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 2009/10, physical inactivity cost Redcar & Cleveland PCT £2.8 million (Sport England Local Sport profile Tool, 2009/10).
This topic is most closely associated with the following JSNA topics:
- Learning disabilities
- Physical disabilities
- Poverty
- Transport
- Diet and nutrition
- Obesity
- Circulatory diseases
- Diabetes mellitus
1. What are the key issues?
At every age, the majority of people don’t achieve recommended levels of physical activity.
- Nationally, 60% of men and 71% of women are not active enough to benefit their health (Active People Survey 7 data)
- Only 32% of boys and 24% of girls aged 2-15 years met the recommended physical activity levels (The Information Centre, 2009).
- Only 38.3% of adults in Redcar & Cleveland take part in sport or active recreation once per week - 4 sessions of at least moderate intensity four times in the last 28 days. (Active People Survey 8). This has increased since 2005/6 from 30.5% reflecting local initiatives and investment in facilities.
- 27.9% of adults in Redcar and Cleveland take part in sport and physical activity three times per week (Active People Survey 8). An increase of 7.4% from baseline figures in 2005/6.
- Only 60% of schools locally meet the two hour target for PE.
Both adult and child obesity in Redcar & Cleveland are a cause for concern.
There is a lack of validated self-report physical activity measures, particularly for children, making it difficult to evaluate and compare interventions and populations.
Motorised transportation, digital entertainment, communications technologies and sedentary jobs are removing the physical activity out of daily experience, leading to an increase in inactive lifestyles.
There is increasing evidence of the negative health effects of time spent in sedentary pursuits independent of how active people are at other times.
Subsidised sport and leisure facilities and public transport are under increas-ing financial pressure. For participants, cost, accessibility and time pressures are key factors to being physically active.
2. What commissioning priorities are recommended?
2014/01
Establish a Redcar & Cleveland Healthy Weight, Health Lives Partnership to en-sure a co-ordinated approach to prevent and manage obesity and reduce levels of physical inactivity across the borough.
2014/02
Facilitate and create increased opportunities for people of all ages to take part in sport and active leisure, wherever possible removing barriers of cost, transport, and perception. Programmes should focus on those who are currently inactive and seek to achieve moderate intensity activity levels.
2014/03
Commission programmes to ensure young people have the opportunities to take part in sport and physical activity linking school sport with community sport and encourage life- long participation in sport and physical activity.
2014/04
Use events as a focus to encourage people to take up physical activity programmes and promote greater understanding of the health benefits of physical activity
2014/05
Increase the capacity of voluntary sector groups running sport and active leisure programmes to sustain higher numbers of participants through investment in work-force, facilities and infrastructure.
2014/06
Maximise use of facilities, including schools and green infrastructure, through com-munity use agreements, an up to date playing pitch strategy, open space study and other relevant strategies to encourage physical activity using the extensive natural resources of the borough.
2014/07
Ensure that the potential for physical activity and healthy eating is maximised through joint working with planning and transport departments including the use of health impact assessments to address the obesogenic environment.
2014/08
Improve detailed understanding of local population characteristics in relation to physical activity to enable better targeted interventions.
Previous commissioning priorities:
2012/01
Facilitate and create increased opportunities for people of all ages to take part in sport and active leisure, wherever possible removing barriers of cost, transport, and perception. Programmes should focus on those who are currently inactive and seek to achieve moderate intensity activity levels.
2012/02
Commission programmes which link schools with community sport and leisure opportunities including those in the voluntary sector and leisure centres to provide performance pathways and to reduce the decline in participation which occurs through the 11-19 years range.
2012/03
Promote greater understanding of the health benefits of physical activity and use events as a focus to encourage people to get involved.
2012/04
Increase the capacity of voluntary sector groups running sport and active leisure programmes to sustain higher numbers of participants.
2012/05
Maximise use of facilities, including schools and green infrastructure, through community use agreements and clear information and guidance. A strategic review of the allotment provision across Redcar & Cleveland should be conducted, which should explore the potential to initiate food growing projects in other settings such as schools and workplaces (using HMP Holme House in Stockton as a case study) and linking volunteers with any such projects. The successes and progress of existing and recent work such as the “Dig It” project should be built upon.
2012/06
Improve detailed understanding of local population characteristics in relation to physical activity to enable better targeted interventions.
2012/07
Commission a single website that brings together the physical activity opportunities available in Redcar & Cleveland 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.
2012/08
Consider the use of health impact assessments for a wide range of Council and partner activities such as transport and housing projects – all of which have the potential to influence the physical activity environment.
2012/09
Use the ‘wellness’ system in the leisure centres to better track and analyse the local population.
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.
4. What is the level of need in the population?
Physical activity behaviour is difficult to measure and many of the self-reported tools that are used are inaccurate whilst the cost and invasiveness of direct measures often precludes use of such methods. Hence only limited data is available.
Behaviour and lifestyle
The Health Profile 2014 for Redcar & Cleveland shows smoking and obesity in adults are significantly worse than England. Adult physical activity rates are also lower than England, but the difference is not statistically significant (PHE, 2014). Binge drinking rates are significantly higher than England (LAPE, 2014).
None of the data discussed below compare physical activity levels of any of the population groups in the Redcar & Cleveland against current or previous Government guidelines, apart from the estimate of adult levels. This is not measured locally but modelled from a national survey.
School sport
Schools in Redcar & Cleveland aspire to provide 2 hours of PE per week. Due to current funding constraints only around 60% of schools are achieving this. Primary schools receive a "top up" of funding (Sport Premium) and work with the School Sports Partnerships to deliver quality Physical Education outcomes but the lack of funding currently within school sport is a concern. Data previously reported is no longer valid as schools are not required to complete data regarding PE. Schools can apply for a School Games Mark to show commitment to school sport and in 2013/14 there were 17 schools in the borough who were successful in gaining this award (17 Primary schools, 5 secondary schools and 1 special school).
All schools in Redcar & Cleveland have committed to continuing to maintain their Healthy School Standards (which includes the promotion of physical activity as a key element) through an annual review process.
Walking and cycling to school
In Redcar & Cleveland, walking or cycling to school is more common than in England as a whole and the difference is greatest at secondary school. Slightly fewer children use active travel for getting to secondary school compared to primary school.
Adult physical activity
The Active People Survey (APS) is the largest ever measurement of sport and recreation to be conducted in Europe. It started in 2005 and the latest results are from the eighth wave of the survey (APS8) ,which was conducted between April 2013 to April 2014.
The pure sports measure for Redcar & Cleveland, which relates to adult participation in three sessions of 30 minutes of moderate intensity sport a week (specifically at least 12 sessions in the previous 28 days), represents a significant increase since 2005/6 – the current figure is 27.9% of adults compared to a baseline of 20.5% in 2005/6.
Adult (16+) participation in sport (at least once a week*), Redcar & Cleveland, 2005/06 to 2012/13 |
|||
Year |
Redcar & Cleveland |
North East |
England |
2005/06 |
30.5% |
32.7% |
34.2% |
2007/08 |
35.6% |
34.2% |
35.8% |
2008/09 |
33.5% |
34.7% |
35.7% |
2009/10 |
35.2% |
35.0% |
35.3% |
2010/11 |
33.9% |
33.3% |
34.8% |
2011/12 |
35.4% |
35.6% |
36.0% |
2012/13 |
34.8% |
34.7% |
35.7% |
Source: Active People Survey, Year: 2005/06 (APS1), to 2012/13 (APS7) |
|||
* 1 session a week (at least 4 sessions of at least moderate intensity for at least 30 minutes in the previous 28 days) |
There is however still a significant gap between male and female participation as measured by this indicator with 33.2% of males taking part compared to 23.1% of females. Participation in sport and active recreation drops with age with 44.9% of 16 to 34 year olds taking part compared to 27.4% between ages 35 and 54. This further drops to just 17.2% at ages 55 plus.
The APS also measures other key performance indicators (KPI) including:
KPI 1 Taking part on at least 3 days a week in moderate intensity sport and active recreation (at least 12 days in the last 4 weeks), for at least 30 minutes continuously in any one session. Participation includes recreational walking and cycling.
KPI 2 Volunteering to support sport for at least one hour a week.
KPI 3 Being a member of a club particularly so that you can participate in sport or recreational activity in the last 4 weeks.
KPI 4 Having received tuition from an instructor or coach to improve your performance in any sport or recreational activity in the last 12 months.
KPI 5 Having taken part in any organised competition in any sport or recreational activity in the last 12 months.
KPI 6 Percentage of adults who are fairly or very satisfied with sports provision in their local area.
Organised sport Percentage of adults who have done at least one of the following: received tuition in the last 12 months, taken part in organised competition in the last 12 months or been a member of a club to play sport.
The APS results for each of the national KPIs are covered in the table above. At the start of APS 5 the volunteering question (KPI 2) was changed to incorporate a wider definition of sport volunteering and, therefore, comparisons with previous data are not possible.
The Local Sport Profile Tool (Sport England, 2014) 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 Redcar & Cleveland, men are more likely than women to do 3 lots of 30 minutes active recreation (33.2% and 23.1%, respectively).
Key Performance Indicators (KPI) |
||||||||
Indicator |
Redcar & Cleveland |
North East |
||||||
2009/10 |
2010/11 |
2011/12 |
2012/13 |
2009/10 |
2010/11 |
2011/12 |
2012/13 |
|
KPI2* - Proportion of the Adult Population volunteering at least one hour a week |
3.0% |
6.6% |
- |
6.9% |
4.9% |
6.3% |
7.1% |
5.7% |
KPI3 - Club Membership in the last 4 weeks |
17.5% |
18.4% |
14.4% |
17.5% |
22.1% |
21.2% |
20.6% |
20.7% |
KPI4 - Received tuition / coaching in last 12 mths |
10.9% |
13.4% |
12.9% |
9.6% |
14.8% |
14.0% |
16.1% |
13.3% |
KPI5 - Took part in organised competition in last 12 months |
15.1% |
10.3% |
14.0% |
8.7% |
12.8% |
11.9% |
13.9% |
12.3% |
KPI6+ - Satisfaction with local provision |
63.7% |
n/a |
n/a |
59.7% |
70.8% |
n/a |
n/a |
62.8% |
Source: Active People Survey , Year: 2009/10-2012/13, Measure: Key Performance Indicators 2, 3, 4, 5, 6 * - Measure changed in APS5, for more information please click the link below + - KPI6 was not measured in APS 5 (2010/11) or APS6 (2011/12) n/a indicates that data is not available |
The Mosaic social segmentation tool enables analysis of Redcar & Cleveland’s population to identify sub-groups that are the least active. Mosaic groups E, J, K and O make up over half of Redcar & Cleveland’s population. Groups J, K and O have higher than average rates of physical inactivity with 61% of group O and 58% of group K participating in no physical activity in the last month. Group E has a rate of inactivity above 40%, despite being better than the England average.
Using Sport England Market Segmentation data the dominant groups in Redcar & Cleveland are “Elsie and Arnold” “Philip” and “roger and Joy” reflecting the apparent older population with projected increases in age 65 Plus (Sport England Local Sport Profile Tool 2014).
Market segmentation |
|||||||||
Code |
Name |
Description |
Redcar & Cleveland |
North East |
|||||
Number |
Rate |
Number |
Rate |
||||||
|
|
|
|
|
|
|
|
|
|
A01 |
Ben |
Competitive Male Urbanites |
3.2 |
2.9% |
58.6 |
2.9% |
|||
A02 |
Jamie |
Sports Team Drinkers |
5.2 |
4.8% |
45.3 |
6.0% |
|||
A03 |
Chloe |
Fitness Class Friends |
2.4 |
2.2% |
45.3 |
2.2% |
|||
A04 |
Leanne |
Supportive Singles |
4.3 |
3.9% |
90.1 |
4.4% |
|||
B05 |
Helena |
Career Focused Females |
2.4 |
2.2% |
46.7 |
2.3% |
|||
B06 |
Tim |
Settling Down Males |
5.5 |
5.1% |
104.4 |
5.1% |
|||
B07 |
Alison |
Stay at Home Mums |
3.5 |
3.2% |
68.2 |
3.4% |
|||
B08 |
Jackie |
Middle England Mums |
7.9 |
7.2% |
133.0 |
6.6% |
|||
B09 |
Kev |
Pub League Team Mates |
7.5 |
6.9% |
174.9 |
8.6% |
|||
B10 |
Paula |
Stretched Single Mums |
5.7 |
5.2% |
115.8 |
5.7% |
|||
C11 |
Philip |
Comfortable Mid-Life Males |
9.7 |
8.9% |
157.3 |
7.7% |
|||
C12 |
Elaine |
Empty Nest Career Ladies |
5.0 |
4.6% |
91.9 |
4.5% |
|||
C13 |
Roger & Joy |
Early Retirement Couples |
8.4 |
7.7% |
111.7 |
5.5% |
|||
C14 |
Brenda |
Older Working Women |
7.5 |
6.9% |
157.0 |
7.7% |
|||
C15 |
Terry |
Local ‘Old Boys’ |
6.0 |
5.5% |
122.1 |
6.0% |
|||
C16 |
Norma |
Later Life Ladies |
3.4 |
3.1% |
68.5 |
3.4% |
|||
D17 |
Ralph & Phyllis |
Comfortable Retired Couples |
1.9 |
1.7% |
45.9 |
2.3% |
|||
D18 |
Frank |
Twilight Year Gents |
7.1 |
6.5% |
100.5 |
5.0% |
|||
D19 |
Elsie & Arnold |
Retirement Home Singles |
12.8 |
11.7% |
215.5 |
10.6% |
|||
|
|
|
|
|
|
|
|
|
|
Total |
|
|
|
109.4 |
100.0% |
2,029.7 |
100.0% |
||
Source: Sport England and Experian Ltd, Year: 2010, Measure: Sport Market Segmentation |
Swimming and Cycling activity is strong in Redcar & Cleveland according to the Active People Survey data but other sport and activities within National and regional top 5 lists are less strong.
Number of adults (16+) wanting to do more sport, Redcar & Cleveland, 2012/13 |
||||||
|
Redcar & Cleveland |
North East |
England |
|||
No. (000s) |
Rate |
No. (000s) |
Rate |
No. (000s) |
Rate |
|
All adults |
63.9 |
57.8% |
1,166.9 |
54.3% |
24,447.1 |
57.5% |
Active adults |
13.6 |
35.4% |
257.1 |
34.5% |
5,525.0 |
36.4% |
Inactive adults |
16.1 |
22.4% |
278.2 |
19.8% |
5,747.1 |
21.0% |
Source: Active People Survey 7, 2012/13 |
The number of adults (16+) who wish to take part in more sport shows 22.4% of inactive adults who wish to take part in more sport whilst 35.4% of active adults wish to take part in more sport and physical activity.
Use of leisure facilities
Leisure centres are one place where a wide range of activities can be provided for individuals and groups of all abilities and backgrounds, including swimming which in a coastal town is vital for health as well as to prevent deaths by drowning. There are five local authority owned leisure facilities in Redcar & Cleveland and from 2013 these were operated by Everyone Active (SLM) on a 20 year contract. Key headlines for leisure facilities:
- Usage in leisure centres has never been higher. Following recent investment there is an expected usage of over a million visits per year.
- Fitness Membership is currently at 7281 (as at end April 2014)
- Group fitness classes now attract over 10,000 users per month, possibly resulting from an increase in both the variety and number of classes as well as the introduction of virtual classes to suit working lifestyles of clients. Over 8000 children access swimming lessons across the contract and these are being boosted by free access to swimming lessons for children aged under 36 months.
- In 2013/14 there was an increase in leisure centre attendance of 12%
- Investment of £1.5m across all centres was undertaken in 2013/14 resulting in higher quality fitness facilities, front of house and changing rooms.
- The new Redcar & Cleveland Leisure and Community Heart (a £30m investment in leisure and civic facilities) opened in 2014. In the first five months of opening the centre has attracted 168,000 visits. The additional swimming facility has resolved issues over latent demand for swimming in the borough and swimming remains the most popular sporting activity in the borough with over 12% of the population taking part at least once per month (APS7).
5. What services are currently provided?
Sport and active leisure
- Five public leisure centres all with swimming pools operated on behalf of the Council by Everyone Active.
- Private fitness facilities
- Annual Mass participation events such as the Redcar Half Marathon, Redcar Triathlon as well as a number of events facilitated by the voluntary sector.
- Schools, including PE in the curriculum, bikeability and after school provision
- A weekly parkrun regularly attracting over a hundred participants per week.
- Countryside and green spaces
- School holiday activities provided by Everyone Active
- Exercise on referral programme operated by Everyone Active.
- Early years provision in children centres
- Over 40 sports clubs in the borough who have Clubmark accreditation (Local Sport Profile Tool 2014)
- Sporting activities in colleges and universities
- Walking and leisure groups
- Active travel programme, including guided rides and walks, advice on cycling routes, bike maintenance and cycle loan schemes. Links with schools, colleges, universities and workplaces in addition to supporting general community.
- Cleveland Fire Brigade ‘Firefit’ programme, including football, rugby and cricket
Infrastructure
- Cycle and walk ways
- Parks, countryside and nature reserves
- Skate parks
- Play equipment
- Allotment
Services that include provision to support people to increase levels of physical activity
- Weight management services for children and adults
- NHS Tees Healthy Heart Check programme (delivered by GP practices and in rkplaces/community venues)
- Cleveland Fire Brigade Vulnerable Persons Pathway, signposting to other services
- The School Sports Partnerships within Redcar & Cleveland.
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) show a significant increase between the active people survey (APS) 1 in October 2005 and October 2006 compared with APS8 in April 2013 to April 2014. Whilst the general trend is towards increasing participation there are still a high percentage of people not currently active once per week.
Population increases in Redcar & Cleveland are minimal with a 0.1% increase expected towards 2017.
There is a trend towards an increasing age profile in Redcar & Cleveland, in particular across the 65+ age group. As this age group are typically the least active this may inhibit increases in sport and physical activity levels.
7. What needs might be unmet?
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.
Activities currently taking place in school facilities or privately owned facilities may be reduced by removal of the opportunity, particularly arising from security and health and safety concerns.
Participation in active leisure in subsidised or commercial facilities, including pools and gyms, may be restricted by economic pressures and increased costs.
Reductions in subsidy to public transport may also increase barriers to participation for some forms of active leisure.
Increasingly inactive and increasingly overweight young people may feel excluded from traditional competitive or recreational group activities such as running, league football, tennis. There may be a lack of services aimed at beginners and people with low self-efficacy.
The increasing numbers of older people, as a proportion of the population, may require an increased number of activities designed to meet their tastes and lifestyles. These will represent an increased demand for subsidy at a time of declining resources.
Insufficient allotment provision and long waiting lists may prevent people taking part in this form of physical activity; the Council currently has 17 sites with 760 plots in total whilst some of the town and parish councils also have some provision. There are available plots in some areas, although these tend to be in the more deprived wards and have been subject to vandalism. Hence, there is a waiting list for plots in other more desirable areas with 746 people on the waiting list (January 2011).
Lack of awareness of the local environment and opportunities for active leisure may limit participation levels.
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
Public Health England (2014). Everybody Active, Every Day: An evidence-based approach to physical activity. Actions include participating in more physical activity reaps greater benefits to individuals and consequently communities and local services. There is a three year difference in the life expectancy between minimally active and inactive people.
Department of Health (2011). Start Active, Stay Active: A Report on Physical Activity from the Four Home Countries’ Chief Medical Officers.
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.
9. What do people say?
As part of the Active People Survey (APS), respondents were asked about their satisfaction with sports provision – these results are summarised below.
Adult satisfaction with local sports provision as measured by the Active People Surveys, Tees, 2005/06 to 2009/10
In contrast, the National Benchmarking Service (NBS) reports undertaken in June 2010 in three leisure centres show above national average satisfaction rates at Loftus Leisure Centre, Saltburn Leisure Centre and Eston Sports Academy. This was for a number of issues including activities available, cost, quality, cleanliness, helpfulness of staff and value for money. The difference in these results may be explained by the fact that the APS is a random telephone interview and many of these respondents may be non-users of the facilities whereas the NBS results are based on the responses of facility users (i.e. perception in the APS versus reality in the NBS).
NHS Stockton-on-Tees commissioned research to understand local young women’s views on physical activity, including mothers. The research revealed:
- In general, participants could explain what physical activity entails, however a few viewed it only as sport.
- Some participants suggested that physical activity was not a priority or does not play a role in their lives, others proposed participating for fun, too look nice and for health benefits.
- Mothers reported taking part in less mild, moderate and strenuous forms of physical activity, than the other three groups.
- The participants scored quite positively (all were above average values) on the beliefs and attitudes scale towards physical activity (enjoyment, perceived competence, self-efficacy, attitudes and social influence), with the exception of the Mums’ self-efficacy score.
- Participants were mostly aware of physical activity opportunities that included the gym and lifestyle activities.
- Main sources of physical activity information for participants were the gym, leisure centres and the internet.
- The most frequently cited barriers to physical activity were time and money.
The evaluation of the Stockton-on-Tees ‘Let’s Get Moving’ physical activity pathway pilot has shown interesting insights from the interim results, including:
- Most popular activities amongst sample of service users are unstructured activities that people can incorporate into their daily lifestyle, such as walking, cycling and swimming. These are followed by gym-based activities and then structured activities.
- Those service users who did not want to discuss increasing their physical activity levels or set goals for physical activity were mainly those who had mobility or health issues.
10. What additional needs assessment is required?
There are no measures of the physical activity levels (against Government recommendations) of specific populations within Redcar & Cleveland, namely:
- Children – both overall and in specific sub-groups (e.g. gender, ethnicity, socioeconomic groups, ward of residence)
- Older adults – both overall and in specific sub-groups (e.g. gender, ethnicity, socioeconomic groups, ward of residence)
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 (e.g. against HSE results).
Key Contact
Name: Andrew Pearson
Job Title: Health Improvement Specialist
e-mail: andrew.pearson@redcar-cleveland.gov.uk
phone: (01642) 771192
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
Other references
Anoyke, N.K., Trueman, P., Green, C., Pavey, T.G., Hillsdon, M. & Taylor, R.S. (2011). The cost effectiveness of exercise referral schemes. BMC Public Health, 11, 954
Barnett, A., Cerin, E. & Baronowski, T. (2011). Active video games for youth: A systematic review. Journal of Physical Activity and Health, 8, 724 – 737
Belanger, M., Townsend, N. & Foster, C. (2011). Age-related differences in physical activity profiles of English adults. Preventive Medicine, 52, 247 – 249
Biddle, S.J.H., O’Connell, S. & Braithwaite, R.E. (2011). Sedentary behaviour interventions in young people: A meta-analysis. British Journal of Sports Medicine, 45, 937 – 942
Biddle, S.J.H., Pearson, N., Ross, G.M. & Braithwaite, R. (2010). Tracking of sedentary behaviours of young people: A systematic review. Preventive Medicine, 51 (5), 345 – 351
Boddy, L.M., Fairclough, S.J., Atkinson, G. & Stratton, G. (in-press). Changes in cardiorespiratory fitness in 9 - 10.9 year old children: SportsLinx 1998-2010. Medicine and Science in Sports and Exercise.
Bravata, D.M., Smith-Spangler, C., Sundaram, V., Gienger, A.L., Lin, N., Lewis, R., Stave, C.D., Olkin, I. & Sirard, J.R. (2007). Using pedometers to increase physical activity and improve health - A systematic review. Journal of the American Medical Association, 298 (19), 2296 – 2304
Carlebach, S., Athey, C. & Shucksmith, J. (2011). Evaluation of the Exercise on Referral schemes in Hartlepool, Middlesbrough, Redcar and Cleveland, and Stockton-on-Tees. Centre for Health and Social Evaluation, Teesside University
Caspersen, C.J., Powell, K.E. & Christenson, G.M. (1985). Physical activity, exercise and physical fitness: definitions and distinctions of health-related research. Public Health Reports, 100, 126 – 131
Corder, K., van Sluijs, E.M.F., Goodyer, I., Ridgeway, C.L., Steele, R.M., Bamber, D., Dunn, V., Griffin, S.J. & Ekelund, U. (2011). Physical activity awareness of British adolescents. Archives of Pediatrics and Adolescent Medicine, 165 (7), 603 – 609
Corder, K., van Sluijs, E.M.F., McMinn, A.M., Ekelund, U., Cassidy, A. & Griffin, S.J. (2010). Perception versus reality – awareness of physical activity levels in British children. American Journal of Preventive Medicine, 38 (1), 1 – 8
Department for Transport (2011) National Travel Survey 2011Duncan, M.J., Al-Nakeeb, Y., Woodfield, L. & Lyons, M. (2007). Pedometer determined physical activity levels in primary school children from central England. Preventive Medicine, 44, 416 – 420
Department of Health (2011b) Health Profiles for local authorities available at www.healthprofiles.info
Ekelund, U., Tomkinson, G. & Armstrong, N. (2011). What proportion of youth are physically active? Measurement issues, levels and recent time trends. British Journal of Sports Medicine, 45, 859 – 865
Foster, C., Hillsdon, M., Thorogood, M., Kaur, A. & Wedatilake, T. (2005). Interventions for promoting physical activity. Cochrane Database of Systematic Reviews, 1, CD003180
Gourlan, M.J., Trouilloud, D.O. & Sarrazin, P.G. (2011). Interventions promoting physical activity among obese populations: a meta-analysis considering global effect, long-term maintenance, physical activity indicators and dose characteristics. Obesity Reviews, 12, e633 – e645
James, W.P.T. (1995). A public health approach to the problem of obesity. International Journal of Obesity and Related Metabolic Disorders, 19, (supp 3), S37 – S45
Jepson, R.G., Harris, F.M., Platt, S. & Tannahill, C. (2010). The effectiveness of interventions to change six health behaviours: A review of reviews. BMC Public Health, 10, 538
King, A.C., Rejeski, J. & Buchner, D.M. (1998). Physical activity interventions targeting older adults – A critical review and recommendations. American Journal of Preventive Medicine, 15 (4), 316 - 333
Kriemler, S., Meyer, U., Martin, E., van Sluijs, E.M.F., Andersen, L.B. & Martin, B.W. (2011). Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. British Journal of Sports Medicine, 45, 923 – 930
Leavy, J.E., Bull, F.C.L., Rosenberg, M. & Bauman, A.E. (2011). Physical activity mass media campaigns and their evaluation: A systematic review of the literature 2003–2010. Health Education Research, 26 (6), 1060 – 1085
Lubans, D.R., Morgan, P.J. & Tudor-Locke, C. (2009). A systematic review of studies using pedometers to promote physical activity among youth. Preventive Medicine, 48, 307 – 315
McLure, S.A., Summerbell, C.D. & Reilly, R.R. (2009). Objectively measured habitual physical activity in a highly obesogenic environment. Child: Care, Health and Development, 35 (3), 369 – 375
Mitchell, J.A., Pate, R.R., Dowda, M., Mattocks, C., Riddoch, C., Ness, A.R. & Blair, S.N. (in-press). A prospective study of sedentary behaviours in a large cohort of youth. Medicine and Science in Sports and Exercise.
Morris, J.N. (1994). Exercise in the prevention of coronary heart disease: today's best buy in public health. Medicine and Science in Sport and Exercise, 26 (7), 807 – 814
Müller-Riemenschneider F., Reinhold, T. & Willich, S.N. (2009). Cost effectiveness of interventions promoting physical activity. British Journal of Sports Medicine, 43, 70 – 76
Müller-Riemenschneider, F., Reinhold, T., Nocon, M. & Willich, S.N. (2008). Long-term effectiveness of interventions promoting physical activity: A systematic review. Preventive Medicine, 47 (8), 354 – 368
Ogilvie, D., Foster, C.E., Rothnie, H., Cavill, N., Hamilton, V., Fitzsimons, C.F. & Mutrie, N. (2007) Interventions to promote walking: systematic review. British Medical Journal, 334, 1204 – 1207
Orrow, G., Kinmonth, A.L., Sanderson, S. & Sutton, S. (in-press). Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. British Medical Journal.
Owen, N., Sugiyama, T., Eakin, E.E., Gardiner, P.A., Tremblay, M.S. & Sallis, J.F. (2011). Adults’ sedentary behaviour: Determinants and interventions. American Journal of Preventive Medicine, 41 (2), 189 – 196
Pate, R.R., Mitchell, J.A., Byun, W. & Dowda, M. (2011). Sedentary behaviour in youth. British Journal of Sports Medicine, 45, 906 – 913
Pavey, T., Taylor, A.H., Fox, K.R., Hillsdon, M., Anokye, N.K., Campbell, J.L., Foster, C., Green, C., Moxham, T., Mutrie, N., Searle, J., Trueman, P. & Taylor, R.S. (2011). Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis. British Medical Journal, 343, d6462
Pearson, N., Atkin, A.J., Biddle, S.J.H., Gorely, T. & Edwardson, C. (2009). Patterns of adolescent physical activity and dietary behaviours. International Journal of Behavioral Nutrition and Physical Activity, 6;45
Perez-Pastor, E.M., Metcalf, B.S., Hosking, J., Jeffery, A.N., Voss, L.D. & Wilkin, T.J. (2009). Assortative weight gain in mother-daughter and father-son pairs: An emerging source of childhood obesity. Longitudinal study of trios (EarlyBird 43). International Journal of Obesity, 33 (7), 727 – 735
Physical Activity Task Force (2002) Let’s make Scotland more active. A strategy for physical activity available at www.scotland.gov.uk/Resource/Doc/47032/0017726.pdf
Prentice, A.M. & Jebb, S.A. (1995). Obesity in Britain: Gluttony or sloth? British Medical Journal, 311, 437 - 439
Riddoch, C.J., Mattocks, C., Deere, K., Saunders, J., Kirkby, J., Tilling, K., Leary, S.D., Blair, S.N. & Ness, A.R. (2007). Objective measurement of levels and patterns of physical activity. Archives of Disease in Childhood, 92, 963 – 969
Ridgers, N.D., Fairclough, S.J. & Stratton, G. (2010). 12-month effects of a playground intervention on children’s morning and lunchtime recess physical activity levels. Journal of Physical Activity and Health, 7 (2), 167 – 175
Rovniak, L.S., Sallis, J.F., Saelens, B.E., Frank, L.D., Marshall, S.J., Norman, G.J., Conway, T.L., Cain, K.L. & Hovell, M.F. (2010). Adults’ physical activity patterns across life domains; Cluster analysis with replication. Health Psychology, 29 (5), 496 – 505
Sallis, J.F. & Owen, N. (1997). Ecological models. In K. Glanz, F.M. Lewis, & B,K. Rimer (eds.), Health Behavior and Health Education: Theory, Research and Practice (2nd Edition, pp. 403 – 424). San Francisco: Jossey-Bass
Salmon, J., Booth, M.L., Phongsavan, P., Murphy, N. & Timperio, A. (2007). Promoting Physical Activity Participation among Children and Adolescents. Epidemiological Reviews, 29, 144 – 159
Scarborough, P., Bhatnagar, P., Wickramasinghe, K.K., Allender, S., Foster, C. & Rayner, M. (2011). The economic burden of ill health due to diet, physical activity, alcohol and obesity in the UK: An update to 2006-07 NHS costs. Journal of Public Health, 33 (4), 527 – 535
Sport England (2012). Local sport profile tool.
Sport England (2011). Active People Survey 5
Sport Scotland (2006) Increasing demand for sport and physical activity for adolescent girls in Scotland: Exploring issues, suggesting solutions.
Stamatakis, E., Ekelund, U. & Wareham, N.J. (2007). Temporal trends in physical activity in England: The Health Survey for England 1991 to 2004. Preventive Medicine, 45, 416 – 423
Telema, R. (2009). Tracking of physical activity from childhood to adulthood. A review. Obesity Facts, 2, 187 – 195
The Information Centre (2006). Health Survey for England 2004: Health of Ethnic Minorities – Full Report
The Information Centre (2008a). Health Survey for England 2007
The Information Centre (2008b). Health Survey for England 2006
The Information Centre (2009). Health Survey for England 2008
The Information Centre (2011). Statistics on Obesity, Physical Activity and Diet: England, 2011
Thorp, A.A., Owen, N., Neuhaus, M. & Dunstan, D.W. (2011). Sedentary behaviors and subsequent health outcomes in adults: A systematic review of longitudinal studies, 1996 – 2011. American Journal of Preventive Medicine, 41 (2), 207 – 215
van der Bij, A.K., Laurant, M.G.H. & Wensing, M. (2002). Effectiveness of physical activity interventions for older adults: A review. American Journal of Preventive Medicine, 22 (2), 120 – 133
van Sluijs, E.M.F., Kriemler, S. & McMinn, A.M. (2011). The effect of community and family interventions on young people's physical activity levels: a review of reviews and updated systematic review. British Journal of Sports Medicine, 45, 914 – 922
Verstraete, S.J.M., Cardon, G.M., De Clercq, D.L.R., De Bourdeaudhuij, I.M.M. (2006). Increasing children's physical activity levels during recess periods in elementary schools: The effects of providing game equipment. European Journal of Public Health, 16, 415 – 419
Vuori, I. (2011). Promoting cycling: A review of interventions. Clinical Journal of Sport Medicine, 21 (6), 542 – 544
Weinsier, R.L., Hunter, G.R., Desmond, R.A., Byrne, N.M., Zuckerman, P.A. & Darnell, B.E. (2002). Free living activity energy expenditure in women successful and unsuccessful at maintaining normal body weight. American Journal of Clinical Nutrition, 75, 499 – 504
Wilkin, T.J. (2011). Can we modulate physical activity in children? No. International Journal of Obesity, 35 (10), 1270 – 1276
Yang, L., Sahlqvist, S., McMinn, A., Griffin, S.J. & Ogilvie, D. (2010). Interventions to promote cycling: systematic review. British Medical Journal, 341, c5293