The epidemiology of physical activity guideline adherence among 35,633 adults: Findings from the South Australian Population Health Survey

Since 2010, global physical activity guidelines have recommended that adults engage in moderate-to-vigorous physical activity (MVPA) and muscle-strengthening exercise (MSE). However, health surveillance rarely assesses both. This study describes the prevalence and correlates of adherence to the joint MVPA-MSE guideline in a large sample of Australian adults. Data were drawn from pooling seven waves of the South Australian Population Health Survey (2018 to 2024). Weighted proportions meeting both guidelines (MVPA ≥150 min/week/MSE ≥2 times/week) were calculated. Poisson regression estimated prevalence ratios for meeting both guidelines across sociodemographic/lifestyle factors and for nine chronic conditions by guideline adherence (met neither; MVPA only; MSE only; met both), adjusted for confounders (e.g., age, smoking, body mass index). Among 35,633 adults (18–64 years), 25.1% (95% CI: 24.7, 25.6%) met both MVPA-MSE guidelines. In a multivariate analysis, older adults, women, people from socioeconomically disadvantaged areas, and those living with obesity had lower prevalence ratios for meeting both guidelines. Meeting both guidelines was associated with the lowest prevalence ratios for anxiety, cardiovascular disease, depression, diabetes, high cholesterol and hypertension. Low prevalence of meeting guidelines and associations with chronic conditions highlight the need for strategies that promote physical activity by addressing both inequalities in access and wider social, environmental, and structural determinants. • 74.9% of adults did not meet both aerobic exercise and muscle-strengthening guidelines. • Older adults, women, individuals from socioeconomically disadvantaged areas, and people living with obesity were less likely to report meeting both guidelines. • Meeting both aerobic-strength guidelines is associated with the lowest prevalence of anxiety, cardiovascular disease, depression, diabetes, high cholesterol and hypertension. • Future strategies to prevent chronic conditions should promote combined aerobic and muscle-strengthening exercise.