Health Survey for England, 2021 part 2

This report presents results from the 2021 Health Survey for England describing physical activity in the context of the 2011 UK guidelines for aerobic activity, muscle-strengthening activities, and, for older adults, activities to improve balance.

Detailed tables accompanying this report can be accessed here.

• A higher proportion of men (70%) than women (59%) aged 16 and over met the 2011 aerobic guidelines of at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week or an equivalent combination of both, in sessions of 10 minutes or more.
• The proportion of adults meeting the 2011 aerobic guidelines varied by region, being lowest in the North West (58%) and highest in the East Midlands (71%).
• The proportion of adults meeting the 2011 aerobic guidelines was lowest (53%) in the most deprived area quintile and highest in the in the least deprived area quintile (68% ) and in the second least deprived quintile (70%).
• Adults are recommended to undertake muscle-strengthening activities on at least two days a week to increase bone strength and muscular fitness. A higher proportion of men (36%) than women (29%) aged 16 and over met this guideline.
• Older adults are recommended to undertake balance exercises on at least two days a week to maintain or improve their physical function. A higher proportion of men (17%) than women (14%) aged 65 and over met both the muscle-strengthening and balance exercise guideline.

Physical activity is important for cardiovascular health. Analysis of the Global Burden of Diseases, Injuries and Risk Factors Study found that physical inactivity (including low physical activity) was the fourth leading risk factor contributing to deaths and the burden of disease globally, ranking ahead of overweight or obesity (Lim, Vos, Flaxman et al, 2012). Physical inactivity was estimated to contribute to almost one in ten premature deaths from coronary heart disease (CHD) and one in six deaths from any cause (Lee, Shiroma, Lobelo et al, 2012).

Regular physical activity is beneficial for mental wellbeing and for reducing the risk of depression (Mammen and Faukner, 2013). Among older people, physical activity is associated with better health and cognitive function (Paillard, Rolland, de Souto Barreto, 2015) and can reduce the risk of falls in those with mobility problems (Bauman, Merom, Bull, 2016).

In 2011, the Chief Medical Officers of the four UK countries introduced revised guidelines for physical activity (Department of Health, 2011). Separate guidelines were issued for aerobic activity (recommending a combination of moderate and vigorous intensity activities, in sessions lasting at least 10 minutes at a time); muscle-strengthening activities; and, among older people at risk of falls, activities to improve balance and co-ordination. 

The 2011 guidelines were revised in 2019 . The current guidelines are broadly consistent with the previous recommendations, while introducing some new elements (for example additional guidance on being active during pregnancy, and after giving birth, and for disabled adults) and removing the 10-minute criterion, reflecting the latest evidence which suggests that there is no minimum amount of physical activity required to achieve some health benefits. 

Data from the Health Survey for England (HSE) are regularly used to monitor adherence to the UK physical activity guidelines (Scholes and Mindell, 2013; Scholes, 2017). As the HSE includes occupational activity in the overall summary measure of physical activity in adults (see below), it complements the local measurement of physical activity and sport through Sport England’s Active Lives Survey.

The physical activity questionnaire in HSE 2021 was previously included in the HSE in 2012 and 2016. In 2021, these questions were asked as part of the telephone interview.

For non-occupational activities, questions concerned participation during the last four weeks in housework, manual work, gardening and DIY activities, walking, and sports and exercise. For each activity, participants were asked:

• how many separate days in the past four weeks they did that activity for at least 10 minutes at a time
• the amount of time they usually spent doing that activity
• (for sports and exercise and for walking) the intensity of the activity.

The questionnaire also asked about physical activity while at work. The questions focused on what participants actually did at work, and asked how many hours they typically spent doing these activities on an average work day. 

Details of how each type of activity was measured and classified are included in the Technical Appendix to this report.

Full details of the questions used to assess physical activity are included in the Survey Documentation.  

Summary levels of aerobic activity

The following abbreviations are used throughout this report: 

• MPA: Moderate physical activity 
• VPA: Vigorous physical activity 
• MVPA: Moderate to vigorous physical activity 

10-minute criterion

The 2011 guidelines recommended that adults aged 19 and over should undertake a minimum of 150 minutes of moderate intensity activity per week (Department of Health, 2011). Alternatively, comparable benefits could be achieved through 75 minutes of vigorous intensity activity, or equivalent combinations of moderate and vigorous intensity activity. Sessions or bouts of physical activity only counted towards the overall total minutes if they lasted for at least 10 minutes at a time. This recommendation is referred to throughout this report as the 2011 aerobic, or MVPA, guideline. 

The 2019 guidelines recommend that adults aged 19 and over should undertake a minimum of 150 minutes of MVPA per week in sessions of any length. 

To enable comparisons over time, the physical activity questions in the HSE 2021 were unchanged from those in the HSE 2012 and 2016. This report continues to reflect the 2011 guidelines, and non-occupational activities are only counted if carried out for at least 10 minutes. 

Physical activity while at work

In HSE 2012 and 2016, participants’ activity while at work was classified by whether it was of at least moderate intensity according to their occupation, which was categorised using the 2000 Standard Occupational Classification (SOC 2000). A full description of the methods, including the list of occupations identified as requiring moderate level activity, is provided in Scholes and Mindell (2013). 

The occupational status of participants was not collected in HSE 2021. Physical activity while at work (walking, climbing stairs or ladders, and lifting, carrying or moving heavy loads) was included in the calculation of aerobic activity levels only for those participants who reported being very physically active in their job. For this report, data from the HSE in 2012 and 2016 have been analysed in a comparable manner. 

Summary levels of aerobic activity

To assess levels of activity against the 2011 guidelines, participants were classified according to the weekly time spent in activities of at least moderate intensity. 

Only sessions of 10 minutes or more were included in the 150 minutes per week target. Minutes of vigorous intensity activity were given twice the credit of minutes of moderate intensity activity when combining moderate and vigorous intensity to calculate the equivalent combination. 

The summary activity level classification is shown in the Table A.

Table A: Classification of summary activity levels (2011 guidelines)

All analyses presented in this report refer to physical activity of at least moderate intensity. 

Further details of the how the intensity levels of activities were assigned are given in the Technical Appendix to this report.

Muscle-strengthening activities

In addition to aerobic activity, the 2011 and 2019 guidelines recommend that adults aged 19 and over should also undertake physical activity to improve muscle strength on at least two days a week to increase bone strength and muscular fitness (Department of Health, 2011; Department of Health and Social Care et al, 2019). 

Physical activities that strengthen muscles involve using body weight or working against a resistance and should involve using all the major muscle groups.  

Participants were provided with examples of sports and exercise activities and asked which they engaged in during the last four weeks (for at least 10 minutes at a time), and whether there were any other similar activities they engaged in. A further question was asked in some cases to establish whether the effort of each specific sport or exercise activity was usually enough to make their muscles ‘feel some tension, shake or feel warm’. 

The guidelines have not specified a recommended session length for muscle-strengthening activities. In this report only sessions of sports or exercise lasting for a minimum of 10 minutes were included in assessing adherence to the muscle-strengthening guideline.

Full details of the activities included are given in the Technical Appendix to this report.

Activities to improve balance among older adults  

The aerobic and muscle-strengthening guidelines apply to all adults aged 19 and over. The 2011 guidelines additionally recommended that older adults (aged 65 and over) at risk of falls should undertake physical activity to improve balance and co-ordination on at least two days a week (Department of Health, 2011).

The 2019 guidelines recommend that older adults should maintain or improve their physical function by undertaking activities aimed at improving balance and flexibility on at least two days a week. Activities aimed at improving balance could be combined with sessions involving muscle-strengthening activity or could be additional sessions aimed specifically at these components of fitness. 

The guidelines have not specified a recommended session length for balance exercises. In this report only sessions of sports or exercise lasting for at least 10 minutes were included in assessing adherence to the balance exercise guideline.

Full details of the activities included are given in the Technical Appendix to this report.

The HSE defines adults as those aged 16 and over, which is the age group used for the main tables and text in this report. The aerobic and muscle-strengthening guidelines are aimed at adults aged 19 and over, and key estimates are also presented separately for this target group.

In 2021, 64% of adults aged 16 and over met the 2011 guidelines for aerobic activity (see Table A above). A further 11% did not meet the guidelines but achieved some activity, 4% had low activity levels and 20% were defined as inactive.

A higher proportion of men (70%) than women (59%) met the guidelines for aerobic activity. 

For more information: Table 1

Adults aged between 25 and 44 were most likely to meet the guidelines (72%). Among older adults, activity fell with age to 60% of adults aged between 65 and 74 and 38% of adults aged 75 and over. 

For more information: Table 1

Summary levels of aerobic activity by region are shown in the tables as both observed and age-standardised. Observed estimates show the actual summary levels of aerobic activity in each region. Comparisons between regions should be based on the age-standardised data, which account for the different regional age profiles.

The proportion of adults who met the 2011 guidelines for aerobic activity varied between regions. The proportion of adults meeting these guidelines was lowest in the North West (58%) and highest in the East Midlands (71%).

For more information: Table 2

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 39 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the Methods Report. 

Data have been age-standardised to take into account different area age profiles across IMD quintiles.

Levels of aerobic activity varied by areas, with those living in more deprived areas being less likely to have met the guidelines. The proportion of adults meeting the guidelines was 53% in the most deprived quintile, compared with 68% in the least deprived quintile and 70% in the second least deprived quintile.

For more information: Table 3

To define overweight or obesity, a measurement is required that allows for differences in weight due to height. Body mass index (BMI), defined as weight in kilograms divided by the square of the height in metres (kg/m2), is used for this purpose in the HSE series. 

Due to the change in mode for the HSE 2021 (from face-to-face interviewer visits to telephone interviews) it was not possible to directly measure participants’ height and weight. Instead, participants were asked about their height and weight during the interview.

Studies have shown that adults tend to overestimate height and underestimate weight compared with measured values. For this report, BMI was calculated using a set of correction factors that adjust self-reported height and weight to predict measured height and weight more accurately. For more details, see the Obesity Report. 

Participants were classified into three mutually exclusive BMI groups (shown in the table below) according to the World Health Organization’s BMI classification (WHO, 2010). BMI status is presented only for these groups due to corrected values likely being less accurate at the low and high ends of the BMI scale.

Table B: BMI category

Data have been age-standardised to take into account different age profiles across BMI categories.

The proportion of adults who met the 2011 guidelines for aerobic activity varied by BMI category. Obese adults were least likely to do so; 55% of obese adults met the guidelines, compared with 69% of adults who were overweight or neither overweight nor obese.

For more information: Table 4

Comparability of findings

Caution is advised if making inferences about whether behaviour has changed. Findings from 2021 are not directly comparable with those from previous years because of changes in survey methodology (in-person interviews in 2012 and 2016, a telephone interview in 2021) and changes in response.

In addition, there is a change to the way occupational activity has been calculated.

In 2012 and 2016, participants’ activity while at work was classified by whether it was of at least moderate intensity according to their occupation, which was categorised using the Standard Occupational Classification (SOC) 2000. 

The occupational status of participants was not collected in HSE 2021. To include activities of at least moderate intensity, physical activity at work was included in the calculation of aerobic activity levels only for those participants who reported being very physically active in their job. 

For this report, data from the HSE 2012 and 2016 have been analysed in a comparable manner, and estimates of summary levels of aerobic activity may differ from previously published tables (Scholes and Mindell 2013; Scholes 2017) which used Standard Occupational Classification codes.

Trends

The proportion of adults aged 16 and over who met the 2011 guidelines for aerobic activity was at a similar level in 2012 and 2016 for men (67% in both surveys) but increased by three percentage points for women (56% in 2012; 59% in 2016). 

The proportion of adults aged 19 and over (the target group) meeting these guidelines was at a similar level in 2012 and 2016 for men (66% in 2012; 67% in 2016) and also increased by three percentage points for women (56% in 2012; 59% in 2016).

In 2021, 70% of men and 59% of women aged 16 and over met the 2011 guidelines for aerobic activity. 70% of men and 60% of women aged 19 and over (the target group) met the guidelines.

Findings from 2021 are not directly comparable with those from previous years because of changes in survey methodology and response, and caution is advised if making inferences about whether behaviour has changed.

For more information: Table 5

This section compares the proportions of adults who met either the aerobic activity guidelines or the muscle strengthening guideline or both (see Definitions above).

In 2021, 32% of adults aged 16 and over met the muscle-strengthening guideline. This included a higher proportion of men (36%) than women (29%). 30% of adults met both the aerobic and the muscle-strengthening guidelines, including a higher proportion of men (34%) than women (27%). 

For more information: Table 6

The proportion who met the muscle-strengthening guideline decreased with age. It was highest among those aged 16 to 24 (45%), lowest among those aged 75 and over (11%). Similarly, the proportion of adults who met both guidelines decreased from 43% of those aged 16 to 24 to 10% of those aged 75 and over.

For more information: Table 6

Caution is advised if making inferences about whether behaviour has changed over time. Findings from 2021 are not directly comparable with those from previous years because of changes in survey methodology (in-person interviews in 2012 and 2016, a telephone interview in 2021) and response.

The proportion of adults aged 16 and over who met both the aerobic and muscle-strengthening guidelines was at a similar level in 2012 and 2016 for men (33% in 2012; 31% in 2016) and for women (23% in 2012; 24% in 2016).

In 2021, 34% of men and 27% of women met both guidelines. 

The proportion of adults aged 19 and over (the target group) who met both the aerobic and muscle-strengthening guidelines was at a similar level in 2012 and 2016 for men (31% in 2012; 30% in 2016) and for women (22% in 2012; 23% in 2016).

In 2021, 33% of men and 26% of women aged 19 and over met both guidelines. 

For more information: Table 6

As well as the muscle-strengthening guideline, older adults (aged 65 and over) are recommended to do balance exercises on at least two days a week. Only sessions of 10 minutes or more were included in this analysis. 

In 2021, 17% of adults in this age group met the muscle-strengthening guideline. 19% of adults aged 65 and over met the balance exercise guideline, including a higher proportion of men (21%) than women (17%). 

15% of adults met both the muscle-strengthening and balance exercise guidelines. This proportion was higher for men (17%) than for women (14%). 

For more information: Table 7

Caution is advised if making inferences about whether behaviour has changed over time. Findings from 2021 are not directly comparable with those from previous years because of changes in survey methodology (in-person interviews in 2012 and 2016, a telephone interview in 2021) and changes in response.

The proportion of adults aged 65 and over (the target group) who met both the muscle-strengthening and balance exercise guidelines was at a similar level in 2012 and 2016 for men (13% in 2012; 11% in 2016) and for women (8% in 2012; 9% in 2016).

In 2021, 17% of men and 14% of women aged 65 and over met both guidelines. 

For more information: Table 7

Heavy housework

A higher proportion of women (60%) than men (52%) had done some heavy housework in the last four weeks (in sessions of 10 minutes or more). 

The mean number of days in the last four weeks on which heavy housework was undertaken was higher for women (3.5 days) than for men (2.8 days). Among both sexes, participation in heavy housework was lowest in the youngest and oldest age groups: an average of 2.1 days for adults aged under 25 and 75 and over, compared with between 3.2 and 3.7 for other age groups.

For more information: Table 8

Heavy manual work, gardening and DIY

A higher proportion of men (30%) than women (14%) had done some heavy manual work, gardening and DIY in the last four weeks (in sessions of 10 minutes or more).

For both sexes, the proportions who did some heavy manual work, gardening or DIY increased up to middle age (peaking between the ages of 55 to 64) then decreased in older age. 

The mean number of days engaged in heavy manual work, gardening or DIY in the last four weeks was higher for men (1.4 days) than for women (0.6 days), and the difference between men and women increased with age in those aged 16 to 74.

For more information: Table 8

48% of men and 38% of women reported walking of at least moderate intensity for 10 minutes or more on at least one day in the past four weeks. The difference in participation between men and women was accounted for by those aged under 65. 

For more information: Table 8

The mean number of days in the last four weeks on which they walked was higher for men (8.7 days) than for women (7.6 days). Among both sexes, the average number of days on which they walked varied with age with no clear pattern.

For more information: Table 8

Sports and exercise

A higher proportion of men (52%) than women (45%) had taken part in sports and exercise of at least moderate intensity at least once during the last four weeks (in sessions of 10 minutes or more). For both sexes, the proportions who did some sports and exercise were highest between the ages of 16 to 44, then decreased with age. 

For more information: Table 8

The mean number of days on which they participated in sports and exercise in the last four weeks was higher for men (7.8 days) than for women (6.0 days). For both sexes, the mean number of days on which they participated in sports and exercise decreased with age.

For more information: Table 8

All non-occupational activities

Similar proportions of men (84%) and women (81%) had taken part in at least one non-occupational physical activity (of at least moderate intensity, in sessions of 10 minutes or more) during the past four weeks. This included home activities, walking and sport and exercise.

The mean number of days on which they participated in non-occupational activity in the last four weeks was higher for men (15.9 days) than for women (13.9 days).

In both men and women, levels of participation in any non-occupational activity in the last four weeks varied with age with no clear pattern. 

For more information: Table 8

Excluding activities carried out at work, men spent on average 428.8 minutes per week (7.1 hours) and women 364.5 minutes per week (6.1 hours) on moderate-intensity non-occupational physical activity. The average time spent in these activities varied with age with no clear pattern. 

For more information: Table 9

Patterns in the average time that participants had spent in the four types of moderate-intensity non-occupational physical activity (in the past four weeks, in sessions of 10 minutes or more) were generally similar to the number of days of participation in the different activities. 

For more information: Table 8

There were differences between men and women in the amount of time per week spent on activities, with the exception of walking.

Women (94.1 minutes per week) spent more time than men (60.8 minutes per week) in heavy housework. For men and women, the time spent in heavy housework was lowest in the youngest and oldest age groups: an average of 55.4 minutes days for adults aged under 25 and 47.2 minutes for those aged 75 and over, compared with between 78.6 and 93.5 minutes for other age groups.

Men (68.7 minutes per week) spent more time than women (25.8 minutes per week) in heavy manual work, gardening and DIY activities.

Men (118.7 minutes per week) participated for more time than women (79.3 minutes per week) in sports and exercise.

Among both sexes, the average time that participants had spent walking varied with age, with the highest level among those aged 65 to 74. The average time spent walking was similar for men and women.

For more information: Table 9

Activities at work were those done as part of a job, either employed or self-employed, including voluntary and unpaid work. Participants aged 75 and over were not asked about occupational activity.

Physical activity while at work (walking, climbing stairs or ladders, and lifting, carrying or moving heavy loads) was included in the calculation of aerobic activity levels only for those participants who reported being very physically active in their job. Work-based activities were assumed to be of moderate intensity.

One in five working adults (20%) reported being very physically active at work. Men (23%) were more likely to report this than were women (16%). 

Among both sexes, this proportion varied with age, with the highest levels among those aged 16 to 24 and 55 to 64. 

For more information: Table 10

Men (5.4 hours) and women (5.3 hours) spent a similar amount of time on an average work day (in the last four weeks) sitting down or standing up while at work.

Overall men (6.0 hours per week) spent more time than women (3.2 hours per week) in moderately intensive physical activity while at work. 

Time spent in different occupational activities

Overall, the amount of time spent walking at work on an average work day (in the last four weeks) was similar among men (1.9 hours) and women (1.7 hours).There were differences by age between men and women in the amount of time spent walking at work. For example, among those aged 35 to 44, women (1.8 hours) averaged more time than men (1.4 hours) walking at work on an average work day. Among those aged 55 to 64, men (2.1 hours) averaged more time than women (1.6 hours) walking at work on an average work day.  

Men (0.3 hours per day) spent more time on average than women (0.2 hours per day) climbing stairs or ladders while at work.

More men (35%) than women (23%) spent some time in lifting, carrying or moving heavy loads while at work in the past four weeks. Men (0.8 hours per day worked) averaged more time than women (0.4 hours per day worked) in this occupational activity.

For more information: Table 10

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