Physical inactivity, ageing, and the impact on NCD burden in Spain by 2030: Macrosimulation study

Background

This study examined the association between physical inactivity, body mass index (BMI), and metabolic equivalent of task (MET), and estimated the potential impact of increased physical activity on non-communicable disease (NCD) burden in Spain by 2030.

Methods

An ecological analysis was conducted using aggregated data from the European Health Interview Survey in Spain, Waves 2 (n = 22,842) and 3 (n = 22,072). Physical inactivity (as a proportion) was modelled using beta regression with a logit link function. Explanatory variables included sex, age group, BMI, MET levels, and calendar year. The WHO Preventable Risk Integrated Model (PRIME) was used to estimate NCD mortality under a counterfactual scenario of a 15% increase in MET-hours/week of moderate-to-vigorous physical activity and a 15% relative reduction in inactivity prevalence. Uncertainty intervals (UI) were derived from 5,000 Monte Carlo simulations.

Results

Physical inactivity increased markedly in older adults, with lower levels observed in males (β = −0.32, p < 0.001). At the population level, higher BMI was associated with increased physical inactivity (β = 0.16, p < 0.001), while higher MET levels were associated with lower inactivity (β = −0.02, p < 0.001). A slight overall decline in inactivity over time was observed (β = −0.05, p < 0.001). If trends persist, 34.7% of adults are expected to be physically inactive by 2030. Under the counterfactual scenario, this would fall to 29.5%, with average activity levels among active individuals increasing from 60.1 (SD 41.7) to 69.1 (SD 47.9) MET-hours/week. These changes are associated with an estimated 1,859 prevented premature deaths (95% UI: 1,644–2,083), and 9,596 prevented NCD deaths (95% UI: 8,400–10,791), representing 4.9% of total NCD mortality across all ages.

Conclusions

Physical inactivity disproportionately affects older adults, and increased physical activity at the population level is associated with lower NCD-related mortality.

Key messages

• Increased physical activity may contribute to lowering the NCD burden.

• Promoting population-level increases in physical activity across the life course is important, particularly in ageing populations.