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Physical activity

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Introduction

Physical inactivity is the 4th leading risk factor for global mortality accounting for 6% of deaths globally. People who have a physically active lifestyle have a 20-35% lower risk of cardiovascular disease, coronary heart disease and stroke compared to those who have a sedentary lifestyle.  Regular physical activity is also associated with a reduced risk of diabetes, obesity, osteoporosis and colon/breast cancer and with improved mental health.  In older adults physical activity is associated with increased functional capacities. The estimated direct cost of physical inactivity to the NHS across the UK is over £1.06 billion per year. 

The Chief Medical Officer (CMO) currently recommends that adults undertake a minimum of 150 minutes (2.5 hours) of moderate physical activity per week, or 75 minutes of vigorous physical activity per week or an equivalent combination of the two (MVPA), in bouts of 10 minutes or more. The overall amount of activity is more important than the type, intensity or frequency.1

Figure 1: Physical activity guidelines for adults

1-Physical Activity guidelines for adults
Source: PHE Guidance, Health matters: getting every adult active every day, July 2016   

The vast majority of the adult population in the UK is not active at levels to benefit their health. Approximately 60% of men and 72% of women do not meet the UK CMOs' physical activity recommendations.2  While increasing the activity levels of all adults who are not meeting the recommendations is important, targeting those adults who are significantly inactive (that is, engaging in less than 30 minutes of activity per week) will produce the greatest reduction in chronic disease.1 

In children aged 4-15 years in England, 69% of boys and 79% of girls do not meet the CMOs'physical activity recommendations3    and only 14% of 15 year olds are physically active for at least one hour per day, seven days a week.4   

Public Health England (PHE) has co-produced the 'Everybody active, every day' framework,5 a national, evidence-based approach to support all sectors to embed physical activity into the fabric of daily life and make it an easy, cost-effective and 'normal' choice in every community in England. The key outcomes within the public health outcomes framework (PHOF) will be central, ie, the percentage of adults physically inactive (primary outcome, PHOF 2.13ii) and physically active (secondary, PHOF 2.13i). 

Evidence for the effectiveness of interventions to increase population levels of physical activity is summarised by Kahn et al.6

Current physical activity guidelines

New physical activity guidelines were introduced in 2011 which set out the volume, duration, frequency and type of activity required across the life course to achieve general health benefits. These guidelines update the existing guidelines for adults, children and young people and for the first time provide guidelines for early years (under 5's - infants who are not yet walking and children capable of walking) older people (65+ years) and pregnant women. The new guidelines allow for more flexibility in achieving recommended levels of physical activity.

PHE have produced a range of infographics explaining the physical activity required to achieve general health benefits for different age ranges: Start active, stay active: infographics on physical activity

Facts and figures

Adults

While Blackpool has significantly worse levels of physical activity than the national average, the town is similar to national trends in the demographics of physical activity participation; younger people are more active than their older counterparts, men are more active than women, white adult populations are more active than non-white adults, and activity levels are lower in those who have a limiting illness or disability.

Local data also indicates that there is a very strong correlation between participation and social class. Within Blackpool, people in the lower socio-economic groups are more inactive (31%) than those in the higher socio-economic groups (24%). Conversely physical activity levels increase in more affluent groups (61%) compared to 53% in more deprived communities.

Information from PHE estimates that in Blackpool:

    • Significantly fewer adults are achieving the recommended amount of physical activity per week compared to the national average (figure 2)
    • Significantly more adults are classed as inactive, that is, doing less than 30  minutes of moderate intensity physical activity per week (figure 2)
    • A lower proportion of Blackpool adults use outdoor space for exercise or health reasons; 13.4% compared to 17.1% nationally7  

Figure 2: Physical activity - percent of adults active and inactive in Blackpool, the North West and England: 2016/17

2-active and inactive adults 1617
Source: PHE Physical Activity Profile

Physical activity that can be incorporated into everyday life, such as brisk walking and cycling, has been found to be as effective for weight loss as supervised exercise programmes. However, over a third of adults report they are not currently active at recommended levels. More accurate objective measurements show that the true proportion of people who are insufficiently active is likely to be much higher than this. Creating an environment where people actively choose to walk and cycle as part of everyday life can have a significant impact on public health and may reduce inequalities in health. It is an essential component of a strategic approach to increasing physical activity and may be more cost-effective than other initiatives that promote exercise, sport and active leisure pursuits.

Walking is the most likely way all adults can achieve the recommended levels of physical activity8 and walking for at least 10 minutes on at least five days a week suggests regular walking. Studies have shown that the physical health benefits associated with cycling, include reduced risk of coronary heart disease, cancer, stroke and type 2 diabetes. In addition active travel can improve mental wellbeing in a number of areas such as concentration.9 

The Sport England Active People Survey (APS) is the largest ever survey of sport and active recreation to be undertaken in Europe. The APS 2014/15 data (figure 3) indicates that in Blackpool, only half of all adults (51.4%) walk at least 5 times per week and only 4.6% cycle at least 3 times per week. However, activity levels are not significantly different to national averages.

Figure 3: Proportion of adults walking and cycling regularly, Blackpool, the North West and England: 2014/15

3-Walking and cycling 1415
Source: PHE Physical Activity Profile (Dept for Transport; Active People Survey, Sport England)

The Local Sport Profile provides a profile of up-to-date data for Blackpool, covering sports participation, facilities, health, economic and demographics, all in one place.

The Health Behaviours in Blackpool Report 2015 was compiled from a survey sent to 10,000 homes in September 2014, and it was found that:

    • 36% of respondents spent more than 4 hours per week doing moderate intensity activity.
    • 10% of respondents did no moderate intensity activity.
    • 33% of respondents did no vigorous intensity activity.
    • 29% of respondents spent more than one hour per week doing vigorous activity.
    • Males, older people (60+), the disabled, those who are obese, people not in work and those struggling financially spend significantly less time doing moderate intensity activity.
    • Males, disabled people, the obese, those not in work and retired, and those who rent their home spend significantly less time doing vigorous intensity activity.

Children

Engaging in physical activity is important for children in the short-, mid- and long-term. Physical activity for children is critical for motor development, cognitive improvement, psychosocial health, and cardio-metabolic health; reduces body fat and can increase academic achievement.10   

There are very limited sources of physical activity data at local authority level for children and survey data that is available is generally for adults only. The Health Survey for England (HSE), 2016, does include data on young people and suggests that of children aged 5-15 years in England, 23% of boys and 20% of girls met the physical activity guidelines of being at least moderately active for at least 60 minutes every day. These proportions have increased since 2012, when 21% of boys and 16% of girls met the guidelines.

Figure 4: Physical activity guidelines for children and young people (5-18 years old)

4-Physical activity guidelines children
Source: Dept of Health and Social Care, Start active, stay active: infographics on physical activity June 2017

Figure 5: Activity levels of children by age group, England, 2016

5-Activity levels children 2016
Source: ONS, Health Survey for England 2015, Physical Activity in Children

Using figures from the HSE it is possible to estimate the number of children aged 5-15 years who are meeting the recommended levels of physical activity in Blackpool.  It is estimated that approximately 3,600 (21.5%) of young people in Blackpool do meet these activity levels while approximately 6,750 (40%) have low levels of activity. It is possible this is an underestimation as it has been shown that the proportion of children with low activity levels is greater in lower income households2 and Blackpool has a significantly higher number of children in low income families (26.8%) compared to the national average of 16.6%.11

A healthy lifestyle survey12 carried out by the Schools Health Education Unit (SHEU) in primary schools (children aged 8-11 years) and secondary schools (children aged 12-15 years) in Blackpool in 2017 and found:

In primary schools

    • 85% of pupils reported  that they enjoy physical activity 'quite a lot' or 'a lot'
    • 64% describe themselves as 'fit' or 'very fit'
    • 41% reported that they had done exercise which made them breath harder and faster 5 times or more in the week before the survey
    • 50% of pupils walked to school on the day of the survey, 45% came by car
    • 80% of pupils said they had a bicycle

In secondary schools

    • 64% of pupils reported  that they enjoy physical activity 'quite a lot' or 'a lot'
    • 43% of boys describe themselves as 'fit' or 'very fit', compared with 36% of girls
    • 58% of pupils reported that they had done some form of physical activity on at least 3 days in the week before the survey, 7% said they had not done any
    • 33% of pupils had exercised enough to increase breathing rate on at least 3 days in the week before the survey, 20% said none

The Health and Social Care Information Centre (HSCIC) What about YOUth? survey asked 15 year olds about their health behaviours and found that in Blackpool a significantly higher proportion had sedentary time of over 7 hours per day when compared to the national average. Figure 6 shows the proportion of active and inactive 15 year olds in Blackpool, the North West and England.

Figure 6: Physical activity - percent of 15 year olds active and inactive in Blackpool, the North West and England: 2015

6-Physical activity 15yo 2015
Source: PHE, Health behaviours in young people-What about YOUth? profile

Risk factors

Despite the well-documented evidence of the benefits of leading a physically active lifestyle, the vast majority of the UK adult population is not active at levels to confer health benefits. Activity levels amongst children and young people are also low.

There are significant inequalities in levels of physical activity in relation to age, gender, ethnicity, socio-economic status and disability.1 In the UK:

    • Physical activity levels are low amongst adults, particularly women.
    • Physical activity declines rapidly with increasing age for both men and women, and drops markedly in those aged over 75 years
    • Physical activity levels are low in children, with girls being less active than boys.
    • Physical activity levels decline in both girls and boys with increasing age, but this occurs more steeply in girls as they move from childhood to adolescence
    • Children from lower socioeconomic groups and some black, Asian and minority ethnic groups are less physically activity than their counterparts from higher socioeconomic groups.
    • Data for 2010 showed that schools were meeting the 2 hours of PE requirement as measured by the School Sports Partnership (SSP). However, the SSP no longer exists as a national strategy so it may become harder to monitor activity levels in schools.
    • Familial involvement in sport is a strong influence on all forms of participation at both Year 6 and Year 9. Where there is no sporting role model in the family, young people are significantly less likely to take part in sport.
    • Individuals with disabilities/living with long-term conditions are less active.
    • With levels of obesity predicted to increase, physical inactivity levels may increase as a result, as there is evidence that overweight/obese individuals have lower levels of physical activity.

The Department for Culture, Media and Sport (DCMS) Strategy; 'Sporting Future: A new Strategy for a Healthy Nation'  also identifies four under-represented groups who sit significantly below the national average in achieving the guidelines on physical activity:

    • Women and girls
    • Lower socio-economic groups
    • People with a limiting illness or disability
    • 65 years and over

Current services in relation to need

A number of core sport and physical activity programmes and services are provided to support the needs identified locally.  The Active Blackpool  programme provides a pathway to support individuals to lead a healthier lifestyle through sport and physical activity.  The programme allows GP's and practice nurses to refer individuals who they have identified would benefit from leading a healthier lifestyle.  The programme provides a range of activities and opportunities and received 1,150 referrals in 2014/15.  The programme actively engaged 3,087 individuals in 2014/15 with 56,641 attendances over the same period.  42.8% of participants were over the age of 60 years whilst 62.6% of participants were from the 10% most deprived areas of Blackpool.

A Steps to Health walking programme operates across Blackpool, providing free opportunities for individuals to be active in a social environment.  The programme saw 7,467 attendances in 2014/15.

The wider leisure services of Sport Blackpool engaged 20.9% of the Blackpool population in 2014/15, engaging 27,610 individuals and achieving 936,795 attendances.

An Early Years programme is provided to all nursery schools; providing training and upskilling opportunities for employees in the nursery setting to raise awareness of the importance of physical activity and practical solutions to increasing the range and quality of physical activity opportunities within the setting.

The School Games programme is a national initiative aimed at increasing the range and quality of sport and physical activity opportunities for children and young people in primary and secondary education.  The programme provides a broad range of opportunities and engaged 10,912 individuals in 2014/15.

A number of externally funded short term projects aimed at 14-25 years olds are delivered locally.  The projects have a number of aims including; reducing anti-social behaviour, engaging individuals within identified geographical wards and encouraging inactive individuals to become active.

Unmet needs and service gaps

29.3% of adults (16+) in Blackpool are inactive compared to 22.2% nationally.  Furthermore, 57.2 % of adults stated they wanted to do more sport[13], demonstrating the opportunity to engage with these individuals and increase overall participation.

While 20.9% of the Blackpool population accessed the Blackpool Council leisure facilities in the last 12 months - of which 8,679 (31.4%) were from the top 10% indices of health deprivation - a gap in provision currently exists for a low cost/free community based physical activity engagement programme, providing additional support to individuals within the most disadvantaged areas of Blackpool. A recent report, Moving the Goal Posts: Poverty and Access to Sport for Young People, found that young people in areas of poverty are significantly less likely to participate in sport because of the cost of taking part.  A gap in provision currently exists in targeting 14-25 year olds living in deprived areas to support them in continuing to lead an active lifestyle as they leave full-time education and Sport England has identified a drop off in sport and physical activity engagement with this age group across England. 

The DCMS Strategy; 'Sporting Future: A new Strategy for a Healthy Nation' will extend the remit and focus of Sport England from 14 years, to 5 years and over, outside of an educational setting recognising the need to engage and form a habit from a younger age, to ensure the lifelong benefits of physical activity are recognised.

The strategy also identifies the potential opportunity and latent demand for outdoor recreation.  Sport England and the Outdoor Industries Association (OIA) recently published Getting Active Outdoors, a detailed study into both the supply and demand for outdoor activities in England.  It showed that of the 43.7m adult population, 18.2m who are not currently active outdoors want to re-engage in outdoor activity in the next 12 months.  Blackpool has the potential to provide a number of outdoor recreational opportunities for a variety of populations and target groups, utilising the existing natural space across the town, with the potential to focus on developing Stanley Park as a key destination for a range of outdoor recreation activities.

National and local strategies

'Everybody active, every day' is a framework, produced by Public Health England (PHE), for national and local action to address the national physical inactivity epidemic. To make active lifestyles a reality for all, the framework's 4 areas for action will:

    • change the social 'norm' to make physical activity the expectation
    • develop expertise and leadership within professionals and volunteers
    • create environments to support active lives
    • identify and up-scale successful programmes nationwide

The Strategy; 'Sporting Future: A new Strategy for a Healthy Nation' aims to tackle head on the flat lining levels of sport participation and high levels of inactivity in this country. Through this strategy, government is redefining what success in sport means, with a new focus on five key outcomes: physical wellbeing, mental wellbeing, individual development, social and community development and economic development. In future, funding decisions will be made on the basis of the outcomes that sport and physical activity can deliver. Furthermore, this strategy will extend the remit and focus of Sport England from 14 years and over, to 5 years and over, outside of an educational setting.  Recognising the need to engage and form a habit from a younger age, to ensure the lifelong benefits of physical activity are recognised.

The Blackpool Sport and Physical Activity Strategy 2013 - 2018 identifies four key themes for the development of sport and physical activity in Blackpool;

    • Physical Activity - Encourage more people to be physically active as part of their everyday lifestyle;
    • Urban Environment and Facilities - Develop high quality and accessible facilities for sport and physical activity and an urban environment that supports every day active lifestyles
    • Clubs, Coaches and Volunteers - Support the development of an accessible, inclusive and sustainable community sport infrastructure;
    • Events - Develop an annual programme of local, regional, national and international sporting events.

Potential investment and resources are specified, together with key partners in achieving the specified primary and secondary outcomes. 

Recommendations for consideration by commissioners

It is recommended that commissioners consider the following when commissioning programmes that focus on improving physical activity levels:

    • Consideration of the DCMS Strategy and whether the proposed programme(s) target any of the underrepresented groups identified in the strategy.
    • Consideration of existing delivery programmes and partners and the integration and utilisation of resources to best achieve a reduction in the number of inactive individuals and an increase in individuals achieving CMO Guidelines on physical activity.
    • Consideration of the longer term sustainability of a project and identified pathways into maintaining an active lifestyle beyond the life of the programme.

 


[1] Department of Health, 2011. Start Active, Stay Active: A report on physical activity for health from the four home countries' Chief Medical Officers, July 2011

[2] National Institute for Health and Clinical Excellence (2012) Physical Activity (external link). London: NICE.

[3] Department of Health, 2011a, UK Physical activity guidelines, London, Dept of Health

[4] PHE, Physical Activity Profile

[5] Public Health England, 2014. Everybody active, every day: an evidence-based approach to physical activity.

[6] Kahn E, Ramsey L, Brownson R, Heath G, Howze E, Powell K, et al. 'The Effectiveness of Interventions to Increase Physical Activity: A Systematic Review'. Am J Prev Med 2002; 22 (4S).

[7] PHE, Public Health Outcomes Framework, Indicator 1.16: Utilisation of outdoor space for exercise/health reasons

[8] NICE Guidance [PH41] Physical activity: walking and cycling. November 2012

[9] NICE News article Commuting by walking or cycling can boost mental wellbeing, September 2014

[10] ONS, Health Survey for England 2015, Physical Activity in Children

[11] PHE, Public Health Outcomes Framework, Indicator 1.01ii: Children in poverty

[12] Blackpool Council/SHEU. Supporting the Health and Wellbeing of Young People in Blackpool, 2017

[13] Sport England, Local Sport Profile, February 2016