{
  "release_id": "73130c34862e2d06",
  "id": "cardio:physical-inactivity",
  "owner": "cardio",
  "kind": "risk_factor",
  "slug": "physical-inactivity",
  "name": "Physical inactivity",
  "aliases": [
    "Sedentary behavior",
    "Not being physically active"
  ],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "Not getting regular physical activity. WHO lists it as a modifiable risk factor for high blood pressure. In the United States, 29.1% of adults were physically inactive in 2015 to 2016, down from 30.9% in 2011 to 2012, by the definition used in the Million Hearts baseline report. MedlinePlus says regular exercise has many benefits, including a lower risk of many long-term diseases, and that aerobic exercise helps keep the heart, lungs and circulation healthy. Its cardiac rehabilitation page also lists not exercising among the risk factors that rehabilitation teaches people to reduce.",
  "summary_technical": "The MeSH heading Sedentary Behavior (D057185) is a broad match, not an exact one. Definitions differ by source: the Million Hearts report counts an adult as inactive when they report no light to moderate or vigorous leisure-time physical activity for at least 10 minutes. Evidence recorded: a WHO risk-factor list for hypertension (descriptive claim, no effect size) and the US prevalence figures (burden claim). No effect size for inactivity and heart disease is recorded here.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-15",
  "last_evidence_check": "2026-10-15",
  "next_review_due": null,
  "identifiers": [
    {
      "scheme": "mesh",
      "value": "D057185",
      "normalized_value": "D057185",
      "match": "broad",
      "version": "read 2026-10-15",
      "label": null,
      "from_source": false
    }
  ],
  "navigation": {
    "cardio": {
      "system": [
        "heart"
      ],
      "condition-area": [
        "risk-and-prevention"
      ]
    }
  },
  "payload": {
    "factor_type": "exposure",
    "definition": "Not being physically active. The Million Hearts baseline report defines it as reporting no light to moderate or vigorous leisure-time physical activity for at least 10 minutes; the WHO fact sheet does not define it.",
    "contexts": [
      "cardio:ctx-who-hypertension-risk-factors",
      "cardio:ctx-us-adults-physical-inactivity"
    ]
  },
  "content_digest": "63a94d37a6ab735e9dbc1f68c6d5737d78f4c1a3167e330a718a0809a7b64cbd",
  "review": {
    "content_digest": "63a94d37a6ab735e9dbc1f68c6d5737d78f4c1a3167e330a718a0809a7b64cbd",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [
    {
      "release_id": "73130c34862e2d06",
      "id": "cardio:claim-physical-inactivity-hypertension-risk-who",
      "owner": "cardio",
      "subject_entity_id": "cardio:physical-inactivity",
      "category": "descriptive",
      "statement": "The WHO hypertension fact sheet (25 September 2025) lists physical inactivity among the modifiable risk factors for hypertension, together with unhealthy diets, consumption of tobacco and alcohol, and being overweight or obese. Its overview list of things that increase the risk of having high blood pressure includes not being physically active.",
      "context": {
        "id": "cardio:ctx-who-hypertension-risk-factors",
        "label": "Risk factors for hypertension as listed by WHO",
        "recipient": "unknown",
        "population": "Not defined for the risk-factor list. The fact sheet's key facts concern adults aged 30 to 79 years.",
        "care_setting": "Not stated in the source.",
        "geography": "Worldwide (WHO fact sheet).",
        "life_stage_note": "Not stated for the risk-factor list",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Not stated in the source.",
        "eligibility": {
          "inclusion": [],
          "exclusion": []
        }
      },
      "evidence_stage": "guidance",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "This is a risk-factor list on a WHO fact sheet. It gives no effect size, no population for the list and no certainty rating, and it does not say how much inactivity raises the risk. It concerns hypertension, not coronary artery disease or other heart conditions.",
      "editorial_state": "draft",
      "checked_at": "2026-10-15",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Risk factors, paragraph 1",
          "applicability_note": "Modifiable risk factors include physical inactivity.",
          "snapshot": {
            "id": "cardio:who-hypertension-fact-sheet-2026-10-15",
            "retrieved_at": "2026-10-15T13:49:17Z",
            "content_hash": "32ffbba46cfbc27cba316446a74eaf7ebc28af89d3b245232bc426c70842d902",
            "source_effective_date": "2025-09-25",
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:who-hypertension-fact-sheet",
            "source_type": "webpage",
            "title": "Hypertension (WHO fact sheet)",
            "canonical_url": "https://www.who.int/news-room/fact-sheets/detail/hypertension",
            "identifiers": [],
            "publication_date": null,
            "publisher": "World Health Organization",
            "edition": "WHO fact sheet fetched 2026-10-15; the page is dated 25 September 2025.",
            "reuse_basis": "The WHO terms of use (fetched 2026-10-15 as cl-who-terms-of-use.html, sha256 8edac88c0773639d74a023402b231adafb407e8a680e6620c099eb5a17fb61ab, hash only) say extracts of the web site may be reproduced for research or private study but not for sale or for commercial use, with acknowledgment of WHO as the source. Public text is quote, with short quotations only and attribution. Hash only; the page is not committed.",
            "public_text": "quote",
            "replaced_by": null,
            "retirement_note": null
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Overview, list of things that increase risk",
          "applicability_note": "The overview list includes not being physically active.",
          "snapshot": {
            "id": "cardio:who-hypertension-fact-sheet-2026-10-15",
            "retrieved_at": "2026-10-15T13:49:17Z",
            "content_hash": "32ffbba46cfbc27cba316446a74eaf7ebc28af89d3b245232bc426c70842d902",
            "source_effective_date": "2025-09-25",
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:who-hypertension-fact-sheet",
            "source_type": "webpage",
            "title": "Hypertension (WHO fact sheet)",
            "canonical_url": "https://www.who.int/news-room/fact-sheets/detail/hypertension",
            "identifiers": [],
            "publication_date": null,
            "publisher": "World Health Organization",
            "edition": "WHO fact sheet fetched 2026-10-15; the page is dated 25 September 2025.",
            "reuse_basis": "The WHO terms of use (fetched 2026-10-15 as cl-who-terms-of-use.html, sha256 8edac88c0773639d74a023402b231adafb407e8a680e6620c099eb5a17fb61ab, hash only) say extracts of the web site may be reproduced for research or private study but not for sale or for commercial use, with acknowledgment of WHO as the source. Public text is quote, with short quotations only and attribution. Hash only; the page is not committed.",
            "public_text": "quote",
            "replaced_by": null,
            "retirement_note": null
          }
        },
        {
          "evidence_role": "context",
          "locator": "Overview, paragraph 1",
          "applicability_note": "The fact sheet's definition of hypertension.",
          "snapshot": {
            "id": "cardio:who-hypertension-fact-sheet-2026-10-15",
            "retrieved_at": "2026-10-15T13:49:17Z",
            "content_hash": "32ffbba46cfbc27cba316446a74eaf7ebc28af89d3b245232bc426c70842d902",
            "source_effective_date": "2025-09-25",
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:who-hypertension-fact-sheet",
            "source_type": "webpage",
            "title": "Hypertension (WHO fact sheet)",
            "canonical_url": "https://www.who.int/news-room/fact-sheets/detail/hypertension",
            "identifiers": [],
            "publication_date": null,
            "publisher": "World Health Organization",
            "edition": "WHO fact sheet fetched 2026-10-15; the page is dated 25 September 2025.",
            "reuse_basis": "The WHO terms of use (fetched 2026-10-15 as cl-who-terms-of-use.html, sha256 8edac88c0773639d74a023402b231adafb407e8a680e6620c099eb5a17fb61ab, hash only) say extracts of the web site may be reproduced for research or private study but not for sale or for commercial use, with acknowledgment of WHO as the source. Public text is quote, with short quotations only and attribution. Hash only; the page is not committed.",
            "public_text": "quote",
            "replaced_by": null,
            "retirement_note": null
          }
        }
      ],
      "review": {
        "content_digest": "270de2e9705219c13cd737e3eadcd5074866cd30424630a85a19dffb2e3e8366",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/cardio--claim-physical-inactivity-hypertension-risk-who.json"
    },
    {
      "release_id": "73130c34862e2d06",
      "id": "cardio:claim-physical-inactivity-us-prevalence",
      "owner": "cardio",
      "subject_entity_id": "cardio:physical-inactivity",
      "category": "burden",
      "statement": "In the Million Hearts 2022 baseline report on key cardiovascular disease risk factors, the prevalence of physical inactivity among US adults was 29.1% during 2015 to 2016, a small but statistically significant decrease from 30.9% during 2011 to 2012. The report defines physical inactivity as reporting no light to moderate or vigorous leisure-time physical activity for at least 10 minutes, and it treats physical inactivity as one of the cardiovascular disease risk factors targeted for reduction by the initiative.",
      "context": {
        "id": "cardio:ctx-us-adults-physical-inactivity",
        "label": "US adults aged 18 and older in the National Health Interview Survey (Million Hearts baseline report)",
        "recipient": "adult",
        "population": "US adults aged 18 and older; the physical inactivity analyses included 202,941 adults from 2011 to 2016 (report).",
        "care_setting": "Survey data from the National Health Interview Survey.",
        "geography": "United States",
        "life_stage_note": "Adults aged 18 and older",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Two-year survey cycles from 2011-2012 to 2015-2016.",
        "eligibility": {
          "inclusion": [
            "US adults aged 18 and older in the National Health Interview Survey"
          ],
          "exclusion": []
        }
      },
      "evidence_stage": "observational",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "The figures are from US survey data on adults and describe how common inactivity was, not how much it raises the risk. They cover 2015 to 2016 and earlier years; this record has not looked for later data.",
      "editorial_state": "draft",
      "checked_at": "2026-10-15",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Results, para 7",
          "applicability_note": "Prevalence in 2015-2016 and the change since 2011-2012.",
          "snapshot": {
            "id": "cardio:pmc-pmc6132182-2026-10-15",
            "retrieved_at": "2026-10-15T13:48:14Z",
            "content_hash": "f4ba555ec87878907faf09b176295eb6843d41bc9badf8a1c4c872c167e2f1a3",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:pmc-pmc6132182",
            "source_type": "publication",
            "title": "Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 — United States, 2011–2016",
            "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6132182/",
            "identifiers": [
              {
                "scheme": "pmcid",
                "value": "PMC6132182",
                "normalized_value": "PMC6132182",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "30188885",
                "normalized_value": "30188885",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "doi",
                "value": "10.15585/mmwr.mm6735a4",
                "normalized_value": "10.15585/mmwr.mm6735a4",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": null,
            "publisher": "Morbidity and Mortality Weekly Report",
            "edition": "PMC Open Access subset full-text XML, from NCBI E-utilities.",
            "reuse_basis": "PMC Open Access subset article under https://creativecommons.org/licenses/by/3.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/cl-pmc-PMC6132182.xml.",
            "public_text": "quote",
            "replaced_by": null,
            "retirement_note": null
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Abstract, Introduction, sentences 2 and 3; Abstract, Results, sentence 2",
          "applicability_note": "The report treats physical inactivity as a targeted risk factor.",
          "snapshot": {
            "id": "cardio:pmc-pmc6132182-2026-10-15",
            "retrieved_at": "2026-10-15T13:48:14Z",
            "content_hash": "f4ba555ec87878907faf09b176295eb6843d41bc9badf8a1c4c872c167e2f1a3",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:pmc-pmc6132182",
            "source_type": "publication",
            "title": "Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 — United States, 2011–2016",
            "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6132182/",
            "identifiers": [
              {
                "scheme": "pmcid",
                "value": "PMC6132182",
                "normalized_value": "PMC6132182",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "30188885",
                "normalized_value": "30188885",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "doi",
                "value": "10.15585/mmwr.mm6735a4",
                "normalized_value": "10.15585/mmwr.mm6735a4",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": null,
            "publisher": "Morbidity and Mortality Weekly Report",
            "edition": "PMC Open Access subset full-text XML, from NCBI E-utilities.",
            "reuse_basis": "PMC Open Access subset article under https://creativecommons.org/licenses/by/3.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/cl-pmc-PMC6132182.xml.",
            "public_text": "quote",
            "replaced_by": null,
            "retirement_note": null
          }
        },
        {
          "evidence_role": "context",
          "locator": "Methods, physical inactivity definition",
          "applicability_note": "How the survey defines physical inactivity.",
          "snapshot": {
            "id": "cardio:pmc-pmc6132182-2026-10-15",
            "retrieved_at": "2026-10-15T13:48:14Z",
            "content_hash": "f4ba555ec87878907faf09b176295eb6843d41bc9badf8a1c4c872c167e2f1a3",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:pmc-pmc6132182",
            "source_type": "publication",
            "title": "Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 — United States, 2011–2016",
            "canonical_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6132182/",
            "identifiers": [
              {
                "scheme": "pmcid",
                "value": "PMC6132182",
                "normalized_value": "PMC6132182",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "pmid",
                "value": "30188885",
                "normalized_value": "30188885",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              },
              {
                "scheme": "doi",
                "value": "10.15585/mmwr.mm6735a4",
                "normalized_value": "10.15585/mmwr.mm6735a4",
                "match": "exact",
                "version": null,
                "label": null,
                "from_source": false
              }
            ],
            "publication_date": null,
            "publisher": "Morbidity and Mortality Weekly Report",
            "edition": "PMC Open Access subset full-text XML, from NCBI E-utilities.",
            "reuse_basis": "PMC Open Access subset article under https://creativecommons.org/licenses/by/3.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/cl-pmc-PMC6132182.xml.",
            "public_text": "quote",
            "replaced_by": null,
            "retirement_note": null
          }
        }
      ],
      "review": {
        "content_digest": "d921c982649469136bf754472c73373c86aa03fa46afb2843f9c5e96d8cbe742",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/cardio--claim-physical-inactivity-us-prevalence.json"
    }
  ],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "increases_risk_of",
        "label": "WHO fact sheet: physical inactivity is on its list of modifiable risk factors for hypertension (a list, with no effect size)",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "core:hypertension",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-physical-inactivity-hypertension-risk-who",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ],
    "incoming": [
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "core:medlineplus",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ]
  },
  "page_path": "risk-factors/physical-inactivity/",
  "context_path": "api/v1/context/cardio--physical-inactivity.md"
}