Sliding down the risk factor rankings: reasons for and consequences of the dramatic downgrading of physical activity in the Global Burden of Disease 2019

Published in the Lancet in 2020, the Global Burden of Disease (GBD) 2019 provided updated disease burden rankings for 87 risk factors including behavioural and metabolic risks. GBD 2019 ranked low physical activity 19th out of 20 risk factors in terms of disabilityadjusted life years, down from 10th in the equivalent 2010 GBD publication. The number of attributable deaths has decreased from 3.2 million in 2010 to approximately 1.2 million in 2019; both estimates are substantially lower than the Lancet 2012 physical activity series estimates (5 million deaths/year). GBD authors do not comment on this remarkable demotion of physical activity’s ranking in 2019, despite the fact that it contradicts the significant progress in the field of physical activity over the last decade. Here, we explore this seemingly counterintuitive downgrade to alert policy makers, health professionals and researchers about the caveats of interpreting GBD data. We also offer suggestions on how to improve future physical activity GBD estimates.