recommendation - Research library - 'We can move' insight2024-03-29T15:54:36Zhttps://www.wecanmoveinsight.net/articles/feed/tag/recommendationRadical Accessibility: Research and Recommendations A deep dive into how accessible charities are during Covid-19 and beyondhttps://www.wecanmoveinsight.net/articles/radical-accessibility-research-and-recommendations-a-deep-dive-in2020-08-05T12:03:26.000Z2020-08-05T12:03:26.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://reasondigital.com/insights/radical-accessibility-charities/">https://reasondigital.com/insights/radical-accessibility-charities/</a></p>
<p>8th July 2020</p>
<p><a href="{{#staticFileLink}}7249064879,original{{/staticFileLink}}">Radical-Accessibility-Report.pdf</a></p>
<p><strong>Executive Summary</strong></p>
<p><br />We’ve heard it a thousand times:whatwe’re living through is unprecedented. Every experience, pattern and data point in 2020 is an anomaly…and what charities and their beneficiaries are contending with is no exception to this.Coronavirus has resulted in a massive, global shock to the system: in terms of health, society and the environment. As a result, there is a greater need for support, at a time when charities are more stretched than ever.</p>
<p><br />With offline services largely out-of-bounds, there is a renewed need for - and focus on - the extent to which charities have adapted to online outreach and delivery of those services. More specifically: can potential service users access online charity services, regardless of their accessibility needs? Coronavirus itself, as well as its numerous indirect effects, is hitting those with pre-existing health conditions (and, by proxy, those who may be relying on charities) disproportionately, so the need tomake charity services both online and accessible has never been greater.</p>
<p><br />In this report, we share with you unique insights into the world of digital accessibility in the charity sector: the attitudes and behaviours of beneficiaries, the accessibility needs of those accessing your website, the impact of coronavirus and, ultimately,what you - as a forward-thinking charity - should do. We build on the knowledge gained fromour 12 years in the digital charity sector, our annual research into digital charity trends, a brand-new, bespoke and nationally representative survey of the general public, and the cutting-edge insights fromsome of the industry’s leading minds inmaking charities accessible.</p>
<p><br />In our findings, we show that:<br />Our digital world is less accessible than our physical world<br />Accessibility is not binary<br />Coronavirus is disproportionately affecting disabled people<br />There is an unmet demand for charity services<br />Proactive charities are benefitting</p>
<p>We also provide to you a list of evidenced and sector-specific recommendations, to help you better meet the needs of your service users, and give your charity the best possible chance of future-proofing its online offering in an accessible and equitableway:<br />Open a dialogue<br />Help the few to help the many<br />Innovate through disability<br />Be accessible by default</p></div>Prioritise play when schools reopen, say mental health expertshttps://www.wecanmoveinsight.net/articles/prioritise-play-when-schools-reopen-say-mental-health-experts2020-05-13T09:01:33.000Z2020-05-13T09:01:33.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://www.theguardian.com/education/2020/may/07/prioritise-play-when-schools-reopen-say-mental-health-experts-coronavirus-lockdown">https://www.theguardian.com/education/2020/may/07/prioritise-play-when-schools-reopen-say-mental-health-experts-coronavirus-lockdown</a></p>
<p>May 2020</p>
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<p><a class="u-underline" href="https://www.theguardian.com/society/youngpeople+mental-health">Child mental health</a> experts have urged the government to prioritise children’s play and socialising with friends over formal lessons and academic progress when schools in England reopen and lockdown restrictions are eased.</p>
<p>They say they are “extremely concerned” about the impact of the lockdown and more than six weeks without face-to-face play with peers on child mental health. They are calling on ministers to ensure that play is at the top of newly permitted activities.</p>
<p>They are also calling for <a class="u-underline" href="https://www.theguardian.com/society/children">children</a> to be allowed to play with their peers without social distancing as soon as it is safe to do so, based on a “risk-benefit approach”, recognising the benefits while ensuring children are not exposed to unnecessary risk.</p>
<p>Helen Dodd, professor of child psychology at the University of Reading, said: “Returning to school after a long period at home will be challenging for lots of children. It will be especially challenging if they are expected to remain 2 metres away from their friends.</p>
<p>“We ask that, once it is safe to do so, the loosening of lockdown is done in a way that allows children to play with their peers, without social distancing, as soon as possible. This may mean that close play is only permitted in pairs or small groups or within social bubbles that allow repeated mixing with a small number of contacts.”</p>
<p>The experts, who specialise in child mental health and development, warn that children will be suffering from loneliness and isolation after being required to stay at home as part of the national effort to stem the spread of coronavirus.</p>
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<p>While ministers will be keen for schools to kickstart academic studies and begin the process of catching up on work missed, the panel of experts who represent five universities including Cambridge and Sussex, say play will be essential to help relieve stress and anxiety among children.</p>
<p>In a letter to the education secretary, <a class="u-underline" href="https://www.theguardian.com/politics/gavin-williamson">Gavin Williamson</a>, they write: “At this time, many children’s emotional health will be suffering due to loneliness and isolation. As experts in children’s mental health and development we urge the government to prioritise children’s social and emotional wellbeing in all decisions related to the easing of lockdown restrictions and the reopening of schools.”</p>
<p>Focusing on children aged 3-11, they recommend a series of measures to support children as the country emerges from lockdown, asking the government to ensure that children have the time and opportunity to play with their peers, both in school and outside.</p>
<p>They say schools should be given the necessary resources and guidance on how to support children’s emotional wellbeing as schools reopen and that “play should be a priority during this time, rather than academic progress”.</p>
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<p>“We hope that when policy decisions are made in the coming weeks and months that children’s emotional health is given the consideration it deserves,” the letter says. “Poor emotional health in children leads to long-term mental health problems, poorer educational attainment and has a considerable economic burden.”</p>
<p>The panel based their recommendations on a “<a class="u-underline" href="https://osf.io/qh5fp/">rapid review</a>” of academic literature exploring the harmful impact of isolation on children and the alleviating benefits of play, including one study which found that children who experienced quarantine or social isolation in previous pandemics were five times more likely to need mental health interventions than those who did not.</p>
<p>Sam Cartwright-Hatton, professor of clinical child psychology at the University of Sussex, said: “All the research indicates that children’s emotional health is suffering in the lockdown and it seems likely that this suffering will, in many cases, continue into the long term. We are urging ministers and policymakers to ensure that children are afforded substantial, and if possible enhanced, access to high-quality play opportunities as soon as possible.”</p>
<p>Dr Jenny Gibson, senior lecturer in psychology and education at the University of Cambridge, added: “It’s easy to dismiss play as unimportant, but for children, playing with friends and classmates has a very significant impact on their social development.</p>
<p>“Critically, it is an important way of working through emotions and will therefore be one of the principal ways in which they cope with the isolating effects of the lockdown. For that reason it’s important that whatever steps are taken to ease social distancing restrictions, children are given time and space to play with friends.”</p>
<p>A government spokesperson said: “We recognise the importance of children and young people’s mental health and wellbeing during the coronavirus outbreak. That is why we have published guidance to schools and families about how best to support children and signposted resources to help them to do so.</p>
<p>“Mental health support continues to be available for those that need it. NHS services remain open and leading mental health charities are being supported to deliver additional services through the £5m coronavirus mental health response fund.”</p>
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</p></div>Blog: Why talking about physical activity in the right way is more important than everhttps://www.wecanmoveinsight.net/articles/blog-why-talking-about-physical-activity-in-the-right-way-is-more2020-04-29T10:55:17.000Z2020-04-29T10:55:17.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://arc-w.nihr.ac.uk/news/why-talking-about-physical-activity-in-the-right-way-is-more-important-than-ever/">https://arc-w.nihr.ac.uk/news/why-talking-about-physical-activity-in-the-right-way-is-more-important-than-ever/</a></p>
<p>April 2020</p>
<p><a href="{{#staticFileLink}}4547542476,original{{/staticFileLink}}">Lets talk about physical activity.pdf</a></p>
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<p>23 April 2020</p>
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<p><strong>In this blog, Dr James Nobles talks about the Bristol recommendations for talking about physical activity, and how important this is in the context of the COVID-19 pandemic.</strong></p>
<p>Daily “exercise” is one of the four reasons for leaving your home during the COVID-19 outbreak. Indoor exercise is also being promoted to help people with their physical and mental health, though at the time of writing we are still allowed out to exercise. (We’ll come on to the use of the word exercise later.)</p>
<p>All this means there’s been a surge in public-facing communications about physical activity, whether on our daily outings or in our living rooms. From PE with Joe Wicks at 9am every morning on YouTube to Sport England’s #StayInWorkOut campaign, the sector is adapting to try and promote the benefits of physical activity to the public.</p>
<p>Just over a year ago in what feels like an entirely different era, ARC West, in collaboration with Knowle West Media Centre and Mufti Games, started the <a href="https://arc-w.nihr.ac.uk/research/projects/how-can-we-improve-the-communication-of-the-national-cmo-physical-activity-guidelines/">“How Do You Move?” project</a>. It aimed to understand how members of the public, particularly people who live in under-served areas, would prefer physical activity messages to be communicated to them.</p>
<p>We recently had <a href="https://www.mdpi.com/1660-4601/17/8/2782">our findings</a> published in the International Journal of Environmental Research and Public Health. Here are our key recommendations, which we hope are useful for anyone promoting physical activity during the COVID-19 outbreak:</p>
<h3>10 ways to improve your physical activity communication: the Bristol recommendations</h3>
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<li>Work with multi-disciplinary teams, and ensure (social) marketers are involved</li>
<li>Understand, and work with, your target audience to develop tailored messages</li>
<li>Keep language simple. You may not need to include the physical activity guidelines!</li>
<li>Promote the benefits of physical activity, including physical, mental and <strong>social</strong> health</li>
<li>Identify influential <strong>and</strong> trustworthy individuals to deliver the message</li>
<li>Use different mechanisms (eg posters, social media, TV) to spread a consistent message</li>
<li>Terminology matters. Physical activity is more than just exercise and sport</li>
<li>Consider how resources can be pooled between organisations to promote a consistent message</li>
<li>Documents for healthcare professionals (eg infographics) are not designed for the public</li>
<li>Reflect on current physical activity messages, and how they might be interpreted by the public</li>
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<p>There is also some really great work that has just been published by colleagues from the University of Edinburgh in the International Journal of Behavioural Nutrition and Physical Activity. They asked a similar question to us, but rather than speaking with the public, they reviewed the published research. As you will see from <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-00954-3">their findings</a>, many of their recommendations are consistent with those of coming from our project.</p>
<p>One consistent finding which is key to consider right now is the terminology that we use to talk about physical activity with the public. For many people, terms such as “exercise” and “sport” have many negative connotations attached to them. There is an opportunity now to make physical activity more inclusive, to move away from the perception that “exercise” is something that can only be done in a gym or on a run. Physical activity relates to movement, and there are many different ways in which people can move more. Finding something that is enjoyable is important.</p>
<p>Finally, to help support professionals who talk to the public about physical activity, the Chief Medical Officer’s Physical Activity Guidelines working group are offering a <a href="http://www.bristol.ac.uk/sps/research/projects/physical-activity/new-resource/">free service</a> for anyone producing physical activity resources in the UK. The intention of this service is to help provide accurate, clear, consistent evidence statements on physical activity.</p>
<p>One outcome of the COVID-19 outbreak could be that more people incorporate physical activity into their daily lives. These resources will help any professionals who are in the business of promoting and advising on physical activity to do that as effectively as possible.</p>
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</div></div>Being active when living within a large body: experiences during lifestyle intervention.https://www.wecanmoveinsight.net/articles/being-active-when-living-within-a-large-body-experiences-during-l2020-03-19T11:42:38.000Z2020-03-19T11:42:38.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://www.tandfonline.com/doi/full/10.1080/17482631.2020.1736769">https://www.tandfonline.com/doi/full/10.1080/17482631.2020.1736769</a></p>
<p>Feb 2020</p>
<p><a href="{{#staticFileLink}}4156230233,original{{/staticFileLink}}">Being active when living within a large body experiences during lifestyle intervention.pdf</a></p>
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<p><strong>Background</strong>: In-depth understanding of the experiences of both well-being and suffering in relation to being severely obese and becoming active through lifestyle intervention is lacking.</p>
<p><strong>Aim</strong>: to explore and describe adults’ existential experiences of being active, when living within a large body—before and during a lifestyle intervention.</p>
<p><strong>Methods: A longitudinal design of repeated indivi</strong>dual interviews with 16 adults with BMI ≥40, based on hermeneutic phenomenology, existential philosophy and a theory of well-being was performed. The study was approved by the Danish health authorities.</p>
<p><strong>Results</strong>: Two dimensions of experiences were found; “Living within a downward spiral” and “Striving for enjoyment and settlement”. The themes describing suffering were: ‘Sense of being thwarted and defeated ‘ and “Tackling energy depletion and impact of sense of self”. The themes describing well-being were: “Hoping for renewal and energised resoluteness” and “Enduring discomfort and feeling safe”.</p>
<p><strong>Conclusions</strong>: Interacting existential experiences can be facilitators or barriers for physical activity. It seems relevant for health care providers to address the individual’s lifeworld experiences of well-being, lack of well-being and suffering. Well-being as a sense of feeling “at home” when physically active may break down an inactivity spiral. Promoting well-being is a legitimate aim of lifestyle intervention.</p>
</div></div>Doctors should prescribe walking to improve mental health, says new reporthttps://www.wecanmoveinsight.net/articles/doctors-should-prescribe-walking-to-improve-mental-health-says-ne2020-03-10T15:22:07.000Z2020-03-10T15:22:07.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://www.livingstreets.org.uk/news-and-blog/press-media/doctors-should-prescribe-walking-to-improve-mental-health-says-new-report">https://www.livingstreets.org.uk/news-and-blog/press-media/doctors-should-prescribe-walking-to-improve-mental-health-says-new-report</a></p>
<p>(March 2020)</p>
<p><a href="{{#staticFileLink}}4065195099,original{{/staticFileLink}}">is-walking-a-miracle-cure_online.pdf</a></p>
<p><span class="p4">More GPs should prescribe walking to improve mental health and long-term physical health conditions, says a new report published today (Friday 6 March) by Living Streets, the UK charity for everyday walking. </span></p>
<p><span><a href="https://www.livingstreets.org.uk/media/4988/is-walking-a-miracle-cure.pdf">‘Is Walking a Miracle Cure?</a>’</span><span> focuses on the health benefits of walking and </span><span>argues that towns and cities designed for walking will significantly improve physical health and mental wellbeing. </span><span> </span></p>
<p><span>The report makes recommendations</span><span> under ten headings</span><span>, including an increase in ‘social prescribing’ with an emphasis on walks in parks and green spaces because of growing evidence of the benefits of walking in nature to mental health outcomes; and promoting walking for disabled people or those with long-term health conditions </span><span>as part of health checks</span><span>. </span><span> </span></p>
<p><span>Other recommendations </span><span>include: </span><span>a</span><span>dopting the Department for Education’s health</span><span>y</span><span> schools rating scheme</span><span> to increase active travel to and from school</span><span>; </span><span>assessing </span><span>all </span><span>new housing developments</span><span> to ensure </span><span>services, leisure and employment opportunities are within walking distance</span><span>; and </span><span>prioritising </span><span>low traffic neighbourhoods to </span><span>increase walking and cycling rates. </span><span> </span></p>
<p><strong>Dame Jane Roberts, Honorary Consultant Child and Adolescent Psychiatrist, Chair of Living Streets, said: </strong></p>
<p><span>“We are facing a physical inactivity crisis with obesity levels at a record high and increasing concerns about mental ill-health problems across the nations. And we are in the midst of a climate emergency with air pollution responsible for over 40,000 premature details a year. Walking is the free, easy and accessible solution. Why would we not do more of it?</span><span>”</span><span> </span></p>
<p class="text-white">The negative impact of our car-centric lifestyles can be seen all around us, with physical activity levels on the decline and poor health conditions related to air pollution on the rise. We can start to turn this around with streets that are better for walking and cycling."</p>
<cite title="Andy Burnham, Mayor of Greater Manchester">Andy Burnham, Mayor of Greater Manchester</cite><cite title="Andy Burnham, Mayor of Greater Manchester"></cite>
<p><span><strong>Andy continues:</strong></span></p>
<p><span>"The time to act is now, and Greater Manchester is drawing up a blueprint for the whole country to follow.</span></p>
<p><span>"Working together with our Cycling and Walking Commissioner Chris Boardman, we’ve set out our vision for the Bee Network – 1,800 miles of protected space for cycling and walking that will help people make 2.5 million journeys by foot and by bike every day, cutting travel times and improving health and wellbeing."</span></p>
<p><span>The report launches at </span><span>Living Streets’ </span><a href="https://www.livingstreets.org.uk/get-involved/national-walking-summit"><span>National Walking Summit</span></a><span> in Manchester today </span><span>(Friday 6 March),</span><span> with guest speakers including World Champion athletes Dame Sarah Storey and Chris Boardman MBE; neuroscientist Professor Shane O’Mara; and Mayor of Greater Manchester, Andy Burnham.</span><span> </span></p>
<p><span>‘Is Walking a Miracle Cure?’ </span><span>is authored by Dr Rachel Lee and Holly Barden.</span></p>
</div>A future for the world’s children? A WHO–UNICEF–Lancet Commissionhttps://www.wecanmoveinsight.net/articles/a-future-for-the-world-s-children-a-who-unicef-lancet-commission2020-02-21T11:27:14.000Z2020-02-21T11:27:14.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32540-1/fulltext?dgcid=etoc-edschoice_email_tlchildhealth20_infocus20">https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32540-1/fulltext?dgcid=etoc-edschoice_email_tlchildhealth20_infocus20</a></p>
<p>(February 2020)</p>
<p><strong><a href="{{#staticFileLink}}3884697783,original{{/staticFileLink}}">PIIS0140673619325401.pdf</a></strong></p>
<p><strong>Recommendations for placing children at the centre of the Sustainable Development Goals (SDGs)</strong></p>
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<div class="ce-list--remove-bullets__list-item__text">Heads of state should create a high-level mechanism or assign one overarching department to coordinate work with and for children across sectors, create an enabling environment to enact child-friendly policies, and assess the effect of all policies on children</div>
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<div class="ce-list--remove-bullets__list-item__text">Heads of state and governments should create or designate a monitoring system to track budget allocations to child wellbeing, using this process to mobilise domestic resources, by means of fiscal instruments that benefit the poorest in society, for additional investment</div>
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<div class="ce-list--remove-bullets__list-item__text">Government officials at the relevant ministry, national academics, and research institutions should develop strategies to improve data reporting for SDG indicators measuring child wellbeing, equity, and carbon emissions, using country information systems and citizen-led data and accountability</div>
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<div class="ce-list--remove-bullets__list-item__text">Local government leaders should establish a cross-cutting team to mobilise action for child health and wellbeing, involving civil society, children themselves, and other stakeholders as appropriate</div>
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<div class="ce-list--remove-bullets__list-item__text">UNICEF child-health ambassadors and other global children's advocates should mobilise governments and communities to adopt child-friendly wellbeing and sustainability policies, and advocate for rapid reductions in carbon emissions to preserve the planet for the next generation</div>
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<li id="celistitem60" class="ce-list--remove-bullets__list-item">
<div class="ce-list--remove-bullets__list-item__text">Leaders in children's health, rights, and sustainability should reframe their understanding of the SDGs as being for and about children, and the threat to their future from greenhouse gas emissions, mainly by high-income countries</div>
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<div class="ce-list--remove-bullets__list-item__text">Children should be given high-level platforms to share their concerns and ideas and to claim their rights to a healthy future and planet</div>
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<div class="ce-list--remove-bullets__list-item__text">Country leaders on child health and child rights should push for the adoption of new protocols by the UN Convention on the Rights of the Child to protect children from harmful commercial practices</div>
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<div class="ce-list--remove-bullets__list-item__text">Country representatives to the UN should work together to create a simplified, effectively multisectoral UN architecture to reduce fragmentation and siloes, and to put action for children at the centre of the SDGs</div>
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<div class="ce-list--remove-bullets__list-item__text">WHO and UNICEF leadership should meet with heads of other UN agencies to plan coordinated action to support countries to enact focused, effective policies to achieve the SDGs, and work with regional bodies to help countries to share progress and best practices</div>
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</div></div>Gloucestershire Joint Health and Wellbeing Strategy 2019-2030https://www.wecanmoveinsight.net/articles/gloucestershire-joint-health-and-wellbeing-strategy-2019-20302020-02-20T11:34:31.000Z2020-02-20T11:34:31.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://www.gloucestershire.gov.uk/council-and-democracy/gloucestershire-health-and-wellbeing-board/our-focus/?">https://www.gloucestershire.gov.uk/council-and-democracy/gloucestershire-health-and-wellbeing-board/our-focus/?</a></p>
<p>(September 2019)</p>
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<p><strong>The Gloucestershire Health and Wellbeing Board is responsible for overseeing the development and delivery of the Joint Health and Wellbeing Strategy, which aims to improve the lives of people in Gloucestershire.</strong></p>
<p>Our vision is that Gloucestershire is a place where everyone can live well, be healthy and thrive. We think that focusing on these priorities is the best way to achieve this:</p>
<ul>
<li>physical activity;</li>
<li>adverse childhood experiences;</li>
<li>mental wellbeing;</li>
<li>social isolation and loneliness;</li>
<li>healthy lifestyles;</li>
<li>early years and best start in life; and</li>
<li>housing.</li>
</ul>
<p><a title="GCC_2596 Joint Health and Wellbeing Strategy_Dev8.pdf" href="https://www.gloucestershire.gov.uk/media/2091564/gcc_2596-joint-health-and-wellbeing-strategy_dev8.pdf">Click here to read the draft strategy online or download a copy to print. (PDF, 962.9 KB)</a></p>
<p> </p>
<p>The strategy has been developed in four main stages with community and wider stakeholder engagement at each stage. We are now at the forth stage and would welcome your views.</p>
<p><strong>Stage 1: Understanding the landscape</strong></p>
<p>There has been a wealth of previous engagement and consultation about health and wellbeing with various populations within Gloucestershire. Findings from a wide range of these were assessed to help build an understanding about what people have already told us. Mental health, loneliness and social and community connections were key themes.</p>
<p><strong>Stage 2: Informing the priority setting</strong></p>
<p>Through workshops and structured interviews, we encouraged residents to consider their top three priorities in maintaining positive health and wellbeing. This helped to inform the priority setting process.</p>
<p><strong>Stage 3: Developing a better understanding of the priorities</strong></p>
<p>This was an opportunity to feed back to communities the priorities that had been chosen and start to understand some more detail about how they viewed these priorities. This gave us better insight into what people view are the strengths and opportunities around the priorities and some examples of positive practice.</p>
<p><strong>Stage 4: Have we got it right?</strong></p>
<p>This final stage involves more engagement to check that the strategy reflects what we have heard throughout the earlier stages. Thank you to those who took the time to respond to the draft Joint Health and Wellbeing Strategy. We are in the process of collating everyone’s feedback which will be presented as a report to Gloucestershire Health and Wellbeing Board. A summary of the report will be sent to those who have responded and made available on the website.</p>
<p>For more information contact: <a href="mailto:GHWB@gloucestershire.gov.uk">GHWB@gloucestershire.gov.uk</a> </p>
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<p> </p></div>Comparing and assessing physical activity guidelines for children and adolescents: a systematic literature review and analysis.https://www.wecanmoveinsight.net/articles/comparing-and-assessing-physical-activity-guidelines-for-children2020-02-20T09:17:08.000Z2020-02-20T09:17:08.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://www.ncbi.nlm.nih.gov/pubmed/32041635">https://www.ncbi.nlm.nih.gov/pubmed/32041635</a></p>
<p>(February 2020)</p>
<p><a href="{{#staticFileLink}}3874255666,original{{/staticFileLink}}">s12966-020-0914-2.pdf</a></p>
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<div class="cit"><span><a title="The international journal of behavioral nutrition and physical activity." href="https://www.ncbi.nlm.nih.gov/pubmed/32041635#">Int J Behav Nutr Phys Act.</a></span> 2020 Feb 10;17(1):16. doi: 10.1186/s12966-020-0914-2.</div>
<h1>Comparing and assessing physical activity guidelines for children and adolescents: a systematic literature review and analysis.</h1>
<div class="auths"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Parrish%20AM%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Parrish AM</a><sup>1,</sup><sup>2,</sup><sup>3</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Tremblay%20MS%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Tremblay MS</a><sup>4</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Carson%20S%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Carson S</a><sup>4</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Veldman%20SLC%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Veldman SLC</a><sup>5</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Cliff%20D%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Cliff D</a><sup>6,</sup><sup>7,</sup><sup>8</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Vella%20S%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Vella S</a><sup>6,</sup><sup>7</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Chong%20KH%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Chong KH</a><sup>6,</sup><sup>7</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Nacher%20M%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Nacher M</a><sup>7</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Del%20Pozo%20Cruz%20B%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Del Pozo Cruz B</a><sup>9</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Ellis%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Ellis Y</a><sup>6</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Aubert%20S%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Aubert S</a><sup>4</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Spaven%20B%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Spaven B</a><sup>6</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Sameeha%20MJ%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Sameeha MJ</a><sup>10</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Zhang%20Z%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Zhang Z</a><sup>6,</sup><sup>7</sup>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Okely%20AD%5BAuthor%5D&cauthor=true&cauthor_uid=32041635">Okely AD</a><sup>6,</sup><sup>7,</sup><sup>8</sup>.</div>
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<h3><a id="ui-ncbitoggler-2" class="jig-ncbitoggler ui-widget ui-ncbitoggler" title="Open/close author information list" href="https://www.ncbi.nlm.nih.gov/pubmed/32041635#"><span class="ui-ncbitoggler-master-text">Author information</span></a></h3>
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<h3>Abstract</h3>
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<h4>BACKGROUND:</h4>
<p>The impact of declining physical activity and increased sedentary behaviour in children and adolescents globally prompted the development of national and international physical activity guidelines. This research aims to systematically identify and compare national and international physical activity guidelines for children and adolescents and appraise the quality of the guidelines to promote best practice in guideline development.</p>
<h4>METHODS:</h4>
<p>This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Only national, or international physical activity and/or sedentary behaviour guidelines were included in the review. Included guidelines targeted children and adolescents aged between 5 and 18 years. A grey literature search was undertaken incorporating electronic databases, custom Google search engines, targeted websites and international expert consultation. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II).</p>
<h4>RESULTS:</h4>
<p>The search resulted in 50 national or international guidelines being identified. Twenty-five countries had a national guideline and there were three international guidelines (European Union, Nordic countries (used by Iceland, Norway and Sweden), World Health Organization (WHO)). Nineteen countries and the European Union adopted the WHO guidelines. Guidelines varied in relation to date of release (2008 to 2019), targeted age group, and guideline wording regarding: type, amount, duration, intensity, frequency and total amount of physical activity. Twenty-two countries included sedentary behaviour within the guidelines and three included sleep. Total scores for all domains of the AGREE II assessment for each guideline indicated considerable variability in guideline quality ranging from 25.8 to 95.3%, with similar variability in the six individual domains. Rigorous guideline development is essential to ensure appropriate guidance for population level initiatives.</p>
<h4>CONCLUSIONS:</h4>
<p>This review revealed considerable variability between national/international physical activity guideline quality, development and recommendations, highlighting the need for rigorous and transparent guideline development methodologies to ensure appropriate guidance for population-based approaches. Where countries do not have the resources to ensure this level of quality, the adoption or adolopment (framework to review and update guidelines) of the WHO guidelines or guidelines of similar quality is recommended.</p>
<h4>TRIAL REGISTRATION:</h4>
<p>Review registration: PROSPERO 2017 CRD42017072558.</p>
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<div class="keywords">
<h4>KEYWORDS:</h4>
<p>AGREE II; Adolescents; Children; Grey literature; Guideline; Movement; Physical activity; Recommendation; Sedentary behaviour; Youth</p>
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<dt>PMID:</dt><dd>32041635</dd><dt>PMCID:</dt><dd><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011603/">PMC7011603</a></dd><dt>DOI:</dt><dd><a href="https://doi.org/10.1186/s12966-020-0914-2" target="_blank">10.1186/s12966-020-0914-2</a></dd>
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</div></div>A tiered approach to physical activity in Scotland - Scottish National Physical Activity Pathwayhttps://www.wecanmoveinsight.net/articles/a-tiered-approach-to-physical-activity-in-scotland-scottish-natio2020-02-07T08:24:08.000Z2020-02-07T08:24:08.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://twitter.com/HansonCoral/status/1225065121132707846">https://twitter.com/HansonCoral/status/1225065121132707846</a></p>
<p><a href="{{#staticFileLink}}3851819525,RESIZE_710x{{/staticFileLink}}"><img class="align-full" src="{{#staticFileLink}}3851819525,RESIZE_710x{{/staticFileLink}}" width="578" alt="3851819525?profile=RESIZE_710x" /></a></p></div>One minute of weekly exercise ‘enough’ to benefit older patientshttps://www.wecanmoveinsight.net/articles/one-minute-of-weekly-exercise-enough-to-benefit-older-patients2020-02-03T08:41:13.000Z2020-02-03T08:41:13.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://www.nursingtimes.net/news/research-and-innovation/one-minute-of-weekly-exercise-enough-to-benefit-older-patients-29-01-2020/">https://www.nursingtimes.net/news/research-and-innovation/one-minute-of-weekly-exercise-enough-to-benefit-older-patients-29-01-2020/</a></p>
<p> </p>
<div class="post_first_paragraph">
<p>Just one minute of exercise per week is enough to provide health benefits to people over the age of 65, according to UK researchers, who are backing a change in guidelines as a result of their findings.</p>
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<p>The researchers said they found that a once weekly exercise session was enough to produce improvements in blood glucose control and general mobility.</p>
<p>Therefore, they suggest that the minimum time and frequency of exercise required for older patients is much lower than currently recommended.</p>
<blockquote>
<p>“Our results provide further support for the inclusion of this form of training in the guidelines”</p>
<p>John Babraj</p>
</blockquote>
<p>The study, by Abertay University in Dundee and Edinburgh Napier University, is the first study to look at training frequency with sprint interval training (SIT) in older adults.</p>
<p>It involved groups of 65- to 75-year-olds participating in either once or twice weekly training sessions for eight weeks.</p>
<p>Each of the 34 participants had previously been living a sedentary lifestyle and had not been taking part in regular exercise.</p>
<p>The study saw them allocated to stationary bikes and then asked to cycle as hard as they were able to for six seconds before resting for at least a minute.</p>
<p>They repeated the process, known as SIT, until they had exercised for a total of one minute, said the researchers.</p>
<p>They noted that, as people aged, they lost the ability to take glucose out of their blood which resulted in insulin resistance and could lead to type 2 diabetes and heart and liver problems.</p>
<p>Following eight weeks, two-hour blood glucose was decreased in both exercise groups, according to the findings published in the <em><a href="https://www.mdpi.com/1660-4601/17/2/454">International Journal Environmental Research and Public Health</a></em>.</p>
<p>The average change for the once a week group was 0.41 mmol and 1.32 mmol for the twice a week group. In contrast, in the control group, there was an increase by an average of 0.80 mmol.</p>
<p>Lead study author Dr John Babraj, from Abertay, said: “We’ve found that SIT, whether it’s done once a week or twice a week, improves the ability to get glucose out of the system.</p>
<p>“While those participating in the twice-weekly sessions observed a greater improvement, those taking part in the single session also observed change,” he said.</p>
<p>“Importantly, they also observed a difference in general function, greatly improving their ability to do everyday tasks such as getting up to answer a door and walk up and down stairs.</p>
<p>“These are major issues for older people,” he said. “As we lose physical function, we start to become socially isolated, and as we become socially isolated our quality of life declines significantly.”</p>
<p>Dr Babraj said he wanted to see SIT introduced to the government’s physical-activity guidelines.</p>
<p>“Currently, older adults are advised to participate in at least 150 minutes of moderate intensity exercise each week, and that can be difficult to accrue," he noted.</p>
<p>“Both of our groups produced greater adaptations than what we would expect the smallest worthwhile change to be."</p>
<p>He added: “Our results provide further support for the inclusion of this form of training in the guidelines as one of the methods to gain health benefits.”</p></div>Health matters: physical activity - prevention and management of long-term conditionshttps://www.wecanmoveinsight.net/articles/health-matters-physical-activity-prevention-and-management-of-lon2020-01-27T09:32:24.000Z2020-01-27T09:32:24.000ZActive Gloucestershirehttps://www.wecanmoveinsight.net/members/ActiveGloucestershire<div><img src="https://storage.ning.com/topology/rest/1.0/file/get/3835480468?profile=RESIZE_180x180&width=141"></div><div><div class="gem-c-title govuk-!-margin-top-8 gem-c-title--inverse govuk-!-margin-bottom-0">
<p class="gem-c-title__context">Guidance</p>
<h1 class="gem-c-title__text">Health matters: physical activity - prevention and management of long-term conditions</h1>
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<p class="publication-header__last-changed">Published 23 January 2020</p>
<p class="publication-header__last-changed">Source: <a href="https://www.gov.uk/government/publications/health-matters-physical-activity/health-matters-physical-activity-prevention-and-management-of-long-term-conditions">https://www.gov.uk/government/publications/health-matters-physical-activity/health-matters-physical-activity-prevention-and-management-of-long-term-conditions</a></p>
<p class="publication-header__last-changed"> </p>
<h2 id="summary">Summary</h2>
<p>This edition of Health Matters focuses on the benefit of physical activity for the prevention and management of long-term conditions in adults.</p>
<p>The government’s <a class="govuk-link" href="https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document">prevention green paper</a> highlights that becoming more active is good for our mental and physical health, and reduces our risk of developing a number of health conditions. It also sets out the ambition of getting everybody active in the 2020s, including those of us who are already living with a health condition.</p>
<p>One in 3 adults in England live with a long-term health condition and they are twice as likely to be amongst the least physically active. However, evidence shows that regular physical activity can help prevent or manage many common conditions such as type 2 diabetes, cardiovascular disease and some cancers. It also helps keep symptoms under control, prevent additional conditions from developing, and reduce inequalities.</p>
<h2 id="health-benefits-of-physical-activity">Health benefits of physical activity</h2>
<p>In the new <a class="govuk-link" href="https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report">UK Chief Medical Officers’ (<abbr title="Chief Medical Officers">CMOs</abbr>) physical activity guidelines</a> launched in September 2019, the <abbr title="Chief Medical Officers">CMOs</abbr> reiterated a clear message about physical activity:</p>
<p>“If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.”</p>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94934/Active_sport-100.jpg" alt="Physical activity includes: active living, active travel, active recreation, active sport (informal sport and organised sport)" /></div>
<p>Regular physical activity provides a range of physical and mental health, and social benefits, many of which are increasing issues for individuals, communities and society. These include:</p>
<ul>
<li>reducing the risk of many long-term conditions</li>
<li>helping manage existing conditions</li>
<li>ensuring good musculoskeletal health</li>
<li>developing and maintaining physical and mental function and independence</li>
<li>supporting social inclusion</li>
<li>helping maintain a healthy weight</li>
<li>reducing inequalities for people with long-term conditions</li>
</ul>
<h3 id="physical-activity-guidelines-for-adults">Physical activity guidelines for adults</h3>
<p>The updated UK <abbr title="Chief Medical Officers">CMOs</abbr>’ physical activity guidelines refreshed the 2011 guidelines across all age groups. It also draws on new evidence to develop additional guidance on being active during pregnancy and after giving birth, and for disabled adults.</p>
<p>The guidelines state that for good physical and mental health, adults should aim to be physically active every day. Any activity is better than none, and more is better still.</p>
<p><a class="govuk-link" href="https://www.youtube.com/watch?v=HyA8c-V4AM8&feature=youtu.be">Christopher Whitty - Chief Medical Officer full interview</a></p>
<p>There are 3 elements of the physical activity guidelines:</p>
<ol>
<li>strengthening activity</li>
<li>cardiovascular activity</li>
<li>sedentary time</li>
</ol>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94935/CMO_guidelines-100.jpg" alt="UK Chief Medical Officers' physical activity guidelines: build strength and improve balance, be active, and minimise sedentary time" /></div>
<h4 id="strengthening-activity">Strengthening activity</h4>
<p>Muscle strength, bone health and the ability to balance underpin physical function. Each attribute contributes independently to overall health and functional ability, and in combination they provide lifelong benefits.</p>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94936/Table-100.jpg" alt="Definitions of muscle function, bone health and balance" /></div>
<p>There is a challenge faced in physical activity promotion with unequal emphasis on the aerobic, rather than the strength components, of the <abbr title="Chief Medical Officers">CMOs</abbr>’ physical activity guidelines for adults.</p>
<p>Considered the ‘forgotten guidelines’, the <abbr title="Chief Medical Officers">CMOs</abbr>’ strengthening activity guidelines state that: adults should do activities to develop or maintain strength in the major muscle groups. Muscle strengthening activities should be done at least 2 days a week, but any strengthening activity is better than none.</p>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94937/What_counts_as_strengthening_and_balance_activities_-100.jpg" alt="What counts as strengthening and balance activities: going to the gym, yoga, carrying heavy shopping, ball games, racquet sports, aerobic circuit training" /></div>
<p>The guidelines also highlight the additional benefit of balance and flexibility exercises for older adults. Exercises that improve leg strength, balance and coordination can help people maintain and improve muscle strength and avoid falls as they age. Improving flexibility can improve posture, reduce aches and pains, lower risk of injury, and help with continuing to carry out everyday tasks.</p>
<p>Evidence suggests that <a class="govuk-link" href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721874/MBSBA_evidence_review.pdf">muscle strength, bone strength and balance ability increase in childhood and peak in early adulthood, eventually followed by a decline</a>.</p>
<p>Therefore, muscle and bone strengthening and balance activities (<abbr title="muscle and bone strengthening and balance activities">MBSBA</abbr>) are important across the lifecourse for different reasons:</p>
<ul>
<li>to develop strength and build healthy bones during childhood and young adulthood</li>
<li>to maintain strength in adulthood</li>
<li>to delay the natural decline in muscle mass and bone density that occurs from around 50 years of age, maintaining function in later life</li>
</ul>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94938/Activities_at_different_ages-100.jpg" alt="Benefits of muscle and bone strengthening activities at different ages" /></div>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94939/Diagram_white-100.jpg" alt="Strength and balance ability over the life course and potential ages or events that may change the trajectory of decline with ageing" /></div>
<h4 id="cardiovascular-activity">Cardiovascular activity</h4>
<p>For cardiovascular activity, the guidelines state that: each week, adults should accumulate:</p>
<ul>
<li>at least 150 minutes of moderate intensity activity (such as brisk walking or cycling), or</li>
<li>75 minutes of vigorous intensity activity (such as running), or</li>
<li>even shorter durations of very vigorous intensity activity (such as sprinting or stair climbing), or</li>
<li>a combination of moderate, vigorous and very vigorous intensity activity</li>
</ul>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94940/Cardiovascular_physical_activity-100.jpg" alt="Cardiovascular physical activity: the UK CMOs' physical activity guidelines recommendations" /></div>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94941/Moderate_intensity_cardiovascular_physical_activity-100.jpg" alt="What counts as moderate intensity cardiovascular physical activity" /></div>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94942/Vigorous_intensity_cardiovascular_physical_activity-100.jpg" alt="What counts as vigorous intensity cardiovascular physical activity: jogging or running, walking/climbing briskly up a hill, fast cycling, aerobics, fast swimming, most competitive sports, carrying or moving heavy loads" /></div>
<h4 id="sedentary-time">Sedentary time</h4>
<p>For sedentary time, the guidelines state that: adults should aim to minimise the amount of time spent being sedentary, and when physically possible should break up long periods of inactivity with at least light physical activity.</p>
<p>There have been notable developments in the evidence base for the health effects of sedentary time in adults, with research suggesting sitting time is associated with increased all-cause and cardiovascular mortality, and cancer risk and post-treatment outcomes (including quality of life and prognosis).</p>
<h3 id="adults-with-long-term-conditions">Adults with long-term conditions</h3>
<p>In England, 15 million people are living with one or more long-term health conditions. One in 3 of the working age population have at least one long term condition and 1 in 7 have more than one.</p>
<p>Since the 2011 physical activity guidelines were published, the evidence to support the health benefits of regular physical activity for all groups has become increasingly compelling.</p>
<p>The 2019 guidelines utilised the latest evidence from systematic reviews, meta-analyses, and pooled analyses comprising hundreds of epidemiological studies with several million study participants comparing active and low activity people. Figures for different health risks cannot be compared as they come from different studies.</p>
<p><a class="govuk-link" href="https://www.youtube.com/watch?v=59ntVvTXJFc&feature=youtu.be">Dr. Zoe Williams - <abbr title="National Health Service">NHS</abbr> <abbr title="general practitioner">GP</abbr> and <abbr title="Public Health England">PHE</abbr> Physical Activity Clinical Champion Full Interview</a></p>
<p>Regular physical activity is associated with a reduced risk of a range of diseases including some cancers and dementia. There is also evidence that it can help to prevent some and manage many common chronic conditions and diseases, many of which are on the rise and affecting people at an earlier age, such as:</p>
<ul>
<li>some cancers</li>
<li>obesity</li>
<li>type 2 diabetes</li>
<li>cardiovascular diseases (<abbr title="cardiovascular diseases">CVD</abbr>) including coronary heart disease and stroke</li>
<li>hypertension</li>
<li>osteoarthritis and lower back pain</li>
<li>mental health conditions including depression and anxiety</li>
<li>dementia</li>
<li>chronic obstructive pulmonary disease (<abbr title="chronic obstructive pulmonary disease">COPD</abbr>) and asthma</li>
<li>musculoskeletal (<abbr title="musculoskeletal">MSK</abbr>) conditions</li>
</ul>
<p>Physical activity is as good or better than treatment with drugs for many conditions, such as type 2 diabetes and lower back pain, and has a much lower risk of any harm.</p>
<p>Physical activity can also benefit those who have <abbr title="musculoskeletal">MSK</abbr> conditions. However, many people with <abbr title="musculoskeletal">MSK</abbr> conditions often mistakenly believe that physical activity will make their conditions worse. The more conditions you have, the more you need to improve the core aspects of fitness:</p>
<ul>
<li>strength</li>
<li>stamina</li>
<li>balance</li>
</ul>
<p>You can read more about this in <a class="govuk-link" href="https://www.gov.uk/government/publications/productive-healthy-ageing-and-musculoskeletal-health/productive-healthy-ageing-and-musculoskeletal-msk-health">this previous edition of Health Matters on productive healthy ageing and <abbr title="musculoskeletal">MSK</abbr> conditions</a> and <a class="govuk-link" href="https://www.gov.uk/government/publications/healthy-ageing-consensus-statement">healthy ageing consensus statement</a> developed by <abbr title="Public Health England">PHE</abbr> and the Centre for Better Ageing.</p>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94943/Lower_health_risks-100.jpg" alt="Physically active people have lower health risks" /></div>
<p>The role of physical activity for preventing and managing illness is included within many <a class="govuk-link" href="https://pathways.nice.org.uk/pathways/physical-activity#path=view%3A/pathways/physical-activity/encouraging-physical-activity-to-prevent-or-treat-specific-conditions.xml&content=view-index">National Institute for Health and Care Excellence (<abbr title="National Institute for Health and Care Excellence">NICE</abbr>) guidelines</a>, and the promotion of physical activity helps to support their implementation.</p>
<div class="call-to-action">
<p><a class="govuk-link" href="https://www.nice.org.uk/guidance/lifestyle-and-wellbeing/physical-activity">All <abbr title="National Institute for Health and Care Excellence">NICE</abbr> products on physical activity including guidance, <abbr title="National Institute for Health and Care Excellence">NICE</abbr> pathways and quality standards can be found here</a>.</p>
</div>
<h3 id="adults-with-disabilities">Adults with disabilities</h3>
<p><abbr title="Public Health England">PHE</abbr> commissioned an <a class="govuk-link" href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/748126/Physical_activity_for_general_health_benefits_in_disabled_adults.pdf">evidence review for the UK <abbr title="Chief Medical Officers">CMOs</abbr>’ guidelines</a>, specifically focusing on the scientific evidence of the health benefits of physical activity for disabled adults. Evidence shows a relationship between engaging in physical activity and positive health outcomes for disabled adults.</p>
<p>It is concluded that for substantial health gains, disabled adults should:</p>
<ul>
<li>do 150 minutes of physical activity at a moderate to vigorous intensity</li>
<li>do 2 sets of challenging strength and balance exercises 2 times per week</li>
<li>minimise sedentary time as per whole population guidelines</li>
</ul>
<p>Little evidence was found to show that physical activity is unsafe for disabled adults when it is performed at an appropriate level for their current level of activity and health conditions.</p>
<p>Individuals with uncontrolled symptoms for cardiac, metabolic, renal and some musculoskeletal conditions should seek advice before greatly increasing physical activity.</p>
<h3 id="physical-activity-during-pregnancy-and-postpartum">Physical activity during pregnancy and postpartum</h3>
<p>The benefits of physical activity during pregnancy include:</p>
<ul>
<li>reduction in hypertensive disorders</li>
<li>improved cardiorespiratory fitness</li>
<li>lower gestational weight gain</li>
<li>reduction in risk of gestational diabetes</li>
</ul>
<p>The benefits of physical activity in the postpartum period (up to one year) include:</p>
<ul>
<li>reduction in depression</li>
<li>improved emotional wellbeing</li>
<li>improved physical conditioning</li>
<li>reduction in postpartum weight gain and a faster return to pre-pregnancy weight</li>
</ul>
<p>Physical activity can safely be recommended to women during and after pregnancy and has not been found to have any negative impacts on breastfeeding postpartum.</p>
<h2 id="wider-role-and-benefits-of-physical-activity">Wider role and benefits of physical activity</h2>
<p>In addition to supporting good physical and mental health and functioning, regular physical activity also contributes to a range of wider social, environmental and economic benefits for individuals, communities and wider society. Addressing physical activity can also benefit a broad range of wider priorities at a local level, such as reducing air pollution and increasing social cohesion.</p>
<p>Wider benefits come primarily from physical activities undertaken in a community setting. such as walking, cycling, active recreation, sport and play. They include:</p>
<ul>
<li>improved learning and attainment</li>
<li>increasing productivity in the workplace</li>
<li>managing stress</li>
<li>self-efficacy</li>
<li>improved sleep</li>
<li>the development of social skills</li>
<li>better social interaction</li>
</ul>
<p>The relevance and importance of these benefits vary according to life stage and other factors.</p>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94944/Diagram_green-100.jpg" alt="The wider physical wellbeing, mental wellbeing and individual development benefits of physical activity" /></div>
<p>Social prescribing enables individuals presenting through primary health care to be signposted and connected to local organisations, groups and activities. There are social prescribing schemes that focus on physical activity and staff with knowledge of the resources available in the local community match individuals to opportunities and support them to engage in activities. In some social prescribing schemes, health trainers and health champions signpost and support clients to become involved in community activities.</p>
<h3 id="social-and-community-development">Social and community development</h3>
<p>Sport England’s <a class="govuk-link" href="https://www.sportengland.org/research/benefits-of-sport/sport-outcomes-evidence-review/">Sport Outcomes Evidence Review</a> sets out how sport and physical activity can contribute to the government’s <a class="govuk-link" href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/486622/Sporting_Future_ACCESSIBLE.pdf">Sporting Future strategy</a> outcomes. One of the outcomes is social and community development, which is described as being about “helping to build stronger communities by bringing people together, often from different backgrounds, to make them feel better about where they live, improve community links and cohesion, and build social capital.”</p>
<p>The evidence review found that sport and physical activity can lead to social and community development through:</p>
<ul>
<li>building stronger communities by bringing people from different backgrounds together via participating, volunteering and spectating</li>
<li>improving community links, levels of cohesion and social capital</li>
<li>improving residents’ sense of belonging in an area</li>
<li>feeling more connected to your neighbourhood or community</li>
<li>increasing levels of social trust</li>
</ul>
<p>There is an increasing importance of taking a whole systems approach to addressing public health challenges, including physical inactivity and obesity. Local government plays an important leadership role in bringing together statutory, voluntary and private sectors together and engage their populations to build confident and connected communities as part of efforts to improve health and reduce health inequalities.</p>
<p>Community-centred approaches seek to mobilise the assets within communities, increase people’s control over their health and promote equity. There is a diverse range of practice, evidence-based approaches that can be used by local leaders, commissioners and service providers to work with communities.</p>
<p><abbr title="Public Health England">PHE</abbr> has developed a <a class="govuk-link" href="https://www.gov.uk/government/publications/health-and-wellbeing-a-guide-to-community-centred-approaches">guide that outlines evidence-based community-centred approaches to health and wellbeing</a> and <a class="govuk-link" href="https://www.gov.uk/government/publications/health-matters-health-and-wellbeing-community-centred-approaches/health-matters-community-centred-approaches-for-health-and-wellbeing">this previous edition of Health Matters</a> details a whole systems approach to obesity and <abbr title="Public Health England">PHE</abbr>’s professional guide to support local approaches to promoting a healthy weight.</p>
<h3 id="wider-economic-benefits">Wider economic benefits</h3>
<p>In terms of wider economic benefits, physical activity can lead to cost savings for the health and social care system. This is because in some cases, long term conditions can lead to greater dependency on home, residential and ultimately nursing care. However, physical activity supports greater independence and reduced requirement of support, including these statutory services, therefore leading to financial cost savings.</p>
<h3 id="the-benefits-of-active-travel">The benefits of active travel</h3>
<p><abbr title="Public Health England">PHE</abbr> conducted an <a class="govuk-link" href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/757756/Cycling_and_walking_for_individual_and_population_health_benefits.pdf">evidence review</a> – intended for health and social care policy makers, decision makers and commissioners – which looks at the impact of walking and/or cycling on different health outcomes. The review found that walking and cycling benefit health in a number of ways, including:</p>
<ul>
<li>improving metabolic health and reducing the risk of premature mortality</li>
<li>reducing risk factors for various long term conditions, including cardiovascular disease, respiratory disease, some cancers and type 2 diabetes</li>
<li>providing mental health and neurological benefits, including reduced risk of dementia, improved sleep quality, and a greater sense of wellbeing</li>
</ul>
<p>Active travel also reduces road congestion and air pollution, which provides both environmental benefits and greater health benefits for the general population.</p>
<p><abbr title="Public Health England">PHE</abbr> has an <a class="govuk-link" href="https://www.gov.uk/government/publications/active-travel-a-briefing-for-local-authorities">active travel briefing for local authorities</a> – including transport planners and public health practitioners – which sets out a range of actions from overall policy to practical implementation.</p>
<h2 id="the-scale-of-physical-inactivity">The scale of physical inactivity</h2>
<p>In England:</p>
<ul>
<li>1 in 3 (34%) men are not active enough for good health</li>
<li>almost 1 in 2 (42%) women are not active enough for good health</li>
<li>1 in 5 (21%) men are classed as physically inactive</li>
<li>1 in 4 (25%) women are classed as physically inactive</li>
<li>44% of disabled adults are physically inactive</li>
<li>only 34% of men and 24% of women undertake muscle-strengthening activities at least twice a week</li>
</ul>
<p>‘Not active enough for good health’ means not achieving the <abbr title="Chief Medical Officers">CMOs</abbr>’ guideline of 150 minutes of moderate intensity physical activity per week.</p>
<p>‘Physically inactive’ is defined as doing less than 30 minutes of moderate intensity physical activity per week.</p>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94945/How_active_are_we-100.jpg" alt="How active are we?" /></div>
<p>Insufficient physical activity is associated with:</p>
<ul>
<li>1 in 6 deaths in the UK</li>
<li>up to 40% of many long-term conditions, including preventable conditions such as type 2 diabetes, cardiovascular disease and some cancers</li>
<li>around 30% of later life functional limitation and falls</li>
</ul>
<p>This is not a new issue. Over the last few decades, trends such as increased car ownership and use, reduced manual element of jobs, and increased home-based entertainment has designed physical activity out of people’s lives. This has made us the first generation that needs to make a proactive choice to be physically active.</p>
<p>According to the World Health Organisation (<abbr title="World Health Organisation">WHO</abbr>), physical inactivity is in the top 5 non-communicable disease (<abbr title="non-communicable disease">NCD</abbr>) risk factors for mortality in high income countries. The <abbr title="World Health Organisation">WHO</abbr> Global Non-Communicable Disease Action Plan 2013 to 2020 sets targets for improvements in the prevalence of <abbr title="non-communicable disease">NCD</abbr> risk factors, including physical inactivity. The Richmond Group of Charities commissioned the <abbr title="British Heart Foundation">BHF</abbr> Centre on Population Approaches for Non-Communicable Disease Prevention to run a research project, which translates these <abbr title="World Health Organisation">WHO</abbr> targets into a UK health context.</p>
<p>This was conducted in a 2-stage process: a modelling project to estimate the <abbr title="non-communicable disease">NCD</abbr> burden in England between 2010 and 2025 if the <a class="govuk-link" href="https://www.who.int/beat-ncds/take-action/targets/en/"><abbr title="World Health Organisation">WHO</abbr> 25 by 25 targets</a> are met, and a policy review of the potential prevention-based population-level interventions that are available, including those for reducing physical inactivity.</p>
<div class="call-to-action">
<p>Read the <a class="govuk-link" href="https://richmondgroupofcharities.org.uk/sites/default/files/the_promise_study_final_report.pdf">UK PROMISE study</a> to find out more about the potential of these interventions.</p>
</div>
<h3 id="physical-activity-and-health-inequalities">Physical activity and health inequalities</h3>
<p>There are inequalities in physical activity across socioeconomic status and the protected characteristics, including:</p>
<ul>
<li>age</li>
<li>gender</li>
<li>disability</li>
<li>race</li>
<li>sexual orientation and gender identity</li>
</ul>
<p>These compound or exacerbate other inequalities and lead to physical inactivity being more prevalent in certain groups.</p>
<p>Data on local inequalities in physical activity are available from the <a class="govuk-link" href="https://fingertips.phe.org.uk/profile/physical-activity"><abbr title="Public Health England">PHE</abbr> physical activity data tool</a>.</p>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/95044/Inequalities_in_physical_activity_-100.jpg" alt="Inequalities in physical activity" /></div>
<p>Inactive people from economically disadvantaged backgrounds are also more likely to undertake unhealthy behaviours such as smoking, alcohol consumption, and have a poor diet.</p>
<p>A rapid review of the evidence base on physical activity for general health benefits for disabled adults found that no evidence exists that suggests appropriate physical activity is a risk. It also found analogous health benefits for disabled people of engaging in physical activity as for the rest of the adult population.</p>
<p>The UK <abbr title="Chief Medical Officers">CMOs</abbr>’ guidelines say that for both adults with and without disabilities, the risk of adverse events from physical activity is relatively low and the health benefits accrued outweigh the risks.</p>
<p>For people with mental health conditions, inequalities in physical activity is associated with inequalities in physical health. Amongst people with severe mental disorders, there is a high prevalence of low physical activity and 12 hours on average is spent on sedentary activities everyday. This can, in part, lead to crucial physical health disparities and premature mortality, reducing their life span by 10 to 20 years.</p>
<p>The World Health Organisation (<abbr title="World Health Organisation">WHO</abbr>) has <a class="govuk-link" href="https://www.who.int/mental_health/evidence/guidelines_physical_health_and_severe_mental_disorders/en/">guidelines that provide evidence-based recommendations</a> to practitioners on how to recognise and manage physical health conditions in adults with severe mental disorders.</p>
<h3 id="everybody-active-every-day">Everybody active, every day</h3>
<p><a class="govuk-link" href="https://www.gov.uk/government/publications/everybody-active-every-day-a-framework-to-embed-physical-activity-into-daily-life">Everybody active, every day</a> is the national physical activity framework co-produced with over 1,000 local and national stakeholders, for national and local action to address the physical inactivity epidemic. It is based on international evidence of ‘what works’ to increase population activity.</p>
<p>The framework sets out that if we want everyone to be active every day, physical activity needs to be made easy, fun and affordable. Physcial activity and active recreation must be available to all, in every community across England.</p>
<p>Creating this vision requires actions across 4 domains at both a national and local level:</p>
<ol>
<li>Active society: creating a social movement</li>
<li>Moving professionals: activating networks of expertise</li>
<li>Active environments: creating the right spaces</li>
<li>Moving at scale: interventions that make us active</li>
</ol>
<p>These 4 domains of action are supported by the <a class="govuk-link" href="https://www.who.int/ncds/prevention/physical-activity/global-action-plan-2018-2030/en/"><abbr title="World Health Organisation">WHO</abbr> Global Action Plan on Physical Activity 2018 to 2030</a>.</p>
<p><a class="govuk-link" href="https://www.gov.uk/government/publications/everybody-active-every-day-2-year-update">Everybody active, every day: 2 years on</a> reviewed the progress of these 4 domains of action 2 years on from the framework’s implementation. <a class="govuk-link" href="https://www.icf.com/insights/health/everybody-active-every-day">This ICF report</a> published in 2018 also review the implementation of the framework at a national and local level. A ‘5 years on’ review will be published in early 2020.</p>
<h2 id="the-barriers-to-physical-activity-for-those-with-long-term-conditions">The barriers to physical activity for those with long-term conditions</h2>
<p>Insight work has found that 61% of people with long-term conditions and 68% of people with multimorbidities are not content with their physical activity levels and wish to be more active.</p>
<p><a class="govuk-link" href="https://richmondgroupofcharities.org.uk/">The Richmond Group of Charities’ Sport and Physical Activity project</a> identified a need for insight into physical activity and long-term conditions. It commissioned research with individuals with long-term conditions and people close to these individuals, to understand the barriers that prevent those with long-term conditions from engaging in physical activity, as well as other factors.</p>
<p>The research found that <a class="govuk-link" href="https://richmondgroupofcharities.org.uk/sites/default/files/richmond_group_debrief_final_1.pdf">people with long-term conditions experience both internal and external barriers to exercise</a>. Internal barriers come from within those with long-term conditions themselves, and external barriers are factors external to those with long-term conditions, which make it harder for them to exercise. The latter are often practical or logistical.</p>
<p>Internal barriers are perceived to be greater than external barriers and include:</p>
<ul>
<li>pain before, during or after physical activity</li>
<li>feeling tired before, during or after physical activity</li>
<li>breathlessness before, during or after physical activity</li>
<li>lack of motivation</li>
<li>not knowing what types of activity are right for them or their condition</li>
<li>fear of hurting themselves</li>
<li>feeling embarrassed</li>
<li>feeling unsafe in public spaces</li>
</ul>
<p>Within this, there is agreement that barriers arising from the symptoms of long-term conditions are greatest, such as pain, feeling tired and breathlessness.</p>
<p>Both exercise and physical activity are seen as “not for people like me” amongst inactive participants with multiple long-term conditions. However, the research found that the majority of people with a long-term health condition want to be active.</p>
<p>Almost all qualitative participants from this research found it much easier to cite barriers to physical activity than benefits. The benefits cited most commonly were psychological, including increased self-esteem and confidence, and improved mood and motivation. Social benefits are also important for many, such as getting out of the house and seeing people, which was seen to support the psychological benefits.</p>
<h2 id="physical-activity-resources-programmes-and-campaigns-for-the-public">Physical activity resources, programmes and campaigns for the public</h2>
<h3 id="oneyou-resources-active-10-and-couch-to-5k">OneYou resources: Active 10 and Couch to 5K</h3>
<p><abbr title="Public Health England">PHE</abbr> and the <abbr title="National Health Service">NHS</abbr>’ <a class="govuk-link" href="https://www.nhs.uk/oneyou/">OneYou resource</a> exists to help the public make small changes that fit their life, so that they feel better and healthier everyday. As part of OneYou, Active 10 and Couch to 5K are resources that support the important physical activity message that ‘some is good, more is better’ and that you can start small and build your activity up. A <a class="govuk-link" href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/639030/Health_benefits_of_10_mins_brisk_walking_evidence_summary.pdf">rapid evidence review</a> found that a reduced level of health benefits can be achieved through activity at less than the optimum 150 minutes, with some benefits shown even at levels of 10 minutes or more of at least moderate intensity activity per day.</p>
<p>Active 10 is a free walking tracker app that can be used to monitor brisk walking, set daily goals, and find out how to increase physical activity. It has been downloaded over 800,000 times and since its launch it has remained popular with a rating of 4.3 and 3.3 out of 5 on the iOS and Google Play App stores, respectively.</p>
<p>Brisk walking is a moderate intensity physical activity and evidence-based intervention for promoting physical activity. For currently inactive individuals, evidence shows the following health benefits could be achieved from 10 minutes of brisk walking per day for 7 days:</p>
<ul>
<li>increased physical fitness</li>
<li>greater ease of performance of everyday physical activities</li>
<li>improved mood</li>
<li>improved quality of life</li>
<li>increased body leanness and healthier weight</li>
<li>15% reduction in risk of early death</li>
</ul>
<p>The Couch to 5K app guides people through a 9-week programme by encouraging them to run 3 times a week. The app was designed to support people who have never run before, regardless of age.</p>
<p>It helps people to increase the distance they run incrementally, so that by the they arrive at week 9 they are encouraged to run for half an hour, which is approximately 5K. Over 3 million people have downloaded the app, and its rating on the app store continues to stay high at 4.5 out of 5.</p>
<h3 id="nhs-health-check"><abbr title="National Health Service">NHS</abbr> Health Check</h3>
<p>The <a class="govuk-link" href="https://www.nhs.uk/conditions/nhs-health-check/"><abbr title="National Health Service">NHS</abbr> Health Check</a> is a health check-up for adults aged 40 to 74 in England, which plays an important role in the prevention and early detection of <abbr title="cardiovascular diseases">CVD</abbr>. According to the <abbr title="World Health Organisation">WHO</abbr>, <abbr title="cardiovascular diseases">CVD</abbr> is the leading cause of death globally, but an estimated 50 to 80% are preventable as they are caused by modifiable risk factors. One of these risk factors is low physical activity (less than 150 minutes of moderate intensity physical activity).</p>
<p>Everyone having an <abbr title="National Health Service">NHS</abbr> Health Check should receive tailored lifestyle advice and access to local services, including physical activity services and the <abbr title="National Health Service">NHS</abbr> Diabetes Prevention Programme (<abbr title="National Health Service">NHS</abbr> <abbr title="Diabetes Prevention Programme">DPP</abbr>).</p>
<div class="call-to-action">
<p>Find out more about the role of the <abbr title="National Health Service">NHS</abbr> Health Check in promoting physical activity in <a class="govuk-link" href="https://www.gov.uk/government/publications/using-the-nhs-health-check-programme-to-prevent-cvd/using-the-world-leading-nhs-health-check-programme-to-prevent-cvd">this previous edition of Health Matters</a>.</p>
</div>
<h3 id="nhs-diabetes-prevention-programme"><abbr title="National Health Service">NHS</abbr> Diabetes Prevention Programme</h3>
<p>Type 2 diabetes is a major cause of premature mortality, with around 22,000 people with diabetes dying early each year in England. Overweight and obesity, driven by the obesogenic environment and physical inactivity, are significant risk factors in the development of type 2 diabetes.</p>
<p>The <abbr title="National Health Service">NHS</abbr> <abbr title="Diabetes Prevention Programme">DPP</abbr> is a joint commitment from <abbr title="Public Health England">PHE</abbr>, <abbr title="National Health Service">NHS</abbr> England and Diabetes UK. The programme provides evidence-based behavioural interventions at scale for individuals identified – for some through the <abbr title="National Health Service">NHS</abbr> Health Check – as being at high risk of developing type 2 diabetes.</p>
<p>One of the 3 core goals that underpins the <abbr title="National Health Service">NHS</abbr> <abbr title="Diabetes Prevention Programme">DPP</abbr> behavioural intervention is: achievement of the <abbr title="Chief Medical Officers">CMOs</abbr>’ physical activity recommendations. This may be through recommending the use of apps such as Active 10 and Couch to 5K to start adding small amounts of physical activity into your life.</p>
<div class="call-to-action">
<p>Find out more about the role of the <abbr title="National Health Service">NHS</abbr> <abbr title="Diabetes Prevention Programme">DPP</abbr> in increasing physical activity to reduce the risk of type 2 diabetes in <a class="govuk-link" href="https://www.gov.uk/government/publications/health-matters-preventing-type-2-diabetes/health-matters-preventing-type-2-diabetes">this previous edition of Health Matters</a>.</p>
</div>
<h3 id="we-are-undefeatable-campaign">We Are Undefeatable campaign</h3>
<p>The <a class="govuk-link" href="https://weareundefeatable.co.uk/">We Are Undefeatable campaign</a> – led by a collaboration of 15 leading health and social care charities and supported by <abbr title="Public Health England">PHE</abbr> and Sport England – is designed to inspire and motivate people living with long-term conditions to get active in a way that’s right for them.</p>
<p>It is designed with the perspective and lived experience of people with health conditions, and provides an opportunity to stimulate positive discussion and action, and identify and address barriers to engaging this audience.</p>
<p>The main audience for the campaign is:</p>
<ul>
<li>people who are doing little physical activity and those who are doing almost none at all</li>
<li>male and female, 30 to 64 years old and beyond</li>
<li>broad range of health conditions and different</li>
</ul>
<p>The campaign drives sustainable attitude and behaviour changes, therefore addressing some of the factors that people with long-term conditions identify as barriers to physical activity.</p>
<div class="call-to-action">
<p><a class="govuk-link" href="https://weareundefeatable.co.uk/login">Access the campaign assets here</a>.</p>
</div>
<h2 id="physical-activity-initiatives-and-training-for-healthcare-professionals">Physical activity initiatives and training for healthcare professionals</h2>
<p>More than 1 in 10 people visit their <abbr title="general practitioner">GP</abbr> every 2 weeks and there are 1.2 million health-related visits to a community pharmacy every year. In most cases, those who are regularly engaging with healthcare professionals have, or are at risk of, developing health conditions and are more likely to be inactive. In addition, 1 in 4 people would be more active if advised by a healthcare professional, so healthcare professionals play a unique role in supporting people to be more physically active.</p>
<p>However, a 2017 survey of 1,000 <abbr title="general practitioners">GPs</abbr> found that:</p>
<ul>
<li>80% of <abbr title="general practitioners">GPs</abbr> in England are unfamiliar with the national physical activity guidelines</li>
<li>less than half (44%) are confident in raising physical activity with patients</li>
<li>over half (55%) had done no specific training on physical activity</li>
</ul>
<p>A 2017 survey of 552 physiotherapists found that:</p>
<ul>
<li>the activity status of patients is not routinely assessed</li>
<li>60% knew the 150 minutes recommendation, but only 16% knew all 3 elements of the guidelines</li>
<li>they did not routinely signpost to further sources of physical activity support</li>
</ul>
<div class="img"><img src="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/image_data/file/94947/Support_healthcare-100.jpg" alt="Support healthcare professionals to discuss physical activity with patients" /></div>
<p>This is, in part, due to a system issue around providing adequate training for healthcare professionals on the guidelines and physical activity for people newly diagnosed with a long-term condition or in treatment.</p>
<p>Healthcare professionals may also feel that they cannot speak to patients about physical activity when they are seeing them about certain symptoms they are experiencing due to their long-term condition, such as fatigue and pain. They may also face time difficulties with regards to fitting a conversation about physical activity into a 10-minute appointment.</p>
<h3 id="moving-healthcare-professionals-programme">Moving Healthcare Professionals Programme</h3>
<p>The <a class="govuk-link" href="https://www.sportengland.org/our-work/health-and-inactivity/moving-healthcare-professionals/">Moving Healthcare Professionals Programme</a> (<abbr title="Moving Healthcare Professionals Programme">MHPP</abbr>) is a national partnership programme led by Sport England and <abbr title="Public Health England">PHE</abbr>. It is a whole-system educational approach to embed prevention and physical activity promotion into clinical practice, helping to address the barrier of healthcare professionals not speaking to their patients about the benefits of physical activity due to either lack of knowledge, skills or confidence.</p>
<p>The programme provides peer-led training and is developing practical resources to support healthcare professionals implement the <abbr title="National Institute for Health and Care Excellence">NICE</abbr> guidance on physical activity, and guidance for treatment of a breadth of conditions that recommend physical activity.</p>
<p>There are multiple strands to the programme:</p>
<ul>
<li>training existing healthcare professionals</li>
<li>development of resources, such as Moving Medicine (outlined below)</li>
<li>upskilling the next generation</li>
<li>testing innovative ideas</li>
</ul>
<p>Further information on each of these strands can be found on <a class="govuk-link" href="https://www.sportengland.org/our-work/health-and-inactivity/moving-healthcare-professionals/">Sport England’s website</a>.</p>
<p>Upskilling <abbr title="National Health Service">NHS</abbr> workforces through the <abbr title="Moving Healthcare Professionals Programme">MHPP</abbr> provides the opportunity to:</p>
<ul>
<li>address a recognised knowledge and skills gap across healthcare professionals and their capability to implement physical activity guidelines</li>
<li>provide the workforce with access to evidence-based training and resources proven to increase their knowledge and confidence, and support their practice</li>
<li>improve management of patients with over 30 long-term conditions that physical activity is known to improve</li>
<li>help reduce service demand and costs to the <abbr title="National Health Service">NHS</abbr></li>
</ul>
<p>Recognised by the <abbr title="World Health Organisation">WHO</abbr> as good practice, a second, 3-year programme was launched in the government’s prevention green paper. It will continue to provide free, evidence-based training and resources to healthcare professionals across their careers.</p>
<div class="call-to-action">
<p>Read this edition’s <a class="govuk-link" href="https://www.gov.uk/government/case-studies/active-hospitals">case study on the Oxford University Hospitals <abbr title="National Health Service">NHS</abbr> Trust’s Active Hospitals pilot</a>, which aimed to explore integrating physical activity interventions in a secondary care setting.</p>
</div>
<h3 id="moving-medicine">Moving Medicine</h3>
<p><a class="govuk-link" href="http://movingmedicine.ac.uk/">Moving Medicine</a> is an initiative led by the Faculty of Sport and Exercise Medicine UK, in partnership with <abbr title="Public Health England">PHE</abbr> and Sport England. It is a digital toolkit for clinicians and allied health professionals that is part of the Moving Healthcare Professionals programme, and has been <a class="govuk-link" href="https://movingmedicine.ac.uk/about/contributors/">developed in collaboration with experts, professional bodies and charities</a> representing patients and healthcare professionals in each disease area.</p>
<p>The toolkit provides <a class="govuk-link" href="https://movingmedicine.ac.uk/prescribing-movement/">accessible, evidence-based and condition-specific information</a> to help give advice on physical activity at all stages of a patient’s treatment pathway for 10 common conditions:</p>
<ul>
<li>cancer</li>
<li><abbr title="chronic obstructive pulmonary disease">COPD</abbr></li>
<li>dementia</li>
<li>depression</li>
<li>falls and frailty</li>
<li>inflammatory rheumatic disease</li>
<li>ischaemic heart disease</li>
<li><abbr title="musculoskeletal">MSK</abbr> pain</li>
<li>primary prevention</li>
<li>type 2 diabetes</li>
</ul>
<p>The toolkit provides what is needed for a 1 minute, 5 minute and longer conversation, complete with step-by-step guides, behavioural change insights, and all the evidence to back it up. This helps to alleviate the barrier of time constraints that healthcare professionals face when speaking to their patients, allowing them to incorporate physical activity into their conversation.</p>
<p>Through the work of the Moving Healthcare Professionals programme and others, we are seeing changes in the awareness and knowledge of healthcare professionals. We are seeing them becoming empowered to embed physical activity into the care of disabled people and people with long-term health conditions, to improve their health and quality of life.</p>
<h3 id="physical-activity-clinical-champions-training">Physical Activity Clinical Champions training</h3>
<p><abbr title="Public Health England">PHE</abbr> and Sport England’s Physical Activity Clinical Champions training involves a national network of 50 healthcare professionals providing a free, peer-to-peer, standardised training package to over 22,000 other healthcare professionals. Clinical champions are paid on a sessional basis to provide the training, which <abbr title="Public Health England">PHE</abbr> has peer-reviewed, sponsored and updated to match the new <abbr title="Chief Medical Officer">CMO</abbr> guidelines.</p>
<p>An independent evaluation has showed that this training:</p>
<ul>
<li>increased knowledge – 1 in 4 (25%) of those who did not know the guidelines recalled them correctly at 4 and 12 weeks</li>
<li>increase confidence – those ‘extremely confidence’ increased from 16% to 30% at 4 weeks</li>
<li>increase regularity of discussions – 40% had more physical activity conversations with patients</li>
</ul>
<div class="call-to-action">
<p><a class="govuk-link" href="https://publichealthmatters.blog.gov.uk/2018/06/21/clinical-champions-embedding-physical-activity-into-routine-clinical-care/">Read this blog to find out more about clinical champions training</a>.</p>
</div>
<h3 id="e-learning-courses">E-learning courses</h3>
<p>There are several other digital resources that <abbr title="Public Health England">PHE</abbr>, in collaboration with partners, has developed to support healthcare professionals in championing the benefits of physical activity with their patients.</p>
<p><abbr title="Public Health England">PHE</abbr>, Health Education England and Sport England have developed a <a class="govuk-link" href="https://www.e-lfh.org.uk/programmes/physical-activity-and-health/">physical activity and health e-learning course</a>, which is hosted on the e-Learning for Healthcare hub. The course will familiarise the learner with:</p>
<ul>
<li>the UK <abbr title="Chief Medical Officers">CMOs</abbr>’ physical activity guidelines</li>
<li>the underpinning evidence base</li>
<li>how to incorporate the guidelines into their daily clinical care</li>
</ul>
<p><abbr title="Public Health England">PHE</abbr>’s <a class="govuk-link" href="https://www.e-lfh.org.uk/programmes/all-our-health/">All Our Health e-learning session on physical activity</a> gives health and care professionals an overview of the topic and provides evidence, data and resources to help professionals in embedding physical activity into daily life. This supports system-wide priorities on prevention, including those within the <abbr title="National Health Service">NHS</abbr> Long Term Plan and prevention green paper.</p>
<h3 id="royal-college-of-general-practitioners-3-year-priority">Royal College of General Practitioners 3-year priority</h3>
<p><abbr title="Public Health England">PHE</abbr> is working with the Royal College of General Practitioners (<abbr title="Royal College of General Practitioners">RCGP</abbr>) on their 3-year priority on physical activity. This includes their <a class="govuk-link" href="https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/physical-activity-and-lifestyle.aspx">Physical Activity and Lifestyle Toolkit</a> and <a class="govuk-link" href="https://r1.dotdigital-pages.com/p/49LX-5IR/active-practice-charter">Active Practice Charter</a>, both developed in partnership with Sport England. The toolkit can be downloaded to help healthcare professionals embed physical activity within the conversations they’re having with patients. The charter inspires and celebrates <abbr title="general practitioner">GP</abbr> practices that are taking steps to increase activity in their patients and staff, and aims to support around 8,000 <abbr title="general practitioner">GP</abbr> practices in the UK.</p>
<p>More resources and condition-specific resources for healthcare professionals can be found on the <a class="govuk-link" href="https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/physical-activity-and-lifestyle.aspx"><abbr title="Royal College of General Practitioners">RCGP</abbr> website</a>.</p>
<p>The <abbr title="Royal College of General Practitioners">RCGP</abbr> and parkrun UK also launched the <a class="govuk-link" href="https://r1.dotdigital-pages.com/p/49LX-52M/parkrunpractice">parkrun practice initiative</a> in June 2018, which asks <abbr title="general practitioners">GPs</abbr> to affiliate themselves with their local parkrun and become parkrun practices. Involvement in this initiative will help practices:</p>
<ul>
<li>improve the health and wellbeing of practice staff</li>
<li>improve the health and wellbeing of patients and carers, particularly those who are inactive or living with long-term conditions, reducing the need for lifelong medication</li>
<li>raise awareness amongst the parkrun community of services that practices provide</li>
<li>contribute to the development of a local community and environment that is centred around wellness generation</li>
<li>support the UK-wide movement to scale up social prescribing activities</li>
</ul>
<p>More than 16% of <abbr title="general practitioner">GP</abbr> practices in the UK have registered to become a parkrun practice to date.</p>
<div class="call-to-action">
<p>Read this edition’s <a class="govuk-link" href="https://www.gov.uk/government/case-studies/the-parkrun-practice-initiative">case study on the parkrun practice initiative</a> to find out more.</p>
</div>
<h2 id="call-to-action">Call to action</h2>
<h3 id="the-role-for-healthcare-professionals">The role for healthcare professionals</h3>
<p>As discussed above, healthcare professionals play a unique role in supporting people living with, or at risk of developing, long-term health conditions to get more physically active.</p>
<p>With this in mind, healthcare professionals should:</p>
<ul>
<li>increase their knowledge of individuals’, communities’ and populations’ needs related to physical activity</li>
<li>use the resources and the services available in the health and wellbeing system to promote physical activity, including those outlined in the section above</li>
<li>incorporate physical activity conversations and brief advice into routine care</li>
<li>understand specific activities or interventions that can prevent physical inactivity and signpost to their local offers</li>
<li>help create a culture and process of physical activity within their workplaces, for example using the Active Practice Charter</li>
</ul>
<p>They can have an impact on the individual level by:</p>
<ul>
<li>providing high-quality brief interventions for physical activity behaviour changes</li>
<li>being familiar with the important messages</li>
<li>being familiar with local physical activity options</li>
<li>becoming a physical activity role model</li>
</ul>
<p><a class="govuk-link" href="https://www.youtube.com/watch?v=K9jDz-lmb5U&feature=youtu.be">Caroline Abrahams - Charity Director at Age UK Full Interview</a></p>
<p>Healthcare professionals also play an important role in using the <abbr title="National Health Service">NHS</abbr> Health Check as an opportunity to assess physical activity levels using the <a class="govuk-link" href="https://www.gov.uk/government/publications/general-practice-physical-activity-questionnaire-gppaq">general practice physical activity questionnaire</a> (<abbr title="general practice physical activity questionnaire">GPPAQ</abbr>). They can subsequently provide brief advice or behaviour change support.</p>
<p>Social prescribing is another important area that <abbr title="general practitioners">GPs</abbr> and other healthcare professionals should focus on, referring people to ‘activities’ or services in their community instead of offering only medical solutions.</p>
<p>The <a class="govuk-link" href="https://www.longtermplan.nhs.uk/"><abbr title="National Health Service">NHS</abbr> Long Term Plan</a> sets out that through social prescribing, the range of support available to people will widen, diversify and become accessible across the country. Over 1,000 social prescribing link workers will be in place by 2020 to 2021, so that over 900,000 people can benefit from social prescribing by 2023 to 2024. This is reiterated in the <a class="govuk-link" href="https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document">prevention green paper</a>.</p>
<h3 id="the-role-for-local-authorities">The role for local authorities</h3>
<p>Local authorities are the main investors in physical activity in local areas, and should adopt a whole systems approach to ensure that physical activity is embedded across their relevant functions.</p>
<p>A local whole systems approach enables local stakeholders, including communities, to come together, share an understanding of the reality of the challenge, consider how the local system is operating and where there are the greatest opportunities for change. Stakeholders agree actions and decide as a network how to work together in an integrated way to bring about sustainable, long term systems change.</p>
<p>However, leading on taking a whole systems approach to physical activity is just one part of local authorities’ role, as they also have a wider role to play in:</p>
<ul>
<li>understanding local physical activity levels and inequalities</li>
<li>providing and leading action to create physical activity opportunities</li>
<li>linking the whole systems approach to other local authority agendas</li>
</ul>
<div class="call-to-action">
<p>You can find out more about the local whole systems approach to obesity programme in <a class="govuk-link" href="https://www.gov.uk/government/publications/health-matters-whole-systems-approach-to-obesity/health-matters-whole-systems-approach-to-obesity">this previous edition of Health Matters</a>.</p>
</div>
<p>Building on this work, <abbr title="Public Health England">PHE</abbr> is working with Sport England to support their <a class="govuk-link" href="https://www.sportengland.org/our-work/local-delivery-pilots-community-of-learning/">Local Delivery Pilots</a>.</p>
<p>Local authorities should work with multiple organisations and groups, for example:</p>
<ul>
<li>local enterprise partnerships to invest in cycling and walking infrastructure to support local businesses with active travel and active retail</li>
<li>leisure, fitness and sport providers to maximise the potential of local physical activity assets</li>
<li>community groups to activate and maximise the potential of parks and green spaces</li>
</ul>
<div class="call-to-action">
<p><abbr title="Public Health England">PHE</abbr> has produced a <a class="govuk-link" href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/523460/Working_Together_to_Promote_Active_Travel_A_briefing_for_local_authorities.pdf">briefing for local authorities on working together to promote active travel</a>.</p>
<p>Use <abbr title="Public Health England">PHE</abbr>’s <a class="govuk-link" href="http://www.phoutcomes.info/">Public health and outcomes framework</a> and <a class="govuk-link" href="https://fingertips.phe.org.uk/profile/physical-activity">Physical Activity Fingertip tool</a> to identify the percentage of physically active and inactive adults in your local area.</p>
</div>
<h3 id="the-role-for-nhs-organisations">The role for <abbr title="National Health Service">NHS</abbr> organisations</h3>
<p><abbr title="National Health Service">NHS</abbr> organisations have an important role to play in the management and prevention of long-term conditions in adults through physical activity. Their role involves:</p>
<ul>
<li>identifying a senior lead for physical activity in line with <a class="govuk-link" href="https://www.nice.org.uk/guidance/qs183/chapter/Quality-statement-1-Physical-activity-champions"><abbr title="National Institute for Health and Care Excellence">NICE</abbr> guidance</a></li>
<li>sharing and encouraging training leads to include Clinical Champions training sessions within the staff training sessions</li>
<li>promoting the use of the e-learning and Moving Medicine resources</li>
<li>creating a culture that promotes physical activity, including supporting national and local campaigns such as <a class="govuk-link" href="https://www.nhs.uk/oneyou/">One You</a>, <a class="govuk-link" href="https://weareundefeatable.co.uk/">We Are Undefeatable</a> and <a class="govuk-link" href="https://r1.dotdigital-pages.com/p/49LX-52M/parkrunpractice">parkrun practices</a></li>
<li>creating links with local physical activity providers (for example, local Active Partnership, Walking for Health)</li>
</ul></div>Finland- Adult Mobility Recommendation - Now including sleephttps://www.wecanmoveinsight.net/articles/finland-adult-mobility-recommendation-now-including-sleep2019-10-30T10:07:27.000Z2019-10-30T10:07:27.000ZActive Gloucestershirehttps://www.wecanmoveinsight.net/members/ActiveGloucestershire<div><img src="https://storage.ning.com/topology/rest/1.0/file/get/3687336776?profile=RESIZE_400x&width=400"></div><div><p><a href="https://www.ukkinstituutti.fi/liikkumisensuositus/aikuisten-liikkumisen-suositus" target="_blank">https://www.ukkinstituutti.fi/liikkumisensuositus/aikuisten-liikkumisen-suositus</a></p>
<p> </p>
<h1>Adult movement recommendation</h1>
<h2>Moving Health - Step by Step</h2>
<p>The Weekly Exercise Recommendation for 18-64 year olds tells you the amount of weekly exercise that is good for your health and gives examples of how to increase your daily activity. At the same time, the ten-year-old fitness pie has become a popular adult exercise recommendation. </p>
<p><img src="https://www.ukkinstituutti.fi/filebank/4191-aikuisten-liikkumisen-suositus-kartio-web.jpg" alt="A cone representing the popularity of adult movement, consisting of blocks" width="723" height="702" /></p>
<p>Figure 1: Weekly mobility recommendation for 18-64 year olds.</p>
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<h2>Data on Adult Mobility Recommendation</h2>
<ul><li class="tplo_QuickSelect"><a href="https://www.ukkinstituutti.fi/filebank/4194-aikuisten-liikkumisen-suositus-tekstit-web.pdf" target="_blank">Brochure on Adult Mobility Recommendation</a> (4 pages pdf)</li>
<li class="tplo_QuickSelect"><a href="https://www.ukkinstituutti.fi/filebank/4203-aikuisten-liikkumisen_suositus-kuva-web.jpg" target="_blank">Picture of Adult Mobility Recommendation</a> (jpg)</li>
<li class="tplo_QuickSelect"><a href="https://www.ukkinstituutti.fi/verkkokauppa">Leaflet on</a> Adult Mobility Recommendation: Four-Sided Printable Order at <a href="https://www.ukkinstituutti.fi/verkkokauppa">UKK Institute Online Store</a></li>
</ul></div>
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<h2>How Much Good to Move <br /> - A few minutes at a time is enough</h2>
<p>There is an old, familiar core to the exercise recommendation: heart rate-increasing exercise, or vigorous exercise, is recommended for 2 hours 30 minutes a week. The same health benefits can also be gained by increasing the power of movement to be stressful. In this case, the amount of movement is 1 hour 15 minutes per week. Exercise and exercise should be exercised at least twice a week.</p>
<p>The requirement to move for at least 10 minutes has been removed from the revised Mobility Recommendation. Now just a few minutes at a time.</p>
<p><img src="https://www.ukkinstituutti.fi/filebank/4184-kartio-ylaosa-aikuisten-suositus-web.jpg?fb_bfn=4181-kartio-ylaosa-aikuisten-suositus-web.jpg" alt="Top of adult cone recommendation cone" /></p>
<p>Figure 2: Familiar core of exercise recommendation: heart rate-increasing exercise and exercising.</p>
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<h2>Muscle fitness and movement management to support performance</h2>
<p class="tplo_QuickSelect"><strong>at least 2 times a week</strong></p>
<ul><li>Load large groups of muscles and challenge your balance more than usual.</li>
<li>Choose your own routine such as stair walking, heavy yard work, group exercise, gym and ball games.</li>
</ul></div>
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<h2>Brisk exercise for health </h2>
<p class="tplo_QuickSelect"><strong>at least 2 hours 30 minutes a week</strong></p>
<ul><li class="tplo_QuickSelect">Any movement that speeds up your heart rate is acceptable.</li>
<li class="tplo_QuickSelect">Choose your own routine like swimming, Nordic walking, gymnastics, dance and hiking.</li>
</ul><p> </p>
<h3>OR</h3>
<h2>Exercise for good condition</h2>
<p><strong>at least 1 hour and 15 minutes a week</strong></p>
<ul><li>You will get the same health benefits in less time as you increase the power of your exercise.</li>
<li>Choose your own way like running, biking, skiing and ball games. </li>
</ul><p> </p>
</div>
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<p>Moving is brisk if you can talk despite being out of breath.<br /> Moving is tiring if you have difficulty breathing because of breathing.</p>
<p> </p>
<h2>Everyday offers many opportunities for movement<br /> - All movement is counted</h2>
<p>The renewed recommendation takes greater account of the importance of light movement, pausing at rest and adequate sleep. Research evidence has shown that lighter mobility also has health benefits, especially for those with reduced mobility. Even light exercise can lower blood sugar and fat levels, among other things. In addition, it stimulates blood circulation and stretches muscles and joints. Exercise and pause at work should be done every day - the more often the better.</p>
<p>Adding sleep along with exercise is also a new recommendation in exercise. Sufficient sleep and exercise together have significant health effects and the impact of sleep on recovery is great. The updated exercise recommendation takes greater account of wellbeing.<img src="https://www.ukkinstituutti.fi/filebank/4180-kartio-alaosa-aikuisten-suositus-web.jpg" alt="Bottom part of the Adult Movement Recommendation Conic" width="723" height="391" /></p>
<p>Figure 3: New part of the motion recommendation: light movement, pausing at rest and adequate sleep.</p>
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<h2>Light movement </h2>
<p class="tplo_QuickSelect"><strong>as often as possible</strong></p>
<ul><li class="tplo_QuickSelect">Every step is worth it: home chores, trade trips and other routines.</li>
<li class="tplo_QuickSelect">Your blood sugar and fat levels will improve, your joints will stretch, your blood circulation will increase and your mind will be refreshed.</li>
<li class="tplo_QuickSelect">Depending on the situation, choose, for example, stair use, dog walking, yard work, walking meetings, family activities.</li>
</ul></div>
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<h2>Breaks in standing still</h2>
<p class="tplo_QuickSelect"><strong>whenever you can</strong></p>
<ul><li class="tplo_QuickSelect">Exercise activates your muscles, reduces the strain on your body and increases the well-being of your musculoskeletal system.</li>
<li class="tplo_QuickSelect">Depending on the situation, choose for example sitting breaks, standing up, breaks.</li>
</ul></div>
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<h2>Restful dream</h2>
<p class="tplo_QuickSelect"><strong>sufficiently</strong></p>
<ul><li class="tplo_QuickSelect">It is not worth losing sleep. During sleep, your brain will structure your thoughts and recover from the stresses of the day.</li>
<li class="tplo_QuickSelect">When you wake up refreshed, you know you've slept enough.</li>
</ul></div>
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<h3> Go your own way. Every day.</h3>
<p> </p>
<h2>Comprehensive research background</h2>
<p>The new Finnish Mobility Recommendation is based on the American Recommendation, which was updated in 2018. The Mobility Recommendation from the US Health Service is based on comprehensive scientific evidence.</p>
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<h2>Check out</h2>
<ul><li class="tplo_QuickSelect"><a href="http://www.health.gov/paguidelines" target="_blank">US Health Agency of movement recommendation</a> (in English) </li>
<li class="tplo_QuickSelect"><a href="https://health.gov/paguidelines/second-edition/report/" target="_blank">2018 Physical Activity Guidelines</a> Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services, 2018.</li>
</ul></div>
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<p> <a class="buttonLink" href="https://www.ukkinstituutti.fi/liikkumisensuositus">See other navigation recommendations</a></p></div>Cycling and walking for individual and population health benefitshttps://www.wecanmoveinsight.net/articles/cycling-and-walking-for-individual-and-population-health-benefits2018-11-20T08:40:00.000Z2018-11-20T08:40:00.000ZAlan Inman-Wardhttps://www.wecanmoveinsight.net/members/AlanInmanWard<div><p>Source: <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/757756/Cycling_and_walking_for_individual_and_population_health_benefits.pdf">https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/757756/Cycling_and_walking_for_individual_and_population_health_benefits.pdf</a></p>
<p>Nov 2018</p>
<p><a href="{{#staticFileLink}}4166178097,original{{/staticFileLink}}">Cycling_and_walking_for_individual_and_population_health_benefits.pdf</a></p>
<p><span style="font-size:12pt;"><strong>Executive summary</strong></span></p>
<p>Regular physical activity benefits long-term health, including mental health, and helps to prevent over 20 common health conditions. The UK Chief Medical Officers’ guidance for adults includes 150 minutes of moderate intensity activity a week, and that the easiest way to achieve this is through daily activity such as walking and cycling.</p>
<p>Over 4 in 10 women (42%) and 1 in 3 men (34%) in England are not active enough for good health, with human and economic costs for the individual, communities and the health and social care system. The most recent estimates are that physical inactivity costs the NHS more than £450 million a year at Clinical Commissioning Group level, equating to £817,274 per 100,000 individuals or £8.17 per person.</p>
<p>This rapid evidence review is intended for health and social care policy makers, decision makers and commissioners and attempts to address the following question: “What is the impact of walking and/or cycling on different health outcomes?”</p>
<p>This review found that walking and cycling benefit health in a number of ways:</p>
<ul>
<li>people who walk or cycle have improved metabolic health and a reduced risk of premature mortality</li>
<li>walking and cycling reduce the risk factors for a number of diseases, including cardiovascular disease, respiratory disease, some cancers, and Type II diabetes</li>
<li>walking and cycling also have positive effects on mental health and general wellbeing. The mental health and neurological benefits include reduced risk of dementia, improved sleep quality, and a greater sense of wellbeing</li>
<li>in environmental terms, health benefits accrue for the general population from a reduction in pollution due to car use and a decrease in road congestion</li>
<li>the evidence is that the health benefits of walking and cycling outweigh any potential health risks and harms – for example from injury or pollution</li>
</ul>
<p>The weight of evidence suggests that if walking and cycling can be increased, they have potential to lead to important health gains at the population level, and thus benefit the NHS and the wider health and care system.</p>
<p>The evidence is stronger and more consistent for certain health outcomes, and evidence gaps remain in some areas. There is little direct evidence about whether walking or cycling to work might have different health effects to walking or cycling for leisure.</p>
<p>There is little specific evidence available on the benefits of walking and cycling for people with disabilities and those living with long-term conditions. Similarly, there is little about the effects on groups living with different levels of deprivation. It would be helpful if these gaps were addressed, particularly regarding practical methods to improve access to physical activity for these groups.</p></div>