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Physical activity
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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.
Audit support
Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
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.
Costing support
Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
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.
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.
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.
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.
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:
- physical activity overview
- exercise referral, pedometers, walking and cycling schemes
- exercise referral, pedometers, walking and cycling schemes
Links to the 'Mental wellbeing and older people' pathway have been added to:
- encouraging physical activity to prevent or treat specific conditions
- training for people involved in encouraging others to be physically active
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.
Local services
Local services
Local services
Also see NICE guidance on behaviour change and community engagement.
Areas of work
What area of work are you interested in?
CVD prevention
View the 'preventing CVD' nodeSpecific conditions
View the 'Encouraging physical activity to prevent or treat specific conditions' pathChildren and young people
Facilities and programmes to encourage children and young people to be physically active
Facilities and programmes to encourage children and young people to be physically active
Also see NICE recommendations on strategies to prevent unintentional injuries among under-15s and preventing unintentional injuries among under-15s: road design.
Planning and leadership
Planning and leadership in relation to spaces, facilities and programmes to encourage physical activity
Planning and leadership in relation to spaces, facilities and programmes to encourage physical activity
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.
Planning the provision of spaces and facilities
Ensure physical activity facilities are suitable for children and young people with different needs and their families, particularly those from lower socioeconomic groups, those from minority ethnic groups with specific cultural requirements and those who have a disability.
Provide children and young people with places and facilities (both indoors and outdoors) where they feel safe taking part in physical activities. These could be provided by the public, voluntary, community and private sectors (for example, in schools, youth clubs, local business premises and private leisure facilities). Local authorities should coordinate the availability of facilities, where appropriate. They should also ensure all groups have access to these facilities, including those with disabilities.
Make school facilities available to children and young people before, during and after the school day, at weekends and during school holidays. These facilities should also be available to public, voluntary, community and private sector groups and organisations offering physical activity programmes and opportunities for physically active play.
Actively promote public parks and facilities as well as more non-traditional spaces (for example, car parks outside working hours) as places where children and young people can be physically active.
Town planners should make provision for children, young people and their families to be physically active in an urban setting. They should ensure open spaces and outdoor facilities encourage physical activity (including activities which are appealing to children and young people, for example, in-line skating). They should also ensure physical activity facilities are located close to walking and cycling routes.
Ensure the spaces and facilities used for physical activity meet recommended safety standards for design, installation and maintenance. For example, outdoor play areas should have areas of shade from the sun and sheltered areas where children can play to reduce the impact of adverse weather.
Assess all proposals for signs restricting physical activity in public spaces and facilities (such as those banning ball games) to judge the effect on physical activity levels.
Responding to children and young people
Identify local factors that may affect whether or not children and young people are physically active by regularly consulting with them, their parents and carers.
Find out what type of physical activities children and young people enjoy, based on existing research or local consultation (for example, some might prefer non-competitive or single-gender activities). Actively involve them in planning the resulting physical activities.
Remove locally identified barriers to participation, such as lack of privacy in changing facilities, inadequate lighting, poorly maintained facilities and lack of access for children and young people with a disability. Any dress policy should be practical, affordable and acceptable to participants without compromising their safety or restricting participation.
Provide regular local programmes and other opportunities for children and young people to be physically active in a challenging environment where they feel safe (both indoors and outdoors). Ensure these programmes and opportunities are well-publicised.
Ensure physical activity programmes are run by people with the relevant training or experience.
Leadership and instruction
Ensure informal and formal physical activity sessions for children and young people (including play) are led by staff or volunteers who have achieved the relevant sector standards or qualifications for working with children. This includes the requirements for child protection, health and safety, equality and diversity.
Ensure staff and volunteers have the skills (including interpersonal skills) to design, plan and deliver physical activity sessions (including active play sessions) that meet children and young people's different needs and abilities. Those leading activities should make them enjoyable. The leaders should also be inspiring. They should raise children and young people's aspirations about what they can participate in – and the level of ability they can achieve. In addition, leaders should help foster children and young people's personal development.
Use community networks and partnerships to encourage, develop and support local communities and volunteers involved in providing physical activities for children and young people. For recommendations on the principles of networking and partnership working, see NICE guidance on community engagement.
Employers should provide regular and relevant development opportunities for employees and volunteers. The impact on practitioner performance and on children and young people's experiences should be monitored.
Multi-component school and community programmes
Identify education institutions willing to deliver multi-component physical activity programmes involving school, family and community-based activities. Identify families, community members, groups and organisations and private sector organisations willing to contribute.
Develop multi-component physical activity programmes. These should include:
- education and advice to increase awareness of the benefits of physical activity and to give children and young people the confidence and motivation to get involved
- policy and environmental changes, such as creating a more supportive school environment and new opportunities for physical activity during breaks and after school
- the family: by providing homework activities which children and their parents or carers can do together, or advice on how to create a supportive home environment. (For example, advice on how they might help their child become involved in an activity.) It could also include school-based family activity days
- the community: for example, by setting up family fun days and schemes such as 'Play in the park'.
Implementation tools
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Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeStructure of programmes
Structure of physical activity programmes
Structure of physical activity programmes
Facilities and equipment
Ensure opportunities, facilities and equipment are available to encourage children to develop movement skills, regardless of their ability or disability.
Provide children with access to environments that stimulate their need to explore and which safely challenge them. (Examples include adventure playgrounds, parks, woodland, common land or fun trails.) Also provide them with the necessary equipment. The aim is to develop their risk awareness and an understanding of their own abilities as necessary life skills.
Ensure children have the opportunity to explore a range of physical activities to help them identify those they can enjoy by themselves and those they can do with friends and family.
Provide daily opportunities for participation in physically active play by providing guidance and support, equipment and facilities. Keep children motivated to be physically active by updating and varying the way physical activities are delivered (including the resources and environments used).
Ensure opportunities are available after school, at weekends, during half-term breaks and during the longer school holidays. Activities should be led by appropriately trained and qualified staff (paid or voluntary) and take place in schools and other community settings.
Supporting girls and young women
Consult with girls and young women to find out what type of physical activities they prefer. Actively involve them in the provision of a range of options in response. This may include formal and informal, competitive and non-competitive activities such as football, wheelchair basketball, dance, aerobics and the gym. Activities may be delivered in single and mixed-gender groups.
Offer school-based physical activities, including extra-curricular ones. Provide advice on self-monitoring and individually tailored feedback and advice.
Address any psychological, social and environmental barriers to physical activity. For example, provide opportunities in easily accessible community settings with appropriate changing facilities offering privacy. Any dress policy should be practical, affordable and acceptable to participants without compromising their safety or restricting participation. For further recommendations on community engagement, see NICE guidance on community engagement.
Implementation tools
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Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeProgramme delivery
Delivering physical activity programmes
Delivering physical activity programmes
Helping children to be active
Provide a range of indoor and outdoor physical activities for children on a daily basis, including opportunities for unstructured, spontaneous play.
Tailor activities according to the child's developmental age and physical ability. Ensure they are inclusive, progressive and enjoyable. The activities should develop the child's movement skills (such as crawling, running, hopping, skipping, climbing, throwing, catching and kicking a ball). Children should also experience more advanced activities such as swimming, cycling, playing football and dancing.
Provide opportunities at intervals throughout the day in pre-school establishments; during playtimes and lunch breaks at school; as part of extra-curricular and extended school provision; and during leisure time (including weekends and holidays) in wider community settings and the private sector.
Help children identify activities they can enjoy by themselves and those they can enjoy with their friends and families.
Helping girls and young women to be active
Support participants of all abilities in a non-judgemental and inclusive way. Emphasise the opportunities for participation, enjoyment and personal development, rather than focusing on the evaluation of performance.
Encourage those who initially choose not to participate to be involved with physical activities in other ways. Help them move gradually towards full participation.
Encourage a dress code that minimises their concerns about body image. It should be practical, affordable and acceptable to them, without compromising their safety or restricting participation.
Provide appropriate role models.
Helping families to be active
Ensure parents and carers are aware of government advice that children and young people should undertake a minimum of 60 minutes moderate to vigorous physical activity a day. Make them aware that, at least twice a week, this should include activities to improve bone health, muscle strength and flexibility.
Provide information and advice on the benefits of physical activity, emphasising how enjoyable it is. Provide examples of local opportunities.
Encourage parents and carers to get involved in physical activities with their children.
Encourage parents and carers to complete at least some local journeys (or some part of a local journey) with young children using a physically active mode of travel. This should take place on most days of the week. The aim is to establish physically active travel (such as walking or cycling) as a life-long habit from an early age. Parents and carers should also be encouraged to allow their children to become more independent, by gradually allowing them to walk, cycle or use another physically active mode of travel for short distances.
Act as a role model by incorporating physical activity into daily life. For example, opt for travel involving physical activity (such as walking or cycling), use the stairs and regularly participate in recreational activities or sport.
Promote physically active travel as an option for all the family. Raise awareness of how it can help children and young people achieve the recommended daily amount of physical activity.
Implementation tools
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Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeTravel plans
Physically active travel plans
Physically active travel plans
Please also refer to preventing unintentional injuries among under-15s: road design.
School travel and local transport plans
Ensure local transport and school travel plans continue to be fully aligned with other local authority plans which may impact on children and young people's physical activity. This includes local partnership agreements, local area play strategies and healthy school plans. Liaise with local partners to achieve this.
Ensure local transport plans continue to be developed in conjunction with local authority departments and other agencies that provide spaces and facilities for children and young people to be physically active.
Ensure local transport plans acknowledge any potential impact on opportunities for children and young people to be physically active. Transport plans should aim to increase the number of children and young people who regularly walk, cycle and use other modes of physically active travel. They should make provision for the additional needs of, or support required by, children, young people and their parents or carers with a disability or impaired mobility.
Continue working with schools to develop, implement and promote school travel plans (see recommendation below). This may, for example, include: mapping safe routes to school; organising walk and bike to school days and walking buses; organising cycle and road safety training; and helping children to be 'streetwise'.
Organise training courses for school travel plan advisers.
Identify any aspect of transport policies which discourages children and young people from using modes of travel involving physical activity (such as walking or cycling). For example, policies that aim to keep traffic moving may make it difficult to cross the road. Consider how these policies can be improved to encourage physically active travel.
Active and sustainable school travel plans
Continue to encourage a culture of physically active travel (such as walking or cycling).
Develop a school travel plan which has physical activity as a key aim, in line with existing guidance – visit Teachernet. Integrate it with the travel plans of other local schools and the local community (see above). The aim is to encourage children and young people to choose physically active modes of travel throughout their school career.
Ensure schools provide suitable cycle and road safety training for all pupils.
Encourage children and young people, especially those who live within a 2-mile radius of their school or other community facilities, to walk, cycle or use another mode of physically active travel to get there.
Work with local authorities to map safe routes to school and to local play and leisure facilities. Take into account the views of pupils, parents and carers and consult with the local community. Overcome any barriers that are identified (for example, a lack of secure cycle parking).
Involve children and young people, their parents and carers, the local community and external agencies in implementing the school travel plan. Use a mix of measures to promote it (for example, walking buses, walk and bike to school days). Work with the local authority school travel plan adviser to recruit volunteers on a long-term basis to help implement it.
Set performance targets for school travel plans which are audited annually and which form part of delivery plans for local partnerships. Remedial action should be taken when agreed targets are not reached.
Develop parents' and carers' awareness of the wider benefits of walking and cycling and other physically active modes of travel. For example, explain how it can improve children and young people's movement skills, social wellbeing, self-confidence and independence. Also explain how it can help children to explore and become more familiar (and at ease) with their local environment while, at the same time, being physically active.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePaths in this pathway
- Physical activity strategy, policy and commissioning
- Local strategy, policy and commissioning for physical activity
- Physical activity in the workplace
- Physical activity and the environment
- Making changes in other areas to encourage physical activity
- Encouraging people to be physically active
- Encouraging physical activity to prevent or treat specific conditions
- Local services: areas of work in relation to physical activity
- Transport and physical activity
- Physical activity and schools
- Training for people involved in encouraging others to be physically active
Pathway created: May 2011 Last updated: November 2012
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