Physical activity

Short Text

This pathway covers interventions, programmes and strategies to encourage people of all ages to be physically active.

Introduction

Increasing physical activity levels will help prevent and manage over 20 conditions and diseases including cancer, coronary heart disease, diabetes and obesity. It can also help to promote mental wellbeing. So it is important that people incorporate regular physical activity into their daily lives.
This pathway includes recommendations for children, young people and adults, including teenage girls and women before, during and after pregnancy.
The recommendations cover policies and strategies to improve the physical environment as a means of encouraging physically active travel and other physical activities. In addition, they advise on action that the NHS and others in the community, workplaces and schools can take to encourage people to be physically active.
Please note, recommendations from NICE's obesity guidance have only been included in this pathway if they refer specifically to physical activity.
Align actions to promote physical activity with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).

Source guidance

The NICE guidance that was used to create the pathway.
Obesity. NICE clinical guideline 43 (2006)
Weight management before, during and after pregnancy. NICE public health guidance 27 (2010)
Prevention of cardiovascular disease. NICE public health guidance 25 (2010)
Promoting physical activity for children and young people. NICE public health guidance 17 (2009)
Promoting physical activity in the workplace. NICE public health guidance 13 (2008)
Maternal and child nutrition. NICE public health guidance 11 (2008)
Physical activity and the environment. NICE public health guidance 8 (2008)
Four commonly used methods to increase physical activity. NICE public health guidance 2 (2006)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Assessment tool

The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Weight management before, during and after pregnancy: self-assessment tool
Prevention of cardiovascular disease: self-assessment

Commissioning guide

Commissioning guides provide information on key clinical and service-related issues to consider during the commissioning process. Each guide contains a commissioning and benchmarking tool, which is a resource that can be used to estimate and inform the level of service needed locally as well as the cost of local commissioning decisions.
Maternal and child nutrition: commissioning guide

Education tools

NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.
Complications in pregnancy: online educational tool.

Information resources and templates

These include key points for scrutiny or compliance assessment, signposting to resources, checklists and case studies. They are designed to offer practical help in putting NICE guidance into practice and the format depends on the specific topic.
Weight management before, during and after pregnancy: questionnaire
Prevention of cardiovascular disease: checklist
Promoting physical activity for children and young people: resources guide
Physical activity and the environment: checklist

Service planning

Providing implementation advice, these tools help people to plan or deliver services. They can include an overview of the key steps and decision points in the care pathway and suggestions for putting the guidance into practice locally.
Four commonly used methods to increase physical activity: implementation advice

Slide sets

Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Weight management before, during and after pregnancy: slide set
Prevention of cardiovascular disease: slide set
Promoting physical activity for children and young people: slide set
Promoting physical activity in the workplace: slide set
Maternal and child nutrition: slide set
Physical activity and the environment: slide set

Pathway information

Updates to this pathway

25 October 2011 Minor maintenance updates
25 May 2012 Minor maintenance updates
28 November 2012
Links to the 'Walking and cycling' pathway have been added to:
Links to the 'Mental wellbeing and older people' pathway have been added to:
Information about obesity prevention added to introduction, Programme resources, leadership and evaluation, Environment and physical activity, Recommendations about local strategy, policy and commissioning, Local strategy and policy and Addressing health inequalities.

Supporting information

Physical activity and the environment

It is important to improve the environment to encourage physical activity and evaluate how such improvements impact on the public's health.
Most of NICE's recommendations on physical activity and the environment are relevant when developing local transport plans and guidance using, for example, planning policy guidance 13.
All the recommendations are relevant when developing joint NHS and local authority strategies. They are also relevant when planning and managing the NHS (including its premises).

Physical activity at work

Many employers recognise that they have an obligation to the health and wellbeing of their workforce. Investing in the health of employees can also bring business benefits such as reduced sickness absence, increased loyalty and better staff retention.
NICE's recommendations aim to help employers and workplace health professionals prevent the diseases associated with a lack of physical activity. The recommendations alone will not reverse the current obesity epidemic or other health trends associated with a sedentary lifestyle. However, efforts made in the workplace, alongside wider strategies to increase physical activity levels, could help improve people's health significantly.

Children and young people: key themes

  • Promoting the benefits of physical activity and encouraging participation
  • Ensuring high-level strategic policy planning for children and young people supports the physical activity agenda
  • Consultation with, and the active involvement of, children and young people
  • The planning and provision of spaces, facilities and opportunities
  • The need for a skilled workforce
  • Promoting physically active and sustainable travel.

A national framework for action

Cardiovascular disease (CVD) is a major public health problem. Changes in the risk factors can be brought about by intervening at the population and individual level. Government has addressed – and continues to address – the risk factors at both levels.
Interventions focused on changing an individual's behaviour are important. But changes at the population level could lead to further substantial benefits.
Population-level changes may be achieved in a number of ways but national or regional policy and legislation are particularly powerful levers. See prevention of cardiovascular disease.
The national framework would be established through policy, led by the Department of Health. It would involve government, government agencies, industry and key, non-governmental organisations working together.
The final decision on whether these policy options are adopted – and how they are prioritised – will be determined by government through normal political processes.

Helping women to achieve and maintain a healthy weight

Women will be more likely to achieve and maintain a healthy weight before, during and after pregnancy if they:
  • base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible
  • eat fibre-rich foods such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta
  • eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories
  • eat a low-fat diet and avoid increasing their fat and/or calorie intake
  • eat as little as possible of fried food; drinks and confectionery high in added sugars (such as cakes, pastries and fizzy drinks); and other food high in fat and sugar (such as some take-away and fast foods)
  • eat breakfast
  • watch the portion size of meals and snacks, and how often they are eating
  • make activities such as walking, cycling, swimming, aerobics and gardening part of everyday life and build activity into daily life – for example, by taking the stairs instead of the lift or taking a walk at lunchtime
  • minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games
  • walk, cycle or use another mode of transport involving physical activity.
Weight-loss programmes are not recommended during pregnancy as they may harm the health of the unborn child.

Physically active travel

Travel offers an important opportunity to help people become more physically active. However, inactive modes of transport have increasingly dominated in recent years. In England, schemes to encourage people to opt for more physically active forms of travel (such as walking and cycling) are 'patchy'.

Glossary

Access (accessibility) can mean that a particular place or destination is accessible to local residents using a mode of transport that involves physical activity. Destinations may include work, healthcare and education facilities and shops. It can also mean the ability to use a facility because, for instance, it is free or affordable, it does not require people to travel a long distance to use it and the environment and activities are suitable for those with disabilities. Examples of facilities include playgrounds, parks or open spaces and leisure, youth or community centres.
The Children's Play Council (now Play England) defines play as: ' …freely chosen, personally directed, intrinsically motivated behaviour that actively engages the child...' Active play involves physical activity.
Cardiovascular disease (CVD) includes coronary heart disease (CHD), stroke and peripheral arterial disease. These conditions are frequently brought about by the development of atheroma and thrombosis (blockages in the arteries). They are also linked to conditions such as heart failure, chronic kidney disease and dementia.
An exercise referral scheme directs someone to a service offering an assessment, development of a tailored physical activity programme, monitoring of progress and follow-up. It involves participation by a number of professionals and may require the individual to go to an exercise facility such as a leisure centre.
Mental wellbeing has been defined as life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support. See NHS Health Scotland Mental health improvement programme, background and policy context
Moderate-intensity activity increases breathing and heart rates to a level where the pulse can be felt and the person feels warmer. It might make someone sweat on a hot or humid day (or when indoors).
Children and young people should undertake a range of activities at this level for at least 60 minutes over the course of a day. At least twice a week this should include weight-bearing activities that produce high physical stresses to improve bone health, muscle strength and flexibility. This amount of physical activity can be achieved in a number of short, 10-minute (minimum) bouts.
Movement skills use skeletal muscles to achieve a physical goal. They are learnt and refined throughout life. Gross movement skills include: rolling over, sitting up, crawling, walking, running, jumping, hopping and skipping. Fine movement skills include the ability to manipulate small objects and transfer them from hand to hand, and tasks that involve hand-eye coordination.
Occupational therapy aims to enable people who have physical, mental and/or social needs, either from birth or as a result of accident, illness or ageing, to achieve as much as they can to get the most out of life.
A school travel plan is a written document detailing a package of measures to improve safety and reduce car use, backed by a partnership involving the school, education and local authority transport officers, the police and the health authority. It is based on consultation with teachers, parents, pupils and governors and other local people. It must include: information about the school, a description and analysis of journeys made and the associated problems, a survey of pupils' current and preferred mode of travel, consultation findings, clearly defined targets and objectives, details of proposed measures and a timetable for implementation, clearly defined responsibilities and proposals for monitoring and review.
Sport is all forms of physical activity which, through casual or organised participation, aim at expressing or improving physical fitness and mental wellbeing, forming social relationships or obtaining results in competition at all levels.
Traffic calming is a means of restricting vehicle speeds, primarily using traffic engineering measures such as speed bumps.
Walking and cycling schemes are defined as organised walks or rides.
Weight management before, during and after pregnancy includes:
  • assessing and monitoring body weight
  • preventing someone from becoming overweight (body mass index [BMI] 25-29.9 kg/m2) or obese (BMI greater than or equal to 30 kg/m2)
  • helping someone to achieve and maintain a healthy weight before, during and after pregnancy by eating healthily and being physically active and gradually losing weight after pregnancy.

Specific conditions

Encouraging physical activity to prevent or treat specific conditions

Managing obesity

Managing obesity

Children and young people

Children and young people

Children and young people

Children and young people should be encouraged to increase their physical activity even if they do not lose weight as a result, because of the other health benefits exercise can bring, such as reduced risk of type 2 diabetes and cardiovascular disease. Children should be encouraged to do at least 60 minutes of at least moderate activity each day. The activity can be in one session or several lasting 10 minutes or more.
Children who are already overweight may need to do more than 60 minutes' activity.
Children should be encouraged to reduce sedentary behaviours, such as sitting watching television, using a computer or playing video games.
Children should be given the opportunity and support to do more exercise in their daily lives (such as walking, cycling, using the stairs and active play). The choice of activity should be made with the child, and be appropriate to their ability and confidence.
Children should be given the opportunity and support to do more regular, structured physical activity, such as football, swimming or dancing. The choice of activity should be made with the child, and be appropriate to their ability and confidence.

Source guidance

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Adults

Adults

Adults

Adults should be encouraged to increase their physical activity even if they do not lose weight as a result, because of the other health benefits physical activity can bring, such as reduced risk of type 2 diabetes and cardiovascular disease. Adults should be encouraged to do at least 30 minutes of at least moderate-intensity physical activity on 5 or more days a week. The activity can be in one session or several lasting 10 minutes or more.
To prevent obesity, most people should be advised they may need to do 45-60 minutes of moderate-intensity activity a day, particularly if they do not reduce their energy intake. People who have been obese and have lost weight should be advised they may need to do 60-90 minutes of activity a day to avoid regaining weight.
Adults should be encouraged to build up to the recommended levels for weight maintenance, using a managed approach with agreed goals.
Recommended types of physical activity include:
  • activities that can be incorporated into everyday life, such as brisk walking, gardening or cycling
  • supervised exercise programmes
  • other activities, such as swimming, aiming to walk a certain number of steps each day, or stair climbing.
Any activity should take into account the person's current physical fitness and ability.
People should also be encouraged to reduce the amount of time they spend inactive, such as watching television or using a computer.

Source guidance

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Mental wellbeing and older people

View the 'Mental wellbeing and older people overview' path

Preventing CVD

View the 'Preventing CVD' node

Weight management and pregnancy

Weight management and pregnancy

Weight management and pregnancy

(For a definition, click on weight management.)
Reputable sources of information and advice about diet and physical activity for women before, during and after pregnancy include: The pregnancy book, Birth to five and the Eat well website.

All women

Women before, during and after pregnancy

Women before, during and after pregnancy

Helping women to achieve and maintain a healthy weight

Women will be more likely to achieve and maintain a healthy weight before, during and after pregnancy if they:
  • base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible
  • eat fibre-rich foods such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta
  • eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories
  • eat a low-fat diet and avoid increasing their fat and/or calorie intake
  • eat as little as possible of fried food; drinks and confectionery high in added sugars (such as cakes, pastries and fizzy drinks); and other food high in fat and sugar (such as some take-away and fast foods)
  • eat breakfast
  • watch the portion size of meals and snacks, and how often they are eating
  • make activities such as walking, cycling, swimming, aerobics and gardening part of everyday life and build activity into daily life – for example, by taking the stairs instead of the lift or taking a walk at lunchtime
  • minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games
  • walk, cycle or use another mode of transport involving physical activity.
Weight-loss programmes are not recommended during pregnancy as they may harm the health of the unborn child.

Pregnant women

Context

If a pregnant woman is obese this will have a greater influence on her health and the health of her unborn child than the amount of weight she may gain during pregnancy. That is why it is important, when necessary, to help women lose weight before they become pregnant.
Dieting during pregnancy is not recommended as it may harm the health of the unborn child.
Many pregnant women ask health professionals for advice on what constitutes appropriate weight gain during pregnancy. However, there are no evidence-based UK guidelines on recommended weight-gain ranges during pregnancy.
The amount of weight a woman may gain in pregnancy can vary a great deal. Only some of it is due to increased body fat – the unborn child, placenta, amniotic fluid and increases in maternal blood and fluid volume all contribute.

What action should be taken?

At the earliest opportunity, for example, during a pregnant woman's first visit to a health professional, discuss her eating habits and how physically active she is. Find out if she has any concerns about diet and the amount of physical activity she does and try to address them.
Advise that a healthy diet and being physically active will benefit both the woman and her unborn child during pregnancy and will also help her to achieve a healthy weight after giving birth. Advise her to seek information and advice on diet and activity from a reputable source.
Offer practical and tailored information. This includes advice on how to use Healthy Start vouchers to increase the fruit and vegetable intakeThis is an edited extract from a recommendation that appears in Maternal and child nutrition (NICE public health guidance 11). of those eligible for the Healthy Start scheme (women under 18 years and those who are receiving benefit payments).
Advise that moderate-intensity physical activity will not harm her or her unborn child. At least 30 minutes per day of moderate-intensity activity is recommended.
Give specific and practical advice about being physically active during pregnancy – see the Royal College of Obstetricians and Gynaecologists:
  • recreational exercise such as swimming or brisk walking and strength conditioning exercise is safe and beneficial
  • the aim of recreational exercise is to stay fit, rather than to reach peak fitness
  • if women have not exercised routinely they should begin with no more than 15 minutes of continuous exercise, three times per week, increasing gradually to daily 30-minute sessionsNICE recommends adults should be encouraged to do at least 30 minutes of at least moderate-intensity physical activity on 5 or more days a week. The activity can be in one session or several lasting 10 minutes or more. See Obesity (NICE clinical guideline 43)
  • if women exercised regularly before pregnancy, they should be able to continue with no adverse effects.
Explain to those women who would find this level of physical activity difficult that it is important not to be sedentary, as far as possible. Encourage them to start walking and to build physical activity into daily life, for example, by taking the stairs instead of the lift, rather than sitting for long periods.
Explain to women with a booking appointment BMI of 30 or more how this poses a risk, both to their health and the health of the unborn child. Explain that they should not try to reduce this risk by dieting while pregnant and that the risk will be managed by the health professionals caring for them during pregnancy.
Offer women with a booking appointment BMI of 30 or more a referral to a dietitian or appropriately trained health professional for assessment and personalised advice on healthy eating and how to be physically active. Encourage them to lose weight after pregnancy.

Supporting women after childbirth

During the 6-8-week postnatal check, or during the follow-up appointment within the next 6 months, provide clear, tailored, consistent, up-to-date and timely advice about how to lose weight safely after childbirth. Ensure women have a realistic expectation of the time it will take to lose weight gained during pregnancy. Discuss the benefits of a healthy diet and regular physical activity, acknowledging the woman's role within the family and how she can be supported by her partner and wider family. Advice on healthy eating and physical activity should be tailored to her circumstances. For example, it should take into account the demands of caring for a baby and any other children, how tired she is and any health problems she may have (such as pelvic floor muscle weakness or backache).
Midwives and other health professionals should encourage women to breastfeed. They should reassure them that a healthy diet and regular, moderate-intensity physical activity and gradual weight loss will not adversely affect the ability to breastfeed or the quantity or quality of breast milk.
Health professionals should give advice on recreational exercise from the Royal College of Obstetricians and Gynaecologists. In summary, this states that:
  • If pregnancy and delivery are uncomplicated, a mild exercise programme consisting of walking, pelvic floor exercises and stretching may begin immediately. But women should not resume high-impact activity too soon after giving birth.
  • After complicated deliveries, or lower segment caesareans, a medical care-giver should be consulted before resuming pre-pregnancy levels of physical activity, usually after the first check-up at 6-8 weeks after giving birth.
Health professionals should also emphasise the importance of participating in physical activities, such as walking, which can be built into daily life.

Community-based services

Local authority leisure and community services should offer women with babies and children the opportunity to take part in a range of physical or recreational activities. This could include swimming, organised walks, cycling or dancing. Activities need to be affordable and available at times that are suitable for women with older children as well as those with babies. Where possible, affordable childcare (for example, a creche) should be provided and provision made for women who wish to breastfeed.
Weight management groups and slimming clubs should adhere to the principles outlined at the beginning of this section. This includes giving advice about healthy eating and the importance of physical activity and using evidence-based behaviour-change techniques to motivate and support women to lose weight.
Health trainers and health and fitness advisers should advise women that a healthy diet and being physically active will benefit both them and their unborn child during pregnancy. They should also explain that it will help them to achieve a healthy weight after giving birth – and could encourage the whole family to eat healthily and be physically active.
Health trainers and health and fitness advisers should encourage those who have weight concerns before, during or after pregnancy to talk to a health professional such as a GP, practice nurse, dietitian, health visitor or pharmacist. They should also advise women, their partners and family to seek information and advice on healthy eating and physical activity from a reputable source.

Professional skills

Ensure health professionals, healthcare assistants and support workers have the skills to advise on the health benefits of weight management and risks of being overweight or obese before, during and after pregnancy, or after successive pregnancies.
Ensure they can advise women on their nutritional needs before, during and after pregnancy and can explain why it is important to have a balanced diet and to be moderately physically active.
Ensure they have behaviour change knowledge, skills and competencies. This includes being able to help people to identify how their behaviour is affecting their health, draw up an action plan, make the changes and maintain them.
Ensure they have the communication techniques needed to broach the subject of weight management in a sensitive manner. They should be able to give women practical advice on how to improve their diet and become more physically active. They should be able to tailor this advice to individual needs and know when to refer them for specialist care and support.
Ensure they have knowledge, skills and competencies in group facilitation, are aware of the needs of minority ethnic groups and have knowledge of local services.
Ensure their training is regularly monitored and updated.

Implementation tools

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Weight management before, during and after pregnancy: questionnaire

Source guidance

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Women with a BMI of 30 or more

Women with a BMI of 30 or more

Women with a BMI of 30 or more

Also see recommendations for women before, during and after pregnancy.

Before, during and after pregnancyThis recommendation is from Maternal and child nutrition (NICE public health guidance 11).

Inform women who have a BMI over 30 about the increased risks this poses to themselves and their babies and encourage them to lose weight before becoming pregnant or after pregnancy. Provide a structured programme that:
  • addresses the reasons why women may find it difficult to lose weight, particularly after pregnancy
  • is tailored to the needs of an individual or group
  • combines advice on healthy eating and physical exercise (advising them to take a brisk walk or other moderate exercise for at least 30 minutes on at least 5 days of the week)
  • identifies and addresses individual barriers to change
  • provides ongoing support over a sufficient period of time to allow for sustained lifestyle changes.
Health professionals should refer pregnant women with a BMI over 30 to a dietitian for assessment and advice on healthy eating and exercise. Do not recommend weight-loss during pregnancy.
Advise breastfeeding women that losing weight by eating healthily and taking regular exercise will not affect the quantity or quality of their milk. See also NICE guidance on antenatal care and guidance on obesity.

Preparing for pregnancyThis recommendation is from Weight management before, during and after pregnancy (NICE public health guidance 27).

Helping women to achieve and maintain a healthy weight

Women will be more likely to achieve and maintain a healthy weight before, during and after pregnancy if they:
  • base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible
  • eat fibre-rich foods such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta
  • eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories
  • eat a low-fat diet and avoid increasing their fat and/or calorie intake
  • eat as little as possible of fried food; drinks and confectionery high in added sugars (such as cakes, pastries and fizzy drinks); and other food high in fat and sugar (such as some take-away and fast foods)
  • eat breakfast
  • watch the portion size of meals and snacks, and how often they are eating
  • make activities such as walking, cycling, swimming, aerobics and gardening part of everyday life and build activity into daily life – for example, by taking the stairs instead of the lift or taking a walk at lunchtime
  • minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games
  • walk, cycle or use another mode of transport involving physical activity.
Weight-loss programmes are not recommended during pregnancy as they may harm the health of the unborn child.

What action should be taken?

Health professionals should offer a weight-loss support programme involving diet and physical activity. The programme should follow the principles of good practice.

After childbirth

Explain the increased risks that being obese poses to them and, if they become pregnant again, their unborn child. Encourage them to lose weight.
Offer a structured weight-loss programme. If more appropriate, offer a referral to a dietitian or an appropriately trained health professional. They will provide a personalised assessment, advice about diet and physical activity and advice on behaviour change strategies such as goal setting. Women who are not yet ready to lose weight should be provided with information about where they can get support when they are ready.
Use evidence-based behaviour change techniques to motivate and support women to lose weight.
Encourage breastfeeding and advise women that losing weight by eating healthily and taking regular exercise will not affect the quantity or quality of their milkThis is an edited extract from a recommendation that appears in Antenatal care (NICE clinical guideline 62). .

Implementation tools

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Maternal and child nutrition: audit support
Maternal and child nutrition: commissioning guide
Maternal and child nutrition: costing statement
Maternal and child nutrition: slide set
Weight management before, during and after pregnancy: audit support
Weight management before, during and after pregnancy: costing report
Weight management before, during and after pregnancy: financial planning tool
Weight management before, during and after pregnancy: questionnaire
Weight management before, during and after pregnancy: self-assessment tool
Weight management before, during and after pregnancy: slide set

Source guidance

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Paths in this pathway

Pathway created: May 2011 Last updated: November 2012

Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.



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