Physical inactivity

Increased levels of physical activity can assist in tackling many of the important health challenges faced by the UK. It can help in the prevention and treatment of over 20 chronic conditions, including coronary heart disease, stroke, type two diabetes, cancer, obesity, mental health problems and musculoskeletal conditions (Department of Health, 2004). An evidence review concluded that physical activity could be the best buy in public health (Morris, 1994).  Helping inactive people to move to a moderate activity level will produce the greatest reduction in risk of ill health (Department of Health, 2009).

Physical activity in childhood has a range of benefits including healthy growth and development, maintenance of energy balance, mental well-being, improved academic performance and social interaction, and reduces osteoporosis risk in later life (Department of Health, 2004).  Active children are less likely to smoke, or to use alcohol/get drunk or take illegal drugs (Physical Activity Task Force, 2002).  Active children are more likely to become active adults (Telema, 2009).

Physical inactivity in England is estimated to cost £8.2 billion a year; this includes both the direct costs of treating major lifestyle-related diseases and the indirect costs of sickness absence (Department of Health, 2004). The NHS cost alone is £900 million based on 2006/07 costs (Scarborough et al, 2011).  In 2006/07, physical inactivity cost Middlesbrough PCT nearly £2.7 million (Department of Health, 2009).

This topic is most closely associated with the following JSNA topics:

 

Last updated: 2015-12-14 17:48:56
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1. What are the key issues?

  • Only 11.4% of adults in Middlesbrough take part in the recommended minimum level of physical activity. Although in line with the national average (11.5%) it means that over 100,000 adults in Middlesbrough do not participate in levels of physical activity to benefit their health.
  • Just over half of Middlesbrough’s adult population are inactive, participating zero days per week in moderate level physical activity.
  • Middlesbrough continues to have higher than average levels of obesity amongst school age children and adults.  Physical activity may be the most important factor in the prevention and treatment of unhealthy weight gain with evidence suggesting that physical inactivity may account for more than 75% of weight regain. This is of major significance due to the increasing prevalence of obesity in children and adults in Middlesbrough.
  • The groups with the lowest levels of physical activity are assumed to be women (particularly those aged 14-24 years); black and minority ethnic (BME) groups; those with a limiting illness/disability; and lower socioeconomic groups. There are inequalities in levels of physical activity within these sub-groups, particularly between the most and least deprived populations.
  • There continues to be a lack of targeted weight management service provision, of which physical activity is an integral element. Alongside this, there is a lack of services aimed at beginners and people with low self-efficacy, and there continues to be a high volume of weight management referrals into the Exercise on Referral service potentially limiting places for those service users most at risk of chronic disease.
  • Motorised transportation, digital entertainment, communications technologies and sedentary jobs are removing the physical activity from people’s daily lives leading to an increase in inactive lifestyles. An increase in sedentary behaviour is independently associated with all cause mortality, type 2 diabetes, some types of cancer and metabolic dysfunction in adults and children.
  • Subsidised sport and leisure facilities and public transport are under increasing financial pressure.  For participants, cost, accessibility and time pressures are key factors to being physically active.
  • There is a lack of validated self-report physical activity measures, particularly for children, making it difficult to evaluate and compare interventions.

 

Last updated: 14/12/15

2. What commissioning priorities are recommended?

The following strategic priorities remain.  No additional priorities have been identified.

2012/01
Adopt a life-course approach and engage people in physical activity
throughout the life-course through a better understanding of the barriers to and potential motivating factors for physical activity within sedentary groups. Work needs to be undertaken to identify and address social, cultural, economic and environmental barriers to being physically active through engagement with the local community.

2012/02
Improve links between the NHS, social care and physical activity pathways
to target high risk, vulnerable and disadvantaged populations at risk of chronic disease due to inactive lifestyles. This may involve re-designing service models to ensure services are responsive to needs and are cost-effective and efficient. Update - The transfer of a physical activity manager from active Middlesbough to work within the Directorate of Improving Public Health may support the ambitions identified above.

2012/03
Maximise opportunities in local planning and transport strategies for physical activity
when developing the built environment ensuring that all major planning decisions are subject to health impact assessments.

2012/04
Improve detailed understanding of local population characteristics
, particularly those with limiting disabilities and from BME groups, in relation to physical activity to enable better targeted interventions.

2012/05
Maximise use of facilities
, including schools and green infrastructure, through community use agreements and clear information and guidance.

2012/06
Encourage workplaces to adopt policies that enable staff to become more physically active
during and outside of work hours. Update - The work undertaken by a Public Health specialist working within three key Middlesbrough organisations will support the ambitions of the above. The Launch of the ‘Extra Life’ brand within these setting identify the organisation, as a setting, that has work being undertaken to realise these ambitions.

2012/07
Commission a single website that brings together the physical activity opportunities available in Middlesbrough
instead of having multiple sources of information although steps must be taken to avoid increasing health inequalities via the ‘digital divide’. Any such site should incorporate the current and emerging opportunities offered by social networking. Update - The Public Health Physical Activity Development Manager is undertaking work to improve physical activity representation within the Middlesbrough Council Public Health webpages.

 

 

Last updated: 14/12/15

3. Who is at risk and why?

Children and young people


Physical activity among children aged 2–15 varies according to a range of factors including gender, ethnicity and socioeconomic status (The Information Centre, 2008a; 2008b).

Gender
A higher percentage of boys than girls aged 2-15 years meet the Government’s recommendations for physical activity (32% and 24% respectively). Among girls the proportion meeting the recommendations generally decreases with age, ranging from 35% in girls aged 2 to 12% among those aged 14. There was a less consistent pattern with age among boys (The Information Centre, 2009).

By contrast, most children perceive themselves as being either very or fairly active compared with children their own age (The Information Centre, 2011). In addition, a substantial number of British adolescents believe themselves to be more physically active than they actually are (Corder et al, 2011).

Ethnicity
Children from minority ethnic groups tend to be less active compared to their white peers (The Information Centre, 2006).

Familial factors
There is a strong positive link between a child’s activity levels and that of their parents, particularly among girls (The Information Centre, 2008b). Furthermore, in terms of childhood obesity, this may be confined to those whose same-sex parents are also obese (Perez-Pastor et al, 2009).

Parents are an important influence on their child’s physical activity behaviour, yet most incorrectly consider their children to be sufficiently active (Corder et al, 2010).

Socioeconomic Status
Physical activity levels in children are related to household income, with those in the lowest income bracket more likely to be active: 36% compared to 25% in boys, and 30% and 22% among girls. This is perhaps surprising, since children in lower income groups are often found to have less healthy lifestyles (National Obesity Observatory, 2011; The Information Centre, 2009b).

Age
Children are becoming less physically fit as they age.  51% of boys and 34% of girls aged 4-10 years met the recommended levels in 2008, but only 7% of boys and no girls aged 11-15 years did so (National Obesity Observatory, 2011).

Disability
Children and young people with a disability take part in physical activity and sport less frequently and their experiences are less positive than their non-disabled peers (Sport Scotland, 2006).

Sedentary behaviour
On weekdays, 10% of children aged 2 to 9 years old were sedentary for six hours or more, but the proportion increased steeply in older children to over 60% of 15-year-olds. The proportion increased significantly across all age groups at weekends.

Household income was significantly associated with sedentary behaviour - for both boys and girls, as household income decreased, the average number of hours spent watching TV increased (The Information Centre, 2009b).

The main method of children aged 5-16 years getting to and from school is walking (41%), while 33% of this age group is being driven to school. Just 2% used a bike to travel to school as their main mode of transport (Department for Transport, 2011).

Adults


Evidence shows that certain population groups tend to have lower levels of physical activity including over 55-year-olds, some black and minority ethnic (BME) groups, disabled people, young women aged 14-24 years and lower socioeconomic groups (Sport England, 2011).

Gender and age
Based on the 2008 Health Survey for England, 39% of men and 29% of women met the Government’s recommendation for physical activity.  Women were significantly less physically fit than men, and fitness decreased significantly with age. The decline was steepest for men, although more males were physically fit in every age group (The Information Centre, 2009).

Ethnicity
Physical activity levels tend to be lower in ethnic minority groups (except Black Caribbean/African and Irish), especially South Asians (The Information Centre, 2006). Only 11% of Bangladeshi and 14% of Pakistani women were reported to have achieved the recommended amounts of physical activity, compared with 25% in the general population (Department of Health, 2009).

Socioeconomic status
There is an association between household income and physical activity; more people are active in households with higher income.  The degree of association is stronger in women than men (The Information Centre, 2009).

People with a limiting long-standing illness and/or a disability are at particular risk from inactivity (Department of Health, 2009).

Physical activity has an important role to play in promoting mental health and well-being by preventing mental health problems and improving the quality of life of those experiencing mental health problems and illnesses. Physical activity can reduce the risk of depression, dementia and Alzheimer’s disease with evidence showing a 20-30% lower risk for depression and dementia for adults participating in daily physical activity. Furthermore, physical activity can enhance psychological well-being, by improving self-perception and self-esteem, mood and sleep quality, and by reducing levels of anxiety and fatigue (Department of Health, 2011).

Sedentary behaviour
The amount of time people spend in sedentary behaviours including domestically (for example use of remote controls, computers and other energy saving devices), as part of transport (motorised transport instead of walking/cycling) and for adults at the workplace is becoming increasingly a concern.  Evidence that suggests sedentary behaviour is independently associated with all-cause mortality, type 2 diabetes, some types of cancer and metabolic dysfunction in adults and children (Department of Health, 2011).

The latest UK physical activity guidelines emphasise that sedentary behaviour should be minimised.  Findings from the 2008 Health Survey for England (The Information Centre, 2009) suggests that:

  • 32% of men and 33% of women were sedentary for six or more hours on weekdays, which increased to 44% and 39% respectively on weekends
  • Average total sedentary time varied by body mass index level – men/women who were a healthy weight were less sedentary than obese men/women
  • Sedentary behaviours in adults are affeccted by age, gender, socioeconomic conditions, occupation, weight status and some characteristics of the physical environment
  • Only 41% of adults made walks of 20 minutes or more at least 3 times a week and only 14% of adults rode a bicycle at least once a week (Department for Transport, 2011).

Patterns of how people travel, including walking and cycling, are contained within the JSNA transport topic.

 

Last updated: 19/04/13

4. What is the level of need in the population?

There is limited data available at a local level for measuring levels of physical activity for children and young people to show variations by gender; age; ethnicity; disability; and socioeconomic status.

Active Recreation Indicator 2011-2013 has been developed to help local authorities in England to generate a sporting profile for their area in the form of charts and tables, bringing together data on sporting participation and provision.  It shows that, in Middlesbrough, men are more likely than women to do 3 lots of 30 minutes active recreation (34.5% and 16.6%, respectively).  For the top five participation sports in Middlesbrough, the profile shows more adults (than the average for England) play football, but fewer take part in cycling and athletics.

Top 5 adult participation sports, middlesbrough, 2011-13

 

Walking and cycling to school
In Middlesbrough, walking to school has fallen by 9% since 2008, although cycling has increased by 20%.  In the 2011 annual school census, the proportion of Middlesbrough pupils opting to walk or to cycle to school was well above the national average in primary schools and was similar to the national average in secondary schools.  Fewer children use active travel for getting to secondary school compared to primary school.

Method of travel to primary school, Middlesbrough, 2010 to 2011

Method of travel to secondary school, Middlesbrough, 2010 to 2011

Adult physical activity
The health profile for Middlesbrough (Department of Health, 2011b) shows only 11.4% of adults in Middlesbrough achieved the recommended levels of physical activity (5 x 30 minutes of moderate intensity activity every week). Although similar to the England average of 11.5%, it means that over 100,000 adults in Middlesbrough do not participate in levels of physical activity that benefit their health.

The Mosaic social segmentation tool enables analysis of Middlesbrough’s population to identify sub-groups that are the least active.  Mosaic groups I, K and O make up nearly half of Middlesbrough’s population, with the largest group being O.  These groups have much higher than average rates of physical inactivity with 61% of group O; 58% of group K and 55% of group I participating in no physical activity in the last month.

Prevalence of inactivity, Mosaic population groups, MiddlesbroughMiddlesbrough Mosaic groups and not exercising

 

Sport England’s Active People Survey (APS) uses a different market segmentation tool which provides an insight into the sporting behaviours, barriers and motivations to physical activity for different subgroups of the population. Higher proportions of people in groups 9, 10 and 19 are dominant in Middlesbrough making up 29% of the population.  Group 19 (10.7%) is the largest, followed by group 9 (9.7%) and group 10 (8.5%).  Groups 19 and 10 are much less active than the average adult population with 82% and 63% respectively having done no sport in the last four weeks. Group 10 has average levels of sport participation with 42% taking part in sport at least once a week.  This information can help to target resources to subgroups of the population with the highest need to encourage them to engage in a more active lifestyle.  See the Sport England Market Segmentation web tool for full details, including group definitions.

The pure sports measure for Middlesbrough, which relates to adult participation in three sessions of 30 minutes of moderate intensity sport a week, demonstrates that there has been no significant change since 2007/08 (16.8% to 16.1% in 2010/11).  When compared to a statistical neighbour (Hull) and England average, participation in moderate intensity sport in Middlesbrough is slightly higher, particularly for the two most recent time periods.
Adult participation in physical exercise, Middlesbrough, 2007/08 to 2010/11

Participation in physical activity
Participation in sport and active recreation (formerly national indicator 8, NI-8) shows the percentage of the adult population (age 16 years and over) who participate in sport and active recreation, at moderate intensity, for at least 30 minutes on 3 or more days a week. This measure includes a wider range of activities and also takes into account the participation levels of those aged 65 or above in light intensity sports. There have been no significant changes in the numbers participating in sport and active recreation in Middlesbrough since October 2005 with recent figures showing only 18.9% participation.

 

Last updated: 14/12/15

5. What services are currently provided?

Sports and Active Leisure

Sport and leisure services
Middlesbrough Sport and Leisure Services provide a portfolio of physical activity sessions and opportunities catering from infant to old age alongside sessions specifically for priority groups such as those with a limiting disability and/or long-term conditions. There are currently five venues which offer accommodation to many sports and activity clubs in Middlesbrough. These include: Rainbow Leisure Centre, Southlands Leisure Centre, The Neptune, Middlesbrough Municipal Golf Centre and Clairville Stadium (to close October 2014). The New Middlesbrough Sports Village will be opened in Middlesbrough in phases between 2014- 2015. Branded as a place for sport, leisure, fitness, health. The new facilities will include: a large sports and leisure venue, outdoor plaza skate park, cycle circuit, athletics track, artificial football pitches and velodrome.

Sports development services
A team of multi-disciplinary officers delivers a broad range of programme for school sport, holiday activity and adult community-based activity. Support is also provided for community sport in terms of club and coach development.

The Sports Development Team is able to work with specific groups in the community and seeks to reduce the barriers to being physically active. Specific outreach work enables access to activity programmes for those unable to use leisure facilities.

Swimming and Swimming Development
Swimming and swimming development operates mainly from local authority services at the Neptune and Rainbow Leisure Centre. Swimming services within Middlesbrough incorporate, public swimming, swimming lessons, swim fitness, swimming clubs and school swimming.

Sporting events
Middlesbrough Council’s sport and leisure services co-ordinate the Run Middlesbrough portfolio which comprises a minimum of two mass participation events each year - the 5km road race and 2km fun run in May and a 10km road race and 3km fun run in September. The events are used as a stimulus for some groups to engage in physical activity.  Last year’s events attracted over 6000 participants.

Cleveland Fire Brigade Firefit (diversionary activities)
The Fire Brigade operates a number of diversionary activities which are designed to steer young people away from crime and anti-social behaviour, and to provide positive role models. In addition, young people take part in sporting activities improving their health and wellbeing. The activities are delivered in targeted hotspot areas during peak incident times across Tees and include football; rugby; cricket; fishing; and non-contact boxing. Middlesbrough Fire Station is currently being rebuilt and redeveloped so it is unclear what the future programme of activities will be.

South Tees Hospital NHS Foundation Trust Health Improvement Service
The Healthy Stepping programme provides a range of free health walks for people of varying ages and abilities. About, 140 people regularly participate in the walking programme each week, with new walkers constantly joining. A programme of 8 walks, led by volunteer walk leaders currently run throughout the Middlesbrough area, with additional regular walks across Teesside and North Yorkshire. All walks are registered with the Ramblers Association as part of the national ‘walking for health’ scheme.

Tees, Esk and Wear Valleys NHS Foundation Trust
There are several physical activity initiatives in place at Roseberry Park Hospital in Middlesbrough including walking groups which provide several walking sessions per week by qualified walk leaders;   cycling groups where a team deliver guided cycle rides; national standards cycle training sessions; off-road mountain bike training; quad biking and private access to British Cycling and the cycle circuit; regular gym sessions; trampoline sessions; regular indoor and outdoor sport sessions and inclusion in a disability 5-a-side football league.

Environmental Health Community Protection Service
Opportunities are provided for children, young people and adults to improve their health and wellbeing;  including the  delivery of the Food4Health Initiative: Community Weight Management programme, the Type 2 diabetes risk-reduction programme; promotion of physical activity in schools including the delivery of boxing skills awards and support for community-led team sports and fitness activities. Working closely with businesses and workplaces to encourage participation and sign up to the Workplace Health Award and involvement in physical activity through the workplace.

Hearty-BEATS (Better Eating & ActivityThrough Schools)
Recent research has shown that children under 12 years of age are already exhibiting risk factors relating to heart disease, highlighting the need to provide health interventions for young people and their families at an early age. The school setting is an ideal place to provide these interventions.

Hearty Beat is a pilot project funded by Public Health which aims to develop the pilot primary schools as a healthy setting for the promotion of heart health and healthy lifestyles to pupils and their family members. This is being achieved through a variety of activities addressing healthy food within the school setting and at home, cooking skills, food growing, physical activity, smoking awareness and the offer of health checks to family members. Four of the five pilot schools have a large number of BME pupils to address the prevalence of heart disease within the BME community.

The primary schools involved in this pilot project include:

  • Abingdon
  • Ayresome
  • Breckon Hill
  • Newport
  • St Thomas More.

Other clubs
There are many sports clubs in Middlesbrough for both children and adults such as swimming; football; boxing; and running clubs. More information can be found at www.middlesbrough.gov.uk and www.teesvalleysport.co.uk.


Community activity groups
There are numerous community groups that either operate under the governance of a governing body or operate in an autonomous manner. These include community, walking and running groups, private fitness classes including outdoor bootcamps and small sporting clubs. These clubs / sessions run from a mix of local authority venues, private health clubs, community halls and church halls. There are now a a number of Community Hubs sited throughout Middlesbrough that operate as youth and community venues for sport, leisure and recreation activities and issues based work.


Community Sport Activation Fund
Following a successful award from Sport England’s Community Sport Activation Fund, Middlesbrough Council will be recruiting two Community Sport Activators in 2014 to work over a three year period, to engage with, target communities, aged14 and above in sport activities and work towards sustaining their involvement. . The project will provide a range of opportunities to engage the communities in a variety of sport and physical activity programmes at an entry level, focusing on enjoyment and family participation.  The project will be delivered in partnership with local voluntary organisations and existing local clubs that are available within and near to the community hubs.

Private Health clubs
There are a number of private health clubs within Middlesbrough. These include multi-national clubs and small / medium independent clubs. Many offer a gym based environment with spar and leisure pools as well as a fitness class portfolio. These include: Otium, DW Leisure Club, Bannatyne, Sparta gym and Steel City.

Infra-structure

The Local Transport Plan
As part of the third round of Local Transport Plans (LTPs) from 2011/12 onwards, Middlesbrough is presented with a new opportunity to continue to expand on the recent capital infrastructure programmes to support walking and cycling.

Green space
Middlesbrough Council manages a number of parks and open spaces including grass sports pitches; walkways; cycle routes; parks and countryside; allotments; and skate parks.  These offer a range of opportunities for formal and informal activity as well as a green and open environment to support mental health promotion. Albert Park and Stewart Park are home to Middlesbrough’s extremely successful 5k Park

Running & Cycling

The Middlesbrough Cycle Centre is managed by Middlesbrough Environment City, in partnership with Middlesbrough Council.  There are over 2,000 members, with up to 50 people using the facility daily.  The facility provides secure cycle parking, shower facilities and lockers as well as cycling advice and route mapping.

The Bike Academy, funded by the Local Sustainable Transport Fund, provides cycle maintenance training both at its main base in Albert Park and also at community venues and work places.  In the last 18 months it has delivered accredited cycle maintenance training to 221 people, provided Bikeability safe cycling training to 406 adults and young people and worked with residents and community groups through a cycle recycle scheme to bring 265 redundant cycles back into use.

The Bikeability school cycle training provides safe cycle training for around 1000 pupils in years 5 and 6 each year.  Funded by the Department for Transport, it is delivered by MEC in partnership with Middlesbrough Council.

Active Middlesbrough manages the Middlesbrough Cycle Circuit. A 1k closed cycle loop that offers cycling activities to the general public and cycling groups/clubs
There are numerous running groups and clubs throughout Middlesbough. Some clubs offer progressive running training in preparation for competitive sport. Some offer informal opportunities to be involved in running such as the Swift-tees group that meet at Hemlington Lake. There are a number of weekly and annual organised runs within Middlesbrough including the Park Run at Albert and Stewart Park and the Tees Pride 5 & 10K.

One Planet Living

The One Planet Living (OPL) framework is a sustainability initiative developed by BioRegional and the Worldwide Fund for Nature (WWF).  Middlesbrough Council was endorsed as a One Planet Living Council in 2011 and is working with key partners to deliver long-term, sustainable improvements to the town and tackle climate change.
Through the adoption of OPL’s ten sustainability principles Middlesbrough Council aims to enhance resident’s social and economic wellbeing, helping people to lead greener, healthier and more affordable lifestyles and improve the local environment whilst reducing harmful impacts on the planet.

Middlesbrough Council has identified priority actions under each of the ten principles, which are renewed annually.  One Planet Living in the wider community is managed in partnership with Middlesbrough Environment City.

The principles linking with physical activity include sustainable transport and health and happiness which encourage active travel and active lifestyles to protect health and wellbeing. The Sustainable Food theme includes a focus on food growing at a community level, engaging residents in physical activity whilst also improving mental well-being.

These principles are promoted and facilitated through offering opportunities for people of all ages to be physically active throughout Middlesbrough.

Active travel
All schools in Middlesbrough have a school travel plan.  There are 35 school crossing patrol officers providing services for 33 primary schools, along with pedestrian training which is offered to every pupil in years 2 and 3. Four ‘walking buses’ have been established.

Through the Healthy Towns Programme, JSNA and Local Sustainable Transport Fund initiatives, various subsidised bike scheme packages have been provided to:

  • Schools (primary) - 375
  • Schools (secondary) - 350
  • Workplace (individuals) - 1,039
  • Work place (Pool bikes) - 227
  • Total - 1991

Almost 2,000 children and adults participated in the schemes from 2010 to date, contributing to an increase in cycle journeys recorded by 247% over the period. In addition, a salary sacrifice bike-to-work scheme is offered to Middlesbrough Council employees and a ‘Walk Middlesbrough’ initiative has recently been launched aiming to encourage more people to walk more regularly, as a means of commuting, as well as a leisure activity to improve health and wellbeing.

Services that include provision to support people to increase levels of physical activity

Health-related programmes
A team of specialist instructors from the Public Health Physical Activity Team co-ordinate and manage community programmes for people with health conditions or who are inactive. 

GP Referral programme – Health Through Activity is a 12 week programme of activities delivered in partnership with local health care professionals and Active Middlesbrough facilities.  Activities include General Exercise, Chair Based Exercise, Breathercise and Aquafit as well as a Weight Management programme for people with a BMI of 25+.  The average annual completion rate is 56%.  Those who drop out tend to do so for a number of reasons: illness, injury, lack of time, work pressure, wanting to attend with someone and transport problems.

New Life, New You programme is an 8 week programme of dietary advice and physical activity targeting people who are 40 – 65 years old and are at risk of developing Type 2 Diabetes.  Support is offered up to 1 year after completing the programme.

The Sporting Chance project has been develop in partnership with the Retired Seniors Volunteers programme to engage men 50+ who do not seek or take up health information.  A varied programme of activities and events are offered each week to impact on physical and mental health and reduce loneliness and isolation.

Commissioned weekly exercise sessions are delivered to condition specific groups such as Teesside Stroke Club, Multiple Sclerosis group and Breathercise group.

Push and Go and MummyBuggy Boot Camp - weekly post natal exercise sessions held in indoor and outdoor venues.

Chair-based exercise sessions are held at various community venues through the town.

Older People
Retired and Senior Volunteer Programme (RSVP) is a programme of community service volunteers which promotes voluntary and community action nationwide, and was established in the Tees Valley in 1999. RSVP encourages people over 50 to become involved as volunteers in their local community.  Some projects specifically targeting physical activity include weekly keep fit sessions; carpet bowling; walking groups; gentle exercise sessions; swimming for the over 50s; line dancing; tea dancing; and chair-based exercise sessions. 

Most recently a partnership between RSVP and Middlesbrough Council submitted a successful application to the Big Lottery Fund to develop a new project called Sporting Chance.  The aim of the project is to bring older men, who do not seek or take up health information,  back into being active by using providing a weekly activity programme and monthly reminiscence sessions and events.

Active For Life are low impact fitness classes held within Active Middlesbrough facilities.  They are suitable for older people and those who have completed a GP Referral programme.

Strategic groups, co-ordinating groups, support groups

Public Health Physical Activity Strategic Partnership
The purpose of this group is to develop and implement a co-ordinated, multi-agency approach to increase participation in physical activity in Middlesbrough. The partnership has a number of key priorities that include: promoting physical activity as prevention, physical activity as treatment / rehabilitation and developing an active environment. The partnerships objectives include strategic planning, communication and engagement and monitoring and evaluation. There is cross part representation including, Public Heath, Tees Valley Sport, Teesside University, Wider education, Middlesbrough Environment City, Regeneration and Sport England.

Children’s Centres (Early Years Provision)
As part of the Wellbeing and Preventative Service a range of physical activity programmes and initiatives are delivered within Middlesbrough’s Children’s Centres. From October 2010 to September 2011, the activities attracted 3,216 adults and children. Physical activity sessions included Leaps and Bounds, a progressive physical and movement programme for children from walking up to five years; football-based programmes; baby gym for babies 3-18 months and weenie gym for children from 18 months to 3 years; a play session for young children with disabilities delivered in partnership with health / physiotherapists and a variety of fitness programmes specifically targeting dads and male carers.

 
 

Last updated: 14/12/15

6. What is the projected level of need?

Adult participation in sport and active recreation
Adult participation in sport and active recreation (formerly National Indicator 8, NI-8) shows no significant change between the Active People Survey (APS) 1 (October 2005) compared with APS 4/5 (October 2009 and October 2011), therefore it is difficult to extrapolate any change for the future.

Based on the APS NI-8 indicator, 81.1% of people did not achieve 3x30 minutes moderate intensity physical activity in 2011.  This is equivalent to 114,500 people out of an estimated total population of 141,200 (Office of National Statistics). The 2011 projected population is made up of 69,500 males and 71,700 females of whom 27,800 are children; 88,200 are working age and 25,200 are older people.

Assuming similar trends in adult participation in sport in 2033 and a projected population of 149,300 the percentage of inactive people at 81.1% is equivalent to 121,100 inactive people (an increase of over 5,000 inactive people). The 2033 projected population of 149,300 will be made of 74,400 males and 74,900 females of whom 29,400 will be children; 84,300 working age and 35,500 older people.

Middlesbrough Projected Populations and Inactivity (NI-8) 2011 to 2033Forecast inactivity, Middlesbrough, 2011 to 2033
Population figures are rounded
Children: 0-15 years; Working age: 16-64years male / 16-59 years female; Older people: 65 and over male / 60 and over female

 

Last updated: 14/12/15

7. What needs might be unmet?

There may be highlight a gap in services for children in early year settings and for pregnant women.  In addition there could be a lack of parallel family activities across Middlesbrough, where family members can exercise together, either as a family or within the same activity setting though participating in different activities.

Declining participation in organised group sport and active leisure could undermine the viability of clubs and leagues, leading to a further decline in opportunities and participation levels.

Participation in active leisure in subsidised or commercial facilities, including swimming pools and gyms, may be restricted by economic pressures and increased costs.

Reductions in subsidy to public transport may also increase barriers to participation in some forms of active leisure, particularly for older people who cite transport as a potential barrier to sport and leisure. Furthermore, the increasing numbers of older people, as a proportion of the population, may require an increased number of activities designed to meet their needs and lifestyles. These will represent an increased demand for subsidy at a time of declining resources.

Increasingly inactive and increasingly overweight children, young people and adults may feel excluded from traditional, competitive or recreational group activities such as running, league football, tennis. The lack of targeted weight management service provision (of which physical activity is an integral element) and the lack of services aimed at beginners and people with low self-efficacy and for those with a limiting illness/disability; and from BME communities may present a barrier to engaging in physical activity programmes and initiatives. The Sports Development (Health Development team) operates interventions that target obese and overweight adults (adult weight management). The New Life New You type 2 diabetes intervention (Sports Development Health Development Team) and BME NLNY (Delivered by Middlesbrough Environment City) target adults at risk from type 2 diabetes.  NUR fitness within Middlesbrough offer a number of fitness classes aimed at the BME population. Although a number of interventions exist it can be argued that there is a need for an expansion of such programmes.

In addition there are a number of sessions / projects aimed at assisting the management of long term conditions delivered by the Health Development team. These include the Stroke Improvement Group, the MS group the Breatheasy group.

There are many opportunities for increasing the use of open spaces to improve physical activity and well-being, including: formal parks; informal countryside, such as the beck valleys; allotments and community gardens; and footpaths and cycle routes. In particular, there is the need to increase awareness of these opportunities, including where appropriate, the provision of training, community activities and promoting community management.

Lack of awareness of the local environment and opportunities for active leisure may limit participation levels. In particular, insufficient allotment provision and long waiting lists may prevent people taking part in this form of physical activity; the Council currently has 8 sites with 900 plots in total with a waiting list for plots totalling 208 people.

Increased waiting times and potential capacity issues for Exercise by Referral is exacerbated by resource pressures and capacity issues. Recent insight demonstrates that 47% of referrals are for weight management reducing access for those who may be more at risk and require more specialist support demonstrating a need to re-evaluate the service model and pathway.

Weight Management referrals for the 1st 6 months of 2014/15 are actually lower 28%.  The issues are bit more in depth than the number of weight management referrals it is more about the drop-out rate due to the person not being ready to make the changes.

Health Development are starting to re-evaluate the service model and pathway and are hopeful this will help to solve some of the issues which have historically limited the effectiveness of the programme.

It is worth noting that the Exercise on referral (Health Through Activity) programme is currently being reviewed to ensure it best meets the needs of the  Middlesbrough community.

There could be a lack of entry level (beginner) provision for public and private sector fitness activities.

There is a gap in walking activities that engage with young people and little publicity promoting walking to young people.

 

Last updated: 14/12/15

8. What evidence is there for effective intervention?

Evidence from the National Institute of Health and Clinical Excellence (NICE)
NICE has completed a number of evidence reviews around the effectiveness of various physical activity or associated lifestyle interventions. These include:

Four commonly used methods to increase physical activity PH2 (NICE 2006)
Physical activity and the environment PH8 (NICE, 2008a)
Promoting physical activity in the workplace PH13 (NICE 2008b)
Promoting physical activity for children and young people PH17 (NICE, 2009a
Behaviour change at population, community and individual levels  PH6 (NICE, 2007)
Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease CG67  (NICE, 2008c)
Prevention of cardiovascular disease at population level  PH25 (NICE, 2010)

 

Reviews and meta-analyses of physical activity interventions

Interventions by age or population sub-group
Interventions delivered through the school setting are the most consistent, promising strategy whilst the effect of community or family based programmes remains unclear.  (Salmon, Booth, Phongsavan et al, 2007; Kriemler, Meyer, Martin et al, 2011; van Sluijs, Kriemler, & McMinn, 2011)

There is sufficient evidence to support the implementation of interventions designed to increase physical activity amongst adults and their cost effectiveness. (Foster, Hillsdon& Thorogood, 2005; Müller-Riemenschneider, Reinhold, Nocon & Willich, 2008 and 2009; Jepson, Harris, Platt & Tannahill, 2010)

Physical activity interventions can be effective with obese individuals. (Gourlan, Trouilloud. & Sarrazin, 2011)

 

Interventions by type
Community-wide promotional activities and improving infrastructure has the potential to increase cycling by modest amounts. (Yang, Sahlqvist, McMinn et al, 2010; Vuori, 2011)

Interventions to promote walking among targeted participants are effective along with interventions using a pedometer which have been shown to be effective both with young people and adults although the long-term sustainability of such impacts is unproven. (Ogilvie, Foster,  Rothnie et al, 2007; Lubans, Morgan & Tudor-Locke, 2009; Bravata, Smith-Spangler, Sundaram et al, 2007)

Improving the marking and physical environment of school playgrounds can increase the physical activity of school children. (Verstraete, Cardon, De Clercq & Bourdeaudhuij, 2006; Ridgers, Fairclough & Stratton, 2010)

The effectiveness of exercise referral schemes (ERS) has yet to be proven; a recent review shows very limited evidence as to the effectiveness of ERS for increasing activity, fitness or health indicators or whether they are an efficient use of resources in sedentary people without a medical diagnosis. A further analysis found that the cost effectiveness of ERS improves when ERS are targeted at individuals with existing conditions while an evaluation of the ERS on Teesside made a number of recommendations to improve the local programmes.  (Pavey, Taylor, Fox et al, 2011; Anoyke, Trueman, Green et al, 2011; Carlebach, Athey & Shucksmith, 2011)

Mass media campaigns targeting physical activity can have the effect of increasing awareness but evidence beyond this (including changing behaviour) remains unclear.  (Leavy, Bull, Rosenberg & Bauman, 2011)

Interventions targeting reduction in sedentary behaviour in children can have a small but positive impact; however, further research is needed to ascertain whether interventions targeted at adults are effective. (Biddle, O’Connell. & Braithwaite, 2011; Owen, Sugiyama, Eakin, et al, 2011)

One promising method of intervention is active video games, which “are capable of generating energy expenditure in youth to attain physical activity guidelines” (Barnett, Cerin & Baranowski, 2011, p. 724) although evidence is required on how to sustain the effect in the medium- and long-term.
 

Last updated: 17/04/13

9. What do people say?

Satisfaction with sports provision
As part of the Active People Survey (APS), respondents were asked about their satisfaction with sports provision. Middlesbrough residents were more satisfied with sports provision compared with other areas in Tees.

Adult satisfaction with local sports provision as measured by the Active People SurveysAdult satisfaction with local sports provision, Tees, 2005/6 to 2009/10
 

Annual young people’s survey
Middlesbrough’s annual young people’s survey includes a number of questions that could be used as a measure of the level of physical activity among young people. Feedback from the latest survey in 2010 indicates that:

  • 87% of children and young people at secondary school state they exercise regularly
  • 61% of secondary school respondents state they take part in sporting activities at school and 57% take part in sporting activities outside school.

 

Active travel                                                                 
The main findings from surveys and consultation exercises have been largely positive.  A recent survey/audit of the road safety service was undertaken to ascertain what gaps in service provision the schools required from the team.  They wanted pedestrian and cycle training to continue to be offered which will continue to support active travel to and from schools.

Most (90%) of respondents thought the Walk Middlesbrough initiative was positive, and stated that they would like to see additional healthy walks created, with varying levels of difficulty identified for different users.

Health Development Report 2013
Middlesbrough Council’s Sports Development Health Development Team co-ordinate and manage programmes in Middlesbrough for people with health conditions or who are inactive.  The aim of the team is to improve the health and well being of individuals and communities, through providing opportunities to be active that encourage them to start and sustain their participation. The programmes achieved 14,837 visits by 605 individuals in 2013/14.

Benefits of exercise on referral, Middlesbough, 2013/14

Outcomes from New Life New You programme – preventing type 2 diabetes , Middlesbrough

Number of participants completing 6 month follow

70.6% 

Number losing or maintaining weight

73.1%

Number with reduced BMI

73.1%

Number with reduced waist circumference

82.9%

Number with improved physical activity (amount)

60.9%

Number with improved physical activity (variety)

60.9%

Number with reduced FINDRISC score

85.3%

Number with improved DINE (fat) score

60.9%

Number with improved DINE (fibre) score                         

68.2%

 

Voiceover Report Winter 2013
The Middlesbrough Voiceover Citizen’s Panel consists of a cross section of Middlesbrough residents, ensuring, as far as possible, a representative spread of sub group demographics (age, gender, and ethnicity). In Winter 2013 a paper questionnaire was distributed by post and via the Council’s consultation portal to 1,200 members of the panel, from which 667 were returned, giving a reasonable return rate of 56%.

Nearly three-quarters of panel members said they would describe themselves as physically active.

Over half (58%) of panel members said they undertake physical activity or exercise of at least 30 minutes duration over three times a week.  One in ten said they do not undertake any physical activity or exercise.  Nearly a quarter (24%) said they exercise five times a week or more.

Panel members were also asked “If you do not participate in sport or fitness activity what would encourage you to be more physically active?”.  The most common
response was ‘cheaper access to activities and facilities’.  Other key motivations were ‘more opportunity and support for beginners’, ‘being advised by a GP or health professional that I should exercise’ and ‘more information on what activities are available’.  Panel members were least likely to say ‘more opportunity to do activity as a family.

 

Last updated: 14/12/15

10. What additional needs assessment is required?

There are no measures of the physical activity levels (against Government recommendations) of specific populations within Middlesbrough for either children or adults both overall and in specific sub-groups (for example gender, ethnicity, age, socioeconomic groups, ward of residence). Further analysis is also required to understand the motivations and barriers to participating in physical activity within these specific sub-groups.

Where possible, any future measurement of physical activity should use direct measurement methods instead of self-report.  Where self-report is used, validated measures that can be compared with other datasets should be used (for example Health Survey for England results).

It could be argued that there is a need to investigate best practice amongst successful physical activity interventionists, to determine reason for success, identify key skill sets and positive delivery methods, to develop a framework for training for future interventionists.

 

Last updated: 14/12/15

Key Contact

Name: Kelvin Hutton
Job Title: Public Health Physical Activity Development Manager
e-mail: kelvin_hutton@middlesbrough.gov.uk
phone: 01642 515385

References

Local strategies and plans

Tees Valley Sport Sub-regional Facilities Strategy (2009)

NHS North East (2008) Better Health, Fairer Health

Neat Moves, Health and Transport Together Report (2011) – NEAT moves outputs and next steps for North East Active Travel.

NHS Tees (2010) Weight Management Services Strategic Review and Development Plan

 

National strategies and plans

Department for Culture, Media and Sport (2008). Before, During and After: Making the Most of the London 2012 Games

Department for Culture, Media and Sport (2008b). Playing to win: A new era for sport

Department for Transport (2010). Active Travel Strategy 

Department of Health (2004). At Least Five a Week – Evidence on the Impact of Physical Activity and its Relationship to Health – A Report from the Chief Medical Officer.

Department of Health (2004b). Choosing Health: Making Health Choices Easier

Department of Health (2005). Choosing activity: a physical activity action plan

Department of Health (2009). Be Active, Be Healthy: A Plan for Getting the Nation Moving

Department of Health (2009b). Let’s Get Moving - A new physical activity care pathway for the NHS: Commissioning guidance

Department of Health (2010). Healthy Lives, Healthy People

Department of Health (2011). Start Active, Stay Active: A Report on Physical Activity from the Four Home Countries’ Chief Medical Officers.

National Institute of Health and Clinical Excellence (2006). Behaviour Change at Population, Community and Individual Levels (PH6)

National Institute of Health and Clinical Excellence (2006). Four Commonly Used Methods to Increase Physical Activity: Brief Interventions in Primary Care, Exercise Referral Schemes, Pedometers and Community-Based Exercise Programmes for Walking and Cycling (PH2)

National Institute of Health and Clinical Excellence (2008a). Promoting and Creating Built or Natural Environments that Encourage and Support Physical Activity (PH8)

National Institute of Health and Clinical Excellence (2008b). Promoting Physical Activity in the Workplace (PH13)

National Institute of Health and Clinical Excellence (2008c). Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease (CG67)

National Institute of Health and Clinical Excellence (2009a). Promoting Physical Activity for Children and Young People (PH17).

National Institute of Health and Clinical Excellence (2009b). Promoting Mental Wellbeing through Productive and Healthy Working Conditions: Guidance for Employers (PH22).

National Institute of Health and Clinical Excellence (2010). Prevention of Cardiovascular Disease at Population Level (PH25)

National Obesity Observatory (2011) Determinants of Obesity: Child Physical Activity http://www.noo.org.uk/NOO_pub/Key_data

Sport England (2008). Creating a sporting habit for life; Sport England strategy 2012-17

 

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