Scaleable activity programs matter

A new systematic review found that the strongest bets for getting more people moving are low-cost programs that can be rolled out at population scale, not one-on-one fixes. (sciencedirect.com) The review, published in *Preventive Medicine* in 2026, looked for studies that both increased physical activity and measured cost-effectiveness with valid activity data. It found just five studies that met those standards. (sciencedirect.com) Those five studies were mostly print-based programs, and their incremental cost-effectiveness ratios ranged from $0.15 to $4.14 in 2024 United States dollars per metabolic equivalent task hour gained, a standard way to compare extra activity delivered for the money spent. The review said the lowest-cost option used computer-tailored physical activity advice for the general population. (oulurepo.oulu.fi) Physical activity is any movement that uses energy, from brisk walking to cycling, and public-health agencies still set the basic adult target at 150 minutes of moderate activity a week or 75 minutes of vigorous activity. In 2024, 47.2% of United States adults met the federal aerobic guideline during leisure time. (cdc.gov 1) (cdc.gov 2) Globally, the gap is larger: the World Health Organization said 31% of adults were insufficiently active in 2022, or about 1.8 billion people. The agency said that share rose by about 5 percentage points from 2010 to 2022. (who.int) (pmc.ncbi.nlm.nih.gov) That backdrop helps explain the review’s narrow question: not whether exercise helps, but which programs can move large numbers of people without blowing through public budgets. The authors said the evidence base is still thin because few population-level interventions have been tested with both strong outcome measures and full economic evaluation. (sciencedirect.com) (oulurepo.oulu.fi) The paper also said comparing studies was difficult because researchers used different settings, cost perspectives, cost calculations, and activity measures. That makes it harder for health systems and governments to judge whether a program that worked in one place will deliver similar value somewhere else. (sciencedirect.com) The authors called for future studies to report costs more accurately, measure activity with higher-quality methods, and account for differences between participants. Until that evidence improves, the clearest signal from the review is simple: if policymakers want broader gains in physical activity, they need programs cheap enough to reach a lot of people. (oulurepo.oulu.fi)