The COVID-19 pandemic has disrupted nearly all aspects of daily life worldwide. Public health interventions necessary to curb disease spread could have unintended consequences that adversely influence long-term health outcomes beyond near-term mortality. 1 For example, step counts—a proxy for physical activity2—were markedly lower early in the COVID-19 pandemic than pre-pandemic. 3 As the global pandemic persists despite vaccines, understanding its long-term ramifications on physical activity—an important determinant of health4—is crucial, and might help to inform public health and regional policy decisions. We examined worldwide trends in physical activity, measured by step counts, 2 years since the onset of the COVID-19 pandemic. We hypothesised that worldwide physical activity remains lower than pre-COVID-19.

We used deidentified individual-level data from Jan 1, 2019, to Feb 17, 2022, collected from the freely available Azumio Argus smartphone app, a popular health-wellness app. Daily step counts are determined using smartphone accelerometers and Apple or Android algorithms for step counting. 5 User location was determined by smartphone IP address. Pre-pandemic baseline mean steps were calculated per region using data from Jan 1, 2019, to Dec 31, 2019. COVID-19 regional case counts were obtained from publicly available sources. Significant differences in mean step counts for various time windows were examined using the Kruskal–Wallis and Conover’s tests with Bonferroni correction at p< 0· 001. This study was reviewed and exempted by the University of California, San Francisco Institutional Review Board (20–30 539). A total of 140 424 429 daily step count measurements were provided by 1 255 811 unique users from more than 200 countries and territories during the study period; 92% of smartphones were iOS, 8% were Android. Worldwide, physical activity has somewhat recovered but remains depressed compared with the pre-pandemic baseline of 5323 steps per day during the 2019 calendar year (figure). The mean step count in the 90 days preceding the end of the study period (November 2021–February 2022) was significantly lower for all continents compared with the same 90-day, 2019–2020 prepandemic period (p< 0· 001). The same 2020–2021 midpandemic 90-day period was also significantly lower