Physical Activity: manifold benefits for health and well-being.
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Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials
Physical Activity: manifold benefits for health and well-being.
Dear Editor
This recent review by Kettle and colleagues has highlighted the critical role that health professionals in primary care can have in supporting the public to increase their physical activity.(1) This is an important study as physical activity has wide ranging health benefits.(2-8) The Academy of Medical Royal Colleges has described physical activity as a “miracle cure.”(4) But, we currently have low levels of activity in the UK and far more needs to be undertaken in different settings including primary care, schools and hospitals. Unfortunately, the Government is not currently prioritising this effective public health intervention in policymaking.
In addition to the current low levels of physical activity in the UK there are also stark inequalities in levels of physical activity within the population.(7) There are large disparities in physical activity participation rates in relation to age, disability, ethnic group and gender. The Institute of Health Promotion and Education firmly believes that physical activity should not just be for the elite or for example individuals of a certain age, or ability, but should be actively promoted to the whole population.
A pioneering individual who has been fighting ageism with her camera is Alex Rotas.(9) Her beautiful photographs of older athletes participating and enjoying sport will certainly help to challenge stereotypes and may encourage more to be involved in active ageing. Some key professionals including journalists, public health and policy makers should view these images as they may obtain a better understanding about this heterogeneous group and what they are capable of.
Similarly, the Women’s Sport Trust, a successful national charity has helped to increase positive media coverage of a diverse group of female athletes and this is likely to encourage more to participate in a range of activities.(10) Besides increasing the percentage and quality of media coverage they also highlight inequalities in sports sponsorship and act as a catalyst for changing funding and sponsorship decisions. However, in relation to women and physical activity, much more still needs to be done in different settings including hospitals and schools.(6)
We need a fundamental shift in the way we think about hospitals. Instead of having hospitals mainly focused on providing services for patients that are sick, we need to develop their positive health promoting roles, and encouraging physical activity is one important element. Facilities need to be provided and staff could use their many contacts on a one-to-one level to encourage activity that is appropriate to the individual’s needs.
A healthy workforce is an integral part of a physical activity strategy and as the NHS is a very large employer, encouraging all types of staff to participate should be seen as a health promotion opportunity. Much more could also be done in relation to encouraging active travel. Moreover, health promoting hospitals could be used as examples to encourage other employers to promote the health of their workforce.
Schools have an important part to play in developing health literacy.(11) This includes Physical Education (PE) which is an important and essential part of the curriculum for all pupils of all ages. Children and young people should be encouraged to participate in a range of physical activities beyond the narrow definition of PE and team games in the curriculum and to understand how such activity is beneficial to health and mental wellbeing. Schools must also help their pupils and their communities to overcome the barriers to participation brought about by disability, gender, religion, ethnicity and culture if we are to prevent the exclusion of many.(12)
Local government also has key roles that they could play. Open spaces can be used for a great variety of physical activities, individual and group, and as they are accessible and free to use, they can be particularly beneficial to those on low incomes.(6,13)
Increasing the availability of swimming pools would for example enable a number of public health topics to be targeted including: physical activity, obesity and drowning prevention. Directors of Public Health within local authorities could play greater roles in tackling physical inactivity and promoting action in different settings, such as schools, hospitals and primary care, but additional resources will be needed.(14-16)
The Government has a crucial role to play in creating environments that will encourage people of all abilities, ages, ethnicities, genders and incomes to engage in physical activities.(6,7,13,17) Facilities are important but so too is the design of the built environment including green spaces, cycling lanes, lighting, public buildings, and the transportation system which can be utilised to encourage physical activity.
To conclude, it is important to emphasise that physical activity is a significant contributor to good physical and mental health, and has social and environmental benefits. Furthermore, there are now evidence-based interventions that can support individuals. In this post pandemic era the promotion of physical activity offers the Government a positive way to reduce inequalities, to level up and create a healthier nation.
References
1) Kettle V E, Madigan C D, Coombe A, Graham H, Thomas J J C, Chalkley A E et al. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials BMJ 2022; 376 :e068465 doi:10.1136/bmj-2021-068465 https://www.bmj.com/content/376/bmj-2021-068465
2) Kohl HW 3rd., Craig CL, Lambert EV, et al., Lancet Physical Activity Series Working Group. The pandemic of physical inactivity: global action for public health. Lancet2012;380:294-305. doi:10.1016/S0140-6736(12)60898-8 pmid:22818941 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60898-8/fulltext
3) Royal College of Physicians. Exercise for life: physical activity in health and disease. Recommendations of the Sport and Exercise Medicine Committee Working Party of the Royal College of Physicians London: RCP, 2012.
4) Academy of Medical Royal Colleges. Exercise: The miracle cure and the role of the doctor in promoting it. London: Academy of Medical Royal Colleges, 2015.
6) World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization, 2018.
12) Lloyd J. Compassion through development of physical and mental health and well-being. In, Towards the Compassionate School. Ed. Maurice Irfan Coles. London: Trentham Books/IOE Press, 2015.
14) Watson M and Tilford S, 2016. Directors of public health are pivotal in tackling health inequalities. BMJ 2016;354:i5013. https://www.bmj.com/content/354/bmj.i5013
15) BMA. Funding for ill-health prevention and public health in the UK. May 2017. http://bit.ly/2quLN3K
Rapid Response:
Physical Activity: manifold benefits for health and well-being.
Dear Editor
This recent review by Kettle and colleagues has highlighted the critical role that health professionals in primary care can have in supporting the public to increase their physical activity.(1) This is an important study as physical activity has wide ranging health benefits.(2-8) The Academy of Medical Royal Colleges has described physical activity as a “miracle cure.”(4) But, we currently have low levels of activity in the UK and far more needs to be undertaken in different settings including primary care, schools and hospitals. Unfortunately, the Government is not currently prioritising this effective public health intervention in policymaking.
In addition to the current low levels of physical activity in the UK there are also stark inequalities in levels of physical activity within the population.(7) There are large disparities in physical activity participation rates in relation to age, disability, ethnic group and gender. The Institute of Health Promotion and Education firmly believes that physical activity should not just be for the elite or for example individuals of a certain age, or ability, but should be actively promoted to the whole population.
A pioneering individual who has been fighting ageism with her camera is Alex Rotas.(9) Her beautiful photographs of older athletes participating and enjoying sport will certainly help to challenge stereotypes and may encourage more to be involved in active ageing. Some key professionals including journalists, public health and policy makers should view these images as they may obtain a better understanding about this heterogeneous group and what they are capable of.
Similarly, the Women’s Sport Trust, a successful national charity has helped to increase positive media coverage of a diverse group of female athletes and this is likely to encourage more to participate in a range of activities.(10) Besides increasing the percentage and quality of media coverage they also highlight inequalities in sports sponsorship and act as a catalyst for changing funding and sponsorship decisions. However, in relation to women and physical activity, much more still needs to be done in different settings including hospitals and schools.(6)
We need a fundamental shift in the way we think about hospitals. Instead of having hospitals mainly focused on providing services for patients that are sick, we need to develop their positive health promoting roles, and encouraging physical activity is one important element. Facilities need to be provided and staff could use their many contacts on a one-to-one level to encourage activity that is appropriate to the individual’s needs.
A healthy workforce is an integral part of a physical activity strategy and as the NHS is a very large employer, encouraging all types of staff to participate should be seen as a health promotion opportunity. Much more could also be done in relation to encouraging active travel. Moreover, health promoting hospitals could be used as examples to encourage other employers to promote the health of their workforce.
Schools have an important part to play in developing health literacy.(11) This includes Physical Education (PE) which is an important and essential part of the curriculum for all pupils of all ages. Children and young people should be encouraged to participate in a range of physical activities beyond the narrow definition of PE and team games in the curriculum and to understand how such activity is beneficial to health and mental wellbeing. Schools must also help their pupils and their communities to overcome the barriers to participation brought about by disability, gender, religion, ethnicity and culture if we are to prevent the exclusion of many.(12)
Local government also has key roles that they could play. Open spaces can be used for a great variety of physical activities, individual and group, and as they are accessible and free to use, they can be particularly beneficial to those on low incomes.(6,13)
Increasing the availability of swimming pools would for example enable a number of public health topics to be targeted including: physical activity, obesity and drowning prevention. Directors of Public Health within local authorities could play greater roles in tackling physical inactivity and promoting action in different settings, such as schools, hospitals and primary care, but additional resources will be needed.(14-16)
The Government has a crucial role to play in creating environments that will encourage people of all abilities, ages, ethnicities, genders and incomes to engage in physical activities.(6,7,13,17) Facilities are important but so too is the design of the built environment including green spaces, cycling lanes, lighting, public buildings, and the transportation system which can be utilised to encourage physical activity.
To conclude, it is important to emphasise that physical activity is a significant contributor to good physical and mental health, and has social and environmental benefits. Furthermore, there are now evidence-based interventions that can support individuals. In this post pandemic era the promotion of physical activity offers the Government a positive way to reduce inequalities, to level up and create a healthier nation.
References
1) Kettle V E, Madigan C D, Coombe A, Graham H, Thomas J J C, Chalkley A E et al. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials BMJ 2022; 376 :e068465 doi:10.1136/bmj-2021-068465
https://www.bmj.com/content/376/bmj-2021-068465
2) Kohl HW 3rd., Craig CL, Lambert EV, et al., Lancet Physical Activity Series Working Group. The pandemic of physical inactivity: global action for public health. Lancet2012;380:294-305. doi:10.1016/S0140-6736(12)60898-8 pmid:22818941
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60898-8/fulltext
3) Royal College of Physicians. Exercise for life: physical activity in health and disease. Recommendations of the Sport and Exercise Medicine Committee Working Party of the Royal College of Physicians London: RCP, 2012.
4) Academy of Medical Royal Colleges. Exercise: The miracle cure and the role of the doctor in promoting it. London: Academy of Medical Royal Colleges, 2015.
5) Public Health England. Health matters: getting every adult active every day. London: Public Health England, 2016. [viewed 26th February 2022]. Available at: https://www.gov.uk/government/publications/health-matters-getting-every-...
6) World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization, 2018.
7) BMA. Get a move on: steps to increase physical activity levels in the UK. Oct 2019. https://www.bma.org.uk/collective-voice/policy-and-research/public-and-p...
8) Haseler C, Crooke R and Haseler T. Promoting physical activity to patients. BMJ 2019;366:l5230
9) Alex Rotas Photography - Promoting active ageing [viewed 26th February 2022]. Available from: https://alexrotasphotography.co.uk/
10) Women’s Sport Trust. What do we do? [viewed 26th February 2022]. Available from: https://www.womenssporttrust.com/
11) Watson M C and Lloyd J. IHPE Position Statement: Unintentional Home Injuries to Children (Under 5s). Lichfield, Institute of Health Promotion and Education, 2019.
https://ihpe.org.uk/wp-content/uploads/2020/02/Position-statement-Child-...
12) Lloyd J. Compassion through development of physical and mental health and well-being. In, Towards the Compassionate School. Ed. Maurice Irfan Coles. London: Trentham Books/IOE Press, 2015.
13) Public Health England. Improving access to greenspace. A new review for 2020. London: Public Health England, 2020.
https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
14) Watson M and Tilford S, 2016. Directors of public health are pivotal in tackling health inequalities. BMJ 2016;354:i5013.
https://www.bmj.com/content/354/bmj.i5013
15) BMA. Funding for ill-health prevention and public health in the UK. May 2017.
http://bit.ly/2quLN3K
16) Watson M C and Thompson S, 2018. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279
17) Watson M C and Lloyd J. Seismic shift in policy needed to increase physical activity. BMJ 2015;350:h3486
https://www.bmj.com/content/350/bmj.h3486
Competing interests: No competing interests