Economic cost of movement behaviours: a systematic review

Public health research and practice are shifting towards integrative consideration of physical activity (PA), sedentary behaviour (SB), and sleep, as interdependent components of daily time use. However, no previous reviews have synthesised evidence on economic costs associated with these movement behaviours. The aim of this systematic review was to synthesise evidence on economic costs of insufficient PA, excessive SB, and inadequate sleep duration. Literature searches were conducted in Open Dissertations, PsycINFO, PubMed/MEDLINE, Scopus, SPORTDiscus, and Web of Science. Publications that provided estimates of total, direct, or indirect monetary cost of any of the three behaviours in the general adult population were included. Out of 21,418 screened references, 40 papers met the inclusion criteria (77.5% from high-income countries; 77.5% on economic costs of PA only; 90% reporting estimates based on self-reported movement-behaviour data). In Canada (the only country for which estimates of economic costs of all three movement behaviours were available) the combined total annual cost of insufficient PA, excessive SB, and inadequate sleep duration was 9.2 billion USD or 0.41% of the gross domestic product. In studies using the population attributable fraction (PAF) based approach, the total annual national costs of insufficient PA and excessive SB ranged from 1.94 to 9.78 billion USD and 1.82 to 1.97 billion USD, respectively. In the only study that used the PAF-based approach to estimate the cost of inadequate sleep duration, the total national cost in Canada was 0.44 billion USD per year. Globally, billions USD per year are cumulatively spent on adverse consequences of unhealthy movement behaviours. However, the exact cost could not be estimated, because evidence was available only for a limited number of mostly high-income countries. In the included studies, the cost of insufficient PA was approximately 2-4 times higher than the cost of excessive SB and 16 times higher than the cost of inadequate sleep duration; hence it seems that public health initiatives should focus primarily on promoting PA. More research is needed, particularly in low- and middle-income countries, using device-based movement-behaviour data, and exploring costs of excessive SB, inadequate sleep duration, and not meeting the overall 24-hour movement guidelines.