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 and obesity. It can also help to promote mental wellbeing. So it is important that people incorporate regular physical activity into their daily lives.
This pathway includes recommendations for children, young people and adults, including teenage girls and women before, during and after pregnancy.
The recommendations cover policies and strategies to improve the physical environment as a means of encouraging physically active travel and other physical activities. In addition, they advise on action that the NHS and others in the community, workplaces and schools can take to encourage people to be physically active.
Please note, recommendations from NICE's obesity guidance have only been included in this pathway if they refer specifically to physical activity.
Align actions to promote physical activity with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).

Source guidance

The NICE guidance that was used to create the pathway.
Obesity. NICE clinical guideline 43 (2006)
Weight management before, during and after pregnancy. NICE public health guidance 27 (2010)
Prevention of cardiovascular disease. NICE public health guidance 25 (2010)
Promoting physical activity for children and young people. NICE public health guidance 17 (2009)
Promoting physical activity in the workplace. NICE public health guidance 13 (2008)
Maternal and child nutrition. NICE public health guidance 11 (2008)
Physical activity and the environment. NICE public health guidance 8 (2008)
Four commonly used methods to increase physical activity. NICE public health guidance 2 (2006)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Assessment tool

The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Weight management before, during and after pregnancy: self-assessment tool
Prevention of cardiovascular disease: self-assessment

Commissioning guide

Commissioning guides provide information on key clinical and service-related issues to consider during the commissioning process. Each guide contains a commissioning and benchmarking tool, which is a resource that can be used to estimate and inform the level of service needed locally as well as the cost of local commissioning decisions.
Maternal and child nutrition: commissioning guide

Education tools

NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.
Complications in pregnancy: online educational tool.

Information resources and templates

These include key points for scrutiny or compliance assessment, signposting to resources, checklists and case studies. They are designed to offer practical help in putting NICE guidance into practice and the format depends on the specific topic.
Weight management before, during and after pregnancy: questionnaire
Prevention of cardiovascular disease: checklist
Promoting physical activity for children and young people: resources guide
Physical activity and the environment: checklist

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.
Four commonly used methods to increase physical activity: implementation advice

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
Physical activity and the environment: 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.

Strategy, policy and commissioning

Strategy, policy and commissioning

Local strategy, policy and commissioning

View the 'Local strategy, policy and commissioning for physical activity' path

National strategy, policy and commissioning

National strategy, policy and commissioning

National strategy, policy and commissioning

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

What action should be taken?

Deliver a long-term (minimum 5 years) national campaign to promote physical activity among children and young people. The campaign should be integrated with and support other national health campaigns and strategies to increase participation in play and sport and reduce obesity (such as 'Change4Life').
Use research, consult and actively involve children and young people and their parents to determine the best media to use, the most effective messages and the most appropriate language for different groups. (Examples of different groups that could be covered include families, parents and carers, and children of different ages, ethnicity and who have different levels of physical ability.)
Ensure the campaign is consistent and sustained. It should convey that physical activity:
  • is healthy, fun and enjoyable, makes you feel good and can be sociable (that is, it can be undertaken with existing friends or can help develop new ones)
  • promotes children and young people's independence
  • helps develop children's movement skills
  • can involve a wide variety of formal and informal activities such as play, dance, swimming, the gym, sport (including street sport and games) and physically active travel (such as walking, cycling and wheelchair travel)
  • can (and should) become a regular part of daily life and that small lifestyle changes can be worthwhile (for example, active travel to school, the shops or the park, using the stairs and ramps instead of lifts and helping with housework)
  • can be maintained by trying new and challenging activities to keep children and young people interested and motivated
  • is something that adults, especially parents and carers, should incorporate into their lives to set an example.
Ensure the campaign addresses any concerns that parents and carers may have about their children's safety.
Encourage regional and local campaigns to use the same messages, as well as promoting examples of local opportunities to be physically active.
Develop resources for regional and local dissemination of the campaign (for example, promotional materials and support for those delivering it). For more on training see training for people involved in encouraging others to be physically active.
Use process, impact and outcome measures to ensure national, regional and local campaigns are delivered effectively. For recommendations on the principles of evaluation, see NICE guidance on behaviour change.

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

See also public open spaces and physical activity programmes including active travel.
The final decision on whether these policy options are adopted – and how they are prioritised – will be determined by government through normal political processes.

Policy goal

Ensure government funding supports physically active modes of travel. To achieve this, the evidence suggests that the following are among the measures that should be considered.
What action should be taken?
Ensure guidance for local transport plans supports physically active travel. This can be achieved by allocating a percentage of the integrated block allocation fund to schemes which support walking and cycling as modes of transport.
Create an environment and incentives which promote physical activity, including physically active travel to and at work.
Consider and address factors which discourage physical activity, including physically active travel to and at work. An example of the latter is subsidised parking.

Implementation tools

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Promoting physical activity for children and young people: costing statement
Promoting physical activity for children and young people: Resources guide

Source guidance

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PH17
PH25

Paths in this pathway

Pathway created: May 2011 Last updated: November 2012

Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.



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