title: Variation in population levels of physical activity in European adults according to cross-European studies: a systematic literature review within DEDIPAC.
abstract: BACKGROUND
  Physical inactivity is a well-known public health risk that should be monitored at the population level. Physical activity levels are often surveyed across Europe. This systematic literature review aims to provide an overview of all existing cross-European studies that assess physical activity in European adults, describe the variation in population levels according to these studies, and discuss the impact of the assessment methods.
  
  
  METHODS
  Six literature databases (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey) were searched, supplemented with backward- and forward tracking and searching authors' and experts' literature databases. Articles were included if they reported on observational studies measuring total physical activity and/or physical activity in leisure time in the general population in two or more European countries. Each record was reviewed, extracted and assessed by two independent researchers and disagreements were resolved by a third researcher. The review protocol of this review is registered in the PROSPERO database under registration number CRD42014010334.
  
  
  RESULTS
  Of the 9,756 unique identified articles, twenty-five were included in this review, reporting on sixteen different studies, including 2 to 35 countries and 321 to 274,740 participants. All but two of the studies used questionnaires to assess physical activity, with the majority of studies using the IPAQ-short questionnaire. The remaining studies used accelerometers. The percentage of participants who either were or were not meeting the physical activity recommendations was the most commonly reported outcome variable, with the percentage of participants meeting the recommendations ranging from 7% to 96% across studies and countries.
  
  
  CONCLUSIONS
  The included studies showed substantial variation in the assessment methods, reported outcome variables and, consequently, the presented physical activity levels. Because of this, absolute population levels of physical activity in European adults are currently unknown. However, when ranking countries, Ireland, Italy, Malta, Portugal, and Spain generally appear to be among the less active countries. Objective data of adults across Europe is currently limited. These findings highlight the need for standardisation of the measurement methods, as well as cross-European monitoring of physical activity levels.
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO+ Institute for Health and Care Research, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands. a.loyen@vumc.nl.
authors.forename: Anne
authors.initials: A
authors.lastname: Loyen
authors.affiliation: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.|Physical activity, Nutrition and Health Research Unit, Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
authors.forename: Linde
authors.initials: L
authors.lastname: Van Hecke
authors.affiliation: Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
authors.forename: Maïté
authors.initials: M
authors.lastname: Verloigne
authors.affiliation: TNO Expertise Centre Lifestyle, Schipholweg 77-89, 2316 ZL, Leiden, The Netherlands.|Body@Work, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hendriksen
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO+ Institute for Health and Care Research, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Lakerveld
authors.affiliation: Department of Sports Medicine, Norwegian School of Sport Sciences, Ullevål Stadion, PO Box 4014, 0806, Oslo, Norway.
authors.forename: Jostein
authors.initials: J
authors.lastname: Steene-Johannessen
authors.affiliation: Faculty of Sport Sciences, EA 4360 APEMAC, University of Lorraine, 30 rue du Jardin Botanique, CS 30156, 54600, Villers-lès-Nancy cedex, Nancy, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Vuillemin
authors.affiliation: Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO BOX 616, 6200MD, Maastricht, The Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Koster
authors.affiliation: Department of Physical Education and Sport Sciences, Centre for Physical Activity and Health Research, University of Limerick, Limerick, Ireland.
authors.forename: Alan
authors.initials: A
authors.lastname: Donnelly
authors.affiliation: Department of Sports Medicine, Norwegian School of Sport Sciences, Ullevål Stadion, PO Box 4014, 0806, Oslo, Norway.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
authors.affiliation: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.|Physical activity, Nutrition and Health Research Unit, Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Deforche
authors.affiliation: Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO+ Institute for Health and Care Research, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.|Sydney School of Public Health, The Charles Perkins Centre (D17), University of Sydney, 2006, NSW, Sydney, Australia.
authors.forename: Hidde P
authors.initials: HP
authors.lastname: van der Ploeg
mesh_terms: D000328:Adult; D005006:Ethnicity; D005060:Europe; D015444:Exercise; D006801:Humans; D008297:Male; D011153:Population; D011795:Surveys and Questionnaires
keywords: Adults; Assessment methods; Europe; Physical Activity; Prevalence; Review