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.

Playgrounds

Playground design

Playground design

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).
Please also refer to the NICE pathway on strategies to prevent unintentional injuries among under-15s.

Encouraging physically active play

Ensure school playgrounds are designed to encourage varied, physically active play.
Primary schools should create areas (for instance, by using different colours) to promote individual and group physical activities such as hopscotch and other games.

Implementation tools

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Source guidance

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Structure of physical activity programmes

View the 'structure of programmes' node

Delivering physical activity programmes

View the 'programme delivery' node

Travel plans

Physically active travel plans

Physically active travel plans

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.
Please also refer to the NICE pathway on 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.
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.

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 – see Making school travel plans work. 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

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Planning and leadership

Planning and leadership

Planning and leadership

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.
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.

Responding to children and young people

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.
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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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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