Why Physical Inactivity is the Cinderella of non-communicable diseases: 8 common myths de-bunked

By Thea Franke and Christina Thiele

Originally published on the Centre for Hip Health and Mobility’s blog (Follow: @Mobility_Health)

Much like Cinderella, physical inactivity goes under-recognized and largely under-appreciated. Bull and Bauman (2011) state that physical inactivity receives a “poverty of policy attention and resourcing proportionate to its importance.”

Addressing physical inactivity needs to be a global public health top-priority. Physical inactivity is the fourth leading risk factor for preventable non-communicable diseases, “preceded only by tobacco use, hypertension, and high blood glucose levels, and accounting for more than 3 million preventable deaths globally in 2010.” (Bull & Bauman, 2011)

ABauman_CHHM-cReturning to the Cinderella analogy, who in the public health realm are the ugly stepsisters keeping Cinderella out of the limelight? How can we enable everyone to play a role as physical activity’s Prince Charming?

Stemming from an engaging recent talk with Professor Adrian Bauman at the Centre for Hip Health and Mobility, we highlight the common myths that contribute to physical inactivity’s treatment as the Cinderella of non-communicable diseases.

Myth #1
The strength of evidence of physical inactivity’s impact on health outcomes is relatively new and not fully accepted.

We’ve had epidemiologic evidence on physical activity, inactivity and health since 1953 (Morris, Lancet). Not only that but 20 years ago Morris described physical activity as the “best buy in public health”.

Myth #2
There is a lack of consensus-based guidelines on how much activity is needed for disease prevention.

We’ve had excellent physical activity guidelines for 13 years (Australia 1999, rev 2012); elsewhere, Global PA guidelines, WHO 2010.

Myth #3
Physical activity is not understood or identified as a discrete risk, because it is a behaviour embedded within everyday life.

In reality physical activity is defined as all large muscle-related bodily movement” (Caspersen, Powell, & Christenson, 1985) and can take on different meanings depending on your cultural and socioeconomic context. In low- and middle-income countries it can mean your daily activities, in other settings it can mean “sports activity”. Clearer communications about “physical activity for health” can be helpful here.

Myth #4
Physical inactivity cannot be measured reliably to provide valid estimates of risk.

Physical activity measures are well established in research (and have been for some time). (Taylor, 2014).

Myth #5
Physical inactivity is not recognized as a problem for low- and middle-income countries.

Low and middle income countries are increasingly affected by inactivity especially due to urbanization and economic growth.

Myth #6
Population-wide levels of participation in physical activity cannot be changed.

Emerging evidence shows that physical inactivity is difficult to change but not impossible as emerging evidence has shown (Pratt et al., 2014). Although complex, multi-sectoral approaches are needed and possible, plus we cannot afford to NOT fix it.

The physical activity community must communicate consistently that there is sufficient evidence to act. In 2011 an economic review of physical activity NCD Prevention: Investments That Work for Physical Activity identifies specific interventions, which are supported by evidence, and is available here.

Myth #7
Lack of “ownership” of the problem and control of the relevant solutions by any single government ministry requires integrated action and partnerships beyond the health sector.

At the individual, societal and political levels we share a responsibility for advocating for change and promoting physical activity as a way to prevent death.

Myth #8
There are insufficient use of advocacy and communications strategies to make a strong and convincing case for the importance of physical activity.

Understanding of the overwhelming burden physical inactivity has on population health is increasing. In accordance, NGO advocacy and improved strategic communication has been on the rise in the past 3 – 4 years.

In Conclusion
Sure, the causes of physical inactivity are more complex than just two ugly stepsisters. But with increased advocacy and support from national and provincial governments to create tailored on-the-ground, evidence-based strategies, action from professionals across disciplines, and individuals that serve as examples and daily champions, there are many opportunities for us to collectively save Cinderella so she can live an active life in good health.

Read Bauman’s article: Physical Inactivity: The “Cinderella” Risk Factor for Non-communicable Disease Prevention

Or this related BJSM Material

*NEW* Gates A. 2015. Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients (Online only) bjsports-2014-094442.

Bull F. 2012. NON COMMUNICABLE DISEASE PREVENTION: Investments that work for physical activity. BJSM 46:709-712.

 Bauman A, Titze S, Rissel Cand Oja P. 2011. Changing gears: bicycling as the panacea for physical inactivity? BJSM 45:761-762. (Free online!)

Hellenius M, Sundberg C. 2011. Physical activity as medicine: time to translate evidence into clinical practice. BJSM, 45:158.

Blair SN. 2009. Physical inactivity: the biggest public health problem of the 21st century. 43:1-2.

Owen N, Salmon J, Koohsari M. 2014 Sedentary behaviour and health: mapping environmental and social contexts to underpin chronic disease prevention. BJSM 48:174-177.

BJSM Podcast: Fit vs fat with Steven Blair

BJSM Podcast: Bob Sallis on Exericise as Medicine

About the authors

Thea Franke is a PhD student in the Interdisciplinary Program at the University of British Columbia. Her doctoral work focuses on the intersections between the built and social environment, older adults’ mobility and health. Her recent publication in The Journal of Aging Studies examined key factors that facilitated physical activity in highly active community dwelling older adults.

Christina Thiele is the award winning Communications and Community Relations Manager at the Centre for Hip Health and Mobility. She develops and implements strategic communications and community relations plans that support CHHM’s health promotion mandate.


Bull, F. C., & Bauman, A. E. (2011). Physical inactivity: the “Cinderella” risk factor for noncommunicable disease prevention. Journal of health communication, 16(sup2), 13-26.

Caspersen , C. J. , Powell , K. E. , & Christenson , G. M. ( 1985 ). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports , 100 ( 2 ), 126 – 131.

Pratt, M., Perez, L. G., Goenka, S., Brownson, R. C., Bauman, A., Sarmiento, O. L., & Hallal, P. C. (2014). Can Population Levels of Physical Activity Be Increased? Global Evidence and Experience. Prog Cardiovasc Dis. doi: 10.1016/j.pcad.2014.09.002

Taylor, D. (2014). Physical activity is medicine for older adults. Postgraduate medical journal, 90(1059), 26-32.

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