Physical inactivity, ageing, and the impact on NCD burden in Spain by 2030: Macrosimulation study
Abstract
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.
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BibTeX
@article{muhlis2026physical,
title = {{Physical inactivity, ageing, and the impact on NCD burden in Spain by 2030: Macrosimulation study}},
author = {ANA Muhlis and O Varga and N Mahrouseh and G Chamouni and GL Tarek},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.855},
url = {https://doi.org/10.1093/eurpub/ckag169.855},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Physical inactivity, ageing, and the impact on NCD burden in Spain by 2030: Macrosimulation study
AU - ANA Muhlis
AU - O Varga
AU - N Mahrouseh
AU - G Chamouni
AU - GL Tarek
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.855
UR - https://doi.org/10.1093/eurpub/ckag169.855
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -