and global 5-year progress in PA surveillance, policy, and research was modest. Therefore, the majority of the world’s population live in countries where PA promotion capacity should be significantly improved. Most countries do not have periodic surveillance of PA and a standalone PA policy. In nearly every sixth country, no research on PA was conducted from 2010 to 2020. GoPA! will continue to monitor PA surveillance, policy, and research globally and identify strategies to increase the capacity for national PA promotion. GoPA! will also continue to make the case for national PA promotion using multisectoral approaches consistent with the WHO Global Action Plan for Physical Activity.40 Ensuring healthy, resilient, and active populations and communities worldwide remains a key public health goal.
Acknowledgments
The authors would like to thank all GoPA! Country Contacts and their teams for reviewing, providing, and approving data for their countries. We appreciate their contributions over the past decade. In particular we would like to thank: Aaron Sim (Singapore), Abchir Houdon, (Djibouti), Angela Koh (Singapore), Audrey Tong (Singapore), Bharathi Viswanathan (Seychelles), Franklyn Edwin Prieto Alvarado (Colombia), Enrique Medina Sandino (Nicaragua), Galina Obreja (Republic of Moldova), Geoffrey P. Whitfield (United States), Gladys Bequer (Cuba), Isabel Cardenas (Bolivia), Juan Rivera (Mexico), Kyaw Zin Thant (Myanmar), Lisa Indar (Caribbean Islands), Louay Labban (Syrian Arab Republic), Lyna E. Fredericks (Virgin Islands), Migle Baceviciene (Lithuania), Mya Lay Sein (Myanmar), Nazan Yardim (Turkey), Olavur Jokladal (Faeroe Islands), Omar Badjie (Gambia), Saad Hassan Aden (Djibouti), Sawadogo Amidou (Burkina Faso), Seyed Ali Hosseini (Iran), Sigridur Lara Gudmundsdottir (Iceland), Takese Foga (Jamaica), Tatiana I Andreeva (Ukraine), Than Naing Soe (Myanmar), Thelma Sanchez (Costa Rica), Tigri Tertulie Lamatou Nawal (Benin), Vera Amanda Solís (Nicaragua), and Wilbroad Mutale (Zambia). We also wish to thank to Cintia Borges and Paulo Ferreira from Universidade Federal de Pelotas, Brazil for the graphic design and GoPA! website management. This research was funded in part by the University of California San Diego, United States, Universidad Federal de Pelotas, Brazil, and Universidad de los Andes, Colombia. Author Contributions: ARV, PH, and MP coordinated the data collection within the GoPA! surveys and conceptualized the study. GoPA! Country Contacts contributed to data collection, revision, and approval of the physical activity surveillance, policy, and research indicators. ARV, JMG, and AN analyzed the data and drafted the first version of the manuscript. ZP, DS, BK, KS, EJ, EDSK, ALO, JR, SI, SA, AJ, MP, PH provided feedback on the first version of the manuscript. ZP, ALO, MP, PH wrote parts of the manuscript. ARV, MP, JMG, AN, ZP, BK, KS, EJ, EDSK, ALO, JR, SI, SA, AJ, MC, DS, IML, AB, ML, HKIII, UE, GH, KP, CF, PH, MP provided feedback on the second version of the manuscript. All authors revised and approved the final version of the manuscript.
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Appendix: Author Affiliations and ORCID Numbers
https://orcid.org/0000-0003-2685-9617Andrea Ramírez Varela,1 https://orcid.org/0000-0003-1470-6461Pedro C. Hallal,2 https://orcid.org/0000-0003-0059-2993Juliana Mejía Grueso,1 https://orcid.org/0000-0003-2886-3556Željko Pedišić,3 https://orcid.org/0000-0002-9726-0882Deborah Salvo,4 Anita Nguyen,5 https://orcid.org/0000-0002-9141-1862Bojana Klepac,3,6 https://orcid.org/0000-0002-0369-4621Adrian Bauman,7 https://orcid.org/0000-0001-5948-2479Katja Siefken,8 https://orcid.org/0000-0003-3928-7830Erica Hinckson,9 https://orcid.org/0000-0002-3737-2911Adewale L. Oyeyemi,10,11 https://orcid.org/0000-0003-4584-8614Justin Richards,12 Elena Daniela Salih Khidir,13 https://orcid.org/0000-0003-1931-2613Shigeru Inoue,14 https://orcid.org/0000-0002-6047-0771Shiho Amagasa,14,15 https://orcid.org/0000-0001-9158-2007Alejandra Jauregui,16 https://orcid.org/0000-0003-2336-7131Marcelo Cozzensa da Silva,2 https://orcid.org/0000-0002-1083-6907I-Min Lee,17,18 https://orcid.org/0000-0001-9850-9224Melody Ding,7 Harold W. Kohl III,4,19 https://orcid.org/0000-0003-2115-9267Ulf Ekelund,20,21 https://orcid.org/0000-0003-2864-5225Gregory W. Heath,22 Kenneth E. Powell,23 https://orcid.org/0000-0002-5041-0601Charlie Foster,24 https://orcid.org/0000-0002-3203-418XAamir Raoof Memon,3,25 Abdoulaye Doumbia,26 https://orcid.org/0000-0003-4137-081XAbdul Roof Rather,27 https://orcid.org/000-0002-9439Abdur Razzaque,28 https://orcid.org/0000-0002-5766-1518Adama Diouf,29 https://orcid.org/0000-0003-1649-9419Adriano Akira Hino,30 Albertino Damasceno,31 https://orcid.org/0000-0002-9297-0383Alem Deksisa Abebe,32 Alex Antonio Florindo,33 https://orcid.org/0000-0002-8527-6940Alice Mannocci,34 https://orcid.org/0000-0002-9056-2394Altyn Aringazina,35 https://orcid.org/0000-0003-0121-920XAndrea Backović Juričan,36 Andrea Poffet,37 https://orcid.org/0000-0003-0121-920XAndrew Decelis,38 https://orcid.org/0000-0001-5404-017XAngela Carlin,39 Angelica Enescu,40 https://orcid.org/0000-0001-7926-3644Angélica María Ochoa Avilés,41 https://orcid.org/0000-0003-2062-1536Anna Kontsevaya,42 https://orcid.org/0000-0003-0716-1854Annamaria Somhegyi,43 https://orcid.org/0000-0002-5778-0285Anne Vuillemin,44 Asmaa El Hamdouchi,45 Asse Amangoua Théodore,46 https://orcid.org/0000-0002-4939-4982Bojan Masanovic,47 Brigid M. Lynch,48,49,50 https://orcid.org/0000-0002-0538-0650Catalina Medina,16 Cecilia del Campo,51 https://orcid.org/0000-0001-6402-9732Chalchisa Abdeta,52 Changa Moreways,53 https://orcid.org/0000-0002-5874-4331Chathuranga Ranasinghe,54 https://orcid.org/0000-0003-0002-4734Christina Howitt,55 https://orcid.org/0000-0003-1192-8667Christine Cameron,56 https://orcid.org/0000-0002-4861-4066Danijel Jurakić,57 https://orcid.org/0000-0002-9598-019XDavid Martinez-Gomez,58,59,60 Dawn Tladi,61 https://orcid.org/0000-0002-2590-3199Debrework Tesfaye Diro,62 https://orcid.org/0000-0002-1720-6780Deepti Adlakha,63 https://orcid.org/0000-0003-0929-7456Dušan Mitić,64 Duško Bjelica,47 https://orcid.org/0000-0002-4675-5017Elżbieta Biernat,65 https://orcid.org/0000-0001-5596-9386Enock M. Chisati,66 https://orcid.org/0000-0003-4315-9153Estelle Victoria Lambert,67 https://orcid.org/0000-0002-7599-165XEster Cerin,68,69 https://orcid.org/0000-0001-9580-8974Eun-Young Lee,70 https://orcid.org/0000-0002-9329-8998Eva-Maria Riso,71 https://orcid.org/0000-0003-3692-366XFelicia Cañete Villalba,72 https://orcid.org/0000-0003-3301-6028Felix Assah,73 https://orcid.org/0000-0003-1790-7576Franjo Lovrić,74 https://orcid.org/0000-0002-1120-9913Gerardo A. Araya-Vargas,75,76 Giuseppe La Torre,77 https://orcid.org/0000-0002-4951-5991Gloria Isabel Niño Cruz,78 https://orcid.org/0000-0002-6513-2499Gul Baltaci,79 https://orcid.org/0000-0001-7357-5823Haleama Al Sabbah,80 https://orcid.org/0000-0003-0384-6469Hanna Nalecz,81 https://orcid.org/0000-0002-1505-8665Hilde Liisa Nashandi,82 https://orcid.org/0000-0002-1976-0005Hyuntae Park,83 https://orcid.org/0000-0003-4560-1953Inés Revuelta-Sánchez,76 Jackline Jema Nusurupia,84 https://orcid.org/0000-0002-8663-1182Jaime Leppe Zamora,85 Jaroslava Kopcakova,86 https://orcid.org/0000-0001-6249-5131Javier Brazo-Sayavera,87 Jean-Michel Oppert,88 https://orcid.org/0000-0003-2326-3615Jinlei Nie,89 https://orcid.org/0000-0001-8485-1336John C. Spence,90 John Stewart Bradley,91 https://orcid.org/0000-0001-7571-9181Jorge Mota,92 https://orcid.org/0000-0001-7219-931XJosef Mitáš,93 Junshi Chen,94 https://orcid.org/0000-0001-8677-5939 Kamilah S Hylton,95 https://orcid.org/0000-0001-7848-3418Karel Fromel,93 https://orcid.org/0000-0002-0506-2214Karen Milton,96 https://orcid.org/0000-0001-9529-2592Katja Borodulin,97 Keita Amadou Moustapha,98,99,100 https://orcid.org/0000-0001-9262-298XKevin Martinez-Folgar,101 https://orcid.org/0000-0003-3707-8218Lara Nasreddine,102 Lars Breum Christiansen,103 https://orcid.org/0000-0002-6601-5630Laurent Malisoux,104 https://orcid.org/0000-0002-8081-0999Leapetswe Malete,105 https://orcid.org/0000-0001-9709-301XLorelie C. Grepo-Jalao,106 https://orcid.org/0000-0001-7484-1185Luciana Zaranza Monteiro,107 https://orcid.org/0000-0002-3767-4899Lyutha K. Al Subhi,108 Maja Dakskobler,36 Majed Alnaji,109 Margarita Claramunt Garro,110 https://orcid.org/0000-0002-4607-8677Maria Hagströmer,111 https://orcid.org/0000-0003-3482-332Marie H. Murphy,39 https://orcid.org/0000-0003-2870-8556Matthew Mclaughlin,112 Mercedes Rivera-Morales,113 Mickey Scheinowitz,114 https://orcid.org/0000-0002-3456-3130Mimoza Shkodra,115 https://orcid.org/0000-0003-3844-550XMonika Piątkowska,116 https://orcid.org/0000-0002-4032-0194Moushumi Chaudhury,117 https://orcid.org/0000-0002-2263-1968Naif Ziyad Alrashdi,118,119 https://orcid.org/0000-0002-5018-6398Nanette Mutrie,120 https://orcid.org/0000-0002-0176-2897Niamh Murphy,121 Norhayati Haji Ahmad,122 https://orcid.org/0000-0002-2827-6872Nour A. Obeidat,123 https://orcid.org/0000-0002-3228-1439Nubia Yaneth Ruiz Gómez,124 https://orcid.org/0000-0002-3623-8411Nucharapon Liangruenrom,125 https://orcid.org/0000-0001-9636-2206Oscar Díaz Arnesto,126 https://orcid.org/0000-0002-9780-937XOscar Flores-Flores,127,128 Oscar Incarbone,129 https://orcid.org/0000-0001-5058-1761Oyun Chimeddamba,130 https://orcid.org/0000-0002-0242-4259Pascal Bovet,131,132 https://orcid.org/0000-0003-2382-6422Pedro Magalhães,133 https://orcid.org/0000-0001-7190-0979Pekka Jousilahti,134 Piyawat Katewongsa,125,135 Rafael Alexander Leandro Gómez,124 Rawan Awni Shihab,123 https://orcid.org/0000-0002-4431-7021Reginald Ocansey,136 Réka Veress,137 Richard Marine,138 https://orcid.org/0000-0003-2603-4017Rolando Carrizales-Ramos,139,140 https://orcid.org/0000-0002-2286-9618Saad Younis Saeed,141 https://orcid.org/0000-0002-8145-2775Said El-Ashker,142 Samuel Green,143 Sandra Kasoma,144 https://orcid.org/0000-0001-5391-5835Santiago Beretervide,145 https://orcid.org/0000-0003-0122-5570Se-Sergio Baldew,146 https://orcid.org/0000-0002-8494-4644Selby Nichols,147 https://orcid.org/0000-0002-3090-9309Selina Khoo,148 https://orcid.org/0000-0001-9122-3952Seyed Ali Hosseini,149 https://orcid.org/0000-0001-6993-2883Shifalika Goenka,150,151 Shima Gholamalishahi,152 https://orcid.org/0000-0002-2517-8118Soewarta Kosen,153 https://orcid.org/0000-0001-7742-2592Sofie Compernolle,154 https://orcid.org/0000-0003-0426-4073Stefan Paul Enescu,40 https://orcid.org/0000-0002-6633-3575Stevo Popovic,47 https://orcid.org/0000-0001-7536-9476Susan Paudel,41 https://orcid.org/0000-0001-7069-5125Susana Andrade,41 https://orcid.org/0000-0001-6125-7182Sylvia Titze,156 https://orcid.org/0000-0003-3465-470XTamu Davidson,157 https://orcid.org/0000-0001-7557-5245Theogene Dusingizimana,158 https://orcid.org/0000-0002-5218-1160Thomas E. Dorner,159 https://orcid.org/0000-0002-5025-3204Tracy L. Kolbe-Alexander,160,161 Tran Thanh Huong,162 https://orcid.org/0000-0002-4313-7336Vanphanom Sychareun,163 https://orcid.org/0000-0001-5289-6468Vera Jarevska-Simovska,164 Viliami Kulikefu Puloka,165 Vincent Onywera,166 https://orcid.org/0000-0002-0653-3620Wanda Wendel-Vos,167 https://orcid.org/0000-0001-6962-1583Yannis Dionyssiotis,168 and https://orcid.org/0000-0002-8939-7715Michael Pratt5
School of Medicine, Universidad de los Andes, Bogotá, Colombia
Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
School of Medicine, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, VIC, Australia
School of Public Health, University of Sydney, Sydney, NSW, Australia
Department Performance, Neuroscience, Therapy & Health, MSH Medical School Hamburg, Hamburg, Germany
Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
Department of Physiotherapy, Redeemer’s University, Ede, Nigeria
Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria
Te Hau Kori, Faculty of Health, Victoria University Wellington, Wellington, New Zealand
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
Graduate School of Public Health, Teikyo University, Tokyo, Japan
Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
University of Texas Health Science Center, School of Public Health, Austin, TX, USA
Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
College of Medicine Chattanooga, University of Tennessee, Chattanooga, TN, USA
Centers for Disease Control and Prevention, Atlanta, GA, USA
University of Bristol, Bristol, United Kingdom
Institute of Physiotherapy & Rehabilitation Sciences, Peoples University of Medical & Health Sciences for Women, Nawabshah, Pakistan
National Institute of Youth and Sports Mali, Mali, Bamako
Department of Physical Education, School of Education, Central University of Kashmir, Ganderbal, Jammu and Kashmir, India
Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Laboratoire de Recherche en Nutrition et Alimentation Humaine, Faculté des Sciences et Techniques, Université Cheikh Anta Diop de Dakar (UCAD), Dakar, Senegal
Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
Public Health, Adama Hospital Medical College, Adama, Ethiopia
School of Arts, Sciences and Humanities at University of São Paulo, São Paulo, SP, Brazil
Faculty of Economics, Universitas Mercatorum, Rome, Italy
Department of Public Health, Caspian University, Almaty, Kazakhstan
National Institute for Public Health, Ljubljana, Slovenia
Division Prevention of Noncommunicable Diseases, Department of NCD Prevention, Directorate for Prevention and Health Care, Swiss Federal Office of Public Health (FOPH), Schwarzenburgstrasse, Switzerland
Institute for Physical Education and Sport, University of Malta, Msida, Malta
Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Newtownabbey, United Kingdom
Researcher, Romania
Department of Bioscience, Universidad de Cuenca, Cuenca, Ecuador
National Medical Research Center for Preventive Medicine, Russian Federation
National Center for Spinal Disorders, Budapest, Hungary
Laboratoire Motricité Humaine expertise Sport Santé (LAMHESS), Université Côte d’Azur, Nice, France
Unité de Nutrition et Alimentation, Centre National de l’Energie, des Sciences et des Techniques Nucléaires (CNESTEN), Maroc, Morocco
Sport and Physical Activity Division, Institut National Polytechnique Félix Houphouët-Boigny (INP-HB), Yamoussoukro, Côte d’Ivoire
Faculty for Sport and Physical Education, University of Montenegro, Niksic, Montenegro
Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, VIC, Australia
Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
Researcher, Uruguay
Early Start, University of Wollongong, Wollongong, NSW, Australia
Sport and Recreation Department, Sports and Recreation Commission, Harare, Zimbabwe
University of Colombo, Colombo, Sri Lanka
University of the West Indies, Cave Hill, Barbados
Canadian Fitness and Lifestyle Research Institute, Ottawa, ON, Canada
Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
Department of Preventive Medicine and Public Health, Universidad Autonoma de Madrid, Madrid, Spain
CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
Department of Sport Science, University of Botswana, Gaborone, Botswana
Department of Sport Science, Wolaita Sodo University, Sodo, Ethiopia
Department of Landscape Architecture and Environmental Planning, Natural Learning Initiative, College of Design, North Carolina State University, Raleigh, NC, USA
Faculty of Sport and Physical Education, University of Belgrade, Beograd, Serbia
SGH Warsaw School of Economics, Warszawa, Poland
Department of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
School of Kinesiology & Health Studies, Queen’s University, Kingston, ON, Canada
University of Tartu, Tartu, Estonia
Universidad Nacional de Asunción, San Lorenzo, Paraguay
Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
Faculty of Science and Education, University of Mostar, Mostar, Bosnia and Herzegovina
Escuela de Educación Física y Deportes, Universidad de Costa Rica, San Pedro, Costa Rica
Escuela de Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional de Costa Rica, Heredia, Costa Rica
Sapienza University of Rome, Rome, Italy
School of Physiotherapy, Universidad Industrial de Santander, Bucaramanga, Colombia
Department of Physical Therapy and Rehabilitation, Güven Health Group, Turkey
Department of Health Sciences, Zayed University, Dubai, United Arab Emirates
Department of Child and Adolescent Health, Institute of Mother and Child, Warszawa, Poland
School of Nursing and Public Health, Faculty of Health Sciences and Veterinary Medicines, University of Namibia, Windhoek, Namibia
College of Health Science, Dong-A University, Busan, Korea
Tanzania Food and Nutrition Center, Dar es Salaam, Tanzania
School of Physical Therapy, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Kosice, Slovakia
PDU EFISAL, Centro Universitario Regional Noreste, Universidad de la República, Rivera, Uruguay
Nutrition Department, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
Faculty of Kinesiology, Sport, & Recreation, University of Alberta, Edmonton, AB, Canada
Public Health Wales NHS Trust, Wales
Research Center in Physical Activity, health and Leisure (CIAFEL), Faculty of Sports-University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
China National Center for Food Safety Risk Assessment, Beijing, China
Faculty of Science and Sport, University of Technology, Kingston, Jamaica
Norwich Medical School, University of East Anglia, Norwich, United Kingdom
Age Institute, Finland
Directeur Technique Fédération de Basket Mauritanie, Mauritania
Instructeur FIBA des Entraineurs, Africa
Ambassadeur ITK de l’Univesrsité de Leipzig, Germany
Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
Department of Precision Health, Luxembourg Institute of Health, Grand Duchy of Luxembourg, Luxembourg
Department of Kinesiology, Michigan State University, East Lansing, MI, USA
University of the Philippines Diliman, Quezon City, Philippines
Centro Universitário do Distrito Federal (UDF), Brasília, Brazil
Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman
Leaders Development Institute, Ministry of Sport, Kingdom of Saudi Arabia
Dirección de Planificación, Ministerio de Salud, San José, Costa Rica
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
Telethon Kids Institute, University of Western Australia, Crawley, WA, Australia
Centro de Acción Urbana, Comunitaria y Empresarial (CAUCE), UPR-Recinto de Rio Piedras, San Juan, Puerto Rico
Department of Biomedical Engineering, Sylvan Adams Sports Institute, School of Public Health, Tel Aviv University, Tel Aviv, Israel
Physical Education and Sports, AAB Collage, Kosovo Polje, Kosovo
Organisation and Economy, Józef Piłsudski University of Physical Education in Warsaw, Warszawa, Poland
Human Potential Centre, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Kingdom of Saudi Arabia
Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, Scotland
Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
Health Promotion Centre, Ministry of Health, Brunei Darussalam
Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
Grupo Interno de Trabajo Actividad Física del Ministerio del Deporte de Colombia, Colombia
Institute for Population and Social Research, Mahidol University, Salaya, Thailand
Cardiology Society, Uruguay
Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Universidad de San Martín de Porres, Lima, Peru
Facultad de Ciencias de la Salud, Universidad Cientifica del Sur, Lima, Peru
Instituto Universitario YMCA miembro de la Coalición Mundial de Universidades YMCA, Argentina
Health Policy and Management, Global Leadership University, Ulaanbaatar, Mongolia
University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
Ministry of Health, Victoria, Republic of Seychelles
Department of Physiological Sciences, Faculty of Medicine of Agostinho Neto University, Luanda, Angola
Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
Thailand Physical Activity Knowledge Development Centre, Salaya, Thailand
University of Ghana, Accra, Ghana
Health-Enhancing Physical Activity Focal Point, Hungary
Numed, Dominican Republic
Physical Education Department, Universidad Nacional Experimental Rafael María Baralt, Cabimas, Venezuela
Physical Education Department, Universidad del Zulia, Maracaibo, Venezuela
Department of Family and Community Medicine, College of Medicine, University of Duhok, Duhok, Iraq
Self-Development Department, Deanship of Preparatory Year, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Researcher, States of Guernsey
Sports Science Unit, Makerere University, Kampala, Uganda
Comisión Honoraria para la Salud Cardiovascular, Montevideo, Uruguay
Department of Physical Therapy, Anton de Kom University of Suriname, Tammenga, Suriname
Department of Agricultural Economics and Extension, The University of the West Indies, St. Augustine, Trinidad and Tobago
Centre for Sport and Exercise Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
Department of Sport Physiology, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran
Head Physical Activity and Obesity Prevention, Centre for Chronic Disease Control, New Delhi, India
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
National Immunization Technical Advisory Groups, Ministry of Health, Jakarta, Indonesia
Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
The Caribbean Public Health Agency (CARPHA), Port of Spain, Trinidad and Tobago
Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, Nyagatare, Rwanda
Department of Social and Preventive Medicine, Centre for Public Health, Medical University Vienna, Vienna, Austria
School of Health and Medical Sciences and Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
National Cancer Institute, Hanoi Medical University, Hanoi, Vietnam
Department of Public Health, University of Health Sciences, Vientiane, Lao People's Democratic Republic
HEPA Macedonia National Organisation for the Promotion of Health-Enhancing Physical Activity at the WHO HEPA Europe, North Macedonia
Health Promotion Strategist, Pacific Portfolio, Health Promotion Forum of New Zealand, Auckland, New Zealand
Department of Physical Education, Exercise and Sports Science, Kenyatta University, Nairobi, Kenya
National Institute for Public Health and the Environment, The Netherlands
Spinal Cord Injury Rehabilitation Clinic, Patras General University Hospital, Patras, Greece
