Presentation by Professor Tess Kay for the ESRC Seminar Series on Ageing and Physical Activity - "Physical activity among hard to reach groups: Issues for research, policy and practice" http://seminars.ecehh.org

1. “Irrespective of gender,
race or socio-economic
status”.
How national PA guidance
is failing older adults
Professor Tess Kay
Institute of the Environment,
Health and Societies.
Brunel, 12 November 2015
tess.kay@brunel.ac.uk

2. 1. The contribution of physical activity to
health
2. National PA guidance for older adults
3. Ignorance kills: sins of omission in PA
guidance for older adults
4. Developing more informed policy guidance

3. The contribution of
physical activity to
health

4. Brunel University London
What is ‘older age’ in the UK? Unequal health and life
expectancy in England
4
ENGLAND
2009-11
Least
Deprived
10% of
Areas
Most
Deprived
10% of
Areas
Life expectancy (years)
Male 83 yrs 73 yrs
Female 86 yrs 79 yrs
Source: Office for National Statistics
Healthy life expectancy (years)
Male 71 52
Female 72 53
Source: Office for National Statistics

5. Brunel University London
What’s killing us?
Low/middle
countries,
% of deaths
High
income,
% of deaths
Cause of deaths
Globally,
% of deaths
High
income
countries,
% of deaths
Communicable Diseases (CDs) -
infectious
e.g. HIV, malaria
40% 7%
Non-Communicable Diseases (NCDs)
– non-infectious:
e.g. heart disease, cancer, diabetes;
e.g. depression, dementia,
addictions
50% 87%
Injuries and accidental deaths 10% 6%

6. Brunel University London
The health contributions of physical activity
BEING ACTIVE
Physical activity
• helps maintain a healthy
weight
• improves health,
regardless of weight.
Being active can reduce risk:
• type 2 diabetes by 30-40%
• stroke and heart disease
by 10%
• depression
• vascular dementia
BEING INACTIVE
Physical inactivity:
• fourth largest cause of disease
and disability in the UK
• contributes to one in six deaths in
the UK
A quarter of the population fail to
achieve 30 minutes of activity a week
Being inactive is twice as common in
low income areas as high income
areas
6

7. National PA guidance for
older adults

8. Brunel University London
Guidelines for PA in the UK
Features of the 2011 guidelines
A life course approach
Stronger recognition of role of
vigorous activity
Flexibility to combine moderate
and vigorous activity
Emphasis on daily activity
New guidelines on sedentary
behaviour
Percentage of adults
meeting pre-2011 physical
activity guidelines
Country Men Women
Scotland 43% 32%
England 40% 28%
Northern
Ireland
33% 28%
Wales 36% 23%

9. Brunel University London
Promoting health through activity: UK Start Active,
Stay Active national guidelines (2011)
Start active, stay
active Department
of Health, 2011.
“It is important that the public health
community provides people with the
information on which to base healthy
lifestyle choices.
Start Active, Stay Active is aimed at
professionals and policy makers and is
the first link in a chain of communication
to inform behaviour change”.

10. Brunel University London
Physical activity guidelines for older adults
1. Older adults should aim to be active daily.
2. Over a week, activity should add up to at least 150 minutes (2½ hours) of
moderate intensity activity in bouts of 10 minutes or more.
3. For those who are already regularly active at moderate intensity, comparable
benefits can be achieved through 75 minutes of vigorous intensity activity
across the week.
4. Older adults should also undertake physical activity to improve muscle
strength on at least two days a week.
5. Older adults at risk of falls should incorporate physical activity to improve
balance and co-ordination on at least two days a week.
6. All older adults should minimise the amount of time spent being sedentary
(sitting) for extended periods.
10

11. Brunel University London
The SASA report: representing ageing and older age
Age group Cases
Early years <5 years 3
Child/youth 5-14 years 2
Adults 15-64 years 3
Older adults 65+ years 2
11
Adults 15-64
• Age 22, 27, 37
• All single and childless
• All employed
Older adults 65+
Meet Jim and Shirley

12. Brunel University London
The SASA case study illustrations for Older adults
Jim (70) is a married man who
retired at 51. He takes part in many
activities, both active and
sedentary. His burning passion is
basketball refereeing, which he’s
done for 56 years. A game involves
two hours’ continuous activity, much
of which is running. To keep up his
activity levels during the summer,
he has also found a summer league
which he is now involved in. During
the summer, he occupies much of
his time doing some part-time
garden maintenance work for
neighbours and he helps out at his
daughter’s allotment. He also hosts
a couple of holiday tours a year,
which involve either walking or
leading visits to gardens. Jim’s wife
also ensures that they get out for
regular walks to visit their friends.
Shirley (81) is a widow who lives
alone and doesn’t drive. She kept
working until the age of 76 and has
been determined to keep busy and
independent ever since. She has built
up strong friendships and local
support networks: during the week,
she has a string of neighbours visiting
her, to chat and have coffee or lunch.
She regularly takes the bus with a
friend to the shops, and pops out on
foot to top up locally. She always
chooses to take the stairs instead of
the lift. When a local exercise class
closed, she sought out a led walk.
She has progressed from the ‘slow’ to
the ‘fast’ stream, and she’s managed
to get four friends to join. In her own
words: ‘I say take advantage,
because I might not be like that next
year!’

13. Brunel University London
Evidence-based or evidence-free: what’s
missing?
Measures of physical functioning
Mobility, motor skills and strength, e.g.
• walking 100 yards
• getting up from a chair
• picking up a 5p coin from a table;
‘Activities of daily living’, e.g.
• dressing
• getting in or out of bed
• using the toilet
‘Instrumental’ living activities e.g.
• shopping for groceries
• making telephone calls
• doing work around the house
Dimensions of inclusion
Resources
> Material and economic resources
> Access to public and private services
> Social resources
Participation
> Economic participation
> Social Participation
> Culture, education and skills
> Political and civic participation
Quality of life
> Health and well-being
> Living environment
> Crime, harm and criminalisation
13

14. Ignorance kills: sins of
omission in PA guidance for
older adults

15. Brunel University London
The production process for the SASA guidance

16. Brunel University London
Evidence base for the SASA guidance
.
16
Start Active, Stay Active - the UK guidance on PA
Key sources were:
• USA Physical Activity Guidelines (2008)
• scientific reviews undertaken to inform the Canadian Physical
Activity Guidelines
• review papers from the British Association of Sport and Exercise
Sciences (BASES)
• selected additional relevant high quality review or study papers
• 2 Day Scientific Meeting in October 2009. convened to allow for wider input
from the scientific community and to communicate more widely the process
that was under way.
• National web-based consultation.

17. Brunel University London
Evidence-based or evidence-free: what could social
science add?
• Social statistical profiling of the
‘older’ population
Profile
population
characteristics
• Social science (led) studies of the
experiences of ageing
Context
representing
everyday life
• Social science (led) studies of the
older adults’ relationship to being
physically active
Specific
understanding being
physically active in
older age
17

18. Brunel University London 18
Addressing the social determinants of health:
accessing expert knowledge
Addressing social determinants will produce
the largest gains in health and the biggest
reductions in health inequalities
World Health Organisation, 2008
The social determinants of health are largely outside the
scope of those who deliver healthcare, with risks driven by
individual behaviour (smoking, diet, exercise) in the context
of societal influences (housing, schools, employment) and
environmental factors (air quality, physical environment).
Better health for London, 2014
Doing nothing is not an economic option. The human cost
is also enormous – 2.5 million years of life potentially lost
to health inequalities by those dying prematurely each year
in England. The Marmot Review, 2010

19. Developing more informed
policy guidance

20. Brunel University London
Who’s listening?
20
In conclusion, we know
enough now to act on
physical activity. The
evidence for action is
compelling, and we have
reached a unique UK-
wide consensus on the
amount and type of
physical activity that is
needed to benefit health.

21. Brunel University London
Learning from external expert communities
21
Producing Start Active, Stay Active -
the UK guidance on PA
Winter
2008-09
UK-wide review of PA
guidance commissioned
June
2009
May
2010
4 sub-groups review
evidence for each age
group and report
Sept
2010
Writing of guidelines
begins
Summer
2011
Start Active, Stay Active
published
Jun-Aug 2009:
Stakeholder
consultation on draft
Marmot (health
inequalities) Review
February 2010:
Publication of Marmot
(health inequalities)
Review
> 6000 visits to
the website and
135 responses

22. Brunel University London
Diversifying expert guidance: consultations on health
inequalities by the Marmot Review working groups
.
22
Fair Society, healthy lives - the Marmot Review (UK) (2010)
Meetings, discussions, consultations and seminars with:
• community groups,
• health sector representatives,
• housing associations and organisations,
• the Local Government Association,
• health care organisations,
• regional government,
• other government departments,
• local public health and local government leaders,
• Primary Care Trusts,
• third sector and other delivery organisations,
• and the public

23. Brunel University London
Enhancing PA through social science research
23
Developing better evidence
Reconceptualise the PA problem:
centring health inequalities
Diversify expert communities: academic integration
across disciplines and with social science
Deepen the knowledge base: cross-sector
integration with local, lay and practitioner expertise

24. Brunel University London
Connecting to the health inequalities agenda:
footnote or focus?
24
Change the social determinants
of health and there will be
dramatic improvements in
health equity.
World Health Organisation, 2008: Health equity
through action on the social determinants of
health.
The more favoured people are, socially and economically, the
better their health. This link between social conditions and health
is not a footnote to the ‘real’ concerns with health – health care
and unhealthy behaviours – it should become the main focus.
The Marmot Review, 2010

25. Brunel University London
17 November 2015
Presentation Title 25