Urban design, planning, and transport play an important role in the promotion of physical activity.1Reis RS Salvo D Ogilvie D et al.Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving.Lancet. 2016; 388: 1337-1348Summary Full Text Full Text PDF PubMed Scopus (395) Google Scholar Since 2010, active transportation systems and active urban design have been recognised as among the best investments for encouraging physical activity at scale.2Global Advocacy Council for Physical Activity International Society for Physical Activity and HealthThe Toronto charter for physical activity: a global call for action.J Phys Act Health. 2010; 7: S370-S385PubMed Google Scholar Designing and planning activity-promoting cities can help prevent premature mortality,3Mueller N Rojas-Rueda D Basagaña X et al.Urban and transport planning related exposures and mortality: a health impact assessment for cities.Environ Health Perspect. 2017; 125: 89-96Crossref PubMed Scopus (139) Google Scholar reduce the high costs associated with physical inactivity,4Ding D Lawson KD Kolbe-Alexander TL et al.The economic burden of physical inactivity: a global analysis of major non-communicable diseases.Lancet. 2016; 388: 1311-1324Summary Full Text Full Text PDF PubMed Scopus (1089) Google Scholar, 5Katzmarzyk PT Friedenreich C Shiroma EJ Lee IM Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries.Br J Sports Med. 2021; (published online March 29.)http://dx.doi.org/10.1136/bjsports-2020-103640Crossref PubMed Scopus (70) Google Scholar and help countries achieve some of the UN Sustainable Development Goals.6Salvo D Garcia L Reis RS et al.Physical activity promotion and the United Nations Sustainable Development Goals: building synergies to maximize impact.J Phys Act Health. 2021; (published online July 13.)https://doi.org/10.1123/jpah.2021-0413Crossref Scopus (37) Google Scholar During the COVID-19 pandemic, there have been declines in physical activity worldwide,7Tison GH Avram R Kuhar P et al.Worldwide effect of COVID-19 on physical activity: a descriptive study.Ann Intern Med. 2020; 173: 767-770Crossref PubMed Scopus (415) Google Scholar highlighting the need for widespread, accessible, and safe public open spaces for active recreation and infrastructure for active transportation in cities. In the COVID-19 pandemic, cycling became an efficient and safe urban mobility option for many city dwellers who had access to high-quality urban infrastructure and public open spaces have been essential community assets for safe recreational physical activity and social interaction. Other people with access to private motor vehicles took to exclusively driving to prevent SARS-CoV-2 transmission. However, among the most economically disadvantaged groups, walking, cycling, or using public transport are necessities and not a choice.8Lambert EV Kolbe-Alexander T Adlakha D et al.Making the case for “physical activity security”: the 2020 WHO guidelines on physical activity and sedentary behaviour from a Global South perspective.Br J Sports Med. 2020; 54: 1447-1448Crossref PubMed Scopus (20) Google Scholar This is the reality for a large proportion of people in low-income and middle-income countries (LMICs), for whom a substantial portion of their total physical activity comes from the active transportation.8Lambert EV Kolbe-Alexander T Adlakha D et al.Making the case for “physical activity security”: the 2020 WHO guidelines on physical activity and sedentary behaviour from a Global South perspective.Br J Sports Med. 2020; 54: 1447-1448Crossref PubMed Scopus (20) Google Scholar, 9Jáuregui A Salvo D Medina C Barquera S Hammond D Understanding the contribution of public- and restricted-access places to overall and domain-specific physical activity among Mexican adults: a cross-sectional study.PLoS One. 2020; 15e0228491Crossref PubMed Scopus (11) Google Scholar, 10Salvo D Reis RS Sarmiento OL Pratt M Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America.Prev Med. 2014; 69: S86-S92Crossref PubMed Scopus (81) Google Scholar During the pandemic, many people's only option was to continue to use crowded public transport systems. Beyond the lives claimed by COVID-19, one of the most devastating effects of the pandemic is that it has worsened pre-existing health and social disparities.11Chirisa I Mutambisi T Chivenge M Mabaso E Matamanda AR Ncube R The urban penalty of COVID-19 lockdowns across the globe: manifestations and lessons for Anglophone sub-Saharan Africa.GeoJournal. 2020; (published online Aug 27.)http://dx.doi.org/10.1007/s10708-020-10281-6Crossref PubMed Scopus (35) Google Scholar Indeed, residents of LMIC cities have faced an urban penalty because poverty, overcrowding, and inequitable access to infrastructure compromise adherence to physical distancing guidelines.11Chirisa I Mutambisi T Chivenge M Mabaso E Matamanda AR Ncube R The urban penalty of COVID-19 lockdowns across the globe: manifestations and lessons for Anglophone sub-Saharan Africa.GeoJournal. 2020; (published online Aug 27.)http://dx.doi.org/10.1007/s10708-020-10281-6Crossref PubMed Scopus (35) Google Scholar Encouragingly, some cities responded to the unexpected situation arising from COVID-19 by implementing rapid, large-scale urban transformations to increase access to public open spaces and active transport infrastructure. Two examples are Sydney, Australia, and Mexico City, Mexico. In both cities, several kilometres of pop-up, protected cycle lanes were rolled out since mid-2020; local authorities have reported increases in cycling and strong public support for this approach.12Gobierno de la Ciudad de MéxicoCiclovía Insurgentes.https://semovi.cdmx.gob.mx/storage/app/media/evaluacion-ciclovia-insurgentes.pdfDate: 2021Date accessed: June 26, 2021Google Scholar, 13City of Sydney NewsPitt Street leads the way with plans for a permanent cycleway.City of Sydney News. May 27, 2021; https://news.cityofsydney.nsw.gov.au/articles/pitt-street-leads-the-way-with-plans-for-a-permanent-cyclewayDate accessed: July 1, 2021Google Scholar Sydney and Mexico City have announced plans to maintain the new cycling infrastructure permanently or develop acceptable long-term alternatives.12Gobierno de la Ciudad de MéxicoCiclovía Insurgentes.https://semovi.cdmx.gob.mx/storage/app/media/evaluacion-ciclovia-insurgentes.pdfDate: 2021Date accessed: June 26, 2021Google Scholar, 13City of Sydney NewsPitt Street leads the way with plans for a permanent cycleway.City of Sydney News. May 27, 2021; https://news.cityofsydney.nsw.gov.au/articles/pitt-street-leads-the-way-with-plans-for-a-permanent-cyclewayDate accessed: July 1, 2021Google Scholar In these contrasting high-income country (HIC) and LMIC settings, a window of opportunity was seized for the promotion of urban physical activity. Notably, active transport, especially cycling, was a resilient and reliable urban mobility option during previous crises in Mexico City, such as during the 2017 earthquake and the 2019 petrol shortage.14García-Franco JL Air quality in Mexico city during the fuel shortage of January 2019.Atmospheric Environ. 2020; 222117131Crossref Scopus (11) Google Scholar, 15de Jong F Parks and bicycles were lifelines after Mexico City's earthquake. Bloomberg, Sept 28, 2017https://www.bloomberg.com/news/articles/2017-09-28/parks-and-bicycles-were-lifelines-after-mexico-city-s-earthquakeDate accessed: July 1, 2021Google Scholar Creating active urban infrastructure is a foundation for encouraging physical activity. With the Tokyo 2020 Olympic Games in July, 2021, the world turned its attention to elite sport for a few weeks. But as Adrian Bauman and colleagues show in their paper in this Lancet Series on physical activity, the Olympic Games alone do not improve population levels of physical activity.16Bauman AE Kamada M Reis RS et al.An evidence-based assessment of the impact of the Olympic Games on population levels of physical activity.Lancet. 2021; (published online July 21.)https://doi.org/10.1016/S0140-6736(21)01165-XSummary Full Text Full Text PDF PubMed Scopus (22) Google Scholar Transformational approaches that shift the focus away from individual responsibility and towards large-scale, systems-oriented strategies for physical activity promotion are crucial.1Reis RS Salvo D Ogilvie D et al.Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving.Lancet. 2016; 388: 1337-1348Summary Full Text Full Text PDF PubMed Scopus (395) Google Scholar, 6Salvo D Garcia L Reis RS et al.Physical activity promotion and the United Nations Sustainable Development Goals: building synergies to maximize impact.J Phys Act Health. 2021; (published online July 13.)https://doi.org/10.1123/jpah.2021-0413Crossref Scopus (37) Google Scholar These strategies are effective investments for physical activity promotion,2Global Advocacy Council for Physical Activity International Society for Physical Activity and HealthThe Toronto charter for physical activity: a global call for action.J Phys Act Health. 2010; 7: S370-S385PubMed Google Scholar and operate across multiple sectors and levels—eg, health care, education, urban planning and transport, environmental sustainability, communications, and public safety. Despite these known solutions for improving population levels of physical activity through urban initiatives, challenges for implementation remain.6Salvo D Garcia L Reis RS et al.Physical activity promotion and the United Nations Sustainable Development Goals: building synergies to maximize impact.J Phys Act Health. 2021; (published online July 13.)https://doi.org/10.1123/jpah.2021-0413Crossref Scopus (37) Google Scholar Securing funding for active recreation and active transport infrastructure can be difficult given competing interests—eg, some cities continue to prioritise maintaining and expanding infrastructure for cars. In some settings, there is insufficient technical capacity in best practices for retrofitting public open spaces and roads for active recreation and transport. Too often there is a lack of alignment of local, regional, and national government priorities for the adoption of large-scale, systems-oriented strategies. Moreover, car-centric culture, policies, and design still predominate in many places. Strategies to disincentivise driving in cities, including reductions in road space to make way for pedestrian and cycling infrastructure, often face strong political and public opposition. These challenges can be overcome through coordinated actions across sectors and levels of government and leveraging the multiple benefits of physical activity promotion for human and planetary health—eg, reductions in chronic diseases, road deaths, congestion, air pollution, and carbon emissions.6Salvo D Garcia L Reis RS et al.Physical activity promotion and the United Nations Sustainable Development Goals: building synergies to maximize impact.J Phys Act Health. 2021; (published online July 13.)https://doi.org/10.1123/jpah.2021-0413Crossref Scopus (37) Google Scholar The Netherlands has shown that long distance active transport is feasible when high-quality, high-coverage cycling infrastructure is combined with new technologies (eg, electric bikes) and fully integrated with mass public transport systems.17Geurs KT la Paix L van Weperen S A multi-modal network approach to model public transport accessibility impacts of bicycle-train integration policies.European Trans Res Rev. 2016; 8: 25Crossref Scopus (25) Google Scholar These types of systems-based approaches can help transform sprawling, car-dependent cities into more active, sustainable places. There is increasing recognition of the need for widespread, accessible, safe, and enjoyable opportunities for physical activity as a basic human right.8Lambert EV Kolbe-Alexander T Adlakha D et al.Making the case for “physical activity security”: the 2020 WHO guidelines on physical activity and sedentary behaviour from a Global South perspective.Br J Sports Med. 2020; 54: 1447-1448Crossref PubMed Scopus (20) Google Scholar Two papers in this Lancet Series underline the importance of designing and planning inclusive cities, for people of all ages,18van Sluijs EMF Ekelund U Crochemore-Silva I et al.Physical activity behaviours in adolescence: current evidence and opportunities for intervention.Lancet. 2021; (published online July 21.)https://doi.org/10.1016/S0140-6736(21)01259-9Summary Full Text Full Text PDF PubMed Scopus (78) Google Scholar genders, and abilities.19Martin Ginis KA van der Ploeg HP Foster C et al.Participation of people living with disabilities in physical activity: a global perspective.Lancet. 2021; (published online July 21.)https://doi.org/10.1016/S0140-6736(21)01164-8Summary Full Text Full Text PDF PubMed Scopus (55) Google Scholar The global burden of physical inactivity is unacceptably high. Physical inactivity accounts for more than 7% of premature deaths per year,5Katzmarzyk PT Friedenreich C Shiroma EJ Lee IM Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries.Br J Sports Med. 2021; (published online March 29.)http://dx.doi.org/10.1136/bjsports-2020-103640Crossref PubMed Scopus (70) Google Scholar costs health-care systems more than INT$53·8 billion annually, and is responsible for 13·4 million disability-adjusted life-years each year.4Ding D Lawson KD Kolbe-Alexander TL et al.The economic burden of physical inactivity: a global analysis of major non-communicable diseases.Lancet. 2016; 388: 1311-1324Summary Full Text Full Text PDF PubMed Scopus (1089) Google Scholar The actions taken in Mexico City and Sydney during the COVID-19 pandemic show how bold political leadership, together with social mobilisation, can make important strides towards achieving global physical activity and sustainable development targets in both HIC and LMIC contexts. Systems-oriented approaches must be prioritised for physical activity promotion and sustainable development. CM is currently the Lord Mayor of the City of Sydney, Australia. All other authors declare no competing interests. A sporting chance: physical activity as part of everyday lifeSport is bringing some much needed joy to the world. The Olympics and Paralympics, the Copa América, the European Football Championship, and Wimbledon are bringing excitement to millions after postponement or cancellation in 2020 ( safety concerns notwithstanding). Although watching elite sport might be more stimulating than addressing modern day sedentarism, a third Lancet Series published this week , following on from publications in 2012 and 2016 , shows the importance of regular physical activity and sport to health and wellbeing. Full-Text PDF Moving beyond more: towards a healthy balance of daily behavioursIncreasing physical activity has long been a target of policies and interventions worldwide and requires system-wide multisectoral solutions. The papers in this Lancet Series on physical activity1–3 allude to the need to move from simply aiming for more physical activity towards finding a healthy balance between daily behaviours. To understand physical activity holistically, and to inform interventions and their best timing across the life course, it is important to consider the trade-offs involved in making time for physical activity alongside the type and context of activities. Full-Text PDF Physical activity behaviours in adolescence: current evidence and opportunities for interventionYoung people aged 10–24 years constitute 24% of the world's population; investing in their health could yield a triple benefit—eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10–14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. Full-Text PDF Participation of people living with disabilities in physical activity: a global perspectiveApproximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16–62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Full-Text PDF An evidence-based assessment of the impact of the Olympic Games on population levels of physical activityPre-Olympic Games predictions commonly include an increase in population-based physical activity in the host city, as often stated in the bid, but the post-Olympic Games effects on physical activity have not been summarised. In this Series paper, we aim to do the following: examine mentions of a physical activity legacy in pre-Olympic bid documentation; analyse existing physical activity surveillance data collected before, during, and after the Olympic Games in hosting areas around the world; and evaluate Google Trends data surrounding the London 2012 Olympic Games as a case study of community interest in the topic of exercise during the time of the Olympic Games. Full-Text PDF