Background: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5–17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. Methods: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations’ human development index (HDI) classification (low or medium, high, and very high HDI). Results: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of “C-,”“D+,” and “C-” was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. Conclusions: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

Physical inactivity, defined as engaging in insufficient levels of physical activity and not meeting the current physical activity recommendations, 1 has been identified as the fourth leading risk factor of premature mortality in adulthood. 2 In contrast, accumulating sufficient moderate-to vigorous-intensity physical activity (MVPA) is recognized as a key determinant of physical, mental, social, and environmental health. 3, 4 Among children and youth (aged 5–17 y), several systematic reviews have reported physical activity benefits on physical, physiological, developmental, mental, cognitive, and social health, as well as academic achievement. 5–10 Despite these benefits, it has been estimated that 80% of youth (11–17 y old) worldwide do not reach the minimum recommendation of 60 minutes of MVPA per day. 11 This is alarming given that physical inactivity among school-aged children and youth has been found to be associated with adverse physical, mental, social, and cognitive health outcomes, 5, 8, 12, 13 lower physical fitness, 14 and lower physical activity levels in later life. 15