Rethinking what counts as healthy movement

A new framework in Nature Medicine argues that not all physical activity is equal, and that some of it may not support health in the same way. For physiotherapists, it shifts the question you ask clients from how much they move to how, why and under what conditions.

A major new analysis published in Nature Medicine is calling on public health researchers, policymakers and clinicians to rethink how they talk about physical activity, with clear relevance for physiotherapists.

For years, the WHO’s Global Action Plan on Physical Activity has promoted the simple, inclusive message that every move counts towards better health. This new research proposes a more nuanced framework: not all physical activity is equal, and some of it may not support health in the same way. The authors introduce the concept of “physical activity for health and wellbeing”, activity that is safe, freely chosen and dignified. Rather than treating all movement as automatically health-supporting, the framework sets this apart from activity that happens under unsafe, economically coercive or undignified conditions, which still counts towards meeting global guidelines on paper.

Why the shift? The researchers drew on WHO survey data from 68 countries and found striking inequalities. While overall activity levels look highest in lower-income countries, this activity is overwhelmingly driven by economic necessity, such as labour and transport, rather than choice.

When gender, wealth and country income are considered together, active leisure, the one domain consistently linked to free choice, showed a gap of around 40 percentage points between wealthy men in high-income countries and low-income women in poor countries. It means that the people who are “most active” by the numbers are often the least able to choose how they move.

The paper also reinforces that physical activity’s benefits extend well beyond cardiometabolic disease prevention, an area in which physiotherapists are already well versed. The evidence review highlights several additional benefits related to immune function, mental health and cancer survival. Despite this evidence, public awareness of physical activity’s mental health and cancer benefits lags far behind.

The paper is written for public health research and policy, but its framework points to some useful shifts for how we practise:

• It widens the conversation between you and your clients beyond cardiometabolic outcomes.
• Your patient education could routinely include the role of physical activity in immune resilience, mental health and cancer prevention and survivorship, not just heart and metabolic health.
• When you prescribe physical activity, ask your clients about the conditions of activity, not just the amount. A patient who walks two hours a day for unsafe informal work is not receiving the same “dose” as someone taking a leisurely walk in a safe park. Screening could usefully consider whether activity is safe, chosen and dignified.

Oversimplified messaging, such as “Just move more”, may inadvertently validate unsafe or coercive activity as sufficient for health. Physical activity guidance should be tailored to the person’s actual circumstances and options.

Physiotherapists have a unique opportunity to lead on a more complete, equity-informed understanding of physical activity: one that recognises not just how much people move, but how, why and under what conditions.