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Physical activity overview

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Physical activity HAI

About

What is covered

Increasing physical activity levels will help prevent and manage over 20 conditions and diseases including cancer, coronary heart disease, diabetes, stroke, musculoskeletal conditions and obesity. It can also help to promote mental wellbeing. So it is important that people incorporate regular physical activity into their daily lives.
This pathway includes recommendations for children, young people and adults, including teenage girls and women before, during and after pregnancy.
The recommendations cover policies and strategies to improve the physical environment as a means of encouraging physically active travel and other physical activities. In addition, they advise on action that the NHS and others in the community, workplaces and schools can take to encourage people to be physically active.
Align actions to promote physical activity with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).

Updates

Updates to this pathway

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

Short Text

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

What is covered

Increasing physical activity levels will help prevent and manage over 20 conditions and diseases including cancer, coronary heart disease, diabetes, stroke, musculoskeletal conditions and obesity. It can also help to promote mental wellbeing. So it is important that people incorporate regular physical activity into their daily lives.
This pathway includes recommendations for children, young people and adults, including teenage girls and women before, during and after pregnancy.
The recommendations cover policies and strategies to improve the physical environment as a means of encouraging physically active travel and other physical activities. In addition, they advise on action that the NHS and others in the community, workplaces and schools can take to encourage people to be physically active.
Align actions to promote physical activity with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).

Updates

Updates to this pathway

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

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Obesity. NICE clinical guideline 43 (2006)
Exercise referral schemes to promote physical activity. NICE public health guidance 54 (2014)
Brief physical activity advice in primary care. NICE public health guidance 44 (2013)
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)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Service improvement and audit

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

Information for the public

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

Pathway information

Supporting information

Physical activity and the environment

It is important to improve the environment to encourage physical activity and evaluate how such improvements impact on the public's health.
Most of NICE's recommendations on physical activity and the environment are relevant when developing local transport plans and guidance using, for example, planning policy guidance 13.
All the recommendations are relevant when developing joint NHS and local authority strategies. They are also relevant when planning and managing the NHS (including its premises).

Physical activity at work

Many employers recognise that they have an obligation to the health and wellbeing of their workforce. Investing in the health of employees can also bring business benefits such as reduced sickness absence, increased loyalty and better staff retention.
NICE's recommendations aim to help employers and workplace health professionals prevent the diseases associated with a lack of physical activity. The recommendations alone will not reverse the current obesity epidemic or other health trends associated with a sedentary lifestyle. However, efforts made in the workplace, alongside wider strategies to increase physical activity levels, could help improve people's health significantly.

Children and young people: key themes

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

Information about exercise referral schemes

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

A national framework for action

Cardiovascular disease (CVD) is a major public health problem. Changes in the risk factors can be brought about by intervening at the population and individual level. Government has addressed – and continues to address – the risk factors at both levels.
Interventions focused on changing an individual's behaviour are important. But changes at the population level could lead to further substantial benefits.
Population-level changes may be achieved in a number of ways but national or regional policy and legislation are particularly powerful levers. See prevention of cardiovascular disease.
The national framework would be established through policy, led by the Department of Health. It would involve government, government agencies, industry and key, non-governmental organisations working together.
The final decision on whether these policy options are adopted – and how they are prioritised – will be determined by government through normal political processes.

Helping women to achieve and maintain a healthy weight

Women will be more likely to achieve and maintain a healthy weight before, during and after pregnancy if they:
  • base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible
  • eat fibre-rich foods such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta
  • eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories
  • eat a low-fat diet and avoid increasing their fat and/or calorie intake
  • eat as little as possible of fried food; drinks and confectionery high in added sugars (such as cakes, pastries and fizzy drinks); and other food high in fat and sugar (such as some take-away and fast foods)
  • eat breakfast
  • watch the portion size of meals and snacks, and how often they are eating
  • make activities such as walking, cycling, swimming, aerobics and gardening part of everyday life and build activity into daily life – for example, by taking the stairs instead of the lift or taking a walk at lunchtime
  • minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games
  • walk, cycle or use another mode of transport involving physical activity.
Weight-loss programmes are not recommended during pregnancy as they may harm the health of the unborn child.

Physically active travel

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

Physical activity: definition and current UK recommendations

Definition

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

National recommendations

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

Benefits of physical activity

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

Glossary

Access (accessibility) can mean that a particular place or destination is accessible to local residents using a mode of transport that involves physical activity. Destinations may include work, healthcare and education facilities and shops. It can also mean the ability to use a facility because, for instance, it is free or affordable, it does not require people to travel a long distance to use it and the environment and activities are suitable for those with disabilities. Examples of facilities include playgrounds, parks or open spaces and leisure, youth or community centres.
The Children's Play Council (now Play England) defines play as: ' …freely chosen, personally directed, intrinsically motivated behaviour that actively engages the child...' Active play involves physical activity.
The term 'brief advice' is used in this guidance to mean verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. It can vary from basic advice to a more extended, individually focused discussion.
Cardiovascular disease (CVD) includes coronary heart disease (CHD), stroke and peripheral arterial disease. These conditions are frequently brought about by the development of atheroma and thrombosis (blockages in the arteries). They are also linked to conditions such as heart failure, chronic kidney disease and dementia.
Defined as not currently meeting the Chief Medical Officer's recommendation for physical activity as outlined in 'Start active, stay active: a report on physical activity from the four home countries' Chief Medical Officers' (Department of Health 2011).
Mental wellbeing has been defined as life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support. See NHS Health Scotland Mental health improvement programme, background and policy context
Moderate-intensity activity increases breathing and heart rates to a level where the pulse can be felt and the person feels warmer. It might make someone sweat on a hot or humid day (or when indoors).
Children and young people should undertake a range of activities at this level for at least 60 minutes over the course of a day. At least twice a week this should include weight-bearing activities that produce high physical stresses to improve bone health, muscle strength and flexibility. This amount of physical activity can be achieved in a number of short, 10-minute (minimum) bouts.
Movement skills use skeletal muscles to achieve a physical goal. They are learnt and refined throughout life. Gross movement skills include: rolling over, sitting up, crawling, walking, running, jumping, hopping and skipping. Fine movement skills include the ability to manipulate small objects and transfer them from hand to hand, and tasks that involve hand-eye coordination.
Occupational therapy aims to enable people who have physical, mental and/or social needs, either from birth or as a result of accident, illness or ageing, to achieve as much as they can to get the most out of life.
For example, risk factors for coronary heart disease, stroke and type 2 diabetes. These include high blood pressure, high blood cholesterol and being overweight.
Read Codes is the standard clinical terminology system used in general practice in the UK.
A school travel plan is a written document detailing a package of measures to improve safety and reduce car use, backed by a partnership involving the school, education and local authority transport officers, the police and the health authority. It is based on consultation with teachers, parents, pupils and governors and other local people. It must include: information about the school, a description and analysis of journeys made and the associated problems, a survey of pupils' current and preferred mode of travel, consultation findings, clearly defined targets and objectives, details of proposed measures and a timetable for implementation, clearly defined responsibilities and proposals for monitoring and review.
Being sedentary is not just a lack of physical activity (see 'inactive'). Sedentary behaviour involves activities that do not increase energy expenditure much above resting levels, for example, sitting, lying down, sleeping, watching TV and reading. Sedentary behaviour is an independent risk factor for chronic disease. People who achieve the recommended levels of physical activity can still be at risk if they spend too long being sedentary. (British Heart Foundation National Centre for Physical Activity and Health 2013).
Sport is all forms of physical activity which, through casual or organised participation, aim at expressing or improving physical fitness and mental wellbeing, forming social relationships or obtaining results in competition at all levels.
Structured exercise programmes vary in format, the mechanism of referral and content. They include components such as phase 3 and phase 4 rehabilitation activities and structured, tailored and supervised activities delivered by a specialist physical activity and exercise instructor (trained to level 4).
Traffic calming is a means of restricting vehicle speeds, primarily using traffic engineering measures such as speed bumps.
Walking and cycling schemes are defined as organised walks or rides.
Weight management before, during and after pregnancy includes:
  • assessing and monitoring body weight
  • preventing someone from becoming overweight (body mass index [BMI] 25-29.9 kg/m2) or obese (BMI greater than or equal to 30 kg/m2)
  • helping someone to achieve and maintain a healthy weight before, during and after pregnancy by eating healthily and being physically active and gradually losing weight after pregnancy.

Paths in this pathway

Pathway created: May 2011 Last updated: November 2014

© NICE 2014

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