National Public Health Service for Wales / Framework for Action – Physical Activity

Framework for Action: Physical Activity 2006-07

SMT Sponsor: Dr Sandra Payne / Author: Malcolm Ward
Date: 29thAugust 2006 / Version: Final
For SMT on: 26th September 2006. / Approved at SMT
Summary: The enclosed is a revised framework for action to reflect the changing priorities and developments in physical activity over the last 12 months. Key changes are the greater emphasis on the need to align local physical activity and nutrition strategies to ensure issues relating to obesity and overweight are addressed effectively, and the inclusion of the workplace as a key setting for physical activity promotion.
Changes also reflect the further strategic developments at national level including the launch of the Food & Fitness Action Plan, Climbing Higher- Next Steps Report, Walking the Way to Health – Next Steps and the revised Corporate Health Standard.
Relevant Previous SMT Papers: Framework for Action: Physical Activity 2005-06 / Ref. No.: SMT 09-06 SP3
Proposed Publication/Distribution if Approved:
  • Internet/ Intranet and LPHT’s.

Framework for Action

Physical Activity- 2006/07

1Introduction

This paper:

  • Provides an overview of the situation pertaining to Physical Activity in Wales.
  • Summarises the effectiveness of interventions for promoting physical activity amongst sedentary individuals and populations.
  • Illustrates the importance of Physical Activity strategies and action plans at both national and local levels to reduce the levels of inactivity and consequently reduce the burden of associated ill health.
  • Identifies the range of current activity supported by NPHS staff in local public health teams (LPHT).
  • Identifies the range of current and planned activity by NPHS in collaboration with national partners.
  • Specifies the Physical Activity commitments to be delivered by NPHS staff in LPHT in support of local partnership work during 2006/07.
  • Makes recommendations for activity to be delivered by local partners and for investment in Physical Activity promotion.

2Priorities for Physical Activity Promotion

To deliver the population effect necessary to increase physical activity to a level that benefits health throughout Wales it is recommended that actions are based on the following principles:

  • Prioritising interventions with known evidence of effectiveness.
  • Evaluating all interventions where evidence is lacking.
  • Assessing of relative cost and feasibility of delivery.

2.1NPHS priorities

It is recommended that the NPHS should deliver the following activity during 2006/07 (subject to resource availability):

Health Care Settings

Work with LHB’s, NHS Trusts, Primary Care teams and others to develop and support phase 4 cardiac rehabilitation and other tertiary rehabilitative programmes within local community settings.

Support the development ofthe national exercise referral programme commencing in October 2006 in line with the guidance produced by the Welsh Assembly Government and with a view to enhancing the present evidence base for effectiveness.Work in partnership with Local Authorities, LHBs and LMCs to deliver local Exercise Referral projects in accordance with nationally agreed programme protocols. Work closely with the designated training provider and Research & Evaluation support team to ensure safe and effective delivery of the programme.

Workplaces

Provide information and advice on physical activity policies and actions in support of employers and agencies engaged in developing healthy workplace programmes including the Corporate Health Standard.

Children and Young People

Support the integration of physical activity within the local Healthy Schools schemes.

Support partners in the delivery of the Welsh Assembly Government ‘Food & Fitness Implementation Plan.’

Older People

Support Older People partnerships in the development of programmes that promote physical activity for older people in line with the current evidence base.

General Population

Prioritise strategies that promote walking and cycling among the inactive population including:

Walking the Way to Health

  • Work with local community organisations, local volunteering bureaus, health alliances and local authorities to facilitate hand over and ownership of local schemes for further development and sustainability.
  • Provide strategic support and advice for any continued development of the Walking the Way to Health programme in line with WAG guidance following their consideration of the recommendations in the CCW ‘Next Steps’ Succession Plan.
  • Support local programmes in addressing monitoring and evaluation needs, joint training initiatives etc.

Big Lottery Fund Mentro Allan Programme.

Continue to develop, monitor and support the Mentro Allan outdoor activity programme in partnership with WLGA, Sports Council for Wales, WCVA and the Countryside Council for Wales.

Provide support to development, delivery, monitoring and evaluation of local Mentro Allan projects.

Inequalities In Health Fund

Continue to support, deliver, monitor and evaluate existing Inequalities In Health funded projects until March 2008 and explore opportunities for integrating effective projects into sustainable long-term programmes where appropriate.

2.2 Local Partners

In support of the activity to be delivered by the NPHS it is recommended that local HSCWB partnerships develop a comprehensive approach to addressing physical inactivity through the establishment of local Physical Activity/ Active Living Networks or forums to co-ordinate the following activity:

  • Map opportunities and gaps in provision of physical activity.
  • Identify potential for joint working, sharing of resources, collecting and combining of local data and information and co-ordination of activity.
  • Assess physical activity needs of sedentary ‘hard to reach’ and vulnerable groups.
  • Work with Local Authorities in thedevelopment, implemention, monitoring and reviewof integratedlocal physical activity/ Climbing Higher action plans that support both the delivery of local Health, Social Care & Well-being strategiesand attainment of the Climbing Higher targets.
  • Continue to support the Physical Activity Network Wales (PAN Wales).
  • Ensure that local planning, environment and transport plans consider the potential impact on physical activity opportunities and, where necessary, include measures to ameliorate any negative impact and enhance any potential for positive impact.
  • Ensure that local physical activity strategies and action plans are complementary, synergistic and in alignment with local nutrition strategies and action plans, providing a clear focus and direction on effective actions that identify, ameliorate and prevent problems of obesity and overweight.

2.3 Professional advice and support

NPHS in partnership with its stakeholders, will constantly review the appropriate employment of evidence based programmes of activities as well as encourage innovation, exploration and evaluation of new ways of increasing physical activity in order to reduce the burden of chronic ill health associated with sedentary behaviour.

3Policy basis

Physical activity not only contributes to well being but is also essential for good health1. People who have a physically active lifestyle have approximately 50% less risk of developing coronary heart disease (CHD), stroke and type 2 diabetes compared to those who have a sedentary lifestyle, and can reduce their risk of premature death by about 20-30% 1. The evidence shows that the health impact of inactivity on coronary heart disease is comparable to that of smoking and almost as great as high cholesterol levels1. Regular physical activity is also associated with reduced risk of obesity, osteoporosis and colon cancer and with improved mental health and increased functional capacity in older adults1. This latter has been identified as a specific action point to be addressed as a ‘Health Gain’ target for Wales by “increasing the present rate of moderate-to-vigorous exercise undertaken by people aged 50 to 65 to 30 minutes on five days a week by 2012”2.

The historically high prevalence of many of these chronic diseases in Wales, particularly in those areas of worst socio-economic deprivation, coupled with high levels of sedentary behaviour, have brought the physical activity agenda to the forefront of both the public health and political agendas in recent years. The evident downward trends in activity levels are one of the principal reasons for the conversely upward trends in obesity.

With physical activity being one half of the energy balance equation, it follows that this must continue to be an important focus for national action in addressing this key priority area identified in Health Challenge Wales3.

The cost of physical inactivity in England, including direct costs of treatment for the major lifestyle related diseases, and the indirect costs caused through sickness absence, has been estimated at £8.2 billion a year1.

In 1999 The Welsh Assembly Government invited the Sports Council for Wales to convene a multi-agency ‘Healthy and Active Lifestyles’ Task Force to advise the Welsh Assembly Government on cross cutting issues that could lead to increases in physical activity levels in Wales. This culminated in 2003 in the publication of ‘Healthy and active lifestyles in Wales: A framework for action’4, which made 14 key recommendations with 41 associated ‘action points’.

In July 2003 a Sport and Active Recreation strategy ‘Climbing Higher’ was widely disseminated for consultation5. Following internal restructuring the consultation document was duly revised and launched as a key strategy document in February 20056 andIn July 2006 the Climbing Higher ‘Next Steps’7 report was published identifying a range of key actions that help inform local authority performance indicators as well as signposting the role of other agencies including the National Public Health Service.

In December 2003, the national Walking & Cycling Strategy for Wales8 was launched in recognition of the potential of these activities on health, environment and the economy. A subsequent Walking and Cycling forum has been established by the Welsh Assembly Government to affirm their commitment to the walking and cycling agenda and to ensure commitments identified within the strategy are translated into effective action. The Walking and Cycling Action Plan is due for publication in the autumn of 2006.

With the completion of the Walking to Health Wales demonstration project due in December 2006, A Succession Plan ‘Next Steps’ has been drafted by a multi-agency Advisory Group and submitted to the Welsh Assembly Government in Summer 2006.

February 2006 saw the launch of the Welsh Assembly Government’s Play Policy Implementation Plan ‘Play in Wales’9which includes a range of actions designed to increase and improve the opportunities for active play for Welsh Children.

Following a review of Welsh Assembly Sponsored Bodies in 2005, the Sports Council for Wales published their Framework for the development of Sport and Physical Activity – From Strategy to Action10, which identified a change in direction from a focus on grant management to a wider role in sport and physical activity development. The report lays out the principals and strategy that encapsulate this change of direction.

In response to the increasing prevalence of overweight and obesity, particularly amongst children, the Welsh Assembly Government established a Food & Fitness Task Group in 2004. As a result the Food & Fitness – Promoting Healthy Eating and Physical Activity for Children & Young People in Wales 5 year Implementation Plan11 was launched in July 2006 identifying a range of actions to help address the problems identified.

4Prevalence and Trends

The Welsh Health survey in 19987 indicated that levels of physical inactivity were amongst the worst in Europe with only 28% achieving the recommended minimum of 30 minutes moderate activity on five or more days of the week12. Provisional results from the latest survey (unpublished) indicate a slight improvement, but with still only 30% achieving the recommended minimum (men 38% but women only 24%). Of particular concern is the finding indicating that inactive lifestyles in England and Wales have more than double the prevalence of smoking, hypertension or high cholesterol1. Prevalence of inactivity increases with age in both men and women. It appears that over the last 20-30 years there has been a decrease in physical activity as part of daily routine, though there has been a small increase in the proportion of people taking physical activity for leisure1.

The strong correlation between social class and physical activity levels1, is supported by results from the Welsh Health Survey12. Low educational attainment also appears to be a strong predictor of high inactivity levels1.

Despite the evident increase in obesity amongst children and young people, recent trends in physical activity offer some hope. Whilst there appear to have been no major changes between 1997 and 2002, there was an increase for young people who did at least 30 minutes activity each day, improving from 64% to 73% for boys and from 51% to 65% in girls. In Wales between 1996 and 2000 there was an increase in young people participating in activity on four or more occasions a week, and in the percentage of those participating in activity for four hours or more a week13. It should be noted, however, that about 30% of boys and 40% of girls are still not meeting the recommended activity guidelines and two in 10 boys and girls do less than 30 minutes physical activity a day14.

5Investment for Health principles

Evidence suggests that interventions that concentrate on behaviour modification tend to work only in the short term. Individual behaviour is influenced by a range of external factors which in the case of physical activity, conspire to make the maintenance of such behaviour difficult. There is an increasing realisation that these external influences must be addressed to reverse the trend of inactivity and to enable people to affect a sustainable transition to a more active lifestyle.

Those activities that are easy to incorporate into people’s daily lives are much more likely to offer long-term sustainability15. Regular brisk walking, for example, can confer huge health benefits for an otherwise sedentary individual, and there are a number of high profile programmes designed to promote this16. But in many areas it is perceived as simply not safe to walk, for a whole range of reasons, and, in many instances, street design and traffic flow priorities deliberately deter walking.Voluntary sector organisations such as Living Streets and Sustrans can provide information, advice and support in tackling some of these problems.

Ottawa Charter Principles Applied to Physical Activity (Local)

Changes in work patterns, increasing automation, the litigation culture, proliferation of media-based entertainment, town planning, diminishing green space, changing school curriculum and increasing reliance on the car have combined to provide what has been called the ‘obesogenic environment’17. Consequently the focus of public health attention in this field is now moving toward a social ecological model built on the five principles of the Ottawa Charter, but with rather less emphasis on ‘developing personal skills’ and rather more on ‘creating supportive environments’18.

Generating the changes that are likely to be required demands collaborative working across a range of disciplines including urban & rural planning, traffic management, architecture & design and many others. Engaging with such disciplines may be difficult at first but is critically important and the NPHS will work with the Welsh Assembly Government and the Welsh Local Government Association to provide guidance on ways in which such collaborations can be effectively established. This reflects the key message about public services working more closely together in the Welsh Assembly Government’s Policy document ‘Making the Connections: Delivering Better Services for Wales’19.

6Effectiveness of physical activity interventions

The evidence base on effectiveness of public health interventions in physical activity is mixed with complete gaps in review level evidence in some areas such as workplace, adults with physical limitations and adults from black and minority ethnic groups20. A full explanation of the evidence of the effectiveness of physical activity interventions, on which this paper is based, is available at: and following the links under ‘Resource Teams’ through the ‘Wider determinants and Inequalities’ to Background Information Sources and clicking on ‘Physical Activity’.

7Current activity supported by the NPHS

Currently staff based within local NPHS teams are involved in a wide range of initiatives to support physical activity. An internal network of physical activity specialists has been established to share good practice and information and to provide continuity across the organisation and support for stakeholders.The physical activity agenda is broad, and, whilst there is some work with a specific focus on physical activity, there are a range of local programmes and projects that encompass elements of physical activity as a part of other initiatives. The breadth of this activity is identified in appendix 1.These supported activities will vary according to the expertise and capacity in local teams and is also influenced by local priorities.

8Further information

For further information on the contents of this paper please contact:

References

  1. Department of Health - At least 5 a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. Dept of Health Publications April 2004.
  2. Welsh Assembly Government – Targeting health improvement for all: Health gain targets (National high-level targets and indicators for Wales). Welsh Assembly Government, 2004.
  3. Welsh Assembly Government - Health Challenge Wales: Question and Answer briefing. Welsh Assembly Government. August 2004.
  4. Welsh Assembly Government – Healthy and active lifestyles in Wales: A framework for action. Welsh Assembly Government. June 2003.
  5. Welsh Assembly Government – Climbing Higher: Sport and Active Recreation in Wales – Strategy for consultation. Welsh Assembly Government. July 2003
  6. Welsh Assembly Government – Climbing Higher: Thje Welsh Assembly Government Strategy for Sport and Physical Activity. Welsh Assembly Government. January 2005.
  7. Welsh Assembly Government – Climbing Higher: Next Steps. Welsh Assembly Government. July 2006.
  8. Welsh Assembly Government – Walking and cycling strategy for Wales. Welsh Assembly Government. December 2003.
  9. Welsh Assembly Government – Play Policy Implementation Plan: Play in Wales. Welsh Assembly Government. February 2006.
  10. Sports Council for Wales – Framework for the Development of Sport & Physical Activity: From Strategy to Action. Sports Council Wales. 2006.
  11. Welsh Assembly Government – Food & Fitness-Promoting Healthy Eating and Physical Activity for Children and Young People in Wales (5 year Implementation Plan). Weslh Assembly Government. June 2006.
  12. National Assembly for Wales – Welsh Health Survey 1998: Results of the second Welsh health survey. National Assembly for Wales. 1999.
  13. Welsh Assembly Government – Health Status Wales 2004-05: Chief Medical Officer’s Report Series. Welsh Assembly Government. 2005.
  14. British Heart Foundation – Couch kids: the continuing epidemic. British Heart Foundation. 2004.
  15. Hillsdon M, Foster C, Naidoo B and Crombie H – The effectiveness of public health interventions for increasing physical activity among adults: a review of reviews. Health Development Agency. February 2004.
  16. Bird W and Reynolds V – Walking for Health. Pub: Carroll and Brown. 2002.
  17. House of Commons Health Committee – Obesity: Third report of session 2003-04 Volume 1. Pub House of Commons. 27th May 2004.
  18. Sallis JF and Owen N – Health Behaviour and Health Education (Ed. Glanz K, Lewis FM, Rimmer BK) Ecological Models. Ch 19. Pub: Jossey Bass. 1997.
  19. National Public Health Service for Wales – Interventions to change the wider determinants of health: What works? – Briefings based on systematic reviews and Health Evidence Bulletins Wales – Physical Activity. National Public Health Service. January 2005.
  20. National Assembly for Wales - Health at Work: The Corporate Standard. National Assembly for Wales. 2000.
  21. Welsh Assembly Government – Making the Connections: Delivering Better Services for Wales. Welsh Assembly Government. October 2004.

Appendix 1.