Physical activity – a national perspective

PAN-WM, 27 March 2007

Alison Giles, Physical Activity programme manager, DH

In April 2006, the Prime Minister asked Caroline Flint to develop a cross-government strategy to transform the population into a fitterand more active nation in the run up tothe 2012 Olympic and Paralympic Games.

This builds on the commitments set outin the Choosing Health White paper.

What are government departments currently doing?

What should they be doing?

What should cross-government working look like?

Early years School age 18-25 Adults Older peopleParents

everyday PA

episodic PA

DCMS/Sport England

Adult sport PSA

DfT/Cycling EnglandPromoting walking and cycling

DCMS/DfES

PESSCL

DCMS Play

DHHealthy Ageing

= impact as function of clarity of focus x leadership x resources (DH qualitative perspective)low medium high

DHHealthy Living Social

Marketing Programme

DfT/DfESTravel to School active

travel

What departments are doing

Healthy schools

fitness

sport

active recreation and play

DEFRApromoting active recreation

DfT/ DEFRA / DTI

PSA 3 Public transport

PSA 4 Congestion

PSA 5 Road accidents

PSA 6 Air quality

PSA 7 Climate change

DEFRA

PSA 3 Countryside

DCMS / Sport England

PSA 3 Adult sport and active recreation

DCMS / DfES

Sport facilities

DfT

Walking and cycling action plan

DCMS / DfES

PSA 1 PE, school sport and club links

DEFRA / Nat. England

Health benefits of outdoor recreation

DH

PSA 3 Child obesity (with DfES and DCMS)

PSA 1 CHD mortality

DCLG

PSA 6 Planning

PSA 8 Cleaner Safer Greener

= PSA = supporting action

What drives departments?

DCMS

Play

DfT / DfES

School travel

PA Implicitno PA targetno audience

PA Explicitspecific PA

target(s)audience identified

DWP

PSA Workplace Health & Safety

Game Plan* priorities - progressTo increase mass participation in physical activity and

sport, we need to:

Support children and young peopleTo build a life-long participation.

Target specific groups who are below the national average in terms of participationLower socioeconomic groups, ethnic minorities, women, disabled.

x Target the sedentaryThis is where the greatest health gains will be made.

x Support older peopleMost to gain in terms of short-term health benefit and delaying or preventing the effects of ageing

*Strategy Unit/DCMS. 2002

Proportion of adult population that is sedentary, by age and sex

0

10

20

30

40

50

60

70

80

90

16-24 25-34 35-44 45-54 55-64 65-74 75 & over

Age group

Men

Women

(Source: Health Survey for England 2003)

Target the sedentary and older people

The effects of activity on disease risk

Childhood Adolescence Youngadulthood

Middleadulthood

Oldadulthood

Impaired growth & development

Risk factors

Diseases and disorders

Death

RISK

ACTIVE

INACTIVE

(Source: “At Least Five a Week” CMO 2004)

As people get older the health gap between active and inactive people widens

Becoming active at any stage in life decreases that health gap significantly

ITS NEVER TOO LATE TO START EXERCISING!

Role of DH

1. Develop the evidence base

2. Promote health benefits of all types of activity

3. Focus on sedentary and older adults

4. Develop a social marketing strategy

5. Identify mechanisms to engage NHS in physical activity promotion

6. Increase regional capacity

7. Deliver a health legacy from 2012 Games

8. Advocate action across government

Engaging the NHS

Patient activity questionnaire

NHS physical activity care pathway

National Step-O-Meter programme

Health trainers

Practice-based commissioning?

GP PA questionnaire

General Practice Physical Activity Questionnaire

Patients 16-74

Self-completion (30 seconds)

Identification of patients who would benefit from increased physical activity

Available from www.dh.gov.uk

GPPAQ

A Exercise Referral

B Condition Specific

C Self Management

Clinical Need

D Activity Clinic Support• Advice• Buddying• Helpline• Drop-in• Incentives• Discounts

A Exercise Referral

B Condition Specific

C Self Management

Clinical Need

D Activity Clinic Support• Advice• Buddying• Helpline• Drop-in• Incentives• Discounts

• BI syllabus• BI script• Advise• Agree• Negotiate

Goals0 – 30 minInactive

30 min –1.5 hr

Mod Inactive

1.5 – 2.5 hrMod Active

2.5 hr+Active

PAIClassification

0 – 30 minInactive

30 min –1.5 hr

Mod Inactive

1.5 – 2.5 hrMod Active

2.5 hr+Active

PAIClassification

Opportunistic

Existing Condition Clinic

Health Screening

Seeking Advice

Practice Nurse

Leaflet Raise issueBenefitsRecordRe-check 3/12

Assess motivation:PrecontemplationContemplationPreparationAction

Not Motivated

Mot

ivat

ed

Jo Foster / John Harkin

NHS London / Sport England London

No

YesInactive

Yes

NoModerately Active or Moderately Inactive

Pre existing Medical Condition

Assist/Arrange

No

YesInactive

Yes

NoModerately Active or Moderately Inactive

Pre existing Medical Condition

Assist/Arrange

Patient

Hea

lth P

rofe

ssio

nals

Draft Primary Care Physical Activity Care Pathway (Adult)

RecordPraiseEncourageIncentivise

BRIEF INTERVENTION

SERVICE DELIVERY OUTCOME MAINTENANCE

Parks & Green Spaces

Active Daily Living (Gardening, DIY)

Active Workplace

Pedometer Prgm

Active Travel

B S

elf D

irect

ed A

ctiv

ity

Fit Club

Sports Clubs

Local Classes

Walk Group

A S

truct

ured

Act

ivity

Green Exercise

Leisure Centre

Condition Unlimited

BI follow-up @ 3 mths

Success

Relapse

Review @ 6 mths

Success

Relapse

Review @ 12 mths

Relapse

1

32

4

5

6

7

89

10

11

12

13

14

15

16

17

18

BRIEF ADVICE

RELAPSE LOOP

ADHERENCE LOOP

GP PAQ

Increasing regional capacity

To work across the GO to influence regional and local plans;

To develop a social marketing approach to delivering regional physical activity and sport strategies, and attract match funding where appropriate;

To ensure senior engagement with the regional sports board, and maximise opportunities for joined up action on physical activity and sport. To engage with the delivery system at the regional, sub-regional and local level;

Increasing regional capacity

To develop a regional Health & 2012 delivery plan that complements the national plan;

To develop plans to maximise the engagement of the NHS in promoting physical activity and sport;

To work in partnership with obesity, food and health, and healthy schools leads to ensure a joined-up approach to tackling obesity.

Role of government departments

1. Focus on their own contribution

2. Get their own house in order

3. Set national policy framework

4. Identify levers to local action

5. Remove barriers to local action

6. Develop regional and local capacity

Walking and cycling

Department for Transport has concluded that:

1. One in 5 of all car journeys are less than 1 mile. By shifting these to bicycle or foot, traffic congestion would become a thing of the past.

Game Plan and Choosing Activity identify that:

2. Walking and cycling provide important opportunities for activity for both young people and adults

3. Walking and cycling are two of the four main activities that continue from childhood to adulthood

The Health Development Agency has concluded that:

4. Activities that do not require specific equipment or facilities are more likely to be maintained long-term

Walking and Cycling - Trends

(Source: National Travel Survey: 1999-2001 Update - figures exclude walking and cycling for leisure)

0

50

100

150

200

250

300

1975-76 1985-86 1989-91 1992-94 1995-97 1998-00 1999-01

Walking

Bicycle

Average miles travelled per person per year

The future…..

…is uncertain

PSA targets are changing and reducing

More local ownership Change of leadership? Change of approach to tackling

obesity?