This section picks out a selection of relevant evidence-based recommendations in relation to:

  • prevention – interventions to get the whole population physically active
  • identification and early intervention – including brief advice and signposting by frontline health and social care staff for people who are inactive and at risk of related health problems in future
  • treatment – tailored interventions for physically inactive people who are at high risk of, or already suffering from, associated health conditions.

Prevention

Planning of housing, employment and business developments should consider ‘active design’ principles, to make it easier for people to be physically active as part of daily life. 19 Health impact assessments to inform the design of new developments can contribute to creating an environment that promotes physical activity. 20 One of the means by which the planning process can achieve this is by creating the infrastructure to support walking and cycling and reduce private car use (for more detail see ‘Transport and travel’ section of the Society and environment JSNA chapter).

Walking and cycling for recreational and travel purposes are integral to increasing physical activity. The uptake of walking in particular is highest among groups with the lowest levels of physical activity (see Local data and unmet need section). NICE recommends the following: 21

  • high level support from the health sector (including senior public health leadership and appropriate contribution of resources to encourage walking and cycling)
  • personalised travel planning (commissioning/providing programmes to support individuals to integrate active travel into their daily lives)
  • cycling training, storage and cycle hire schemes
  • community-wide approaches (including addressing infrastructure issues that may discourage walking and cycling, providing a range of walking programmes and events, car free days and public awareness campaigns)
  • individual support, including targeted information and advice and appropriate use of pedometers
  • encouraging active travel through schools and workplace interventions.

Increasing physical activity among children should be guided by research on effective approaches, where available. A systematic review on barriers and facilitators to physical activity for children identified the following approaches to be effective: 22

  • education and provision of equipment for monitoring ‘screen time’
  • engaging and supporting parents to encourage their children’s physical activity and providing opportunities for family participation
  • multi-component, multi-site interventions using a combination of education in the classroom, improvements in school physical education and home based activities.

Promising approaches include: providing children with a diverse range of physical activities to choose from; emphasizing the aspects of participating in physical activity that children value (e.g. opportunities to spend time with friends); providing free or low-cost transportation and reducing costs of participating; and actions to create a safer local environment in which children can actively travel and play. 23

Dance is a form of physical activity with a range of mental and physical health benefits. Dance is effective for engaging women and certain minority ethnic groups who tend to be less active on average. For older people, it can maintain cognitive function, reduce cardiovascular risk and reduce the risk of falls. Dance can provide a way to be active, have fun and engage socially. The ‘Commissioning Dance for Health and Wellbeing’ resource sets out the evidence and how to use dance as an opportunity for partnership at local level to improve physical and mental health. 24

Commissioning community-based physical activity. NICE recommends that commissioners and local authority Public Health Teams should create an environment that allows the ‘local system’ to take a truly community-wide approach to increasing physical activity. 25 This includes working with the community to identify and harness unused open spaces or meeting places that could be used for community-based events and courses.

Tailoring activities to the needs of specific groups. Research suggests that some factors such as cost, the fear of ‘walking in alone’, accessibility of facilities, and appropriate communication strategies may be of particular importance to increasing recruitment of low income groups, who have higher rates of physical inactivity and associated chronic health conditions. Interventions targeting low income groups should consider: 26

  • low cost sessions and childcare
  • activities popular with the target group and associated with good recruitment and retention
  • sessions held at accessible times
  • a focus on fun and socialising
  • well-researched and designed communications strategies
  • targeting of friendship groups
  • clearly branded beginners’ sessions
  • the potential of social marketing to increase uptake.

Interventions to encourage older people to take up physical activity opportunities were described in the Causes and risk factors section.  For people with disabilities, facilitators include inclusive community facilities (including playgrounds), appropriate PE and physical activity experiences in school, accessible information about available activities, plus appropriately skilled staff to deliver inclusive programmes. 27

Social marketing. People are more likely to be physically active if being active is seen as ‘normal’ and their friends and peers are also active. Large-scale community-wide campaigns have been effective in increasing physical activity, when supported by community activities at local level. 28 Examples of national campaigns include This Girl Can (to increase physical activity among women and girls), the One You campaign (targeted at ‘middle aged’ adults) and apps such as Couch to 5k. These campaigns can be complemented by action at local level to target advertising and other forms of engagement, based on local insight about inactive sections of the community.

Workplace health. The workplace presents a vital opportunity to encourage and facilitate physical activity. The London Healthy Workplace Charter provides a framework for action to help employers build good practice in health and work in their organisation. The business benefits of having a healthy, fit and committed workforce are now clearly recognised. These include lower absence rates, fewer accidents, improved productivity, staff who are engaged and committed to the organisation and fitter employees as they grow older. 29 The Charter works by recognising good practice at three tiers: ‘commitment’, ‘achievement’ and ‘excellence’. The standards for physical activity are outlined in the table below.

Table 4: London Healthy Workplace Charter – physical activity standards 30

Level of

Achievement

Requirements
Commitment level Information is made available on the benefits of physical activity.
The minimum legally required breaks are taken by all employees and employees are encouraged to take regular breaks.
Achievement level

 

Physical activity in the workplace is actively encouraged and supported by the physical environment.
Physical activity opportunities in the local area are actively promoted to staff and supported by the organisation.
Excellence level Opportunities for physical activity linked to the workplace have been investigated and implemented. These activities are sustainable and embedded in the organisational culture.
The organisation has a travel plan that promotes physically active ways of getting to and from work and travelling between meetings.

 

Identification and early intervention

NICE guidance on ‘Preventing type 2 diabetes: population and community-level interventions’, directs us to: 31

  • identify local communities at high risk
  • assess their knowledge, attitudes and beliefs about risk factors
  • assess their specific cultural, language and literacy needs
  • identify successful local interventions and note any gaps in service provision
  • identify local resources and existing community groups that could help promote physical activity, particularly within local communities at high risk.

This points to a targeted, tailored approach, to focus on those with the highest levels of physical inactivity and the most to gain in health terms from becoming more active.

Brief advice in primary care. One in four people in England say they would be more active if they were advised to do so by a doctor or a nurse. 32 The average patient will visit their GP about four times a year. 33 There are therefore considerable opportunities for healthcare workers (and other frontline staff who engage with members of the public) to identify people who are physically inactive, give them brief advice and/or signpost them to sources of further support to help them become more active. 34

There are opportunities to embed these approaches into routine primary care practice, for example through NHS Health Check and annual review appointments. The National Diabetes Prevention Programme is also an opportunity to link primary care with structured support to prevent inactivity-related ill health for those who need it most. As noted in the introduction, diabetes is the biggest single area of expenditure on treatment of health conditions related to physical activity.

Treatment

Physical activity on referral helps individuals to manage an existing health condition or reduce the risk of developing a future health condition related to physical inactivity. National recommendations for physical activity on referral include the following: 35

  1. programmes should only be funded for people who are sedentary or inactive and have an existing condition or risk factors for future ill health
  2. programmes should incorporate the core techniques for individual behaviour change approaches, including: 36
    • recognising when people may or may not be open to change
    • agreeing goals and developing action plans to help change behaviour
    • advising on and arranging social support
    • tailoring behaviour change techniques/interventions to individual need
    • monitoring progress and providing feedback
    • developing coping plans to prevent relapse
  3. programmes should collect data to meet the essential criteria in the Standard Evaluation Framework for physical activity (programme details, evaluation details, demographics of participants, baseline data, follow-up data, process evaluation).

References

  1. Sport England and Public Health England, “Active Design Guidance,” 2015.
  2. Town and Country Planning Association, “Planning Healthy Weight Environments,” 2014.
  3. Social Science Research Unit, University of London , “Children and physical activity: a systematic review of barriers and facilitators,” 2003.
  4. Social Science Research Unit, University of London , “Children and physical activity: a systematic review of barriers and facilitators,” 2003.
  5. Social Science Research Unit, University of London , “Children and physical activity: a systematic review of barriers and facilitators,” 2003.
  6. Dance Active, “Commissioning Dance for Health and Wellbeing: guidance and resources for commissioners,” 2012.
  7. National Institute for Health and Clinical Excellence, “Public Health guideline 42. Obesity: working with local communities,” 2012.
  8. J. Withall, R. Jago and K. R. Fox, “Why some do but most don’t: barriers and enablers to engaging low-income groups in physical activity programmes,” BMC Public Health, vol. 11, no. 507, 2011.
  9. National Disability Authority, “Promoting the participation of people with disabilities in physical activity and sport in Ireland,” 2005.
  10. Public Health England, “Health matters: getting every adult active every day,” 2016.
  11. Greater London Authority, “London Healthy Workplace Charter,” 2015. [Online]. Available: https://www.london.gov.uk/sites/default/files/self-assessment_framework.pdf (PDF document).
  12. Greater London Authority, “London Healthy Workplace Charter,” 2015. [Online]. Available: https://www.london.gov.uk/sites/default/files/self-assessment_framework.pdf (PDF document).
  13. National Institute for Health and Clinical Excellence, “Public Health guideline 35. Preventing type 2 diabetes: population and community level interventions,” 2011.
  14. Health and Social Care Information Centre, “Health Survey for England,” 2008.
  15. NHS, “Let’s Get Moving: Commissioning Guidance – a physical care pathway,” 2012.
  16. National Institute for Health and Clinical Excellence, “Public Health guideline 44. Physical activity: brief advice for adults in primary care,” 2013.
  17. National Institute for Health and Clinical Excellence, “Public Health guideline 54. Exercise referral schemes to promote physical activity,” 2014.
  18. National Institute for Health and Clinical Excellence, “Public Health guideline 49. Behaviour change: individual approaches,” 2014.
  19. Sport England and Public Health England, “Active Design Guidance,” 2015.
  20. Town and Country Planning Association, “Planning Healthy Weight Environments,” 2014.
  21. Social Science Research Unit, University of London , “Children and physical activity: a systematic review of barriers and facilitators,” 2003.
  22. Social Science Research Unit, University of London , “Children and physical activity: a systematic review of barriers and facilitators,” 2003.
  23. Social Science Research Unit, University of London , “Children and physical activity: a systematic review of barriers and facilitators,” 2003.
  24. Dance Active, “Commissioning Dance for Health and Wellbeing: guidance and resources for commissioners,” 2012.
  25. National Institute for Health and Clinical Excellence, “Public Health guideline 42. Obesity: working with local communities,” 2012.
  26. J. Withall, R. Jago and K. R. Fox, “Why some do but most don’t: barriers and enablers to engaging low-income groups in physical activity programmes,” BMC Public Health, vol. 11, no. 507, 2011.
  27. National Disability Authority, “Promoting the participation of people with disabilities in physical activity and sport in Ireland,” 2005.
  28. Public Health England, “Health matters: getting every adult active every day,” 2016.
  29. Greater London Authority, “London Healthy Workplace Charter,” 2015. [Online]. Available: https://www.london.gov.uk/sites/default/files/self-assessment_framework.pdf (PDF document).
  30. Greater London Authority, “London Healthy Workplace Charter,” 2015. [Online]. Available: https://www.london.gov.uk/sites/default/files/self-assessment_framework.pdf (PDF document).
  31. National Institute for Health and Clinical Excellence, “Public Health guideline 35. Preventing type 2 diabetes: population and community level interventions,” 2011.
  32. Health and Social Care Information Centre, “Health Survey for England,” 2008.
  33. NHS, “Let’s Get Moving: Commissioning Guidance – a physical care pathway,” 2012.
  34. National Institute for Health and Clinical Excellence, “Public Health guideline 44. Physical activity: brief advice for adults in primary care,” 2013.
  35. National Institute for Health and Clinical Excellence, “Public Health guideline 54. Exercise referral schemes to promote physical activity,” 2014.
  36. National Institute for Health and Clinical Excellence, “Public Health guideline 49. Behaviour change: individual approaches,” 2014.