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Encouraging physical activity to prevent or treat specific conditions

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Physical activity HAI

About

What is covered

Increasing physical activity levels will help prevent and manage over 20 conditions and diseases including cancer, coronary heart disease, diabetes, stroke, musculoskeletal conditions 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.
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).

Updates

Updates to this pathway

30 April 2015 Minor maintenance update.
24 March 2015 Physical activity: encouraging activity in all people in contact with the NHS (NICE quality standard 84) added to this pathway.
12 March 2015 Minor maintenance updates.
26 November 2014 Update to preventing cardiovascular disease and encouraging physical activity to prevent or treat specific conditions in children and young people and adults on publication of obesity (NICE guideline CG189).
26 September 2014 Minor maintenance updates.
23 September 2014 New guidance on exercise referral (NICE public health guidance 54) has been added to this pathway. See exercise referral, pedometers, walking and cycling schemes; the encouraging people to be physically active path and national strategy, policy and commissioning.
2 September 2014 Minor maintenance update.
18 August 2014 Minor maintenance update.
11 March 2014 Minor maintenance update.
24 January 2014 Minor maintenance updates.
2 January 2014 Minor maintenance update.
23 October 2013 Link to NICE pathway on obesity added to this pathway.
12 June 2013 Minor maintenance to update sustainable development objectives link in the public open spaces node of the physical activity and the environment path.
5 June 2013 Minor maintenance updates.
29 May 2013
A partial update to the guidance 'Four commonly used methods to increase physical activity' (NICE public health guidance 2 [2006]) has resulted in the following changes:
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:
25 May 2012 Minor maintenance updates
25 October 2011 Minor maintenance updates

Short Text

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

What is covered

Increasing physical activity levels will help prevent and manage over 20 conditions and diseases including cancer, coronary heart disease, diabetes, stroke, musculoskeletal conditions 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.
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).

Updates

Updates to this pathway

30 April 2015 Minor maintenance update.
24 March 2015 Physical activity: encouraging activity in all people in contact with the NHS (NICE quality standard 84) added to this pathway.
12 March 2015 Minor maintenance updates.
26 November 2014 Update to preventing cardiovascular disease and encouraging physical activity to prevent or treat specific conditions in children and young people and adults on publication of obesity (NICE guideline CG189).
26 September 2014 Minor maintenance updates.
23 September 2014 New guidance on exercise referral (NICE public health guidance 54) has been added to this pathway. See exercise referral, pedometers, walking and cycling schemes; the encouraging people to be physically active path and national strategy, policy and commissioning.
2 September 2014 Minor maintenance update.
18 August 2014 Minor maintenance update.
11 March 2014 Minor maintenance update.
24 January 2014 Minor maintenance updates.
2 January 2014 Minor maintenance update.
23 October 2013 Link to NICE pathway on obesity added to this pathway.
12 June 2013 Minor maintenance to update sustainable development objectives link in the public open spaces node of the physical activity and the environment path.
5 June 2013 Minor maintenance updates.
29 May 2013
A partial update to the guidance 'Four commonly used methods to increase physical activity' (NICE public health guidance 2 [2006]) has resulted in the following changes:
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:
25 May 2012 Minor maintenance updates
25 October 2011 Minor maintenance updates

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Obesity (2006) NICE guideline CG43
Prevention of cardiovascular disease (2010) NICE guideline PH25
Maternal and child nutrition (2008) NICE guideline PH11
Physical activity and the environment (2008) NICE guideline PH8

Quality standards

Physical activity: encouraging activity in all people in contact with the NHS

These quality statements are taken from the physical activity: encouraging activity in all people in contact with the NHS. The quality standard defines clinical best practice for physical activity: encouraging activity in all people in contact with the NHS and should be read in full.

Quality statements

Advice for adults during NHS Health Checks

This quality statement is taken from the physical activity: encouraging activity in all people in contact with the NHS quality standard. The quality standard defines clinical best practice in physical activity: encouraging activity in all people in contact with the NHS and should be read in full.

Quality statement

Adults having their NHS Health Check are given brief advice about how to be more physically active.

Rationale

The primary care setting provides opportunities to implement the principles of the Making Every Contact Count initiative by enabling healthcare professionals to deliver lifestyle advice as a preventative measure. The NHS Health Check aims to reduce the risk of a number of conditions that physical activity can help to prevent. The NHS Health Check gives healthcare professionals a good opportunity to give brief advice to adults on a one‑to‑one basis about the benefits of physical activity and of using local physical activity services such as walking groups. This should therefore lead to an increase in physical activity levels.

Quality measures

Structure
Evidence of local arrangements to ensure that adults who are having their NHS Health Check are given brief advice about how to be more physically active.
Data source: Local data collection. NHS Health Check Data Set – NHS Health Check: Coverage.
Process
a) Proportion of adults having their NHS Health Check whose records state that they have been given brief advice about how to be more physically active.
Numerator – the number in the denominator whose records state that they have been given brief advice about how to be more physically active as part of their NHS Health Check.
Denominator – the number of adults having their NHS Health Check.
Data source: Local data collection. NHS Health Check Data Set – NHS Health Check: Referrals and risk management.
b) Proportion of adults having their NHS Health Check who are identified as needing to do more physical activity after receiving brief advice and whose records state that they have been signposted to physical activity services.
Numerator – the number in the denominator whose records state that they have been signposted to physical activity services as part of their NHS Health Check.
Denominator – the number of adults having their NHS Health Check who are identified as needing to do more physical activity after receiving brief advice.
Data source: Local data collection. NHS Health Check Data Set – NHS Health Check: Referrals and risk management.
c) Proportion of adults who have had an NHS Health Check and been signposted to physical activity services whose outcome is recorded.
Numerator – the number in the denominator whose outcome is recorded.
Denominator – the number of adults who have had their NHS Health Check and been signposted to physical activity services.
Data source: Local data collection. NHS Health Check programme standards – section 7 on risk management.
Outcome
Proportion of adults meeting the recommendations in the UK physical activity guidelines.
Data source: Contained within the Health and Social Care Information Centre's Health Survey for England: Health, social care and lifestyles, chapter on physical activity in adults and Sport England's Active People Survey.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary care services such as GP surgeries and pharmacies) ensure that their staff are trained and competent to give adults who are having their NHS Health Check brief advice about how to be more physically active, and in signposting adults to physical activity services.
Healthcare professionals (such as GPs and pharmacists) give adults who are having their NHS Health Check brief advice about how to be more physically active, and signpost them to physical activity services.
Commissioners (NHS England and local authorities) ensure that they commission services in which NHS Health Checks include giving brief advice to adults about physical activity, and signposting them to physical activity services.

What the quality statement means for patients, service users and carers

Adults having their NHS Health Check are given advice and information about how to be more physically active and what services are available locally. The NHS Health Check is a national programme to identify people at risk of heart disease, stroke, diabetes, kidney disease and certain types of dementia.

Source guidance

Definitions of terms used in this quality statement

Brief advice
Giving brief advice or intervention involves oral discussion, negotiation or encouragement, with or without written or other support or follow‑up. It may also involve a referral for further interventions, directing people to other services or more intensive support. In this context, if the person is already achieving the UK physical activity guidelines the advice should focus on sustaining this by offering praise and encouragement. Brief advice can be delivered by anyone who is trained in the necessary skills and knowledge. These interventions typically take no more than a few minutes for basic advice. [Adapted from Physical activity: brief advice for adults in primary care (NICE guideline PH44), Behaviour change: individual approaches (NICE guideline PH49), and expert opinion]
NHS Health Check
The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia. Everyone between the ages of 40 and 74, who have not already been diagnosed with 1 of these conditions will be invited (once every 5 years) to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes. People attending NHS Health Checks will have their risk assessed through a combination of their personal details, family history of illness, smoking, alcohol consumption, physical activity, BMI, blood pressure and cholesterol. They should be given support and advice to help them reduce or manage their risk. [Adapted from NHS Health Check competence framework (Public Health England) and NICE local government briefing 15]
Signposting to physical activity services
Signposting describes the process for directing a person to a suitable local service. As part of an NHS Health Check, a person may be signposted or directed to the local gym or walking group, for example, or referred to lifestyle or clinical services. This aims to help guide people to local services that are appropriate for them. This will encourage people to use the services and support them in making lifestyle changes. [Adapted from NHS Health Check Data Set user guidance (Health and Social Care Information Centre)]
UK physical activity guidelines
The current recommendations for physical activity from the Chief Medical Office state the following:
  • All adults aged 19 years and over should aim to be active daily.
  • Over a week, this should add up to at least 150 minutes (2.5 hours) of moderate intensity physical activity in bouts of 10 minutes or more.
  • Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous intensity activity.
  • All adults should also undertake physical activity to improve muscle strength on at least 2 days a week.
  • They should minimise the amount of time spent being sedentary for extended periods.
  • Older adults (65 years and over) who are at risk of falls should incorporate physical activity to improve balance and coordination on at least 2 days a week.
  • Individual physical and mental capabilities should be considered when interpreting the guidelines, but the key issue is that some activity is better than no activity. [UK physical activity guidelines (Department of Health)]

Equality and diversity considerations

When advising adults to become more physically active and signposting them to physical activity services, healthcare professionals should take into account gender, the needs of people from different socioeconomic backgrounds and cultures, and the needs of adults with mental health conditions and learning or physical disabilities. When providing written information, healthcare professionals should ensure that it is accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English.

Advice for parents or carers as part of the Healthy Child Programme 2-year review

This quality statement is taken from the physical activity: encouraging activity in all people in contact with the NHS quality standard. The quality standard defines clinical best practice in physical activity: encouraging activity in all people in contact with the NHS and should be read in full.

Quality statement

Parents or carers of children are given advice about physical activity during their child's Healthy Child Programme 2‑year review.

Rationale

Children's participation in physical activity is important for their healthy growth and development. It is important to establish being physically active as a life‑long habit from an early age, and the Healthy Child Programme 2‑year review provides a good opportunity to advise on this. Giving advice to parents and carers at key points during their child's development can be an effective way to 'make every contact count'. It can also lead to whole families establishing good physical activity habits.

Quality measures

Structure
Evidence of local arrangements to ensure that parents or carers of children are given advice about physical activity as part of their child's Healthy Child Programme 2‑year review.
Data source: Local data collection.
Process
a) Proportion of Healthy Child Programme 2‑year reviews in which parents or carers of children are given advice about physical activity.
Numerator – the number in the denominator in which parents or carers of children are given advice about physical activity.
Denominator – the number of Healthy Child Programme 2‑year reviews.
b) Proportion of Healthy Child Programme 2‑year reviews in which parents or carers of children are offered written information about local opportunities to be physically active.
Numerator – the number in the denominator in which parents or carers of children are offered written information about local opportunities to be physically active.
Denominator – the number of Healthy Child Programme 2‑year reviews.
Data source: Local data collection.
Outcome
Proportion of children achieving the recommendations in the UK physical activity guidelines.
Data source: Contained within the Health and Social Care Information Centre's Health Survey for England: Health, social care and lifestyles, chapter on physical activity in children.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (health visiting services) ensure that their staff are trained to give parents or carers of children advice about physical activity and information about local opportunities to be physically active as a key component of the Healthy Child Programme 2‑year review.
Healthcare professionals (health visitors, nursery nurses and children's nurses) give parents or carers advice about physical activity and information about local opportunities to be physically active as a key component of the Healthy Child Programme 2‑year review.
Commissioners (such as clinical commissioning groups, NHS England and local authorities) ensure that they commission services from providers who include giving advice about physical activity and information about local opportunities as a key component of the Healthy Child Programme 2‑year review. Commissioners may wish to monitor activity by requesting evidence of practice locally.

What the quality statement means for patients, service users and carers

Parents or carers of children who are having their 2-year review are given information about the ways in which their child can benefit from being physically active. They are also given information about what they can do to be more active, as well as what is available locally.

Source guidance

Definitions of terms used in this quality statement

Advice about physical activity as part of the Healthy Child Programme 2-year review
Parents and carers of children should be advised that:
  • Children of pre‑school age who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day.
  • All children should undertake a range of moderate to vigorous intensity activities for at least 60 minutes over the course of a day.
  • All children should minimise the amount of time they spend being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).
  • It is beneficial for them to get involved in physical activities with their children and to complete at least some local journeys (or some part of a local journey) with young children using a physically active mode of travel with the aim of establishing active travel as a life‑long habit from an early age.
Parents and carers of children should be given oral and written information about:
Healthy Child Programme 2-year review
This is the third, full health and development review that children have as part of the Healthy Child Programme. This review will be carried out between the age of 2 and 2.5 years by a member of the Healthy Child team, usually a health visitor, nursery nurse or children's nurse. The review might be at a local children's centre, GP surgery or at home. [Adapted from NHS Choices, The Healthy Child Programme]

Equality and diversity considerations

When giving parents and carers advice on physical activity for children, healthcare professionals should take into account the age, developmental stage and gender of the child, any medical needs as well as the ethnicity and socioeconomic status of the family in order to communicate the information in a sensitive manner. All information given about physical activity should be accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English.
When sharing information about local opportunities to be active, healthcare professionals should take into account the needs of children from different socioeconomic backgrounds, and the needs of children with mental health conditions, and learning and physical disabilities.

Advice for parents or carers as part of the National Child Measurement Programme

This quality statement is taken from the physical activity: encouraging activity in all people in contact with the NHS quality standard. The quality standard defines clinical best practice in encouraging activity in all people in contact with the NHS and should be read in full.

Quality statement

Parents or carers of children are given advice about physical activity as part of the National Child Measurement Programme (NCMP).

Rationale

Children's participation in physical activity is important for their healthy growth and development. It is important to establish being physically active as a life‑long habit from an early age. Giving advice to parents and carers at key points during their child's development can be an effective way to 'make every contact count'. It can also lead to whole families establishing good physical activity habits.
The NCMP is delivered by all local authorities across England and involves measuring the weight and height of children aged 4 to 5 years and 10 to 11 years to assess overweight children and obesity levels in primary schools. Parents or carers receive feedback about their children's results. While it is not a mandated component of the programme, local authorities are encouraged to provide parents with their child's results. The National Child Measurement Programme Operational Guidance additionally highlights that parents generally want to receive their child's NCMP results, and that providing this information is an effective mechanism for raising awareness of the potential associated health consequences of excess weight. This therefore provides a good opportunity to give advice about physical activity, because parents are more likely to be receptive to thinking about behaviour change.

Quality measures

Structure
Evidence of local arrangements to ensure that parents or carers of children are given advice about physical activity as part of the NCMP.
Data source: Local data collection.

Process

a) Proportion of children aged 4 to 5 years who are measured as part of the NCMP whose parents or carers are given advice about physical activity.
Numerator – the number in the denominator whose parents or carers are given advice about physical activity.
Denominator – the number of children aged 4 to 5 years who are measured as part of the NCMP.
Data source: Local data collection.
b) Proportion of children aged 10 to 11 years who are measured as part of the NCMP whose parents or carers are given advice about physical activity.
Numerator – the number in the denominator whose parents or carers are given advice about physical activity.
Denominator – the number of children aged 10 to 11 years who are measured as part of the NCMP.
Data source: Local data collection.
Outcome
Proportion of children achieving the recommendations in the UK physical activity guidelines.
Data source: Contained within the Health and Social Care Information Centre's Health Survey for England: Health, social care and lifestyles, chapter on physical activity in children.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers (such as school nursing services) ensure that their staff are trained to give parents or carers of children advice about physical activity and information about local opportunities to be physically active as a key component of the routine feedback that is provided to parents or carers of children who are measured as part of the NCMP.
Healthcare practitioners incorporate advice about physical activity within the routine feedback they provide to parents or carers of children who are measured as part of the NCMP.
Commissioners (Public Health England, NHS England and local authorities) ensure that they commission services from providers who include giving advice about physical activity as a key component of the routine feedback they provide to parents or carers of children who are measured as part of the NCMP. Commissioners may wish to monitor activity by requesting evidence of practice locally.

What the quality statement means for patients, service users and carers

Parents or carers of children whose weight and height is measured at school as part of the National Child Measurement Programme are given information about the ways in which their child can benefit from being physically active. They are also given information about what they can do to be more active, as well as what is available locally. The National Child Measurement Programme was established in 2005, and involves measuring the weight and height of Reception and Year 6 children at state schools in England.

Source guidance

Definitions of terms used in this quality statement

Advice about physical activity as part of the National Child Measurement Programme
Parents and carers of children should be given written information advising them that:
  • All children should undertake a range of moderate to vigorous intensity activities for at least 60 minutes over the course of a day.
  • Children aged 5 years and over should undertake vigorous intensity activities, including those that strengthen muscle and bone, at least 3 days a week.
  • All children should minimise the amount of time they spend being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).
  • It is beneficial for them to get involved in physical activities with their children and to complete at least some local journeys (or some part of a local journey) with young children using a physically active mode of travel with the aim of establishing active travel as a life‑long habit from an early age.
Parents and carers of children should also be given written information about:
  • The benefits of physical activity and how enjoyable it is.
  • Local opportunities to be physically active.
The National Child Measurement Programme Operational Guidance includes specimen result letters to parents that can be adapted to include advice about physical activity for all children who take part in the programme. [Adapted from UK physical activity guidelines (Department of Health), Promoting physical activity for children and young people (NICE guideline PH17) recommendation 15, and expert opinion]
National Child Measurement Programme (NCMP)
The NCMP was established in 2005, and involves measuring the weight and height of Reception and Year 6 children at state‑maintained schools, including academies, in England.
The NCMP has 2 key purposes:
  • To provide robust public health surveillance data on child weight status: to understand and monitor obesity prevalence and trends at national and local levels, inform obesity planning and commissioning, and underpin the Public Health Outcomes Framework indicators on excess weight in children aged 4–5 years and 10–11 years.
  • To provide parents with feedback on their child's weight status: to help them understand their child's health status, support and encourage behaviour change, and provide a mechanism for direct engagement with families. [Adapted from National Child Measurement Programme Operational Guidance, Public Health England]

Equality and diversity considerations

When giving parents and carers advice on physical activity for children, healthcare professionals should take into account the age and gender of the child, as well as the ethnicity and socioeconomic status of the family in order to communicate the information in a sensitive manner. All information given about physical activity should be accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English.
When sharing information about local opportunities to be active, healthcare professionals should take into account the needs of children from different socioeconomic backgrounds, and the needs of children with mental health conditions, and learning and physical disabilities.

Implementing a physical activity programme for employees in NHS organisations

This quality statement is taken from the physical activity: encouraging activity in all people in contact with the NHS quality standard. The quality standard defines clinical best practice in encouraging activity in all people in contact with the NHS and should be read in full.

Quality statement

NHS organisations have an organisation-wide, multi-component programme to encourage and support employees to be more physically active.

Rationale

Multi-component physical activity programmes in NHS organisations should incorporate a range of measures to encourage and support their employees to be more physically active. Providing information about physical activity and promoting its health benefits should help support people who are interested in becoming more active. Identifying an 'active travel champion' (working at a senior level) to promote active travel should increase the number of NHS employees who adopt more active modes of travel for commuting and while at work. This should encourage and enable employees to increase the amount of physical activity they undertake and improve their overall health and wellbeing.

Quality measures

Structure
a) Evidence that NHS organisations have in place an organisation wide, multi component programme to encourage and support employees to be more physically active.
Data source: Local data collection.
b) Evidence that NHS organisations monitor their organisation wide, multi component physical activity programme.
Data source: Local data collection. Contained within the Royal College of Physicians' Implementing NICE public health guidance for the workplace – organisational audit, section 3.3: Physical activity and building/site design.
c) Evidence that NHS organisations encourage active travel through schemes that have been developed or promoted by an active travel champion.
Data source: Local data collection.
Process
a) Proportion of NHS organisations with a multi component physical activity programme that disseminate information (including written information) on at least an annual basis to their employees on how to be more physically active and on the health benefits of such activity.
Numerator – the number in the denominator that disseminate information (including written information) on at least an annual basis on how to be more physically active and on the health benefits of such activity to their employees.
Denominator – the number of NHS organisations with a multi component physical activity programme.
Data source: Local data collection.
b) Proportion of organisation-wide, multi-component physical activity programmes in NHS organisations that include incentive schemes.
Numerator – the number in the denominator that include incentive schemes.
Denominator – the number of organisation-wide, multi component physical activity programmes in NHS organisations.
Data source: Local data collection.
c) Proportion of employees in NHS organisations who take part in incentive schemes that are part of a multi component physical activity programme.
Numerator – the number in the denominator who take part in incentive schemes that are part of a multi component physical activity programme.
Denominator – the number of people employed by an NHS organisation that has incentive schemes included within a multi component physical activity programme.
Data source: Local data collection.
d) Proportion of NHS employees recorded as having taken part in active travel schemes that are led or promoted by their organisation within the last 12 months.
Numerator – the number in the denominator recorded as having taken part in active travel schemes that are led or promoted by their organisation within the last 12 months.
Denominator – the number of people employed by an NHS organisation with active travel schemes.
Data source: Local data collection.

Outcomes

a) Proportion of employees in NHS organisations who feel supported to be more physically active.
Data source: Local data collection. The NHS staff survey (2014) contained the following questions: 14b My immediate manager takes a positive interest in my health and wellbeing; 14c My organisation takes positive action on health and wellbeing.
b) Proportion of NHS employees who use physically active modes of travel for commuting and while at work.
Data source: Local data collection. The National Travel Survey for England (2013) contains information on: Commuting/business trips by main mode (chart 15). The 2011 UK Census data contains information on: Method of travel to work for England and Wales.

What the quality statement means for NHS organisations

NHS organisations have an organisation-wide, multi-component programme to encourage and support employees to be more physically active, and monitor the uptake of the programme initiatives and incentive schemes by employees.
Active travel champions ensure that they coordinate activities, and develop or promote schemes that encourage and enable employees in their organisation to use active modes of travel, such as walking and cycling.

What the quality statement means for employees in NHS organisations

Employees in NHS organisations are encouraged and supported to be more physically active (both within and outside the workplace), and are provided with information and practical support on how to do this.

Source guidance

Definitions of terms used in this quality statement

Employees in NHS organisations
In this context, employees include people who are employed directly by any type of NHS organisation. Where possible, this would also include people who are employed by any type of an NHS organisation through a subcontract, as a volunteer or as a temporary member of staff. [Adapted from Promoting physical activity in the workplace (NICE guideline PH13)]
Multi-component programme
The programme should consist of a number of components in order to ensure that employees with different needs and interests are encouraged and supported to be more physically active. It should be linked to and support achievement of the goals outlined in the organisation wide policy or plan for physical activity. It could include:
  • Incentive schemes such as Cycle to Work schemes and subsidised gym memberships.
  • Mechanisms to support employees to walk, cycle or use other modes of transport involving physical activity (to travel to and from work and as part of their working day). Examples of mechanisms include:
    • providing facilities such as bicycle storage, showers and changing facilities
    • ensuring that staircases are clearly signposted and attractive to use, to encourage people to use the stairs rather than lifts if they can
    • offering flexibility around taking breaks to enable employees to take short walks during work breaks
    • developing (or promoting) schemes that facilitate active travel, for example, schemes that give staff access to a pool of bicycles for short distance business travel, or access to discounted cycle purchases (such as Cycle to Work schemes).
  • Providing information (including written information) on how to minimise sedentary behaviour and be more physically active, and on the health benefits of such activity.
  • Written information on local opportunities to be physically active (both within and outside the workplace) tailored to meet specific needs, for example, the needs of shift workers. Examples include information about: walking and cycling routes (this may include maps), local walking groups, exercise classes, cycle training programmes and local challenges and events.
  • Ongoing advice and support to help people plan how they are going to increase their levels of physical activity and reduce sedentary behaviour. This may include a confidential, independent health check administered by a suitably qualified practitioner and focused on physical activity.
To deliver the programme, employers could:
  • Ensure that when planning new developments and refurbishing existing buildings, they maximise opportunities for people (including those who have limited mobility) to be physically active as a routine part of their daily life. As part of the planning, employers should:
    • Involve local communities and experts to ensure the potential for physical activity is maximised.
    • Complete an assessment in advance, of the impact (both intended and unintended) that the proposals are likely to have on physical activity levels. Results should be made publicly available and accessible.
  • Help employees to be physically active and minimise sedentary behaviour during the working day by:
    • where possible, encouraging them to move around more at work (for example, by walking or cycling to external meetings or standing up during meetings)
    • encouraging them to set goals on how far they walk and cycle and to monitor the distances they cover.
  • Take account of the nature of the work and any health and safety issues. For example, many people already walk long distances during the working day, whereas those involved in shift work may be vulnerable if walking home alone at night.
  • Work in collaboration with other NHS organisations. This is particularly relevant for smaller organisations that may find it challenging to deliver activities in isolation. [Adapted from Promoting physical activity in the workplace (NICE guideline PH13) recommendations 2 and 3, Physical activity and the environment (NICE guideline PH8) recommendations 1, 5 and 6, Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation (NICE guideline PH41) and expert consensus]
Active travel champion
Active travel champions working in NHS organisations should be enthusiastic and passionate about physical activity, and able to engage with and support people to become more active. They should have the ability to influence people working at a senior level, and should encourage and enable employees to be more physically active.

Equality and diversity considerations

When developing an organisation-wide, multi-component physical activity programme, NHS employers should take into account the needs of employees with mental health conditions, and learning and physical disabilities. Any written information provided as part of the programme should be accessible to people with additional needs, such as physical, sensory or learning disabilities.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

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.

Information about exercise referral schemes

Exercise referral schemes seek to increase someone's physical activity levels on the basis that physical activity has a range of positive health benefits. In this pathway, exercise referral schemes consist of all the following components:
  • An assessment involving a primary care or allied health professional to determine that someone is sedentary or inactive, that is, they are not meeting current UK physical activity guidelines. (See Start active, stay active.)
  • A referral by a primary care or allied health professional to a physical activity specialist or service.
  • A personal assessment involving a physical activity specialist or service to determine what programme of physical activity to recommend for their specific needs.
  • An opportunity to participate in a physical activity programme.
Some schemes also review participants' progress at completion of the scheme.
Structured exercise programmes
This pathway does not cover structured exercise programmes designed for managing a specific health condition or for rehabilitation following recovery from a specific condition. This includes cancer, cardiac or pulmonary rehabilitation programmes.
Other benefits of exercise referral schemes
Exercise referral schemes are popular and they may offer other benefits aside from physical activity, such as helping people to socialise, providing a means of getting involved with the community and providing affordable access to facilities. However, although not excluded from the scope of the work for the recommendations on exercise referral schemes in this pathway, no evidence of the impact on these outcomes was identified in the evidence of effectiveness and cost effectiveness, so they were not captured in the economic model.
NICE is therefore unable to judge the effect of exercise referral schemes on these outcomes, compared with other interventions that seek to address the same issues.

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'.

Physical activity: definition and current UK recommendations

Definition

Physical activity includes everyday activity such as walking and cycling to get from A to B, work-related activity, housework, DIY and gardening. It also includes recreational activities such as working out in a gym, dancing, or playing active games, as well as organised and competitive sport. (See the Chief Medical Officers' [CMOs'] report.)

National recommendations

The CMOs' current recommendations for physical activity (see UK physical activity guidelines) state that:
  • All adults aged 19 years and over should aim to be active daily.
  • Over a week, this should add up to at least 150 minutes (2.5 hours) of moderate intensityModerate-intensity physical activity leads to faster breathing, increased heart rate and feeling warmer. Moderate-intensity physical activity could include walking at 3-4 mph, and household tasks such as vacuum cleaning or mowing the lawn. physical activity in bouts of 10 minutes or more.
  • Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensityVigorous-intensity physical activity leads to very hard breathing, shortness of breath, rapid heartbeat and should leave a person unable to maintain a conversation comfortably. Vigorous-intensity activity could include running at 6-8 mph, cycling at 12-14 mph or swimming slow crawl (50 yards per minute). activity spread across the week or combinations of moderate and vigorous intensity activity.
  • All adults should also undertake physical activity to improve muscle strength on at least 2 days a week.
  • They should minimise the amount of time spent being sedentary (sitting) for extended periods.
  • Older adults (65 years and over) who are at risk of falls should incorporate physical activity to improve balance and coordination on at least 2 days a week.
  • Individual physical and mental capabilities should be considered when interpreting the guidelines, but the key issue is that some activity is better than no activity.

Benefits of physical activity

  • Prevents and helps to manage conditions such as coronary heart disease, type 2 diabetes, stroke, mental health problems, musculoskeletal conditions and some cancers.
  • Has a positive effect on wellbeing, mood, sense of achievement, relaxation and release from daily stress.
Encourage adults 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 (for example, reduced risk of type 2 diabetes and cardiovascular disease). Encourage adults to do at least 30 minutes of moderate or greater intensity physical activity on 5 or more days a week. The activity can be in 1 session or several sessions lasting 10 minutes or more.
Advise that to prevent obesity, most people may need to do 45–60 minutes of moderate-intensity activity a day, particularly if they do not reduce their energy intake. Advise people who have been obese and have lost weight that they may need to do 60–90 minutes of activity a day to avoid regaining weight.
Encourage adults to build up to the recommended activity levels for weight maintenance, using a managed approach with agreed goals.
Recommend types of physical activity, including:
  • activities that can be incorporated into everyday life, such as brisk walking, gardening or cycling (see the NICE pathway on walking and cycling)
  • supervised exercise programmes
  • other activities, such as swimming, aiming to walk a certain number of steps each day, or stair climbing.
Take into account the person's current physical fitness and ability for all activities. Encourage people to also reduce the amount of time they spend inactive, such as watching television, using a computer or playing video games.

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.
The term 'brief advice' is used in this guidance to mean verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. It can vary from basic advice to a more extended, individually focused discussion.
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.
Defined as not currently meeting the Chief Medical Officer's recommendation for physical activity as outlined in 'Start active, stay active: a report on physical activity from the four home countries' Chief Medical Officers' (Department of Health 2011).
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.
For example, risk factors for coronary heart disease, stroke and type 2 diabetes. These include high blood pressure, high blood cholesterol and being overweight.
Read Codes is the standard clinical terminology system used in general practice in the UK.
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.
Being sedentary is not just a lack of physical activity (see 'inactive'). Sedentary behaviour involves activities that do not increase energy expenditure much above resting levels, for example, sitting, lying down, sleeping, watching TV and reading. Sedentary behaviour is an independent risk factor for chronic disease. People who achieve the recommended levels of physical activity can still be at risk if they spend too long being sedentary. (British Heart Foundation National Centre for Physical Activity and Health 2013).
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.
Structured exercise programmes vary in format, the mechanism of referral and content. They include components such as phase 3 and phase 4 rehabilitation activities and structured, tailored and supervised activities delivered by a specialist physical activity and exercise instructor (trained to level 4).
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.

Paths in this pathway

Pathway created: May 2011 Last updated: April 2015

© NICE 2015

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