JSNA - Physical Activity
- Key issues and gaps
- Who is at risk and why
- The level of need in the population
- Current services in relation to need
- Service users and carers opinion
- Expert opinion and evidence base
- Projected service use in 3-5 years and 5-10 years
- Unmet needs and service gaps
- Recommendations for consideration by commissioners
- Recommendations for further needs assessments
- Key contacts
- Friendly version of this section (PDF, 279KB)
- Data for this section (Excel, 45KB)
Physical activity – the definition
Physical activity is defined as being any bodily movement produced by the skeletal muscles that result in an energy expenditure, and includes a range of leisure-time, routine and occupational activities. The terms ‘physical activity’ and ‘exercise’ are often used interchangeably.
The four Chief Medical Officers strongly assert the importance of physical activity and refer to physical inactivity as a ‘silent killer’ (Department of Health (DH), 2011). Physical inactivity is the fourth leading risk factor for global mortality, accounting for 6% of deaths (WHO, 2010). The risk of premature death amongst physically active adults is reduced by 20%-30%, and the risk of developing major long-term conditions such as coronary heart disease (CHD), stroke diabetes and some cancers are reduced by up to 50% (DH, 2004). Since the 1950’s, irrefutable evidence has accumulated on the association between physical inactivity and the risk of cardiovascular disease (CVD) (Morris et al, 1953). The strong evidence for physical activity has led to physical inactivity being recognised as a major modifiable risk factor for CHD, a preventable disease, which itself is the commonest cause of premature death in England.
Physical inactivity is associated with increases in obesity, CVD, cancer, hypertension, and in the development of type II diabetes. Participation in regular physical activity can help to prevent and treat over twenty long-term conditions or disorders, including stroke, obesity, some cancers, mental health and type II diabetes(DH, 2011). In children and young people, additional potential benefits of leading an active lifestyle include the acquisition of social skills through engaging in active play, improved concentration and displacement of anti-social and criminal behaviour (Warwick, Mooney and Oliver, 2009).
There is also growing evidence of the risks of excessive sedentary behaviour (for example, watching TV and computer use) across all age groups, suggesting a link between sedentary behaviour and overweight and obesity. In addition, some research suggests that sedentary behaviour is independently associated with all-cause mortality, type II diabetes, some cancers and metabolic dysfunction, even amongst those who are active at the recommended levels (Sedentary Behaviour and Obesity Expert Working Group, 2010).
The vast majority of the adult population in the UK is not active at levels to benefit their health. Approximately 60% of men and 72% of women do not meet the UK Chief Medical Officers’ physical activity recommendations (NICE, 2012).
However, it is important to highlight that individuals tend to overestimate the amount of activity undertaken in self-report surveys. Data derived using objective measures in England revealed only 6% of men and 4% of women met previous physical activity recommendations (NHS Information Centre for Health and Social Care, 2009).
In children aged 2-15 years in England, 68% of boys and 76% of girls do not met the Chief Medical Officers’ physical activity recommendations (NICE, 2012). The National Travel Survey (2012) revealed that children’s trips made to and from primary school on foot have declined by approximately 6%, to 47% compared to 1995/97 figure at 53%. School trips made by car have also increased by similar proportions. In secondary school children, similar patterns are observed, although only 36% of trips to school are made on foot.
Costs associated with physical inactivity
The costs associated with physical inactivity are immense, resulting in direct costs to the NHS and indirectly, affecting the wider economy, for example through sickness absence. The estimated direct costs to the NHS total £1.06 billion based on five long-term conditions linked to inactivity, which exclude other conditions and health problems such as falls and osteoporosis which affect many older people (Allender et al, 2007). Indirect costs of inactivity, which affect the wider economy, from sickness absence and premature death have been estimated at £6.5 billion per annum (NICE, 2012).
Workplace physical activity programmes have been found to reduce sickness by up to 20%, with physically active staff taking 27% fewer sick days (NICE, 2012).
Current physical activity guidelines
New physical activity guidelines were introduced in 2011 which set out the volume, duration, frequency and type of activity required across the life course to achieve general health benefits (DH, 2011). These guidelines update the existing guidelines for adults (19-64 years), children and young people (5-18 years), and for the first time provide guidelines for early years (under 5’s – infants who are not yet walking and children capable of walking) and older people (65+ years). The new guidelines allow for more flexibility in achieving recommended levels of physical activity.
Adults (19-64 years)
Adults should aim to be active on a daily basis. Over a week, activity should amount to at least 150 minutes (2½ hours) of moderate intensity physical activity in bouts of 10 minutes or more. This could be achieved by undertaking 30 minutes on at least 5 days of the week. Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous activity. Adults should also undertake physical activity to improve muscle strength on at least two days a week. Adults should also reduce sedentary behaviour.
Adults (65+ years)
The guidelines for older adults are the same as for adults (as above). In addition, older adults at risk of falls should incorporate activity to improve balance and co-ordination (eg. tai chi and yoga) on at least two days a week.
Children and young people (5-18 years)
Children and young people should aim to be active for at least 60 minutes and up to several hours each day at a moderate to vigorous intensity. This should include vigorous intensity activities that strengthen muscle and bone at least three days a week. Sedentary behaviour should be minimised.
Early Years (under 5 years)
Children capable of walking unaided should be physically active on a daily basis for at least 180 minutes (3 hours), spread throughout the day. The time spent being sedentary for extended periods should be minimised (except time spent sleeping).
For infants who are not yet walking, physical activity should be encouraged from birth, for example, through floor-based play and water-based activities. Time spent being sedentary for extended periods should be minimised (except time spent sleeping).
It is important to highlight that sedentary populations (those active for less than 30 minutes per week) have the most to gain from increasing their activity levels, even if levels remain below the recommended levels. In addition, even small increases in activity levels are associated with some protection against the development of long-term conditions and improved quality of life (DH, 2011).
- Physical activity levels are low amongst adults, particularly women.
- Physical activity levels are low in children, with girls being less active than boys.
- Children from lower socioeconomic groups and some black, Asian and minority ethnic groups are less physical activity than their counterparts from higher socioeconomic groups.
- Data for 2010 showed that schools were meeting the 2 hours of PE requirement as measured by the School Sports Partnership (SSP). However, the SSP no longer exists as a national strategy so it may become harder to monitor activity levels in schools.
- Familial involvement in sport is a strong influence on all forms of participation at both Year 6 and Year 9. Where there is no sporting role model in the family, young people are significantly less likely to take part in sport.
- Certain black and minority ethnic groups are less active than their white counterparts.
- Individuals with disabilities/living with long-term conditions are less active.
- Individuals in the lower socio-economic groups are less active than those in higher socio-economic groups.
- With levels of obesity predicted to increase, physical inactivity levels may increase as a result, as there is evidence that overweight/obese individuals have lower levels of physical activity.
Despite the well-documented evidence of the benefits of leading a physically active lifestyle, the vast majority of the UK adult population is not active at levels to confer health benefits. Activity levels amongst children and young people are also low.
There are significant inequalities in levels of physical activity in relation to age, gender, ethnicity, socio-economic status and disability (DH, 2011). In the UK:
- Men are more active than women at all ages
- Physical activity declines rapidly with increasing age for both men and women, and drops markedly in those aged over 75 years
- Physical activity is lower in low-income households
- Participation in physical activity is less likely in some Black and minority ethnic groups. For example, in England, physical activity is lower for black and minority ethnic groups, with the exception of African-Caribbean and Irish populations
- Boys are more active than girls at almost every age
- Physical activity levels decline in both girls and boys with increasing age, but this occurs more steeply in girls as they move from childhood to adolescence
- In Haringey in the east of the borough where the lower socio-economic groups are more highly represented physical activity rates are amongst the lowest in the country
The Sport England, Active People Survey (APS) is the largest ever survey of sport and active recreation to be undertaken in Europe. The APS 5/6 (October 2010-October 2012 data) indicates that in Haringey, 20.8% of adults (aged 16 years+) participated in sport and active recreation at a moderate intensity, for at least 30 minutes on at least 12 days out of the last 4 weeks (equivalent to 30 minutes on 3 or more days a week). Activity levels have not significantly changed since APS 1 (Figure 1).
Figure 1: Active People Survey results (2005/06 – 2010/12)
Source: Sport England (2012)
National trends are similar in Haringey with younger people being more active than their older counterparts, men are more active than women, white adult populations are more active than non-white adults, and activity levels are lower in those who have a limiting illness or disability (figures 2 to 5).
Figure 2: Participation by age
Source: Sport England (2012)
Figure 3: Participation by gender
Source: Sport England (2012)
Figure 4: Participation by whites and non-whites
Source: Sport England (2012)
Figure 5: Participation in those living with a limiting long term illness/disability
Source: Sport England (2012)
Local data indicates that there is a very strong correlation between participation and social class. Within Haringey, people in the lower socio-economic groups (NS SEC 5, 6, 7 & 8) are less active than those in the higher socio-economic groups (NS SEC 1.1, 1.2 & 2), at levels of 15% and 26.5% respectively (figure 6). Such evidence exists for some long term conditions, eg. CHD and cancer which, indicate that increases in physical activity levels in lower socio-economic groups could help offset such gradients.
Figure 6: Participation by socio-economic group
Source: Sport England (2012)
Health Survey for England (2008) data suggest that in children aged 2-15 years in England 32% of boys and 24% of girls met the previous physical activity recommendations (NHS Information Centre for Health and Social Care, 2009). Using these figures, it is estimated that 15,436 boys and 16,581 girls in Haringey, equating to 72%, do not meet the previous physical activity recommendations.
A strategic approach is being taken in Haringey to address physical inactivity within the context of reducing the gap in life expectancy and reducing health inequalities generally. The draft Haringey Health and Wellbeing Strategy has identified physical activity as key priority work programme in addition to other related areas, namely cardiovascular disease and cancer prevention. In seeking to reduce levels of physical inactivity a key driver is to strengthen clubs and informal sport and physical activity networks to ensure that there is ongoing sustainable provision of opportunity for people to take part in sport and physical activity.
In addition the Haringey Community Sport and Physical Activity Network (CSPAN), set up in January 2009, provides the governance for a range of local projects. It was established as part of Sport England’s delivery system for sport and physical activity. The core function of the network is to facilitate the effective strategic coordination of sports and physical activity planning and provision for Haringey in order for people of all ages and abilities to have the opportunity to participate in high quality sport and physical activity and therefore reduce inequalities in access and participation.
The following services are in place:
- Key provision – leisure centres, Green Flag Award parks and open spaces.
- General sports development – mainly enablement activity and some monetary support from London Borough of Haringey (LBH) to support key clubs mainly in the east of the borough to achieve important objectives, eg. improving club capacity and increasing junior, female and disabled membership.
- Programmes targeting key market segments (Sport England).
- Programmes specifically designed to increase the activity levels of sedentary individuals, eg. ‘Tottenham Active’ and ‘Active with Ease’.
- Physical activity referral scheme operating in the east of the borough to help address health inequalities.
- Walking, jogging and running programmes.
- Sports programmes, eg. Netball and tennis.
- Smarter Travel projects which includes a range of cycling projects and Biking Borough.
- The School Games programme (which has taken on elements of the previous School Sports Partnership). In Haringey all the secondary schools are working with their local primary schools to support PE and school sport through increased competition and there are also 30 Change 4 Life Clubs in primary schools aimed at the least active and those potentially most likely to become obese.
- The Health Trainer Service is a community-based service which and provides one-to-one support to people who are interested in making lifestyle changes to benefit their health in the areas of physical activity, alcohol, smoking and healthy eating. All Haringey residents can access this service, though the service is operational within the east of the borough only.
- Health Champions are lay people who are trained local volunteers whose role focuses on peer education and bridging (linking people to health services and programmes. eg. physical activity). The service represents a visible link between professionals and disadvantaged communities.
- A wide range of community-based projects delivered by a range of organisations including Tottenham Hotspur Foundation and Age UK.
The findings of the Annual Haringey Residents Survey (2010/11) were similar to London as a whole. The survey found:
- In terms of perceived service delivery for sports and leisure facilities, 45% of respondents rated the service as good or excellent.
- 65% of respondents rated parks and open spaces positively.
- In terms of residents personal concerns, 6% of respondents cited lack of recreational facilities as an area of concern.
The School Health Education Unit (SHEU) Health Related Behaviour Survey was conducted in a sample of Haringey schools during 2008 and 2009. A total of 1800 pupils in 17 primary schools and 8 secondary schools took part. Pupils at the Pupil Referral Unit also undertook the exercise. A summary of the report found that for primary aged children:
- 82% of pupils reported that they enjoyed physical activities ‘quite a lot’ or ‘a lot’.
- 71% of pupils thought that they were ‘fit’ or ‘very fit’.
- 23% of boys and 8% of girls reported that they had exercised for five hours or more, in the last week, which made them breathe harder and faster. 29% said less than one hour.
For secondary aged pupils:
- 75% of pupils reported that they enjoyed physical activities ‘quite a lot’ or ‘a lot’.
- 44% describe themselves as ‘fit’ or ‘very fit’.
- Not including school lessons, 17% of pupils aid that they ‘never’ or ‘hardly ever’ spent time doing physical activity.
- When asked what activities they would like to start doing or do more of 19% of boys said they would like to do more football. 29% of girls said they would like to do more swimming.
- Department of Health (2011) Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers (external link). London: Department of Health
- National Institute for Health and Clinical Excellence (2006) Four commonly used methods to increase physical activity (external link).
- National Institute for Health and Clinical Excellence (2007) Behaviour change (external link). London: NICE.
- National Institute for Health and Clinical Excellence (2008) Physical activity and the environment (external link). London: NICE.
- National Institute for Health and Clinical Excellence (2008) Promoting physical activity in the workplace (external link). London: NICE.
- National Institute for Health and Clinical Excellence (2009) Promoting physical activity for children and young children (external link). London: NICE.
- National Institute for Health and Clinical Excellence (2010) Prevention of cardiovascular disease (external link). London: NICE.
- National Institute for Health and Clinical Excellence (2012) Physical activity: walking and cycling (external link). London: NICE
Health Survey for England (2008) data suggest a slight increase in physical activity levels amongst adults (NHS Information Centre for Health and Social Care, 2009), however, no known modelling has been carried out in this area for adults or children. Locally, data suggests that physical activity levels in adults remain unchanged since APS1 to-date. Increases in overall population and increases in the older population within the borough need to be taken into account.
It is difficult to predict projected service use with any accuracy. However, it is important to note that overweight and obese individuals are less active than their normal weight counterparts. The percentage of normal weight individuals who met the physical activity recommendations was 46% men and 36% women, compared to those who were overweight at levels of 41% men and 31% women, followed by their obese counterparts who were active at levels of 32% and 19% respectively (NHS Information Centre, 2013). With overweight and obesity levels projected to increase in both adults and children, levels of physical inactivity may rise as a result of such increases. In addition, the poor national economic outlook may add to demands for free or subsidised sport and physical activity provision.
Current provision need to be strengthened for all at risk groups, ie:
- Interventions to increase activity levels in girls.
- Interventions to address low levels of inactivity in certain black and minority ethnic groups.
- Interventions targeting overweight and obese individuals are as they are amongst the least active.
- Interventions to address sedentary behaviour across all age groups.
- Interventions to increase activity levels of individuals with disabilities and those with long-term conditions.
- Interventions to increase the activity levels of older adults.
- Interventions targeting those in lower socio-economic groups as they are amongst the least active, i.e. east of the borough.
- Interventions which take account of Haringey’s market segments (Sport England).
- Interventions which take a holistic family approach to increasing levels of participation.
- Interventions to promote physical activity in schools due to reduced funding of the School Sports Partnership.
- Regarding facilities, the borough lacks football facilities, sports hall provision and a wet and dry facility in the Wood Green area.
The evidence base is growing for interventions which help and encourage individuals to lead active lifestyles. These include:
- Environmental action: Prioritising cycling and walking and facilitating active lifestyles, for example through maintaining quality open spaces. This would be as part of the local authority transport plans which will involve investing in cycling infrastructure and promoting opportunities for cycling. It would also link with the Tottenham regeneration.
- Organisational action: Including promoting physical activity in the workplace. This will involve developing policies to help staff to be more active and less sedentary. This may be achieved using different approaches such as the provision of showers for walkers/cyclists, and through encouraging active commuting. Specifically front line staff should be trained in brief interventions to give appropriate advice on healthy lifestyles to patients/clients.
- Community action: Investing in whole-community approaches. Community-level programmes such as quality parks, playgrounds, conservation schemes, walking programmes and supporting local clubs and facilities can help people to become more active. One key action is to scale up community health champions and health trainers to give advice and support on becoming physically active, particularly in the east of the borough.
- Interpersonal action – The role of primary care. Health care professionals are well placed to positively influence physical activity levels. Physical activity promotion should be mainstreamed into primary healthcare settings and made a key element of regular screening, patient advice/education and referral. An example of this approach is the DH, ’Let’s Get Moving (external link) initiative. One key scheme that should be maintained and strengthened is the exercise referral scheme for patients with long term conditions who are inactive.
- Interventions to reduce sedentary behaviours across all age groups.
- Strategic direction to strengthen co-ordination of schemes across the borough to maximise resources and focus on the least active.
A repeat of the year 6/9 study (Ashley Godfrey Associates, 2007)
- Andrea Keeble - Sport & Physical Activity Commissioning Manager
- Allender, S., Foster, C., Scarborough, P., Rayner, M. (2007) The burden of physical activity-related ill-health in the UK (external link). Journal of Epidemiology and Community Health. 61: 344-348.
- Ashley Godfrey Associates (2007) Haringey Participation Study (external link - PDF, 114KB) (Using the Active People Survey results to deliver increases in participation in physical activity)
- Department of Health (2004) At least five a week. Evidence on the impact of physical activity and its relationship to health (external link - PDF, 2MB). London: Department of Health.
- Department of Health (2011) Start Active, Stay Active. A report on physical activity for health from the four home countries’ Chief Medical Officers. (external link - PDF, 1MB)
- Department for Culture, Media and Sport/Strategy Unit (2002) Game Plan: a strategy for delivering Government’s sport and physical activity objectives. London, Strategy Unit. (external link - PDF, 6MB)
- Morris, J. N., Heady, J. A., Raffle, P. A. B., Roberts, C. G., Park, J. W. (1953) Coronary heart disease and physical activity of work (external link) Lancet. 265: 1053-1057, 111-1120.
- Department for Transport (2010). National Travel Survey 2015 (external link)
- National Institute for Health and Clinical Excellence (2012) Physical Activity (external link). London: NICE.
- NHS Information Centre for Health and Social Care (2009) Health Survey for England - 2008: Physical Activity and Fitness (external link)
- Sedentary behaviour and Obesity Expert Working Group (2010) Sedentary Behaviour and Obesity: Review of the current scientific evidence (external link - PDF, 963KB). London: Department of Health.
- Active Lives Survey Sport England website (external link)
- The NHS Information Centre (2013) Statistics on obesity, physical activity and diet: England, 2013
- Warwick, I., Mooney, A. and Oliver, C. (2009) National healthy schools programme: Developing the evidence base. London: Thomas Coram Research Unit and Institute of Education (external link - PDF, 965KB) University of London.
- World Health Organisation (2010) Global recommendations on physical activity for health (external link - PDF, 2MB)
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