This is the largest study till date to report on physical activity patterns in India. Our results show the following:
Nearly half of the population in the four regions studied were inactive. This translates to 392 million inactive individuals in India.
Physical inactivity was significantly more common in urban areas of the country compared to rural areas
Males were significantly more active than females
Most of the time spent in moderate to vigorous intensity activity was at the workplace.
More than 90% of subjects in all the four regions studied did no recreational physical activity. This was significantly higher in rural areas and among females.
Even among those who reported recreational physical activity, the time spent in moderate to vigorous intensity activity was overall less than 20 mins/day.
Over the past decade, a number of studies carried out in developed nations have shown high prevalence of physical inactivity. The Behavioral Risk Factor Surveillance System  published in 2003 showed that 52.8% of U.S. citizens were inactive (50.2% men and 55.4% women). In a study done using the International Physical Activity Questionnaire (IPAQ) in Sweden in 2002–03 on 1470 adults aged 18 to 74 years, 31% of the population was found to be inactive  while the Health Survey for England  reported a 63% prevalence of inactivity for men and 76% prevalence for women. The Eurobarometer wave 58.2  showed a combined prevalence of inactivity of 31%. However, the 51 country study of worldwide variability in physical inactivity [World Health Survey (WHS)] , showed overall physical inactivity to be much lower (17.7%; 19.8% women and 15.2% men). In the WHS, the prevalence of physical inactivity in India was 9.3% in men and 15.2% in women. This figure is much lower than those seen in the present study (54.4%; 41.7% men). However, the WHS was performed more than a decade ago, and India has gone through far reaching demographic and socioeconomic changes in the interim, making comparisons of that survey with the present study difficult. Also, the WHS used the IPAQ, whereas in the present study we have used the GPAQ, which could account for some of the differences seen .
A 20 country study  conducted between 2002 to 2004 showed that the prevalence of "low physical activity" varied from 9% to 43%. A review of 55 population based sureys of physical activity from 29 Asia-Pacific countries was published recently . Varying methodologies were used in the different studies – 19 surveys used the IPAQ, 18 surveys used the GPAQ and 18, other instruments. The review demonstrated that physical activity estimates vary widely even within a single country using different surveys in similar time periods. Three surveys from India were included in the above review- the WHO Modified STEPS Survey (GPAQ) in 2003–2005, the World Health Survey (IPAQ) in 2003 and the IPAQ Short Form (2003). The prevalence rates of “sufficiently active” were 84, 88 and 77% respectively. These figures are much higher than that shown in this study, which could be accounted for by the different methodology and sample selection criteria adopted by these studies. It is also possible that over the last decade, physical activity levels may have considerably declined, although such wide differences probably reflect methodological variations.
Indeed, a more recent multisite cross sectional study done in 9 rural areas in five Asian countries utilizing the GPAQ showed that levels of physical inactivity varied from 13% to 58%. In the study site in India (Vadu, Maharashtra), the level of physical inactivity was 53% , which is similar to that in our study (50.0%).
A study done by Shah et al.,  in 2005 in six regions of India (Delhi and Ballabgarh in the north, Chennai and Trivandrum in the south, Nagpur in the west and Dibrugarh in the east) showed that overall inactivity levels were 12.6% in males and 18.9% in females. Moreover, this study also showed marked variability in physical activity in different regions of the country. In the current study also, there was variability in physical activity across different regions of the country; however, there seems to be a marked increase in the proportion of individuals reporting inactivity compared to the study conducted eight years ago. This could again point to declining physical activity levels in recent times.
A more recent study done using cluster sampling in 6198 subjects (3426 men and 2772 women) from eleven cities across India showed that 38.8% of men and 46.1% of women were physically inactive , and these figures are similar to those reported in the present study. Similarly, another recent study from Jaipur looked at the prevalence of cardiovascular risk factors in 739 subjects (451 men, 288 women). It was found that 69.6% of men and 52.4% of women were physically inactive .
Hallal et al.  in a recent review showed that the prevalence of physical inactivity varied widely between regions of the world: 27.5% in Africa, 43.3% in the Americas, 43.2% in the Eastern Mediterranean, 34.8% in Europe, 17% in South East Asia and 33.7% in the Western Pacific.
We report that the highest prevalence of physical inactivity was found in Chandigarh (66.8%). This is not surprising since Chandigarh is a highly urbanized territory and is located adjacent to two of India’s prosperous states, Punjab and Haryana, of which it serves as the joint capital. This can also explain why the rural urban disparity in inactivity is the least marked in Chandigarh. In a study conducted in 2010 on 2227 subjects aged 20 years and above in a representative sample of the urban Chandigarh population, Ravikiran et al.  found that 61.3% of the study subjects were inactive, which is similar to our results.
We found that there was a significant difference among males and females with respect to physical activity, with males being more active. This is in agreement with earlier studies, most of which have reported higher levels of activity in males compared to females [18, 20, 26, 29, 31].
The prevalence of inactivity was higher in urban areas compared to rural areas. Factors like higher levels of income, less physically demanding occupations and increased availability of mechanized transport and household appliances among urban dwellers could explain this disparity. A similar finding was noted in a study from Tamilnadu , which found that levels of sedentary behaviour were highest in the cities, followed by the smaller towns and the periurban villages. This also agrees with the findings of the 51 Country Study quoted above . A similar finding was also noted in China, where the percentage of active individuals was found to be much higher in the rural areas compared to the urban areas (78.1% vs. 21.8%) .
Our study underscores the fact that leisure-time or recreational physical activity levels are extremely low in India. More than 90% of individuals in both urban and rural areas reported doing no recreational physical activity. This is similar to the situation in China , where only 28.9% of rural residents and 7.9% of urban residents reported leisure time physical activity. In Brazil also, the prevalence of physical inactivity in the recreational domain was found to be 80.7% . Another study from Vitenam also reported inactivity in the recreational domain to be as high as 90.6%, which is similar to our findings . The high prevalence of insufficient recreational activity observed across all age groups and both genders could reflect limited access to and availability of facilities for recreational physical activity.
The WHO recommends that individuals perform at least 150 minutes of moderate to vigorous physical activity per week for the maintenance of health. In India at the present time, more than half of the population do not meet these recommendations. Moreover, individuals appear to derive most of their physical activity from the occupational domain. This is similar to the situation in China and Vietnam, where most of time spent in physical activity is in the work domain [35, 36]. As physical activity levels in the occupational domain decline, individuals will have to obtain much of their physical activity requirements through their leisure time pursuits. This assumes significance in view of our findings that over 90% of the population do no recreational physical activity at all. This points to the need for increasing awareness regarding physical activity in India, and provision of facilities for individuals in both urban and rural areas to engage in recreational physical activity.
There are some limitations to this study. For assessment of physical activity, GPAQ has been used, which has been designed chiefly for surveillance purposes in developing countries. As for any self-reporting measure, recall bias leading to over- or under-reporting of physical activity cannot be ruled out in the study. Moreoever, the GPAQ may not be culturally specific. In the present study, data from three states of India has been used to calculate the numbers of physically active persons in the country. It is possible that these numbers might change once the entire study, comprising all the states of the country, is completed. However, since the three states have been selected to represent distinct regions of the country and within each region, a representative population has been sampled in both the urban and rural areas major changes in the numbers are unlikely.