Public Policy Actions Needed to Promote Physical Activity
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Physical inactivity is a major risk factor for cardiovascular disease, and strategies to increase activity levels are as important to population health as smoking cessation, cholesterol control, or preventing obesity. The World Health Organization has identified that governments and non-government agencies have a central role in the creation of environments that facilitate physical activity changes by individuals, families, and communities. This article describes recent policy-related programs at a large-scale or national level to promote physical activity. This is proposed within a framework that codifies evidence-based policy actions, based on the International Physical Activity Recommendations. Examples are provided of current policy actions from diverse settings around the world. Finally, future policy directions needed for the promotion of physical activity are discussed and related research needs identified.
KeywordsPhysical activity Health policy Health promotion Disease prevention
Thanks to Dr Tom Schmid, CDC Atlanta USA, for comments on an earlier draft of this paper.
The authors report no potential conflicts of interest relevant to this article.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 2.Foster C. Guidelines for health-enhancing physical activity promotion programmes. Tampere: the UKK Institute for Health Promotion Research; 2000.Google Scholar
- 3.Hagströmer M. Assessment of health-enhancing physical activity at population level. Stockholm: Karolinska Institute; 2007.Google Scholar
- 5.• World Health Organisation. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: WHO; 2009. Available at http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf. Accessed 13 January 2011. This report identifies physical inactivity as the fourth leading risk factor for global mortality (6% of deaths globally).Google Scholar
- 6.• World Health Organization. Global recommendations on physical activity for health. 2010. Available at http://www.who.int/dietphysicalactivity/publications/en/. Accessed 13 January 2011. This report sets out the first global evidence-based recommendations for the amount, duration, frequency, and intensity of Health Enhancing Physical Activity for three age groups: 5 to 17 years of age, 18 to 64 years of age, and ≥65 years of age. These are global versions of, and are similar to, the US Health and Human Services physical activity recommendations in 2007 and 2008 [see references 7,8, 11].
- 11.Physical Activity Guidelines Advisory Committee (PAGAC). Physical activity guidelines advisory committee report. Washington: US Department of Health and Human Services; 2008. Available at http://www.health.gov/paguidelines/committeereport.aspx. Accessed 13 January 2011.Google Scholar
- 12.World Health Organisation. Health promotion glossary. Geneva: WHO; 1998. Available at http://www.who.int/entity/healthpromotion/about/HPR%20Glossary%201998.pdf. Accessed 13 January 2011.Google Scholar
- 13.Schmid T, Pratt M, Witmer L. A framework for physical activity policy research. J Phys Activ Health. 2006;3 Suppl 1:S20–9.Google Scholar
- 14.O’Dwyer L. A critical review of evidence-based policy making. Australian Housing and Urban Research Institute; 2004. Available at http://www.ahuri.edu.au/publications/download/40185_fr. Accessed 13 January 2011.
- 15.World Health Organization. The global strategy on diet, physical activity and health. Geneva: World Health Organisation; 2004. Available at http://www.who.int/entity/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf. Accessed 13 January 2011.Google Scholar
- 16.• Schilling JM, Giles-Corti B, et al. Connecting active living research and public policy: transdisciplinary research and policy interventions to increase physical activity. J Public Health Policy. 2009;30 Suppl 1:S1–S15. This article gives an overview of several derived from a conference whose theme was “Connecting Active Living Research to Policy Solutions.” Translation of research into physical activity policy is an emerging science; the commentary proposes principles for improving the translation of research to policy. This is an important idea emanating from this area of research—policy actions are often implementing evidence-based physical activity interventions on a much larger scale, to reach a whole population.PubMedCrossRefGoogle Scholar
- 17.• Global Advocacy Council for Physical Activity and Health [International Society for Physical Activity and Health]. The Toronto charter for physical activity: a global call to action. Toronto; 2010. May 20 2010. Available at http://www.globalpa.org.uk/pdf/torontocharter-eng-20may2010.pdf. Accessed 13 January 2011. The Toronto Charter sets out four priority actions based on nine guiding principles for a population approach to the promotion of physical activity. Principle seven of this Charter is explicit about the importance of advocacy to decision makers for an increase in political commitment to and resources for physical activity.
- 18.World Health Organization. A guide for population-based approaches to increasing levels of physical activity: implementation of the WHO global strategy on diet, physical activity and health. Geneva: WHO; 2007. Available at http://www.who.int/dietphysicalactivity/PA-promotionguide-2007.pdf. Accessed 13 January 2011.Google Scholar
- 19.World Health Organization. Interventions on diet and physical activity: what works: summary report. Geneva: WHO; 2009. Available at http://www.who.int/entity/dietphysicalactivity/summary-report-09.pdf. Accessed 13 January 2011.Google Scholar
- 21.Heath GW, Brownson RC, Kruger J, Miles R, Powell KE, Ramsey LT, et al. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. J Phys Activ Health. 2006;3 Suppl 1:S55–76.Google Scholar
- 22.National Institute for Health and Clinical Excellence (NICE). Interventions that use the environment to encourage physical activity. Evidence review; 2006.Google Scholar
- 23.National Institute for Health and Clinical Excellence (NICE). Transport interventions promoting safe cycling and walking. Evidence briefing; 2006.Google Scholar
- 24.National Institute for Health and Clinical Excellence (NICE). 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. Public health intervention guidance No. 2; 2006. Available at http://www.nice.org.uk/nicemedia/live/11373/31838/31838.pdf. Accessed 13 January 2011.
- 25.National Institute for Health and Clinical Excellence (NICE). Promoting and creating built or natural environments that encourage and support physical activity. NICE Public Health Guidance 8; 2008.Google Scholar
- 26.National Institute for Health and Clinical Excellence (NICE). Workplace health promotion: how to encourage employees to be physically active. Public health guidance No 13; 2008. Available at http://www.nice.org.uk/nicemedia/live/11981/40672/40672.pdf. Accessed 13 January 2011.
- 27.National Institute for Health and Clinical Excellence (NICE). Promoting physical activity, active play and sport for pre-school and school-age children and young people in family, pre-school, school and community settings. NICE Public Health Guidance 17; 2009.Google Scholar
- 28.National Institute for Health and Clinical Excellence (NICE). Dietary interventions and physical activity interventions for weight management before, during and after pregnancy. NICE Public Health Guidance 27; 2010.Google Scholar
- 29.National Institute for Health and Clinical Excellence (NICE). Prevention of cardiovascular disease at population level. NICE Public Health Guidance 25; 2010.Google Scholar
- 31.Ogilvie RS, Zimmerman J. Opening school grounds to the community after hours. A toolkit for increasing physical activity through joint use agreements. 2010. Available at http://www.phlpnet.org/healthy-planning/products/joint_use_toolkit. Accessed 13 January 2010.
- 32.City of New York; Bloomberg M, Burney D, Farley T, Sadik-Khan J, Burden A. Active design guidelines: promoting physical activity and health in design. 2010. Available at http://ddcftp.nyc.gov/adg/downloads/adguidelines.pdf. Accessed 13 January 2011.
- 33.UK Department of Health. Be active be healthy: a plan for getting the nation moving. London: Department of Health; 2009. Available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_094359.pdf. Accessed 13 January 2011.Google Scholar
- 37.Kelly P, Cavill N, Foster C. An analysis of national approaches to promoting physical activity and sports in children and adolescents—full report. British Heart Foundation Health promotion Research Group. Oxford: WHO; 2010. Available at http://www.euro.who.int/__data/assets/pdf_file/0009/119295/HEPA_children_analysis_report.pdf. Accessed 13 January 2011.Google Scholar
- 39.Bull F, Adams E, Hooper P. Well@Work: promoting active and healthy workplaces: final evaluation report. 2008. Available at http://www.bhfactive.org.uk/files/115/W@W_EVALUATION_REPORT.pdf. Accessed 13 January 2011.
- 41.Yancey T. Instant recess, building a fit nation 10 min at a time. Berkeley: Univ of Calif Press; 2010.Google Scholar
- 45.The CATCH Partnership. CATCH website. 2011. Available at http://www.catchinfo.org. Accessed 13 January 2011.
- 46.Cycling England. Cycling demonstration towns; surveys of cycling and physical activity 2006 to 2009. London; 2009. Available at http://www.dft.gov.uk/cyclingengland/site/wp-content/uploads/2010/02/cdts-surveys-of-cycling-and-physical-activity-2006-09.pdf. Accessed 13 January 2011.
- 47.Martin-Diener E, Anrig P, Capirone M, Martin BW. SwitzerlandMobility, the national network for non-motorized traffic: a model project of intersectoral collaboration. In; Mutrie N, Fitzsimons C, editors. 1st Annual Conference of HEPA Europe. European network for the promotion of health-enhancing physical activity. Glasgow, Scotland, United Kingdom, 8–9 September 2008. Programme & Abstracts. Glasgow, University of Strathclyde 2008: 104 [see also http://www.schweizmobil.ch]; 2008.
- 50.Professional Associations for Physical Activity (Sweden). Physical activity in the prevention and treatment of disease. 2010. Available at http://www.fhi.se/PageFiles/10682/Physical-Activity-Prevention-Treatment-Disease-webb.pdf. Accessed 13 January 2011.
- 54.Lee DC, Sui X, et al. Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Br J Sports Med. 2010.Google Scholar
- 55.Wanless D. Securing good health for the whole population; final report. HM Treasury: HMSO. UK Government; 2004. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4074426. Accessed 13 January 2011.
- 58.Western Australia—Premiers Physical Activity Task Force. Strategic Plan 2007–2011. 2007. Available at http://www.beactive.wa.gov.au/docs/Strategic%20Plan%202007%20-%202011%20Online%20Version.PDF. Accessed 13 January 2011.
- 59.• Merom D, van der Ploeg HP, et al. Public health perspectives on household travel surveys active travel between 1997 and 2007. Am J Prev Med. 2010;39(2):113–21. This article provides a good example from Sydney, Australia, of cross-sectoral/cross-disciplinary research on transportation and travel policies. Transportation surveys can be used to assess the contribution of active travel to changes in physical activity levels assessed by public health surveillance and to identify subgroups for active travel interventions. This article shows that despite all the interest in “active travel” as a method for promoting physical activity, over the past decade population shifts have been small.PubMedCrossRefGoogle Scholar
- 61.• Sallis JF, Story M, et al. Study designs and analytic strategies for environmental and policy research on obesity, physical activity, and diet: recommendations from a meeting of experts. Am J Prev Med. 2009;36(2 Suppl):S72–7. This article presents expert consensus recommendations for methods to enhance environmental and policy research. Expert recommendations included use of prospective studies and economic studies and evaluation of natural experiments; training in statistical methods for complex designs and interdisciplinary collaboration; and development of measures of policy, health impact assessments, and the investigation of policy adoption and implementation. This provides a research framework, and policy-led programs can also use this typology.PubMedCrossRefGoogle Scholar
- 62.• Cobiac LJ, Vos T, et al. Cost-effectiveness of interventions to promote physical activity: a modelling study. PLoS Med. 2009;6(7):e1000110. This article describes the use of an innovative cost-effectiveness research methodology used in Australia to examine not only the cost-effectiveness of individual policies but the most cost-effective mix of policy actions. For Australia, the authors suggest programs encouraging the use of pedometers and mass media–based community campaigns as the two most cost-effective strategies to implement and that are very likely to be cost-saving.PubMedCrossRefGoogle Scholar
- 63.• Cecchini M, Sassi F, et al. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet. 2010;376(9754):1775–84. This article presents an assessment of public health strategies designed to tackle behavioral risk factors (including physical inactivity) for chronic diseases in several countries. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health care expenditures. These policies include health information and communication strategies that improve population awareness about the benefits of physical activity.PubMedCrossRefGoogle Scholar
- 69.• Eyler A, Brownson R, et al. Understanding policies and physical activity: frontiers of knowledge to improve population health. J Phys Act Health. 2010;7 Suppl 1:S9–S12. Scientific literature on the policy development process for physical activity is sparse; this article provides a framework that organizes and conceptualizes policy interventions and priorities for public health efforts to promote physical activity. In the United States, the Physical Activity Policy Research Network (PAPRN) was formed as a way to operationalize the framework.PubMedGoogle Scholar
- 72.Walk England. Walk 4 Life initiative—website. 2011. Available at http://www.walk4life.info/about-walk4life/walk4life-miles. Accessed 13 January 2011.
- 73.Buhrmann S. New seamless mobility services—public bicycles: policy notes. NICHES for the European Commission. 2010. Available at http://niches-transport.org/fileadmin/archive/Deliverables/D4.3b_5.8_b_PolicyNotes/14397_pn4_public_bikes_ok_low.pdf. Accessed 13 January 2011.
- 74.Australian Government. Measure up campaign—website. 2010. Available at http://www.measureup.gov.au/internet/abhi/publishing.nsf/content/home. Accessed 13 January 2011.
- 76.ParticipACTION. ParticipACTION website.2007. Available at http://www.participaction.com. Accessed 14 January 2011.
- 78.American College of Sports Medicine. Exercise is medicine—website. 2010. Available at http://exerciseismedicine.org/. Accessed 14 January 2011.