Abstract: Exercise referral services have received WHO recommendations and are becoming a global public health priority. Integration of exercise into the healthcare system in China has not yet received policy priority and may be constrained by insufficient health economics evidence. A systematic review of studies on the global burden of disease of physical inactivity revealed that (1) prevalence. the prevalence of physical inactivity in China increased by 7.93% from 2010-2018; (2) health burden. the number of deaths attributable to physical inactivity in China from 1990-2019 increased by 3.24 times, disability-adjusted life expectancy (DALE) increased 2.64 times per year, life expectancy loss (LES) increased 2.89 times per year, and disability life expectancy loss (DALE) increased 2.56 times per year, and the health burden has continued to grow over the past nearly 30 years;(3)Economic burden.In 2020-2030, the 12 common NCDs attributed to insufficient physical activity will generate 45,170,100 cases, resulting in a total cost of 3669.45 billion RMB for healthcare and healthcare;(4)Macroeconomic gains.The cumulative minimal economic gains from addressing insufficient physical activity in China in 2020-2050 are expected to be to be 4.14 trillion yuan, and the maximum gain is expected to be 15.01 trillion RMB. These data provide health economics evidence for the inclusion of exercise referral services as a healthcare priority in China, but elevating the policy priority will require (1)an independent measure of the burden of disease of physical inactivity in China to provide reliable evidence for healthcare policy;(2)the inclusion of exercise referral as a priority policy for the management of non-communicable diseases in China;(3)the establishment of a mechanism for referral to exercise and the inclusion of exercise referral services in the catalogue of healthcare services.

Key words: Exercise referrals, physical inactivity, NCD burden, health services, priorities, national fitness