Dr. Hidde van der Ploeg is professor of physical activity and public health at the Department of Public and Occupational Health of Amsterdam UMC (The Netherlands).
According to OECD data, almost half (45%) of Europeans report that they never exercise or play sports. Could you please explain the primary reasons behind this lack of physical activity among Europeans, and how these reasons vary by demographics (e.g. age, gender, and socioeconomic status)?
Hidde van der Ploeg: Coming from a background in physical activity and public health, I see exercise and sports as just a small part of the total amount of physical activity people are doing. And it’s a nice and important part, of course, but I think the public health picture is a little bit bigger than that. So having said that, I do think inactivity levels in Europe are quite high. It’s not just about how much we move or we don’t move. Sedentary behaviour is also a problem, as highlighted by WHO physical activity guidelines.
For example, the Dutch may be the most sedentary people in Europe, but they are also quite active. This shows that being sedentary doesn’t necessarily mean being inactive. You can be quite sedentary and active at the same time. And the reverse is also possible. So, you can be inactive but not sedentary. For example, suppose you have a job where you’re on your feet all day, like working in a store or being a hairdresser. In that case, you’re not necessarily meeting the WHO guidelines. Still, you’re not sedentary either.
The health guidelines suggest that a mix of activities, from light to vigorous, can provide health benefits. For example, a truck driver might need more vigorous activity to compensate for sedentary work, while for someone with limited mobility lighter activities will be more feasible and already bring health benefits. So, if you sleep eight hours a day, you’re awake for 16 hours, you only have to spend about 2% of the time that you’re awake to be physically active on a moderate to vigorous intensity level to meet the recommendations.
That also means that you tend to move less during the rest of the day when you’re awake. And all of that time is spent in either sedentary time or light-intensity activities. These are activities where you’re on your feet, but you’re not at walking speed. So for example, you’re cooking, or, you know, doing the dishes, like I said, working in a store or being a hairdresser you do a lot of light intensity activities.
Education and occupation play also a role in these lifestyle choices; higher education often correlates with more sitting due to desk jobs, while lower education may lead to more physical jobs. Because moderate to vigorous activity makes up only a small part of our weekly routine, it’s important to balance being sedentary with light activity throughout the day. This balance is key to our health and varies depending on how we work and live in general.
What role does the living environment play in influencing physical activity levels within the EU? Is there a significant difference in terms of physical inactivity rates between people living in cities and those living in more rural areas?
Hidde van der Ploeg: I think the environment is very important, of course, opportunity can facilitate behaviour, right? So, just to give you an example: if you take Amsterdam and Copenhagen, which are very cycling- and walking-friendly cities, you see that the rates of walking and cycling are much higher there than in cities where the infrastructure for cycling and walking is much lower. So, there’s definitely a difference in physical activity levels in those cities.
The same goes for the way our cities are structured or the opportunities you have to walk, cycle or exercise in your neighbourhood. Of course, that doesn’t mean that everyone living in an activity friendly neighbourhood will be active. People will still make their own choices. So, it’s only one part of the picture, but it’s an important part of the picture because the available opportunities will certainly influence how much a person is active.
In terms of rural versus urban, it could be that it’s easier to walk in the beautiful countryside, for example, if there are good footpaths. On the other hand, it could also be that in rural areas there isn’t a good infrastructure for cycling or for walking. Additionally, everything is really car-based, and the distances are longer, resulting in people relying more on cars. So it could go both ways, right? Transport and the infrastructure for getting around are an important aspect, but it also very much depends on the specific rural or urban environment considered, I think.
From your perspective, what are the most significant barriers preventing Europeans from engaging in regular physical activity, and how do these barriers differ across EU countries?
Hidde van der Ploeg: Our environment is structured in such a way that it’s easy to remain sedentary throughout the day, which is not conducive to staying active. Many adults find it difficult to make time for physical activity due to busy schedules. However, an effective and enjoyable way to stay active is to incorporate physical activity into daily routines, such as walking or cycling to the local store for example. Choosing activities that are fun to do can also help to encourage these habits to last beyond the fleeting enthusiasm of a New Year’s resolution.
As I already said, cities like Amsterdam and Copenhagen are prime examples of cycling-friendly environments, demonstrating how urban planning can influence physical activity levels. These cycle-friendly cities emphasise the ease of cycling through their streets compared to driving, with plenty of cycle lanes and less emphasis on car traffic. However, such facilities are not uniformly available in all European cities.
Finally, other differences in inactivity levels across different countries may be due to cultural, environmental or occupational differences, as well as climate, which may influence the willingness to engage in outdoor activities. An example of how cultural values can significantly influence physical activity trends is Norway, which has a strong culture of outdoor activities, such as cross-country skiing, hiking and orienteering.
Considering the current EU policies on the promotion of sports & physical activity, what additional strategies or policies would you recommend to effectively address the issue of physical inactivity across EU member states?
Hidde van der Ploeg: I am a big fan of the Eight investments that work for physical activity, which cover different sectors such as schools, workplaces, sports facilities, transport, urban and environmental infrastructure, health, communities and mass media campaigns. Promotion of physical activity in these areas is essential to reduce levels of inactivity, as improving physical activity and reducing sedentary behaviour can be a challenge in our environment, which is often conducive to inactivity and sedentary behaviour. This is also in line with the WHO’s Global Plan of Action for Physical Activity.
While most people are aware of the need to be active and eat well, knowledge alone isn’t enough to change behaviour, especially when inactivity and sedentary behaviour are so easily integrated in our daily lives. This is particularly true for those people who have a natural tendency to be less active. In addition to providing information, we need interventions that make physical activity an attractive and convenient part of people’s lives. In the Netherlands, for example, lifestyle medicine initiatives, including lifestyle brokers in hospitals and primary care, help patients integrate physical activity into their daily lives.
Despite these efforts, less than half of the Dutch population meets physical activity recommendations. This figure has remained stable for the past two decades. To reverse this stagnating trend and to increase the number of people who meet these guidelines, we need to work together across all of these sectors. It is through collaboration that the promotion of physical activity will have the greatest impact on public health.
In what ways can technology and digital platforms be utilised to combat physical inactivity (such as mobile steps counter apps etc), particularly among younger populations?
Hidde van der Ploeg: I think there’s obviously an opportunity there with all the developments in technology and often it’s in combination with other initiatives. Just to give you an example, if we’re trying to increase physical activity in patients, giving them an activity tracker like a Fitbit, Garmin or Apple Watch is a nice tool in a larger intervention to help them monitor their behaviour and set goals to improve their physical activity. So, I think that’s a nice example of how the technology that’s all around us can be a part of that or can be used for that purpose. But usually, this is only one component of a larger set of tools or strategies to improve physical activity. On its own, it is unlikely to lead to long-term behaviour change in most people; but it can be a helpful tool in a broader set of strategies. To have a significant impact on population physical activity levels, we need to implement strategies across different sectors.
How has smart working during the COVID-19 pandemic affected physical activity, and how can we promote daily exercise for Europeans working from home?
Hidde van der Ploeg: So, working from home has a bit of a mixed outcome, because people tend to save on travel time, which they could potentially spend on exercise time or going for a walk. At the same time, that travel time could be active travel, like walking or cycling to work. And then once you’re in the office or whether you’re at home, the amount of particularly light intensity activity you do and the number of steps you take is also quite different.
Depending on the size of your office, at least I tend to take many more steps in the office than at home, because I have to go to the next meeting with colleagues, I have to go to the coffee machine and so on, and the distances are simply longer than at home. Then I’ve got all that travelling, which in my case would be some active commuting to the train, then taking the train (I often stand a few stops), and then walking from the train station to work. All of that gives me a lot more step counts and a lot more physical activity in terms of moderate and light intensity activity, especially compared to when I’m at home because my home is not a big castle.
On the other hand, I save time and I could more easily go for a nice little walk during lunch or at the beginning or end of the day, or even do some exercise, because I saved some time travelling. So it’s a bit mixed. I think it depends a lot on your own circumstances. So in terms of how it’s changed, there’s not really a clear answer. You can see that working from home has its opportunities and its limitations.
I think the same is true in the office, if you really have a desk job, trying to find ways to be less sedentary, are more and more common in companies. So you see a lot more sit-stand desks, for example, where you can switch between sitting and standing. And standing would be counted under light levels, which is a little bit more energy expenditure than sitting, but only a little.
Another good way to incorporate more movement into your day is to stand or walk during phone calls or meetings. These are examples of activities that companies often implement when they try to increase (light intensity) activity and reduce sedentary behaviour, especially in sedentary desk jobs.
Based on your expertise, what advice would you offer to individuals seeking to lead more active lifestyles and to European policymakers aiming to reduce physical inactivity rates?
Hidde van der Ploeg: So, for the individual, it very much depends on their own particular circumstances. As said, I think that if you want to keep physical activity a constant in your life, it is important to do something that you have to do anyway but make it active. For example, walking to the bakery instead of driving to the bakery. Additionally, enjoyable activities are more likely to become long-term habits. So, if you can find activities that you think are fun or are fun because they’re with other people that you want to be with, I think those are the things to look out for.
In terms of policymakers, I think the WHO’s global action plan for physical activity is a great starting point. And the Eight best investments for physical activity that I mentioned earlier are also, in my view, a great place to try to make progress. And you really do need to work across all of these areas to make progress in your own country.