Salvo, DeborahCrochemore-Silva, InacioWendt, AndreaTarp, JakobShiroma, Eric JSimpson, Richard JLee, I-MinEkelund, UlfCerin, EsterKeita, YoussoufBauman, AdrianHallal, Pedro CRamirez Varela, AndreaPratt, MichaelReis, RodrigoHinckson, EricaDing, DingKohl, Harold WSallis, James2026-05-182026-05-182026-03-09Nature Medicine, ISSN: 1078-8956 (Print); 1546-170X (Online), Nature Research, 32(4), 1479-1489. doi: 10.1038/s41591-026-04237-51078-89561546-170Xhttp://hdl.handle.net/10292/21110With over 5 million attributed deaths per year, physical inactivity is a major global public health issue. Although the importance of physical activity is well recognized within the scope of obesity and cardiometabolic disease prevention and control, its broader benefits for the health of individuals and societies are yet to be fully harnessed. Furthermore, the role of active leisure, active transport and active labor-primary domains of physical activity-in supporting or hindering social and health equity has been largely overlooked. Here we (1) used a health equity lens to describe global domain-specific physical activity inequalities through an analysis of World Health Organization STEPwise approach to NCD risk factor surveillance (WHO STEPS) data from 68 countries; (2) summarized evidence linking physical activity with health outcomes beyond cardiometabolic disease, including immunity and infectious disease, depression and cancer; and (3) developed a new model reconceptualizing physical activity to better respond to 21st-century public health challenges. Our global, intersectional analysis of gender and socioeconomic physical activity inequalities revealed a 40-percentage-point gap in active leisure-the only domain consistently driven by choice-between historically privileged groups (wealthy men in high-income countries) and historically disadvantaged ones (poor women in low-income countries). Robust evidence supports the benefits of physical activity for immunity and infectious disease, depression and cancer. Our reconceptualized model recognizes the influence of social identities, norms, policies and structures on physical activity for health and wellbeing and emphasizes the urgent need to develop and roll out policies and programs that disseminate and harness the full benefits of physical activity for human, societal and planetary health.Open Access. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.http://creativecommons.org/licenses/by-nc-nd/4.0/https://creativecommons.org/licenses/by/4.0/32 Biomedical and Clinical Sciences4206 Public Health42 Health Sciences3202 Clinical SciencesPreventionSocial Determinants of HealthHealth DisparitiesBehavioral and Social ScienceHealth Disparities and Racial or Ethnic Minority Health ResearchPhysical ActivityBasic Behavioral and Social ScienceClinical Research3.1 Primary prevention interventions to modify behaviours or promote wellbeingCancerCardiovascular3 Good Health and Well Being10 Reduced Inequalities11 Medical and Health SciencesImmunology32 Biomedical and clinical sciences42 Health sciencesHumansExercisePublic HealthFemaleMaleSocioeconomic FactorsGlobal HealthRisk FactorsWorld Health OrganizationHumansExerciseRisk FactorsPublic HealthSocioeconomic FactorsWorld Health OrganizationFemaleMaleGlobal HealthHumansExercisePublic HealthFemaleMaleSocioeconomic FactorsGlobal HealthRisk FactorsWorld Health OrganizationJournal ArticleOpenAccess10.1038/s41591-026-04237-5