Physical Activity 2021

Being physically active plays a key role in the health and wellbeing of many people across Bournemouth, Christchurch and Poole (BCP) and Dorset from childhood to later life. Being active supports both mental and physical health and can reduce the risk of developing non-communicable diseases including cardiovascular disease, diabetes and cancer.

A lack of physical activity is associated with 1 in 6 deaths in the UK and up to 40% of many long term and preventable conditions including type 2 diabetes and cardiovascular disease. Across Dorset Clinical Commissioning Group (CCG) area 4.3% of people were living with a diagnosis of coronary heart disease and heart failure during 2019/2020 [1].

Physical activity: how much is enough?

The UK Chief Medical Officers (CMOs) provide guidelines for how much physical activity people should aim for on a daily or weekly basis [2]. As well as providing guidelines for time spent ‘moving’, both the UK CMOs and the World Health Organisation (WHO) empathise the harmful effects of time spent being sedentary (sitting) and the importance of reducing sitting time for all of us whatever our age.

How physically active are people across BCP and Dorset?

Sport England’s Active Lives survey collects data on physical activity levels for adults and young people [3].

During the period November 2019 to November 2020:

• 19.9% (63,600 people) of adults (16 and over) in Dorset Council area did less than 30 minutes activity per week
• 30.6% (100,00 people) of adults (16 and over) in BCP Council area did less than 30 minutes activity per week

During the academic year September 2019 to September 2020:

• 35.5% (20,600) children and young people (school years 1 to 11) did less than 30 minutes activity per week

References

1. Cardiovascular disease - PHE
2. Physical activity guidelines: UK Chief Medical Officers' report

3. Sport England: Active Lives - this data is collected through randomly selected sample of households and schools across England

In 2021 Active Dorset and Dorset Council Public Health launched an online conversation asking organisations and individuals for their views on the local causes and effects of physical inactivity. Participants were then asked what they are currently doing to support and encourage people to ‘move more’ and for their ideas on how people could be supported to increase their level of physical activity. Following this, in March 2021, workshops were held with key stakeholders from across BCP and Dorset to explore their perspectives on the causes and effects of physical activity. Common themes expressed by stakeholders included:

• competing pressures and priorities can outweigh the ‘value’ attached to physical activity – motivation, enjoyment and understanding of how to be active plays a key role in shaping the extent to which people take advantage of opportunities be active in daily life
• the environment people live and work in can reinforce the ‘norm’ of inactivity by making movement challenging and sedentary behaviour convenient through how they are designed and used. For example, availability of facilities that can support physical activity for some, but don’t meet other people’s needs and motivation, environments that prioritise car use over walking and cycling and fear of actual or perceived risks (e.g. traffic, crime etc)
• physical and mental health can trap people in a cycle of inactivity driven by ‘fear’ of harm from engaging in activity. This inactivity is driven by both perceived and actual ability and has a detrimental impact on peoples’ health and wellbeing further impacting on their ability to be active
• a ‘norm’ of inactivity learnt from family and social peers lays the foundation for physical inactivity and leaves people ‘missing out’ on the benefits of shared participation in physical activity e.g. for social interaction, family life

Figure 1: The system that drives physical inactivity

A detailed flowchart that represents the system that drives physical activity, including behaviour barriers. The centred circle is labelled 'people living inactive lives' and surrounding it is circles in grey focusing on values and motivations, circles in green focus on 'social norms that prevent physical activity', light green circles focus on 'a system under pressure from non-communicable disease, blue circles focus on 'an environment that limits active travel use' Lines connect the circles, illustrating relationships between factors, interventions, and outcomes.

Some of the points are:

• motivation to engage in physical activity
• inactivity at school and education
• perception of inactivity as normal
• belief that physical activity costs time and money
• physical and mental health
• pressure on NHS services
• care use for transport
• ease of use of environment for active travel
• fear of harm from physical activity
• perceived ability to be physically active

There is already significant work underway across BCP and Dorset to enable and support people to be physically active. This is delivered through organisations at varying scales and through numerous, interrelated policies and interventions. This ongoing activity is the foundation for supporting existing levels of physical activity and provides a starting point for increasing the number of people who are physically active.

Local workshop participants identified three key areas of intervention which they considered to offer opportunities for making change to increase physical activity locally:

• building physical activity into everyday life – for some people physical activity is viewed solely as sport or time ‘dedicated’ to exercise and opportunities to build physical activity and the enjoyment of moving more into everyday life are not identified or acted on
• tackling the belief that physical activity costs time and money – understanding who this belief actually prevents from moving more and enabling them to access and engage in affordable ways to be active
• prioritising the role of active travel (walking and cycling) over travel by car – active travel was seen as a key enabler for building movement into daily life and ongoing and increased development of appropriate infrastructure can support this. But, active travel infrastructure and modification of local environments will not maximise active travel use without an understanding of, and implementation of measures to address, the factors that motivate people to choose car travel over other modes e.g. journey distances where no alternative to car use exist or time constraints

To take advantage of these opportunities a number of potential areas for action or development of deeper understanding were identified (appendix 1) which include:

• developing a system wide approach to re-framing physical activity as ‘daily movement’ (including and extending beyond sport, exercise and active travel) through leaders at an organisational and community level who can ‘model’ the value of physical activity and take advantage of opportunities for brief interventions to promote physical activity
• recognising the need to understand how physical activity can deliver ‘value’ for people who are less active in order for them to build daily movement into their lives
• increasing communication of the population scale benefits of physical activity and existing opportunities to be active, while also recognising that this will not be sufficient on it’s own if those benefits and opportunities do not relate to the values and motivation of people who are less active

Active Dorset and Dorset Council Public Health are working with partners to further develop the insights set out above, and progress the development of a shared strategy for increasing physical activity locally. This will require partners across the system, from strategic to operational levels, collaborating with communities to respond to these insights in ways that tale advantage of their own capacity and capabilities.

Increasing leverage for system change - insights from the March 2021 workshop

Events

Potential area for change: population awareness of availability

Ideas generated from stakeholders:

• resources to promote the availability of free activities e.g. online directories
• promotion of ways to be active at home and nearby
• events to provide 'gateways' to build activity into everyday life e.g. temporary active streets

Potential area for change: population awareness of benefits movement

Ideas generate from stakeholders:

• promotion of community champions or role models to demonstrate how to be active in every-day life
• promotion of messaging on the benefits of physical activity and the risks of inactivity by health and care practitioners

Structures

Potential area for change: collective system understanding of population groups who are least active

Ideas generated from stakeholders:

• identify population groups who are the least active to enable targeting of interventions

Potential area for change: environments that support or present barriers to physical activity

Ideas generated from stakeholders:

• support schools to plan and implement road layout and restrictions at schools to support safe active travel
• increased delivery of safe routes/dedicated space for active travel and measures to support integration with daily life e.g. facilities needed to support 'all weather' use of active travel
• development of country parks to support physical activity and increase accessibility of countryside
• modifications to indoor and outdoors environments to 'nudge' people toward physical activity while ensuring design is inclusive for all e.g. planning for liveable neighbourhoods that encourage play

Potential area for change: allocation of funding to support physical activity

Ideas generated from stakeholders:

• recognise and build on work schools already do to support physical activity, the PE premium funding is crucial to this
• discussion of monetising the system benefits of time spent engaging in physical activity to support investment of health and social care budgets in interventions to increase physical activity
• incentivising participating in physical activity through 'real rewards' or demonstration of value for health and wellbeing

Goals

Potential area for change: shared commitment to reframe physical activity

Ideas generated from stakeholders:

• system wide 're-framing' of physical activity as 'daily movement' that includes but goes beyond sport and exercise. Includes system leaders openly talking about and modelling 'daily movement' and broaden delivery of brief interventions to promote 'daily movement' beyond health and care professionals already involved
• include consideration of the impact on physical activity in policy making and movement beyond the sphere of influence of services/organisations already working to support and increase physical activity

Beliefs

Potential area for change: leveraging the value people place on physical activity

Ideas generated from stakeholders:

• discussion of the need to understand the challenges and barriers people face to being physically active
• understand what value being more active could have for people. What can it offer them e.g. health, financial saving, fun, status, social contact, employment

Potential area for change: perception that being active costs time and money

Ideas generated from stakeholders:

• discussion of the need to understand who this is a barrier for and its strength
• discussion of how to identify and leverage community champions/trusted voices who can engage with populations who hold this perception and inspire affordable physical activity

Potential area for change: prioritisation of cars over active travel

Ideas generated from stakeholders:

• discussion of how to understand and target opportunities for people to incorporate active travel into daily life and the factors that would increase their motivation to do so by delivering what they value