The National Heart, Lung, and Blood Institute (NHLBI), of the National Institutes of Health (NIH), convened a two-day virtual workshop titled “Physical Activity Across the Lifespan: Critical Challenges, Innovations, and Opportunities” to explore the role of physical activity in cardiovascular health across the lifespan from pregnancy through older adulthood on December 3rd-4th, 2024. The workshop brought together multidisciplinary experts in epidemiology, behavioral science, clinical medicine, public health, implementation science, and community engagement. Participants examined the biological, behavioral, and social determinants of physical activity, identified research gaps, and proposed strategies to promote accessible and sustainable physical activity.

Background

Physical activity has been consistently shown to improve health for most people across all ages, sex, race, people living with a chronic condition or a disability, and women who are pregnant or postpartum. The 2018 US Federal Physical Activity Guidelines provide guidance to help increase physical activity and health for preschool-aged children, children and adolescents, adults, older adults, women during pregnancy and postpartum, and adults with chronic health conditions or disabilities. However, a large proportion of people remain insufficiently active. In 2020, 24.2% of adults aged 18 years and older met the federal guidelines for both aerobic and muscle-strengthening activity. In addition, the proportion of people meeting guidelines differs by sex, age, race, and social determinants of health. Physical activity has been shown to decrease with age starting among children and adolescents through older adulthood. These changes in activity levels can be attributed to a multitude of factors including biological and behavioral changes, social factors, and major life events that can change or disrupt normal activity patterns. While physical activity is a lifelong behavior, research is limited on how physical activity changes, accumulation, and disruption impact health across an individual’s lifespan.

Key Objectives

• To explore recent breakthroughs in physical activity research across the lifespan
• To identify critical challenges and opportunities in promoting physical activity
• To discuss health disparities, particularly among higher risk individuals, associated with physical activity and cardiovascular health
• To highlight innovative strategies and tools for measurement, implementation, and policy
• To advance community-engaged approaches to physical activity promotion

Workshop Areas of Focus

1. Physical Activity as a Lifelong, Dynamic Behavior

Physical activity is not a static trait but a behavior that fluctuates across the lifespan in response to developmental stages, life transitions, and social roles. While the benefits and challenges of physical activity and health may not always be identical at different life stages, physical activity remains a pillar of cardiovascular health at any age. Speakers highlighted that increased physical activity among women who are pregnant or postpartum not only benefits the mother, including maternal mental health, but also the child, which can be thought of as ‘primordial prevention’ of disease. Adolescence and early adulthood were identified as periods of steep decline in activity, often due to shifting priorities, academic pressures, and reduced structured opportunities. Discussions included topics such as organized sports, physical fitness testing in schools, and the transition from adolescence to adulthood. Providing insights for activity among adults, speakers presented on the social epidemiology of activity, major life events, and barriers to increasing and maintaining activity levels. Speakers noted that older adulthood presents a window for re-engagement, particularly when physical activity is framed around preserving independence and cognitive function, preventing sarcopenia, and increasing muscle mass.. For example, interventions targeting older adults emphasized maintaining mobility and preventing falls, while programs for pregnant individuals focused on reducing gestational complications and supporting postpartum recovery.

Research Opportunities

• Encourage large, rigorous research studies as well as effective and scalable interventions that address the risk of pregnancy complications and maternal mental health
• Develop and examine tools and resources throughout the school fitness testing process
• Explore the intersection of rurality in physical activity and youth sports participation
• Investigate the heterogeneity of activity patterns during the transition from adolescence to adulthood
• Employ inclusive, tailored approaches to initiate and maintain regular physical activity by addressing psychological, economic, and environmental barriers and impediments.
• Explore the integration of self-determination in interventions targeted at older adults and their age-specific health goals

2. Cardiovascular Risk Factors and Health Outcomes

Physical activity and fitness convey benefits across multiple biological and metabolic systems, including cardiovascular, muscular, pulmonary, immune, and neurological systems. Exercise capacity, a measure of physical fitness, was highlighted as a measure associated with multi-organ health benefits, clinical cardiovascular risk factors, and longevity. For example, in the cardiovascular system, mechanisms include insulin sensitivity, weight, muscle and vascular function, and resilience. Physical activity plays an important role in the prevention of cognitive function and dementia. While the current research is encouraging for the benefit of physical activity on cognitive impairment or dementia, the evidence is not substantial enough or strong enough to justify recommendations or guidelines. More research is needed to examine the amount, type, frequency, and intensity of activity, preferably within a rigorous interventional study. Speakers highlighted the importance of future research to examine the role of age in physical activity and health. There are differences in when and how diseases develop and progress. For example, brain changes can begin approximately 20 years prior to clinical symptom onset of cognitive decline. In addition to a person’s current age, it is important to consider activity levels at multiple points and the changes over time and which health outcome is of interest. Resiliency, the body’s ability to remain healthy, decreases with age and increases with physical fitness. Increased resiliency has been observed among all ages when activity levels increase, independent of prior fitness levels. In spite of the differences observed in the importance of age across different health outcomes, the emerging evidence supports the idea that it is never too late to become active.

Research Opportunities

• Explore the use of -omics and metabolic biomarkers to assess exercise capacity and physical fitness as well as a risk factor for cardiovascular disease (i.e., physical fitness as a vital sign).
• Evaluate the use of physical activity and its metabolic biomarkers as a ‘vital sign’.
• Conduct physical activity interventions in humans to understand biological, multi-organ mechanisms.
• Develop and evaluate methods to study the cumulative effects and latency of physical activity and cardiovascular disease across the lifespan.
• Leverage existing data sources (e.g., cohort studies, completed trials, electronic health records, biomedical repositories with metabolic markers) and machine learning methods to personalize interventions.
• Investigate the components of physical activity (type, frequency, intensity, duration) and their effects on cognitive function among both younger and older adults.
• Conduct research to examine the role and heterogeneity of exposure timing and age within physical activity and aging resiliency.

3. Beyond Moderate-to-Vigorous Activity: Expanding Definitions and Focus

Traditionally, physical activity research has focused on leisure-time moderate-to-vigorous intensity physical activity (MVPA), such as walking and jogging. Speakers emphasized the need to move beyond a narrow focus on leisure-time MVPA to include light-intensity movement, muscle-strengthening activity, short bouts of activity (“exercise snacks”), transportation, and occupational activity. For example, these forms of movement are especially relevant for older adults, individuals with disabilities, and those with chronic conditions who may not meet traditional moderate-to-vigorous intensity thresholds, but still benefit from regular movement. Resistance training was highlighted as a critical but underutilized strategy for preserving muscle mass and metabolic health in aging populations, while culturally embedded practices like hula were shown to improve cardiovascular outcomes and community engagement. Short bouts of activity, light-intensity activity, and occupational activity are the most common activity patterns, but are frequently not included in research studies. In addition, it was noted that the research examining the relative importance of these types of activity compared to MVPA are mixed. For example, the occupational activity ‘paradox’ describes the observation that people participating in higher levels of occupational activity experience greater rates of premature mortality, but no significant difference in cardiovascular disease. Several potential explanations and implications were presented, such as measurement difficulties, biological plausibility, the unique challenges for initiating and maintaining participation, the relative importance of including them in an exercise program at different ages, and potential separate guidelines for occupational activity.

Research Opportunities

• Develop and implement measurement tools for non-MVPA patterns, particularly light-intensity and occupational activity.
• Encourage population-based intervention research that incorporates non-MVPA, lifestyle integration, and short bouts of activity.
• Customize physical activity programs based on the health outcome, social determinants of health, and individual characteristics and barriers.
• Explore the heterogeneity of effects of non-MVPA across the lifespan on a diverse set of health outcomes.

4. Health Disparities within Physical Activity Research

Physical activity is deeply shaped by structural and social determinants, including access to safe environments, cultural relevance, and social roles. The workshop highlighted how some communities—such as Native Hawaiians, people with disabilities, and low-income populations—may face unique barriers to physical activity, including lack of accessible infrastructure, transportation, and culturally appropriate programming. Successful interventions, such as telehealth-delivered exercise for individuals with mobility impairments and culturally grounded programs like hula-based cardiovascular interventions, demonstrated how centering community voices and values can enhance both reach and effectiveness. Presentations on people with disabilities included a lived-experience component and provided personal insights to the health disparities experienced by their communities, higher risk of health conditions, accessibility and appropriateness challenges unique to these groups, and characteristics of successful research studies and interventions. Throughout the session, speakers focused on the importance and opportunities of incorporating socioeconomic, social and cultural, and work and lifestyle factors in research and programming. Discussions highlighted the need for considering the appropriateness of studies and programs when working with people across the lifespan, particularly multi-generationally. These successful collaborations incorporated culturally- and socially-tailored programming, addressing social determinants for initiation and adherence.

Research Opportunities

• Address the limited inclusion of higher-risk populations with limited access to research and healthcare in longitudinal and intervention studies.
• Assess the effectiveness, feasibility, and impact of telehealth and remote delivery models that increase access for rural and mobility-limited populations.
• Incorporate culturally tailored interventions that integrate physical activity into traditional practices and community life.
• Encourage collaborations between researchers, healthcare providers, and communities throughout the research and implementation process.
• Explore the interplay between age, race/ethnicity, sex, income, and rurality in physical activity behaviors and health.

5. Implementation Science, Surveillance, and Policy

While many interventions demonstrate efficacy in controlled settings, translating them into real-world practice requires attention to implementation, scalability, sustainability, and accessibility. Speakers emphasized the importance of embedding physical activity into healthcare systems (e.g., through exercise prescriptions), community infrastructure (e.g., parks, schools, faith-based organizations), and policy frameworks (e.g., built environment, workplace wellness). For example, the integration of physical activity into primary care via the “exercise is medicine” model and the use of adaptive trial designs (e.g., SMART, MOST) were highlighted as strategies to personalize interventions and improve long-term adherence. Innovations such as telehealth, remote assessment, wearable devices, machine learning algorithms to incorporate personalized approaches, and ecological momentary assessment were discussed as promising tools—though their accessibility, cultural appropriateness, and validation across all populations remain ongoing challenges. Current surveillance systems and research tools often fail to capture the full spectrum of physical activity, particularly outside of leisure time. Speakers called for improved measurement and inclusion of resistance training, occupational activity, and light-intensity movement, which are often overlooked in national surveys and cohort studies. Particular emphasis was placed on the inclusion of people across the lifespan and the importance of utilizing an appropriate measurement tool for the research goal. For example, discussions included the challenges of a single, standardized measure for all ages as well as the harmonization and generalizability of results from different measurement tools.

Research Opportunities

• Examine built environment and policy interventions that promote walkability, safety, and access to green space.
• Investigate the disconnect between clinical guidelines and real-world feasibility, especially for older adults and those with disabilities.
• Understand and address barriers to sustained engagement, including cost, transportation, and cultural mismatch.
• Encourage adaptive trial designs and leveraging diverse data resources (e.g., All of Us Research Program, surveillance systems, and data linkage) to evaluate real-world health outcomes, inform level of interventions, and develop effective implementation strategies.
• Develop and evaluate methods to harmonize physical activity measures across the lifespan among different studies and populations.

Cross Cutting Themes

The workshop underscored that physical activity is not a one-size-fits-all prescription, but a dynamic, context-dependent behavior shaped by biology, culture, policy, and lived experience. Promoting physical activity across the lifespan requires a shift from individual responsibility to systemic support—through inclusive research, policy, and community-driven innovation. The path forward lies in embracing complexity, addressing disparities in physical activity among all populations , and ensuring that all people have opportunity to move, thrive, and age well. Below are examples of potential research opportunities identified throughout the workshop:

• Develop life course models that account for cumulative exposure and critical periods of vulnerability and opportunity.
• Expand research on light-intensity and resistance-based activity, especially in aging and clinical populations.
• Improve surveillance systems to capture domain-specific activity (e.g., occupational, caregiving, transportation).
• Prioritize examining health disparities in funding, design, and dissemination of physical activity interventions.
• Foster interdisciplinary collaborations that bridge public health, clinical care, urban planning, and community development.

The findings, knowledge gaps, and opportunities described here represent a summary of individual opinions and ideas expressed during the workshop. The summary does not represent a consensus opinion or directive made to or by the NHLBI or NIH.

Workshop Organizing Committee and Leadership

Workshop Chairs

• Kelley Pettee Gabriel, PhD MS - University of Alabama at Birmingham
• Daheia Barr-Anderson, PhD, MSPH – University of North Carolina at Charlotte

Workshop Program Leads

• Eric Shiroma, ScD, MEd, FACSM – National Heart Lung and Blood Institute
• Charlotte Pratt, PhD, MS, RD, FAHA – National Heart Lung and Blood Institute

Workshop Speakers and Moderators

• Sylvia Badon, PhD – Kaiser Permanente Northern California Division of Research
• Bethany Barone Gibbs, PhD, FAHA – West Virginia University
• Benjamin D Boudreaux, PhD – Columbia University Irving Medical Center
• Candance S Brown, PhD, MA, MEd, FGSA – University of North Carolina at Charlotte
• Keith Diaz, PhD – Columbia University Irving Medical Center
• Erin Dooley, PhD – University of Alabama at Birmingham
• Amanda Folk, PhD – Rowan University
• Rebecca Hasson, PhD, FACSM – University of Michigan
• Jammie Hopkins, DrPH, MS, MSCR – Morehouse School of Medicine
• Ray Jones, PhD – University of Alabama at Birmingham
• Ashleigh Johnson, DrPH – San Diego State University
• Joseph Keawe’aimoku Kaholokula, PhD – University of Hawai’i
• Amber W Kinsey, PhD – University of Alabama at Birmingham
• Eydie Kramer-Kostecka, PhD, MA – University of Minnesota Twin Cities
• Michael J LaMonte, PhD, MPH – University of Buffalo, SUNY
• Pablo Martinez- Amezcua, MD, PhD, MHS – Johns Hopkins Bloomberg School of Public Health
• James McClain, PhD, MPH – NIH All of Us Research Program
• James M Nagata, MD, MSc – University of California San Francisco
• M Benjamin Nelson, MS, ACSM-CEP – Wake Forest School of Medicine
• Priya Palta, PhD, MHS, FAHA – University of North Carolina at Chapel Hill
• Russell R Pate, PhD – University of South Carolina
• Sarah Peskoe, PhD – Duke University School of Medicine
• Jingyi Qian, PhD – Brigham and Women’s Hospital and Harvard Medical School
• Tyler Quinn, PhD – West Virginia University
• Deborah Salvo, PhD – University of Texas at Austin
• Ravi Shah, MD – Vanderbilt University Medical Center
• Shaila M Strayhorn-Carter, PhD MPH – University of North Carolina Wilmington
• Geoffrey Whitfield, PhD – Center for Disease Control and Prevention
• Jereme Wilroy, PhD – University of Alabama at Birmingham

Program Booklet

See the program booklet.

Videocast

Day 1:
https://videocast.nih.gov/watch=55266

Day 2:
https://videocast.nih.gov/watch=55267