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Physical Activity for Health and Wellbeing

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					  Evidence into Action:
Physical Activity for Health
     and Well-being
    Maureen Kidd, Health Improvement
            Programme Manager
   Graeme Scobie, Public Health Adviser
     (last updated 18th January 2008)
                  Purpose
• To provide Health Scotland staff with
  information summarising the key issues for each
  of the priority programmes in the work
  programme
• To provide HS staff with a source document for
  use when preparing presentations, briefings etc
• Dimensions covered are:
   – Epidemiological evidence (patterns and
     trends)
   – Evidence on effective interventions
   – Policy context
   – Current activity
         What is physical activity?
  • A broad term to describe movement of the body
    that uses energy

                       Physical activity



Activ    Recreationa     Sport    Exercis   Play   Danc
e        l activity               e                e
living
   How much physical activity
      is good for health?
• Adults should accumulate at least 30 minutes of
  moderate activity on most days of the week.
• Children should accumulate at least one hour of
  moderate activity on most days of the week
• Does not need to be strenuous to have
  significant effect on people’s health
Percentage of Scottish population meeting recommended
         physical activity levels (2003 SHeS)
                      90


                      80
                                                                                 male

                      70
                                                                                 female

                      60
         Percentage



                      50


                      40


                      30


                      20


                      10


                       0
                           2-4   5-7   8-10 11-12 13-15 16-24 25-34 35-54 45-54 55-64 65-74
                                                         Age
Socio-economic status - 1
           Proportion m eeting current recom m endations by NS-
                  SEC. Age standardised 16+. SHeS 2003.
     55
     50                                            Males    Fem ales
     45
     40
     35
     30
 %




     25
     20
     15
     10
     5
     0
           Managerial   Inter-       Small      Lower Semi-routine
               &       mediate     employers supervisory & routine
          professional                       & technical
Socio-economic status - 2
         Proportion meeting recommendations by SIMD quintile.
                   Age standardised 16+. SHeS 2003.
    55
    50                                          Males   Females
    45
    40
    35
    30
%




    25
    20
    15
    10
     5
     0
          Least         2           3            4          Most
         deprived                                         deprived
               Scotland in an international
                                   context
                Percentage of 15-year-olds engaging in physical activity for
                               an hour or more on most days, 2002

               60

               50
Percentage %




               40
                                                                                 Boys
               30
                                                                                 Girls
               20

               10

               0
                    Wales   Scotland England   USA   Denmark Portugal   HBSC
                                                                        (n=29)
  Physical inactivity as an
independent risk factor for
            CHD




                     Source: National Heart Forum 2002
   What are the other risks of
           inactivity?
• After diet, physical inactivity is recognised as
  the greatest contributor to the growing problem
  of obesity
• It is a recognised risk factor for development of
  Type II diabetes, colon cancer, osteoporosis and
  other musculoskeletal disorders
• Strong association with mental ill health and
  other health-related risk behaviours such as
  smoking.
     Role of physical activity in
        preventing and treating
PURPOSE
                  diseases
         PREVENTION      THERAPY
MODE           EVIDENCE         EFFECT     EVIDENCE            EFFECT
CVD            high             strong     medium              moderate
Obesity        medium           moderate   medium              moderate
Cancer         moderate         moderate   -                   -
Type II        high             strong     medium              weak
Diabetes
  There is evidence of a dose response
                                               Adapted from ‘At Least Five a
  effect for CHD and Type II diabetes          Week’
 The wider benefits of physical
           activity
• Families: opportunities for strengthening
  relationships
• Communities: social cohesion, reduced traffic-
  related accidents, perception of safety
• Environment: reduced traffic congestion, cleaner
  air, protection of open spaces
• Economy: tourism, reduced health care costs,
  lower absenteeism from work
  Initiatives for effective promotion of
           physical activity - 1
• There have been numerous initiatives aimed at promoting
  and sustaining physical activity in populations
• The majority have targeted walking as a means to increase
  daily physical activity levels
• Some of these initiatives include 1:1 counselling,
  encouraging stair-climbing, use of pedometers, safer
  routes to school for walking and cycling and environmental
  initiatives such as cycle paths and walkways
• Although evaluations of single initiatives often show
  evidence of effectiveness, many of the results are
  excluded from formal guidance or systematic reviews due
  to strict inclusion criteria
 Initiatives for effective promotion of
          physical activity - 2
Initiatives to increase physical activity include:
• Exercise referral schemes
• Pedometers
• Stair climbing
• Cycling/walking routes and clubs (e.g. Paths to
   Health)
• Active transport – cycling to work
• Environmental changes
• Workplace initiatives
• Schools – PE and walking to school
    Evidence for effective promotion of
           physical activity - 1
    HS Commentary on NICE guidance on four commonly used
    methods to increase physical activity recommended:
•   Primary care practitioners should take the opportunity,
    whenever appropriate, to identify inactive adults and advise
    them to aim for 30 minutes of moderate activity on 5 days of the
    week (or more).
•   When providing physical activity advice, primary care
    practitioners should take into account the individual’s needs,
    preferences and circumstances, agree goals with them, offer
    written information about the benefits of physical activity and
    the local opportunities to be active and follow them up at
    appropriate intervals over a 3 to 6 month period.
•   Local policy makers, commissioners and managers, together
    with primary care practitioners, should monitor the
    effectiveness of local strategies and systems to promote
    physical activity
  Evidence for effective promotion of
         physical activity - 2
  HS Commentary on NICE guidance on four commonly used
  methods to increase physical activity recommended (cont)
• Local policy makers, commissioners and managers,
  together with primary care practitioners, should pay
  particular attention to the needs of hard to reach and
  disadvantaged communities, including minority ethnic
  groups
• New exercise referral schemes should not be established
  other than as part of an evaluation programme or other
  relevant evaluative study
• A coordinated programme of evaluative research is
  desirable to add to the limited existing evidence base on
  the effectiveness of pedometers, walking and cycling
  schemes. If establishing new schemes for evaluation, or
  continuing existing schemes, good practice principles
  should be applied.
    Evidence for effective promotion of
           physical activity - 3
    A recent NICE Evidence into Practice Briefing
    recommended:
•   Systems should be developed in primary care to promote
    access to community exercise specialists or behaviour
    change specialists
•   Healthcare professionals should target inactive patients
    with single-factor interventions where possible
•   Community interventions should be developed using
    theories of behaviour change
•   Programmes should promote home-based walking and
    other moderate-intensity physical activities and offer
    participants the choice of using a range of local
    opportunities to be active
•   A range of physical activity programmes should be
    developed that target adults aged 50 and over
National Physical Activity Strategy
              (2003)
“People  in
Scotland will
enjoy the
benefits of
having a
physically active
life”
          National Targets
By 2022
• 50% of all adults will have met the minimum
  recommended levels of physical activity
• 80% of all children will have met the minimum
  recommended levels of physical activity
• Focus on getting inactive people to be active,
  and on preventing people from reducing the
  amount of activity they do
• Scottish Health Survey will track progress
  against the targets
National Strategic Priorities
• Develop and maintain long-lasting, high-quality
  physical environments to support inactive people
  to become active
• Provide accurate and evidence-based advice to
  staff who are involved in government policy and
  service delivery and who work in the voluntary
  and private sectors
• To raise awareness and develop knowledge and
  understanding about the benefits of physical
  activity and provide access to information
• To carry out research, monitoring and evaluation
        Improve the Physical
            Environment
AIM
  Create, improve and
  maintain the supply of
  natural and built facilities
  for activity

HEALTH SCOTLAND ROLE
  Advocacy; equity
  proofing; consultation
  input
          Develop the Workforce
AIM
    Build capacity across wide
    range of settings and sectors

HEALTH SCOTLAND ROLE
•   Implement Workforce
    Development Plan
•   Support PA workforce via
    Physical Activity & Health
    Alliance website
    www.paha.org.uk
•   Develop resources e.g.
    Guidance for Local
    Authorities and Primary
    Care; Active Scotland
    database; Policy Maze; Guide
    to Accreditation
    Increase Communication
AIM
  Stimulate demand for
  increased physical activity
  through awareness-
  raising in the general
  population

HEALTH SCOTLAND ROLE
  healthyliving campaign;
  national and local PR
            Build and disseminate
AIM
                evidence base
  Monitor impact of current
  activity and ensure
  current policy and
  practice are supported by
  best available evidence
  and best practice

HEALTH SCOTLAND ROLE
  Includes SPARColl;
  Evidence mapping; HS
  commentaries on NICE
  guidance; minimum
  dataset; ‘Green Exercise’
  conference

				
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