Can we really be ‘fit for the future’ without physical activity?

Physical activity (PA) is one of the most powerful tools in preventive medicine. It reduces the risk of long-term conditions, such as heart disease, diabetes and cancer, and supports good mental health. Despite this, the government’s 10 Year Health Plan for England, published in July 2025, pays only limited attention to PA.

In the Executive Summary, the sole mention of PA is a vague description of a partnership with the Great Run Company to ‘motivate millions to move more on a regular basis’. Beyond that, the most visible references to PA are a stock image of people walking with poles, a casual line about Joe Wicks ‘getting the nation into exercise’ – later contradicted by the sentence ‘inactivity levels remain stubbornly high, particularly among children’ – and statistics about parkrun participation. While highlighting these examples shows awareness of a popular influencer and a successful mass participation event, it does not represent a coherent national strategy.  

The reference to Joe Wicks suggests that the government may view individual personalities as central to solving inactivity. Indeed, shortly after the 10 Year Health Plan was announced, the government launched Activate, a series of 5-minute animated videos aimed at tackling childhood obesity, in which a cartoon Wicks performs a sequence of bodyweight movements. While at-home bodyweight exercise videos have proven popular with adults – Wicks’s YouTube channel has amassed almost 400 million views – this format is unlikely to engage the target population: children in deprived areas, where severe obesity rates are four times higher than in the least deprived communities. Moreover, exercise-based interventions are ineffective for weight loss compared with dietary and behavioural ones.

Similarly, although parkrun is a valuable and inspiring initiative, its participation base remains skewed. A survey in 2018 found that although parkrun resulted in self-reported improvements in physical and mental health, only 13.1% of participants came from the most deprived quartile. Many people cannot join a Saturday morning 5K due to cultural, religious or practical barriers. For instance, some Muslim women prefer female-only spaces, and shift workers may be excluded altogether. Attempts have been made to broaden parkrun’s reach. Since 2016, the government has invested in initiatives to increase inclusivity, and by 2025 around a third of GP practices had signed up to ‘socially prescribe’ it. Yet questions remain about its overall impact: how many previously inactive people became regular participants, and what proportion sustained that change? The relationship between PA and health benefits is curvilinear: the largest gains are seen when the least active people start to move more. The risk is that parkrun and similar initiatives, such as the newly proposed walking- and running-based campaign led by Sir Brendan Foster, primarily attract people who are already physically active. 

Through my intercalated degree in Sport and Exercise Medicine, postgraduate diploma in Exercise Medicine, and day job as a GP registrar, I have learnt that an individualised approach to PA promotion, targeting those who are least active, is most effective. However, exercise prescription can be complex, requiring specific training and regular practice. It should be a structured, personalised process that involves understanding a patient’s current activity level, motivations and barriers, and using behaviour-change techniques to support sustainable progress. Motivational interviewing in primary care settings appears to be a highly cost-effective way to promote PA, unlike less individualised exercise referral schemes. Health care professionals should play a central role in promoting PA, yet research shows many lack the training and confidence to do so. Further investment is needed to promote physical activity among people who are least active and unlikely to respond to initiatives aimed at the general population.

The 10 Year Health Plan does recognise that cross-system and place-based approaches are effective and will require collaboration across sectors such as education, transport and urban planning. This shows an awareness of the dramatic variation in region-specific barriers to PA and activity rates. For example, in London, 63% of people in Wandsworth meet the national PA guidelines, compared with just 23% in Tower Hamlets. 

However, in announcing a new competition to crown the UK’s ‘most physically active community’, modelled on the City of Culture award, the government risks rewarding already advantaged communities with facilities and resources, rather than supporting those with the greatest need. To remain equitable, the government must ensure that all local authorities have the resources to address their own barriers and deficits, which might include a lack of safe public spaces, limited opportunities for ‘active transport’, or cultural constraints. 

Overall, the 10 Year Health Plan risks being a missed opportunity. ‘Fit for the Future’ – the plan’s strapline – might imply that PA is one of its core components, and the plan does acknowledge that inactivity costs the NHS an estimated £10.5 billion a year. Yet the commitments it makes are modest: £250 million into 100 places through Sport England, plus £400 million into community facilities, with no clear timeframe. 

A comprehensive national strategy would include greater long-term investment and a focus on locally designed solutions that target the least active people who have not engaged with initiatives aimed at the general population. It must also include proposals on how best to train staff to promote PA at an individual level. 

We have been promised that ‘DCMS [the Department of Culture, Media and Sport] will set out more detail on the strategy for physical activity in due course’. The 10 Year Health Plan has raised important questions that the DCMS’s upcoming strategy must answer.