ACTIVITY PATTERNS YOUNG PEOPLE Aged 518 Years

1
ACTIVITY PATTERNS YOUNG PEOPLE Aged 5-18 Years
2
General Trends2

• 70 of boys 61 of girls aged 2-15 years
  reached the recommended levels of physical
  activity to benefit their health
• For girls, activity levels started to
• decline around the age of 8-10 years
• By 15 years, 50 girls reached
• HEA activity recommendations
• For boys, activity levels remained relatively
  stable through to age 15

3
Active Play

• 68 of boys and 60 girls participated in active
  play on 5 or more days of the week.
• The time spent in active play decreased steadily
  with age for boys and girls but most markedly in
  girls.

4
Sports and Exercise Participation2

• 58 of boys 56 of girls aged 5-10 years
  participated for at least 15 minutes on at least
  1 day
• 66 of boys 57 of girls aged 11-15 years
  participated for at least 15 minutes on at least
  1 day
• 50 of females aged 15 years
• 43 of females aged 12 years did not participate
  in any active sports on a weekly basis

5
Travel Patterns5

• The proportion of 5-16 years olds walking to
  school has decreased since 1989/91
• 51 of primary age children walked to school in
  2002 compared with 38 of secondary age children
• About 2 of trips to school by 11-16 year olds
  were made by bicycle

6
Physical Education in Schools6

• 49 of young people (6-16 years) were spending 2
  or more hours a week in PE lessons
• In 2002, only 29 of 6-8 year olds and 32 of
  9-11 year olds spent 2 hours or more per week in
  PE.
• In 2003, around half of all young people were
  still not receiving 2 hours of PE a week

7
Sedentary Behaviours78Young People spend
considerable amounts of leisure time in sedentary
pursuits

• Approximately 5 hours a day of young peoples
  leisure time is accounted for by multi-media
  activities
• 50-60 of this time is devoted to watching
  television
• Media-use alone did not displace physical
  activity behaviours

8
Inequalities in Activity2 Socio-Economic Status

• Participation rates in Active Play, Walking and
  Housework/Gardening did not vary by
  socio-economic group
• Sport Exercise were related to socio-economic
  category.
• Sport Exercise participation rates were higher
  for boys and girls aged 2-10 years in the least
  deprived group compared with the most deprived
  group (14 v 11)

9
Inequalities in Activity9 Disabled People

• Proportion of disabled children young people
  participating in sport exercise was lower than
  young people in the general population
• Disabled young people educated at special schools
  were more likely to participate in sport and
  exercise than those in mainstream schools
• Young people with a mobility disability and those
  with a self-care related disability are least
  likely to be active

10
Inequalities in Activity10 Minority Ethnic Groups

• Indian, Pakistani, Bangladeshi and Chinese young
  people had lower participation rates compared to
  young people in the general population
• Irish and Black Caribbean young people had
  similar participation rates to young people in
  the general population

11
Summary

• Growing public health concern over the effects of
  sedentary lifestyles
• Overweight and obesity in young people is of
  particular concern
• Reducing the time spent being INACTIVE is
  important because physical inactivity appears to
  track from childhood to adolescence and from
  adolescence to early adulthood

12
References

• Biddle, S., Sallis, J. Cavill, N (1998). Young
  and Active? Young people and health enhancing
  physical activity evidence and implications.
  Health Education Authority.
• Department of Health (2004). At Least Five A
  Week Evidence on the impact of physical activity
  and its relationship to health. A Report from the
  Chief Medical Officer. London DoH.
• Sproston, K. Primatesta (2002). Health Survey
  for England The Health of Children Young
  People. London HMSO.
• Food Standards Agency. (2000). National Diet
  Nutrition Survey Young People Aged 4-18 years.
  London Stationary Office.

13
References

• Department for Transport (2003). Travel to
  School in GB. Personal Travel Factsheet 2.
  London Department for Transport.
• Department for Transport (2004). National Travel
  Survey 2003 Provisional Results. Transport
  Statistics Bulletin. London Office of National
  Statistics.
• Sport England. (2003). Young People and Sport in
  England Trends in participation 1994 2002.
  London Sport England.
• Project STIL (Sedentary Teenagers and Inactive
  Lifestyles). Loughborough University
  URLhttp//www.lboro.ac.uk/departments/SSES/about/
  newsboard/couchpots.html.

14
References

• Marshall, S. Project STIL Systematic Literature
  Reviews. Loughborough University Unpublished
  Report.
• Biddle, S., Gorely, T. Marshall, S., Murdey, I.,
  Cameron, C. (2004). Physical activity and
  sedentary behaviours in youth issues and
  controversies. Journal of the Royal Society for
  the Promotion of Health. 124 (1) 29-33.
• Marshall, S., Biddle, S., Gorely, T. Cameron, N.,
  Murdey, I. (In press). Relationships between
  media use, body fatness and physical activity in
  children and youth a meta-analysis.
  International Journal of Obesity.

15
References

• Sport England (2001). Disability Survey 2000
  Young people with a disability and sport
  headline findings. London Sport England.
• Joint Health Surveys Unit (2001). Health Survey
  for England The health of minority ethnic groups
  1999. LondonHMSO.
• Malina, R.M. (1996). Tracking physical activity
  and physical fitness across the lifespan.
  Research Quarterly for Exercise and Sport. 67
  (3) 48-57.
• National Association for Sport Physical
  Education (2004). Physical Activity for
  Children. A Statement of Guidelines for Children
  Ages 5-12. Second Edition. Reston, VA NASPE.

16
ACTIVITY PATTERNS ADULTS Aged 16-to-54 Years
17
General Trends3

• According to the Health Survey for England (HSE
  98)
• Only 46 of men 31 of women aged between
  16-to-54 years met the recommended levels of
  physical activity to benefit their health.
• 29 of men 38 of women aged between 16to-54
  years were insufficiently active
• A quarter of men just under a third of women
  aged between 16to-54 years were deemed to be
  totally inactive

18
The proportion of men and women who do NOT meet
the 5 x 30 recommendation is highest in women,
but increases with age in men
19
Sports Exercise Participation3

• 44 of men 53 of women aged 16-54 years did
  not participate in any form of sports or exercise
  4 weeks prior to the HSE
• Young men aged 16-24 years were more likely to
  participate in some sports and exercise of at
  least 15 minutes duration in comparison to
• Older men (45-54 years)
• Young females

20
Travel Patterns6

• The average time spent walking or cycling per
  person is decreasing and is now as little as 11.6
  minutes per day
• The total distance walked per year has fallen by
  19 since 1989/91
• The proportion of trips to work made on foot has
  fallen by 6
• Shopping trips made on foot have decreased by 16
  since 1985/6

21
Occupational Activity

• According to the Health Survey for England
  (1998)
• 28 of men aged 16-54 years were classified as
  moderately active at work compared to 16 of
  women of a similar age

22
Sedentary Behaviours7

• Approximately 5 of men and 6 of women do no
  physical activity at all.

UK Time Use Survey, 2002
23
Inequalities in Activity Socio-Economic Status3

• Participation in sport and exercise and walking
  was strongly related to social status

24
Inequalities in ActivityDisabled People8

• According to Sport England (2002)
• Participation rates in sport (including walking)
  for disabled adults were 24 lower than for
  non-disabled adults
• 51 disabled adults participated in some form of
  sport in the last four weeks compared to 75 of
  adults without a disability

25
Inequalities in ActivityMinority Ethnic Groups9

• According to HSE (1999)
• Men women from BME groups based in England are
  6 less likely to participate in physical
  activity compared with the indigenous population.
• Only 18 of men 7 women in Bangladeshi
  community meet the recommended physical activity
  levels

26
Summary

• The current evidence on sport, exercise and
  physical activity patterns of adult men and women
  aged 16-to-54 years highlights that the majority
  do insufficient levels to benefit their health

27
References

• Department of Health (1996). Strategy Statement
  on Physical Activity. London DH
• Department of Health (2004). At Least Five A
  Week Evidence on the impact of physical activity
  and its relationship to health. A Report from the
  Chief Medical Officer. London HMSO.
• Joint Health Surveys Unit (2004). Health Survey
  for England 2003 Trends Commentary. London The
  Stationary Office (In Press) www.dh.gov.uk
• Joint Health Surveys Unit (1999). Health Survey
  for England. London HMSO

28
References

• National Statistics Office Medical Research
  Council of Human Nutrition (2004). National Diet
  and Nutrition Surveyadults aged 19-64 years.
  London Stationary Office. Joint Health Surveys
  Unit (2002). Health Survey for England The
  Health of Children and Young People. London HMSO
  
• Sproston, K. Primatesta, P. (2003). Health
  Survey for England 2002 The Health of Children
  Young People. London The Stationary Office.
• Department for Transport (2004). Transport
  Trends. Seventh Edition. DfT London.
• Department for Transport (2004). National Travel
  Survey for Great Britain 2002. HMSO London.

29
References

• National Statistics Office. (2002). The UK Time
  Use Survey 2000. London NSO
• Sport England (2002). Adults with a disability
  and sport National Survey 200-2001. London
  Sport England. HMSO
• Joint Health Surveys Unit (2001). Health Survey
  for England The Health of Minority Ethnic Groups
  1999. London HMSO
• Department for Culture, Media and Sport and the
  Strategy Unit (2002). GAME PLAN A strategy for
  delivering Governments sport and physical
  activity objectives. London HMSO

30
ACTIVITY PATTERNS ADULTS IN LATER LIFEAged 50
Years and Over
31
General Trends3

• 81 of men and 87 of women aged 55 years and
  over do not reach the recommended levels of
  physical activity to benefit health
• There is a sharp decline in activity levels with
  age
• 32 of men aged 55 to 64 years were reaching the
  recommended levels
• This figure decreased by 15 for men aged 65-74
  years and a further 9 for men aged 75 years and
  over.

32
Functional capacity declines with age 3,4

• 1 in 4 women 1 in 14 men aged 50 years and over
  did not have the strength and power in their legs
  to perform general activities of daily living
  without assistance
• 20 of women 14 of men aged 50 years and over
  did not have the flexibility to wash their hair

33
Sports Exercise Participation3

• Participation in sporting activities of an
  intensity likely to produce health benefits
  declines with age

ADNFS HEA Survey of Activity Health (1999)
34
Sports Exercise Participation3

• Few men or women aged 50 years and over
  participated in sports and exercise more than
  once or twice a week
• Only 3 of men and 2 of women aged 50 years and
  over participated at least five times a week at
  an intensity to produce a health benefit

35
Travel Patterns5

• According to the National Travel Survey for GB
  (2001)
• Total distance walked cycled per year by men
  women showed a decline after the age of 60
• Men women aged over 60 years walked a total
• of 201 miles and 147 miles per year
  respectively
• After the age of 60, men made more walk only
  journeys than women, men also made about twice as
  many bicycle trips than women

36
Sedentary Behaviours6

• Men women aged 65 years and over, spend
  approximately three and three quarter hours a day
  on sedentary activities
• Over 75 of this time is spent watching TV or
  videos

37
Inequalities in Activity6,7

• Little data is available on socio-economic status
  and physical activity patterns in later life
• Participation rates in sport among
• disabled adults decreases with age

38
Inequalities in ActivityMinority Ethnic Groups

• Health Survey for England (2001) revealed
• The proportion of inactive black and minority
  ethnic men women increased with age
• Within the Bangladeshi community 85 of men 92
  of women aged over 55 years were sedentary
• Older Indian, Pakistani and Chinese men women
  also displayed low physical activity levels
• Older Black Caribbean men women had similar
  activity patterns to the indigenous population

39
Summary

• In later life physical activity has an important
  role to play in
• the maintenance of functional ability
• in the prevention of disability, immobility and
  isolation.
• Physical INACTIVITY in later life is a major
  public health burden

40
References

• Department of Health. (1996). Strategy Statement
  on Physical Activity. London DH..
• Department of Health (2004). At Least Five A
  Week Evidence on the impact of physical activity
  and its relationship to health. A Report from the
  Chief Medical Officer. London DH.
• Joint Health Surveys Unit (2004). Health Survey
  for England 2003 Trends Commentary. London The
  Stationary Office, In Press. www.dh.gov.uk

41
References

• Joint Health Surveys Unit (2002). Health Survey
  for England The health of older people. London
  Stationary Office Publication.
• Skelton, D.A., Young, A., Walker, A. and
  Hoinville, E. (1999). Physical activity in later
  life Further analysis of the Allied Dunbar
  National Fitness Survey of Activity and the
  Health Education Authority National Survey of
  Activity and Health. London HEA.
• Skelton, D.A. and McLaughlin, A.W. (1996).
  Training functional ability in old age.
  Physiotherapy. 82 (3) 159-167.

42
References

• Department of the Environment, Transport the
  Regions (2001). National Travel Survey for Great
  Britain. HMSO London.
• Department for Transport (2004). National Travel
  Survey for Great Britain. HMSO London.
• National Statistics Office (2002). Adults with a
  disability and sport National Survey 2000-2001.
  London Sport England.
• Sport England (2002). Adults with a disability
  and sport. London Sport England.
• Joint Health Surveys Unit (2001). Health Survey
  for England The Health of Minority Ethnic Groups
  1999. London HMSO.

43
PHYSICAL ACTIVITY AND HEALTHKey Facts and Figures
44
Opportunities for Physical Activity

• At work
• For transport
• In domestic duties
• In leisure time
• The majority of people do very little or no
  physical activity in any of these domains1

45
Health Risks of Physical Inactivity 1,2

• Has a substantial negative impact on individual
  and public health.
• Leading causes of disease and disability
  associated with physical inactivity
• Coronary Heart Disease (CHD)
• Stroke
• Obesity
• Type II Diabetes
• Hypertension

46
Health Risks of Physical Inactivity

• 6. Colorectal cancer
• 7. Stress and Anxiety
• 8. Osteo-arthritis
• 9. Osteoporosis
• 10. Low back pain
• 37 of CHD deaths can be attributed
• to physical inactivity
• Britton McPherson (2002)

47
Health Benefits of Physical ActivityPremature
Mortality

• 134, 611 men 89,756 women died prematurely
  from all-causes in 2000 in England
• Moderate-to-high levels of physical activity are
  associated with lower all-cause mortality rates
• Sedentary people experience a 1.2
• to a 2- fold increased risk of dying prematurely

48
Health Benefits of Physical ActivityCardiovascula
r Disease (CVD)

• 35 of premature deaths in men 27 of premature
  deaths in women are from CVD in England
• CHD accounts for 22 of premature deaths in men
  13 of premature deaths in women
• Individuals who are active are 1.9 times less
  likely to have a heart attack than inactive
  people 7

49
Health Benefits of Physical ActivityCancer

• Colo-rectal cancer accounts for 3 of premature
  deaths in men and women
• Over 7000 women died prematurely from breast
  cancer in England in 2000
• Regular physical activity is associated with a
  decreased risk of developing colon cancer by up
  to 50

50
Health Benefits of Physical ActivityType II
Diabetes

• 1.35 million people have been diagnosed with type
  II diabetes
• Regular physical activity lowers the risk of
  developing non-insulin dependent diabetes
  mellitus by 50
• Risk may also be reduced in groups of people with
  impaired glucose tolerance

51
Health Benefits of Physical ActivityHypertension

• 14 of deaths from CHD in men and 12 in women
  are due to raised blood pressure
• 37 of men 34 of women have hypertension in
  England
• Regular physical activity prevents or delays the
  development of high BP
• It also helps to reduce systolic
• diastolic BP by 6-7mmHg

52
Health Benefits of Physical ActivityOsteoporosis

• 1 in 3 women 1 in 12 men, over the age of 50,
  in the UK will sustain a spine, hip or wrist
  fracture due to osteoporosis
• 1 in 3 over 65s and 50 of over 85s fall each
  year
• Regular weight bearing physical activity is
  essential for normal skeletal development
• Strength training and other forms of exercise in
  older women reduces the risk of hip fracture by
  50

53
Health Benefits of Physical ActivityWeight
Control

• 46 of men and 32 of women are overweight
• 17 of men and 21 of women are obese
• Regular physical activity reduces
• the risk of becoming obese by
• 50 compared to people with
• sedentary lifestyles

54
Health Benefits of Physical ActivityPsychological
Well-being

• Mixed anxiety and depression is experienced by
  9.2 of adults in Great Britain
• Regular physical activity appears to
• Relieve symptoms of depression and anxiety
• Improve mood
• It may protect against the development of mild
  forms of depression
• It is associated with improved self-esteem

55
Health Benefits of Physical ActivityBrain
Function

• 18,500 people with dementia are
• aged under 65 years
• Physical activity enhances and protects brain
  function
• It may delay age-related neuron dysfunction and
  degeneration responsible for cognitive decline
  and personality changes 6

56
Health Benefits of Physical ActivityPainful
Conditions

• Physical activity
• Is essential for maintaining the health of joints
• Controls the symptoms of arthritis and
  osteoporosis
• Helps to improve stamina in people with
  disabilities
• Can help to prevent lower back pain
• Can help to manage lower back and knee pain

57
Health Benefits of Physical ActivityHealth
Related Quality of Life

• Physical activity improves health-related quality
  of life through
• Enhancing psychological well-being
• Improving physical functioning
• Enables individuals to maintain independence and
  mobility in later life

58
Health Risks of Physical Activity2,4

• Most musculo-skeletal injuries sustained during
  physical activity are likely to be preventable
• Injuries sustained during competitive sports have
  been shown to increase the risk of developing
  osteoarthritis
• Serious cardiac events can occur with physical
  exertion, HOWEVER, the overall benefit of regular
  physical activity is lower all-cause mortality

59
Inequalities in Health

• Mortality rates among men and women are 3 times
  higher for those in social class V than those in
  I
• There is a marked social gradient in many of the
  leading causes of disease and disability in the
  UK
• Physical Inactivity mirrors the health
  disparities seen among men and women in social
  class IV V
• Ethnic differences exist in mortality rates.

60
Summary

• Physical inactivity is estimated to cause 1.9
  million deaths globally
• The proportion of deaths attributed to physical
  inactivity is about 5-8
• Physical inactivity is one of the top 10 leading
  causes of death and disability in the developed
  world
• Health benefits of physical activity are
  particularly important for individuals in
  socio-economic groups IV and V

61

• Summary
• There are few public health initiatives that
  have greater potential for improving health and
  well-being than increasing the activity levels of
  the population in England.
• Chief Medical Officer, 2004

62
References

• Department of Health (2004). At Least Five A
  Week Evidence on the impact of physical activity
  and its relationship to health. A Report from the
  Chief Medical Officer. London DH.
• World Health Organisation (2002). The World
  Health Report Reducing risks, promoting healthy
  life. France WHO
• Britton and McPherson, K. (2002). Monitoring the
  progress of 2010 target for CHD Mortality
  Estimated consequences on CHD incidence and
  mortality from changing prevalence of risk
  factors. London National Heart Forum

63
References

• British Heart Foundation (2004). Coronary Heart
  Disease Statistics BHF Statistics Database.
  London British Heart Foundation.
• US Department of Health and Human Services,
  Centres for Disease Control and Prevention,
  National Centre for Chronic Disease Prevention
  and Health Promotion, The Presidents Council on
  Physical Fitness and Sports. (1996). Physical
  Activity and Health A report of the Surgeon
  General. Pittsburgh CDC.
• Blair, S.N. et al. (1992). How much physical
  activity is good for health? Annual Review of
  Public Health, 13 99-126.

64
References

• Joint Health Surveys Unit. (1999). Health Survey
  for England 1998. London.
• Department of Health (2002). Health Survey for
  England 2002 Trend Data. See DH website
  www.publications.doh.gov.uk/stats/trends1.htm
• National Osteoporosis Society (2002). Primary
  Care Strategy for Osteoporosis and Falls. A
  Framework for health improvement programmes
  implementing the National Service Framework for
  Older People. www.nos.org.uk/PDF/PCGDoc2002.pdf

65
References

• Spirduso (1996). Physical Dimensions of Ageing.
  Illnois Human Kinetics.
• Office for National Statistics (2000). London
  Office for National Statistics.
• Cotman, C.W. Engesser-Cesar, C (2002).
  Exercise enhances and protects brain function.
  Exercise Sport Science Reviews. 30 (2) 75-79.

66
YOUNG PEOPLES HEALTH TRENDSAGED 5-18 YEARS
67
Prevalence of Obesity

• Over a fifth of boys and a quarter of girls are
  overweight or obese
• The number of obese children has almost doubled
  among boys between 1997 and 2002.
• Obese children have a 20-25 chance of becoming
  obese adults3
• More than 60 of overweight children have at
  least one additional risk factor for
  Cardiovascular Disease CVD4
• More than 20 of obese children have 2 or more
  risk factors for CVD4

68
Inequalities in Obesity

• Obesity prevalence is more common in boys than
  girls (7.9 v 6.7)5
• Overweight and obesity is more common in children
  from most deprived areas.
• Boys were 12 times more likely to be obese if
  they had 2 obese parents.

69
Type II Diabetes

• Overall prevalence of Type II Diabetes is unknown
• Children of some ethnic groups are more
  susceptible to type II diabetes
• At least 4 white English adolescents, aged 13-15
  years, are known to have developed type II
  diabetes9 as a direct consequence of obesity9

70
Mental Health9

• Among children aged 5-15 years, 10 had one or
  more mental health disorders
• More common among boys than girls, and older
  rather than younger children
• Nearly 10 of white children and 12 of black
  children have been diagnosed as having some form
  of mental health problem

71
Inequalities in Mental Health10

• Family characteristics
• Children of lone parents are twice as likely to
  have a mental health problem than those living
  with married or cohabitating couples
• Children from a lower socio-economic background
  are more likely to have mental health problems
  than those from a higher socio-economic background

72
Asthma10,11

• The number of new cases of Asthma is now 6 times
  higher in children than it was 25 years ago
• 1 in 8 children are currently being treated for
  asthma
• For every 100,000 patients in a primary care
  organisation, there will be at least 4000 with
• asthma, 50 visiting their GP at least
• once per year

73
Summary

• The current health trends of Young People are
  cause for concern
• Overweight and obesity in young people is
  increasing
• Recently cases of type II diabetes in white,
  English adolescents have been reported
• 1 in 10 children experience some form of Mental
  Health problem
• The UK has one of the highest prevalence rates of
  asthma in the world

74
References

• Chinn, S Rona, R.J. (2001). Prevalence and
  trends in overweight and obesity in three
  cross-sectional studies of British children,
  1974-1994. British Medical Journal. 322 24-36.
• International Obesity Taskforce and European
  Association for the Study of Obesity (2002).
  Obesity in Europe the case for action. London
  International Taskforce and Association for the
  Study of Obesity.
• Sproston, K. Primatesta, P. (2002) Health
  Survey for England The Health of Children
  Young People. London HMSO.
• New South Wales Childhood Obesity Secretariat.
  (2002). Childhood Obesity Background Paper. NSW
  Center for Public Health Nutrition.

75
References

• Freedman, D.S., Dietz, W.H., Srinivasan, S.R.
  Berenson, G.S. (1999). The relation of
  overweight to cardiovascular risk factors among
  children and adolescents The Bogalusa Heart
  Study. Pediatrics. 1031175-1182.
• Department of Health. (2004). At Least Five a
  Week Evidence on the impact of physical activity
  and its relationship to health. A report from the
  Chief Medical Officer. London Department of
  Health Publications.
• Armstrong, J., Reilly, J.J. Child Health
  Information Team Information Statistics
  Division, Edinburgh. (2001). Assessment of the
  National Child Health Surveillance System as a
  tool for obesity surveillance at national and
  health board level. www.show.scot.nhs.uk

76
References

• Saxena, et al. (2004). Ethnic group differences
  in overweightand obese children and young people
  in England cross-sectional survey. Archives of
  Disease in Childhood. 8930-36.
• Barrett, T.G., Ehtisham, S., Smith, A.
  Hattersley, A.T. (2002). Pediatric diabetes
  survey shows type 2 diabetes prevalence 0.4,
  distinct from type 1, and associated with
  overweight, puberty, female sex and ethnic
  minority status. Endocrin Abstracts. 3108.

77
References

• Howdle, S. Wilkin, T. (2001). Type 2 diabetes
  in children. Nursing Standard. 15 (18) 38-42.
• Drake, A.J., Smith, A., Betts, P.R., Crowne, E.C.
  Shield, J.P.H. (2002). Type 2 diabetes in
  obese white chidlren. Archives of Disease in
  Childhood. 86 207-208.
• American Diabetes Association (2000). Type 2
  diabetes in children and adolescents.
  Paediatrics. 105 671-680.

78
References

• Office for National Statistics. (2000). The
  mental health of children and adolescents in
  Great Britain Summary Report. London NSO.
• National Asthma Campaign (2001). Asthma Audit
  2001. The Asthma Journal. 6 (3).
• National Asthma Campaign (2002). Starting as we
  mean to go on An audit of childrens asthma in
  the UK. The Asthma Journal. Special Supplement. 8
  (2).

79
PHYSICAL ACTIVITY, SPORT EDUCATIONTheir Value
to Education
80
School as a Setting for Promoting Physical
Activity Sport

• Schools provide the opportunity to address the
  full range of individuals in a population - a
  captive audience3
• Any positive impact from schools has the
  potential to have an immediate and lifetime
  effect4
• Schools have the responsibility to develop young
  peoples physical skills and to encourage them to
  recognise the importance of a healthy lifestyle 5

81
Schools as a Setting for Promoting Physical
Activity Sport 6, 7

• All children, whatever their circumstances or
  abilities, should be able to participate in and
  enjoy physical education and sport
• (DfES DCMS 2002 p1)
• The schools role in promoting physical
  education, sport and physical activity is
  increasingly important given the rising obesity
  problem in children 7

82
Academic Achievement8

• Participation in regular physical activity and
  sport has been linked to improved academic
  performance in several studies
• Shephard (1997) found academic performance was
  maintained or even enhanced through an increase
  in physical activity levels
• When curricular time was allocated to physical
  activity learning seemed to proceed more rapidly
  per unit of classroom time
• Academic development is not compromised by an
  increase in time spent on PE (Shephard, 1997,
  p113)

83
Academic Achievement 9,10

• A project called Fit to Succeed found scores in
  government S.A.T.s were highest among children
  who reported exercising hard at least 3 times per
  week 9
• Improved numeracy and literacy scores have been
  reported in the latest independent review of the
  Government Initiative Playing for Success10

84
Academic Achievement,11, 12

• Successful PE and school sport contribute to
• Higher levels of participation and achievement 11
• Higher levels of attainment 11
• Relaxed and focused pupils12

85
Social Inclusion 11,13

• Sport and physical activity may be a tool to
  engage the most vulnerable young people 13
• PE and school sport contribute to11
• Lower levels of truancy and improved behaviour
• Reduced negative behaviour
• A decline in exclusions

86
Social Inclusion 14

• There are strong theoretical arguments for the
  potential positive contribution sport can make to
  reduce the propensity to commit crime
• 25 of males 15 of females, aged 12-17 years,
  admitted committing at least 1 offence 14
• 50 of these offenders committed persistent
  and/or serious offences 14

87
Social Inclusion 15

• Programmes focusing on outreach approaches and
  non-traditional, local provision appears to have
  the best chance of success
• Sport is most effective when combined with
  programmes that address personal and social
  development

88
The Environment 3,16

• During 2001 there were 2,608 road accidents
  involving pedestrians aged 5-7 years across Great
  Britian16
• 18 of cars in urban areas at the morning peak
  times are taking children to school 16
• School environments and policies are not always
  conducive to physical activity 3

89
Summary

• Cross-sectional and longitudinal studies have
  shown that the rate of academic learning per unit
  of class time is enhanced in physically active
  students
• Lack of curricular time is not a valid reason for
  denying children daily quality PE
• Active children tend to be healthier, happier and
  better learners than their sedentary peers

90
References

• Department of Health (1999). Saving Lives Our
  Healthier Nation. London HMSO.
• Acheson, D. (1998). Independent inquiry into
  inequalities in health report. London HMSO
• Cale, L. (2000). Physical activity promotion in
  secondary schools. European Physical Education
  Review. 6 (1) 71-90
• Fox, K.R. (1996). Physical activity promotion and
  the active school. In N. Armstrong (ed.). New
  directions in physical education. London Cassell
  Education. pp. 94-109

91
References

• Department for Education and Employement,
  Qualifications and Curriculum Authority (1999).
  The National Curriculum. London Stationary
  Office. P11
• Department for Education and Skills and
  Department for Culture Media and Sport. (2002).
  Learning through PE and sport A guide to
  physical education, school sport and club links
  strategy. London DfES
• Reilly, J.J. Dorosty, A.R. (1999). Epidemic of
  obesity in UK children. The Lancet. 354 Nov 27
• Shephard, R.J. (1997). Curricular physical
  activity and academic performance. Pediatric
  Exercise Science. 9 113-126

92
References

• To view the Fit to Succeed report and
  associated dpress releases visit
  http//www.sheu.org.uk/fts/fts.htm
• Department for Education and Skills (2003).
  Playing for Success 4th Evaluation Report.
  Nottingham National Foundation for Educational
  Research.
• Qualifications and Curriculum Authority (2001).
  Survey into Physical Education and School Sport.
• Health Education Board for Scotland. (2001).
  Evaluation of Class Moves!. Scottish Council for
  Research in Education Edinburgh.

93
References

• Sport England (1999). The Value of Sport. London
  Sport England.
• Home Office (1999). Aspects of Crime Young
  Offenders. London HMSO.
• Collins, M.F. (2002). Sport and Social Exclusion.
  London Routledge.
• Department for Transport (2001). School Travel.

94
ECONOMIC COSTS OF PHYSICAL INACTIVITY
95
Cost of Physical Inactivity1

• Estimated costs are 8.3 billion per year in
  England
• Includes direct costs of treatment for major
  lifestyle related diseases
• Includes indirect costs through sickness absence

96
Health Risks of Physical Inactivity 2,3

• Physical inactivity is a major risk factor for
  CHD 3
• Individuals who are inactive are 1.9 times more
  likely to have a heart attack 3
• 37 of CHD deaths can be attributed to physical
  inactivity 3
• 19 are attributed to smoking 4
• 13 are attributed to high blood
• pressure4

97
Healthcare Costs of Diseases Associated with
Physical Inactivity 5-8

• CHD costs the UK health care system 1.73
  billion5
• Stroke accounted for 1.8 billion of NHS
  expenditure6
• Direct costs of obesity are at least 500 million
  per year7
• Diabetes treatment accounts for
• approximately 5.2 billion8

98
Healthcare Costs of Diseases Associated with
Physical Inactivity9,10

• Osteoporosis results in over 200 000 fractures
  each year, costing the NHS over 940 million8
• Approximately 1,632 million was spent on back
  pain in the UK10
• 6.5 billion was spent on mental health services
  in the NHS last year in England alone

99
Economic Costs of Diseases Associated with
Physical Inactivity 5-7

• CHD cost the UK economy 5.33 billion through
  informal care and lost productivity5
• Stroke resulted in 7.7 million lost working days
  about 459 million in lost production6
• Obesity costs to the individual and industry are
  approximately 2 billion per year7

100
Economic Costs of Diseases Associated with
Physical Inactivity 10,11

• Type II diabetes costs industry around 564
  million per year11
• Insulin dependent diabetes costs a further 231
  million11
• Back pain cost the economy 10,700 million from
  lost production and informal care10

101
Potential Savings

• Northern Ireland Physical Activity Strategy aims
  to
• Reduce sedentary population from 20 to 15
• This will result in
• At least 121 saved lives per year among under 75
  years
• An associated economic benefit of 131 million

102
Potential Savings

• Physical Activity Strategy for Scotland
• Estimated that 85.2 million could be saved if
  levels of inactivity were reduced by 1 each year
  for the next 5 years
• These economic benefits are associated with the
  number of life years saved through
• preventing premature death from
• CHD, strokes and colon cancer

103
Potential Savings

• 9 of CHD could be avoided if sedentary and
  lightly active became more moderately active4
• Regular moderate physical activity has the
  potential to reduce half the incidence of hip
  fractures in over 45 year olds12
• Risk of death in men who walk more than 1 mile a
  day is 1.8 times that of men who walk less than 1
  mile a day16

104
Potential SavingsDiabetes 13

• A landmark clinical trial (RCT) found that diet
  exercise were significantly more effective than
  metformin in the prevention of diabetes in
  glucose intolerant patients
• Lifestyle intervention group reduced incidence of
  diabetes by 58 compared with the placebo,
  metformin reduced incidence by 31
• To prevent 1 new case of diabetes need to treat
• 6.9 persons for 3 years with lifestyle
  intervention
• 13.9 persons for 3 years with metformin

105
Potential SavingsFunctional Decline

• 50 of all fallers who fracture their hips are
  never functional walkers again
• 1 in 5 will die within 6 months
• It is possible to reverse age- and
  activity-related decline relatively quickly with
  physical activity

106
Summary

• Physical inactivity costs the economy an
  estimated 8.3 billion
• The total cost of all CHD related burdens was
  7.06 billion in 1999
• If the current obesity trends are not reversed
  then diabetes healthcare costs will increase by
  15 over the next 20 years
• Developing public policy to create a supportive
  environment for physical activity has the
  potential to save lives, healthcare resources and
  industry lost production costs.

107
References

• Department of Health (2004). At Least Five a
  Week Evidence on the impact of physical activity
  and its relationship to health. A Report from the
  Chief Medical Officer. London DoH.
• World Health Organisation (2002). Report on the
  global burden of disease from 22 health risk
  factors. Geneva WHO
• Blair, S.N. et al., (1992). How much physical
  activity is good for health? Annual Review of
  Public Health. 13 99-126
• Britton, A. McPherson, K. (2002). Monitoring
  the progress of the 2010 target for CHD
  mortality Estimated consequences on CHD
  incidence and mortality from changing prevalence
  of risk factors. London National Heart Forum.

108
References

• Liu, J.L.Y., Maniadakis, N., Gray, A. Rayner,
  M. (2002). The economic burden of Coronary Heart
  Disease in the UK. Heart. 88 597-603.
• Bosanquet, N. Franks, P. (1998). Stroke care
  reducing the burden of disease. London Stroke
  Association.
• National Audit Office (2001). Tackling Obesity.
  London NAO.
• Diabetes UK (2003). London Diabetes and Lip
  Centre.

109
References

• Dolan, P Togerson, D.J. (1998). The cost of
  treating osteoporotic fractures in the UK female
  population. Osteoporosis International. 8
  611-617 Manaiadikis, N. Gray, A. (2000). The
  economic burden of back pain in the UK.
• Gray, A., Fenn, P., et al. (1996). Economic
  analysis of diabetes. Journal of Diabetes and Its
  Complications. 10 149-150.
• Nicholl, J.P., Coleman, P. and Brazier, J.E.
  (1994). Health and health care costs and benefits
  of exercise. Pharmoeconomics. 5 (2) 109-122.

110
References

• Knowler, W.C., Barrett-Connor, E., Fowler, S.E.
  et al., (2002). Reduction in the incidence of
  type 2 diabetes with lifestyle intervention or
  metformin. New England Journal of Medicine. 346
  (6) 393-403.
• Tuomilehto, J., Lindstorm, J., Eriksson, J.G.
  et.al. (2001). Prevention of type 2 diabetes
  mellitus by changes in lifestyle among subjects
  with impaired glucose tolerance. New England
  Journal of Medicine. 344 (18) 1843-1350.
• Pan, X.R., Li, G.W., Hu, Y.H. et al. (1997).
  Effects of diet and exercise in preventing NIDDM
  in people with impaired glucose tolerance.
  Diabetes Care, 20 (4) 537-544.

111
References

• Hakim, A.A., Petrovitch, H., Burchfield, C.M. et
  al. (1998). Effects of walking on mortality among
  non-smoking retired men. New England Journal of
  Medicine. 338 94-99.
• Spirduso, W. (1996). Physical dimensions of
  ageing. Illnois Human Kinetics.
• Skelton, D.A. McLaughlin, A.W. (1996).
  Training functional ability in old age.
  Physiotherapy. 82 (3) 159-167.
• Sainsburys Centre for Mental Health.

112
HEALTH POLICY STATEMENTSRelevance to sport
physical activity
113
Saving Lives Our Healthier Nation (1999)

• Cancer To reduce the death rate in people under
  75 by at least 1/5th
• CHD StrokeTo reduce the death rate in people
  under 75 by at least 2/5th
• Accidents To reduce the death rate by at least
  1/5th and serious injury by at least 1/10th
• Mental Illness To reduce the death rate from
  suicide and undetermined injury by at least 1/5th

114
Potential Influence of Physical Activity I

• Physical activity reduces the risk of
• Death from heart disease/stroke
• Developing heart disease and colon cancer
• Helps to prevent/reduce the risk of osteoporosis
• Hip fracture in women
• Promotes psychological well-being

115
NHS Plan (2000)

• Section 1.5 of the plan states that NHS will
• provide a growing range of products and services
  to help people adopt healthier lifestyles
• Advice on diet and exercise will be accepted as a
  routine service at the local surgery
• Section 13.21 of the plan requires
• Local action to tackle obesity and physical
  inactivity by 2004

116
Priorities and Planning Framework (2003-2006)

• Update practice-based registers so that people
  with CHD and diabetes receive appropriate advice
  on physical activity.
• By 2005, all general hospitals and all health and
  social care systems will have established an
  integrated falls service
• A national reduction in death rates from
• CHD of at least 25 in people under 75

117
Potential Influence of Physical Activity II

• Physical activity has a protective effect against
  developing type II diabetes
• Lowering the risk of developing non-insulin
  dependent diabetes by 50
• Effective against falling and fractures among
  adults in later life (by up to 50)

118
National Service Frameworks (NSFs)Mental Health
(1999)

• HIMPs should demonstrate links between NHS
  organisations and partners to promote mental
  health in schools, individuals at risk and groups
  who are most vulnerable (April 2000)
• Protocols should be agreed and implemented
  between Primary Care and specialist services for
  the management of several mental health disorders
  (April 2001)

119
NSF CHD (2000)

• Standard One
• Quantitative data about the implementation of
  policies on promoting physical activity
• Implemented plans to evaluate progress against
  national targets associated with Saving Lives
  Our Healthier Nation
• Standard Three
• Every practice to offer advice about each of the
  specified effective interventions to all those in
  whom they are indicated

120
NSF CHD (2000)

• Standard Four
• Clinical audit data that describes the relevant
  effective interventions should be available
• Standard Twelve
• More than 85 of people discharged from hospital
  with a primary diagnosis of AMI are offered
  cardiac rehabilitation and 1 year after
  discharge, at least 50 are non-smokers, regular
  exercisers and have a BMI lt30kg/m2.

121
NSF Older People (2001)

• Standard Five
• Every GP can identify and treat patients
  identified as being at risk of high blood
  pressure or other risk factors
• Standard Six
• Local health care providers should have put
• in place risk management procedures to reduce
• the risk of falling
• All local and social care systems should have
• established an integrated falls service

122
NSF Older People (2001)

• Standard Eight
• Local health systems should be able to
  demonstrate ongoing improvements in
• measures of health and well-being
• E.g. blood pressure management

123
NSF Diabetes (2003)

• Standard One
• Strategies to reduce the risk of developing Type
  2 diabetes and to reduce the inequalities in risk
  need to be developed, implemented and monitored
• Standard Three
• All children, young people
• adults with diabetes will receive a
• service that helps them to adopt and
• maintain a healthy lifestyle

124
NSF Diabetes (2003)

• Standard Four
• Support to optimise the control of blood glucose
  and blood pressure and other risk factors for
  developing complications
• Standard Five
• Children and young people will be supported to
  optimise the control of their blood glucose

125
NSF Childrens Service Framework (2003)

• Standards for Hospital Services
• Child-Centred services an active role to
  improve health and tackle inequalities
• A basic need for play and recreation that needs
  to be met through offering a variety of play
  interventions

126
Childrens NSF Core Standards

• Standard 1 promoting health and well-being,
  identifying needs and intervening early
• Standard 2 supporting parenting
• Standard 3 Child, young person
• and family-centred services
• Standard 4 Growing up into
• adulthood

127
National Cancer Plan

• The National Cancer Plan recommends
• Providing ongoing guidance on supervised
  programmes of exercise for people whose health
  may benefit

128
Chief Medical Officer Annual ReportThe State of
Public Health

• Leisure and Sports Industry
• Market participation in sport and exercise as
  cool
• Local Government
• Use the facilities provide in the area,
  addressing needs of all
• Policies that encourage active
• transport should be a priority

129
Chief Medical Officer Annual ReportThe State of
Public Health

• PCTs
• work with partner organisations on exercise
  referral for high risk groups
• GPs and Primary Care
• Take action to prevent and tackle obesity in
  their practice populations
• Health Professionals
• Identify early signs of obesity in children and
  offer interventions at an early stage

130
General Medical Services Contract (2003)

• Essential Services
• Management of patients who are ill with
  conditions from which recovery is expected,
  including relevant health promotion advice and
  referral as appropriate
• Management of 10 chronic diseases CHD, stroke,
  hypertension, diabetes, chronic obstructive
  airways disease, epilepsy, cancer, mental health,
  hyperthyroidism and asthma.

131
General Medical Services Contract (2003)

• Recommendations for Primary Care Sector
• Supporting non-GP based chronic disease
  management schemes helping to manage ongoing,
  and develop new secondary prevention initiatives
• Promote education of young people about
  management of health, maintaining health and how
  to use health services responsibly

132
National Healthy SchoolStandard (NHSS)

• Guidance Criteria for Physical Activity
• A whole-school approach to the promotion of
  physical activity
• Offers a minimum of 2 hours of physical activity
  a week within and outside the National Curriculum

133
National Healthy School Standard

• Aware of a range of relevant initiatives and
  networks and takes advantage of appropriate
  opportunities to promote and develop physical
  activity
• Encourages people to become involved in promoting
  physical activity and develops their skills,
  abilities and understanding through appropriate
• training

134
Tackling Obesity in England

• Set realistic milestones and targets for
  improving nutrition and diet, promoting physical
  activity and for arresting the rising trends of
  overweight and obesity
• Build on the plan in the NSF for CHD for a full
  assessment of risk factors to be carried out in
  general practice
• Encourage other potential partners to adopt local
  targets for cycling and walking

135
Tackling Obesity in England

• Work with local agencies to help them develop
  targets to increase the number of school journeys
  made on foot, by bicycle or public transport
• The adoption of joint performance targets for
  increasing the number of people participating in
  sport and physical activity
• Continue to encourage all schools to achieve at
  least 2 hours of physical activity a week for
• all pupils

136
Department of Health (2000) Improving Working
Lives

• 3 Stages to achieving the IWL Standard
• Pledge organisations need to put in place the
  policies, procedures and plans to achieve
  accreditation
• Practice provide a portfolio of evidence over a
  wide range of policies and procedures that
  improve working lives of staff
• Practice Plus awarded when all the gaps have
  been remedied

137
Independent Inquiry into Inequalities in Health
Report (1998)

• The further development of health promoting
  schools
• Further measures to encourage walking and cycling
  as forms of transport
• Policies to improve the health and nutrition of
  women of childbearing age and their children
• Priority to the elimination of food poverty
• and the prevention and reduction of obesity

138
Independent Inquiry into Inequalities in Health
Report (1998)

• Physical and psychological health needs of
  looked after children are to be identified and
  addressed
• Policies that promote moderate intensity exercise
  are recommended

139
Independent Inquiry into Inequalities in Health
Report (1998)

• Policies that promote the maintenance of
  mobility, independence and social contacts
• The needs of ethnic minority groups need to be
  specifically considered in needs assessment,
  resource allocation, healthcare planning and
  provision
• Recommends alternative methods of focusing
  resources for health promotion and public health
  care to be considered

140
Tackling Health InequalitiesSummary of the 2002
Cross-Cutting Review

• Priority narrow the gap in life expectancy by
  area, by 2020, to be achieved through
• Early identification and intervention of physical
  inactivity, obesity and hypertension

141
Tackling Health InequalitiesSummary of the 2002
Cross-Cutting Review

• Physical inactivity is a significant causal
  factor for socio-economic differences in the
  incidence of heart disease
• Recommend policies that give people the skills,
  information and support to make and sustain
  healthy lifestyle choices

142
Tackling Health InequalitiesA Programme for
Action

• School Sport Coordinator programme expanded
• Health needs of young people who spend time in
  prison need to be assessed and comprehensive
  health promotion put in place
• Raising physical activity levels to reduce risk
  of illness
• Safer local environments for young people to
  engage in social and physical activities in
  public places

143
Wanless Report (2002)

• More success in public health to reduce
  projected overall resource requirements
• Focus on health promotion and disease prevention
• Change in the way public health is viewed,
  resourced and delivered, therefore supporting a a
  public that is more engaged in maintaining health

144
Department of Health (1996) Strategy Statement on
Physical Activity

• Recommendations
• Those already taking vigorous activity maintain a
  total of 3 periods of vigorous activity of 20
  minutes a week
• Those doing irregular activity should try to
  accumulate 30 minutes of moderate intensity
  physical activity on most days of the week
• Those engaged in promoting physical activity need
  to consider how to assess the impact of local
  policies in particular areas and for special
  groups

145
Overview and Scrutiny Committees Health
Scrutiny Regulations (2003)

• A lever to improve the health of local people
• Focus on health improvement
• Matters to be reviewed and scrutinised
• Arrangements made by local
• NHS bodies for public
• health in the authoritys area

146
At Least Five A Week (DH, 2004)

• At least 30 minutes on 5 or more days of the
  week, of at least moderate intensity physical
  activity for general health in adults.
• Children and young people should participate in
  at least 60 minutes of at least moderate
  intensity physical activity a day.
• 45-60 minutes of moderate intensity physical
  activity is necessary to prevent obesity in
  adults.

147
NHS Improvement Plan

• Reinforces the flexibility given to GPs in the
  GMS contract.
• Encourages the development of partnerships
  between NHS organisations and alternative service
  providers.
• Encourages collaborative work at a local and
  national level.

148
Wanless Report (2004)Securing Good Health for
the Whole Population

• The need for action is too pressing for the lack
  of a comprehensive evidence-base to be used as an
  excuse.
• Future resource allocations should be conditional
  on proper evaluation of initiatives to build up
  the evidence-base.
• Lower-medium term physical activity targets
  should be set.
• PCTs and Local Authorities should agree joint
  local targets considering national objectives and
  local needs.

149
Choosing Health (DH, 2004)

• 3 underlying principles informed choice,
  personalisation and partnership working
• 6 overarching priorities
• Decrease number of people who smoke
• Decrease obesity
• Increase number of people who exercise
• Encourage and support sensible drinking
• Improve sexual health
• Improve mental health

150
References

• Department of Health (1999) Saving Lives Our
  Healthier Nation. London HMSO.
• Department of Health (2000) The NHS Plan A plan
  for investment, A plan for reform. London HMSO.
• Department of Health (2002) Improvement,
  expansion and reform The next 3 years.
  Priorities and Planning Framework 2003-2006.
  London HMSO.
• Department of Health (1999) National Service
  Frameworks Mental Health. London Department of
  Health Publications.

151
References

• Department of Health (2000) National Service
  Frameworks Coronary Heart Disease. London
  Department of Health Publications.
• Department of Health (2000) National Cancer Plan.
  London Department of Health Publications.
• Department of Health (2001) National Service
  Frameworks Older People. London Department of
  Health Publications.
• Department of Health (2003) National Service
  Frameworks Diabetes. London Department of
  Health Publications.

152
References

• Department of Health (2003) National Service
  Frameworks Childrens Services - Part 1.
  London Department of Health Publications.
• Department of Health (2003) Health Check on the
  state of the public health. Annual Report of the
  Chief Medical Officer. London Department of
  Health Publications.
• Department of Health (2003) The new General
  Medical Services Contract. London Department of
  Health Publications.
• Department for Education and Employment and
  Department of Health (1999) National Healthy
  School Standard Guidance.

153
References

• National Audit Office (2001) Tackling Obesity in
  England. London The Stationery Office.
• Department of Health (2001) Improving Working
  Lives Standard. London Department of Health
  Publications.
• Department of Health (1998) Acheson Independent
  Inquiry into Inequalities in Health Report.
  London The Stationery Office.
• HM Treasury Department of Health (2003)
  Tackling Health Inequalities Summary of the 2002
  cross-