The health of the nation – older, sicker, fatter! By Charlie Foster
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The health of the nation – older, sicker, fatter! By Charlie Foster

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The health of the nation – older, sicker, fatter! By Charlie Foster

The health of the nation – older, sicker, fatter! By Charlie Foster

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  • Some 50 years since Morris’ first study there is now international consensus on the health benefits of physical activity. The US Surgeon General in 1996 and now in March of this year the Chief Medical Officer published major public health reports on the health benefits of physical activity.
  • Walking prevalence varies according to type of walking. Walking is socially patterned but the pattern varies by walking purpose. Long, brisk paced walks are more common among affluent groups, whereas walking for transport reveals an opposite trend. The availability of physical activity facilities declines with level of deprivation Areas in most need of facilities to assist people live physically active lifestyles have fewer resources The likelihood of this differential effect is magnified by the invitation and dose of physical activity offered. You need a car to give up or exchange a car journey for another mode of transport   Car use journeys to work, school, shops,   This choice is more limited and frustrating if you don’t have access to a reliable and cheap public transport system
  • The availability of physical activity facilities declines with level of deprivation Areas in most need of facilities to assist people live physically active lifestyles have fewer resources
  • Odense, Copenhagen
  • How you work with target group matters Do not underestimate the power of a good therapeutic relationship Evidence offers a direction for practice (with details) It’s art and it’s science There are other things in people’s lives which influence their physical activity choices over which we and them have little or no control Keeping adding to your toolbox
  • How you work with target group matters Do not underestimate the power of a good therapeutic relationship Evidence offers a direction for practice (with details) It’s art and it’s science There are other things in people’s lives which influence their physical activity choices over which we and them have little or no control Keeping adding to your toolbox

The health of the nation – older, sicker, fatter! By Charlie Foster The health of the nation – older, sicker, fatter! By Charlie Foster Presentation Transcript

    • Dr Charlie Foster
    • The health of the nation – older, sicker, fatter!
  • The effectiveness of physical activity promotion interventions - changing attitudes and environments Dr Charlie Foster BHF Health Promotion Research Group Department of Public Health University of Oxford Fitness Industry Association Conference 2010
  • So what’s in FIA’s tool box? Research evidence Communication & sales skills Behaviour strategies Business Skills Exercise promotion training, knowledge & skills Toolbox Advocacy & Policy placement
  • Outline
    • Physical activity basics
    • What is the EB for promoting physical activity?
        • Attitudes
        • Environment
        • Community & Individual
    • Limitations of evidence base
    • Other options
    • Conclusions
  • 61% of men and 71% of women do not meet the Chief Medical Officer’s minimum recommendations for physical activity in adults Men Women % active Age
  • International consensus on health benefits of physical activity
    • Physical activity can reduce the risk of:
      • Cardiovascular disease
      • Hypertension
      • Obesity
      • Some forms of cancers
      • Non insulin-dependent diabetes mellitus
      • Strokes
      • Osteoarthritis, by maintaining normal muscle strength, joint structure and joint function
      • Osteoporosis
      • Cognitive function
      • Crime reduction and community safety
      • Economic impact and regeneration of communities
      • Education and lifelong learning
      • Psychological well-being
      • Self esteem
      • Management of anxiety and depression
      • Social capital and community cohesion
      • Drug misuse
      • Carbon use
    (US Dept Health & Human Sciences, 1996; CMO, 2004; Sport England, 2009)
  • Cost of physical inactivity (£/population) related disease by SHA Foster et al, 2009 £14.85 £14.01 £17.20 £12.95 £14.85 £14.63 £13.94 £15.96 £18.71 £15.27
  • Cost of physical inactivity (£/population) related disease by SHA Spend in London is 85p per head Foster et al, 2009 £14.85 £14.01 £17.20 £12.95 £14.85 £14.63 £13.94 £15.96 £18.71 £15.27
  • Physical activity and inequalities
    • Physical activity choices are socially patterned
    • Individual approaches to promote physical activity have the potential to increase inequalities
    • Availability of physical activity facilities declines with level of area deprivation
  • The density of exercise facilities by quintile of deprivation for the county of Kent in Southeast England Availability of physical activity facilities declines with level of area deprivation
  • Attitudes
    • How are attitudes constructed?
      • KAB
    • What is a social norm?
    • Change4Life
    • Within families not within communities
      • Increase the desirability of physical activity behaviour
      • Decrease the desire to be sedentary
      • Change attitudes to behaviour or change environment,
        • places acceptable for the behaviour
        • More acceptable, normal
  • MINDSPACE: Influencing behaviour through public policy was a joint commission by the Cabinet Office and the Institute for Government.   It shows how the latest insights from the science of behaviour change can be used to generate new and cost-effective solutions to some of the current major policy challenges, such as reducing crime, tackling obesity and climate change.
  • So what does affect our behaviour? MINDSPACE. Influencing behaviour through public policy. Cabinet Office & Institute for Government, 2010.
  • Presentation Objectives
    • Physical activity basics
    • What is the EB for promoting physical activity?
        • Attitudes
        • Environment
        • Individual
    • Limitations of evidence base
    • Other options
    • Conclusions
  •  
  • The effectiveness of environmental change interventions to promote physical activity
    • NICE review – physical activity and environment
    • Systematic reviews have also found some evidence to support the impact of large scale environmental changes on physical activity
    • A combination of changes to working practices, policies and the physical environment encouraged adults to maintain their vigorous physical activity and fitness
    • Active travel interventions must contain environmental supports to sustain individual choice (i.e. public transport)
  • Using the environment to promote active living
    • Successful active travel interventions blend changes to places, people and policies
    • European examples demonstrate what can be achieved in the long term
    • NICE Physical activity and Environment public health guidance offers direction
  •  
  •  
  • The Cycling Demonstration Towns programme
    • First phase: October 2005 – October 2008
    • All towns funded at approx £5 per head per year, matched by the local authority
    • Comprehensive evaluation
  • Annual growth rates: European cities and CDTs Adapted from: Transport for London (2004) ‘Creating a chain reaction. The London Cycling Action Plan. February 2004. ( http://www.croydon-lcc.org.uk/downloads/2004_TfL_LondonCyclingActionPlan.pdf ) City Annual increase in cycling flows Darlington +14.2% Exeter +9.9% Brighton & Hove +9.0% Strasbourg +7.0% Lanc w Morecambe +6.2% Vienna +6.4% Graz +5.9% Munich +5.5% Hanover +5.4% City Annual increase in cycling flows Nottingham +4.8% Freiburg +4.4% Munster +3.6% Aylesbury +3.6% Berlin +3.2% Derby +2.5% Zurich +2.3% Delft +1.2%
  • The effectiveness of community-based approaches using person-focused techniques to promote physical activity
    • community wide campaigns using person focused techniques
      • Sustained changes in physical activity up to one year post intervention
      • those tailored to people’s needs
      • targeted at the most sedentary or at those most motivated to change
      • delivered either at the level of the individual (brief advice, supported use of pedometers, telecommunications) or household (individualised marketing) or through groups
      • Interventions which provide people with professional guidance about starting an exercise programme and then provide on going support
  •  
  • The findings of this review indicate that professional advice and guidance with continued support can encourage people to be more physically active in the short to mid-term.
  • Estimated net increase in walking in general by validity and then sample size Ogilvie D, Foster C, Rothnie H, Cavill N, Hamilton V, Fitzsimons CF, Mutrie N. Scottish Physical Activity Research Collaboration. Interventions to promote walking: systematic review. BMJ 2007;334 (7605):1204;
  • The effectiveness of community-based approaches using person-focused techniques to promote physical activity
    • community wide campaigns using person focused techniques
      • Sustained changes in physical activity up to one year post intervention
      • those tailored to people’s needs
      • targeted at the most sedentary or at those most motivated to change
      • delivered either at the level of the individual (brief advice, supported use of pedometers, telecommunications) or household (individualised marketing) or through groups
      • Interventions which provide people with professional guidance about starting an exercise programme and then provide on going support
  • Presentation Objectives
    • Physical activity basics
    • What is the EB for promoting physical activity?
        • Attitudes
        • Environment
        • Community & Individual
    • Limitations of evidence base
    • Other options
    • Conclusions
  • Limitations of evidence base
    • Measurement
    • Study design
    • Expense
    • Population sample
    • Applicability to the UK from international work
    • Differential effects on different population groups
    • Very little from the fitness industry
  • Other options
    • Reducing sedentary behaviours
    • Provision of free swimming and/or free sports centre access
    • Discounted or free public transport provision for children or the elderly
    • The use of local authority regulatory, legislative and policy guidance on physical activity promotion
    • The impact of combined programmes to tackle healthy eating and physical activity together at a community level
    • The recruitment of those in most need to participate in community based physical activity programmes
    • YMCA Activate England, Walking For Health Initiative, Sport Action Zones, Positive Futures
  • Social-ecological model of physical activity behaviour Foster et al (2005). Understanding why adults and children participate in physical activity and sport. London, Sport England. Law & Regulations Fiscal Built environment Natural environment Health care systems National policies & programmes
    • Evidence base does suffer limitations (maturity) but it offers a direction of travel
    • Evidence to support smaller more individually focused activities rather than larger scale community interventions
    • Recommend multiple level interventions
      • Environment, legislation, fiscal, policy approaches
      • Support individual approaches as part of RF prevention and management
    • Populate our list of options
    Conclusions
  • Public Health White Paper Late 2010
    • Local authorities, who will employ the Director of Public Health
    • Public Health Service in place, with ring-fenced budget and local health improvement led by Directors of Public Health in local authorities
      • Budget allocated to reflect relative population health outcomes, with a new health premium to promote action to reduce health inequalities.
    • NICE put on a firmer statutory footing
    • Health and Wellbeing boards (2012)
    • New and interesting times for physical activity promoters
    • Partnerships with industry
      • workplace
    • Partnerships with LAs
    • Partnership with new NHS
      • Primary care fund holders
    Conclusions