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Transcript of “Evidence into Action”: How to create societies that provide ongoing physical activity support...
“Evidence into Action”: How to create societies that provide ongoing
physical activity support and promotion
Dr Karen MartinSchool of Population Health,
The University of Western Australia
The Oxford Health Alliance Summit 2011
Creating active communities requires a multidimensional approach
Policies
Programs
Sustainable???
Partnerships
Planning and place
Before focusing on PA supportive environment - infrastructure for basic needs is priority (WHO Kobe Meeting Healthy Urban Planning)
1. Local economic development2. Safe, affordable and appropriate shelter3. Appropriate sanitation and drainage systems
Basic environmental needs come first
opportunity for redevelopment to support health including physical
activity…
rather than just redevelopment…..
Planning and place
Govt agreed to substitute the walls combination of stretches of • nature paths, including handrails for people with mobility problems • bicycle and skating paths • playgrounds
Rio de Janeiro, Brazil
Developing country example
Prioritise infrastructure improvements Hoehner, 2011
– comprehensive sidewalks– medians– crosswalks– street lighting– bike lanes– plantings
How to plan environments to support PA?
Planning and place
City of 7 million, of these 3 million live in poverty
Bogota’s former mayor shifted budgets intended forhighways to parks bike lanes mass-rapid public transit
Bogotá, Columbia
“I was almost impeached for getting cars off sidewalks which car owning upper classes had illegally appropriated for parking.”
Enrique Peñalosa, Mayor
Developing country example: focus on planning
300 km of bicycle lanes, stretch from the slums & suburbs into the capital
Ongoing project under concurrent development
Since lanes constructed, bicycle use increased by 5 x in the city
Between 300,000 and 400,000 trips made daily in Bogotá by bike
Bogotá, Columbia
Active commuting plus increasingpedestrian access
Ciclovia... Street closures
“I realized that we in the Third World are not going to catch up to the developed countries for two or three hundred years. If we defined our success just in terms of income per capita, we would have to accept ourselves as second- or third-rate societies – as a bunch of losers – which is not exactly enticing for our young people. So we are forced to find another measure of success. I think the only real obvious measure of success is happiness.”
Enrique Peñalosa
Bogotá, Columbia
Also some programs…
1. Point of decision prompts (Kahn 2002)
strong evidence for effect effect sizes net increase from 2.5% to 128.6%
(see U Tube; piano stairs, the fun theory and Fast lane, the slide
2. Mass media campaigns (Leavy 2011)
few studies show effective reduction in PA when combined with other strategies (such as community involvement) may
be effective
What works??
Programs
Recent review of mass media PA campaigns campaigns reported higher awareness
• women• tertiary education• physically active women• women with active children
(Leavy 2011)
Messages and materials culturally adapted to specific populations improves intervention effectiveness (Müller-Riemenschneider 2008)
Mass-media interventions create awareness but not good investment for changing behavior when used alone (Müller-Riemenschneider 2008)
Do mass media programs preach to the converted???
more on mass media programs….
3. Community-wide programs/campaignsMass media plus social support
strong evidence for effect
4. School based programs↑ PE class (number/length),↑ MVPA, mandating PE
strong evidence for effect barriers: school or system based
5. Social support in community settingsSupport groups outside family, e.g. walking groups
strong evidence for effect barriers: costly, target fewer people
6. Individually adapted health behaviour change programsTeach participants specific skills relevant to their situation
strong evidence for effect barriers: costly, target fewer people
(Kahn 2002)
Programs
PA promotion in Perth, Western Australia Western Australia, 2.3 mill, Perth city 1.7 mill, temperate climate
• Various government and not-for-profit programs to promote PA Find 30 everyday (adult- encourage 30 minutes each day)
Be active (Physical activity taskforce, beactive.wa.gov.au)
Travelsmart (encourage active transport transport.wa.gov.au/14890.asp)
• 61% respondents in recent adult survey were aware that 30 minutes of moderate-intensity PA is required on most days for good health.
s
Isolated city example: focus on programs
Adults; proportion participating in sufficient activity
1999 2002 2006 200950%
60%
70%
Proportion of adults sufficiently active in Western Australia btw 1999 and 2009
significant difference p< 0.05
PA trends in Perth, Western Australia
PA trends in Perth, Western Australia
Children’s physical activity remained stable between 2003 and 2008
41%59%
Primary school boys
met guidelines didn’t meet guidelines
27%
73%
Primary school girls
met guidelines didn’t meet guidelines
38%62%
Secondary school boys
met guidelines didn’t meet guidelines
10%
90%
Secondary school girls
met guidelines didn’t meet guidelines
Take advantage of climate and place: Eg programs,
Nature Play natureplaywa.org.au
Opportunities in Perth….
Planning and infrastructure
Promising strategies and partnerships
Parks and recreation agencies (Bruton 2011)
Partnerships with schools e.g. sharing facilities, access to oval out of hours (Bruton 2011)
co-locating: with parks? community hub? 1. Maryland (co-location program)
2. Rosa Parks School, Oregonedfacilities.org/rl/community_use.cfm
Community participation (Bruton 2011)
Partnerships
San Diego County Childhood Obesity Initiative (COI)
Public/private partnership advocacy policy development environmental change government, healthcare, school and after school,
early childhood, community, media and business.
Early policy change success (school, workplace policies, planning policies etc)
Developed country example: focus on partnerships
Find a common agenda and shared solutions effectively engages partners from different sectors. e.g. climate change
Leadership and political will on multiple levels is critical
(Linton 2011)
(San Diego County COI)
Childhood Obesity Initiative recommendations
West Virginia University Department of Community Medicine
Place• Upgrading and connecting local trails
• Adding rest rooms and telephones
• Improving overall safety & aesthetics
• planning for an urban state park
• University engineering team to develop walkable community plan
Programs•mass media•involved local physician –prescription for walking•walking clinic
Developed country example: multifaceted
(Reger-Nash 2005)
Partnerships:
• On-going Walkable Wheeling Task Force (initiated by mayor)
• Local schools to expand youth physical activity
• Local clubs to develop walking opportunities
• Engaged city agencies—mayor, streets, highways, parks, law enforcement, planning, local clubs, government,
• Schools, press, businesses, medical society, other stakeholders
• Community advisory committee helped plan campaign
Wheeling Walks, West Virginia
Evaluation measuresMedia exposureSelf reported walking
Outcome30% of Wheeling's sedentary residents increased their walking to the recommended level compared to a 16% increase in a control community (14% net increase in Wheeling)
The cost pp to change sedentary to regular walker =$26.32 pp/per month.
Wheeling Walks, West Virginia
Results of intervention
Blue Zones Vitality Project, Albert Lea
http://www.bluezones.com/programs/vitality-cities/
Habitat
Community
Social Networks
Inner-self
Developed country example: multifaceted
Changes to the community
Partnerships:• AARP and the United Health Foundation funding• Local government• 60% city’s local restaurants, 51% largest employers, every school• Social, commercial, communal and professional networks
City of 18 000 people 25% participated in program
component
Initial program cost = approx $750 000
Albert Lea
Place• Workplace modifications• Space for community gardens• Bike and walking paths connected
Programs• Walking school bus and adult walking
teams• Standing or walking meetings
Policies• Amended school and workplace wellness
policies
Changes to the community
Albert Lea
Results of intervention
Project longevity:3.2 yrs
PA and weight:•Engaged in more PA•lost average 1.5 kg (every member of the community)
Other health benefits:•20% reduction in absenteeism for key employers •49% decrease in health care costs of city employees
Successful interventions are run by people who know the community and recommendations are specific and appropriate
(bespoke!)
Sustainable???
Albert Lea
Agita São Paulo, Brazil
• 37 mill State of Sao Paulo, started in 1996• WHO praised program as model for developing countries• Scientific board and executive board
Outcomes Reach: 60% Recall and knowledge: well distributed different socioeconomic groups The prevalence of people reaching the PA recommendation was 54.8%
Risk of being sedentary was smaller amongst those who knew the Agita message (7.1%) compared with those who did not know (13.1%).
Example in developed country: multifaceted
Key elements for program success
Agita São Paulo, Brazil
Scientific based information (university research centre)
Inclusion principle
Stakeholders
Simple message: “At least 30 min of PA per day”
Appropriateness of PA interventions
Linking existing policies
Cultural links
Specific messages relevant to intrapersonal factors
Qualitative and quantitative evaluation
Political and technical support
Participants choose enjoyable activities
• every year since 1997• Every public schools and hundreds of
private schools• students participate in sports events
and a neighborhood walk
Agita São Paulo, Brazil
Agita Galera Day (Active Community Day)
recreational facilities:• availability
• accessibility • convenience
physical activity equipment
having a companion
psychosocial (e.g. enjoyment, expected
benefit)
(Sallis 2002, Wendel-Vos 2007)
healthy diet
program access
social support
SES education level
age (-)
sex (male)
race (white)
overweight/obese (-)
Climate/season
physician influence
Adult physical activity correlates
sex (male)intention to be
active
physical activity preferences
parental overweight status (-)
program access
perceived barriers (-)
previous physical activity
healthy diet
time spentoutdoors
Child physical activity correlates
perceived activity
competence
(Sallis 2000, Davidson 2007)
recreational infrastructure (access
to recreationalfacilities and schools).
transport infrastructure (sidewalks/controlled
intersections/ destination access / public transportation
local conditions (crime, area deprivation) (-)
transport infrastructure (N roads to cross/traffic density&speed) (-)
sex (male)
depression (-)
intentions
ethnicity (white)
previous physical activity
community sports
sedentary after school and on weekends (-)
opportunities to exercise
Adolescent physical activity correlates
sensation seeking
support from others
sibling physical activity
direct helpfrom parent & parent support
recreational infrastructure (access
to recreationalfacilities and schools).
transport infrastructure (sidewalks/controlled
intersections/ destination access / public transportation
local conditions (crime, area
deprivation) (-)
transport infrastructure (N roads to cross/traffic density&speed) (-)
(Sallis 2000, Davidson 2007)
age (-)
physical activity preferences
LOCAL COMMUNITY SPECIFICITY….
Example (low SES suburb, WA)
1. overweight & obesity rates/physical activity/low SES adolescents
2. place and partnerships
3. improving perceptions of safety, increased maintenance of skate parks (local council), working with schools to promote sport
Be locally specific with…..
1. identifying health promotion priorities
health issue/behaviour/target group
2. identifying strategy (i.e. program, planning and place/partnerships/policy)
3. identifying priority target
EFFECTIVE LOCAL STRATEGIES
1. Lobbying/partnerships with policy
makers
2. Brief brochures summarising
research findings to
stakeholders/policy makers (plus
journal publications)
3. Partnerships to help identify priorities
Take home messages…..
1. Opportunities within developing countries to plan for PA
2. Remove barriers to physical activity
3. Programs alone are not enough
4. Identify and target correlates
5. Community wide approaches with community ‘buy-in’
6. Ask how can we create sustainable changes in the local community?
How can
governments and
people in power be
motivated to act
and prioritise?
Need to build an evidence base about
what works, what doesn’t ?
What are
barriers to
implementing
and sustaining
effective
programs?
More in-situ research (program evaluation)
How can programs be developed in
times of economic downturn?
Challenges for researchers....
More emphasis on interventions
“Over the past 80 years we have been building cities for cars much more than
for people. If only children had as much public space
as cars, most cities in the world would become
marvelous.”Enrique Peñalosa
References
•Bruton 2011 Active Living Research Annual Conference 2011
•Hoehner 2011 Active Living Research Annual Conference 2011
•Kahn 2002 Am J Prev Med 2002 22 (4s) 73-107
•Linton 2011 Active Living Research Annual Conference 2011
• Leavy 2011 Physical activity mass media campaigns and their evaluation: a systematic review of the literature 2003-2010 Health Education Research Accepted March 2011
•Matsudo 2004 J Phys Act Health 2004; 81-97
•Matsudo 2010 Med Sci Sports Exerc 2010; 45 (12); 2231
•Reger-Nash 2005 Fam Community Health 2005;28:64-78
•Sallis 2000 Med Sc Sports Exerc 2000; 32(5):963-975
•Sallis 2002 Med Sc Sports Exerc 2002 34(12) 1996–2001
•Wendel-Vos 2007 Obesity reviews 2007 8 (5) 425
Enrique Peñalosa http://www.pps.org/articles/epenalosa-2/