Future Trends of Physical Activity in Health Promotion

1. Introduction

Physical activity is one of the most powerful and cost-effective tools available for promoting health and preventing disease across the lifespan [1,2]. International guidelines recommend regular aerobic and muscle-strengthening activity for all age groups and highlight that any amount of movement is better than none [3]. However, recent global estimates indicate that almost one in three adults does not meet these recommendations, and that insufficient physical activity has increased over the last two decades [4]. Closing this gap requires not only promoting more physical activity, but also identifying which forms, settings and strategies are most effective for each population [5].

In parallel, the fitness and physical activity sector has expanded considerably, and new trends are continuously emerging. Not all of them, however, are supported by solid scientific evidence. With this in mind, the Special Issue “Future Trends of Physical Activity in Health Promotion” was launched to gather rigorous evidence on the different ways in which physical activity can be used to improve health, regardless of the study population or the methodological approach. We invited scholars to submit cross-sectional, longitudinal and intervention studies; reviews; protocols; and instrument validation studies on topics such as technological innovation, tailored physical activity models, community-based interventions and future perspectives on movement-based health.

The Special Issue includes eleven contributions [6,7,8,9,10,11,12,13,14,15,16]: seven original research articles, two study protocols and two systematic reviews, one of which included a meta-analysis. Together, they cover the whole lifespan, from adolescents and university students to middle-aged and older adults, as well as clinical populations with chronic pain and breast cancer survivors; moreover, they address physical activity in a wide range of settings, including schools, residential care facilities, outdoor community spaces, clinical practice, organised sport and remotely delivered, home-based programmes. In the following section, we briefly summarise each contribution.

2. Overview of the Published Contributions

Lee and Yun [6] addressed one of the most topical challenges in adolescent health: how digital media use and physical activity jointly shape health behaviours, and whether this interplay differs by gender. Using quota sampling, they surveyed 652 adolescents from Seoul (South Korea) on digital detox practices, physical activity and perceived improvement in health habits. Girls reported greater engagement in digital detox, whereas boys were more physically active and reported higher health efficacy. Digital detox was positively associated with improvements in health habits, while the paths linking digital detox to physical activity, and physical activity to health habits, were not statistically significant. The authors interpret these findings from a social-construction perspective, arguing that gender norms shape how adolescents engage with screens and movement, and that health promotion strategies for this age group should be tailored to these sociocultural dynamics rather than following a one-size-fits-all approach.

Also focusing on adolescents, but in a school setting, Lizandra et al. [7] presented the design and protocol of the “Estilos de Vida Activos” (EVA) project, a participatory intervention in secondary schools aimed at fostering students’ agency and motivation to adopt active lifestyles. The intervention is grounded in the salutogenic model, self-determination theory and the health-based Physical Education pedagogical model, and is co-designed by students, teachers and researchers through participatory action research, from the initial analysis of needs to the creation of tailored physical activity programmes. The evaluation combines validated questionnaires on active commuting, socioeconomic status, basic psychological needs, motivation, and physical activity levels and intentions with qualitative data from teacher interviews, photovoice sessions with students, observation notes and programme materials. The intervention employs the TIDieR checklist, which strengthens its transparency and replicability, offering a useful model for inclusive, context-sensitive school-based health promotion.

Focusing on adulthood, García-Pérez et al. [8] examined how three lifestyle habits (physical activity, adherence to the Mediterranean diet and sleep duration) relate to resilience, psychological distress and self-esteem in 928 education students from the University of Granada (Spain). Men reported more physical activity, better dietary adherence, longer sleep and more favourable psychological outcomes than women. In stepwise regression models, Mediterranean diet adherence was the most consistent predictor of the three psychological indicators, and sleep duration was particularly relevant for resilience in men. Although physical activity was not directly associated with psychological distress, a mediation analysis revealed an indirect effect through sleep duration. These results support integrated, sex-sensitive strategies that address several lifestyle behaviours simultaneously, and the authors highlight the strategic value of targeting future teachers, who will later act as promoters of well-being in schools.

Healthy ageing was the focus of three contributions to this Special Issue. García-Llorente et al. [9] described the design and protocol of ACTIVA-Senior, an 18-week, single-blind randomised controlled trial testing a multidomain outdoor exercise programme in middle-aged and older adults enrolled in a University for Seniors programme. Participants in the training group attend two supervised sessions per week that combine a warm-up; resistance, cardiorespiratory, balance and coordination training; and a cool-down with flexibility, relaxation and emotional intelligence tasks, with cognitive challenges embedded throughout and recommendations for additional autonomous aerobic activity. The protocol, reported according to the SPIRIT and CONSORT guidelines, includes a broad set of outcomes: cognitive state, body composition, cardiovascular health, physical fitness, physical activity, frailty, sarcopenia and life satisfaction. Notably, the inclusion of adults from 55 years of age reflects a life-course view of healthy ageing in which prevention begins before old age.

The results of this trial were subsequently reported by García-Llorente et al. [10]. Of the 52 randomised participants (mean age 66 years), 46 completed the study. Compared with the control group, in the intervention group, systolic and diastolic blood pressure were reduced by 17.4 and 9.2 mmHg, respectively, and the distance covered in the Six-Minute Walk Test increased by approximately 65 m, with large effect sizes. Within-group improvements in body fat percentage and visceral fat were also observed, although these changes did not differ significantly between groups. The low numbers needed to treat for clinically relevant changes in blood pressure (2.2) and functional capacity (1.4) underline the practical relevance of the programme and suggest that structured outdoor exercise is a scalable, low-cost strategy that could be integrated into public healthy-ageing policies.

In institutionalised older adults, Caña-Pino and Marín-Rubio [11] conducted a randomised controlled pilot trial comparing a multicomponent occupational therapy intervention (combining balance and postural stability exercises, proprioceptive stimulation, lower-limb strengthening and functional occupational tasks) with conventional gerontogymnastics and a control group. Thirty-five participants were allocated to a 6-week programme of two 45 min sessions per week. Lower-limb strength improved significantly, while the multicomponent group showed improvements in proprioceptive accuracy (22.1%) and in mobility measured with the Timed Up and Go test (13.9%) that approached clinical relevance but did not reach statistical significance. Although the small sample and short duration call for caution, the study provides preliminary evidence that integrating balance-specific and proprioceptive training into occupational therapy may help preserve mobility and independence and reduce fall risk in residential care settings.

Several contributions explored the role of physical activity and exercise in people with chronic or musculoskeletal pain. Parolini et al. [12] analysed data from 1021 individuals with acute low back pain, collected through an online platform, to examine how emotional distress (depression, anxiety and stress) and pain catastrophising relate to functional disability across different physical activity levels. Canonical correlation analyses showed that higher emotional distress was associated with greater low-back-pain-related functional impairment, particularly in the light and vigorous physical activity groups. Participants engaging in vigorous physical activity displayed more favourable psychological profiles and lower disability than those with lower activity levels. These findings suggest that regular, vigorous physical activity may act as a protective factor for mental health and function in this population, and that activity levels should be considered when addressing the psychological dimension of low back pain.

Tatsios et al. [13] investigated the emerging role of respiratory mechanics in the management of non-specific chronic neck pain. In this randomised controlled trial, 90 patients were allocated to one of three groups (cervical spine manual therapy (Mulligan Concept) plus diaphragm manual therapy and breathing re-education exercises; cervical manual therapy plus sham diaphragmatic techniques; or conventional physiotherapy), each delivered in 10 sessions over one month. Cervical range of motion and craniovertebral angle improved most after treatment, and range-of-motion gains were maintained at the three-month follow-up. The group receiving diaphragm therapy and performing breathing exercises showed the largest overall improvement, outperforming the conventional physiotherapy group in all movement directions except flexion and the sham group in extension, whereas changes in forward head posture were similar across groups. These results point to the interaction between breathing and neck mobility as a promising avenue for both assessing and treating these patients.

Palacio-Del Río et al. [14] contributed a systematic review on the effectiveness of exercise in chronic tension-type headache and chronic migraine. Following the PRISMA statement and searching PubMed, Web of Science and Scopus, the authors included ten randomised or quasi-experimental trials (848 participants) of acceptable methodological quality according to the PEDro and RoB 2 tools. In most studies, exercise-based interventions achieved greater pain reduction than conventional treatment, which the authors relate to improved central pain modulation and to the potential of body-based strategies such as postural integration. Although the limited number of trials and the difficulty in blinding participants, therapists and assessors weaken the strength of the evidence, the review supports exercise as a useful strategy in managing these chronic headache disorders.

Valeriani et al. [15] extended the scope of the Special Issue to oncology and digital health through a systematic review and meta-analysis of remotely delivered yoga interventions for women with breast cancer. The review, registered in PROSPERO and based on searches in PubMed, Scopus, Web of Science and the Cochrane Library, included 26 publications corresponding to 19 independent cohorts, covering home-based, hybrid and fully remote programmes delivered through digital platforms, videos or remote support. Pooling the nine randomised controlled trials that assessed health-related quality of life showed a moderate improvement (Hedges’ g = 0.56, 95% CI 0.17–0.96), although heterogeneity between studies was substantial (I² = 72.4%). Psychological and physical symptoms also tended to improve, albeit with less consistent results, while feasibility and adherence were generally good and no serious yoga-related adverse events were reported. The authors conclude that remote yoga is a promising supportive-care option for breast cancer survivors but call for standardised and adequately powered trials before its widespread implementation.

Finally, Aparicio-Chueca and Muñoz-Vila [16] examined a specific sport as a vehicle for health promotion. Through a questionnaire administered to 329 table tennis players in Catalonia (Spain), they analysed the perceived physical, cognitive, emotional and social benefits of regular practice. Factor analysis identified two dimensions (physical–cognitive and emotional–social benefits) exhibiting excellent internal consistency and the capacity to predict the overall perception of table tennis as a health-enhancing activity, with the physical–cognitive dimension showing the strongest effect. Cluster analysis further distinguished three player profiles (sceptical, functional and integrative). Given its low impact, accessibility and adaptability, the authors propose table tennis as an inclusive option for community programmes and public health strategies, and call for further research on the motivations of different user profiles and underrepresented populations.

3. Conclusions and Future Directions

Taken together, the contributions to this Special Issue point to several trends that are likely to shape the future of physical activity in health promotion. First, there is a clear shift towards multidomain and multicomponent interventions, which combine physical, cognitive, emotional and functional components rather than isolated exercise modalities [9,10,11]. Second, physical activity is increasingly studied alongside other lifestyle behaviours (such as sleep, diet and digital media use) [6,8] highlighting the need for integrated approaches. Third, the setting matters: outdoor spaces, schools, residential care facilities and community sport emerge as accessible and scalable contexts for intervention [7,9,10,11,16], while digital platforms are opening the door to remotely delivered, home-based programmes [15]. Finally, participatory as well as gender- and sex-sensitive approaches appear essential to adapt interventions to the needs and social realities of each population [6,7,8].

The contributions to this Special Issue also reveal some challenges for future research. Several studies relied on cross-sectional designs and self-reported measures [6,8,12,16], and some of the trials were based on small samples and short interventions [11], which limits causal inference and generalisability. Future studies should prioritise larger and longer randomised controlled trials, objective measures of physical activity (e.g., accelerometers and other wearable devices), follow-up periods that allow the maintenance of effects to be assessed, and implementation and cost-effectiveness analyses that facilitate the transfer of effective programmes to health and education systems.

We would like to thank all the authors for their valuable contributions, the reviewers for their careful and constructive evaluations, and the editorial staff of Healthcare for their support throughout the development of this Special Issue. We hope that this collection will serve as a useful resource for researchers, practitioners and policymakers working to make physical activity an effective, evidence-based tool for health promotion.