The epidemiology of muscle-strengthening exercise in Europe: A 28-country comparison including 280,605 adults

Jason A Bennie, Katrien De Cocker, Jordan J Smith, Glen H Wiesner, Jason A Bennie, Katrien De Cocker, Jordan J Smith, Glen H Wiesner

Abstract

Objective: Muscle-strengthening exercise (use of weight machines, free weights, push-ups, sit-ups), has multiple independent health benefits, and is a component of the Global physical activity guidelines. However, there is currently a lack of multi-country muscle-strengthening exercise prevalence studies. This study describes the prevalence and correlates of muscle-strengthening exercise across multiple European countries.

Methods: Data were drawn from the European Health Interview Survey Wave 2 (2013-14), which included nationally representative samples (n = 3,774-24,016) from 28 European countries. Muscle-strengthening exercise was assessed using the European Health Interview Survey Physical Activity Questionnaire. Population-weighted proportions were calculated for (1) "insufficient" (0-1 days/week) or (2) "sufficient" muscle-strengthening exercise (≥2 days/week). Prevalence ratios were calculated using multivariate Poisson regression for those reporting sufficient muscle-strengthening by country and by sociodemographic/lifestyle characteristics (sex, age, education, income, self-rated health etc.).

Results: Data were available for 280,605 European adults aged ≥18 years. Overall, 17.3% (95% CI = 17.1%-17.5%) reported sufficient muscle-strengthening exercise (≥2 days/week). Muscle-strengthening exercise was geographically patterned with the lowest prevalence reported in South-eastern European countries (Romania, Malta and Cyprus: range: 0.7%-7.4%), and the highest prevalence in the Nordic countries (Iceland, Sweden, and Denmark: range: 34.1%-51.6%). Older age, insufficient aerobic activity, poorer self-rated health, lower income/education, being female, and being overweight/obese were significantly associated with lower likelihood of reporting sufficient muscle-strengthening exercise, independently of other characteristics.

Conclusions: Most European adults do not report sufficient muscle-strengthening exercise, and prevalence estimates varied considerably across countries. Low participation in muscle-strengthening exercise is widespread across Europe, and warrants public health attention.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Proportion of people 18 years…
Fig 1. Proportion of people 18 years and older who report muscle-strengthening exercisea two or more times per week by countryb.
aMuscle-strengthening exercise defined as physical activities specifically designed to strengthen muscles, such as doing resistance training or strength exercises (using weights, elastic band, own body weight, etc.) or push-ups (press-ups)/knee bends (squats). (Data shown in S1 Appendix). bThis figure was generated using the open source statistical software R (version 4.0.2; R Core Team [2020]. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/.), and the following mapping packages available via the CRAN network: "rnaturalearth" and "rnaturalearthdata". rnaturalearth: World Map Data from Natural Earth. R package version 0.1.0. https://CRAN.R-project.org/package=rnaturalearth. These packages facilitate interaction with Natural Earth map data (http://www.naturalearthdata.com/) and are public domain dataset commonly used in world mapping, and as such does not contravene any copyright law.

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