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Behavioural epidemiology of physical activity in people living with chronic conditions

Chronic conditions, typically characterised as diseases of long duration, slow progression and that require longterm management, contribute significantly to the global burden of disease and are predicted to become more prevalent in the years to come. People with chronic conditions are less likely to be physically active than the general population, which has important health and economic consequences. In 2020, the WHO released public health guidelines on physical activity and sedentary behaviour including, for the first time, specific recommendations for people living with chronic conditions. These guidelines are a significant milestone in the public health movement to promote physical activity for all. However, the WHO Guideline Development Group identified important gaps in the evidence for this population, which may be attributable, in part, to a lack of research funding in this field. In their recent consensus statement, Reid and colleagues provide guidance for practitioners on promoting physical activity in people living with longterm conditions. Their paper is a valuable contribution to the field, however, substantially more research and implementation activity is needed to increase activity levels in these populations. Here, we use the Behavioural Epidemiology Framework to outline the spectrum of research needs in this field. For brevity, we focus specifically on physical activity, but many of the issues raised also apply to sedentary behaviour. The Behavioural Epidemiology Framework outlines five phases of research relevant to healthrelated behaviours, ranging from establishing associations between behaviour and health, through to the translation of research into policy and practice (table 1). Effective public health practice and policy will likely emerge from systematic reviews and, where appropriate, metaanalyses of primary studies within each phase. The framework’s value lies in highlighting the spectrum of research required to deliver effective public health action to support behaviour change and guiding the prioritisation of research activity. Below, we address each phase in turn, highlighting key issues and deficits in the current evidence base.