Physical inactivity

A picture showing a person pressing their hand on their back to relief back pain

Source: sorapop - stock.adobe.com

Minimum recommendations exist for physical activity, below which one can speak of physical inactivity or lack of exercise. According to the World Health Organization (WHO), adults should engage in physical activity for at least 150 minutes each week. Such activity includes cycling or brisk walking, as well as intensive training. The WHO considers it of additional benefit for activities of medium or higher intensity for strengthening all major muscle groups to be performed at least two days each week [1].

According to the WHO report, 44% of women and 40% of men in Germany do not get enough exercise. The proportion of 11 to 17-year-olds who do not exercise sufficiently is even higher, at 88% of girls and 80% of boys [2]. The figures differ depending on the definitions and terminology used. The 2023 DKV Report indicates a slight reversal in the trend, referring to a drop in the proportion of "inactive" persons in all areas of life (work, transport, leisure) to 14% (from 19% in 2021). However, the COVID-19 pandemic could be a factor in this trend, as the overall level of activity is significantly lower than in the first survey, which was conducted in 2010 [3].

Lack of exercise is a risk factor for numerous diseases. The physical consequences of a sedentary lifestyle include: [4-6]:

  • Obesity: besides an unhealthy diet, insufficient exercise is considered the main reason for the rise in the numbers of obese people
  • Cardiovascular diseases: insufficient physical activity affects blood pressure and cholesterol levels and can lead to heart disease, even in people not exposed to other risk factors
  • Type 2 diabetes due to high blood sugar levels
  • Cancer: insufficient exercise increases the risk of various forms of cancer, including bladder, breast, bowel and lung cancer
  • Musculoskeletal disorders: poor posture and back and other pain due to weak muscle tissue
  • Weakening of tendons, ligaments and joints
  • Poor bone health and osteoporosis

A lack of exercise can also lead to sleep disorders, mood swings and stress, and can promote mental illnesses such as anxiety disorders, depression and dementia [4]. It shortens life expectancy: for less active men by half a year, for women by as much as a year and a half. It is estimated that a good 7% of all deaths in Germany can be attributed to a lack of physical activity [7].

Diseases attributable to insufficient physical activity cause personal suffering, jeopardize fitness for work and place a considerable economic burden on the healthcare system and society as a whole [8].

An adequate level of physical activity, on the other hand, has a positive effect on mental health and personal well-being, while a high fitness level improves self-esteem [6]. Physical activity also influences the brain’s performance: neural pathways and connections between nerve cells are retained longer and memory performance deteriorates more slowly in old age [6]. Fitness for work can thus also be retained longer.


  • What is accelerating the trend, and what is slowing it down?

    A lack of exercise is often accompanied by long, uninterrupted periods spent sitting (sedentary behaviour). A sedentary lifestyle presents risks similar to those associated with physical inactivity and can lead to elevated premature mortality [9]. The combination of sedentary behaviour and physical inactivity can exacerbate negative effects [10].

    The digital transformation is contributing to a change in social and leisure behaviour and promoting a lack of exercise and long periods spent sitting. People of all ages are spending more sedentary time with digital technologies, consumer electronics and social media. The sharp increase in media use has a negative impact on exercise behaviour, particularly among children and adolescents [11]. In addition, increasing use of labour-saving devices reduces physical exertion in the domestic environment.

    The impact of mechanization and computerization on the world of work is increasing. The number of skilled manual workers is falling, and the service society, with its high proportion of sedentary work performed primarily in offices, is shaping a growing proportion of jobs [9]. According to a survey by the AOK health insurance institution (2023), a majority of people in employment (61%) spend more than four hours of each working day sitting down. 27% are seated for six to eight hours, and 12% for eight hours or more [12]. The time spent seated each day is higher for respondents who work from home (691 minutes) or in a hybrid arrangement (658 minutes) than for respondents who do not work from home (546 minutes) [3]. Longer commutes to work - often due to a housing shortage - also contribute to a lack of exercise, as long commutes are not usually possible by bicycle or on foot [13].

    The increase in working from home associated with the COVID-19 pandemic has exacerbated the lack of exercise. 52% of respondents in an AOK survey (2023) stated that when working from home, they move around somewhat less (24%) or significantly less (28%) than on a working day spent at their employer’s premises [12]. A study conducted by the Karlsruhe Institute of Technology (KIT) in 2023 confirms that working from home promotes a lack of exercise: time spent moving was found to decrease by an average of 18 minutes a day. However, the more frequent short breaks involving movement, for example for the performance of domestic chores, may have a positive effect [14], since flexible working hours offer the opportunity to fit in private appointments and errands and, in theory, to integrate exercise activities into the working day.

    Physical activity may decline in a hot and humid environment. In developing countries, a 1 °C rise in temperature is associated with an increase in the body mass index (BMI) of 4% in children and 2% in women [15]. An increase in the average annual temperature caused by climate change may therefore also promote the development of obesity in Germany.

    Policymakers increasingly recognize the health benefits of an active lifestyle. A funding initiative for the promotion of exercise has been launched with the purpose of providing information on its benefits for the population and motivating people through practical projects to introduce exercise into their everyday lives and leisure time [16]. Physical activity can also be encouraged by efforts to promote sustainable and active mobility on foot or by bicycle and government subsidies for expansion of the cycling infrastructure.

    Policymakers and urban planners are becoming more conscious of the need for a living environment that promotes exercise and is safe, as the residential environment and municipal infrastructure have the potential to promote active leisure behaviour, particularly among children and young people. This includes a wide range of play, sports and leisure facilities, parks and cycle paths. According to the AOK family study, children who live in an attractive residential environment get 27% more exercise on average than those who do not [17].

    Digital technologies, consumer electronics and social media can also offer innovative solutions for integrating exercise into everyday life and motivating people to lead a more active lifestyle. Virtual or augmented reality is able to simulate sports realistically; users can move through exotic landscapes or take part in interactive fitness classes, all without leaving their homes. The immersive experiences combine exercise and entertainment (gamification) and can make sporting activities more accessible. Provided they are used in awareness of the risks, fitness apps and challenge platforms can also help to integrate elements promoting exercise into leisure time [18].

    Digital tools that regularly remind people to move or perform fitness exercises (exergames) can counteract the rise in physical inactivity in the workplace. Under-desk exercise equipment (such as treadmills or ergometers) that enables light physical activity to be combined with office tasks can be used in the office workspace, for example at shared workstations, or by the use of loan equipment [19]. Finally, long periods spent sitting can be reduced by the use of desks featuring electric height adjustment [9]. However, since standing is also a static posture, all desk work should be interrupted intermittently for exercise.

  • Who is affected?

    Lack of movement at work particularly affects employees whose work involves long periods spent sitting or standing. This may be unavoidable or caused by rigid working hours. The sectors affected include the following: road freight transport, logistics, rail transport, road passenger transport, public administration, office work.

  • Examples (only in German)
  • What do these developments mean for workers’ safety and health?

    A cohort study of almost half a million individuals found mortality among people who work predominantly sitting down to be 16% higher than among those who are seated only part of the time. For those who spend a large part of their time at work seated, the risk of death from heart attacks, strokes and other cardiovascular diseases is higher still, by 34% [20]. Obesity promotes both long periods of time spent sitting and low levels of physical activity. People who spend a large part of their time sitting are disproportionately often highly educated younger men with good incomes; conversely, people who are generally physically inactive are older and have a low level of education and a low income [3].

    Standing for long periods, for example at conveyor belts, in hairdressing salons, during care work or in retail stores, involves physical inactivity and has a number of impacts upon health, such as pain in the lower back and in the legs, cardiovascular problems and fatigue. Static workstations in general are critical; work should instead be designed to permit walking around and a range of postures, supported by sit-stand chairs [21].

    A sustained lack of exercise impacts negatively on fitness for work and is considered a key cause of musculoskeletal disorders. In 2023, such disorders were the second most common reason for unfitness for work, with an average of 373 days’ absence from work per 100 insured persons [22]. Musculoskeletal disorders are often associated with long periods of absence from work (16.4 days per case in 2022 [23]) and thus also place a burden on the remaining employees, particularly against the backdrop of the widespread shortage of skilled workers and other personnel.

    Physical inactivity can have an unfavourable effect on concentration and stamina. Physical dexterity can also suffer, and the risk of accidents, such as tripping, slipping and mis-stepping, also rises. The negative effects of a lack of exercise are particularly relevant in sectors where physical fitness is essential, such as the fire services. Monotonous sitting for many hours places strain on the muscles and joints of professional drivers and is the cause of an above-average incidence of back problems. It can also impair concentration and thus increase the risk of accidents.

    Working on computer screens at flexible locations off the employer’s premises, for example on trains or in airports, is routine for many knowledge workers. Even where performed only for a short duration, mobile screen work can lead to physical impairments owing to unfavourable postures, unsuitable work equipment and environmental factors such as unsuitable furniture or lighting conditions [24]. Non-neutral postures lead for example to increased muscle tension, which often manifests itself as complaints in the neck area. This exacerbates the adverse consequences for the musculoskeletal system.

    The risks posed by sedentary behaviour at work may be aggravated if they are accompanied by other risk factors such as an unhealthy diet, excessive demands, stress, or shift and night work. Where time is limited owing to intensification of work, a risk also exists of employees not taking advantage of opportunities to exercise. This increases the negative effects on physical and mental well-being, and on performance.

    Means exist of easily increasing the amount of exercise possible at many workplaces. Just 3.4 to 3.6 minutes of VILPA (vigorous intermittent lifestyle physical activity) a day reduces the risk of cancer by around 17%, according to one study [25]. A VILPA duration of 4.4 minutes per day reduces the risk of death from cardiovascular disease by between 32% and 34% [26]. VILPA includes very fast walking or climbing stairs.

    An increase in physical inactivity often begins in early childhood [17]. It has become more pronounced since the COVID-19 pandemic [27]. It is one of the key factors influencing physical and mental health, including in later life. A lack of exercise jeopardizes both physical health, for example by increasing the risk of heart attacks and strokes, and mental health [28; 29]. This raises fears that, owing to a lack of exercise, a generation of people are growing up many of whom could be affected by serious health problems - with consequences for the future generations’ fitness for work. The number of accidents in schools and commuting accidents to and from schools in Germany in 2023 (provisional statistic) rose slightly compared to 2022, but is still below pre-pandemic levels [30; 31]. Nevertheless, children and adolescents who are inactive and less fit generally face an increased risk of sporting and commuting accidents [32].

  • Sources (in German only)

    [1] WHO guidelines on physical activity and sedentary behaviour. Hrsg.: World Health Organization (WHO), Genf 2020
    https://iris.who.int/bitstream/handle/10665/336656/9789240015128-eng.pdf?sequence=1 (non-accessible) (abgerufen am 9.2.2024)

    [2] Bericht der WHO - Bewegungsmangel macht Millionen krank. Hrsg.: Norddeutscher Rundfunk, Hamburg 2022
    https://www.tagesschau.de/wissen/gesundheit/who-bewegungsmangel-101.html (abgerufen am 13.2.2024)

    [3] Der DKV-Report 2023 - Wie gesund lebt Deutschland? Hrsg.: DKV Deutsche Krankenversicherung, Düsseldorf 2023
    https://www.dkv.com/downloads/DKV-Report-2023.pdf (non-accessible) (abgerufen am 5.3.2024)

    [4] Bewegungsmangel ist ein Gesundheitsrisiko. Hrsg.: AOK-Bundesverband GbR, Berlin 2023
    https://www.aok.de/pk/magazin/sport/fitness/bewegungsmangel-und-seine-gesundheitlichen-folgen/ (abgerufen am 13.2.2024)

    [5] Bewegungsmangel erhöht das Schlaganfall-Risiko. Hrsg.: Stiftung Deutsche Schlaganfall-Hilfe, Gütersloh 2024 https://www.schlaganfall-hilfe.de/de/verstehen-vermeiden/risiken-erkennen-und-vermeiden/schlaganfall-risiken/bewegungsmangel (abgerufen am 13.2.2024)

    [6] Gesünder leben mit Bewegung. Hrsg.: Stiftung Gesundheitswissen, Berlin 2021 https://www.stiftung-gesundheitswissen.de/wissen/gesuender-leben-mit-bewegung/warum-ist-bewegung-wichtig#verhindert-oder-bessert-mehr-bewegung-krankheiten (abgerufen am 14.2.2024)

    [7] Krebsrisiken – das sagt die Wissenschaft. Hrsg.: Deutsches Krebsforschungszentrum (DKFZ), Heidelberg 2024 https://www.dkfz.de/de/krebspraevention/Krebsrisiken_das-sagt-die-Wissenschaft/5_Risikofaktor_Bewegungsmangel/Risikofaktor-Bewegungsmangel.html

    [8] Costs associated with insufficient physical activity in Germany: cross-sectional results from the baseline examination of the German national cohort (NAKO). Hrsg.: Springer Nature, Berlin 2024 https://link.springer.com/article/10.1007/s10198-024-01697-9 (abgerufen am 14.5.2024)

    [9] Workshop Gesundheitsgefährdung durch langes Sitzen am Arbeitsplatz - Teil I wissenschaftliche Perspektiven. Hrsg.: Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA), Dortmund 2020 https://www.baua.de/DE/Angebote/Publikationen/Aufsaetze/artikel2816.html (abgerufen am 22.1.2024)

    [10] Sit less and move more for cardiovascular health: emerging insights and opportunities. Hrsg.: National Library of Medicine, Bethesda 2021 https://pubmed.ncbi.nlm.nih.gov/34017139/ (abgerufen am 5.3.2024)

    [11] Bewegungsmangel bei Kindern – Ursachen, Folgen und Empfehlungen. Hrsg.: RheinFit Sportakademie GmbH, Köln 2024 https://www.move-it-sportcamps.de/bewegungsmangel-kinder-ursachen-folgen/#:~:text=Weitere%20Gr%C3%BCnde%20sind%20ein%20zunehmender,Eltern%20spielt%20eine%20entscheidende%20Rolle. (abgerufen am 23.2.2024)

    [12] AOK-Umfrage: 42 Prozent führen gesundheitliche Probleme auf Bewegungsmangel und langes Sitzen zurück. Hrsg.: AOK-Bundesverband GbR, Berlin 2023
    https://www.aok.de/pp/bv/pm/umfrage-zu-bewegungsmangel/ (abgerufen am 20.2.2024)

    [13] Wohnungsmangel lässt die Pendlerzahl weiter steigen. Hrsg.: DER SPIEGEL GmbH & Co. KG, Hamburg 2022 https://www.spiegel.de/auto/pendler-jeder-zehnte-wechselt-zwischen-wohnen-und-arbeiten-das-bundesland-a-9f638873-add8-4acc-a7d2-75a223fc0578 (abgerufen am 28.2.2024)

    [14] Insights on physical behavior while working from home: An ecological momentary assessment study. Hrsg.: Wiley-VCH GmbH, Weinheim 2023
    https://onlinelibrary.wiley.com/doi/10.1111/sms.14447 (abgerufen am 26.2.2024)

    [15] Climate change and obesity: A global analysis. Hrsg.: Elsevier B.V., Amsterdam 2021
    https://www.sciencedirect.com/science/article/abs/pii/S2211912421000493?msclkid=a2a7296cc48b11ec9d71d6a239ea8f2a (abgerufen am 3.4.2024)

    [16] Förderschwerpunkt Bewegung und Bewegungsförderung. Hrsg.: Bundesministerium für Gesundheit (BMG), Bonn 2024 https://www.bundesgesundheitsministerium.de/ministerium/ressortforschung/handlungsfelder/forschungsschwerpunkte/bewegungsfoerderung.html (abgerufen am 26.2.2024)

    [17] AOK-Familienstudie 2018. Hrsg.: AOK-Bundesverband, Berlin 2018
    https://www.aok.de/pk/familienstudie/familienstudie-2018/ (abgerufen am 20.2.2024)

    [18] Brainstorming fürs Gemeinwohl: Wie können wir uns wieder mehr bewegen? Hrsg.: Messe München GmbH, München 2024
    https://www.ispo.com/sports-business/digitalisierung-forderungen-die-sportbranche (abgerufen am 20.2.2024)

    [19] Bewegungsarmut bei sitzenden Tätigkeiten. Hrsg.: Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin 2024
    https://www.dguv.de/ifa/fachinfos/ergonomie/sitzende-taetigkeiten/index.jsp (abgerufen am 28.2.2024)

    [20] Occupational Sitting Time, Leisure Physical Activity, and All-Cause and Cardiovascular Disease Mortality. Hrsg.: American Medical Association, Chicago 2024 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814094?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=011924 (abgerufen am 4.3.2024)

    [21] Evidence of Health Risks Associated with Prolonged Standing at Work and Intervention Effectiveness. Hrsg.: National Library of Medicine, Bethesda 2015
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591921/ (abgerufen am 15.5.2024)

    [22] Fehltage aufgrund der zehn wichtigsten Krankheitsarten in Deutschland im Jahr 2023. Hrsg.: Statista GmbH, Hamburg 2024 https://de.statista.com/statistik/daten/studie/1456047/umfrage/wichtigste-krankheitsarten-nach-arbeitsunfaehigkeitstagen/ (abgerufen am 19.4.2024)

    [23] Krankheitsbedingte Fehlzeiten in der deutschen Wirtschaft im Jahr 2022. Hrsg.: Badura, B., Ducki, A., Baumgardt, J., Meyer, M., Schröder, H., Berlin 2023 https://www.wido.de/fileadmin/Dateien/Dokumente/Publikationen_Produkte/Buchreihen/Fehlzeitenreport/wido_fzr2023_zeitenwende_krankheitsbed_fehlzeiten_2022.pdf (non-accessible) (abgerufen am 19.4.2024)

    [24] The impact of remote work using mobile information and communication technologies on physical health: a systematic review. Hrsg.: Taylor & Francis, London 2024 https://www.tandfonline.com/doi/full/10.1080/00140139.2024.2304582 (abgerufen am 22.4.2024)

    [25] Vigorous Intermittent Lifestyle Physical Activity and Cancer Incidence Among Nonexercising Adults: The UK Biobank Accelerometry Study. Hrsg.: National Library of Medicine, Bethesda 2023 https://pubmed.ncbi.nlm.nih.gov/37498576/ (abgerufen am 16.2.2024)

    [26] Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Hrsg.: Nature Medicine, London 2022
    https://www.nature.com/articles/s41591-022-02100-x (abgerufen am 16.2.2024)

    [27] Dauerhafte Gesundheitsschäden könnten die Folge sein: Körperliche Aktivität von Kindern und Jugendlichen während der Pandemie drastisch gesunken. Hrsg.: Bundesinstitut für Bevölkerungsforschung, Wiesbaden 2024 https://www.bib.bund.de/DE/Presse/Mitteilungen/2024/2024-01-11-Dauerhafte-Gesundheitsschaeden-koennten-die-Folge-sein-Koerperliche-Aktivitaet-von-Kindern-und-Jugendlichen-waehrend-der-Pandemie-drastisch-gesunken.html (abgerufen am 25.3.2024)

    [28] Accelerometer-based sedentary time and physical activity from childhood through young adulthood with progressive cardiac changes: a 13-year longitudinal study. Hrsg.: National Library of Medicine, Bethesda 2024 https://pubmed.ncbi.nlm.nih.gov/38711312/ (abgerufen am 8.5.2024)

    [29] Unsere Kinder werden immer unsportlicher und mental schwächer! Hrsg.: BurdaForward GmbH, München 2023 https://www.focus.de/experts/sport-experte-schlaegt-alarm-unsere-kinder-werden-immer-unsportlicher-und-mental-schwaecher_id_200632224.html (abgerufen am 8.5.2024)

    [30] Vorläufige Unfallzahlen 2023. Hrsg.: Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin 2024
    https://www.dguv.de/de/zahlen-fakten/vorlaeufige_zahlen/schueler-uv/index.jsp (abgerufen am 8.5.2024)

    [31] Anzahl der gemeldeten Schulunfälle in Deutschland in den Jahren 1986 bis 2022. Hrsg.: Statista GmbH, Hamburg 2024 https://de.statista.com/statistik/daten/studie/6053/umfrage/gemeldete-schulunfaelle-in-deutschland-seit-1986/ (abgerufen am 8.5.2024)

    [32] Bewegung und Kinderunfälle - Chancen motorischer Förderung zur Prävention von Kinderunfällen. Hrsg.: Bundesverband der Unfallkassen, Bonn 2005 https://www.hochsauerlandsport.de/fileadmin/co_system/hochsauerlandkreis/media/Downloads/Material_UEL-C/Ausbildung/Bewegung_und_Kinderunfaelle.pdf (non-accessible) (abgerufen am 10.5.2024)

    [33] Aktiv zur Schule. Hrsg.: Springer Nature, Berlin 2020
    https://link.springer.com/article/10.1007/s11553-020-00776-y (abgerufen am 22.4.2024)

  • What observations have been made for occupational safety and health, and what is the outlook?
    • Regular physical activity can improve general well-being and physical, mental and social health, increase performance at work and help to maintain fitness for work in the long term.
    • The increasingly digital lifestyle is one of the most important drivers of inactivity - at work and during leisure time.
    • Physical inactivity interacts with many other job-related risk factors, such as an unhealthy diet, shift work or intensification of work. It should therefore have a firm place in the prevention activities of the statutory accident insurance institutions, particularly in connection with measures for raising awareness and providing information.
    • To ensure that employees enjoy good health in the future, it is important that health be promoted through physical activity in daycare centres and schools and by the development of suitable programmes for this purpose.
    • Promoting sustainable and active mobility can have fundamentally positive effects on maintaining adults’ fitness for work, and can also promote children’s road user skills [33].
    • Reducing sedentary behaviour and promoting exercise are two mutually complementary aspects that can both be supported in the workplace. By means of VILPA, employees who spend a large proportion of their working time sitting down can improve their health even when time is limited.
    • The potentials of prevention measures aimed at the working environment must be exploited to a greater extent. To this end, the German Social Accident Insurance – also within the framework of the National Prevention Conference - can play a major role in reform projects and legislative initiatives of the Federal Government, which are intended to achieve conditions that promote physical activity and health.
    • Existing cooperation with other public bodies and social insurance institutions on the topic of exercise should be maintained and expanded where possible. Collaboration with new institutions should also be initiated. These include, for example, the Centre for Planetary Health Policy (CPHP) and the legislative initiative of the Federal Ministry of Health to reduce the burden of cardiovascular disease.
    • Future research should analyse the relationships between lack of exercise, socio-demographic factors and various forms of mobile work closely over longer periods of time, in order for preventive activity to be targeted effectively.
    • Further research must be conducted into ways of promoting exercise at affected workplaces, to determine the forms of exercise particularly beneficial to work-related well-being and health. In view of the growing volume of screen work that is being performed from flexible locations, a particular need for action exists here. This also applies to the growing road haulage sector.
    • In consideration of the diverse needs of groups that are particularly affected by a lack of exercise or long periods spent sitting down, and the various options available to these groups, adapting the promotion of exercise to the target groups and communicating it is an important success factor.

Contact

Dipl.-Psych. Angelika Hauke

Interdisciplinary Services

Tel: +49 30 13001-3633


Dipl.-Übers. Ina Neitzner

Interdisciplinary Services

Tel: +49 30 13001-3630
Fax: +49 30 13001-38001