Why We Still Lack a Global Fitness Plan and How to Fix It

In collaboration with my UC San Diego colleagues, Jim Sallis, PhD, distinguished professor at the Herbert Wertheim School of Public Health and Human Longevity Science, and Tarik Benmarhnia, PhD, professor at Scripps Institution of Oceanography, we co-authored a March 2026 Nature Medicine and Nature Health series highlighting gaps in physical activity policy implementation, the health impacts of unequal access and benefits of physical activity beyond health.

Altogether, we produced three thematically linked papers and a policy brief, each addressing part of the challenge to increase physical activity worldwide.

Active ways forward

Why, despite it being clearly good for health and seemingly without any enemies or downsides, has physical activity struggled to gain traction in public health and public policy? The paper “Low global physical activity despite two decades of policy progress” suggests a number of reasons.

Physical activity is a growing priority within public health and is recognized as valuable in education, transport, sports and recreation, yet it is not a top priority in any sector. Without clear accountability, it remains a public policy orphan. Efforts to promote physical activity have been hampered by an overly health-centric approach, limiting political priority and multisectoral engagement.

Perhaps part of the answer to raising physical activity as a public policy priority may be to couple it with a more top-of-mind issue such as climate change as suggested in the paper “Benefit of physical activity initiatives for climate change mitigation and adaptation.”

Increasing urban green space, enhancing infrastructure for walking and cycling, and integrating public transit with active transport have all been documented to increase physical activity and are key strategies for mitigating climate change.

Reimaging physical activity

Perhaps an even bigger reconceptualization is needed — a new perspective, model and understanding of how physical activity fits into our lives in the 21st century (“Physical activity for public health in the 21st century”).

Together with co-authors from around the world, we propose moving away from the current model centered on cardiovascular disease prevention toward one that emphasizes socioeconomic and gender equity and the totality of health benefits, including those related to infectious diseases. These papers suggest that reconceptualizing physical activity from an individual healthy choice to a societal priority that engages many sectors, but also identifies responsibility, budgets and accountability, will be essential for increasing physical activity across the globe.