Active ScotlandPolicy in to Practice

Emma BroadhurstLocal Authority and Legacy Manager

ACTIVE SCOTLAND

• Background – what do we mean by physical activity?

• What does the evidence say?• How do we translate that to policy?• What is the current national picture?• Where does Aberdeenshire fit?

Stand Up – Sit Down

Physical Activity - What is it?

Physical activity is any active movement of the body that is produced by muscular contractions

and that results in the expenditure of energy

Ie

Any movement of the body that uses energy

Dimensions and Domains

Dimensions of physical activity

• Intensity: effort required (low, moderate, vigorous)

• Duration: length of time activity carried out

• Frequency: number of sessions over a fixed period (usually per week)

Domains of physical activity

• Leisure time (eg sports, recreational walking )

• Household activities (eg cleaning, gardening)

• Occupational/school (activity at work or school eg PE)

• Active transport ( walking, cycling as transport)

The Active Scotland spectrum…

VISION – A MORE ACTIVE SCOTLAND Physical activity is about getting people moving. Daily walking, playing in a park, going to a gym, training with a team or aspiring to win a gold medal- it doesn’t really matter how people get active, it just matters that we do. Being physically active contributes to our personal, community and national wellbeing. Our vision is of a Scotland where more people are more active more often.

Why the Fuss?

Seminal studies linking PA to healthContribution to health

Costs of inactivity – Global, UK, Scotland

• Seminal studies – CVD/cardiorespiratory fitness (late 1950s) links PA to health

• Worldwide, estimate that physical inactivity causes – 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of

the burden of disease from coronary heart disease– 7% (3·9–9·6) of type 2 diabetes, – 10% (5·6–14·1) of breast cancer– 10% (5·7–13·8) of colon cancer[(Lee et al 2012) ]

Leading causes of attributable global mortality, WHO 2004

% 1. High blood pressure 12.82. Tobacco use 8.73. High blood glucose 5.84. Physical inactivity 5.55. Overweight and obesity 4.86. High cholesterol 4.57. Unsafe sex 4.08. Alcohol use 3.89. Childhood underweight 3.810. Indoor smoke from solid fuels 3.3

59 million total global deaths in 2004

UK – 2006/7• Comparative level of importance varies depending of figures used –

message is the same – physical inactivity is a major issue– In 2006–07, costs to NHS in UK for behaviour related ill health:

• poor diet £5.8 billion• Smoking £3.3 billion• alcohol £3.3 billion• overweight and obesity cost £5.1 billion • physical inactivity was £0.9 billion

[Scarborough et al 2011, http://www.ias.org.uk/uploads/pdf/Economic%20impacts%20docs/pubmed.fdr033.full.pdf ]• 2002 study commissioned by the UK Department for Culture, Media and

Sport which summed direct and indirect costs to the NHS, including loss of earnings due to inability to work and premature death. This produced a total estimated cost of physical inactivity of £8.2 billion

• Unhelpful always to compare - Lifestyle behaviours usually co-exist so all co-related

Government

Roots of guidelinesCurrent guidelines

Government and Physical Activity Guidelines (PAGs)

• American College of Sports Medicine (ACSM) and American Heart Association – first guidelines

• Others followed suit including WHO• New UK-wide 2011, based on latest evidence

UK Guidelines 2011https://www.gov.uk/government/publications/uk-physical-activity-guidelines

• 150 minutes of moderate intensity or 75 minutes of vigorous physical activity per week (or a combination)

• At least 2 sessions per week of muscle strengthening exercises

• Minimise time spent being inactive (sitting)

Policy Landscape

Recent research trend leading to widening of responsibility and gain across multiple policy

areasCurrent policy landscape in Scotland

Not just about Health – Impacts and Influence

• IMPACT - Research widened into costs and benefits of PA beyond health – environment, education, economy etc

• INFLUENCE - socio-ecological perspective and role of environment - move away from focus on the individual and realisation of role for other policy areas to promote PA

Everyone’s responsibility - All stand to gain

Transport & environment

Economy

Health and Social Care

Education

Communities

congestion, carbon emissions, air/noise pollution, road safety

absenteeism, productivity

burden of disease (mental and physical)

Social cohesion, social capital

Attainment, social skills

Policy Landscape - Scotland• Let’s Make Scotland More Active (LMSMA) 2003

• Review of LMSMA 2008

• Obesity Route Map 2010

• Physical Activity Implementation Plan (PAIP) 2014

• Active Scotland Outcomes Framework (ASOF) 2014

So what about Scotland?

PAIP and ASOF

• PAIP is about physical activity settings for intervention and recognising the need for action across a range

• ASOF are the high level outcomes that PAIP seeks to address – draws together policy landscape

We encourage and enable the active to stay active throughout life

We develop physical confidence and competence from the earliest age

Physical activity is about getting people moving. Daily walking, playing in a park, going to a gym, training with a team or aspiring to win a gold medal- it doesn’t really matter how people get active, it just matters that we do. Being physically active contributes to our personal, community and national wellbeing. Our vision is of a Scotland where more people are more active, more often.

We improve our active infrastructure – people and places

We support wellbeing and resilience in communities through physical activity and sport

We improve opportunities to participate, progress and achieve in sport

Equality – Our commitment to equality underpins everything we do

Vision: A More Active Scotland

Active Scotland Outcomes

National Outcomes

We encourage and enable the inactive to be more active

Primary connections only are shown, although it is recognised there are multiple interconnections that could be added

A MORE ACTIVE SCOTLAND

MORE PEOPLE MORE ACTIVE MORE OFTEN

OUTCOME 4

We improve our active infrastructure - people and places

The NWS, CAPS and Designing Streets will be implemented

20mph zones will be widely introduced in residential and shopping areas

More active and inactive people will know about and use local opportunities to be active

Urban and rural environements will be designed to increase physical activity

There will be an Increased use of Scotland's outdoors

More children and students use active travel to get to their places of learning

More people use active travel for work

More people use active travel for leisure

OUTCOME 2

We encourage and enable the active to stay active throughout

life

Employee support programmes and activities for both less and more active staff.

Work place Active Travel Plans

OUTCOME 1

We encourage and enaable the inactive to be more active

The national physical activity pathway will be embedded within clinical settings across the healthcare system

Hospitals routinely support patients to be more physically active

New links exisit between healthcare and the community to signpost patients to phusical actiivty opportunities

Integrated care services routinely take account of physical activity

OUTCOME 3

We develop physical confidence and competence from the earliest

age

Education staff have the appropriate knowledge and skills to promote increased physical activity

All places of learning can demonstrate the use of their estate and greenspace for physical activity

All places of learning can demonstrate that pupils, students and staff have increased levels of physical activity

OUTCOME 5

We support wellbeing and resilience in communities through

physical activity and sport.

More children will have opportunities for active and outdoor play

The coach and volunteer workforce will have the knowledge and skills to promote increased physical activity

All Community Sports Hubs will be in place (signposting both inactive and active people on how to be more active) with at least 50% in schools

There will be an increase in grass-roots participation in sport by all

OUTCOME 6

We improve opportunities to participate, progress and achieve

in sport.

Vision Active Framework Outcomes PAIP 5 Year Milestones

Delivery Theme 1 Environment

Delivery Theme 5 Sport & Active

Recreation

Delivery Theme 2 Workplace

Delivery Theme 3 Health & Social Care

Delivery Theme 4 Education

The way ahead

Current PA situation and trends in ScotlandPositives – PA, walking, freq of sport

Challenges – inactive, more into sport, inequalitiesWhere stand to gain the most (does-response/numbers)

Picture in Scotland?• Tentative increase in physical activity, recreational walking,

frequency of sports participation

• No change inactive and proportion participating in sport

• Indication that active getting more active

• Increase in physical activity is those doing some moving into meeting the guidelines

Scotland 2013 – Adults (16+)

Physical Activity Recreational Walking

64% met the recommended amount of 150 mins of moderate or vigorous activity per week.

A small increase since 2012

65% walked for at least 30 minutes for recreational purposes in the last four weeks.

Year on year increase since 2010

Scotland 2013 – Adults (16+)Sports participation Frequency of

sports participation

52% reported participating in sport in the last four weeks.

Relatively stable 2010 to 2013

48% of participants took part in sport and exercise regularly (15 or more days) in the four weeks prior to interview.

Increased yearly since 2010

2012

2013

0 10 20 30 40 50 60 70 80 90 100

21

21

17

15

62

64

InactiveSome activityMeets MVPA

None Some Enough

Adult Physical Activity Levels - Scotland, 2012 - 2013

Reasons for optimism Rise in interest in recreational sport

International recognition of Scotland's work on PA

Renewed policy push across multiple fronts: Physical Activity Champions; Physical Activity Implementation Plan; Brief Interventions; National Walking Strategy; Active Schools; ...and Commonwealth Games!

The progress made, particularly at high levels of government and leadership – support and recognition has increased since my last visit a couple of years ago. There

is clear intent to address this problem.

Professor Fiona Bull, PA expert, March 2013

What do the figures all mean

• Sporty getting sportier

• Moved those doing something to doing more

• Inactive remains a challenge

Percentage of adults meeting recommended levels of physical activity by age, 2011

Source: Scottish Health Survey

Participation in sport last four weeks

Participation in sport and exercise in last four weeks

Participation in sport and exercise in last four weeks by age

Includes walking

Excludes walking

Walking distance to nearest greenspace

Frequency of visits made outdoors

How often uses nearest useable greenspace

Who are the inactive - AGE(% who are younger than 45(blue), 45-64(red) and 65+(green))

Scotland (2014)

Inactive (2012)

0 10 20 30 40 50 60 70 80 90 100

45

25

33

35

22

40

Who are the inactive - DISABILITY (% who are healthy (blue) or who have a long-term illness (red))

Scotland (2013)

Inactive (2012)

0 10 20 30 40 50 60 70 80 90 100

56

28

44

72

Key characteristics of those who are inactive

Health, long-term illness and disability

Economic activity status - especially inability to work and to a lesser extent those who are retired

Age – activity declines with age from about age 45

Income and sex were not influential

Dose response activity vs relative risk of all cause deathrisk reduces as activity increases

[Adapted from Brown et al (2012)]

Rela

tive

risk

Mins per week of moderate activity

• Shaded area indicates optimal range for health benefits.

• Equates to 150 - 300 mins per week MVPA.

Numbers of inactive in high risk groups

Inactive LLI +LI Inactive 65+ Unable to work inactive retired0

100000

200000

300000

400000

500000

600000

700000

800000

670771

372651

167693

391283

NB - number of adults 16+ in inactive group based on 2014 mid term estimate - 931627

Contribution of different domains of PA to the activity of the inactive group, 2012

% of mean hours per week

Heavy Housework57%

DIY/Garden-ing7%

Walking 14%

Oc-cupa-tional Work 22%

• The main activity making up total of any PA per week in the inactive group is heavy housework.

• Negligible contribution of sport.

Contribution of different domains of PA to the activity of all adults in Scotland, 2012

% of mean hours per week

Heavy Housework14%

DIY/Garden-ing7%

Walking 25%Sport & exercise

39

Occupational Work 15%

• Sport & exercise major difference.

• Relatively larger contribution of walking.

Risk reduction associated with physical activity

Chronic condition Risk reductionAll cause mortality 30% risk reductionCVD, stroke 20-35% reductionDiabetes 30-40% reductionHip fractures 36-68% reductionColon cancer 30% reductionBreast cancer 20% reductionLoss of function 30% reductionDepression/dementia 20-30% reduction

Next Steps - nationally

• Driving policy across SG• Delivery of PAIP• Gathering LA /CPP information

Next steps locally Current SOA outcome

Physical activity increased across the population including those who are vulnerable through

shifts in culture, improvements in infrastructure, opportunities and community empowerment

My questions to you

• Who are your inactive?• What are the priorities?• How will you get them active? How will you

keep people active?• How will you deliver this to help make that

step change in an environment of shrinking resources?