Physical Activity and Health Promotion: Evidence-based Approaches to Practice - Softcover

Softcover

ISBN 10: 1405169257 ISBN 13: 9781405169257

Publisher: Wiley-Blackwell, 2009

Synopsis

Physical Activity and Health Promotion: Evidence-based Approaches to Practice evaluates the realities and complexities of working to reverse the adverse trend towards physical inactivity. It is a well-rounded, evidence-based analysis of interventions for physical activity practice, covering a range of settings and target groups. Expert contributors present case studies which help to translate the theory into practice, from individual to societal levels, enriched by explanations of the socio-political context.

The first section covers the concepts for the development of physical activity practice; influencing sustained health behaviour change, explaining the role and function of health policy in physical activity promotion, and developing the evidence base for physical activity interventions. Section Two explores the evidence base for interventions in physical activity practice, in varied settings and target groups. Physical Activity and Health Promotion concludes with a challenge to innovate in promoting physical activity.

Physical Activity and Health Promotion will be of relevant to health professionals and students with an interest in sport, physical activity and exercise, particularly health and exercise promotion specialists across the disciplines.

About this title

About the Author

Lindsey Dugdill, Reader in Exercise and Health in the School of Health Care Professions, University of Salford, UK

Diane Crone, Reader in Exercise Science at the University of Gloucestershire, UK and BASES (British Association of Sport and Exercise Sciences) Accredited Sport and Exercise Scientist (Support and Research).

Rebecca Murphy, Lecturer in Exercise and Health at Liverpool John Moores University.

The first section covers the concepts for the development of physical activity practice; influencing sustained health behaviour change, explaining the role and function of health policy in physical activity promotion, and developing the evidence base for physical activity interventions. Section Two explores the evidence base for interventions in physical activity practice, in varied settings and target groups. Physical Activity and Health Promotion concludes with a challenge to innovate in promoting physical activity.

Physical Activity and Health Promotion will be of relevant to health professionals and students with an interest in sport, physical activity and exercise, particularly health and exercise promotion specialists across the disciplines.

The first section covers the concepts for the development of physical activity practice; influencing sustained health behaviour change, explaining the role and function of health policy in physical activity promotion, and developing the evidence base for physical activity interventions. Section Two explores the evidence base for interventions in physical activity practice, in varied settings and target groups. Physical Activity and Health Promotion concludes with a challenge to innovate in promoting physical activity.

Physical Activity and Health Promotion will be of relevant to health professionals and students with an interest in sport, physical activity and exercise, particularly health and exercise promotion specialists across the disciplines.

Excerpt. © Reprinted by permission. All rights reserved.

Physical Activity and Health Promotion

Evidence-based Approaches to Practice

John Wiley & Sons

Copyright © 2009 Lindsey Dugdill, Diane Crone, Rebecca Murphy
All right reserved.
ISBN: 978-1-4051-6925-7

Chapter One

Physical activity, health and health promotion

Rebecca Murphy, Lindsey Dugdill and Diane Crone

Introduction

Physical activity research has clearly established the link between inactivity and poor health status in populations (United States Department of Health and Human Services, 1996; Department of Health, 2004 a,b,c; Department of Health, 2005). In addition, it is widely accepted that population physical activity levels in the UK are lower than that recommended for ensuring optimal health. Physical inactivity is becoming an issue of extreme public health importance to all health professionals and agencies within the UK, across Europe and in other Western industrialised countries. A range of global and international health policies outline the significance to public health of promoting healthy lifestyles in the twenty first century (Department of Health, 2004a, 2008; World Health Organisation [WHO], 2004; Wanless, 2004; Hillsdon et al., 2004). In the UK, physical activity is cited as a key intervention to tackle many health problems (Department of Health 2004a). The Department of Health has a joint public service agreement with the Treasury, the Department for Education and Skills and the Department for Culture Media and Sport (DCMS, 2002) to halt the year-on-year rise in obesity among children under 11 by 2010, in the context of a broader strategy to tackle obesity in the population as a whole (Dugdill and Stratton, 2007; Department of Health, 2008). In addition, the importance of physical activity as a risk factor for coronary heart disease is increasingly being recognised throughout Europe (Health Enhancing Physical Activity Guidelines [HEPA], 2000) and beyond (WHO, 2004).

Physical activity is a key component to maintaining a healthy lifestyle for all individuals. To assist in contextualising the significance of physical activity promotion to public health, this chapter outlines and considers definitions of health and health promotion, health trends, and current recommendations for physical activity within health promotion.

Defining exercise and physical activity

Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure (Caspersen et al., 1985). It has dimensions of 'volume (how much), duration (how long), frequency (how often), intensity (how hard) and mode (what type)' (Cale and Harris, 2005, p. 7). It is, therefore, a multi-faceted, complex and broad-ranging behaviour that may encompass activities of daily living (housework, gardening, stair climbing), occupation-related activity completed as part of one's job (walking, hauling, lifting and packing), transportation physical activity [walking, biking or wheeling (for wheelchair users), to and from places)] also known as active travel or transport, leisure time activity (exercise, sports recreation or hobbies), or engagement in specific prescribed interventions (Dugdill and Stratton, 2007). Exercise is considered a subset of physical activity which includes planned, structured, and repetitive bodily movement which is undertaken to improve or maintain one or more components of physical fitness (Casperson et al., 1985).

Understanding the political climate

In recent years, the Chief Medical Officer has collated and summarised the scientific evidence on the contribution of active living to promoting health and well-being across the lifespan (Department of Health, 2004b). Evidence suggests that increasing physical activity participation could significantly contribute to the prevention and management of over 20 diseases and conditions. In addition it is estimated that the cost of inactivity in England could be 8.2 billon annually (DCMS, 2002). In recent years various targets for increasing participation levels in sport and physical activity have been proposed. These include a target to increase participation levels to 70% of individuals undertaking 30 minutes of physical activity 5 days a week by 2020 (DCMS, 2002), and a less ambitious target of an increase in participation to 50% by 2020 (Wanless, 2004) (see also Chapters 3 and 6). Physical activity promotion was a key target of the Public Health White Paper Choosing Health: Making Healthier Choices Easier (Department of Health, 2004a). Furthermore, Choosing Activity: A Physical Activity Action Plan (Department of Health, 2005) outlined the action that needs to be taken in order to promote physical activity in the UK, and documents Government priorities for physical activity promotion in the form of cross-departmental Public Service Agreement Targets, which are:

'To halt the year-on-year increase in obesity among children under 11 by 2010, in the context of a broader strategy to tackle obesity in the population as a whole. By 2008, increase the uptake of cultural and sporting opportunities by adults and young people aged 16 and above from priority groups by increasing the number of people who participate in active sports, at least 12 times a year by 3% and increasing the number who engage in at least 30 minutes of moderate intensity level sport, at least 3 times a week by 3%. Enhance the take-up of sporting opportunities by 5-16 year olds so that the percentage of school children in England who spend a minimum of two hours each week on high quality PE and school sport, within and beyond the curriculum, increases from 25% in 2002 to 75% by 2006 and 85% by 2008 in England, and at least 75% in each school sport partnership by 2008'. (Department of Health, 2005, p. 7)

Physical activity prevalence and trends

Worldwide, 60% of the population are insufficiently active to benefit their health (WHO, 2004) and physical activity levels in the UK are exceptionally low (Department of Health, 2004b); e.g. only 21% of the adult population are regularly participating in sport or recreational activity (defined as taking part, on at least 3 days a week, in moderate intensity sport and active recreation, for at least 30 minutes continuously in any one session) (Sport England, 2006). Variation in participation exists according to demographic variables. More males (37%) than females (25%), residing within the UK, attain current recommended activity guidelines (Department of Health, 2004c), participation declines with age for both men and women and, compared with the general population, men from certain ethnic groups (Indian, Pakistani, Bangladeshi and Chinese) are less likely to meet physical activity recommendations (Department of Health, 2004c). According to the National Travel Survey (Department for Transport, 2001) between 1975-1976 and 1999-2001 average miles travelled by foot and bicycle had decreased by approximately 26%. In contrast, participation levels in selected leisure time physical activity such as walking, swimming and keep-fit/ yoga were reported to have increased or at least remained the same between 1987 and 1996 (Department for Transport, 2001). In conclusion, therefore, over the past 20-30 years it seems that there has been a significant decrease in physical activity as part of daily routines and a small increase in activity during leisure time.

Health and health promotion

Health is a multidisciplinary concept, which encompasses states of both positive and negative well-being. Definitions of health arise from different perspectives, and as such, broad variations exist (Lucas and Lloyd, 2005). Historically, definitions have evolved with social change:

'The rising expectations of the past 150 years have led to a shift away from viewing health in terms of survival, through a phase of defining it in terms of freedom from disease, onward to an emphasis on an individuals ability to perform daily activities, and more recently to an emphasis on positive themes of happiness, social and emotional well-being, and quality of life'. (Lindau et al., 2003, p. 3)

In 1948 the World Health Organisation defined health as 'a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity' (cited in Nutbeam, 1998, p. 351). This definition encapsulates health as both a positive and holistic concept emphasising physical, mental and social elements. In contrast, biomedical models of health propose a negative definition, through which health is defined as freedom from disease, dysfunction or injury (Naidoo and Wills, 2000). In historical terms biomedical definitions of health were commonly adopted during the nineteenth and twentieth centuries, during which time the predominant focus of public health was to control disease and infection. Despite more recent acceptance of the holistic concept of health, arguably, the biomedical perspective remains the favoured definition adopted by health care professionals in the UK (Ewles and Simnett, 1999). In addition to biomedical and holistic approaches to defining health, Keleher and Murphy (2004) also outline sociological, socio-ecological, lay and health promotion approaches to understanding health.

The complexity of the concept of health is further evident when considering the various dimensions of health. Viewed from a holistic perspective, health can be experienced from a range of inter-related and interdependent dimensions, including physical, mental, emotional, social and spiritual (Ewles and Simnett, 1999), as such complex states of health can co-exist. Physical and mental health, arguably the most commonly described dimensions of health, are concerned with the mechanistic function of the body and the ability to think clearly and coherently, respectively. Emotional and social health are closely related to mental health and refer to the ability to recognise emotions and the ability to make and maintain relationships. Spiritual health is concerned with feeling at peace with oneself and the quality of 'innermost' feelings.

Determinants of health

Health is shaped by multiple factors including personal lifestyle and the social, cultural and physical environment within which a person exists. The multi-layered model of factors determining health status (Dahlgren and Whitehead, 1991) represents the inter-related nature of the determinants of health (Figure 1.1). At the centre of the model are non-modifiable (fixed determinants) factors such as age, gender and genetics. Extending from the centre of the model are layers of influence that are potentially modifiable (variable determinants) by manipulation of either the environment or individual behaviour. The inner most layer represents individual lifestyle factors such as physical activity or dietary behaviour. Elements of the social environment include family structure and social networks and the final outer layer represents physical environmental conditions that have been linked to health, which include the provision of public services such as education, housing and healthcare. This model recognises the importance of the broader social, cultural and environmental determinants of health, and their inter-relationship with lifestyle choices of individuals.

Health and health promotion - an historical perspective

Expressed in terms of measurable biological outcomes, i.e. morbidity (disease) or mortality (death) rates, significant improvements in population health and well-being have been experienced. Such improvements have been attributed to rising standards of living (Department of Health, 2004a), advances in science, medicine and technology, and suppression of the incidences of infectious diseases, in developed countries (Naidoo and Wills, 2000). Over the last 50 years, global life expectancy at birth has increased by approximately 20 years, from 46.5 years in 1950 to 65.2 years in 2002 (WHO, 2003). In the UK, in 2004, female life expectancy was 81.1 years, for males 76.7 years (ONS, 2006). Increased life expectancy is not, however, synonymous with healthy life expectancy. Primarily as a consequence of non-communicable diseases individuals experience a significant number of unhealthy years at the end of life. Healthy life expectancy in the UK is currently 69.9 years and 67.1 years for females and males, respectively (ONS, 2006). In both developed and developing countries, non-communicable diseases represent 60% of the global disease burden (WHO, 2006). For example, circulatory diseases and cancer are the two most common causes of death and disability in the UK. Furthermore, coronary heart disease, diabetes and stroke are the most common illness to impair quality of life (ONS, 2006). In developed countries, therefore, a large proportion of illness and deaths can be attributed to a small number of lifestyle-behavioural risk factors, unhealthy diet, tobacco usage, physical inactivity and alcohol abuse (Wanless, 2004).

Health promotion has emerged as an increasingly important academic and professional multi-discipline (Ewles and Simnett, 1999). Measures designed to enhance health include health education (lifestyle and preventative) approaches alongside environmental (policy and fiscal) measures (Tones, 2001). The foundations of health promotion have emerged from the specialist areas of public health and health education (Edmonson and Kelleher, 2000). Public health is defined as 'the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society' (Nutbeam, 1998, p. 352). In the nineteenth century, public health action was primarily concerned with the improvement of living conditions and infectious disease control with a focus upon better housing, education and sanitation. In contrast health education, when introduced in the 1960s, was primarily concerned with individual responsibility for health and illness and arose as a result of increasing lifestyle related diseases and the subsequent requirement to convey information regarding personal health behaviours (Egger et al., 1999).

Health promotion emerged in an attempt to overcome the limited focus of both public health and health education on individual health behaviour, and recognised the importance of addressing environmental as well as individual (behavioural) determinants of health (Tones and Green, 2004). A wide range of actions constitutes the multi-disciplinary nature of health promotion practice (Rootman et al., 2001); and since its inception, broad ranges of health promotion definitions have emerged (Rootman et al., 2001). Explanations of health promotion action are underpinned by the different meanings attached to the concept of health, including considerations of the determinants of health (Naidoo and Wills, 2000). For example, WHO define health promotion as 'the process of enabling people to increase control over, and to improve, their health' (Ottawa Charter, 1986, p. 2).

Health promotion therefore includes the strengthening of individual capabilities to influence economic, societal and political actions in order to impact on public health (Naidoo and Wills, 2000). This is reflected in the Ottawa Charter (1986), a seminal document in the emergence and development of health promotion, which outlined five inter-related action areas for health promotion interventions, including: (1) building healthy public policy, (2) creating supportive environments, (3) strengthening community action, (4) developing personal skills and (5) reorienting health services.

The principles of, and strategies for health promotion can be applied to a variety of population groups (e.g. older people), risk factors (e.g. hyperlipidaemia), diseases (e.g. coronary heart disease) and settings (e.g. inner city areas) (O'Byrne, 2000). Over the past 10 years physical activity has become increasingly recognised as an activity that has positive health benefits in both treatment and prevention of ill health. As a consequence, physical activity exists within the context of health promotion and it is not unusual, for example for a primary care trust (PCT) to have a lead health professional, who has a remit for the strategic promotion of physical activity.

(Continues...)

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Edition details

• Publisher: Wiley-Blackwell
• Publication date: 2009
• Language: English
• ISBN 10: 1405169257
• ISBN 13: 9781405169257
• Binding: Paperback
• Edition number: 1
• Number of pages: 288
• Editor: Dugdill Lindsey, Crone Diane, Murphy Rebecca