Making changes in other areas to encourage physical activity

Four commonly used methods to increase physical activity: implementation advice

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.

Weight management before, during and after pregnancy: slide set

Prevention of cardiovascular disease: slide set

Promoting physical activity for children and young people: slide set

Promoting physical activity in the workplace: slide set

Maternal and child nutrition: slide set

Pathway information

Updates to this pathway

25 October 2011 Minor maintenance updates

25 May 2012 Minor maintenance updates

28 November 2012

Links to the 'Walking and cycling' pathway have been added to:

Links to the 'Mental wellbeing and older people' pathway have been added to:

Information about obesity prevention added to introduction, Programme resources, leadership and evaluation, Environment and physical activity, Recommendations about local strategy, policy and commissioning, Local strategy and policy and Addressing health inequalities.

Supporting information

Physical activity and the environment

It is important to improve the environment to encourage physical activity and evaluate how such improvements impact on the public's health.

Most of NICE's recommendations on physical activity and the environment are relevant when developing local transport plans and guidance using, for example, planning policy guidance 13.

All the recommendations are relevant when developing joint NHS and local authority strategies. They are also relevant when planning and managing the NHS (including its premises).

Physical activity at work

Many employers recognise that they have an obligation to the health and wellbeing of their workforce. Investing in the health of employees can also bring business benefits such as reduced sickness absence, increased loyalty and better staff retention.

NICE's recommendations aim to help employers and workplace health professionals prevent the diseases associated with a lack of physical activity. The recommendations alone will not reverse the current obesity epidemic or other health trends associated with a sedentary lifestyle. However, efforts made in the workplace, alongside wider strategies to increase physical activity levels, could help improve people's health significantly.

Children and young people: key themes

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

A national framework for action

Cardiovascular disease (CVD) is a major public health problem. Changes in the risk factors can be brought about by intervening at the population and individual level. Government has addressed – and continues to address – the risk factors at both levels.

Interventions focused on changing an individual's behaviour are important. But changes at the population level could lead to further substantial benefits.

Population-level changes may be achieved in a number of ways but national or regional policy and legislation are particularly powerful levers. See prevention of cardiovascular disease.

The national framework would be established through policy, led by the Department of Health. It would involve government, government agencies, industry and key, non-governmental organisations working together.

The final decision on whether these policy options are adopted – and how they are prioritised – will be determined by government through normal political processes.

Helping women to achieve and maintain a healthy weight

Women will be more likely to achieve and maintain a healthy weight before, during and after pregnancy if they:

base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible
eat fibre-rich foods such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta
eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories
eat a low-fat diet and avoid increasing their fat and/or calorie intake
eat as little as possible of fried food; drinks and confectionery high in added sugars (such as cakes, pastries and fizzy drinks); and other food high in fat and sugar (such as some take-away and fast foods)
eat breakfast
watch the portion size of meals and snacks, and how often they are eating
make activities such as walking, cycling, swimming, aerobics and gardening part of everyday life and build activity into daily life – for example, by taking the stairs instead of the lift or taking a walk at lunchtime
minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games
walk, cycle or use another mode of transport involving physical activity.

Weight-loss programmes are not recommended during pregnancy as they may harm the health of the unborn child.

Physically active travel

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

Glossary

Access (accessibility) can mean that a particular place or destination is accessible to local residents using a mode of transport that involves physical activity. Destinations may include work, healthcare and education facilities and shops. It can also mean the ability to use a facility because, for instance, it is free or affordable, it does not require people to travel a long distance to use it and the environment and activities are suitable for those with disabilities. Examples of facilities include playgrounds, parks or open spaces and leisure, youth or community centres.

The Children's Play Council (now Play England) defines play as: ' …freely chosen, personally directed, intrinsically motivated behaviour that actively engages the child...' Active play involves physical activity.

Cardiovascular disease (CVD) includes coronary heart disease (CHD), stroke and peripheral arterial disease. These conditions are frequently brought about by the development of atheroma and thrombosis (blockages in the arteries). They are also linked to conditions such as heart failure, chronic kidney disease and dementia.

An exercise referral scheme directs someone to a service offering an assessment, development of a tailored physical activity programme, monitoring of progress and follow-up. It involves participation by a number of professionals and may require the individual to go to an exercise facility such as a leisure centre.

Mental wellbeing has been defined as life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support. See NHS Health Scotland Mental health improvement programme, background and policy context

Moderate-intensity activity increases breathing and heart rates to a level where the pulse can be felt and the person feels warmer. It might make someone sweat on a hot or humid day (or when indoors).

Children and young people should undertake a range of activities at this level for at least 60 minutes over the course of a day. At least twice a week this should include weight-bearing activities that produce high physical stresses to improve bone health, muscle strength and flexibility. This amount of physical activity can be achieved in a number of short, 10-minute (minimum) bouts.

Movement skills use skeletal muscles to achieve a physical goal. They are learnt and refined throughout life. Gross movement skills include: rolling over, sitting up, crawling, walking, running, jumping, hopping and skipping. Fine movement skills include the ability to manipulate small objects and transfer them from hand to hand, and tasks that involve hand-eye coordination.

Occupational therapy aims to enable people who have physical, mental and/or social needs, either from birth or as a result of accident, illness or ageing, to achieve as much as they can to get the most out of life.

A school travel plan is a written document detailing a package of measures to improve safety and reduce car use, backed by a partnership involving the school, education and local authority transport officers, the police and the health authority. It is based on consultation with teachers, parents, pupils and governors and other local people. It must include: information about the school, a description and analysis of journeys made and the associated problems, a survey of pupils' current and preferred mode of travel, consultation findings, clearly defined targets and objectives, details of proposed measures and a timetable for implementation, clearly defined responsibilities and proposals for monitoring and review.

Sport is all forms of physical activity which, through casual or organised participation, aim at expressing or improving physical fitness and mental wellbeing, forming social relationships or obtaining results in competition at all levels.

Traffic calming is a means of restricting vehicle speeds, primarily using traffic engineering measures such as speed bumps.

Walking and cycling schemes are defined as organised walks or rides.

Weight management before, during and after pregnancy includes:

assessing and monitoring body weight
preventing someone from becoming overweight (body mass index [BMI] 25-29.9 kg/m2) or obese (BMI greater than or equal to 30 kg/m2)
helping someone to achieve and maintain a healthy weight before, during and after pregnancy by eating healthily and being physically active and gradually losing weight after pregnancy.

Making changes in other areas to encourage physical activity

Environment
Transport
Workplaces

NHS environment

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).

NHS buildings – walking and cycling links

Those involved with campus sites, including hospitals and universities, should ensure different parts of the site are linked by appropriate walking and cycling routes. (Campuses comprise two or more related buildings set together in the grounds of a defined site.)

Ensure new workplaces are linked to walking and cycling networks. Where possible, these links should improve the existing walking and cycling infrastructure by creating new, through routes (and not just links to the new facility).

NHS buildings – staircases

During building design or refurbishment, ensure staircases are designed and positioned to encourage people to use them.

Ensure staircases are clearly signposted and are attractive to use. For example, they should be well-lit and well-decorated.

Implementation tools

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Physical activity and the environment: costing report

Source guidance

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Non-NHS environments

Public health practitioners should be involved in local plans for the environment to help ensure any changes encourage 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.

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

Physical activity at work

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.

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.

General environmental improvementsThis is part of a recommendation from Prevention of cardiovascular disease (NICE public health guidance 25).

A national framework for action

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 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

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. It also includes developing and implementing public sector workplace travel plans that incorporate physical activity – see physical activity programmes including active travel. Encourage and support employers in other sectors to do the same.

Ensure the need for children and young people to be physically active is addressed. This includes providing adequate play spaces and opportunities for formal and informal physical activity.

Audit bye-laws and amend those that prohibit physical activity in public spaces (such as those that prohibit ball games).

Align all 'planning gain' agreements with the promotion of heart health to ensure there is funding to support physically active travel. (For example, Section 106 agreements are sometimes used to bring development in line with sustainable development objectives.

Implementation tools

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Physical activity and the environment: costing report

Promoting physical activity for children and young people: audit support

Promoting physical activity for children and young people: costing statement

Promoting physical activity for children and young people: resources guide

Promoting physical activity for children and young people: slide set

Prevention of cardiovascular disease: checklist

Prevention of cardiovascular disease: costing report

Prevention of cardiovascular disease: costing template

Prevention of cardiovascular disease: self-assessment

Prevention of cardiovascular disease: slide set

Source guidance

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PH25

PH17

Transport

Transport outside the NHS
NHS transport

NHS transport

NHS transport: walking and cycling between NHS sites

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).

Walking and cycle routes

Implementation tools

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Physical activity and the environment: costing report

Source guidance

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Transport outside the NHS

Transport provision outside the NHS

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).

Public health practitioners should be involved in local transport planning to help increase physical activity levels.

General transport strategies, policies and plans

Involve all local communities and experts at all stages of the development to ensure the potential for physical activity is maximised.

Road design

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).

Walking and cycling routes

Plan and provide a comprehensive network of routes for walking, cycling and using other modes of transport involving physical activity. These routes should offer everyone (including people whose mobility is impaired) convenient, safe and attractive access to workplaces, homes, schools and other public facilities. (The latter includes shops, play and green areas and social destinations.) They should be built and maintained to a high standard.

Implementation tools

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Physical activity and the environment: costing report

Source guidance

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Workplaces

Non-NHS workplaces
NHS workplaces

NHS workplaces

NHS buildings – staircasesThis 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?

During building design or refurbishment, ensure staircases are designed and positioned to encourage people to use them.

Ensure staircases are clearly signposted and are attractive to use. For example, they should be well-lit and well-decorated.

Physical activity at work

Policy and planning to encourage physical activityThis recommendation is from Promoting physical activity in the workplace (NICE public health guidance 13).

Develop an organisation-wide plan or policy to encourage and support employees to be more physically active. This should:

include measures to maximise the opportunity for all employees to participate
be based on consultation with staff and should ensure they are involved in planning and design, as well as monitoring activities, on an ongoing basis
be supported by management and have dedicated resources
set organisational goals and be linked to other relevant internal policies (for example, on alcohol, smoking, occupational health and safety, flexible working or travel)
link to relevant national and local policies (for example, on health or transport).

Implementing a physical activity programme

Introduce and monitor an organisation-wide, multi-component programme to encourage and support employees to be physically active. This could be part of a broader programme to improve health. It could include:

flexible working policies and incentive schemes
policies to encourage 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)
the dissemination of information (including written information) on how to be more physically active and on the health benefits of such activity. This could include 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
ongoing advice and support to help people plan how they are going to increase their levels of physical activity
the offer of a confidential, independent health check administered by a suitably qualified practitioner and focused on physical activity.

Components of the physical activity programme

Encourage employees to walk, cycle or use another mode of transport involving physical activity to travel part or all of the way to and from work (for example, by developing a travel plan).

Help employees to be physically active during the working day by:

where possible, encouraging them to move around more at work (for example, by walking to external meetings)
putting up signs at strategic points and distributing written information to encourage them to use the stairs rather than lifts if they can
providing information about walking and cycling routes and encouraging them to take short walks during work breaks
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, while those involved in shift work may be vulnerable if walking home alone at night.

Travel plans, showers and secure cycle parkingThis is part of a recommendation from Obesity (NICE clinical guideline 43).

In their role as employers, NHS organisations should set an example in developing public health policies to prevent and manage obesity by following existing guidance and (in England) the local obesity strategy. In particular, there should be policies, facilities and information that promote physical activity, for example, through travel plans, by providing showers and secure cycle parking and by using signposting and improved décor to encourage stair use.

Implementation tools

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Physical activity and the environment: costing report

Promoting physical activity in the workplace: business case

Promoting physical activity in the workplace: slide set

Source guidance

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CG43

PH13