The National Institute for Health and Care Excellence (NICE) has published a wealth of guidance relating to physical activity, as summarised in Box 2.

Box 2: NICE guidance relating to physical activity

  • PH6 Behaviour change: the principles for effective interventions (2007)
  • PH8 Physical activity and the environment (2008)
  • PH13 Promoting physical activity in the workplace (2008)
  • PH17 Promoting physical activity for children and young people (2009)
  • PH41 Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation (2012)
  • PH42 Obesity: working with local communities (2012)
  • PH44 Physical activity: brief advice for adults in primary care (2013)
  • PH49 Behaviour change; individual approaches (2014)
  • PH54 Exercise referral schemes to promote physical activity (2014)

Source: NICE website

In addition to NICE guidance, in 2014 Public Health England (PHE) published ‘Everybody active, every day’, which sets out a framework for increasing physical activity, working across a range of settings and life stages. 5 Implementation across different settings entails work on the following areas.

  • The physical environment: creating and maintaining environments that encourage people to be active. This relates to planning the built environment, transport, green spaces, access to public services, employment, leisure and cultural facilities.
  • The social environment: creating a sense that physical activity is ‘normal’, something that friends and peers are doing, to encourage participation.
  • Community-wide action: increasing social and practical support for physical activity through targeted and tailored work with communities with lower levels of physical activity, such as residents of social or private rented housing or members of minority ethnic groups.
  • Group level actions: using the social aspects of physical activity to enhance enjoyment and make it more attractive, and encourage sustained behaviour change. This includes group-based activities, such as walking groups or dance classes, promoted to physically inactive people (and addressing potential barriers, such as providing women-only sessions).
  • Individual level actions: providing brief advice to inactive patients in primary care, referrals to physical activity programmes for people with related health conditions, signposting to local physical activity opportunities, and personalised travel planning.

Implementation across the life course means:

  • starting well: considerations include active play, whole family approaches, schools as settings for physical activity, after-school activities, transition stages in education and into employment
  • living well: aspects include covering a range of physical and social settings, such as housing estates, mosques, churches; as well as workplace health, and family-based approaches
  • ageing well: retirement can be a stimulus to try new activities, and physical activity can reduce social isolation in older age.

Physical activity needs to be seen more broadly than just structured exercise. It also includes active travel, such as walking and cycling, as well as activities like gardening and active work. For many people, physical activity will be a means to an end, rather than an end in itself. The end might be another valued activity, or meeting people or having fun; and not necessarily related to improving health, as illustrated by the case study in Box 3.

Box 3: Case study – understanding physical activity in the context of daily lives

“Can I use the example of Bob? Bob is a 42-year-old diabetic, depressed and living on the 14th floor of a tower block with two unruly teenage children. He is the kind of person that I will see as a doctor. To give Bob a badminton racket and tell him to go off and do some sport is not going to be the key thing. He is depressed and stressed; he has loads of problems. The kinds of ideas we have gone through before are to get off the bus a stop early and to use the stairs. These are complete anathema to Bob. He has too many problems in his life to go off on a rainy day to do that extra walk. What he does do is walk to Anfield—he is from Liverpool—two miles there and two miles back. He does not call that exercise at all. That to him is not exercise; that is going to Anfield as a supporter. We have to find the end for people or the reward, so physical activity is the means to the end, not the end in itself.”

Dr. William Bird, evidence to House of Commons Health Committee, March 2015 6

‘Everybody active, every day’ identifies four areas for local and national action, based on international evidence of what works, and co-produced with stakeholders – these are, ‘active society’ (actions to make physical activity normal and popular, such as social marketing campaigns), ‘moving professionals’ (tapping into the access and influence of healthcare and other frontline professionals to raise physical activity with individuals), ‘active environments’ (creating places and spaces conducive to physical activity, such as making walking and cycling easier), and ‘moving at scale’ (putting all this together to ensure local authorities, NHS organisations, healthcare workers, and the sports and leisure sector work together and contribute to reducing physical inactivity). 7

There are five key steps that can be taken locally to support change at an individual and population level, namely: 8

  1. teach every child to have and enjoy the skills to be active every day
  2. create safe and attractive environments where everyone can walk or cycle, regardless of age or disability
  3. ‘make every contact count’ for professionals and volunteers to encourage active lives
  4. lead by example in every public sector workspace
  5. evaluate and share the findings so the learning of what works can grow.

References

  1. Public Health England , “Everybody active, every day: an evidence-based approach to physical activity,” 2014.
  2. UK Parliament, “2015,” Health Select Committee inquiry into the effects of diet and exercise on health.
  3. Public Health England , “Everybody active, every day: an evidence-based approach to physical activity,” 2014.
  4. Public Health England , “Everybody active, every day: an evidence-based approach to physical activity,” 2014.
  5. Public Health England , “Everybody active, every day: an evidence-based approach to physical activity,” 2014.
  6. UK Parliament, “2015,” Health Select Committee inquiry into the effects of diet and exercise on health.
  7. Public Health England , “Everybody active, every day: an evidence-based approach to physical activity,” 2014.
  8. Public Health England , “Everybody active, every day: an evidence-based approach to physical activity,” 2014.