Q&A: Why Physical Activity Matters

Take-Home Messages 🔑

Introduction 🏃‍♀️💪❤️🧠🌱

A major concern among researchers and healthcare professionals is the large proportion of the global population who fails to meet recommended physical activity guidelines, with sedentary lifestyles becoming increasingly prevalent. This widespread inactivity is occurring alongside the escalating obesity pandemic, compounding risks for non-communicable diseases and premature mortality. Physical inactivity has been classified as a pandemic-level threat, with prevalence particularly high in high-income and digitally advanced nations (1). A pooled analysis of 507 surveys across 163 countries found that the global prevalence of insufficient physical activity among adults rose from 23.4% in 2000 to 31.3% in 2022 (1). Rates were higher among women (33.8%) than men (28.7%) and inactivity increased among adults aged 60 and older across all regions (1). Unless movement is recognised as a fundamental human necessity, society risks “engineering our extinction — one chair at a time.”

A healthy diet alone cannot secure long-term wellbeing without physical activity, because food provides the nutrients but movement ensures the body uses them effectively. Physical activity strengthens muscles, bones and the cardiovascular system, improves insulin sensitivity and supports mental health in ways diet cannot achieve on its own. Together, diet and physical activity create the synergy needed to prevent chronic disease, maintain independence and promote vitality throughout life. Importantly, the benefits of physical activity extend beyond disease prevention to improved quality of life, functional independence and mental health, reinforcing its role as a foundational, non-pharmacological intervention in both clinical and public health contexts.

This review provides an overview of why physical activity matters, beginning with its domains, types, and energy costs, and exploring motivations and barriers to engagement. It examines physical activity’s impact on health across the lifespan, including its role in reducing mortality, managing chronic conditions, enhancing cognitive and mental health and improving sleep quality. Attention is given to physical activity during pregnancy, postpartum recovery and paternal influences on epigenetics. I also address health risks, measurement methods and age-specific recommendations, concluding with practical tips for becoming more active and reflections.

Domains of physical activities 💼🚶‍♂️🏠 🧹🧺🪣

The World Health Organisation (WHO), through the Global Physical Activity Questionnaire (GPAQ) (2), defines physical activity across three distinct domains to capture movement in daily life (https://www.who.int/publications/m/item/global-physical-activity-questionnaire). These domains include work-related physical activity (paid or unpaid work, household tasks and subsistence activities), transport-related physical activity (walking or cycling to get from place to place) and leisure-time physical activity (exercise, sport and recreational activities). By distinguishing these domains, physical activity is recognised as extending beyond structured exercise, with substantial activity in low- and middle-income settings often occurring through work and transport rather than leisure.

The GPAQ does not include sexual activity, though it involves muscular effort, elevated heart rate and energy expenditure (3). Its omission likely reflects discomfort in reporting, variability in intensity and duration, and cultural or privacy concerns.

Types of physical activities 🏃‍♀️💪🧘‍♀️⚽

Physical activity includes all energy-requiring movements, such as walking, gardening or cleaning, while exercise is a structured, repetitive subset designed to improve fitness. Exercise is a subset of physical activity—every exercise session counts as physical activity, but not all physical activity qualifies as exercise and are sometimes referred to as non-exercise activities. Training refers to a systematic program of repeated exercise sessions aimed at specific outcomes i.e. strength, endurance or competition preparation.

In the table below I define the types of physical activities that people engage in. Aerobic and resistance training provide complementary benefits: aerobic exercise improves cardiorespiratory fitness and energy expenditure, while resistance training preserves lean mass, supports metabolic health, and boosts post-exercise energy use (4). Evidence shows that combining both is the most effective strategy for long-term health (4). Bodybuilding, focused on resistance training for strength and hypertrophy, is a moderate- to vigorous-intensity activity when performed progressively. Plyometric training, a subtype of power training, uses the muscle–tendon stretch–shortening cycle for explosive force. Not all power training is plyometric, as power can also be developed through high-velocity movements with or without external loads.

 From mid-life onwards, balance training becomes a vital component of physical activity, as age-related changes such as stiffness, arthritis and inner-ear issues can compromise stability and increase health risks. Beginning targeted balance exercises around age 45 helps preserve fitness, extend active years and enhance brain function by challenging postural control. Simple practices such as standing on one leg, as well as structured activities such as tai chi or racquet sports, strengthen balance across different movement planes. Long-term studies link regular balance training with improved bone health, reduced risk of stroke and lower all-cause mortality, underscoring its importance for healthy ageing (5).

Table: Overview of physical activity modalities and their health benefits

TRX, Total Resistance Exercises (also known as suspension-based training)

Genetic variations influence responses to different types of physical activity

Genetic testing for fitness seeks to identify how individuals may respond to different types of physical activity by analysing variations in genes linked to muscle fibre type, endurance capacity, recovery and injury risk. E.g. markers such as alpha‑actinin‑3 (ACTN3) can indicate a predisposition toward sprint or endurance performance, while others such as angiotensin converting enzyme (ACE) relate to aerobic capacity. Commercial DNA tests may guide training preferences, but lifestyle factors such as diet, sleep and stress are far more influential. Current evidence supports using these tests only as supplementary insights, not strict exercise prescriptions.

Table: Genetic variants (ACTN3 and ACE) and their associations with physical activity

Energy cost of physical activity

The energy cost of physical activity, expressed in kilojoules (kJ), varies widely depending on the type, intensity, duration and individual characteristics such as body mass and fitness level. To standardise these differences, researchers and dietitians often use metabolic equivalents of task (METs). One MET represents the energy expenditure at rest (approximately 3.5 ml O₂ per kg body weight per minute), and activities are expressed as multiples of this baseline. E.g., walking at a moderate pace may be around 3.5 METs, while running at 10 km/h is closer to 10 METs.

Because energy expenditure scales with body weight and activity intensity, researchers and health care workers such as dietitians adopt different approaches depending on the population. For non-athletes, energy needs are often estimated using predictive equations such as the Harris–Benedict formulae, which calculate basal metabolic rate (BMR; the energy your body uses at rest to maintain vital functions) and then apply an activity factor to approximate total energy expenditure. The activity factor adjusts BMR to account for lifestyle and physical activity levels, ranging from 1.2 for sedentary individuals (little or no exercise), 1.375 for lightly active (light exercise/sports 1–3 days per week), 1.55 for moderately active (moderate exercise/sports 3–5 days per week), 1.725 for very active (hard exercise/sports 6–7 days per week), and up to 1.9 for extra active (very hard physical job or training twice daily).

In contrast, athletes require more precise assessment using METs or direct measures, ensuring nutrition matches training demands and supports health, performance, and recovery. Below is a Table with the energy expenditure of common activities for a women and man of average weight.

🔢 Table: Energy expenditure of common activities (approximate, per hour)

📌 *METs = Metabolic Equivalent of Task. 1 MET ≈ resting energy expenditure (3.5 ml O₂/kg/min). - Cricket varies widely: batting bursts and fast bowling can reach ~6 METs, while fielding or standing periods are closer to ~3–4 METs. The average across a match is ~4.8–6 METs. quash is among the highest-intensity racket sports, with continuous rallies, rapid changes of direction, and sustained cardiovascular demand. Competitive play often pushes toward the upper end of the MET range (~9)(6). .Padel is a moderate-to-vigorous activity, averaging 5–7 METs, with energy costs similar to doubles tennis and heart rates often sustained at 150–180 bpm (7). Portable sensor studies suggest men burn ~418 kJ and women ~293 kJ per encounter, averaging 12.6–16.7 kJ per minute. This aligns with an intensity of ~5–6 METs, though the total energy cost depends heavily on duration, positions, and vigour (3).

Motivations for engaging in exercise🎯💬

It is essential for researchers and health care professionals to understand both why people engage in physical activity and the factors preventing them, as this knowledge guides public health strategies and enables individualised interventions (8). Importantly, these motivations and barriers change over time and should be researched regularly. At the population level, such insight informs policies and programmes that enhance motivation while addressing structural barriers, whereas at the patient level, clinicians and dietitians can tailor recommendations to each person’s health status, preferences and lifestyle demands.

People exercise for a complex interplay of health-driven, appearance-related, psychological, social, functional and contextual reasons. Importantly, motivations evolve over time, and sustainable exercise behaviour is most strongly linked to intrinsic, health-aligned and enjoyment-based motives rather than appearance- or pressure-driven ones.

Framing body image ideals around leanness and muscularity (definition and tone rather than bulk and size) can serve as a positive motivation for engaging in regular physical activity when these ideals are explicitly linked to health and function rather than appearance alone. Valuing a body that is strong, fit and metabolically healthy encourages participation in both aerobic and muscle-strengthening activities, thereby supporting adherence to physical activity guidelines for both men and women (9, 10). When grounded in realistic and inclusive expectations, this perspective can foster sustainable engagement in physical activity by emphasising capability, vitality, and long-term health benefits over short-term aesthetic outcomes.

Table: Reasons for engaging in physical activity

Research shows physical activity is influenced not only by fitness but also by heritable biological processes, with human and animal studies demonstrating genetic contributions to daily activity levels. Heritability estimates vary widely, partly due to differences in study design, measurement, and individual responses—whether rewarding or aversive—suggesting involvement of genetic pathways linked to reward and pain (8). Candidate gene studies highlight associations with dopaminergic and melanocortinergic systems, particularly variants in melanocortin 4 receptor (MC4R), leptin receptor and dopamine receptor D2, while genome-wide linkage studies reveal promising loci but no consistent genome-wide associations (8).

Runner’s high is a euphoric state after sustained aerobic exercise such as running, cycling or swimming (14). It results from endorphin and endocannabinoid release in the brain, elevating mood, reducing anxiety and increasing pain tolerance (15). This neurochemical response fosters relaxation, clarity and exhilaration, making exercise rewarding beyond physical benefits. For some, this powerful reward system reinforces habit formation, stress management and even identity, making exercise non-negotiable. Genetics also influence who experiences runner’s high (16). Variations in genes such as opioid receptor Mu 1 (OPRM1), fatty acid amide hydrolase (FAAH), dopamine receptor D2 (DRD2), and Catechol-o-methyltransferase (COMT) affect sensitivity to neurochemical changes driving this state. While not everyone experiences runner’s high, those with favourable genetic profiles are more likely to crave exercise as a natural reward, making physical activity essential to wellbeing.

Non-participation in physical activity is rarely due to a single factor. It typically reflects a complex interaction of personal, social, environmental and structural barriers. Effective interventions therefore require multilevel approaches that address not only individual motivation but also context, access, safety and social norms.

Table: Barriers to engagement in physical activity

Health benefits of physical activity ❤️🧠🦴

Physical activity and reduced mortality, greater longevity and delayed aging

Regular physical activity is strongly linked to reduced mortality risk and greater longevity, with evidence showing benefits across intensity, volume and consistency of exercise. Large-scale meta-analyses and cohort studies confirm that even modest increases in PA can lower all-cause and cardiovascular mortality (17-19). A study of 8,124 former US Olympians found that they live about five years longer than the general population, primarily due to lower risks of cardiovascular disease and cancer (20). An active lifestyle positively influences key hallmarks of aging—including genomic stability, telomere maintenance, mitochondrial function, proteostasis, cellular senescence and inflammation—thereby supporting both physical and mental health and reducing the risk of age-related diseases (21).

Physical activity and weight status

Physical activity plays a nuanced role in weight status (22). It increases energy expenditure, regulates fat mass, and helps preserve lean body mass (23). A review of 12 systematic reviews and meta-analyses (149 studies) found exercise produced modest but significant reductions in body weight, fat mass, and visceral fat in adults with overweight or obesity (24). Aerobic and high-intensity interval training were equally effective when energy expenditure was matched, while resistance training preserved lean mass during weight loss(24). Exercise improves body composition and visceral fat with cardiometabolic benefits, but evidence for long-term weight maintenance remains limited, requiring further research (24).

Physical activity and spot reducing

The scientific evidence on “spot reduction” (losing fat in specific body areas through targeted exercise) is mixed, but recent studies have revisited the topic with more rigorous designs. While traditional consensus holds that fat loss is systemic rather than localised, some newer trials suggest that under certain conditions, localised fat reduction may occur (25, 26).

Physical activity, muscle function and musculoskeletal health

A meta-analysis of 39 randomised controlled trials (1714 participants) found antioxidants improved muscle strength and function in older adults, while exercise alone enhanced walking distance. The combination produced the greatest gains in strength, speed and overall performance (27). A systematic review of 14 randomised controlled trials (561 older adults with sarcopenia) showed resistance training improved strength, gait speed, functional performance and reduced body fat, though effects on muscle mass were inconsistent (28). A meta-analysis of seven randomised controlled trials (349 participants with osteosarcopenia) found strength training improved muscle mass, handgrip strength, and protein intake, but not bone density, body fat %, gait speed or calcium intake; elastic band training reduced fat more than resistance training (29). High-impact jumping increased bone mineral content in children and adolescents—especially girls—while resistance exercise showed no effect, highlighting the need for further trials (30). A meta-analysis of 10 studies (761 men) found tennis increased bone density in the dominant arm, radius, lumbar spine, trochanter, and femur, but not whole-body or femoral neck; improvements were asymmetrical, favouring the dominant side, so contralateral training is recommended (31). In postmenopausal women, leisure-time activity did not increase bone density but helped maintain mass, with structured exercise providing the greatest localised benefits depending on type and duration (32).

Exercise-induced heart enlargement and heart rate 📊💓

Regular exercise can enlarge the heart through physiological hypertrophy, a healthy adaptation distinct from disease-related enlargement (33). Endurance training expands the left ventricular cavity for greater blood output, while resistance training thickens heart walls to boost contractile strength. These exercise-driven changes remodel heart muscle without harmful fibrosis, producing larger, more efficient hearts with lower resting heartbeat rates. Enlargement is reversible if training stops.

Table: Typical resting heart rates across fitness levels

Footnote: bpm, beats per minute; RHR, resting heart rate.

Low heart rate in fit people is usually healthy, but if accompanied by dizziness, fatigue, or fainting, it may signal a medical issue.

Measurement tip: The most accurate resting heart rate is taken in the morning before getting out of bed, after a full night’s sleep, and without caffeine or stress influences.

Age and gender differences: Women tend to have slightly higher resting heart rates than men, and rates naturally rise with age.

Physical activity protects cognition, brain health and reduces dementia risk

A single bout of exercise offers small but promising improvements in executive function, reaction time and memory in adults with cognitive impairment (34). A network meta-analysis of 37 randomised controlled trials including 2,585 older adults, comparing the effects of different exercise interventions on cognitive function showed that resistance training most strongly improved overall cognition and inhibitory control, aerobic exercise was most effective for memory and physical-mental training (e.g., Tai Chi) provided the greatest benefits for working memory and task-switching (35).

A systematic review and meta-analysis of 17 randomised control trials (739 participants) found that resistance exercise improves overall cognition, working memory, verbal learning and spatial memory in older adults, though effects on processing speed, executive function and attention were not significant (36). The benefits appear influenced by age and exercise parameters, indicating a possible dose–response relationship (36). These findings support resistance training as a targeted strategy for promoting cognitive health and rehabilitation in ageing populations.

Regular physical activity in patients with early Parkinson’s disease is linked to slower neurodegeneration in temporoparietal and limbic brain regions, including the hippocampus and amygdala (37). These structural brain changes mediate the preservation of memory and attention, supporting exercise as a key intervention to delay cognitive decline and improve long-term outcomes (37).

The Framingham Heart Study found that higher levels of physical activity in midlife and late life were linked to a 41–45% lower risk of dementia, while activity in early adulthood showed no association (38). These results suggest that promoting physical activity during midlife and late life may be most effective for delaying or preventing dementia (38).

Physical activity and depression 😊

A meta-analysis of 50 studies with nearly 90,000 children and adolescents found physical activity linked to lower depressive symptoms, though protection against future depression was weak, underscoring the need for standardised measures and longitudinal research (12). Another systematic review of over 191,000 adults showed physical activity inversely associated with depression risk, with greatest benefits at lower activity levels (13). Even modest activity, such as 2.5 hours of brisk walking weekly, reduced depression likelihood compared to none (13).

Physical activity and sleep quality

A 12-week randomised controlled trial by Buğday (39) compared the effects of diet alone versus diet combined with resistance training in individuals with obesity. the combined intervention led to greater improvements in physical activity levels; sleep quality; fatigue reduction and body weight and waist circumference.

Physical activity and cancer

Consistently maintaining moderate physical activity (~17 MET-hours/week, e.g., 5 hours brisk walking weekly) over decades reduces digestive system cancer risk and mortality, with no added benefit from much higher activity levels (40). Acute exercise alters the serum proteomic profile, increasing immune- and vascular-related proteins such as interleukin 6, and produces systemic factors that enhance DNA repair and reduce DNA damage in colon cancer cells (41). These exercise-conditioned serum effects are accompanied by upregulation of DNA repair genes and suppression of proliferative pathways, providing a plausible biological mechanism through which exercise may protect against colorectal cancer progression (41).

Physical activity and hypertension, cardiovascular disease and heart failure

A meta-analysis of 15 trials found aerobic exercise lowers systolic and diastolic blood pressure in obese adults, with greatest effects in high-intensity, short-term programmes. Low-to-moderate intensity and longer interventions showed limited impact, highlighting the need for refined prescriptions (42).

Reviews show physical activity inversely linked to cardiovascular disease risk, with even moderate amounts reducing mortality (6). Brisk walking 30–60 minutes most days provides substantial protection without requiring vigorous exercise (43). Regular activity improves fitness, function, and quality of life in heart failure patients, with evidence it may also prevent heart failure (44).

Aerobic exercise combined with at least modest weight loss produced greater improvements in insulin sensitivity, triglycerides and lipid particle profiles in overweight and obese adults, supporting its role in enhancing cardiovascular health (45). The EPIC‑Norfolk study of 23,201 men and women found that higher habitual physical activity is independently associated with lower plasma fibrinogen concentrations (a blood plasma protein essential for clot formation) suggesting a protective mechanism for cardiovascular health (46) .

Physical activity on insulin action

Research consistently shows that physical activity improves metabolic health, though the magnitude and mechanisms vary across study designs. Habitual endurance and resistance exercise enhanced insulin-stimulated glycogen synthesis in skeletal muscle stem cells compared to sedentary individuals, yet neither modality protected against fatty-acid–induced insulin resistance, suggesting benefits are limited under lipid-driven stress (47). In contrast, structured 12‑week programmes combining aerobic and resistance training produced significant improvements in HbA1c and insulin resistance in patients with type 2 diabetes (48), while aerobic exercise paired with modest weight loss yielded greater gains in insulin sensitivity overweight adults (45). Preclinical models further revealed differences between modalities: resistance exercise was more effective than endurance training in improving glucose and insulin tolerance despite similar fat mass reductions (49).

Physical activity and inflammation and psychoneuroimmunology

Regular physical activity is strongly associated with reduced systemic inflammation, with evidence showing improvements in key biomarkers across diverse populations. Psychoneuroimmunology—the study of interactions between the brain, nervous system and immune system—reveals how optimised communication among these systems enhances the body’s ability to regulate inflammation, resist disease, and support mental well-being. Practices such as exercise and meditation are scientifically validated interventions that leverage psychoneuroimmunology to promote health.

Table: Evidence linking physical activity to reduced inflammation

Physical activity and immune function

Based on a systematic review and meta-analysis of randomised controlled trials and prospective observational studies, regular moderate-to-vigorous physical activity reduces the risk of community-acquired infectious diseases and infectious disease mortality, while also enhancing immune parameters such as CD4 cell counts and salivary IgA (54). It further improves antibody responses to vaccination, (54).

Physical activity to recover from COVID

A randomised clinical trial of 233 adults recovering from COVID-19 found that a 3‑month personalised resistance exercise programme improved walking distance, grip strength, quality of life and reduced anxiety and depression compared with usual care (55).

Physical activity for the management of arthritis

A meta-analysis of 28 studies with 4,111 adults found physical activity interventions moderately improved activity levels and produced small but positive effects on pain and physical function (11). Although both groups showed gains, interventions were more effective overall, highlighting the need for research on optimal exercise types, frequencies and intensities (11).

Physical activity to reduce school bullying

A  longitudinal study involving 577 Chinese adolescents found that physical activity and school bullying are negatively linked over time, with more active students experiencing less bullying and vice versa (56). The protective effect of physical activity was stronger in boys, who also showed greater declines in activity after being bullied, highlighting the need for gender-sensitive interventions (56). Resistance training in children, including prepubertal populations, offers safe and wide-ranging benefits for physical, metabolic, psychological and cognitive health, making it a vital strategy for combating childhood inactivity and promoting lifelong well-being (57).

🏃 Physical activity and polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and exercise is a key lifestyle intervention to improve health outcomes. A randomised controlled trial (58) demonstrated that an eight-week combined training programme led to improvements in metabolic, hormonal, inflammatory and oxidative stress markers in women with PCOS. The study found that insulin levels, insulin resistance (HOMA-IR), total and LDL cholesterol, testosterone and markers of oxidative stress decreased, while insulin sensitivity (QUICKI) improved compared to a control group. A meta-analysis of six randomised controlled trials found no  differences between high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) in improving anthropometric, cardiorespiratory, metabolic, or hormonal measures in women with PCOS (59). Given the low certainty of evidence, both HIIT and MICT can be recommended based on patient preference, though larger, high-quality trials are needed to strengthen clinical guidance (59).

Intergenerational and maternal benefits of physical activity 👶🤰🧬

Physical activity as a holistic strategy with wide-ranging benefits for both parents and children.

Paternal physical activity and sperm microRNAs: An epigenetic pathway to enhanced offspring fitness and metabolism

Yin et al. (60) demonstrated in mice that paternal exercise modifies sperm microRNAs, which regulate the nuclear receptor corepressor 1 (NCoR1) during embryogenesis, thereby enhancing progeny fitness and metabolism. Male mice exercising for eight weeks produced offspring with superior endurance, mitochondrial function and glucose uptake, effects replicated by peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC‑1α) overexpression. Crucially, sperm small RNAs—especially microRNA-148—were shown to causally transmit these phenotypes by repressing nuclear receptor corepressor 1 during early embryogenesis, establishing a key epigenetic mechanism for intergenerational fitness programming.

Effects of prenatal physical activity on mental health 🧘

Prenatal exercise reduces symptoms of prenatal depression and anxiety, while also preventing postpartum depression compared to usual care (61). Different exercise modalities, such as yoga with meditation, maternal gymnastics, fertility dance and water-based aerobic training, show specific benefits for prevention and treatment (61). Overall, structured prenatal exercise programmes provide both therapeutic and preventive effects, supporting maternal mental health during and after pregnancy (61).

Physical activity during pregnancy improves maternal and foetal outcomes

Physical activity during pregnancy is strongly associated with improved maternal and foetal outcomes, including reduced risk of gestational diabetes, preeclampsia, excessive weight gain, and caesarean delivery. Meta-analyses confirm that both moderate and, in some cases, high-intensity exercise are safe and beneficial when appropriately supervised.

Table: Key evidence from recent meta-analyses

Physical activity to manage postpartum depression

A meta-analysis of 12 randomised controlled trials found that exercise-based interventions during pregnancy and postpartum reduced depressive symptoms, with stronger effects in women already experiencing postpartum depression (65). Overall, physical activity proved to be a safe and effective strategy for improving psychological well-being in the postnatal period (65).

Ripple effects of physical activity

Engaging in regular physical activity often sparks a positive chain reaction in other lifestyle habits. People who exercise consistently tend to make healthier food choices (66), improve their sleep routines (67) and manage stress more effectively (68). Importantly, physical activity is also linked to a reduced likelihood of smoking or greater success in quitting (69), because the sense of well-being and discipline gained from exercise can replace unhealthy coping mechanisms.

Health risks of physical activity

Physical activity carries some health risks, but these are generally low and depend on intensity, individual health status and context. Common risks include musculoskeletal injuries, particularly strains, sprains and overuse injuries (70). Rare but more serious risks include cardiovascular events, mainly in individuals with underlying heart disease during unaccustomed vigorous exercise (70), exertional heat-related illness (EHRI; such as muscle cramps, heat exhaustion and heat stroke) (71), water intoxication also known as exercise-associated hyponatremia (EAH)(72), hypoglycaemia (73), concussion or trauma in contact sports (74) and excessive or compulsive exercise (75). Overall, these risks are largely preventable with appropriate screening, gradual progression, proper technique and adequate recovery, and they are far outweighed by the well-established health risks of physical inactivity.

In addition to these physical and psychological risks, regular exercise cannot compensate for poor dietary habits; optimal health requires both consistent physical activity and balanced nutrition. Misbeliefs that exercise alone offsets an unhealthy diet may lead individuals to neglect proper nutrition (76).

Sports drinks, gels, and energy chews are widely used among physically active populations to support hydration and provide quick energy. However, because they are often acidic and high in sugar, they increase the risk of dental caries and enamel erosion (77).

Supplements such as protein powders, creatine, pre‑workout formulations and fat burners are especially prevalent in bodybuilding and fitness subcultures (78). While certain supplements (e.g., protein and creatine monohydrate) can offer modest benefits when dietary intake is insufficient or training demands are high, widespread and indiscriminate use raises concerns about efficacy, safety, cost and regulatory oversight.

Measuring physical activity

Physical activity levels in research are determined using a combination of self-report instruments and objective measures, each with strengths and limitations. Questionnaires such as the GPAQ, IPAQ and activity diaries are commonly used in large population studies because they are cost-effective and capture contextual information across activity domains, although they are subject to recall and social desirability bias. Objective methods—including accelerometers, pedometers, heart rate monitors and wearable devices—provide more precise estimates of activity intensity, frequency, and duration, but may miss certain activities (such as cycling, resistance training, or water-based exercise) and are more resource-intensive. Importantly, individuals do not need to be researchers to monitor their own activity levels: everyday tools such as step counters, smartphone health apps, exercise logs and simple weekly checklists can help people determine whether they meet physical activity recommendations and support awareness, motivation and sustained adherence guidelines.

The active time-to-sedentary ratio and non-exercise activity are crucial in research because they capture the balance between movement and inactivity, offering a more holistic view of lifestyle than exercise minutes alone. This measure highlights how prolonged sitting can offset the benefits of physical activity, provides insights into metabolic health risks such as obesity and cardiovascular disease and reflects daily behavioural patterns—whether activity is spread throughout the day or concentrated in short bouts followed by long sedentary periods. To assess these patterns effectively, researchers employ several tools. Accelerometers and wearable devices allow continuous monitoring to capture both active periods and sedentary bouts across the day. Activity diaries combine objective data with self-reported logs, contextualising whether post-exercise time was spent resting or moving. Post-exercise behaviour tracking segments data into exercise sessions and non-exercise time, helping to evaluate compensatory inactivity (for example, lying on the couch versus light walking). Finally, pattern analysis using machine learning or clustering methods can distinguish activity profiles, such as exercisers who remain sedentary afterward compared to those who maintain light activity. These approaches allow the assessment of daily activity in a nuanced way.

PA recommendations

The South African Food-Based Dietary Guidelines include a specific recommendation related to physical activity, namely “Be active!”, which emphasises that regular movement is an essential component of a healthy lifestyle alongside healthy eating (79). This guideline encourages people of all ages to engage in physical activity on most days of the week to support energy balance, maintain a healthy body weight, strengthen muscles and bones, and reduce the risk of non-communicable diseases. The guideline recognises that physical activity does not need to be structured exercise only, but can include everyday activities such as walking, household tasks, active play and occupational movement, making it achievable.

Children

The World Health Organisation recommends that children and adolescents aged 5–17 years engage in at least 60 minutes of moderate-to-vigorous physical activity daily, mostly aerobic, with vigorous-intensity activities and those that strengthen muscle and bone included at least 3 times per week (https://www.who.int/publications/i/item/9789240015128).

Adults

The World Health Organization recommends adults achieve at least 150–300 minutes of moderate-intensity activity per week (≈600 MET-min), alongside muscle-strengthening exercises twice weekly and reduced sedentary time. Recent evidence shows that walking around 7,000 steps per day provides substantial health benefits, including lower risks of mortality, cardiovascular disease, diabetes, depression and dementia (80), with sustained bouts of 15 minutes or more offering added protection compared to fragmented steps (81). While 10,000 steps remains a popular benchmark, 7,000 is a more achievable and protective target (80).

Research also highlight sex differences, with women gaining cardiovascular benefits at lower activity volumes than men (3). While global guidelines recommend 150 minutes of moderate-to-vigorous physical activity weekly for all adults, the study found that women achieved greater cardiovascular disease risk and mortality reduction at lower activity levels than men—250 minutes/week versus 530 minutes/week for comparable benefits. These findings highlight the need for sex-specific physical activity recommendations and for higher levels than those recommended by the WHO for men (3).

A recent systematic review and meta-analysis found that incorporating short bursts of high-intensity activity—known as "exercise snacks" (ExSn)—into daily routines improves cardiometabolic health in adults, particularly among those who are physically inactive. While ExSn did not affect body weight or fat, it led to notable improvements in maximal oxygen uptake, peak power output and reductions in total and LDL cholesterol, making it a promising, time-efficient strategy for enhancing health in populations with limited time for traditional exercise (82).

During pregnancy

Pregnant women who are generally healthy are advised to engage in at least 150 minutes of moderate-intensity aerobic activity per week (e.g., 30 minutes a day, 5 days a week) (South African Society of Obstetricians and Gynaecologists (SASOG) guideline). Activities should be safe, adapted to pregnancy, and spread throughout the week, with emphasis on avoiding high-risk or contact sports. High-intensity exercise during pregnancy was found to be safe for healthy women, with no adverse effects on birth outcomes such as preterm delivery or birth weight (63). There is an urgent need for personalised, evidence-based physical activity guidelines—supported by tailored exercise plans, culturally sensitive approaches, and technology—to improve outcomes for both mother and child (83).

Tips to be more active

Research shows that forming a new health-related habit typically takes about two months (84-86), though individuals may need anywhere from a few weeks to nearly a year. Here are tips grounded in evidence to improve the odds of success:

·       Enjoyment of physical activity depends on matching exercise intensity to individual preferences; tailoring activity to comfort and motivation boosts adherence and sustainability (87)

·       Exercising outdoors can boost mood, increase feelings of tranquillity and improve adherence compared to indoor workouts, making outdoor activity a powerful way to stay consistent and enjoy long-term physical and mental health benefits (88).

·       Temptation bundling—pairing something you should do with something you enjoy—can boost physical activity, as shown in a study where participants who only listened to audiobooks while exercising increased their gym attendance by 10–18% (89).

·       44% of previously inactive individuals adopted physical activity when influenced by active partners (90). Exercising alongside someone who is already active not only enhances accountability but also makes the experience more enjoyable and sustainable. In addition, the social dynamic can motivate individuals to keep up, as few want to appear inactive when their partner is exercising.

·       Encouraging active transport, such as cycling instead of driving when possible, can help reduce sedentary time and increase daily physical activity (91). Choosing a bicycle over a car not only supports fitness but also promotes environmental sustainability.

·       Don't worry if travel, illness, or a break disrupts your exercise routine. While a temporary pause in resistance training may lead to short-term declines in muscle strength and size, these adaptations are quickly regained upon resuming exercise (92). In the long run, consistent training—regardless of occasional breaks—leads to similar overall gains.

·       Nutrition plays a vital role in reducing delayed onset of muscle soreness (DOMS) and keeping individuals motivated to continue physical activity. Antioxidant-rich foods such as tart cherries (93) help limit oxidative stress and inflammation. Omega-3 fatty acids from fish and plant sources reduce inflammatory responses and improve recovery (94). Adequate protein intake, especially timed around exercise, supports muscle repair and reduces soreness (95). Hydration and electrolytes maintain muscle function, while anti-inflammatory foods such as turmeric and ginger further ease discomfort. Together, these strategies accelerate recovery, minimise pain and encourage adherence to regular physical activity programmes.

Conclusion

Collectively, the evidence underscores physical activity as one of the most powerful and versatile determinants of health and well-being across diverse populations. While the physiological benefits of regular activity are substantial, they are not linear or unlimited; more is not always better, and inappropriate intensity, volume or recovery can introduce avoidable risks. Achieving recommended activity levels through a balanced combination of aerobic and resistance exercise—adapted to life stage, health status, and personal circumstances—offers the greatest return with minimal harm. Physical activity and diet work in synergy. Balanced nutrition fuels performance, supports recovery and enhances adaptation. A sound diet’s health benefits are maximised when combined with regular physical activity. Ultimately, the goal is not maximal exercise, but sustainable enjoyable movement that supports long-term health, resilience and functional capacity, recognising that consistency, adaptability and recovery are as critical as the activity itself.

Disclaimer

Always seek advice from a qualified health care professional—such as a clinician or biokineticist—before beginning any new physical activity regimen. Individual needs and health conditions vary, and professional guidance ensures that exercise is safe, appropriate and effective for you

Reflections on physical activity 🔄💡

🏃Am I reaching the minimum recommended dose each week?

Do I accumulate at least 150 minutes of moderate activity (or 75 minutes vigorous), plus muscle‑strengthening on two or more days? If not, the priority is building frequency and duration before intensity. 

💪 Does my activity feel challenging but sustainable?

Can I speak in short sentences during moderate exercise, or feel pushed but not exhausted during vigorous sessions? Persistent fatigue, soreness, or poor recovery may signal overdoing it. 

📅 Am I active on most days, not just occasionally?

Is my movement spread across the week—through walking, structured exercise, or daily tasks—or crammed into one or two demanding sessions? Regular, distributed activity offers greater health benefits and lowers injury risk. 

😴 Am I supporting my activity with recovery and energy intake?

Do I sleep well, feel energised, and maintain stable mood and appetite? Poor sleep or declining performance may mean my activity exceeds recovery capacity. 

🌟 Does my activity improve how I function and feel overall?

Has regular movement made daily tasks easier, boosted mood, strength, or fitness, and supported health rather than disrupted it? If exercise feels obligatory, anxiety‑provoking, or harmful, it’s time to reassess. 

⚖️ Do I exercise too much?

Am I balancing effort with rest, ensuring activity enhances resilience and wellbeing rather than undermining them?

Love what you’re reading? Share the knowledge! 📨 Forward this link to a friend who might also enjoy it.

References

1.           Strain T, Flaxman S, Guthold R, Semenova E, Cowan M, Riley LM, et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants. The Lancet Global Health. 2024;12(8):e1232-e43.

2.           Armstrong T, Bull F. Development of the world health organization global physical activity questionnaire (GPAQ). Journal of Public Health. 2006;14(2):66-70.

3.           Chen J, Wang Y, Zhong Z, Chen X, Zhang L, Jie L, et al. Sex differences in the association of wearable accelerometer-derived physical activity with coronary heart disease incidence and mortality. Nature Cardiovascular Research. 2025:1-11.

4.           Lafontant K, Rukstela A, Hanson A, Chan J, Alsayed Y, Ayers-Creech WA, et al. Comparison of concurrent, resistance, or aerobic training on body fat loss: a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2025;22(1):2507949.

5.           Skelton DA, Mavroeidi A. Which strength and balance activities are safe and efficacious for individuals with specific challenges (osteoporosis, vertebral fractures, frailty, dementia)?: A Narrative review. J Frailty Sarcopenia Falls. 2018;3(2):85-104.

6.           Girard O, Chevalier R, Habrard M, Sciberras P. Game analysis and energy requirements of elite squash. Journal of Strength and Conditioning Research. 2007;21(3):909.

7.           Martín-Miguel I, Escudero-Tena A, Sánchez-Alcaraz BJ, Courel-Ibáñez J, Munoz D. Physiological, physical and anthropometric parameters in padel: A systematic review. International Journal of Sports Science & Coaching. 2025;20(1):407-24.

8.           Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW. Correlates of physical activity: why are some people physically active and others not? The Lancet. 2012;380(9838):258-71.

9.           Gruber AJ. A more muscular female body ideal. 2007.

10.        Davis C, Cowles M. Body image and exercise: A study of relationships and comparisons between physically active men and women. Sex roles. 1991;25(1):33-44.

11.        Conn VS, Hafdahl AR, Minor MA, Nielsen PJ. Physical Activity Interventions Among Adults with Arthritis: Meta-Analysis of Outcomes. Seminars in Arthritis and Rheumatism. 2008;37(5):307-16.

12.        Korczak DJ, Madigan S, Colasanto M. Children’s physical activity and depression: a meta-analysis. Pediatrics. 2017;139(4):e20162266.

13.        Pearce M, Garcia L, Abbas A, Strain T, Schuch FB, Golubic R, et al. Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022;79(6):550-9.

14.        Boecker H, Sprenger T, Spilker ME, Henriksen G, Koppenhoefer M, Wagner KJ, et al. The Runner's High: Opioidergic Mechanisms in the Human Brain. Cerebral Cortex. 2008;18(11):2523-31.

15.        Fuss J, Steinle J, Bindila L, Auer MK, Kirchherr H, Lutz B, et al. A runner’s high depends on cannabinoid receptors in mice. Proceedings of the National Academy of Sciences. 2015;112(42):13105-8.

16.        Hicks SD, Jacob P, Perez O, Baffuto M, Gagnon Z, Middleton FA. The transcriptional signature of a runner’s high. Medicine & Science in Sports & Exercise. 2019;51(5):970-8.

17.        Yu R, Duncombe SL, Nemoto Y, Araujo RH, Chung H-F, Mielke GI. Physical activity trajectories and accumulation over adulthood and their associations with all-cause and cause-specific mortality: a systematic review and meta-analysis. British journal of sports medicine. 2025;59(17):1228-41.

18.        Schwendinger F, Infanger D, Lichtenstein E, Hinrichs T, Knaier R, Rowlands AV, et al. Intensity or volume: the role of physical activity in longevity. European Journal of Preventive Cardiology. 2025;32(1):10-9.

19.        Ekelund U, Tarp J, Ding D, Sanchez-Lastra MA, Dalene KE, Anderssen SA, et al. Deaths potentially averted by small changes in physical activity and sedentary time: an individual participant data meta-analysis of prospective cohort studies. The Lancet. 2026.

20.        Antero J, Tanaka H, De Larochelambert Q, Pohar-Perme M, Toussaint J-F. Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians. British journal of sports medicine. 2021;55(4):206-12.

21.        Qiu Y, Fernández-García B, Lehmann HI, Li G, Kroemer G, López-Otín C, et al. Exercise attenuates the hallmarks of aging: Novel perspectives. Journal of Sport and Health Science. 2025:101108.

22.        Bourdier P, Simon C, Bessesen DH, Blanc S, Bergouignan A. The role of physical activity in the regulation of body weight: The overlooked contribution of light physical activity and sedentary behaviors. Obesity Reviews. 2023;24(2):e13528.

23.        Oppert J-M, Ciangura C, Bellicha A. Physical activity and exercise for weight loss and maintenance in people living with obesity. Reviews in Endocrine and Metabolic Disorders. 2023;24(5):937-49.

24.        Bellicha A, van Baak MA, Battista F, Beaulieu K, Blundell JE, Busetto L, et al. Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies. Obesity Reviews. 2021;22:e13256.

25.        Ramirez-Campillo R, Andrade D, Clemente F, Afonso J, Pérez-Castilla A, Gentil P. A proposed model to test the hypothesis of exercise-induced localized fat reduction (spot reduction), including a systematic review with meta-analysis. Human Movement. 2021;23(3):1-14.

26.        Brobakken MF, Krogsæter I, Helgerud J, Wang E, Hoff J. Abdominal aerobic endurance exercise reveals spot reduction exists: A randomized controlled trial. Physiological reports. 2023;11(22):e15853.

27.        Wang Y, He Z, Long C, Li Y, Yuan Y, Huang T. Systematic review and meta-analysis of antioxidants with or without exercise training improving muscle condition in older adults. Sci Rep. 2025;15(1):34356.

28.        Chen N, He X, Feng Y, Ainsworth BE, Liu Y. Effects of resistance training in healthy older people with sarcopenia: a systematic review and meta-analysis of randomized controlled trials. European Review of Aging and Physical Activity. 2021;18(1):23.

29.        Hernandez-Martinez J, Branco BHM, Vasquez-Carrasco E, Cid-Calfucura I, Herrera-Valenzuela T, Guzmán-Muñoz E, et al. Effects of Strength Training on Body Composition, Physical Performance, and Protein or Calcium Intake in Older People with Osteosarcopenia: A Meta-Analysis. Nutrients. 2025;17(17).

30.        Miao T, Li X, Zhang W, Yang F, Wang X. Effects of high-impact jumping versus resistance exercise on bone mineral content in children and adolescents: a systematic review and meta-analysis. PeerJ. 2025;13:e19616.

31.        Huiwen H, Ju H, Dong F, Yan F, Tao W. The effect of tennis on male bone mineral density: A meta-analysis. PloS one. 2025;20(8):e0328636.

32.        Siyahtaş A, Sayın E, Kurnaz D. The effect of leisure-time physical activities on bone mineral density in postmenopausal women: Systematic review and meta-analysis. Arch Gerontol Geriatr. 2026;140:106054.

33.        Huang S, Chen Z, Li H, Zheng L, Zhou Z, Peng X, et al. An overview of the multi-dimensional mechanisms of exercise-regulated hormones and growth factors in cardiac physiological adaptation. Frontiers in Physiology. 2025;16:1642389.

34.        Scott CL, Morgan ML, Kelley GA, Nyman SR. Effects of an Acute Bout of Exercise on Cognitive Function in Adults With Cognitive Impairment: A Systematic Review With Meta-Analysis of Randomized Controlled Trials. Journal of Physical Activity and Health. 2025:1-10.

35.        Zhang J, Ye W, Li W, Zhang F, Wu Z. Comparative efficacy of exercise interventions for cognitive health in older adults: A network meta-analysis. Experimental Gerontology. 2025;206:112768.

36.        Wu J, Huang C. A systematic review and meta-analysis of the effects of resistance exercise on cognitive function in older adults. Frontiers in Psychiatry. 2025;16:1708244.

37.        Diaz-Galvan P, Franco-Rosado P, Silva-Rodriguez J, Castro-Labrador S, Labrador-Espinosa MA, Muñoz-Delgado L, et al. Association of Physical Exercise With Structural Brain Changes and Cognitive Decline in Patients With Early Parkinson Disease. Neurology. 2025;105(5):e213932.

38.        Marino FR, Lyu C, Li Y, Liu T, Au R, Hwang PH. Physical Activity Over the Adult Life Course and Risk of Dementia in the Framingham Heart Study. JAMA Network Open. 2025;8(11):e2544439-e.

39.        Buğday B, Çelik AL, Safran EE, Şevgin Ö. Impact of resistance exercise and diet on physical activity, sleep, and fatigue in obese individuals: a randomized controlled trial. BMC Public Health. 2025;25(1):2282.

40.        Zhang Y, Lee DH, Rezende LFM, Keum N, Giovannucci EL. Consistent Adherence to Physical Activity Guidelines and Digestive System Cancer Risk and Mortality. JAMA Oncology. 2025.

41.        Orange ST, Dodd E, Nath S, Bowden H, Jordan AR, Tweddle H, et al. Exercise serum promotes DNA damage repair and remodels gene expression in colon cancer cells. International Journal of Cancer. 2025.

42.        Mandal AK, Rana T, Shrestha S, Mat Hassan MK, Au-Yong P, Syed Abdul Kadir SZ, et al. Effectiveness of aerobic exercise in reducing blood pressure among obese adults: systematic review and meta-analysis. Journal of Hypertension. 9900:10.1097/HJH.0000000000004138.

43.        Haennel RG, Lemire F. Physical activity to prevent cardiovascular disease. How much is enough? Canadian Family Physician. 2002;48(1):65.

44.        LaMonte MJ, Eaton CB. Physical Activity in the Treatment and Prevention of Heart Failure: An Update. Curr Sports Med Rep. 2021;20(8):410-7.

45.        Swift DL, Houmard JA, Slentz CA, Kraus WE. Effects of aerobic training with and without weight loss on insulin sensitivity and lipids. PloS one. 2018;13(5):e0196637.

46.        Myint PK, Luben RN, Wareham NJ, Welch AA, Bingham SA, Khaw K-T. Physical activity and fibrinogen concentrations in 23,201 men and women in the EPIC-Norfolk population-based study. Atherosclerosis. 2008;198(2):419-25.

47.        Aalipanah E, Askarpour M, Eskandari MH, Zare M, Famouri M, Bedeltavana A, et al. Comparing the effects of yogurt containing Akkermansia muciniphilia postbiotic with yogurt containing Lactobacillus rhamnosus postbiotic on body composition, biochemical indices, appetite, and depression scores in overweight or obese adults: A randomized, double-blind, controlled clinical trial. Clin Nutr ESPEN. 2025;68:438-46.

48.        Amare F, Kiflu A, Taddese A. Effects of concurrent continuous aerobic and short rest resistance exercise training on metabolic biomarkers in type 2 diabetes patients: a systematic review and meta-analysis. Diabetol Metab Syndr. 2025;17(1):290.

49.        Shute RJ, Montalvo RN, Shen W, Guan Y, Yu Q, Zhang M, et al. Weightlifting outperforms voluntary wheel running for improving adiposity and insulin sensitivity in obese mice. Journal of Sport and Health Science. 2025:101100.

50.        Fedewa MV, Hathaway ED, Ward-Ritacco CL. Effect of exercise training on C reactive protein: a systematic review and meta-analysis of randomised and non-randomised controlled trials. British journal of sports medicine. 2017;51(8):670-6.

51.        Feng W, Wang Y, Gu X, Yu D, Liu Z. Exercise as a modulator of systemic inflammation and oxidative stress biomarkers across clinical and healthy populations: an umbrella meta-analysis. BMC Sports Science, Medicine and Rehabilitation. 2025;17(1):360.

52.        Magni O, Arnaoutis G, Panagiotakos D. The impact of exercise on chronic systemic inflammation: a systematic review and meta–meta-analysis. Sport Sciences for Health. 2025:1-13.

53.        de Melo DG, de Sá Pereira GJ, dos Santos Canciglieri R, da Cruz Rodrigues VC, de Campos TDP, da Costa Fernandes CJ, et al. Seven days of strength training reprograms hydroxymethylation in the visceral adipose tissue of obese Swiss mice. Journal of Endocrinology. 2025;267(3).

54.        Chastin SFM, Abaraogu U, Bourgois JG, Dall PM, Darnborough J, Duncan E, et al. Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis. Sports Medicine. 2021;51(8):1673-86.

55.        Berry C, McKinley G, Bayes HK, Anderson D, Lang CC, Gill A, et al. Resistance Exercise Therapy After COVID-19 Infection: A Randomized Clinical Trial. JAMA Network Open. 2025;8(11):e2534304-e.

56.        Wang K, Qiu F. Longitudinal Association Between Physical Activity and School Bullying in Adolescents: A Cross-Lagged Panel Model. Behavioral Sciences. 2025;15(9):1236.

57.        Shakoor E, Sortwell A, Ramirez-Campillo R. Lifting More Than Weights: Multi-dimensional Health Benefits of Resistance Training in Children. International Journal of Kinesiology & Sports Science. 2025;13(3):1.

58.        Nasiri M, Monazzami A, Alavimilani S, Asemi Z. Modulation of hormonal, metabolic, inflammatory and oxidative stress biomarkers in women with polycystic ovary syndrome following combined (resistant and endurance) training: a randomized controlled trail. BMC Endocr Disord. 2025;25(1):1.

59.        Zhao Y, Long Y, Zhu H, He R, Chen Y, Li J. High-intensity interval training versus moderate-intensity continuous training for polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2025;16:1672257.

60.        Yin X, Anwar A, Yan L, Yu R, Luo Y, Shi L, et al. Paternal exercise confers endurance capacity to offspring through sperm microRNAs. Cell Metabolism. 2025;37(11):2167-84. e8.

61.        Dong J, Chi J, Lei EF. Effects of prenatal exercise on prenatal and postpartum depression and anxiety symptoms: A systematic review and network meta-analysis. J Affect Disord. 2026;393(Pt B):120438.

62.        Poprzeczny AJ, Deussen AR, Mitchell M, Slade L, Louise J, Dodd JM. Antenatal Physical Activity Interventions and Pregnancy Outcomes: A Systematic Review and Meta‐Analysis With a Focus on Trial Quality. BJOG: An International Journal of Obstetrics & Gynaecology. 2025;132(6):709-23.

63.        Liu X, Guo X, Jie R, Tang Y. The effects of high intensity exercise on pregnancy outcomes and complications during pregnancy: a meta-analysis of randomized controlled trials. European Journal of Applied Physiology. 2025;125(7):1905-21.

64.        Andargie BA, Legas A, W/Sellassie A, Abuhay H, Angaw DA. Effects of physical exercise during pregnancy on delivery outcomes: Systematic review and meta-analysis of randomized controlled trials. PloS one. 2025;20(7):e0326868.

65.        Poyatos-León R, García-Hermoso A, Sanabria-Martínez G, Álvarez-Bueno C, Cavero-Redondo I, Martínez-Vizcaíno V. Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized controlled trials. Birth. 2017;44(3):200-8.

66.        Tavares AI. Physical activity and healthy diet: determinants and implicit relationship. Public Health. 2014;128(6):568-75.

67.        Altunalan T, Arslan E, Ocakoglu AO. The relationship between physical activity level and timing and sleep quality and hygiene in healthy individuals: a cross-sectional study. BMC Public Health. 2024;24(1):3261.

68.        Churchill R, Riadi I, Kervin L, Teo K, Cosco T. Deciphering the role of physical activity in stress management during a global pandemic in older adult populations: a systematic review protocol. Systematic Reviews. 2021;10(1):140.

69.        Xu J, Zhang S, Chen Z, Wu Z. Effects of exercise intervention on tobacco dependence: a meta-analysis. Frontiers in Public Health. 2025;Volume 13 - 2025.

70.        Bruyère O, Kaux J-F. How much sport is too much? A focus on musculoskeletal health of the adult. Aging Clinical and Experimental Research. 2023;35(7):1401-3.

71.        Nichols AW. Heat-related illness in sports and exercise. Current Reviews in Musculoskeletal Medicine. 2014;7(4):355-65.

72.        Hew-Butler T, Loi V, Pani A, Rosner MH. Exercise-associated hyponatremia: 2017 update. Frontiers in medicine. 2017;4:21.

73.        Porter JW, Pettit-Mee RJ, Ready ST, Liu Y, Lastra G, Chockalingam A, et al. Post meal exercise may lead to transient hypoglycemia irrespective of glycemic status in humans. Frontiers in Endocrinology. 2020;11:578.

74.        Schneider KJ, Patricios JS. Amsterdam 2022 International Consensus on Concussion in Sport: calling clinicians to action! : BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine; 2023. p. 615-6.

75.        Cosh S, McNeil D, Tully P. Compulsive exercise and its relationship with mental health and psychosocial wellbeing in recreational exercisers and athletes. Journal of Science and Medicine in Sport. 2023;26(7):338-44.

76.        Karp J. Can You Outrun a Bad Diet? Current Sports Medicine Reports. 2025;24(10):307-8.

77.        Ashley P, Di Iorio A, Cole E, Tanday A, Needleman I. Oral health of elite athletes and association with performance: a systematic review. British journal of sports medicine. 2015;49(1):14-9.

78.        Karimian J, Esfahani PS. Supplement consumption in body builder athletes. J Res Med Sci. 2011;16(10):1347-53.

79.        Botha CR, Moss S, Kolbe-Alexander T. “Be active!” Revisiting the South African food-based dietary guideline for activity. South African Journal of Clinical Nutrition. 2013;26:S18-S27.

80.        Ding D, Nguyen B, Nau T, Luo M, del Pozo Cruz B, Dempsey PC, et al. Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis. The Lancet Public Health. 2025;10(8):e668-e81.

81.        del Pozo Cruz B, Ahmadi M, Sabag A, Saint Maurice PF, Lee I-M, Stamatakis E. Step accumulation patterns and risk for cardiovascular events and mortality among suboptimally active adults. Annals of Internal Medicine. 2025.

82.        Wan KW, Dai ZH, Wong PS, Huang WY, Lei EF, Little JP, et al. Effects of Exercise Snacks on Cardiometabolic Health and Body Composition in Adults: A Systematic Review and Meta-Analysis. Scand J Med Sci Sports. 2025;35(8):e70114.

83.        Car J, Pekošak L, Arechvo A, Davenport MH. Personalised physical activity guidelines for pregnant women with overweight and obesity: a neglected priority. The Lancet Obstetrics, Gynaecology, & Women’s Health. 2025;1(4):e320-e4.

84.        Lally P, van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology. 2010;40(6):998-1009.

85.        Keller J, Kwasnicka D, Klaiber P, Sichert L, Lally P, Fleig L. Habit formation following routine-based versus time-based cue planning: A randomized controlled trial. Br J Health Psychol. 2021;26(3):807-24.

86.        Singh B, Murphy A, Maher C, Smith AE. Time to Form a Habit: A Systematic Review and Meta-Analysis of Health Behaviour Habit Formation and Its Determinants. Healthcare (Basel). 2024;12(23).

87.        Teixeira DS, Rodrigues F, Machado S, Cid L, Monteiro D. Did You Enjoy It? The Role of Intensity-Trait Preference/Tolerance in Basic Psychological Needs and Exercise Enjoyment. Front Psychol. 2021;12:682480.

88.        Lacharité-Lemieux M, Brunelle JP, Dionne IJ. Adherence to exercise and affective responses: comparison between outdoor and indoor training. Menopause. 2015;22(7):731-40.

89.        Kirgios EL, Mandel GH, Park Y, Milkman KL, Gromet DM, Kay JS, et al. Teaching temptation bundling to boost exercise: A field experiment. Organizational Behavior and Human Decision Processes. 2020;161:20-35.

90.        Jackson SE, Steptoe A, Wardle J. The influence of partner’s behavior on health behavior change: the English Longitudinal Study of Ageing. JAMA internal medicine. 2015;175(3):385-92.

91.        Frank LD, Carson J. Obesity, Sprawl, and Time Spent in Cars Revisited: Converging Public Health and Transportation Policy. American Journal of Preventive Medicine. 2026;70(1).

92.        Halonen EJ, Gabriel I, Kelahaara MM, Ahtiainen JP, Hulmi JJ. Does Taking a Break Matter-Adaptations in Muscle Strength and Size Between Continuous and Periodic Resistance Training. Scand J Med Sci Sports. 2024;34(10):e14739.

93.        Connolly D, McHugh M, Padilla-Zakour O. Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage. British journal of sports medicine. 2006;40(8):679-83.

94.        Lee SR, Directo D, Kang Y, Stein J, Calvert M, An YW, et al. Effects of Acute Fish Oil Supplementation on Muscle Function and Soreness After Eccentric Contraction-Induced Muscle Damage. Nutrients. 2025;17(21).

95.        Jäger R, Kerksick CM, Campbell BI, Cribb PJ, Wells SD, Skwiat TM, et al. International society of sports nutrition position stand: protein and exercise. Journal of the International Society of Sports Nutrition. 2017;14(1):20.

In developing this work, the author utilised Copilot to assist with language editing.