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Topic on a Page - Physical Activity

Data Sources:

Physical Activity Supplementary statement Published: October 2019

NHS Digitial:

Statistics on Obesity, Physical Activity and Diet

Public Health England (PHE):

Public Health England: Physical Activity Profile

Association for Young People's Health:

Key data on Young People 2017

World Cancer Research Fund:

Interactive infographic summarising risk factors for certain cancers

Further data sources:

Scroll to the bottom of the page to view and compare further datasets

Supporting
Information:

Department of Health and Social Care:

Physical Activity guidelines Published September 2019

National Institute For Care And Health Excellence (NICE):

Guideline: Physical activity for children and young people [PH17] 2009

Guideline: Physical activity: walking and cycling [PH41] 2012

Guideline: Physical activity in the workplace [PH13] 2008

Guideline: Physical activity: brief advice for adults in primary care [PH44] 2013

Local Government Briefing: Physical Activity [LGB3] 2013

Physical Activity and the environment [NG90] 2018

Physical Activity: encouraging activity in the community [QS183] Published June 2019

Public Health England (PHE):

What works in schools and colleges to increase physical activity Published: October 2015

Physical activity: applying All Our Health

Everybody active, every day: An evidence-based approach to physical activity

Health matters: physical activity – prevention and management of long-term conditions

Health Matters: Physical Activity

Sport England:

Resources: Partnering local government

Evaluation Framework

NHS Evidence

Physical Activity

Miscellaneous:

UK Active

Linked Topics

Topic last reviewed: Oct-19

JSNA Topic: Physical Activity

Background

Physical activity is any form of movement or force upon the skeleton and muscles that results in energy expenditure and raises the heart beat above a resting level. The physical activity spectrum can include active living, active travel, recreation, exercise and sport:

  • Active Living: housework, gardening, walking and play;
  • Active Travel: walking, cycling and running;
  • Recreation: exercise, dance and swimming;
  • Sport: informal sport, organised sport, structured competition, elite and professional sport.

According to Public Health England (PHE), physical inactivity "is one of the country’s most urgent challenges". Without action the burden upon health and social care will destabilise services and have a major impact on people's physical and mental health:

  • There is evidence that achieving recommended physical activity levels cuts the risk of type 2 diabetes, colon cancer, CHD, stroke, falls and hypertension by at least 30%
  • There is evidence that physical activity reduces the risk of Alzheimer's, osteoarthritis, hip fractures and depression by between 20% and 80%. (Source: Start Active Stay Active 2011)
  • Physical inactivity is estimated to cost the NHS and wider society £7.4 billion annually (Source: Public Health England 2014)
  • Physical inactivity is one of the top ten risk factors for premature mortality (Source: World Health Organisation, 2013). It is responsible for one in six deaths in the UK
  • There is a strong, well established association between physical inactivity and obesity. (Source: Everybody active, every day)

It can be hard to start and keep the habit of regular activity. An increasing reliance on technology at home and work with the reduced daily activity in paid and domestic work along with a tendency to use the car has resulted in an increase in the number of people having increasingly sedentary lifestyles.

Chief Medical Officer Guidance recommends;

  • The intensity at which we exercise is key; light activity such as strolling and housework is unlikely to have much positive impact on the health of most people. For aerobic exercise to be beneficial it must raise your heartbeat to make you sweat and build regular strength based exercise into life
  • The more exercise you do, the better. Everyone should do a minimum of 150 minutes a week of moderate-intensity aerobic exercise but that really is the minimum for health benefits. If you can go beyond 150 minutes, you’ll gain even more health benefits
  • Sedentary time (time spent sitting down to watch TV, use a computer, read or listen to music) is bad for your health, even for those who are achieving 150 minutes of exercise a week.

People can reduce their risk of many serious diseases by staying active. Activity is important for mental wellbeing and keeping socially connected.

Context

National Strategies, Policies & Guidance

Internationally, physical inactivity is recognised as a leading contribution to premature morbidity and mortality and being active is a key determinant related to positive mental, social and environmental health and wellbeing. In 2010, the Toronto Charter for Physical Activity was published. This tool has been used globally to advocate for greater political and social commitment to enhance physical activity for all.

In 2018, the World Health Organisation (WHO) developed this advocacy role further with the publication of the Global Action Plan on Physical Activity 2018-2030. With a vision for a more active world, the WHO has set a series of guidance documents and methodologies to implement a whole-systems / whole-community approach to increase physical activity for people of all ages and abilities.

The Foresight report: Tackling obesities: future choices-project report (2nd edn.) (2007) locates physical activity as a key component of the obesity problem in the UK.

Sporting Future: A new strategy for an active nation (Department for Culture, Media and Sport (DCMS) 2015) outlines the strategy for sport and activity, including the role of central and local government. Focus has moved towards engaging inactive groups including women, older people, disabled people and those in lower socioeconomic groups. Outcomes have been prioritised as supporting five core themes: physical wellbeing, mental wellbeing, individual development, social and community development and economic development.

In response to Sporting Future, Sport England published its strategy; 'Towards an Active Nation' 2016-2021. This strategy places a greater emphasis on:

  • Focussing resources on tackling inactivity
  • Investing in children and young people, from the age of five to build positive attitudes to sport and activity as the foundation of an active life
  • Helping those who are active now to carry on, but at a lower cost to the public purse
  • Putting customers at the centre of what is done
  • Stronger local collaboration to deliver more joined-up experience for sport and activity for customers
  • Working with a wider range of partners, and
  • Encouraging innovation and the application of best practice, particularly in regards to behaviour change.

It has also brought about a change to the role of county sport partnerships, renamed as county activity partnerships. They are challenged to help Sport England deliver its strategy, placing a greater emphasis on physical activity and its wider benefits as part of a new primary role.

The NICE Pathway: Physical Activity advises on promotion of physical activity and its role in preventing long term conditions. NICE Guideline: Physical activity and the environment [NG90] covers how to improve the physical environment to encourage and support physical activity. The aim is to increase the general population’s physical activity levels. NICE Guideline: Physical Activity: brief advice for adults in primary care [PH44] promotes the use of brief advice as an effective means of increasing people's physical activity levels. NICE Guideline: Physical activity: walking and cycling [PH41] encourages the implementation of local policies and planning measures to encourage the use of walking and cycling as a means of everyday travel as well as recreation.

NICE also produce quality standards that are tools to use to determine the priority areas for quality improvement for health and care services. Two NICE quality standards exist for this topic: Physical Activity: for NHS staff, patients and carers (2015) and Physical Activity: encouraging activity in the community (2019). The latter identifies how local strategy, policy and planning, and improvements to the built or natural physical environment such as public open spaces, workplaces and schools can encourage and support people of all ages and all abilities to be physically active.

'Everybody active, every day'(PHE 2014) proposes long-term solutions to the problem of inactivity. It details the impact of inactivity on health as well as its costs to the NHS and the UK economy.

The Government has published A Green Future: Our 25 Year Plan to Improve the Environment. The plan recognises the value and benefits for positive health and wellbeing of spending time in the natural environment and complements the `Sporting Future` strategy for an active nation in seeking to connect people with the natural world.

People’s opportunities for health are influenced by factors outside of the health and social care system. They lie in the circumstances into which people are born, and in which they grow, live, work, and age. NHS England has published ‘Putting health into place’, a set of four documents that provide practical guidance for creating healthier new places, drawing on learning from the Healthy New Towns. The publication covers topics such as 'active travel' and 'healthy play and leisure'.

The planning system provides huge opportunities for communities to lead healthy and active lifestyles, whether that’s providing access to sports facilities and spaces for informal exercise or making it safe and convenient to walk and cycle to everyday destinations. Sport England's 'Planning for Sport Guidance' offers 12 planning for sport principles on how the planning system can help to provide opportunities for all to take part in sport and be physically active.

In 2011 all four UK Chief Medical Officers (CMO) produced UK physical activity guidelines for all age-groups in Start Active, Stay Active. This guidance provides recommendations on the amount of activity that is needed to benefit health as well as the type of activities that are defined as being of light, moderate or vigorous intensity. The report provides evidence for the effects of physical activity being dose-responsive, in particular with respect to CHD and type-2 diabetes.

New and revised UK CMO guidance on physical activity has been published this year. These guidelines are based on a comprehensive review of the latest scientific evidence regarding physical activity and health. The new guidelines include the following points:

  • Infants should be active several times a day in a variety of ways, including interactive floor-based activities
  • Under-fives should be active daily for at least three hours per day
  • Children and young people should engage in moderate-to-vigorous intensity physical activity for an average of at least 60 minutes per day across the week
  • Adults and older adults should aim to be physically active every day.
  • Any activity is better than none, and more is better still. Each week, adults should accumulate at least 150 minutes of moderate intensity activity (such as brisk walking or cycling); or 75 minutes of vigorous intensity activity (such as running); or even shorter durations of very vigorous intensity activity (such as sprinting or stair climbing); or a combination of moderate, vigorous and very vigorous intensity activity
  • Physical activity can safely be recommended to women during and after pregnancy with no negative impact on breastfeeding postpartum. Physical activity choices should reflect activity levels pre-pregnancy and should include strength training. Vigorous activity is not recommended for previously inactive women
  • Everyone should minimise the time spent sitting or lying down (sedentary behaviour):

These guidelines also include recommendations for muscle-building and bone strengthening activities such as lifting weights and yoga.

In relation to a number of physical and mental health conditions physical activity has a protective and therapeutic value. Both the NICE and CMO publications endorse this position. Recently, examples of such guidance have been published:

The Royal College of GPs: physical activity was named as a clinical priority for 2016 – 2019. To support this, Public Health England deliver a GP training programme and resources around physical activity:

Clinical Champions

Moving Medicine

Physical Activity & Lifestyle Toolkit

NHS Five Year Forward View 2014: calls for a 'radical upgrade in prevention' to avoid a 'sharply rising burden of avoidable illness' through preventative lifestyle initiatives such as those that promote physical activity.

In 2019, NHS England published the NHS Long Term Plan with a focus on prevention, recognising that the NHS can take important action to complement the role of local authorities and the contribution of government, communities, industry and individuals. A ‘renewed’ NHS prevention programme will focus on maximising the role of the NHS in influencing behaviour change, guided by the top five risk factors identified by the Global burden of disease study: smoking, poor diet, high blood pressure, obesity, and alcohol and drug use.

The Government has published a Green Paper Advancing our health: prevention in the 2020s for consultation this summer (2019). Within the paper there is a section on Staying Active, which sets out a series of ambitions to improve regular strength and balance exercise for older people; professional education for healthcare staff to promote physical activity, new physical activity campaigns and cross-government working on spatial planning.

In respect of children and young people's physical activity, the Government published the School Sport and Activity Action Plan in the summer of 2019. The action plan is a statement of intent, setting out a joint commitment from the Department for Education (DfE), Department for Digital, Culture, Media and Sport (DCMS), and Department for Health and Social Care (DHSC), to collaborate at a national level to ensure that sport and physical activity are an integral part of both the school day and after-school activities, so that all children have the opportunity to take part in at least 60 minutes of physical activity every day. The plan has three overarching ambitions:

  • All children and young people take part in at least 60 minutes of physical activity every day
  • Children and young people have the opportunity to realise developmental, character-building experiences through sport, competition and active pursuits
  • All sport and physical activity provision for children and young people is designed around the principles of physical literacy, focuses on fun and enjoyment and aims to reach the least active.

Public Health England have published PHE: What works in schools and colleges to increase physical activity A briefing for head teachers, college principals, staff working in education settings, directors of public health and wider partners.

There is a wealth of plans and guidance to support value of physical activity within peoples' lives. In 2019 the National Institute for Health Research published a synopsis of the findings from their research on physical activity as an evidence base to guide future practice, Moving Matters – Interventions to Increase Physical Activity.

Local Strategies & Plans

In the Joint Health and Wellbeing Strategy for Lincolnshire (2018), physical activity is one of the seven priority areas. Active Lincolnshire is leading on the work to support the Lincolnshire Physical Activity Taskforce. The new taskforce is seeking to:

  • develop a blueprint for a more active county, particularly focussing on reducing levels of physical inactivity
  • encourage collaborative leadership across partners
  • publicise the many and multi-faceted benefits of physical activity
  • promote the creation of environments that bring physical activity opportunities within everyone’s reach,
  • support healthier living, where physical activity is a regular daily habit.

The Taskforce has produced a ‘Blueprint for a more active Lincolnshire’. The publication offers a framework for partner collaboration using a whole systems approach, to create: active societies; active places; active people and active systems.

The Lincolnshire Strategic Education Plan identifies a number of areas where a contribution can be made to support the ambitions outlined in this JSNA topic. The Education plan is a whole system plan with a goal to develop the wider conditions of the education system including: developing new partnerships, collaborating with partners and advocating key messages that ultimately lead to the improvement of education in the county. The plan will:

  • develop and deepen partnerships with key agencies to ensure that the facts and issues relating to the children's health and wellbeing is known, understood and improved.
  • advocate through key events the guidance and messages of partners, and
  • support delivery of the key goals and priorities of the Lincolnshire Education Strategic Plan.

What is the picture in Lincolnshire?

What the data is telling us

Adults

The primary data source for physical activity is the Sport England's Active Lives Survey (formerly the Active People Survey). Sport England reports upon physical activity (minus gardening) twice a year. The sports and leisure sector typically utilise this dataset.

Public Health England also utilise the Active Lives Survey with an additional component of gardening within their interpretation of physical activity PHE PA Data Tool. Public Health departments, the NHS and local authorities often use this dataset to reflect activities of daily life, as much as it can.

In 2017/18, 63.8% of adults (age 19+) in Lincolnshire reached the minimum activity levels recommended by the four UK Chief Medical Officers; that is, for at least 150 minutes of moderate, or 75 minutes of vigorous, activity per week (in bouts of 10 minutes or more), plus some activity to improve muscle strength and balance on at least two days per week. The level in Lincolnshire is significantly lower than England (66.3%) but similar to the East Midlands rate (65.7%).

In terms of inactivity, Lincolnshire has a significantly worse proportion of inactive adults (25.2%) compared with the East Midlands (22.7%) and England (22.2%) (Source: Public Health Outcomes Framework). 'Inactivity' is defined in the Active People Survey as: the proportion of the population doing less than 30 minutes equivalent (in bouts of 10 minutes or more) of at least moderate activity at least once a week. More than half of these inactive adults report doing no activity, the remainder light activity.

This leaves 11% of the population considered as 'fairly active'.

There is considerable variation across the county. The most active district is Lincoln with 69.7% of the population considered active. The least active population in Lincolnshire and the East Midlands is Boston with 55.9%. Inactivity rates are highest in Boston at 30% and lowest in Lincoln at 21.7% in 2017/18 (Source: Public Health Outcomes Framework).

The Active Lives Survey 2019 for 2017-18 reports that 57.6% of the population were active sufficiently to reach the Chief Medical Officers' physical active recommendations and 30.5% were inactive.

Evidence suggests that adequate access to green space has a positive impact on physical and mental wellbeing and cognitive function through encouraging higher levels of physical activity. 19% of people in Lincolnshire report using green space in order to benefit their health in 2015/16; this is broadly in line with levels in the East Midlands (18.5%) and England (17.9%). (Source: Public Health Outcomes Framework).

The Natural England toolkit of the Monitor of Engagement with the Natural Environment (MENE) reported, for the period 2015-16, that 59% of the people in Lincolnshire used outdoor space for walking (with a dog); 20% for walking (without a dog); 20% for exercise purposes; 7% using the outdoor space for playing with children; 7% for eating or drinking out; 3% for road cycling; 3% for visiting an attraction and 3% for wildlife watching.

Lincolnshire has lower rates of sports participation compared with England for running/jogging (although an increasing trend), swimming (a declining trend), walking and active travel. Cycling for leisure or sport is higher than the national average, but a declining trend. (Source: Active Lives 2017/18)

Sports participation often needs enough volunteers to administer, officiate and regulate sports. A shortage of people willing and able to volunteer in this way is likely to have a negative impact on provision and therefore also on participation levels.

The Department of Transport publishes annual statistics for local authority areas for walking or cycling, for any purpose (leisure or travel). For 2017/18, 75.7% of Lincolnshire respondents reported walking for over 10 minutes once per month, reducing to 31.2% reported walking over 10 minutes five times per week. These figures are comparable with the East Midlands (76.3% and 30.1%), but less than the England figure (78.2% and 32.4%).

For the same period of 2017/18 the proportion of adults in Lincolnshire cycling for any purpose (leisure and travel) was more than the East Midlands and national averages: Lincolnshire 18.2% any cycling / once a month reducing to 3.4% cycling five time a week; East Midlands 15.5% - 3.2% and England 16.1% - 2.3%.

When comparing the walking/cycling data for leisure or travel there is a contrasting position for the county, with more adults walking or cycling for leisure compared to regional or national figures. Fewer adults walk for travel compared with regional or national figures. Cycling for travel in the county is comparable to national figures and better than regional statistics.

There is considerable local authority variation within this data. When walking for any purpose South Kesteven, North Kesteven, Lincoln and West Lindsey have values above the county average; Boston, South Holland and East Lindsey are below the county average. In regards to cycling for any purpose; Boston, Lincoln, West Lindsey and North Kesteven are above the county average; South Kesteven, East Lindsey and South Holland below the county average.

The NHS Health Check programme offers preventative checks to people aged 40-74 years to assess their risk of vascular disease (heart disease, stroke, diabetes and kidney disease) followed by appropriate management and intervention, e.g. medical intervention and/or referral and signposting to lifestyle services. Within this screening process adults complete the General Practice Physical Activity Questionnaire (GPPAQ). In 2018/19 nearly 25,000 adults undertook screening for cardiovascular risk of which 19,000 completed the GPPAQ survey:

  • 39.6% reported being active
  • 28.8% being moderately active
  • 13.7% moderately inactive, and
  • 17.9% being inactive.

Analysis of the local NHS Health Checks data demonstrates that physical activity decreases with age, deprivation levels and is different between males and females, with men more active than women.

Children

The Active Lives Survey: Children and Young People, demonstrates a new approach to gathering data on how children engage with sport and physical activity. It has been designed to help understand children's behaviour and attitudes regarding sport and physical activity. The survey covers England only and is carried out in state and some independent schools covering class years 1-11.

The Active Lives: Children & Young People survey on physical activities shows that children and young people in Lincolnshire were similar to, but generally more active than the England average. Lincolnshire students were marginally more active than the national results for:

  • activity overall
  • activity outside school
  • activity outdoors overall and activity outdoors outside school.

In terms of overall activity for children and young people:

  • 22.2% report being active every day (60+ minutes every day)
  • 22.7% report being active across the week (average 60+ minutes a day but not every day)
  • 22.7% report being fairly active (average 30-59 minutes a day), and
  • 32.4% report being less active (less than 30 minutes a day).

44.9% of children and young people in this survey are active most days. However, only 22% of students meet the recommended guidance for daily activity that will be beneficial to their health. One third of children are deemed inactive. Children and young people report being more active outside school than at school.

Within the county the variation is considerable with the range of inactivity across districts spanning 24%-46%. Boston local authority area has a significant level of physical inactivity when compared to the county and England.

Trend

Before 2015, the PHE dataset on physical activity reported that between 2012-2015 both the active and inactive levels within Lincolnshire were consistent, with no significant change. In contrast, the Sport England dataset displayed a contrasting picture where physical activity increased by 2.3% and physical inactivity decreased by 1.7%.

Post 2015 the two datasets show a similar picture. The PHE data reported a reduction of 2.5% in physical activity and an increase in physical inactivity of 2.8%, across the time periods 2015/16 to 2017/18.

The Active Lives Survey for Lincolnshire reported 1.7% less activity and 1.5% less fairly active in 2017/18 compared with 2015/16. The county saw a corresponding rise in more people being inactive, rising by 3.2% from 2015/16 to 2017/18.

Analysis of the Active Lives survey demonstrates that for the county there has been a statistically significant increase in physical inactivity. More substantially, the local authority area of East Lindsey has had statistically significant reductions in physical activity of 10.2% and increases in physical inactivity of 13.6%.

The levels of physical activity and inactivity vary across the district council areas:

  • East Lindsey, Boston and South Holland local authority areas display consistently the lowest levels for physical activity; Lincoln, North Kesteven and South Kesteven consistently the highest levels of physical activity
  • During the Active People Survey period, non-significant improvements for activity were seen for: South Holland, West Lindsey and South Kesteven; during the same period there were non-significant declines in activity for Boston, North Kesteven, City of Lincoln
  • East Lindsey district area has had a significant decline in physical activity and a corresponding increase in physical inactivity.

The utilisation of Lincolnshire's green space by the county's population for exercise/health reasons, as measured through the MENE survey, has increased in the past 5 years from 10.1% in 2011/12 to 19.0% in 2015/16, and is now approaching a similar level to the national average. However, the frequency of use of the outdoor space is consistently lower for Lincolnshire when compared to the county's comparator local authority areas.

The most recent report of the MENE survey highlighted the fact that Lincolnshire was the 9th of the 10 least active counties in the country.

The Department of Transport and Active Lives surveys for walking and cycling, within the county, report the district variations have had no change in cycling activity in recent years, but there was a significant decrease in walking activity for Boston and East Lindsey across the years, and for West Lindsey within a year.

Key Inequalities

The scale and nature of physical activity and inactivity are important for individuals and communities. The reasons why people are active are many and the determinants for physical activity can be categorised as:

  • Demographic – age, gender, disability, socioeconomic status
  • Social – culture, education, access, health status, work
  • Environmental - safety, access, quality, design, appeal
  • Cognitive – self efficacy, value, past behaviours, future behaviours, defaults
  • Emotional - attitudes, experiences, costs, benefits, motivation.

There are a number of inequalities in the physical activity levels of different population groups, for example;

  • disabled people are less than half as likely to take part in sports as non-disabled
  • people with learning difficulties are less than half as likely to take part in physical activity than the population as a whole;
  • women are more likely to be inactive than men (26% compared to 19%), similarly girls tend to be less active than boys – the difference is particularly marked after the age of 10;
  • people living in the least prosperous areas are twice as likely to be inactive as those living in the most prosperous areas, and
  • physical activity declines with age, most significantly after the age of 75.

(Source: Everybody Active Every Day 2014)

The Active Lives Survey for Lincolnshire mirrors such inequalities, with: physical activity decreasing with age; physical activity being less for people with life limiting illness or disability; physical activity being more for men than women and physical activity aligned closely with socio economic status deprivation.

The geographical distribution of physical activity and inactivity exhibits a pattern related to deprivation and is similar for many lifestyle risk factors recorded in the county.

The report, The Wider Determinants of Health Inequality in Lincolnshire describes the relationship between numerous health conditions and deprivation within the county.

Analysis within the county of factors most associated with physical activity and inactivity highlight poor economic, educational and health correlations with physical inactivity and these have a substantial relationship with deprivation. Any population-based `structural` changes affecting the county across such wider determinants would impact upon physical activity levels, positively or negatively.

Current Activity & Services

Sport England has a vision that everyone in England, regardless of age, background or ability, feels able to take part in sport or physical activity. Some might be fit and talented, but others won’t be so confident and may need support to be active.

Sport England invests in 43 Active Partnerships covering every part of England. This network of organisations has a strong understanding of their local place. They can broker and support the right relationships, and help identify the best opportunities to increase sport and physical activity in their communities. Their focus is now on activity and not just sport, with a focus on engaging inactive people and under-represented groups in order to achieve the health, social and economic outcomes in the government’s Sporting Future strategy

Active Lincolnshire's role is to influence, support and deliver action to get more people physically active. Sport England commissions Active Lincolnshire to deliver its programmes including satellite clubs, primary school support, workforce and school games.

Active Lincolnshire has developed an app, called Go Explore Lincolnshire. It promotes walking, cycling and orienteering style quizzes. It aims to help get people active by discovering new routes, creating unique content, through active transport with park and walk routes working with Stagecoach. The app gives insight on the behaviour of its users including activity levels and mood.

As part of the national Spirit of 2012, Programme `Get Out Get Active` (GOGA) for East Lindsey has been running on the East Coast since 2016 with over 2,200 individual participants taking part; of these 34% reported having a disability and 41% were over 50. Over 200 volunteers and over 200 people trained, attending one of the 1,300+ sessions through GOGA events.

Change for Life is a national PHE campaign that supports families and children to be more active through programmes such as the 10 Minute Shake Up, PHE: Physical activity helps children to deal with life's challenges

One You - Is a national PHE campaign aimed primarily at people aged 40 – 60. It encourages people to make small changes to a range of behaviours, including their physical activity levels, which can have a major impact on their health in later life. It links to apps such as ‘Couch to 5k’ that support people to be more active

District councils, who are strategic partners for their `place`, are providers of key services which have a direct impact on the social determinants of health, such as housing, planning, leisure, recreation and environmental health which directly impact on the health of the population. Sport and leisure provision has an increasingly important role to play in tackling rising levels of obesity and inactivity:

Boston Borough Council

City of Lincoln Council

East Lindsey District Council

North Kesteven District Council

South Holland District Council

South Kesteven District Council

West Lindsey District Council

Six district councils in Lincolnshire have contracted provision of leisure services to external provider trusts; one district has retained an in-house service. Some of these services provide exercise and health improvement offers to their local communities, over and above the general benefit provided by use of their leisure facilities, for example North Kesteven District Council provides a health trainer programme.

In addition to local authority facilities, there is a plethora of gyms, personal trainers, and local sports clubs and associations that manage their own facilities for dedicated sports throughout the county (Club Finder).

There are a number of physical activity schemes, in particular walking, active travel and cycling projects, taking place in local communities.

Access Lincoln is a Department for Transport supported project seeking to effect behaviour change in people's travel choices. The project is planned to run through to March 2021 and will engage with thousands of people in the Access Lincoln area of Lincoln City, Hykeham, Waddington, Skellingthorpe, Bracebridge Heath and Nettleham with personalised travel planning, walking and cycling events, community engagement sessions and other initiatives. The outcomes are to help ease congestion, contribute to the carbon management agenda, and improve health and wellbeing outcomes for local residents.

Lincolnshire Co-operative and a range of local leisure providers co-ordinate the county's Health Walk's programme. There are more than 60 regular, volunteer-run health walks across Lincolnshire. They come under the national Walking for Health scheme which is run in partnership by the Ramblers and Macmillan Cancer Support. Local health walks can be found at Walking for Health.

A number of walking festivals and walking promotions contribute to the opportunity for physical activity:

Lincolnshire Heritage are to review the two walking festivals post 2019.

The Lincolnshire Wildlife Trust offers a number of volunteer opportunities as part of their work parties, though the main focus is on habitat management with physical activity being a positive side effect of participation.

Natural England and Lincolnshire Wildlife Trust have secured national grant funding to conserve and restore some of the UK’s most important dune landscapes, which includes the east coast of the county. The Dynamic Dunescapes programme will start in 2020 and involve children and older people in the planning and implementation of the project.

Other smaller organisations also offer volunteering such as the Eco Centre in Skegness, which mentions the weight loss benefits of their volunteer days.

Vitality is a Lincolnshire based programme of exercise classes through movement and music for the over 60’s. Vitality run weekly classes across Lincolnshire in a variety of different town and rural settings.

Lincolnshire County Council (LCC) is responsible for maintenance of public rights of way. These are recorded on Definitive Maps and are described in accompanying statements. LCC, like all surveying authorities, is required to maintain the maps and statements and make them available for public inspection. Lincolnshire's 2500 miles of public rights of way (footpaths, bridleways and byways), managed by LCC's Countryside Service Team, offer a great opportunity to be active and explore the county's countryside and coast.

The Health and Social Care Act (2013) gave local authorities responsibility for improving the health of their local population and for local public health services. LCC Public Health services continue to promote physical activity through population-level initiatives such as Making Every Contact Count (MECC) and through their health improvement network that includes partners from a range of sectors including local authorities, voluntary organisations, Active Lincolnshire and leisure providers.

In 2019, Lincolnshire County Council commissioned an integrated lifestyle Service, One You Lincolnshire, providing four support services for adults to stop smoking, manage weight, brief advice of alcohol and be more physically active.

As a source of clinical leadership and impartial clinical advice to the NHS, the East Midlands Clinical Senate report on `Physical Exercise as Treatment (May 2019)`describes how and why physical activity as treatment could be commissioned system wide. The report recommends physical activity as a treatment is given parity with other clinical interventions.

Within the county, the Diabetes Prevention Programme applies physical activity interventions as part of lifestyle support offer Pre-diabetes Prevention Programme.

The Living With and Beyond Cancer Programme has a commitment to embed physical activity opportunities into the respective areas of the clinical pathway, e.g. the recovery / rehabilitation phase.

The Lincolnshire Pain Management Service, Connect Health, offers an innovative pain management programme with physical activity as part of the opportunities that support long-term self-management.

The Neighbourhood teams in the south of the county are developing a pilot project to deliver falls and balance education to older adults at risk of falls as part of the Lincolnshire frailty programme.

The Lincolnshire Partnership NHS Foundation Trust administers the Managed Care Network for Mental Health, a network of partners who work to help people to prevent, manage and recover from mental health problems. A number of funded partners regularly promote the benefits of physical activity for mental health & wellbeing. The mental health trust has recently invested in its staff to raise the profile of physical activity as a clinical tool to support people's health and wellbeing with their Think Active Conference 2019.

The provision of PE and sport within schools is a fundamental component of the development of physical literacy within children. The Office for Standards in Education (Ofsted) has traditionally measured the quality of PE within schools. In 2019, Ofsted announced a new inspection framework for schools supporting a more balanced and broader curriculum for students, particularly for health & wellbeing.

Active Lincolnshire monitors the use of the Primary PE and Sport Premium across the county. Analysis has identified extensive use of the grant for the benefit of pupil's physical activity, exercise and competition. In 2019 the audit identified a series of key activities:

  • Most schools are investing in utilising coaching companies for afterschool clubs and activities (similar to last year)
  • 89% of primary schools invest in extending participation in competitive activities
  • 74% of schools invest in extra curricular activities (down from 100% last year)
  • 70% of schools are using specialist / peripatetic teachers for PE provision (up from 14% last year)
  • 47% of schools are investing in transport to support participation (down from 59% last year)
  • 47% of schools are investing in health enhancing activities (similar to last year)
  • 33% of schools are investing in inclusion (down from 94% last year).

67% of schools recognise that PE and physical activity has an impact on participation and 50% recognise the value of participation on attainment.

The Youth Sport Trust (YST) sponsors the roles of Schools Games Organiser and School Games through the local School Sport Network of eight school sports partnerships and 89 YST member primary schools.

Active Lincolnshire delivers the Wheelchair Sports Programme in schools which includes reverse integration enabling everyone to take part in wheelchairs in disability sports/activities. Staff are trained to deliver the programme with inclusive session plans. The programme also includes the corporate wheelchair basketball league, team building sessions for organisations and supports individual budding athletes with equipment loans as they grow into a disability sport.

Inspire Plus, a school sports charity, provides a range of services to member schools across Lincolnshire including training and supporting staff to deliver higher quality PE, the provision of specialist coaches and PE and sports apprenticeships.

Unmet Needs & Gaps

What the county's population perceive to be as physical activity is mixed and not clearly understood. A variety of stories from projects locally describe the level of physical activity (e.g. dog walking or play) as valuable for heath & wellbeing. Yet, this type of activity that is described as no/little activity by the Active Lives Survey does not satisfy the CMO's levels of physical activity for health benefits.

To extrapolate the Active Lives Survey to the adult population of the county, the scale of the adults being less active is approx. 190,000 adults. With 20,000 more inactive adults across the last three years of the survey this indicates the scale of the challenge in the county.

Insights and Local Views

The new Active Lives Survey for children and young people has reinforced a number of insights about physical activity, PE and sport:

  • Across the school years top primary and lower secondary school ages tend to be the most active, with years 9-11 the least active;
  • Boys are more likely to be active than girls;
  • There is a gradient of physical activity with family affluence. Children from high affluence families are more active most days than low affluence families;
  • There is little difference in the activity profiles of children and young people with and without a disability.

In terms of children's wellbeing the survey demonstrates a positive association between confidence, trust, perseverance and mental wellbeing and the engagement of children in sport, physical activity and volunteering.

Active Lincolnshire has commissioned a series of insight packs investigating the Active Lives surveys up to 2016-17 based on local authority areas. These show the most physically inactive populations in Lincolnshire are:

  • People with limited illness or disability
  • People from more deprived communities (socio-economic class 6-8), and
  • People aged 55 years and over

The Active Lives Survey differentiates, within the Inactive results, adults who report doing nothing, light activity and physical activity up to 29 minutes a week. Over half of adults do nothing, a large minority do light active and only 5% of this group are doing anything near enough to tip them into the `Fairly Active` category; yet with a little support a 5% change would help tremendously .

In order to begin to understand the population needs Active Lincolnshire has commissioned a piece of research into older people's perceptions on physical activity to understand people's attitudes and behaviours. Recent interim findings give a sense of local views and insights:

Who do you do physical activity with?

  • Own / independently (55% response rate);
  • with family (18% response rate);
  • with friends (16% response rate);
  • others (10% response rate).

Reasons that prevent physical activity?

  • My joints get sore and I have general aches and pains (39% response rate);
  • motivation – I sometimes lack the motivation to be more active (38% response rate);
  • I have health issues that make being active difficult such as asthma and arthritis (32% response rate).

Who might influence you to be more active?

  • People like me (same age, physical build) (48% response rate);
  • friends (41% response rate);
  • family members (40% response rate);
  • health professionals (34% response rate).

Which of the following might motivate you?

  • Knowing that the changes I make now will improve my health and wellbeing in the future (53% response rate);
  • Putting on clothes and they don’t fit or look good (47% response rate);
  • Seeing or feeling immediate and short-term improvements in my health and well-being (46% response rate);
  • Looking in the mirror and not feeling great about myself (44% response rate).

The work of the Lincolnshire Physical Activity Taskforce has been about engaging with partners and stakeholders to identify the common themes they are willing to focus upon, such themes being:

  • Working with communities to positively affect the culture and mind-set towards regular physical activity
  • Influence the design and opportunities in environments (urban and natural) to be physically active
  • Develop partnerships between sectors to inspire and collaborate in order to make change happen,
  • Adopt a life-course approach covering the range of ages, and
  • Educate the professional workforce in order for them to advocate for physical activity in their interactions with the population.

In addition, partners have proposed exploring opportunities in order to:

  • Contribute to the Better Births strategy from the NHS and engage proactively with ante / postnatal care provision
  • Establish opportunities to promote physical activity messages throughout the Early Years settings
  • Value the role volunteers have in promoting physical activity
  • Collaborate with campaigns with specific audiences, e.g. self-care week, and
  • Workforce development across health & care settings.

Risks of not doing something

Across England, many people are not sufficiently active to reduce the health-related risks of a sedentary lifestyle or gain the many benefits related to being active. Lincolnshire is no different, comparatively worse than the national trend.

Reasons why people are active or inactive are varied. Many are aware of the benefits of healthier lifestyles, yet fewer people are being active in this county. There are wider circumstances that significantly influence the potential for and the extent of physical activity and exercise a person may do and these can be categorised as demographic; economic; environmental; health-related; psychological and again socially determined.

Physical activity has been phased out of our lives with the reduction in manual jobs, an increase in technology both at home and at work; along with the tendency to use cars even for short journeys. Urbanisation has allowed for environmental factors that discourage participation in daily physical activity: high-density housing, the changing nature of retail, traffic congestion, concerns over public safety, poor air quality and pollution, lack of access to open spaces and pavement and highways infrastructure.

Physical inactivity currently costs the NHS and wider society £7.4 billion. These costs will be proportionately higher in Lincolnshire as the local population is less active than that of the country as a whole. Inactivity and hence costs are likely to increase as the county ages.

A lack of physical activity is strongly associated with a number of chronic conditions including colon cancer, breast cancer, CHD, stroke, falls and hypertension. Such inactivity will have a significant impact on the population's health.

What is coming on the horizon?

The Lincolnshire Physical Activity Taskforce – an alliance of partners from across the county – is taking a 'Whole System Approach' to look at inactivity in order to:

  • support people who are inactive to be physically active, working across a life-course approach: pregnancy, children, young people, working age adults, and older people;
  • recognise the impact of inequalities in physical activity, e.g. gender, deprivation, age, disability;
  • ensure people are supported to remain active.

The Let's Move Lincolnshire: A blueprint for creating a more active Lincolnshire sets out the direction and the priorities that have been agreed collectively, which partners will work upon together. Using the World Health Organisation's Global Action on Physical Activity (WHO 2018) framework, the plan will focus on the policies, infrastructure, institutions, sectors, people and the places that will make the greatest differences to physical activity levels.

Collaboration is at the heart of what partners are trying to achieve. Principles are guiding us to assist leaders to challenge and change existing systems that are not working at scale or well enough, to bring together advocates from different sectors to learn from each other, influence and support each other to increase the impact we can have on physical inactivity.

The Lincolnshire Physical Activity Taskforce work is also applying a behaviour change approach using the `Behaviour Change Wheel`; a tool involving three essential conditions for behaviour change: capability, opportunity, and motivation (COM-B Model).

What should we be doing next?

Guidance highlights the important role of physical activity throughout life and supports a strong case for the promotion of active daily living through integrated approaches across health, education, sports, leisure, transport, planning and employment (PHE: Everyone Active Every Day, WHO: Global Action on Physical Activity). The contributions from local agencies will need to include:

  • Planning and design - creation and maintenance of environments that promote and enable access to safe places and open spaces for daily activity, including walking and cycling
  • Recreation and leisure – culture & heritage opportunities, exercise, sports development and participation locally, access to parks and outdoor spaces, play opportunities, allotments, gardening and `green exercise` within communities
  • Education – physical education, sports and physical activity through the curriculum, extra-curricular activities, strong school-club links and increasingly the community use of school facilities
  • Health and care – commissioning health improvement programmes (primary and secondary prevention), physical activity provision for people with specific conditions through clinical and care pathways (therapy and rehabilitation) and actions for building a healthy workforce
  • Voluntary and community – volunteering, community engagement, social prescribing, engagement with sports clubs and associations
  • Commercial and private sector– access to facilities, outdoor spaces, sponsorship, employment and actions for a healthy workforce
  • Media and marketing – education on the benefits of physical activity, promotion of local activities, publicity and the celebration of success.

 

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