Sitting, Sleeping Poorly and Skipping Exercise Costs Billions Every Year

How much does a sedentary, sleep-deprived, under-exercised life actually cost? A new systematic review has attempted to put a price tag on the full spectrum of human movement behaviours, and the numbers are striking. According to the analysis, published in the Journal of Activity, Sedentary and Sleep Behaviors, the combined annual economic burden of insufficient physical activity, excessive sedentary behaviour, and inadequate sleep reaches billions of dollars in countries where estimates exist. In Canada, the only nation for which cost data were available for all three behaviours simultaneously, the total annual bill came to 9.2 billion US dollars, equivalent to roughly 0.41 percent of the country’s gross domestic product. The review, led by Sitong Chen of Victoria University in Melbourne together with colleagues in Croatia, Australia and Hong Kong, is the first to systematically synthesise the economic literature across all three interdependent components of daily movement.

The research team screened 21,418 references drawn from six major databases, including PubMed/MEDLINE, Scopus, Web of Science, SPORTDiscus, PsycINFO and Open Dissertations. From this vast pool, only 40 papers met the stringent inclusion criteria, which required studies to report total, direct or indirect monetary costs associated with at least one of the three movement behaviours in the general adult population. That small yield is itself revealing. Despite growing scientific consensus that physical activity, sedentary behaviour and sleep should be understood as a continuous, integrated 24-hour cycle of time use, the economic evidence base remains remarkably thin, fragmented and geographically skewed. Fully 77.5 percent of the included studies came from high-income countries, and an equally striking 77.5 percent addressed the costs of physical activity alone, leaving sedentary behaviour and sleep largely neglected in economic terms.

The methodological foundation of the review deserves attention because cost-of-illness studies vary enormously in how they count the money. Most of the included research, some 90 percent, relied on self-reported movement-behaviour data rather than device-based measurements, a choice that introduces well-documented recall and social desirability biases. People systematically overestimate how much they move and underestimate how long they sit. Many of the studies also employed the population attributable fraction approach, a technique borrowed from epidemiology that estimates what proportion of disease burden and associated costs could be avoided if exposure to a risk factor, such as insufficient exercise, were eliminated from the population. When applied to national data, PAF-based studies estimated the total annual cost of insufficient physical activity at between 1.94 and 9.78 billion US dollars, while the cost of excessive sedentary behaviour ranged from 1.82 to 1.97 billion dollars.

Sleep, the third pillar of the movement-behaviour triad, fared worst in terms of research attention. Only a single study in the review used the population attributable fraction approach to estimate the economic cost of inadequate sleep duration, placing Canada’s national bill at 0.44 billion US dollars per year. That figure, while substantial in absolute terms, is dwarfed by the estimates for physical inactivity, and the authors caution that it rests on a solitary data point rather than a robust, replicated body of evidence. The scarcity of sleep-cost studies is especially notable given the accelerating public health interest in sleep as a modifiable risk factor for cardiometabolic disease, mental illness, workplace accidents and lost productivity.

Perhaps the most consequential finding of the review is the relative ranking of the three behaviours. Across the included studies, the economic cost of insufficient physical activity was approximately two to four times higher than the cost of excessive sedentary behaviour and roughly sixteen times higher than the cost of inadequate sleep duration. On the basis of this cost hierarchy, the authors suggest that public health initiatives should focus primarily on promoting physical activity, while continuing to address sitting time and sleep within a broader 24-hour framework. The conclusion carries practical weight for policymakers forced to allocate finite prevention budgets: if the goal is to maximise the economic return on public health investment, getting populations moving appears to deliver the largest financial dividend.

The direct and indirect cost categories underlying these figures illuminate why unhealthy movement behaviours drain national economies so severely. Direct costs encompass healthcare expenditure, including hospital admissions, physician visits, medications and treatment for conditions attributable to inactivity, prolonged sitting or poor sleep, such as cardiovascular disease, type 2 diabetes, several cancers, depression and musculoskeletal disorders. Indirect costs capture productivity losses from absenteeism, presenteeism, premature mortality and unpaid informal care. Because movement behaviours influence such a wide array of chronic diseases, even modest shifts in population-level behaviour can translate into enormous aggregate expenditure changes. A behaviour that raises the risk of multiple conditions simultaneously multiplies its economic footprint across every disease pathway it touches.

The review’s global picture, however, remains frustratingly incomplete. The authors emphasise that while billions of dollars are cumulatively spent each year on the adverse consequences of unhealthy movement behaviours worldwide, the exact global cost could not be estimated because evidence exists only for a limited number of mostly high-income countries. This gap matters enormously. Low- and middle-income countries bear a growing share of the global burden of non-communicable disease, driven by rapid urbanisation, motorised transport, desk-based employment and changing dietary and sleep patterns, yet virtually no economic cost estimates exist for these settings. Without local cost data, governments in these countries lack the financial arguments needed to justify investment in physical activity infrastructure, workplace interventions or sleep health programmes.

The study also highlights a deeper conceptual challenge within the field. Public health research is increasingly shifting toward an integrative, compositional view of daily time use, in which physical activity, sedentary behaviour and sleep are treated as interdependent components constrained by the finite 24-hour day. Time spent in one behaviour necessarily displaces time in another, so the health and economic effects of any single behaviour depend on what it replaces. Yet the economic literature reviewed here remains overwhelmingly siloed, with most studies costing one behaviour in isolation and almost none examining the economic consequences of failing to meet the overall 24-hour movement guidelines that now appear in national and international recommendations. The authors explicitly call for more research exploring the costs of non-compliance with these integrated guidelines.

Looking forward, the research agenda outlined by the review is clear. Future studies should extend cost estimation to low- and middle-income countries, replace self-reported behaviour data with device-based measurements from accelerometers and other research-grade movement sensors, and address the glaring underrepresentation of sedentary behaviour and sleep in economic analyses. Until such work is done, the 9.2 billion dollar Canadian figure and the multi-billion dollar estimates for physical inactivity should be read as conservative, incomplete accounting of a problem whose true global scale remains hidden. What the review makes unambiguous is that unhealthy movement is not merely a personal health risk but a macroeconomic liability, and that the price of collective inactivity compounds year after year on national balance sheets.

Subject of Research: Systematic review of the economic costs of insufficient physical activity, excessive sedentary behaviour and inadequate sleep duration in adults

Article Title: Economic cost of movement behaviours: a systematic review

Article References: Chen, S., Matolic, T., Memon, A. R., Rachele, J. N., Grgic, J., Espinoza, M. A., & Pedisic, Z. (2026). Economic cost of movement behaviours: a systematic review. Journal of Activity, Sedentary and Sleep Behaviors. https://doi.org/10.1186/s44167-026-00108-z

Image Credits: AI Generated

DOI: 10.1186/s44167-026-00108-z

Keywords: physical activity, sedentary behaviour, sleep, economic cost, systematic review, public health, cost of illness, 24-hour movement behaviours, population attributable fraction, health economics, physical inactivity, chronic disease