Embedding Physical Activity in the Heart of the NHS: The Need for a Whole-System Approach

Helen Speake, Robert J Copeland, Simon H Till, Jeff D Breckon, Steve Haake, Oliver Hart, Helen Speake, Robert J Copeland, Simon H Till, Jeff D Breckon, Steve Haake, Oliver Hart

Abstract

Solutions to the global challenge of physical inactivity have tended to focus on interventions at an individual level, when evidence shows that wider factors, including the social and physical environment, play a major part in influencing health-related behaviour. A multidisciplinary perspective is needed to rewrite the research agenda on physical activity if population-level public health benefits are to be demonstrated. This article explores the questions that this raises regarding the particular role that the UK National Health Service (NHS) plays in the system. The National Centre for Sport and Exercise Medicine in Sheffield is put forward as a case study to discuss some of the ways in which health systems can work in collaboration with other partners to develop environments and systems that promote active lives for patients and staff.

References

    1. Health and Social Care Information Centre. Health survey for England 2012: is the adult population in England active enough? Initial results. Leeds: Health and Social Care Information Centre; 2013. . Accessed 26 Jan 2016.
    1. World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010. . Accessed 26 Jan 2016.
    1. World Health Organization. Political declaration of the high-level meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Geneva: World Health Organization; 2011. . Accessed 26 Jan 2016.
    1. Public Health England. Everybody active, every day: the case for taking action now. London: Public Health England; 2014. . Accessed 26 Jan 2016.
    1. Cabinet Office. Moving more, living more: the physical activity Olympic and Paralympic legacy for the nation. London: Cabinet Office; 2014. . Accessed 26 Jan 2016.
    1. Jarrett J, Woodcock J, Griffiths UK, et al. Effect of increasing active travel in urban England and Wales on costs to the National Health Service. Lancet. 2012;379(9832):2198–2205. doi: 10.1016/S0140-6736(12)60766-1.
    1. UK Active. Turning the tide of inactivity. London: UK Active; 2014. . Accessed 26 Jan 2016.
    1. Lee I, Shiroma EJ, Lobelo F, et al. Impact of physical inactivity on the world’s major non-communicable diseases. Lancet. 2012;380(9838):219–229. doi: 10.1016/S0140-6736(12)61031-9.
    1. Michie S, Ashford S, Sniehotta FF, et al. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011;26(11):1479–1498. doi: 10.1080/08870446.2010.540664.
    1. Tully MA, Hunter RF. Promoting physical activity: time for a major re-think. Aspetar Sports Med J. 2015;4:258–263.
    1. Greaves CJ, Sheppard KE, Abraham C, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Pub Health. 2011;11:119–131. doi: 10.1186/1471-2458-11-119.
    1. Ogilvie D, Foster C, Rothnie H, et al. Interventions to promote walking: systematic review. BMJ. 2007;334(7605):1204. doi: 10.1136/.
    1. Bauman AE, Reis RS, Sallis JF, for the Lancet PA Series Working Group et al. Physical activity 2. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380:258–271. doi: 10.1016/S0140-6736(12)60735-1.
    1. Burke NJ, Joseph G, Pasick RJ, et al. Theorizing social context: rethinking behavioural theory. Health Educ Behav. 2009;36(Suppl 1):55s–70s. doi: 10.1177/1090198109335338.
    1. Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. 4. San Francisco: Jossey-Bass; 2008.
    1. Sallis JF, Floyd MF, Rodriguez DA, et al. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125:729–737. doi: 10.1161/CIRCULATIONAHA.110.969022.
    1. Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: what are the contributors? Ann Rev Pub Health. 2005;26:421–443. doi: 10.1146/annurev.publhealth.26.021304.144437.
    1. Ford ES, Caspersen CJ. Sedentary behaviour and cardiovascular disease: a review of prospective studies. Int J Epidemiol. 2012;41(5):1338–1353. doi: 10.1093/ije/dys078.
    1. The Marmot Review. Fair society, healthy lives: strategic review of health inequalities in England post-2010. London: The Marmot Review; 2010. . Accessed 26 Jan 2016.
    1. Coombes E, Jones AP, Hillsdon M. The relationship of physical activity and overweight to objectively measured green space accessibility and use. Soc Sci Med. 2010;70(6):816–822. doi: 10.1016/j.socscimed.2009.11.020.
    1. Gordon-Larsen P, Norton MC, Page P, et al. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117(2):417–424. doi: 10.1542/peds.2005-0058.
    1. Cattell V, Dines N, Gesler W, et al. Mingling, observing, and lingering: everyday public spaces and their implications for well-being and social relations. Health Place. 2008;14:544–561. doi: 10.1016/j.healthplace.2007.10.007.
    1. Cabinet Office. Applying behavioural insight to health. London: HM Government; 2011. . Accessed 26 Jan 2016.
    1. Neuhaus M, Eakin EG, Straker L, et al. Reducing occupational sedentary time: a systematic review and meta-analysis of evidence on activity-permissive workstations. Obes Rev. 2014;15(10):822–838. doi: 10.1111/obr.12201.
    1. Faskunger J. Promoting active living in healthy cities of Europe. J Urban Health. 2013;90(Suppl 1):142–153. doi: 10.1007/s11524-011-9645-7.
    1. Pronk NP, Katz AS, Lowry M, et al. Reducing occupational sitting time and improving worker health: The Take-a-Stand Project. Prev Chronic Dis. 2012;9:E154. doi: 10.5888/pcd9.110323.
    1. Hunter RF, Christian H, Veitch J, et al. The impact of interventions to promote physical activity in urban green space: a systematic review and recommendations for future research. Soc Sci Med. 2015;124:246–256. doi: 10.1016/j.socscimed.2014.11.051.
    1. 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. . Accessed 26 Jan 2016.
    1. Kohl HW, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305. doi: 10.1016/S0140-6736(12)60898-8.
    1. Weiler R, Feldschreiber P, Stamatakis E. Medicolegal neglect? The case for physical activity promotion and exercise medicine. Br J Sports Med. 2012;46(4):228–232. doi: 10.1136/bjsm.2011.084186.
    1. British Heart Foundation. The national audit of cardiac rehabilitation annual statistical report 2014. London: British Heart Foundation; 2014. . Accessed 26 Jan 2016.
    1. National Institute for Health and Care Excellence. Physical activity: exercise referral schemes. London: National Institute for Health and Care Excellence; 2014. . Accessed 26 Jan 2016.
    1. Golden SD, Earp JAL. Social ecological approaches to individuals and their contexts: twenty years of Health Education and Behaviour health promotion interventions. Health Educ Behav. 2012;39(3):364–372. doi: 10.1177/1090198111418634.
    1. Vrijens B, Vincze G, Kristanto P, et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008;336(7653):1114–1117. doi: 10.1136/bmj.39553.670231.25.
    1. National Institute for Health and Care Excellence. Physical activity: brief advice for adults in primary care. London: National Institute for Health and Care Excellence; 2013. . Accessed 2016 Jan 26.
    1. National Institute for Health and Care Excellence. Four commonly used methods to increase physical activity. London: National Institute for Health and Care Excellence; 2006. . Accessed 26 Jan 2016.
    1. Bull F, Milton K. Let’s get moving: a systematic pathway for the promotion of physical activity in a primary care setting. Global Health Prom. 2011;18(1):59–61. doi: 10.1177/1757975910393173.
    1. Jackson F, Myers F, Oates A, et al. NHS primary care physical activity pathway feasibility study: final main report. Edinburgh: NHS Health Scotland; 2014. . Accessed 26 Jan 2016.
    1. Bellg AJ, Borrelli B, Resnick B, et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2014;23:443–451. doi: 10.1037/0278-6133.23.5.443.
    1. Heath GW, Parra DC, Sarmiento OL, et al. Evidence-based intervention in physical activity: lessons from around the world. Lancet. 2012;380:272–281. doi: 10.1016/S0140-6736(12)60816-2.
    1. NHS England. Five year forward view. London: NHS England; 2014. . Accessed 26 Jan 2016.
    1. Breckon JD, Johnston LH, Hutchison A. Physical activity counseling content and competency: a systematic review. J Phys Act Health. 2008;5:398–417.
    1. Mills H, Crone D, James DV, et al. Exploring the perceptions of success in an exercise referral scheme: a mixed method investigation. Eval Rev. 2012;36(6):407–429. doi: 10.1177/0193841X12474452.
    1. Breton ER, Fuemmeler BF, Abroms LC. Weight loss—there is an app for that! But does it adhere to evidence-informed practices? Transl Behav Med. 2011;1(4):523–529. doi: 10.1007/s13142-011-0076-5.
    1. Pagoto S, Schneider K, Jojic M, et al. Evidence based strategies in weight-loss mobile apps. Am J Prev Med. 2013;45(5):576–582. doi: 10.1016/j.amepre.2013.04.025.
    1. Jun GT, Morrison C, Clarkson PJ. Articulating current service development practices: a qualitative analysis of eleven mental health projects. BMC Health Serv Res. 2014;17(14):20. doi: 10.1186/1472-6963-14-20.
    1. Van Hecke A, Verhaeghe S, Grypdonck M, et al. Systematic development and validation of a nursing intervention: the case of lifestyle adherence promotion in patients with leg ulcers. J Adv Nurs. 2011;67(3):662–676. doi: 10.1111/j.1365-2648.2010.05539.x.
    1. Rodgers M, Cohen ZA, Joseph L, et al. Workshop on personal motion technologies for healthy independent living: executive summary. Arch Phys Med Rehabil. 2012;93(6):935–939. doi: 10.1016/j.apmr.2011.12.026.
    1. Gammon D, Strand M, Eng LS. Service users’ perspectives in the design of an online tool for assisted self-help in mental health: a case study of implications. Int J Ment Health Syst. 2014;8(1):2–8. doi: 10.1186/1752-4458-8-2.
    1. Nesta. By us, for us: the power of co-design and co-delivery. London: Nesta; 2013. . Accessed 26 Jan 2016.
    1. User Centred Healthcare Design. Better services by design. Sheffield: User Centred Healthcare Design; 2012. . Accessed 26 Jan 2016.
    1. Bradwell P, Marr S. Making the most of collaboration: an international survey of public service co-design. Demos report 23. London: Demos; 2008. . Accessed 26 Jan 2016.
    1. Design Council. Design for public good. London: Design Council; 2013. . Accessed 26 Jan 2016.
    1. Design Council. A&E design challenge: impact evaluation summary. London: Design Council; 2013. . Accessed 26 Jan 2016.
    1. Fitzgerald MM, Kirk GD, Bristow CA. Description and evaluation of a serious game intervention to engage low secure service users with serious mental illness in the design and refurbishment of their environment. J Psychiatr Ment Health Nurs. 2011;18:316–322. doi: 10.1111/j.1365-2850.2010.01668.x.
    1. Blake H, Zhou D, Batt ME. Five-year workplace wellness intervention in the NHS. Perspect Public Health. 2013;133(5):262–271. doi: 10.1177/1757913913489611.
    1. Maben J, Adams M, Peccei R, et al. ‘Poppets and parcels’: the links between staff experience of work and acutely ill older peoples’ experiences of hospital care. Int J Older Person Nurs. 2012;7:83–94. doi: 10.1111/j.1748-3743.2012.00326.x.
    1. Sallis J, Cervero RB, Ascher W, et al. An ecological approach to creating active living communities. Ann Rev Public Health. 2006;27:297–322. doi: 10.1146/annurev.publhealth.27.021405.102100.
    1. Owen N, Salmon J, Koohsari MJ, et al. Sedentary behaviour and health: mapping environmental and social contexts to underpin chronic disease prevention. Br J Sports Med. 2014;48:174–177. doi: 10.1136/bjsports-2013-093107.
    1. Designed to Move. A guide for city leaders. Designed to move: active cities. Beaverton: Nike, Inc.; 2015. . Accessed 26 Jan 2016.
    1. Nesta. Realising the value. London: Nesta; 2015. . Accessed 26 Jan 2016.
    1. Matheson GO, Klügl M, Engebretsen L, et al. Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne 2013. Sports Med. 2013;43:1075–1088. doi: 10.1007/s40279-013-0104-3.
    1. American College of Sports Medicine. Exercise is Medicine®. Indianapolis: American College of Sports Medicine; 2016. . Accessed 26 Jan 2016.
    1. Puttick R, Ludlow J. Standards of evidence: an approach that balances the need for evidence with innovation. London: NESTA; 2013. . Accessed 26 Jan 2016.
    1. Dell’Era C, Landoni P. Living lab: a methodology between user-centred design and participatory design. Creat Innov Manag J. 2014;23(2):137–154. doi: 10.1111/caim.12061.
    1. Move More. Creating a culture of physical activity. The Move More Plan: a framework for increasing physical activity in Sheffield 2015–2020. Sheffield: Move More; 2015. . Accessed 26 Jan 2016.
    1. Green LW, Glasgow GE. Evaluating the relevance, generalization, and applicability of research: issues in external validation and translation methodology. Eval Health Prof. 2006;29(1):126–153. doi: 10.1177/0163278705284445.
    1. National Health Service. Five year forward view: time to deliver. London: National Health Service; 2015. . Accessed 26 Jan 2016.

Source: PubMed

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