Guidance

UK Chief Medical Officers' physical activity guidelines: supplementary information

Updated 10 July 2026

2019 update to guidelines

Description of evidence review methods

A number of expert working groups were established to review the evidence for updating the 2011 Chief Medical Officers’ physical activity guidelines. Each expert working group drew on 3 types of evidence:

1. Recent published evidence reviews used to construct or update international physical activity guidelines.
2. The most recent pooled analyses, meta-analyses and systematic reviews from prospective and randomised controlled trial (RCT) research published since the most recent reviews used to update international guidelines.
3. Any additional relevant papers identified by each expert working group.

In addition, comments and suggestions about the 2011 Chief Medical Officers’ physical activity recommendations were identified for each expert working group from the first national consultation.

The sections below describe these review methods in more detail.

Methods for the under-5s physical activity guidelines

Extensive guideline development work for 24-hour movement behaviours for the under-5s has occurred internationally over the past 24 months (see references 83 to 85 in the guidelines).

In order to develop draft recommendations for the UK, the under-5s expert working group used the GRADE-ADOLOPMENT (adoption and/or adaptation of an existing guideline, plus de novo development) approach (see reference 86 in the guidelines). This approach has been used to adopt and/or adapt the 2017 Canadian Society for Exercise Physiology 24-Hour Movement Guidelines for the early years (0 to 4 years) to produce:

• guidelines for Australia in 2017 (see reference 84 in the guidelines)
• international World Health Organization (WHO) guidelines
• guidelines for South Africa (see reference 85 in the guidelines)

The under-5s expert working group used the Canadian Society for Exercise Physiology 24-Hour Movement Guideline for the early years (0 to 4 years) (see reference 83 in the guidelines) as the basis of the UK draft recommendations. The Canadian guidelines were chosen because, in contrast to other candidate guidelines, they:

• met a number of essential and/or desirable criteria (see references 84 and 86 in the guidelines)
• followed grading of recommendations, assessment, development and evaluation (GRADE) methodology
• addressed clear questions
• had an assessment of benefit and/or harms
• had been assessed using the international approach to guidelines, research, and evaluation (AGREE) (see reference 87 in the guidelines)
• could be updated
• had risk of bias assessment
• took a 24-hour movement behaviour approach
• provided access to evidence tables and/or summaries for consideration by the UK under-5s expert working group

The results of the literature searches (summary of findings and GRADE tables) were made available by the Canadian Society for Exercise Physiology and the Australian Guideline Development Group in 2017. It was desirable to update and extend these searches for the UK process which took place in 2018. The WHO Guidelines Development Group kindly shared the results of their updated literature searches with the UK expert working group in 2018. The expert working group draft recommendations are based on the updated and extended evidence synthesis where possible.

The under-5s expert working group considered evidence for 3 distinct populations:

• infants (up to 1 year)
• toddlers (1 to 2 years)
• pre-schoolers (3 to 4 years)

A large number of exposures were considered, under the general headings of physical activity, sedentary behaviour and sleep duration. We included the following outcomes:

• adiposity, motor development, emotional-behavioural regulation
• psychosocial health (for example, wellbeing and quality of life), cognitive development, cardiovascular and musculoskeletal fitness, harms (injuries), skeletal health, cardiometabolic health
• growth, physical activity and/or TV viewing (outcomes with sleep as the exposure variable)

Methods for the children and young people, adults, and older adults physical activity and sedentary behaviour guidelines

Each expert working group adopted the same principle, namely, to identify whether there was any new evidence to suggest a change to the 2011 guidelines based on the GRADE-ADOLOPMENT process (see reference 88 in the guidelines). Using the GRADE-ADOLOPMENT process, the most recent international physical activity guidelines for children and young people were identified - these were from the Netherlands. Together with the 2011 UK guidelines, this formed the starting point of the review.

The current UK physical activity guidelines were written as advice to the general population about the recommended frequency, intensity, time and types of physical activity required to prevent major chronic disease and to maintain health. In the UK, the diseases refer specifically to:

• mortality
• years of life lost
• disease burden, such as:
  • coronary heart disease
  • stroke
  • heart failure
  • diabetes mellitus type 2
  • chronic obstructive pulmonary disease
  • breast cancer
  • colorectal cancer
  • lung cancer
  • osteoarthritis
  • dementia and cognitive decline
  • depression and depressive symptoms

The guidelines also focus on preventing premature (or all-cause) mortality and fractures, disabilities in the elderly, injuries and, in children, attention deficit hyperactivity disorder symptoms. Four risk factors that have a causal relationship with these chronic diseases were also included:

• systolic blood pressure
• LDL cholesterol
• body weight (BMI z-score in children)
• insulin sensitivity

For the children and young people expert review, muscle strength, cardiorespiratory fitness, bone health, cognitive functioning and academic performance were included as important health indicators for this age group.

The specific steps that were followed to address items 1 to 3 above, are described in detail below.

Identifying recent national evidence reviews used to construct or update physical activity guidelines

Online searches were conducted (using Google) and public health bodies (National Centre for Health and Clinical Excellence, Centers for Disease Control and Prevention) were targeted to search for evidence reviews of physical activity that had been used to construct national physical activity guidelines and recommendations (published since 2010). International experts who had authored recent national guidelines to identify further examples of relevant reviews from Australia, Canada and the Netherlands were also contacted (see references 23, 89 and 90 in the guidelines). National evidence reviews for the construction of children’s physical activity guidelines were found for 15 European countries and 4 other worldwide countries. Twelve of these evidence reviews were eligible for inclusion based on publication date (see references 23 and 89 to 99).

Identifying the most recent pooled analyses, meta-analyses and systematic reviews from prospective and RCT research to answer the specific questions posed

Targeted searches were undertaken to identify relevant literature on the relationship between physical activity and health outcomes. These primarily focused on review-level evidence for longitudinal cohort studies examining the relationship between physical activity and health outcomes. Systematic reviews and meta-analyses were also examined for randomised controlled trials to identify what types and volume of physical activity were used in effectiveness studies. PubMed was searched using a tailored set of broad medical subject headings (MeSH) terms to capture the most recent studies published, relevant to the needs of each expert working group. For example:

• resistance training
• muscle
• bone
• balance
• physical activity and adults

The terms of the searches and their dates reflected the most recent international evidence reviews searches. For example, the Netherlands searches were truncated at 1 October 2016, so searches include all publications from 1 January 2016 (in case of delayed archiving) to 1 January 2018. Expert working groups synthesised the effectiveness of the evidence across their health outcomes using this process.

A total of 42 publications were identified through the PubMed search. Studies were excluded if they were outside of the date range, included ‘at risk’ populations or focused solely on sedentary behaviour. The central review team research associate removed duplicates and assessed the eligibility of the studies against the core questions outlined below, and through this process a total of 14 publications were eligible for inclusion (see references 30 and 100 to 112).

Identification by each expert working group of any additional relevant papers

Each expert working group was also asked to identify any relevant outcomes and primary papers from their own sources and networks. Expert working groups identified the most relevant and up to date high quality reviews from these sources and summarised the effectiveness of the evidence across their health outcomes.

Communication and surveillance

The communication and surveillance expert working group considered how the communication of the Chief Medical Officers’ physical activity guidelines 2019 could be made most effective and targeted to different audiences, and how monitoring of the uptake of the guidelines could be improved and made more consistent across the UK. A paper on the monitoring issues has been published (see reference 113) and further work on both communication and monitoring was taken forward through 2 working groups following publication of these guidelines.

Membership of expert working groups

Expert working group: under 5s

Members:

• Prof John Reilly - chair
• Dr Kathryn Hesketh
• Dr Catherine Hill
• Dr Adrienne Hughes
• Dr Xanne Janssen
• Dr Ruth Kipping
• Prof Sonia Livingstone
• Dr Anne Martin

Expert working group: children and young people

Members:

• Prof Russell Jago - chair
• Prof Stuart Fairclough
• Dr Kelly Mackintosh
• Dr Paul McCrorie
• Dr Simon Sebire
• Dr Lauren Sherar
• Dr Esther van Sluij
• Prof Craig Williams

Expert working group: adults 

Members:

• Prof Marie Murphy - chair
• Dr David Broom
• Prof Jason Gill
• Dr Cindy Gray
• Prof Andy Jones
• Dr James Steele
• Prof Dylan Thompson
• Dr Jet Veldhuijzen van Zanten

Expert working group: adults with disabilities

Members:

• Prof Brett Smith - chair
• Nathalie Kirby
• Dr Rebekah Lucas
• Bethany Skinner
• Leanne Wightman

Expert working group: older adults

Members:

• Prof Dawn Skelton - chair
• Dr Daniel Cleather
• Prof Rob Copeland
• Dr Carolyn Greig
• Dr Alexandra Mavroeidi
• Dr Afroditi Stathi
• Dr Garry Tew
• Prof Mark Tully

Expert working group: sedentary behaviour

Members:

• Prof Ashley Cooper - chair
• Prof Stuart Biddle
• Dr Sebastien Chastin
• Dr Stacy Clemes
• Dr Sally Fenton
• Dr Claire Fitzsimons
• Dr Richard Pulsford
• Dr Thomas Yates

Expert working group: communication and surveillance 

Members:

• Prof Nanette Mutrie - chair
• Anna Chalkley
• Nick Colledge
• Dr Philippa Dall
• Dr Paul Kelly
• Bob Laventure
• Dr Karen Milton
• Dr Andy Pringle
• Sarah Ruane
• Laura Smith
• Prof Martyn Standage
• Dr Tessa Strain

Expert working group: pregnancy

Members:

• Prof Marion Knight - chair
• Dr Lucy Mackillop
• Dr Anne Matthews
• Dr Manisha Nair
• Dr Hamish Reid
• Dr Ralph Smith

Expert working group: postpartum

Members:

• Dr Hayley Mills - chair
• Katie Dalrymple
• Dr Marlize De Vivo
• Prof Marian Knight
• Dr Lucy Mackillop
• Dr Islay McEwan
• Prof Lucilla Poston
• Dr Shuby Puthussery
• Dr Ralph Smith

Expert working group: UK external reviewers

Members:

• Prof Alan Batterham
• Prof Melvyn Hillsdon
• Prof Gareth Stratton
• Dr Simon Williams

International advisory group

Members:

• Prof Ulf Ekelund, Department of Sports Medicine, Norwegian School of Sports Sciences, Norway
• Prof Abby King, Health Research and Policy, Stanford University, USA
• Prof Tony Okely, Early Start Research Institute, University of Wollongong, Australia
• Prof Russ Pate Arnold School of Public Health, University of South Carolina, USA
• Prof Jo Salmon School of Exercise and Nutrition Science, Deakin University, Australia
• Dr Wanda Wendel-Vos, Centre for Prevention and Health Services Research of the National Institute for Public Health and the Environment, Netherlands

Acknowledgements

We would like to give special thanks for the support we have received from the Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies at the University of Bristol and the leadership provided by Dr Charlie Foster.

We would like to thank the following contributing authors and members of our UK Chief Medical Officer guidelines writing group and the members of the expert working groups (listed below). Their ongoing advice and support have been invaluable.

• Chair: Dr Charlie Foster, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, England
• under 5s working group: Prof John Reilly, School for Psychological Sciences and Health, University of Strathclyde Glasgow, Scotland
• children and young people working group: Prof Russell Jago, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, England
• adults working group: Prof Marie Murphy, Doctoral College and Sport and Exercise Sciences Research Institute, Ulster University, Northern Ireland
• older adults working group: Prof Dawn Skelton, Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Scotland
• sedentary behaviour working group:
  • Prof Ashley Cooper, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, England
  • Dr Richard Pulsford, Sport and Health Sciences, University of Exeter
• disability working group: Prof Brett Smith, School of Sport and Exercise Sciences, Durham University, England
• communications and surveillance working group: Prof Nanette Mutrie, Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Scotland

Thanks to the following people, who all contributed to the report and/or to the scientific consensus meetings:

• Kate Willis (Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol)
• Catherine Falconer (England Chief Medical Officer’s office)
• Scottish Physical Activity Research Connections

Thanks also to:

• the UK policy leads for physical activity of the 4 nations for their contributions
• our UK external reviewers:
  • Prof Melvyn Hillsdon
  • Gareth Stratton
  • Alan Batterham
  • Dr Simon Williams

Finally, a special thanks to the Department of Health and Social Care (DHSC) and Active Scotland Division of the Scottish Government, in particular Beelin Baxter and Caspian Richards who project managed this work on behalf of the 4 nations, supported by Fiona Cunnah and Ian McClure.

We would like to also acknowledge support provided by Sport England and Dr Mike Brannan at Public Health England (now the Office for Health Improvement and Disparities).

2026 refresh of evidence

Before the 2026 refresh of the evidence, the guidelines document was last updated in 2019 and this used an evidence review alongside expert-led working groups to identify, evaluate and integrate important research. A full update in co-ordination with WHO is being planned with outputs expected in 2030.

Since the 2019 guideline update was published, the evidence base has continued to develop, including the emergence of studies which strengthen the existing guidelines. Inclusion of this more recent evidence has the potential to increase the relevance and usability of the existing guidelines.

With this in mind, an interim, light touch approach has been taken to refresh the supporting evidence for the adult section of the guideline. This is intended to increase utility of the existing guidelines, while remaining proportionate in light of the planned fuller update in the medium term.

This process was carried out by analysts and librarians from Public Health Scotland, the UK Health Security Agency Library Service and DHSC.

Evidence review methods

The Australian Daily Movement guidelines were published in March 2026. These were based on a review of evidence published before December 2023, with the review process described in an accompanying report. The citations from this were reviewed and, where relevant, were included in this review. Additionally, leading academics were approached and asked to recommend studies for inclusion. Supplementary literature searches were carried out as follows.

Searches were carried out by the UK Health Security Agency between December 2023 and March 2026. This aimed to identify systematic reviews, meta-analyses and prospective cohort studies published since the Australian review. Inclusion criteria included:

• studies relevant to UK or Organisation for Economic Co-operation and Development (OECD) populations
• systematic reviews, meta analyses or prospective cohort studies
• studies whose population was primarily healthy adults
• studies where physical activity or inactivity was the intervention or variable factor, and with mortality, healthy life expectancy, quality of life or long term health indicators as the primary outcome measure

Studies looking at health benefits for predominantly diseased populations were excluded.

Another literature search looked specifically at the benefits of below guideline levels, or small increases in physical activity on mortality. This was carried out by Public Health Scotland - it looked only at systematic reviews and covered the period 2019 to 2026.

Quality appraisal

The Scottish literature review identified 14 studies. These were critically appraised using AMSTAR 2 criteria, with all studies being found to be of low or critically low quality. This is in line with the findings of the Australian review and not uncommon in studies relating to public health, reflecting the limitations of observational study methodologies.

Prioritisation

A total of 323 studies were identified by the broad literature search. Sixteen studies were recommended by academics and a further 16 were identified from the Australian review. Titles and abstracts were reviewed and categorised according to which of the current guidelines they related to. A pragmatic approach was needed to identify the most pertinent research. This recognised that:

• a good quality systematic review will have identified and included all relevant research within the search period - if multiple systematic reviews exist, there will be crossover between included studies
• within the literature, findings are broadly similar

Therefore:

• if a relevant, peer reviewed systematic review had been identified by the Australian review or by academic colleagues, this was considered the primary source
• additional systematic reviews were reviewed and included if they were more recent, or included relevant findings that were not covered by the primary source
• prospective cohort studies were only considered if a recent systematic review cannot be identified on the topic

Limitations

A systematic evidence review was not carried out. Additionally, the scope of this review has been limited to health outcomes such as:

• mortality and incidence of cardiovascular events
• long term conditions such as cancer or diabetes
• falls

This has not included health markers such as:

• blood pressure or BMI
• measures of physical function
• indicators such as cardiorespiratory fitness or muscle mass

This limits the scope of the review to associations between physical activity and mortality - and physical activity and the incidence of cardiovascular events, long term conditions or falls. It should also be noted that this review did not consider the efficacy of specific interventions or seek behavioural insight to consider the acceptability or efficacy of approaches to increasing physical activity.