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Physical Activity Appendix 2 by ye58M2

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									                                                                                                                            APPENDIX 2
                                                                                                                        APPENDIX 2
                                                 The Evidence Base for Interventions
NICE Guidance

    NICE Guidance              Physical Activity                                                Who in NHS
      Document                  Interventions                  Recommendation                  should take it             How
                                                                                                 forward
Four Commonly used                                    Recommendation 1
methods to increase
physical activity: brief   Brief Interventions           Take the opportunity, wherever      Primary Care         Implement GPPAQ
interventions, exercise                                   possible, to identify inactive      Practitioners         across locality
referral schemes,                                         adults using validated tools such                        Implement the
pedometers and                                            as the Department of Health’s                             Department of
community based exercise                                  General Practitioner Physical                             Health’s forthcoming
programmes for walking                                    Activity Questionnaire (GPPAQ)                            “Let’s Get Moving”
and cyclingi                                              and advise them to aim to                                 Physical Activity
                                                          achieve 30 minutes of moderate                            Pathway
                                                          intensity activity of 5 or more
                                                          days of the week.
                                                         Use their judgement to determine
                                                          when this advice is inappropriate
                                                          e.g. because of medical
                                                          conditions or personal
                                                          circumstances.

                                                      Recommendation 2

                                                         When providing advice,              Primary Care         Implement GPPAQ
                                                          practitioners should take into      Practitioners         across locality
                                                          account individual needs,                                Implement the
                                                          preferences and circumstances.                            Department of
                                                                                                                                           1
NICE Guidance   Physical Activity                                                   Who in NHS
  Document       Interventions               Recommendation                        should take it              How
                                                                                     forward
                                       Goals should be agreed with the                                  Health’s forthcoming
                                        patient                                                          “Let’s Get Moving”
                                       Written information about the                                    Physical Activity
                                        benefits of physical activity                                    Pathway
                                        should be provided along with
                                        information on local opportunities
                                        to be active.
                                       Patients should be followed up at
                                        appropriate intervals over a 3-6
                                        month period.

                                    Recommendation 3

                                       Monitor the effectiveness of local          Local Policy       Implement and
                                        strategies and systems to                    Makers              monitor GPPAQ
                                        promote physical activity                   Commissioners       across locality
                                        focussing on whether or not                 Primary Care       Implement and
                                        opportunistic advice is helping to           Managers            monitor the
                                        increase physical activity levels           Primary Care        Department of
                                        from people from disadvantaged               Practitioners       Health’s forthcoming
                                        groups.                                                          “Let’s Get Moving”
                                       Assess how effective                                             Physical Activity
                                        professionals from a range of                                    Pathway
                                        disciplines are at raising physical
                                        activity levels, long term, in these
                                        groups.

                                    Recommendation 4

                                       Pay particular attention to the             Local Policy
                                        needs of hard to reach and                   Makers
                                        disadvantaged communities                   Commissioners
                                        (including ethnic minority groups)          Primary Care
                                        when developing infrastructures              Managers
                                                                                                                                2
    NICE Guidance           Physical Activity                                                  Who in NHS
      Document               Interventions                  Recommendation                    should take it    How
                                                                                                 forward
                                                       to promote physical activity.          Primary Care
                                                                                                Practitioners

Promoting & Creating    Facilitating Walking and   Recommendation 5
built and natural       Cycling
environments that                                     Ensure that different parts of           NHS Trusts
encourage and support                                  campus sites including hospitals         Developers
physical activityii                                    and universities are linked by
                                                       appropriate walking and cycling
                                                       routes. A campus comprises of
                                                       two or more related buildings set
                                                       together in the grounds of a
                                                       defined site.
                                                      Ensure new workplaces are
                                                       linked to walking and cycling
                                                       networks. Where possible these
                                                       links should improve the existing
                                                       walking and cycling infrastructure
                                                       by creating new through routes
                                                       (not just links to new facilities).

                        Facilitating active        Recommendation 6
                        movement around
                        buildings                     During building design or                Facility
                                                       refurbishment, ensure staircases          Managers
                                                       are designed and positioned to           Architects
                                                       encourage people to use them.            Developers
                                                      Ensure Staircases are clearly
                                                       signposted and are attractive to
                                                       use eg well lit and well
                                                       decorated.



                                                                                                                      3
     NICE Guidance            Physical Activity                                                 Who in NHS
       Document                Interventions                Recommendation                     should take it     How
                                                                                                 forward
Workplace Health          Facilitating an active   Recommendation 1
promotion: how to         work force
encourage employees to                                Develop an organisation wide             Employers in
be physically activeiii                                plan or policy to encourage and           NHS
                                                       support employees to be more              organisations
                                                       physically active. The plan should        of all sizes –
                                                       include measures to maximise              this includes
                                                       the opportunity for all employees         people
                                                       to:-                                      working in
                                                                                                 human
                                                    participate                                 resources,
                                                    Be developed through                        directors and
                                                     consultation with staff, on an              senior
                                                     ongoing basis with staff involved           managers
                                                     in designing, planning and                 Public Health
                                                     monitoring activities.                      professionals
                                                    Be supported by management                 Occupational
                                                     and have dedicated resources                Health
                                                    Set goals for the organisation              professionals
                                                     and be linked to relevant internal         Workplace
                                                    policies (occupational health,              health
                                                     travel plans etc.                           promoters
                                                    Link to relevant national and local        Trades
                                                     policies eg health, transport etc.          Unions &
                                                                                                 employee
                                                                                                 representative
                                                                                                NHS
                                                                                                 Employees.

                          Facilitating an active   Recommendation 2
                          work force
                                                      Introduce and monitor an                 Employers in
                                                       organisation wide, multi                  NHS
                                                       component programme to                    organisations
                                                                                                                        4
NICE Guidance   Physical Activity                                             Who in NHS
  Document       Interventions              Recommendation                   should take it      How
                                                                                forward
                                       encourage and support                   of all sizes –
                                       employees to be physically              this includes
                                       active. It could include;               people
                                                                               working in
                                     Flexible working policies and            human
                                      incentive schemes                        resources,
                                     Policies to encourage walking,           directors and
                                      cycle use and the use of other           senior
                                      modes of transport involving             managers
                                      physical activity for travel to and    Public Health
                                      from work and as part of their           professionals
                                      working day.                           Occupational
                                     Disseminating information on             Health
                                      how to be more active and the            professionals
                                      benefits of such activity. This        Workplace
                                      can include written information          health
                                      and may incorporate information          promoters
                                      on local opportunities to be           Trades
                                      active (within and outside the           Unions &
                                      workplace) and should be                 employee
                                      tailored to meet specific                 representative
                                     employee needs eg shift                  NHS
                                      workers etc.                              Employees
                                     Advice and support to help
                                      people plan how they will
                                      increase their
                                     Physical activity levels.
                                     Offer a confidential, independent
                                      health check administered by a
                                      suitable qualified practitioner
                                      and focussed on physical
                                      activity.



                                                                                                       5
NICE Guidance   Physical Activity                                                  Who in NHS
  Document       Interventions               Recommendation                       should take it     How
                                                                                    forward
                                    Recommendation 3

                                       Encourage employees to walk,               Employers in
                                        cycle and use of other modes of             NHS
                                        transport involving physical                organisations
                                        activity to travel part or all of the       of all sizes –
                                        way to and from work for                    this includes
                                        example by developing a travel              people
                                        plan                                        working in
                                        Help employees to be physically            human
                                        active during the working day by:           resources,
                                                                                    directors and
                                     Encouraging them to move                      senior
                                      around more at work (eg by                    managers
                                      walking to                                   Public Health
                                     external meetings)                            professionals
                                     Putting up signs and                         Occupational
                                      disseminating information to                  Health
                                      encourage stair use rather than               professionals
                                      the lift if they can.                        Workplace
                                     Provide information about                     health
                                      walking and cycling routes and                promoters
                                      encourage them to take short                 Trades
                                      walks during work breaks.                     Unions &
                                     Encourage them to set goals on                employee
                                      how far they walk and cycle and               representative
                                      to                                           NHS
                                     Monitor the distances they                    Employees
                                      cover.

                                       Take account of the nature of the
                                        work and any potential health
                                        and safety issues for example
                                        people already walking long
                                                                                                           6
NICE Guidance   Physical Activity                                                Who in NHS
  Document       Interventions               Recommendation                     should take it    How
                                                                                  forward
                                        distances during the working day,
                                        Shift workers being vulnerable if
                                        walking home alone at night.

                                    Recommendation 4

                                       Offer support to employers who           Directors of
                                        want to implement this guidance.          Public Health
                                        Where appropriate and feasible,          Public Health
                                        this support should be provided           Practitioners
                                        on the employer’s premises.               in statutory
                                        This support could include                and voluntary
                                        providing information on or links         sectors
                                        to local resources for example
                                        the services of physical activity   Working with:-
                                        experts or the provision of          Local
                                        advice.                               Strategic
                                       If initial demand exceeds the         partnerships
                                        resources available focus on:-       Private,
                                                                              statutory and
                                     Enterprises where a high                voluntary
                                      proportion of employees are             organisations
                                      from a disadvantaged                    with
                                      background.                             responsibility
                                     Enterprises where a high                for increasing
                                      proportion of employees are             physical
                                      sedentary                               activity levels
                                     - Small and medium enterprises.         or for
                                                                              occupational
                                                                              health
                                                                             Trades
                                                                              unions,
                                                                              business
                                                                              federations
                                                                                                        7
     NICE Guidance              Physical Activity                                                       Who in NHS
       Document                  Interventions                   Recommendation                        should take it    How
                                                                                                          forward
                                                                                                         and
                                                                                                         chambers of
                                                                                                         commerce.

Promoting physical           Raising awareness of the   Recommendation 2
activity, active play, and   importance of physical
sport for pre-school and     activity                       Ensure that Children and young             Chief
school age children and                                      people’s plans, joint strategic             Executives of
young people in family,                                      needs assessments, local                    PCTs
pre-school, school and                                       development and planning
community settingsiv                                         frameworks and sustainable                 Directors of
                                                             community plans and strategies              Public Health
                                                             explicitly address the need for
                                                             Children and Young People to          Alongside Local
                                                             be physically active.                 Authority
                                                            Ensure that there is a co-            colleagues
                                                             ordinated local strategy to
                                                             increase physical activity
                                                             among children and young
                                                             people, their families and carers
                                                             that links to the delivery of Local
                                                             Area Agreement (LAA) targets.
                                                             The strategy should ensure
                                                             that:-

                                                          There are local indoor and
                                                           outdoor activity opportunities for
                                                           CYP
                                                          Individuals responsible for
                                                           increasing physical activity are
                                                           aware of national and local
                                                           government strategies and local
                                                           plans to achieve this.
                                                          Partnerships should be
                                                                                                                               8
NICE Guidance      Physical Activity                                                     Who in NHS
  Document          Interventions                     Recommendation                    should take it   How
                                                                                          forward
                                               established and supported via
                                               local physical activity networks,
                                               which deliver multi-component
                                              Interventions involving schools,
                                               colleges, children’s centres,
                                               community groups etc.
                                              Identify and act upon local
                                               factors that help or prevent CYP
                                               to be physically active.
                                              Co-ordinate local transport and
                                               school travel plans so that all
                                               local journeys can be carried
                                               out using physically active
                                               modes of travel.

                                                  Ensure that initiatives aimed at
                                                   CYP are regularly evaluated,
                                                   including measuring the uptake
                                                   of activities among different
                                                   groups – this should include
                                                   changes in physical activity,
                                                   physical skills and health
                                                   outcomes.
                                                Progress towards LAA targets
                                                 should be monitored alongside
                                                 this.

                Helping Families to be   Recommendation 15
                active
                                                Ensure that parents and carers        Groups and
                                                 are aware of recommended              individuals who
                                                 levels of physical activity for CYP   have regular
                                                 (a minimum of 60 minutes of           contact with
                                                 moderate- vigorous intensity          CYP, parents
                                                                                                               9
NICE Guidance   Physical Activity                                                 Who in NHS
  Document       Interventions               Recommendation                      should take it   How
                                                                                    forward
                                        physical activity every day, with      and carers
                                        activities to improve bone health,     including Health
                                        muscle strength and flexibility at     practitioners
                                        least twice a week.
                                       Provide information and advice
                                        on the benefits of physical activity
                                        that emphasises how enjoyable
                                        activity is and include information
                                        regarding local opportunities to
                                        be active.
                                       Encourage parents and carers to
                                        get involved in physical activities
                                        with their Children.
                                       Encourage parents and carers
                                        use physically active modes of
                                        travel with young children for at
                                        least some journeys (or part of a
                                        local journey). This should take
                                        place on most days of the week
                                        to aid the establishment of active
                                        travel as a life-long habit.
                                       Encourage parents and carers to
                                        allow CYP to become more
                                        independent, by gradually
                                        allowing them to walk, cycle or
                                        use other modes of active travel
                                        for short journeys. Act as a role
                                        model by incorporating physical
                                        activity into your daily life eg
                                        choose active travel methods,
                                        use the stairs or participate in
                                        recreational activity/sport.
                                       Promote active travel for the
                                        whole family and raise
                                                                                                        10
     NICE Guidance                Physical Activity                                                       Who in NHS
       Document                    Interventions                   Recommendation                        should take it          How
                                                                                                           forward
                                                              awareness of how this can
                                                              contribute to CYP’s physical
                                                              activity levels.

Obesity: guidance on the                              Overarching recommendation
prevention, identifications,
assessment and                                               As part of regulation,                      PCT Senior
management of overweight                                      enforcement and promoting well               Managers
and obesity in adultsv                                        being role, preventing and                  Local Health
                                                              managing obesity should be                   Boards
                                                              seen as a priority for action at            Local
                                                              strategic and delivery levels with           Strategic
                                                              dedicated resources allocated.               Partnerships

                               Promoting physical     Recommendations for the NHS                                         -   Travel plans
                               activity                                                                                   -   Secure cycle
                                                             NHS organisations should set an                                 parking
                                                              example in delivering public                                -   Provision of
                                                              health policies to prevent and                                  showers
                                                              manage obesity, including:                                  -   Signposting
                                                              Policies, facilities and information                        -   Encouraging stair
                                                              that promote physical activity.                                 use.

                                                      Recommendations for the NHS                                         -   BHF primary Care
                                                      Workforce                                                               Toolkit training
                                                                                                                          -   Let’s Get Moving
                                                              Local Health agencies should                                   Physical Activity
                                                               identify appropriate health                                    Care Pathway
                                                               professionals and ensure that                                  Training
                                                               they received training in:

                                                           The health benefits and
                                                            potential effectiveness of
                                                            interventions to prevent obesity,
                                                                                                                                              11
NICE Guidance      Physical Activity                                              Who in NHS
  Document          Interventions                 Recommendation                 should take it       How
                                                                                   forward
                                             increase activity levels and
                                             improve diet
                                            Best practice approaches in
                                             delivering interventions and
                                             tailoring support to meet
                                             people’s needs
                                            Use of motivational and
                                             counselling techniques.

                Everyday activity      Recommendations for health                                 -
                                       professional delivery

                                            Interventions to increase
                                             physical activity should focus on
                                             activities that fit into people’s
                                             everyday life such as walking
                                             and should take into account
                                             personal preferences.
                                            Aim to improve people’s belief in
                                             their ability to change behaviour
                                            Provide on-going support in
                                             person or via phone, mail or
                                             internet.

                Walking and cycling    Recommendations for health
                                       professionals in broader
                                       community settings

                                            All community programmes to
                                             increase activity levels should
                                             address the concerns of local
                                             people from the outset e.g.
                                             dangers associated with walking
                                             and cycling etc.
                                                                                                            12
NICE Guidance       Physical Activity                                               Who in NHS
  Document           Interventions               Recommendation                    should take it   How
                                                                                     forward
                                           Health professionals should
                                            support and promote community
                                            schemes and facilities that
                                            improve access to physical
                                            activity, such as walking or
                                            cycling routes, combined with
                                            tailored information, based on an
                                            audit of local needs
                                           Health professionals should
                                            support and promote behavioural
                                            change programmes along with
                                            tailored advice to help people
                                            who are motivated to change
                                            become m ore active for example
                                            by walking or cycling instead of
                                            driving or taking the bus.

                Family activity         Delivery Recommendations for
                                        health professionals

                                           Any programme to prevent
                                            obesity in preschool, childcare or
                                            family settings should incorporate
                                            a range of components such as –
                                            interactive demonstrations,
                                            videos and group discussions on
                                            practical issues such as ideas for
                                            activities, opportunities for active
                                            play, safety and local facilities
                                           Family programmes to prevent
                                            obesity, that include increasing
                                            activity levels should provide
                                            ongoing, tailored support and
                                            incorporate a range of behaviour
                                                                                                          13
     NICE Guidance             Physical Activity                                                   Who in NHS
       Document                 Interventions                     Recommendation                  should take it   How
                                                                                                    forward
                                                             change techniques.

NICE Clinical Guidance     Physical activity as a           Advise people with low back pain
Low back pain: early       treatment                         that staying physically active is
management of persistent                                     likely to be beneficial.
non-specific low back                                       Advise people with low back pain
painvi                                                       to exercise.
                                                            Consider offering a structured
                                                             exercise programme tailored to
                                                             the person:-

                                                            This should comprise up to a
                                                             maximum of eight sessions
                                                             over a period of up to 12 weeks.
                                                            Offer a group supervised
                                                             exercise programme, in a group
                                                             of up to 10 people.
                                                            A one-to-one supervised
                                                             exercise programme may be
                                                             offered if a group programme is
                                                             not suitable for a particular
                                                             person.

NICE Clinical practice     Falls Prevention physical        Strength and balance training
guideline for the          activity                         Strength and balance training is
assessment and                                               recommended. Those most likely
prevention of falls in                                       to benefit are older community
older peoplevii (2004)                                       dwelling people with a history of
                                                             recurrent falls and/or balance and
                                                             gait deficit. A muscle
                                                             strengthening and balance
                                                             programme should be offered.
                                                             This should be individually
                                                             prescribed and monitored by an
                                                                                                                         14
     NICE Guidance           Physical Activity                                                  Who in NHS
       Document               Interventions               Recommendation                       should take it    How
                                                                                                 forward
                                                     appropriately trained
                                                     professional.
                                                    Encouraging the participation of
                                                     older people in falls prevention
                                                     programmes
                                                    Education and information-giving
                                                    Individuals at risk of falling, and
                                                     their carers, should be offered
                                                     information, both orally and in
                                                     writing about what measures they
                                                     can take to prevent further falls.

NICE Public Health                               Recommendation 1: Preparing for
Guidelines; Dietary                              pregnancy: women with a BMI of
Interventions and physical                       30 or more
activity interventions for
weight management                                   Health professionals should offer          Health
before, during and after                             a weight loss support programme             professionals
pregnancyviii                                        involving diet and physical
                                                     activity. The programme should
                                                     follow the principles of good
                                                     practice, as outlined at the
                                                     beginning of this section.

                                                 Recommendation 2: Pregnant                     Health
                                                 Women                                           professionals
                                                                                                Exercise
                                                    At the earliest opportunity, for            specialists
                                                     example, during a pregnant
                                                     woman’s first visit to a health
                                                     professional, discuss her eating
                                                     habits and how physically active
                                                     she is. Find out if she has any
                                                     concerns about diet and the
                                                                                                                       15
NICE Guidance   Physical Activity                                                 Who in NHS
  Document       Interventions                Recommendation                     should take it   How
                                                                                   forward
                                        amount of physical activity she
                                        does and try to address them.
                                       Advise that a healthy diet and
                                        being physically active will benefit
                                        both the woman and the unborn
                                        child during pregnancy and will
                                        also help her to achieve a healthy
                                        weight after giving birth. Advise
                                        her to seek information and
                                        advice on diet and activity from a
                                        reputable source.
                                       Advice that moderate intensity
                                        physical activity will not harm her
                                        or her unborn child. At least 30
                                        minutes per day of moderate
                                        intensity activity is
                                        recommended.
                                       Give specific advice about being
                                        physically active during
                                        pregnancy, eg swimming, brisk
                                        walking and strength conditioning
                                        exercises may be beneficial, if
                                        they have not exercised routinely
                                        then they should begin with no
                                        more than 15minutes of
                                        continuous activity three times a
                                        week and gradually increase.
                                       If already exercising before
                                        pregnancy then they should be
                                        able to continue with no adverse
                                        side effects
                                       Explain to those women who may
                                        find the recommended levels of
                                        physical activity difficult that it is
                                                                                                        16
NICE Guidance   Physical Activity                                                    Who in NHS
  Document       Interventions                Recommendation                        should take it    How
                                                                                      forward
                                        important to not be sedentary as
                                        far as possible. Encourage them
                                        to start walking and to build
                                        physical activity into their daily
                                        life.

                                    Recommendation 3: Supporting
                                    Women After Childbirth

                                       During the 6-8 week check..........          Health
                                        discuss the benefits of a healthy             visitors
                                        diet and regular physical                    Health
                                        activity....... Advice on healthy             professionals
                                        eating and physical activity
                                        should be tailored to her
                                        circumstances. E.g. take into
                                        account the demands of caring
                                        for a baby, how tired she is, back
                                        pain etc.
                                       .....a healthy diet and regular
                                        moderate intensity physical
                                        activity and gradual weight loss
                                        will not adversely affect the ability
                                        to breastfeed or the quantity or
                                        quality of breast milk.
                                       Health professionals should give
                                        advice on recreational exercise
                                        from the Royal College of
                                        Obstetrics and Gynaecology

                                     If pregnancy and delivery are
                                      uncomplicated, a mild exercise
                                      programme consisting of walking,
                                      pelvic floor exercises and
                                                                                                            17
NICE Guidance   Physical Activity                                                  Who in NHS
  Document       Interventions               Recommendation                       should take it    How
                                                                                    forward
                                      stretching may begin
                                      immediately. But women should
                                      not resume high-impact activity
                                      too soon after giving birth.
                                     After complicated deliveries, or
                                      lower segment caesareans, a
                                      medical care-giver should be
                                      consulted before resuming pre-
                                      pregnancy levels of physical
                                      activity, usually after the first
                                      check-up at 6–8 weeks after
                                      giving birth.

                                     Health professionals should also
                                      emphasise the importance of
                                      participating in physical activities,
                                      such as walking, which can be
                                      built into daily life.

                                    Recommendation 4: Women with
                                    a BMI of 30 or more after
                                    childbirth

                                     Offer a structured weight-loss               Health
                                      programme. If more appropriate,               professionals
                                      offer a referral to a dietitian or an
                                      appropriately trained health
                                      professional. They will provide a
                                      personalised assessment, advice
                                      about diet and physical activity
                                      and advice on behaviour change
                                      strategies such as goal setting.
                                      Women who are not yet ready to
                                      lose weight should be provided
                                                                                                          18
NICE Guidance   Physical Activity                                                Who in NHS
  Document       Interventions               Recommendation                     should take it    How
                                                                                  forward
                                      with information about where they
                                      can get support when they are
                                      ready.

                                    Recommendation 5: Community
                                    based services
                                     Local authority leisure and                Local
                                      community services should offer             Authority and
                                      women with babies and children              PCT
                                      the opportunity to take part in a           Commissioners
                                      range of physical or recreational          Service
                                      activities. This could include              providers
                                      swimming, organised walks,                 Health
                                      cycling or dancing. Activities need         Trainers
                                      to be affordable and available at          Exercise
                                      times that are suitable for women           specialists
                                      with older children as well as        
                                      those with babies. Where
                                      possible, affordable childcare (for
                                      example, a crèche) should be
                                      provided and provision made for
                                      women who wish to breastfeed.
                                     Weight management groups and
                                      slimming clubs should adhere to
                                      the principles outlined at the
                                      beginning of this section. This
                                      includes giving advice about
                                      healthy eating and the importance
                                      of physical activity and using
                                      evidence-based behaviour-
                                      change techniques to motivate
                                      and support women to lose
                                      weight.
                                     NHS health trainers and non-NHS
                                                                                                        19
        NICE Guidance                   Physical Activity                                                     Who in NHS
          Document                       Interventions                       Recommendation                  should take it   How
                                                                                                               forward
                                                                    health and fitness advisers should
                                                                    advise women that a healthy diet
                                                                    and being physically active will
                                                                    benefit both them and their
                                                                    unborn child during pregnancy.
                                                                    They should also explain that it
                                                                    will help them to achieve a healthy
                                                                    weight after giving birth – and
                                                                    could encourage the whole family
                                                                    to eat healthily and be physically
                                                                    active.
                                                                   NHS health trainers and non-NHS
                                                                    health and fitness advisers should
                                                                    encourage those who have weight
                                                                    concerns before, during or after
                                                                    pregnancy to talk to a health
                                                                    professional such as a GP,
                                                                    practice nurse, dietitian, health
                                                                    visitor or pharmacist1. They
                                                                    should also advise women, their
                                                                    partners and family to seek
                                                                    information and advice on healthy
                                                                    eating and physical activity from a
                                                                    reputable source.
                                                                   NHS health trainers and non-NHS
                                                                    health and fitness advisers should
                                                                    offer specific dietary advice in
                                                                    preparation for pregnancy,
                                                                    including the need to take daily
                                                                    folic acid supplements.



1
    This is an edited extract from a recommendation that appears in ‘Obesity’. NICE clinical guideline 43.
                                                                                                                                    20
Effectiveness of specific Physical Activity Interventions

Physical Activity   Evidence       What is the evidence                              Who in the NHS   How                 Comments
Intervention        Derived from                                                     should take it
                                                                                     forward
Primary             HDA               Short-term effectiveness of primary
Prevention                             prevention interventions is associated
                                       with single-factor interventions (physical
                                       activity only) that focus on the promotion
                                       of moderate intensity physical activity
                                       (typically walking) in a sedentary
                                       population vii.

Brief
Interventions       NICE , HDA        There is evidence from controlled trials      Primary Care     Implement Let’s
                                       that brief interventions in primary care      Practitioners    Get Moving
                                       can be effective in producing moderate
                                       increases in physical activity in middle
                                       aged and older populations in the short
                                       and longer term. The evidence suggests
                                       that several follow up sessions are
                                       required over a period of 3 – 6 months
                                       to acquire longer term behaviour
                                       changei (NICE Guidance).
                                      Brief advice from a health professional
                                       supported by written materials is likely to
                                       be effective in producing a modest short
                                       term (6 – 12 week) effect on physical
                                       activityix.

Exercise Referral   NICE              The review of the evidence of                                  Tailor schemes to   NICE
Schemes             Guidance,          effectiveness concluded that exercise                          meet the            recommends
                    LEAP               referral schemes, involving a referral                         Department of       further
                    Evaluation         either from or within primary care, can                        Health              research into
                    report & HDA       have positive effects on physical activity                     recommendations     the long term
                                       levels in the short term (6 to 12 weeks)x.                     regarding chronic   effectiveness
                                                                                                                                     21
   The recently published findings of the        disease      of exercise
    Local Exercise Action Pilots reinforce        management   referral
    this observation, and demonstrate that                     schemes in
    exercise referral schemes can                              increasing
    successfully increase physical activity                    physical
    levels, particularly in older age groups.                  activity in the
   The NICE review also found that referral                   long term
    schemes are ineffective in increasing
    physical activity levels in the longer term
    (over 12 weeks) or over a very long
    timeframe (over 1 year). The reviewers
    suggested that further research, using a
    controlled research design, is required
    to determine the impact that exercise
    referral schemes may have on reducing
    health inequalities and on their
    effectiveness in increasing physical
    activity levels in adult populations i .
   Exercise referral schemes which fall
    outside the scope of the NICE review
    and are therefore not affected by the
    NICE guidance include those which
    address the following:-

 The medical management of related
  conditions, eg type 2 diabetes, obesity
  and osteoporosis.
 Approaches specific to preventing or
  ameliorating individual health conditions
  (e.g. falls prevention) which fall outside
  the overarching advice to achieve 30
  minutes moderate activity on at least 5
  days a week.

The Department of Health urges
commissioners, practitioners and policy
makers to continue to provide high quality
                                                                            22
                exercise referral schemes for their local
                population where these address:

                 The medical management of conditions,
                  eg type 2 diabetes, obesity and
                  osteoporosis.
                 Approaches specific to preventing or
                  improving individual health conditions
                  (e.g. falls prevention), which fall outside
                  the overarching advice to achieve 30
                  minutes moderate activity on at least 5
                  days a weekxi.

                   Referral to an exercise specialist, based
                    in the community, can lead to longer
                    term (>8 months) changes in physical
                    activityxii.
                   Regular contact with an exercise
                    specialist tend to report sustained
                    changes in physical activityvi .

Walking   HDA      Interventions that promote moderate         NICE
                    intensity physical activity, particularly   recommends
                    walking, and are not facility dependent     further
                    are associated with longer term changes     research into
                    in behaviour vii                            the long term
                   There is some evidence to suggest that      effectiveness
                    walking buses led to increases in self      of community
                    reported walking among 5 – 11 year          based
                    olds at 10 weeks and 14 – 30 months iv      walking
                   There is evidence to suggest that           schemes in
                    targeting children and parents who live a   increasing
                    short distance to school (1 mile or less)   physical
                    may support interventions to encourage      activity in the
                    increases in walking levels for the         long term
                    school journeyxiii.

                                                                            23
Pedometers          NICE          Workplace walking interventions using         NICE
                                   pedometers that focus on facilitated goal     recommends
                                   setting, diaries, self monitoring and         further
                                   walking routes can produce positive           research into
                                   results on step countsxiv.                    the long term
                                                                                 effectiveness
                                                                                 of pedometer
                                                                                 schemes in
                                                                                 increasing
                                                                                 physical
                                                                                 activity in the
                                                                                 long term.

Older People’s      HDA, CMO      Interventions restricted to adults aged
Physical Activity   Report         50 years and older are effective in
Programmes                         producing short term changes in
                                   physical activity and there is limited
                                   evidence that they can be effective in
                                   producing mid to long term changes in
                                   physical activityxv.
                                  Interventions that used individual-based
                                   or groups based behavioural or
                                   cognitive approaches with a combination
                                   of group and home based exercise
                                   sessions are equally effective in
                                   producing changes in physical activityxvi.
                                  Interventions that promote moderate
                                   intensity and non-endurance physical
                                   activities (e.g. flexibility exercises) are
                                   associated with changes in physical
                                   activity viii. Interventions that provide
                                   support and follow up are also
                                   associated with changes in physical
                                   activity.



                                                                                             24
Falls Prevention   CMO report      Physical Activity programmes can help
                                    reduce the risk of falling, and therefore
                                    fractures among older peoplexvii
                                   Strength training is effective in mitigating
                                    muscle loss and shown to be highly
                                    effective in reducing subsequent
                                    incidence of falls among older people viii
                                   Risk of falls was reduced by 10% in
                                    programmes that combine strength,
                                    balance and endurance training.
                                    Programmes with balance training alone
                                    reduced the risk by 25%, and Tai Chi
                                    reduced by 47%xviii.

Workplace Health   NICE            Use of posters and signs can increase
                                    stair usage in the short termxix.
                                   Workplace walking interventions using
                                    pedometers that focus on facilitated goal
                                    setting, diaries, self monitoring and
                                    walking routes can produce positive
                                    results on step countsxx.
                                   The provision of written health materials
                                    distributed to employees can increase
                                    walking to work in economically
                                    advantaged womenxxi.
                                   Employee designed interventions that
                                    include written health and physical
                                    activity information, active commuting,
                                    stair climbing, led walks, fitness testing
                                    and counselling can have a positive
                                    effect on physical activityxxii.
                                   Internet interventions could be effective
                                    at increasing physical activity in the
                                    short term (up to 3 months)iii.

Cycling                            Cycling promotion projects targeting           NICE
                                    primary and secondary school children          recommends
                                                                                            25
                               can lead to large self reported increases     further
                               in cycling both at 9-11 months and 20-        research into
                               23 monthsxxiii.                               the long term
                                                                             effectiveness
                                                                             of community
                                                                             cycling
                                                                             schemes in
                                                                             increasing
                                                                             physical
                                                                             activity in the
                                                                             long term.

Cardiac                       In patients with chronic ischaemic heart
Rehabilitation                 disease, physical activity can reduce
                               mortality as part of cardiac
                               rehabilitationxxiv.
                              Short-term physical exercise training in
                               selected patients with chronic heart
                               failure may have physiological benefits
                               and positive effects on quality of lifexxv.

Physical Activity   NICE      Large positive association between
Programmes for                 parental and social support and physical
children and                   activity in young peoplexxvi.
young people                  There is evidence that supervised
                               physical activity interventions conducted
                               in the pre school setting can be effective
                               in improving core physical skillsxxvii.
                              There is evidence to suggest that a mix
                               of promotional measures including
                               curriculum, parental and community
                               promotions can increase self reported
                               walking and cyclingxxviii.
                              There is some evidence that family
                               based interventions, targeting physical
                               activity can lead to increases in physical
                               activity in young peoplexxix.
                                                                                         26
                     There is some evidence that
                      interventions involving both the school
                      and family and/or community agencies
                      lead to positive changes in physical
                      activity in boys and girls aged 13 or
                      underxxx.

NICE Public          In collaboration with older people and
Health Guidance       their carers, offer tailored exercise and
(2008) Mental         physical activity programmes in the
wellbeing and         community, focusing on:-
older people
                   a range of mixed exercise programmes
                    of moderate intensity (for example,
                    dancing, walking, swimming)
                   strength and resistance exercise,
                    especially for frail older people
                   toning and stretching exercise.

                     Ensure that exercise programmes reflect
                      the preferences of older people.
                     Encourage older people to attend
                      sessions at least once or twice a week
                      by explaining the benefits of regular
                      physical activity.
                     Advise older people and their carers
                      how to exercise safely for 30 minutes a
                      day (which can be broken down into 10-
                      minute bursts) on 5 days each week or
                      more. Provide useful examples of
                      activities in daily life that would help
                      achieve this (for example, shopping,
                      housework, gardening, cycling).
                      Invite regular feedback from participants
                      and use it to inform the content of the
                      service and to gauge levels of
                      motivationxxxi.
                                                                  27
REFERENCES
i
   NICE ( 2006) Four Commonly used methods to increase physical activity: brief interventions, exercise referral schemes, pedometers and community based
exercise programmes for walking and cycling
ii
    NICE (2008) Promoting & Creating built and natural environments that encourage and support physical activity
iii
     NICE (2008) Workplace Health promotion: how to encourage employees to be physically active
iv
     NICE (2009) Promoting physical activity, active play, and sport for pre-school and school age children and young people in family, pre-school, school and
community settings
v
    NICE (2006) Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children
vi
     NICE (2009) Clinical Guidance Low back pain: early management of persistent non-specific low back pain
vii
     NICE (2004) Clinical practice guideline for the assessment and prevention of falls in older people
viii
      NICE (2010) Dietary interventions and physical activity interventions for weight management before, during and after pregnancy
ix
    Op Cit (vii)
x
    Op Cit (1)
xi
     Department of Health (2007) DH statement on Exercise Referral. London
xii
     Op Cit (vi)
xiii
     Op Cit (iv)
xiv
     Op Cit (iii)
xv
     Op Cit (viii)
xvi
     Op Cit (viii)
xvii
      Department of Health Chief Medical Officer’s Report: (2004) At Least Five a Week: Evidence on the impact of physical activity and its relationship to
health. London.
xviii
       Province MA et al (1995) cited in Department of Health Chief Medical Officer’s Report: (2004) At Least Five a Week: Evidence on the impact of physical
activity and its relationship to health. London.
xix
     Op Cit (iii)
xx
     Op Cit (iii)
xxi
     Op Cit (iii)
xxii
      Op Cit (iii)
xxiii
      Op Cit (iv)
xxiv
       Joshi, S.B. exercise training in the management of chronic heart failure and ischaemic heart disease. Heart, Lung and Circulation 2007, doi:10.1016/j.hlc.
xxv
      Lloyd-Williams F, Mair FS, Leitner M (2002) cited in Department of Health Chief Medical Officer’s Report: (2004) At Least Five a Week: Evidence on the
impact of physical activity and its relationship to health. London.
xxvi
      Op Cit (iv)
xxvii
       Op Cit (iv)
xxviii
       Op Cit (iv)
xxix
      Op Cit (iv)
xxx
      Op Cit (iv)
xxxi
       NICE (2008) Mental wellbeing and older people guidance.

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