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, 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).

Source guidance

The NICE guidance that was used to create the pathway.
Brief physical activity advice in primary care. NICE public health guidance 44 (2013)
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

Pathway information

Updates to this pathway

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

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'.

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.

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.
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.
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.
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 strategy, policy and commissioning

Recommendations about local strategy, policy and commissioning

Recommendations about local strategy, policy and commissioning

For related recommendations see the NICE pathways on community engagement and unintentional injuries among under-15s.
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).

Preventing CVD

Preventing cardiovascular disease

Preventing cardiovascular disease

Please also see NICE pathways on smoking prevention and cessation and on diet.
In addition, when developing CVD prevention programmes please also refer to recommendations made in the NICE pathway on behaviour change.

CVD programmes

Programmes to prevent cardiovascular disease

Programmes to prevent cardiovascular disease

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.
The recommendations below should be implemented before recommendations in this pathway on CVD programme resources, leadership and evaluation.

Good practice principles

Ensure a cardiovascular disease (CVD) prevention programme comprises intense, multi-component interventions.
Ensure it takes into account issues identified in this pathway. See also prevention of cardiovascular disease.
Ensure it includes initiatives aimed at the whole population (such as local policy and regulatory initiatives) which complement existing programmes aimed at individuals at high risk of CVD.
Ensure it is sustainable for a minimum of 5 years.
Ensure appropriate time and resources are allocated for all stages, including planning and evaluation.

Preparation

Gain a good understanding of the prevalence and incidence of CVD in the community. Find out about any previous CVD prevention initiatives that have been run (including any positive or negative experiences).
Consider how existing policies relating to food, tobacco control and physical activity, including those developed by the local authority, may impact on the prevalence of CVD locally.
Gauge the community's level of knowledge of, and beliefs about, CVD risk factors. This includes beliefs that smoking is the only solace in life for people with little money, or that only people who have a lot of money eat salad.
Gauge how confident people in the community are that they can change their behaviour to reduce the risks of CVD. See the NICE pathway on behaviour change.
Identify groups of the population who are disproportionately affected by CVD and develop strategies with them to address their needs.
Take into account the community's exposure to risk factors (factors currently facing adults and those emerging for children and younger people).

Programme development

Develop a population-based approach.
Ensure a 'programme theory' is developed and used to underpin the programmeEvidence based policy: 2. The promise of 'realist synthesis'. This should cover the reasons why particular actions are expected to have particular outcomes.
Ensure the programme helps address local targets and tackles health inequalities.
Link the programme with existing strategies for targeting people at particularly high risk of CVD and take account of ongoing, accredited screening activities by GPs and other healthcare professionals. This includes the NHS Health Checks programme.
Work closely with local authorities and other organisations covering specific areas to promote policies which are likely to encourage healthier eating, tobacco control and increased physical activity. Policies may cover spatial planning, transport, food retailing and procurement. Organisations that may get involved could include statutory, public sector and civil society groups (examples of the latter are charities, clubs, self-help and community groups).
When developing CVD programmes, take account of relevant recommendations made within the NICE guidance for this path and the related NICE guidance listed below:
Only develop, plan and implement a strategic, integrated media campaign as part of a wider package of interventions to address CVD risk factors. Media campaigns should be based on an acknowledged theoretical framework.

Implementation tools

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Source guidance

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CVD resources, leadership and evaluation

Programme resources, leadership and evaluation

Programme resources, leadership and evaluation

The recommendations below should be implemented after following advice on how to develop programmes to prevent cardiovascular disease in this pathway.

Resources

Ensure the programme lasts a minimum of 5 years (while subject to annual evaluation reports) to maximise its potential impact.
Produce a long-term plan – and gain political commitment – for funding to ensure the programme has adequate resources and is sustainable beyond the end of the research or evaluation period.
Ensure the programme is adequately staffed. Avoid adding cardiovascular disease (CVD) prevention to the workload of existing staff without relieving them of other tasks.
Ensure volunteers are an additional (rather than a core) resource and that their training and support is adequately resourced.
Ensure steps are taken to retain staff.
Where staff are recruited from the local community ensure, as far as possible, that they reflect the local culture and ethnic mix.
Ensure there are effective links with other existing and relevant community initiatives.

Leadership

Act as leader and governor of CVD prevention. Identify and articulate local community needs and aspirations and how these may impact on the community's risk of CVD. Reconcile these needs and aspirations or arbitrate on them to help prevent CVDHM Government; Communities and Local Government (2008) Creating strong, safe and prosperous communities. Statutory guidance. London: Community and Local Government Publications..
Identify senior commissioners of public health services as well as others from within local authorities as champions for CVD prevention.
Identify people to lead the CVD programme, including members of the local community. Identify in advance – and provide for – the training and other needs of these potential leaders.
Develop systems within local and other partnerships for agreeing shared priorities with other organisations involved in CVD prevention. Ensure senior staff are involved, as appropriate.

Evaluation

Establish baseline measures before the CVD programme begins. These should include lifestyle and other factors that influence cardiovascular risk, as well as figures on CVD prevalence and mortality. The establishment of such measures should be budgeted for as part of the programme.
Ensure evaluation is built in – in line with the NICE pathway on behaviour change. It should include the policies and activities of partner organisations which are likely to influence CVD prevalence.
Ensure appropriate methods (using multiple approaches and measures) are used to evaluate the programme's processes, outcomes and measures or indicators. Evaluation should include determining how acceptable the programme is to the local community or the groups targeted.
Ensure the results of evaluation are freely available and shared with partner organisations. Use the findings to inform future activities.
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

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Environment

Environment and physical activity

Environment and physical activity

Planning applications and new developmentsThis recommendation is from Physical activity and the environment (NICE public health guidance 8).

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).

What action should be taken?

Involve all local communities and experts at all stages of the development to ensure the potential for physical activity is maximised.
Ensure planning applications for new developments always prioritise the need for people (including those whose mobility is impaired) to be physically active as a routine part of their daily life. Ensure local facilities and services are easily accessible on foot, by bicycle and by other modes of transport involving physical activity. Ensure children can participate in physically active play.
Assess in advance what impact (both intended and unintended) the proposals are likely to have on physical activity levels. (For example, will local services be accessible on foot, by bicycle or by people whose mobility is impaired?) Make the results publicly available and accessible. Existing impact assessment tools could be used.

Public open spaces

Ensure public open spaces and public paths can be reached on foot, by bicycle and using other modes of transport involving physical activity. They should also be accessible by public transport.
Ensure public open spaces and public paths are maintained to a high standard. They should be safe, attractive and welcoming to everyone.

Planning for children and young peopleThis recommendation is from Promoting physical activity for children and young people (NICE public health guidance 17).

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.

What action should be taken?

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.
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

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Exercise referral, pedometers, walking, cycling

Exercise referral, pedometers, walking and cycling schemes

Exercise referral, pedometers, walking and cycling schemes

Exercise referral schemes

Practitioners, policy makers and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness. Measures should include intermediate outcomes such as knowledge, attitudes and skills, as well as measures of physical activity levels. Individuals should only be referred to schemes that are part of such a study.

Pedometers and walking and cycling schemes

See providing individual support and community-wide walking programmes in the walking and cycling pathway.

Source guidance

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Transport

Transport and physical activity

Transport and physical activity

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).

Planning applications and new developmentsThis recommendation is from Physical activity and the environment (NICE public health guidance 8).

Involve all local communities and experts at all stages of the development to ensure the potential for physical activity is maximised.
Ensure planning applications for new developments always prioritise the need for people (including those whose mobility is impaired) to be physically active as a routine part of their daily life. Ensure local facilities and services are easily accessible on foot, by bicycle and by other modes of transport involving physical activity. Ensure children can participate in physically active play.
Assess in advance what impact (both intended and unintended) the proposals are likely to have on physical activity levels. (For example, will local services be accessible on foot, by bicycle or by people whose mobility is impaired?) Make the results publicly available and accessible. Existing impact assessment tools could be used.

Prioritising physically active travel

Ensure pedestrians, cyclists and users of other modes of transport that involve physical activity are given the highest priority when developing or maintaining streets and roads. (This includes people whose mobility is impaired.) Use one or more of the following methods:
  • re-allocate road space to support physically active modes of transport (as an example, this could be achieved by widening pavements and introducing cycle lanes)
  • restrict motor vehicle access (for example, by closing or narrowing roads to reduce capacity)
  • introduce road-user charging schemes
  • introduce traffic-calming schemes to restrict vehicle speeds (using signage and changes to highway design)
  • create safe routes to schools (for example, by using traffic-calming measures near schools and by creating or improving walking and cycle routes to schools).

Encouraging physically active travelThis is part of a recommendation from Prevention of cardiovascular disease (NICE public health guidance 25).

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.

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'.

What action should be taken?

Ensure the physical environment encourages people to be physically active. Implement changes where necessary. This includes prioritising the needs of pedestrians and cyclists over motorists when developing or redeveloping highways.
Apportion part of local transport funding to promote walking, cycling and other forms of travel that involve physical activity. The proportion allocated should be in line with growth targets for the use of these modes of transport.
Ensure cycle tracks created under the Cycle Tracks Act 1984 are part of the definitive map (the legal record of public rights of way).

Local transport plans – young peopleThis recommendation is from Promoting physical activity for children and young people (NICE public health guidance 17)

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.

What action should be taken?

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. Liaise with local partnerships 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. 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'.
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.

Source guidance

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Children and young people

Encouraging children and young people to be physically active

Local policy and strategy

Local strategy and policy

Local strategy and policy

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.

Raising awareness of the importance of physical activity

Ensure the following (where they exist) address the need for children and young people to be physically active:
  • children and young people's plans
  • joint strategic needs assessments
  • local development and planning frameworks
  • sustainable community plans and strategies.
Ensure there is a coordinated local strategy to increase physical activity among children and young people, their families and carers.
The strategy should ensure:
  • there are local indoor and outdoor opportunities for physical activity where children and young people feel safe
  • individuals responsible for increasing physical activity are aware of national and local government strategies as well as local plans for increasing physical activity
  • partnership working is developed and supported within local physical activity networks
  • physical activity partnerships establish and deliver multi-component interventions involving schools, families and communities. (Partners may include: schools, colleges, out-of-schoolOut-of-school services are defined as those providing activities that take place outside the formal school day, possibly as part of extended school services. They could involve using school facilities during the evening, weekends and school holidays. services, children's centres and play services, youth services, further education institutions, community clubs and groups and private sector providers)
  • local factors that help children and young people to be (or which prevent them from being) physically active are identified and acted upon
  • local transport and school travel plans are coordinated so that all local journeys can be carried out using a physically active mode of travel. See transport and physical activity in this pathway.
Ensure physical activity initiatives aimed at children and young people are regularly evaluated. Evaluations should measure uptake among different groups (for example, among those with disabilities or from different ethnic backgrounds). Any changes in physical activity, physical skills and health outcomes should be recorded.
Identify a senior council member to be a champion for children and young people's physical activity. They should:
  • promote the importance of encouraging physical activity as part of all council portfolios
  • ensure physical activity is a key priority when developing local authority programmes and targets
  • promote partnership working with council member leads of relevant departments (for example, transport, leisure and health)
  • explain to the public the local authority's role in promoting physical activity.

Developing physical activity plans for children

Identify groups of local children and young people who are unlikely to participate in at least 1 hour of moderate to vigorous physical activity a day. Work with the public health observatory, schools and established community partnerships and voluntary organisations to achieve this.
Involve these children and young people in the design, planning and delivery of physical activity opportunities, using the information gathered.
Consult with different groups of children and young people and their families on a regular basis to understand the factors that help or prevent them from being physically active. Pay particular attention to those who are likely to be less physically active. Ensure children and young people from different socioeconomic and minority ethnic groups are actively involved in the provision of activities. Also ensure those with a disability (or who are living with a family member who has a disability) are actively involved.
Use the information gathered to increase opportunities for children and young people to be physically active and to plan dedicated programmes that tackle any inequalities in provision. For further recommendations on community engagement, see the NICE pathway on community engagement.

Planning the provision of spaces and facilities for children

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.
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

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Commissioning

Commissioning activities and resources

Commissioning activities and resources

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.

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 for activities aimed at children and young people

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 the NICE pathway 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'.

Source guidance

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Incorporating brief advice in commissioning

Incorporating brief advice in commissioning

Incorporating brief advice in commissioning

Who should take action?

Commissioners of health services, including primary care and public health services.

What action should they take?

When commissioning primary care services to prevent or treat conditions such as cardiovascular disease, type 2 diabetes and stroke or to improve mental health, ensure brief advice on physical activity is incorporated into the care pathway.
Ensure brief advice on physical activity is incorporated into services for groups that are particularly likely to be inactive. This includes people aged 65 years and over, people with a disability and people from certain minority ethnic groups.
Include physical activity assessment and brief advice as part of a strategy for addressing domain 2 of the public health outcomes framework (Proportion of physically active and inactive adults indicator).
Ensure assessment of physical activity and the delivery of, and follow up on, brief advice (see brief advice for adults in this pathway) are built into local long-term disease management strategies. Highlight physical activity as an independent modifiable risk factor for many conditions (see physical activity: definition and current UK recommendations). Strategies should also raise awareness of physical activity assessment as part of relevant quality and outcomes framework (QOF) indicators.

Source guidance

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Systems to support brief advice

Systems to support brief advice

Systems to support brief advice

Commissioners of health services, including primary care and public health services should:
  • Ensure systems such as Read Codes are being used to identify opportunities to assess people's physical activity levels and deliver brief advice.
  • Ensure resources (for example, standard documents and forms) and systems are available to assess, record and follow up on the provision of brief advice.
  • Ensure information about local opportunities to be active (including non-sporting activities) is available and up to date. This could include online maps and route finding for walking or adapted cycling.

Source guidance

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Recommendations for commissioners on information and training

View the 'Information and training in primary care about physical activity and adults' node

Paths in this pathway

Pathway created: May 2011 Last updated: March 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.



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