Potential impact of increasing physical activity on NCD mortality in the EU: pathways to SDG 3.4.1 by 2030

BACKGROUND: Physical inactivity affects 36.2% of adults in the European Union (EU), contributing substantially to the burden of non-communicable diseases (NCDs). The WHO's Global Action Plan on Physical Activity 2018-2030 targets a 15% relative reduction in physical inactivity by 2030, supporting Sustainable Development Goal (SDG) 3.4.1 to achieve over 30% reduction in premature NCD mortality. This study estimates the number of averted deaths, premature deaths and cause-specific NCD deaths averted if physical activity targets are achieved across EU countries. METHODS: We applied the WHO Preventable Risk Integrated ModEl using baseline physical activity and body mass index from waves 2 and 3 of the European Health Interview Survey. The counterfactual scenario modelled a 15% increase in metabolic equivalent of task hours/week of moderate-to-vigorous physical activity and a 15% relative reduction in the proportion of adults who are physically inactive across the EU. FINDINGS: Increased physical activity is associated with an estimated 24 178 premature deaths averted by 2030 (95% uncertainty interval (UI): 23 253-25 103), equivalent to 3.3% of premature NCD mortality. Overall, 107 108 deaths (95% UI: 102 479-111 737) across all ages could be prevented, representing 4.7% of total NCD deaths in EU member states. INTERPRETATION: Increasing physical activity alone is unlikely to achieve the SDG 3.4.1 target of reducing premature NCD deaths by 2030. However, when combined with other WHO 'best buy' interventions, such as improved diet and reduced tobacco and alcohol use, this target could be attainable across the EU.