Chief Medical Officer’s Physical Activity Guidelines 2026

The numbers didn’t move. The conversation should.

The four UK Chief Medical Officers refreshed their physical activity guidelines last week, the first update since 2019. I have taken a few days to reflect (and, I’ll be honest, catch up after a delightful holiday to Italy!). My first reaction is a warm one. The evidence that movement protects health is about as strong as it gets, and it is good to see it restated with all four nations behind it. The CMOs reach again for the phrase “miracle cure”, and on what we now know, that is fair.

This is an evidence update, though, not a change to the numbers.

What changed

Almost none of the advice has moved. Adults are still asked for 150 minutes of moderate activity a week, or 75 vigorous, with strengthening on two days; children for an average of an hour a day; the under-fives figure untouched. These numbers have held since 2011. What has been reworked is the evidence beneath them and the emphasis on top, and three things stand out.

The change I am very glad to see is strength training treated, at last, as the equal of aerobic activity: resistance work, the report says plainly, counts every bit as much as the 150 minutes. Those of us who watched it ignored for a decade will welcome it.

Light activity is promoted, too, from also-ran to a legitimate way in, which matters for anyone deconditioned, older or living with a long-term condition. So much of promoting activity, in my experience as a clinician, is helping a person over the barriers in their way, and this reframing helps.

And the guidelines take on GLP-1 medication, the most topical addition by far. As these drugs move into everyday prescribing, the point about muscle is the one clinicians and patients need to hear: weight shed as lean tissue is no triumph, and resistance training is how you keep it.

All of this is welcome. But the bigger question this update raises is about the kind of guideline we are still choosing to write.

The better model already exists

These are physical activity guidelines, and it is reasonable that they stick to physical activity. The real question is whether a standalone physical activity guideline is still worth writing at all.

Canada decided years ago that it was not. Rather than refresh a movement guideline in isolation, it built a single 24-hour framework treating activity, sedentary time and sleep as one whole: children in 2016, adults in 2020. Australia followed this year, and the WHO does the same for the under-fives. It matches how a day is lived, and guidance that sees moving, sitting and sleeping together says what movement guidance alone cannot.

Lifestyle medicine has known this for years: two of our six pillars are physical activity and restorative sleep, and we would not tend one while ignoring the other. So it is a little painful to see the 2026 update borrow the Australian evidence review, but not the integrated architecture behind it. The evidence for integration is mature, and I think all of us recognise the importance of being holistic.

I would go further than Canada or Australia has. What we eat, how we handle stress, what we drink and whether we smoke, the company we keep: each shapes health as powerfully as activity does, and each is tangled up with the rest. If we want guidance to match how people actually live, the destination is not a movement guideline, nor even a movement-and-sleep one, but integrated advice built around all six (and more!) pillars of health. That is the whole idea of lifestyle medicine.

Children weren’t prioritised

I’m also a little disappointed in the thinnest part of the document, because it is the part that I, with my passion for improving the health and well-being of children and young people, naturally focus. This was, in substance, an update for adults. The fresh evidence is overwhelmingly adult, and the chapters on children, teenagers and the under-fives rest on evidence last examined before 2019.

The people that leaves behind are the ones we can least afford to. Activity falls away sharply in adolescence; girls are less active than boys at every age, and the habits formed then tend to follow people into adult life. The gradient of disadvantage is steep here, and the lifetime return is greatest. We did our careful work on the people with much of their lives behind them, and waved through the ones with most of theirs still ahead.

Children are the group for whom integration matters most: a young person’s sleep, screens, sitting and moving are bound together more tightly than at any later stage. Canada and Australia give their young people whole-day guidance; we give ours a movement target and little sense of how it fits the rest. It did not help that the update came wrapped in a summer-holidays message about keeping children active, from a document whose advice for children had barely moved.

Guidelines don’t deliver themselves

The report admits most adults, and many children, are not active enough, and haven’t been for every version of this guidance since 2004. The trouble was never that people did not know they should move; it is that knowing changes little on its own. Closing that gap is the whole of lifestyle medicine, and it is why the second of our three principles is behaviour change: person-centred techniques to help people make a change and, harder still, keep it.

So what would move this? Chiefly, making physical activity a routine part of the consultation, not an afterthought. The tools already exist.

The Faculty of Sport and Exercise Medicine’s Moving Medicine helps clinicians raise it in the minutes a consultation allows. The Physical Activity Clinical Champions have trained tens of thousands of clinicians, peer-to-peer. Social prescribing, exercise referral and parkrun practices can carry a patient from advice to a habit. None of this is exotic; it is under-resourced and under-joined-up, a solvable problem.

Two structural changes would do more than any single scheme. The first is to build lifestyle medicine into the Quality and Outcomes Framework, so that assessing and supporting the pillars is measured and rewarded in primary care rather than left to individual enthusiasm, using validated, evidence-based tools rather than good intentions. The second is education. Lifestyle medicine belongs in the curriculum from medical school to specialist training, so that every clinician is qualified and ready to have these conversations, not just the committed few.

We must be honest about who is left behind. A single universal target will not reach the least active; targeted, credible engagement will, of the kind Sport England’s This Girl Can managed at scale. And part of the answer, frankly, is us. The British Society of Lifestyle Medicine exists to turn this evidence into everyday practice: to train clinicians in behaviour change, to champion the pillars, and to bridge a guideline on a government website and a real ten-minute appointment. The CMOs have set out what good looks like; delivering it is where BSLM and its members come in alongside the many committed colleagues and aligned organisations out there.

The next four years

The CMOs have said the next review is anticipated for 2030, in collaboration with the WHO. That is both a deadline and an opening, and this is where I want the British Society of Lifestyle Medicine to help lead. I would like us to reach 2030 by arguing not merely for a 24-hour movement framework, but for the whole-life view behind it, reaching in time toward every pillar of health. I want children at the front of that work rather than the back, their evidence redone rather than inherited, and the delivery gap owned, because no guideline closes it alone.

The CMOs have done their job, and done it well, keeping the science current and the tone open to everyone. What follows is the harder and less rewarding part: turning what we know into what people actually do. That’s the bit we need to focus on.

Dr Alex Maxwell

President of the British Society of Lifestyle Medicine.