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Physical activity

Introduction

This section deals with physical activity at all ages.  The most recent national document describing the role and need for physical activity was Start Active, Stay Active https://www.gov.uk/government/publications/start-active-stay-active-a-report-on-physical-activity-from-the-four-home-countries-chief-medical-officers

 

The key recommendations were:

 

  • Physical activity programming should take a life course approach
  • There be a stronger recognition of the role of vigorous intensity activity 
  • Have flexibility to combine moderate and vigorous intensity activity
  • An emphasis upon daily activity
  • New guidelines on reducing sedentary behaviour

 

The evidence that habitual physical activity is beneficial to a range of health outcomes is unequivocal (see pages 11 and 12 in Start Active Stay Active).  The World Health Organisation (WHO) has identified inactivity as the 4th leading risk factor for mortality globally.

 

The mechanisms for these inferred health benefits are many but can be summarised to some extent as shown below:

 

  • Muscle as an endocrine organ
  • Regulates components of the endocrine system managing hormone levels and supporting effective functioning of things such as growth, metabolism and mood.
  • The muscle pump (blood pooling,  cardiac output)
  • Returns blood back to the heart from the extremities therefore reducing the need for the heart to work harder pumping a reduced amount of blood volume.
  • Muscle action also acts on the intestine decreasing the amount of time faecal matter stays in the body.
  • Use it or lose it (muscle and bone)
  • Positive stresses associated with movement encourage muscle development/retention and good bone mineral density supporting stronger bones and better movement
  • Endorphin hypothesis (opioid peptides)
  • Endorphin and serotonin can be regulated by physical activity improving mood which has corresponding positive impact on a wider scale.
  • Associated behaviours (distraction hypothesis)
  • Inactivity is associated with snaking and poor food choice (favouring simple sugar based snacks) which increases calorie intake and levels of overweight/obesity

 

The evidence that people can be moved from inactive to regularly active over a sustainable time frame is relatively weak and much work is needed here to understand the reasons for this and what can be done to enable such sustained transition.

Growing research suggests that sedentary behaviour is independently associated with all-cause mortality, type 2 diabetes, some types of cancer, metabolic dysfunction and low self-esteem.  This means that even if a person engages in the minimum recommended levels of physical activity as defined in Start Active Stay Active but is otherwise sedentary, they still carry an increased level of risk.

 

Facts, Figures and Trends

The greatest overall benefit is when a person moves from being sedentary to regularly active at a low level.  As activity levels increase the health benefit increases but at a reduced rate until there is a plateau and eventually a decline associated with excessively high levels of performance associated with athletes.

 

The benefit of understanding this is that efforts can be focused on moving large numbers of people from inactive to regularly active at low, sustainable levels, dispelling the perceptions of having to work at very high levels to sustain health benefit. 

 

Moderate intensity physical activity:

Will cause adults to get warmer and breathe harder and their hearts to beat faster, but they should still be able to carry on a conversation.

 

Vigorous intensity physical activity:

Will cause adults to get warmer and breathe much harder and their hearts to beat rapidly, making it more difficult to carry on a conversation.

 

Resistance activity relates to actions that strengthen muscles using body weight or working against a resistance. This should involve all the major muscle groups, examples include:

 

  • Exercising with weights or bands
  • Carrying or moving (relatively) heavy loads
  • What else?

 

Brief summaries of actions against age ranges are shown below:

Under 5s

  • Activity encouraged from birth
  • Minimise the amount of time spent being sedentary (being restrained or sitting)
  • Adults should support and encourage play based fun

 

5 to 18 years

  • Moderate to vigorous intensity physical activity for at least 60 minutes every day
  • Minimise the amount of time spent being sedentary
  • Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.

 

19 to 64 years

  • Aim to be active every day (min 30 mins)
  • Undertake physical activity to improve muscle strength
  • Minimise the amount of time spent being sedentary

 

  • 65 + years
  • Undertake physical activity to improve muscle strength on at least two days a week
  • Incorporate physical activity to improve balance and co-ordination on at least two days a week

 

Local Prevalence

The relationship between answers given and actual values are subject to substantial error as they are self-reported. As an example, the 2008 survey for physical activity returned values of 40% and 28% for men and women respectively, who reported doing the minimum levels of activity based on the current guidelines.  When a representative sample were assessed using direct accelerometry only 6% of men and 4% of women reached the minimum recommendations.

 

The Active People Survey 6 gave the following data:

 

LA

<30 mins

30-89 mins

90-149 mins

150+ mins

 

28.50%

8.10%

7.30%

56.00%

Bedford

25.60%

8.80%

7.10%

58.50%

 

However, given the very small sample numbers (<500) and the evidence about misreporting shown above the table it is reasonable to suggest there are significant numbers of people who regularly fail to sustain healthy levels of physical activity.

 

What does inactivity cost?

 

There is insufficient evidence to assess the direct costs of inactivity at a local level due to the complex interactions of risk factors and mis-reporting from questionnaires.  However, the British Heart Foundation (BHF) in their document Economic Costs of Inactivity (March 2013) has estimated the cost to each Primary Care Trust (prior to their disbandment) at £6.2 million.  The commentary added “These figures only take into consideration the direct costs from coronary heart disease, cerebrovascular disease, breast cancer, colon/rectum cancer and diabetes mellitus, therefore the potential healthcare costs associated with physical inactivity could be considerably higher.” 

There are substantial additional costs in social care associated with inactivity as well as significant lost working days due to musculoskeletal issues and poor mental health.  Low levels of physical activity in the older population can increase levels of isolation and increase the potential for falls.

 

Local and National Strategies

Physical activity can be in any form; the important aspect is that it is stainable within an individual or family’s lifestyle and enjoyable.  There is no need to focus on higher level participation in sport or competition although this is sometimes an outcome for a small percentage of those who choose to become more active.

The principle national programme designed to increase physical activity is Let’s Get Moving.  This uses behavioural insight to understand why people are not active and then motivational interviewing to support people into new programmes.

In Bedford Borough this programme is supported by additional funding from Sport England across 2013/14 – 2014/15 via a consortium bid from ukactive, public health, Bedford Borough sport and leisure development and the County Sports Partnership (CSP).

The Bedford Borough sport and leisure team deliver a range of programmes under the Re-Active8 scheme that are ideal for “adults who may never have tried sport before and would now like to have a go at something new or for adults who might have tried sport a long time ago and want to return to an activity” (Reactive programme Sept 2013).  Programmes include:

  • Ballet Fitness
  • Ballroom and Latin Dancing
  • Cardio Tennis
  • Climbing
  • Golf Beginners A
  • Golf Beginners B
  • Golf Improvers A
  • Golf Improvers B
  • Golf Intermediates
  • Squash
  • (Beginners & Intermediates)
  • Tennis Beginners
  • Tennis Intermediates
  • Tennis Advanced

 

The Sports Development and Physical Activity Strategy (2013-16) is under development at the time this section was written (November 2013), subject to sign off this will identify the strategy and associated actions to increase physical activity over the next 3 years.

 

Active transport also plays a significant part in sustainable, habitual physical activity and is one of the most sustainable aspects as it becomes normal behaviour (as opposed to going to a commercial gym for example).

 

The County Sports Partnership plays a significant role in developing physical activity through sporting engagement and has aligned with public health over the past 2 years by providing a place on the Board for a senior public health manager.

 

What are the key inequalities?

What are the challenges in obesity?

 

What are we doing and why?

 

Lifestyle Hub (GP Referral Support) – A pilot programme which uses motivational interviewing to establish the most effective referral programme for them based on their individual circumstances.  It is likely that this will improve the quality of referrals into the above programmes by facilitating 20 – 30 minute discussions regarding lifestyle and assessing the programme that is most likely to have the greatest effect.  The addition of the Let’s Get Moving programme for patients who suit this method most adds a further dimension to the services available to Bedford Borough patients.  According to the NICE guidance, LGM provides a robust vehicle to implement brief interventions for physical activity while harnessing the health benefits of this clinically effective and cost-effective methodology. (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/152000/dh_133101.pdf.pdf)

[N.B. Motivational interviewing (MI) is a directive, patient-centred counselling approach focused on exploring and resolving ambivalence enhance intrinsic motivation and promote confidence in a person's ability to make behaviour changes (employed by the Lifestyle Advisors).  There is much evidence reporting the efficacy of MI in modifying behaviours and this is a central component of the Let’s Get Moving programme, mentioned above]

 

Pat ‘Do Something’ Smartphone App – The app is designed for use by the population of Bedford Borough with a smart phone who are looking to find things to do in Bedford and beyond.  The app contains information about programmes, clubs, societies and organisations from a range of areas including both physical activity and non-physical-activity based programmes.  This will contribute to a decrease in sedentary behaviour (indicated in Start Active Stay Active [2011] as independently associated with risk of obesity) and increasing physical activity and social interaction, both of which are important for physical and mental wellbeing.  Of the 50% of smartphone users, approximately 74% use their smartphone regularly to access internet services and applications.  Cisco predict that mobile data use will increase 21-fold by 2015 in the UK, particularly with the onset of the 4G networks that are currently being released in the UK.  This is an exciting innovation in the newly emerging field of behaviour change through mobile and social applications.

 

Bedford Borough Sports Development Team provide a range of subsidised programmes of sport and activity programming designed to re-engage people with previous enjoyment of sport (participants per year – ppy)

  • Pre-activate8 (entry level programme) 160 ppy
  • ReActive8 GOLD (55 + years old) 600 ppy
  • ReActive8 GOLD – RURAL 200 ppy
  • ReActive8 (sports course programme for 30-50 year olds) 400 ppy
  • She-Activate8 (For mothers/carers and daughters) 40 ppy
  • Sportivate (17-25 year olds) 2012 legacy programme 160 ppy

 

86% of adults reported that taking part in Sports Development activities had increased their participation in sport or physical activity

33% of adults said that they had improved health as a result of participation and 12% that it had aided weight loss

More detail on Active8 at http://www.bedford.gov.uk/leisure_and_culture/sports_development.aspxPhysical activity is highly cost effective with Quality Adjusted Life Year (QALY) costs between £20 - £500 (values below £30,000 are considered cost effective – NICE 2006) (Lewis et al, 2010).

 

Lets Get Moving Back Into – In 2013, Public Health, as part of a small group, secured £430,000 for Bedfordshire to deliver a brand new initiave to tie into the Lifestyle Hub.  It is designed as a package to increase sporting activity in people who currently do no sport by targeting at risk patients, providing them with the Let’s Get Moving programme and signposting them into local activities, either bespoke or existing.

 

What are the unmet service needs/gaps?

The principal gaps in service are insufficient capacity in weight management programmes based on available budget to meet identified need. Access to high quality affordable food is not universal and accessibility of open play areas and opportunities to use active transport are not universally available to the whole population.

 

Recommendations

 

 

This section links to the following sections in the JSNA:

 

  • Obesity (Children and Young People)
  • Obesity (Adults)
  • Cancer
  • Diabetes
  • Circulatory Disease

 

References

1.    Healthy Lives, Healthy People: A call to action on obesity in England. Department of Health, 2011.

2.    Foresight - Tackling Obesities - Future Choices.  Government Office for Science, 2007.

3.    (Heslehurst N, Rankin J, Wilkinson J, Summerbell C., 2010. A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619 323 births, 1989-2007. Int J Obes, 34(3):420-8.)  

4.    Government Policy Document: Reducing obesity and improving diet (March 2013) (https://www.gov.uk/government/policies/reducing-obesity-and-improving-diet)

5.    Health Technology Assessment.  The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. 2011;15(2):1–182

6.    Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 7; 341(15):1097-105.

7.    McPherson, K., Marsh, T. and Brown, M. 2007. Modelling Future Trends in Obesity and the Impact on Health. Foresight Tackling Obesities: Future Choices.

8.    Saving Mothers Lives 2003-2005. London: CEMACH; 2007  

9.    Healthy Weight Healthy Lives Toolkit for Developing Local Strategies, 2010  

10. The economic burden of obesity (2010), NOO, UK.

11. MRC: Developing and evaluating complex interventions: new guidance.  University of Cambridge, 2006.

12. Blackburn, G. (1995) Effect of Degree of Weight Loss on Health Benefits.  Obesity Research; 3; Suppl. 2; 211s-216s.

13. Start Active Stay Active, A report on physical activity for health from the four home countries’ Chief Medical Officers.  Department of Health, 2011.

14. NICE CG43 - Obesity Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children.  Department of Health, 2006.

15. Hurling et al. (2007) Using Internet and Mobile Phone Technology to Deliver an Automated Physical Activity Program: Randomized Controlled Trial. J Med Internet Res; 2007; 9(2); e7

16. Ware et al. (2008) Rates and Determinants of Uptake and Use of an Internet Physical Activity and Weight Management Program in Office and Manufacturing Work Sites in England: Cohort Study.  J Med Internet Res; 10; 4; e56; 1-17.

17. Hurling, B. et al. (2008) Using Internet and Mobile Phone Technology to Deliver an Automated Physical Activity Program: Randomized Controlled Trial.  J Med Internet Res; 9 (2); e7; 2-13.

18. 11. Davis, R. and Rollnick, S. (2006) Motivational Interviewing for Pediatric Obesity: Conceptual Issues and Evidence Review. J Am Dietetic Assoc.; 106(12); 2024-2033.

19. Lewis, C. Ubido, J. Holford R and Scott-Samuel A., (2010). Prevention Programmes Cost-Effectiveness Review: Physical activity. Liverpool Public Health Observatory