For decades, public health agencies across the world have tended to urge people to engage in as much physical activity (PA) as possible, citing numerous potential health benefits. Current recommendations, while recognizing that any activity is better than none, usually continue to specify a minimum threshold for these benefits to materialize, such as World Health Organization’s (WHO) most recent guidelines with 150–300 min/week (WHO, 2020). Recommending a maximum amount, however, is generally not considered necessary for the general population. Likewise, recommendations usually do not generally rule out any type of PA or sport as long as it does more good than harm to the health of the individual.
The emerging climate crisis, however, forces us to question many of our behaviors, potentially including multiple forms of PA and sport: While activities such as walking and cycling may be considered comparatively positive from a climate perspective, other activities may warrant a critical review. This may include, for instance, alpine skiing on artificial snow, the use of heated indoor swimming pools in winter, land-intensive sports such as golf, but also transport to amateur league games and sports equipment in general.
In this article, we argue that the apparent failure of current PA guidelines (as issued by major organizations in the field such as the ACSM, U.S. Department of Health and Human Services, 2018), and the WHO, 2020) and recommendations for PA promotion (such as WHO’s GAPPA (2018) or Germany’s National Recommendations for PA and PA promotion, Rütten & Pfeifer, 2017) to include limits to certain types of PA is not a mere oversight.
Instead, these recommendations continue to be based on largely individualistic concepts of health, and consequently do not account for any negative effects PA behavior may cause beyond the individual. In the past decades, several newer and broader concepts of health have been proposed that include entire communities and, importantly, non-human beings such as animals or even entire eco-systems. But interestingly, they have all been largely ignored in past and current PA recommendations.
Given the urgency of the climate crisis, we believe it is high time to reconsider the implications of those concepts that take into account planetary health for recommendations on both individual PA and PA promotion. However, we believe it is also important to explore the more general reasons behind the disconnect between health concepts and PA recommendations. Only if we understand its history and underlying reasons, is there a chance of changing future recommendations for the better.
This commentary will therefore proceed as follows: We start by illustrating our basic assumption that broader health perspectives generally lead to a limitation of PA and sport options that can be recommended as “healthy.” We then provide an overview of the most relevant health perspectives and show how most of them have been largely ignored by past and current PA recommendations. This will culminate in a more detailed reflection on recent holistic health perspectives with their strong focus on the environment and global climate. We then propose some potential reasons for the concept–recommendations disconnect and discuss ways in which holistic, climate-conscious perspectives could be successfully integrated into future PA recommendations. Finally, we provide some suggestions for future action in the field—most of all regarding the development of updated PA recommendations, but also with respect to supporting policy actions that will bring PA promotion more in line with holistic health concepts and the current challenge of global climate change.
Major perspectives on health and Physical Activity
Numerous concepts of health exist, which can generally be sorted into three categories: (1) the individual perspective, (2) the population perspective, and (3) the holistic perspective.
The first category (see section on “Individual perspectives” for details) includes concepts that exclusively consider individual human beings (most notably the “negative” and “positive” definition of health) when conceptualizing health. Some concepts in this category (bio-psycho-social model, socioecological model) do mention other people, entire societies, and the environment, but only insofar as they influence the individual’s health. Their own health is not a matter of concern. A second category of concepts (see “Population perspectives” section) transcends this perspective by focusing not only on individuals but on entire societies, spanning from communities and nations (public health) to entire world regions (international health, global health). However, the concepts in this category remain focused on human health. The third category (see “Holistic perspectives”) adds yet another dimension by expanding the focus of attention from human health to the health of animals, the environment, or the entire planet (one health, eco health, planetary health). Successively, the concepts seem to move from a narrower individualistic perspective to a more holistic perspective over time.
This broadening perspective comes with an implicit, but very important implication for physical activity (PA) promotion: Broadening the focus of the consequences of PA automatically comes with a narrowing scope of recommendable activities. In other words, the more entities we consider when deciding what is healthy, the more limited our range of acceptable, i.e., “health-enhancing” types of PA and sport—at least in theory: From an individualistic point of view, any activity that benefits the individual is acceptable, regardless of its effects on other people, animals, or the environment. From a population-centered perspective, activities that benefit the individual but negatively affect other people (e.g., by limiting PA opportunities or by worsening living conditions in other countries) cannot be recommended any more. When considering animal welfare, the environment, or the global climate, the list of recommendable activities becomes even shorter: For instance, certain types of sport and PA considered healthy for people may have negative effects on wildlife habitats. In addition, they may cause environmental pollution and use considerable amounts of energy (for the construction of facilities, maintenance, equipment, travel etc.), which in turn causes greenhouse gas emissions detrimental to the global climate. Figure 1 summarizes this inverse relationship between the focus and the scope of recommendable activities. The following sections investigate this interplay in greater detail for each of the three health perspectives and show how PA recommendations have so far failed to reflect any limitations regarding the activity types or amounts that they might imply.
Some of the oldest and most widespread concepts of health focus entirely on the individual. This includes the traditional negative definition of health (“the absence of disease and infirmity”; WHO, 1946) and the WHO’s positive definition of health (“state of complete physical, mental, and social well-being”; WHO, 1946). More recent concepts, such as the bio-psycho-social model (Engel, 1980) and the ecological model of health (Dahlgren & Whitehead, 1991), include social interactions, settings, societies, the built environment, and politics, but only as factors of influence on the health of the individual. From this perspective, things like social support, conducive environments, or healthy public policy may contribute to increased Physical Activity (PA) in individuals. Unlike in some of the holistic perspectives described below, however, the health of these other entities is not considered a relevant outcome for health promotion.
Individual-centered concepts continue to dominate medicine and rehabilitation to this day, and they are the basis for the current focus of PA recommendations. Notably, the WHO’s Guidelines on Physical Activity and Sedentary Behavior (WHO, 2020) emphasize the benefits of PA for individual health, such as reduced risk of cardiovascular diseases, certain types of cancer and diabetes, as well as positive effects on long-term weight management, mental health, and overall well-being. For individuals who do not suffer from chronic conditions, the guidelines follow a logic of maximizing engagement in any type of PA preferred by the individual: The current recommendation is a minimum of 150–300 min of moderate-intensity aerobic PA, preferably increased to more than 300 min for additional health benefits (WHO, 2020). The guidelines do not include a specific catalogue of recommendable activities but mention walking, wheeling, cycling, and household tasks as examples for potentially healthy types of PA (WHO, 2020). A similar focus on the individual can also be found in the field of PA promotion interventions, many of which emphasize the maximization of individual PA levels, e.g., by means of education, motivation, or instructional classes. Likewise, the most frequently used tools to measure progress in the field—such as IPAQ (Hagströmer, Oja, & Sjöström, 2006) and GPAQ (Armstrong & Bull, 2006)—typically use individuals’ PA time, intensity and type as their primary benchmark.
Researchers have pointed to a number of limitations to this “more is better” rationale, e.g., the higher risk of injury as well as musculoskeletal and cardiovascular issues involved in some types of PA and sport (Franklin & Nagelirk, 2004) or the problem of sport addiction (Larocque & Moreau, 2023). However, we argue that it is still widely accepted in the field that any PA can be recommended as long as it meets the “classic” definition of health-enhancing PA (HEPA), i.e., it “benefits health and functional capacity without undue harm and risk” for the individual (Foster, 2000). Beyond this, current recommendations provide no specific limitations regarding amounts or types of PA.
Other concepts have gone beyond an individual focus by considering the health of entire communities. The most prominent of these is public health, which the WHO has defined as “an organized activity of society to promote […] the health of individuals, specified groups, or the entire population” (WHO, 2021). The goal of public health promotion efforts is to improve health in the entire population, with a special focus on health equity (WHO, 1986), i.e., supporting vulnerable or socioeconomically disadvantaged groups to reach the same health status as more privileged ones. This may involve large-scale actions, such as mass vaccinations, or changes to the broader social, political, and built environment (Franzkowiak, 2022).
While certain aspects of public health (e.g., sanitation systems) were already introduced by ancient civilizations, more recent concepts expanded the scope to the earth’s entire human population. Since the late 19th century, international health has been used to conceptualize joint public health efforts by various nations, such as counteracting the spread of pandemics or support for population health in developing countries (Brown, Cueto, & Fee, 2006). A further evolution is global health, which is aimed at bringing about global health equity, e.g., by making vaccines available worldwide (Chen et al., 2020; Kickbusch, 2011; Koplan et al., 2009).
Physical activity (PA) plays quite an important role in health promotion from these perspectives: Together with tobacco, alcohol, and unhealthy diets, lack of PA is recognized as one of the four major risk factors for noncommunicable diseases (NCDs; WHO, 2013), and promoting PA has consequently become a health promotion priority in many countries. While the general idea is to increase the overall share of people in the population who are physically active, in practice, this leads to a strong focus on health equity, i.e., the idea to support those most in need and/or with the lowest resources. As a consequence, closing the health gap between socially disadvantaged and well-off populations becomes an important secondary goal of health promotion, often conceptualized using approaches such as the social determinants of health (Hacker, Auerbach, Ikeda, Philip, & Houry, 2022) and empowerment (Wallerstein, 2016). An international health perspective would add to this by focusing on how countries could collaborate to promote PA more effectively for their own populations, while a global health perspective would attempt to tackle inequalities between world regions with respect to PA promotion.
Current recommendations for PA promotion (e.g., the German National Recommendations for PA and PA promotion; Rütten & Pfeifer, 2017) address the aspect of inequality, e.g., by highlighting “vulnerable groups” such as children and adolescents, older people, or people with NCDs. There is also a broad range of programs to promote PA specifically in these groups. However, the interaction between the PA and health among different population groups is hardly ever discussed, although there may be a need to limit certain PA behaviors of certain groups to ensure health equity. This may be the case, for instance, where PA engagement by one group limits the opportunities for another, and where a decision needs to be taken about whose interest takes precedence (e.g., women-only pool hours to promote PA in migrant women; Rütten, Röger, Abu-Omar, & Frahsa, 2008). Likewise, public funding, subsidies, or access fees for programs and facilities may have to be revised to channel resources away from well-off people to socially disadvantaged groups.
International collaboration to promote PA in recent years can be found in the development of a joint evidence base for international PA guidelines (e.g., the international expert group responsible for the 2020 WHO PA Guidelines) or in supporting measures such as academic collaboration (e.g., in the form of international societies such as the ISPAH, ISBNPA, IUHPE and HEPA Europe) or government networks such as the EU/WHO PA Focal Points Network (Tcymbal et al., 2022). On paper, physical inactivity is also universally recognized as a global health issue—even as a global pandemic (Guthold, Stevens, Riley, & Bull, 2018; Haseler & Haseler, 2022). International and strategic documents such as the WHO’s Global Action Plan on PA (WHO, 2018, emphasis added) also appear to be written from a global health perspective. Arguably, however, even these documents are mostly concerned with providing guidance for national public health policy; there is no discussion about whether PA in one country may lead to detrimental health effects elsewhere in the world, e.g., when it comes to the production and use of sports apparel or equipment or negative effects of PA behavior in rich countries on the environment of other countries.
Regardless of their geographical scope, all the aforementioned perspectives maintain a focus on human health. Recently, however, several concepts have transcended this perspective and taken what can be termed as a “holistic” point of view that considers the interaction between humans, animals, and the environment (Lerner & Berg, 2017). In particular, three specific approaches—which differ slightly in terms of their origin, focus, or main field of application—seem to warrant further consideration (Almada, Golden, Osofsky, & Myers, 2017; Lerner & Berg, 2017).
The one health concept has received increasing attention over the past decade (Hill-Cawthorne, 2019). While there are numerous, slightly differing definitions (Lerner & Berg, 2015, 2017; One Health High-Level Expert Panel et al., 2022), all agree that the health of human society is also dependent on the health of animals (as many diseases that emerge from animals can also be transmitted to humans; Rahman et al., 2020) and plants (since contaminated plants can have a negative effect on health; Degeling, Dawson, & Gilbert, 2019; Fletcher, Franz, & Leclerc, 2009; Lerner & Berg, 2015). Roger et al. (2016) have argued that one health can best be conceptualized as part of the global health paradigm, extended by a veterinary and environmental perspective. The one health umbrella has been used to investigate the influence of the human–nature relationship on mental well-being, health, and physical activity (PA) (Brymer, Freeman, & Richardson, 2019), and there are indications that the WHO is beginning to endorse this perspective as well (WHO, 2022).
Eco health resembles one health, but rather than considering the health of all involved entities (humans, animals, and the environment) equally, it is mainly concerned with the influence of animals and the environment on human health (Hill-Cawthorne, 2019; Lerner & Berg, 2017), (Lamar & Jainonthee, 2013). A third perspective to be mentioned here is planetary health (sometimes also called global environmental and occupational health, or geo health for short). It conceptualizes the health of human civilization and the state of the natural systems on which it depends (Horton et al., 2014; Lerner & Berg, 2017; Prescott & Logan, 2019; Whitmee et al., 2015). It also has a strong focus on sustainability and its consequences for human health (Lerner & Berg, 2017). While researchers have noted that the three concepts are sometimes difficult to clearly delineate (Roger et al., 2016), one could argue that eco health maintains the strongest human-centered perspective out of the three, while planetary health is the most holistic one.
In general, the holistic perspective has received only limited attention in the field of PA promotion so far. There is plenty of research on the effects of the natural environment on human PA behavior (Calogiuri & Chroni, 2014). This includes research on the effects of climate change (Obradovich & Fowler, 2017) and on potential ways to adapt sports and PA to these changed conditions (Bernard et al., 2021). However, while such research could be framed under the eco health paradigm, it more often seems to be rooted in socioecological models of health (see section on “Individual perspectives”). Research on the impacts of human PA on animal health remains scarce, although some studies investigate the potential direct negative impact of certain sports on animal health (such as horseback riding; Williams & Tabor, 2017). Other activities, such as hiking, cross-country running, or mountain-biking, have been shown to have negative impacts on biodiversity (Brownlie, 2019) by invading and damaging natural wildlife habitats. By contrast, the literature on the effects of PA on the environment and climate change is growing rapidly (Wicker, 2018). In this context, some forms of PA are often cited as highly beneficial, most notably human-powered transport (Abu-Omar, Gelius, & Messing, 2020). For example, the UN Economic Commission for Europe, the C4 Cities Climate Leadership group, and The Lancet’s Countdown on Health and Climate Change group for Germany have recommended the development of walking and biking infrastructures to make cities carbon-neutral (UN, 2011; C40, 2021; Lancet, 2020). However, other types of PA (and particularly sports), while healthy from an individual and even a public health perspective, may have negative health effects from a holistic perspective. Sports such as skiing (Rixen et al., 2011), swimming in heated indoor pools, or sports that require a lot of land have been identified as potential planetary health hazards due to their large carbon footprints. Meanwhile, organized team sports like soccer, tennis, and volleyball may cause issues for planetary health due to the way in which league play is organized, with individuals driving to matches by car and having teams play single matches rather than using centralized tournament formats (Wicker, 2018). Many sports also require large amounts of water (to maintain facilities) and equipment (e.g., balls), especially at the professional level (Pimentel-Rodrigues & Silva-Afonso, 2022). Available quantitative data indicate that the various types of PA and sport differ significantly with respect to important aspects. For example, travel-related CO2 emissions for fitness training (228 kg per person and year) or football (337 kg) are significantly lower than for climbing (1156 kg) and surfing (2074 kg; Wicker, 2018). Likewise, the energy consumption of heated indoor pools was found to be higher (1250–1750 kWh per m2) than for indoor gyms (210–350 kWh; Boussabaine, Kirkham, & Grew, 1999). Overall, current estimates put the annual global emissions from sport at around 350 M t CO2 (Wilby et al., 2023). While this may seem rather modest compared to an estimated 37.8 B t in total global emissions in 2021, it still amounted to about 53% of Germany’s overall emissions, 95% of Australia’s overall emissions, or 90% of the emissions caused by international (i.e., excluding domestic) aviation (Crippa et al., 2022).
Given the persistent disconnect between broader health perspectives and PA recommendations outlined in the previous sections, it is not surprising that virtually none of these scientific findings have been translated into individual PA guidelines or recommendations for PA promotion so far. The preambles of some recommendations and policies—like the GAPPA—include general references to the “potential environmental benefits” (WHO, 2018) of certain forms of PA, notably human-powered transport, but planetary health is mostly treated as a welcome side effect of PA rather than a health outcome with a similar importance as human health. As in the case of public and global health, the question of having to limit certain kinds of PA behavior to achieve health goals are not on the agenda, even though this would be especially relevant from a holistic health perspective: Some beloved leisure-time activities (especially sports) that are fully recommendable from an individual and often even a public health perspective would have to be questioned from a global or one health point of view—at least regarding their frequency and the way they are currently practiced by many people.
Despite multiple theoretical advancements in the past decades and a rapidly unfolding debate about necessary restrictions to “unlimited growth” to counteract global social injustice and climate change, current Physical Activity (PA) guidelines and policy recommendations still mostly follow a “more is better” logic. There has been no major discourse about the potential need to limit the extent of certain types of PA and sports or the way in which they are practiced, although scientific evidence on potentially detrimental effects of PA on health exists from all the aforementioned perspectives. Arguably, holistic concepts such as planetary health make the most urgent case for reducing the scope of “recommendable” types of PA and sport.
It has been pointed out before that current PA guidelines and policies seem to lag behind the conceptual state of the art and continue to be based on outdated concepts (Rütten, 2006). There are a couple of potential reasons for this: First, the current message of PA promotion is, at its core, very simple and much easier to communicate than, say, current nutritional guidelines. It is understandable that health promoters do not wish to dilute this message. Instead, potentially caused by stagnating PA levels in many countries over the past decades, there have been trends to further simplify it, e.g., by eliminating the 10-min minimum exercise bouts (WHO, 2020) or moving toward telling people to simply “sit less” (Piercy et al., 2018). Second, the current approach is politically convenient, as it does not involve any demands for specific groups to change or limit their PA or sports behavior to support others. Such demands may affect well-off people playing resource-intense kinds of sport, people in rich countries, and maybe even many sports enthusiasts. In addition, fierce resistance from the sports equipment, sports apparel, or tourism industry is to be expected if certain economically lucrative activities were to be called into question. Taken together, these aspects may so far have prevented a broader discourse about some well-known but “inconvenient truths” and necessary changes to our PA behavior.
At the same time, radical solutions such as a complete ban of sports with a particularly high carbon footprint may seem unwise, as they would lead to a societal backlash by those enjoying these activities and limit the acceptance for the discourse among those who might fear they might be the next to come under attack. Moreover, they might be difficult to implement in practice as it would be extremely difficult to decide where to draw a general line between “acceptable” and “unacceptable” activities. Finally, people may ask ethical questions that cannot be dismissed so easily, e.g., whether the (indirect, long-term) effects of an individual’s PA on climate change should take precedence over the (direct, immediate) effects of the same PA on that individual’s health.
Consequently, rather than settling for one of the simple solutions—proposing radical change vs. continuing to ignore the problem altogether—PA recommendations, interventions, and policies will likely have to become more complex in the future. A potential way forward might be to emulate trends set by recent guidelines in the field of nutrition, which has made advances in integrating individual and planetary health perspectives in the development of dietary recommendations and guidelines (Willett et al., 2019; von Koerber & Kretschmer, 2006). From this perspective, recommendations to maximize environmental- and climate-friendly PA could emphasize activities that take place close to home, that can be easily performed at the given time of year without technical support (e.g., in terms of artificial heating), or that replace other carbon-intensive and environmentally unsustainable activities (such as transport by car).
However, making such specific recommendations—e.g., by providing concrete lists of physical activities that can be recommended or that should be avoided from a planetary health perspective—is quite difficult at this point in time. This is partially due to the fact that knowledge on the exact overall CO2 emissions (i.e., including travel, facility construction and maintenance, heating/climatization, equipment etc.) of different types of PA and sport is still very limited. Human-powered transport is a case in point here: While immediate emissions are lower than for motorized travel, there is evidence that a modal shift to walking and biking requires more food that causes increased greenhouse gas emissions (Mizdrak, Cobiac, Cleghorn, Woodward, & Blakely, 2020). Conversely, one could argue that increased individual health thanks to human-powered transport helps reduce CO2 in the healthcare sector, which was responsible for 4–6% of global greenhouse gas emissions in 2017 (Watts et al., 2020). This makes it difficult to compare the actual emissions of different types of PA with each other and with other activities (e.g., screen time).
Another problem is the appropriate object of comparison: Pointing out that certain types of PA have a higher carbon footprint than others is implicitly based on the assumption that the alternative to PA is inactivity. However, one might argue that people will choose an alternative if their “favorite” activity were to be restricted, and that these alternatives should be used to identify the highest potential for CO2 reduction. This argument follows a logic often used in the field of nutrition, where foodstuffs with a high footprint are compared against the most likely alternatives that people will choose (Jarmul et al., 2020). While one might argue that PA may follow different rules (since it is not as essential for survival as nutrition, and research indicates that many people are easily “driven” into physical inactivity), the truth of the matter is that, to our best of knowledge, there is simply no research available on this subject that would provide guidance on this issue. There is, however, research on the carbon footprint of different daily activities. For example, it has been estimated that 1 h of streaming online videos causes 55 g CO2 (Stephens et al., 2021) and that driving a fossil-fueled car with two passengers takes 96 g/km (Ritchie, 2020). These figures indicate that, based on our current state of knowledge, it is indeed possible that a person skips PA and engages in an inactivity that has a comparably higher carbon footprint—but the opposite might also be true just as well.
A third important issue pertains to the connection between PA recommendations and PA promotion: The fact current guidelines may follow “growth imperatives” that are potentially problematic for planetary health does not imply that PA promotion must automatically employ the same logic. Again, we are not aware of any empirical data on this topic, which is another issue that warrants further research. However, as many interventions are justified using the recommendations, it seems at least plausible to hypothesize that they, too, aim to maximize PA amounts.
These problems notwithstanding, we still believe that it is critical to start reviewing the concepts underlying current PA guidelines and policies right now, as the accelerating pace of the climate crisis may not allow us to wait until all the evidence is in. It is important to tackle both theoretical and empirical issues simultaneously, and ideally, even a slightly improved conceptual basis—e.g., one that moves from an individual-focused HEPA concept to a more holistic notion of PHEPA (planetary HEPA)—may help stimulate further research into some of the important empirical problems discussed above.
Taking a holistic approach for physical activity (PA) promotion seriously might result, first and foremost, in recognizing the need for developing new, evidence-based PA guidelines for individuals on the basis of a revised concept of PA that adequately considers holistic concepts of health—probably led by academia but involving practitioners, policymakers, and population groups from the outset of the process.
Regarding recommendations for PA promotion, experts and policymakers will need to discuss a suitable mix of policy instruments to achieve a “modal shift” toward more environmentally and climate-friendly types of PA and sport. In line with the aforementioned tenets of global health equity, we believe that well-off societies bear a special responsibility to lead such efforts—not only because they have more resources to implement the necessary changes but also because they continue to be the largest per capita contributors to global warming (Crippa et al., 2022).
Guidelines for action toward such a transition may involve a combination of regulation, fiscal measures (e.g., subsidies, incentives and fees), and information/education. While specific guidelines exist for some areas, e.g., in the form of advice on how to “Copenhagenize” human-powered transport in cities (Colville-Andersen, 2018) or a checklist on how to develop climate-friendly PA programs at the community level (Abu-Omar et al., 2022), overall guidelines are not available yet, and substantial development work remains to be done in this field.
To support the transition, civil society and in particular organized sport should take additional measures, e.g., by focusing not only on how to adapt to climate change, but also on finding ways of reducing the carbon footprint of popular sports. This pertains both to the energy consumption of the activities themselves (e.g., heating for indoor facilities, energy consumption for ski lifts and artificial snow), but also organizational matters (e.g., more climate-friendly modes of league play).
All in all, the goal of PA recommendations should not be to simply tell people to be less active in order to protect the environment and to counteract climate change. Instead, we need to initiate a broad societal discourse on the potential contribution that PA and sport can make to planetary health. As outlined in the previous section, this commentary cannot provide ready-made solutions, but we hope that our reflections—while rather theoretical—may spark a discussion about the urgency of the topic and help lay the foundation for future discussions.
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Conflict of interest
P. Gelius, M. Till, S. Messing, A. Tcymbal and K. Abu-Omar declare that they have no competing interests.
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Gelius, P., Till, M., Messing, S. et al. Must we tell people to be less active? The dilemma of physical activity recommendations from a holistic health perspective. Ger J Exerc Sport Res (2023). https://doi.org/10.1007/s12662-023-00912-8