Enhancing global, UK and Scottish physical activity policy and guidance
Internationally-recognised researchers from the Physical Activity for Health Research Centre (PAHRC) have had a demonstrable impact on shaping local, national and global public health policy by enhancing international economic assessment of the benefits of walking and cycling.
What was the problem?
The Physical Activity for Health Research Centre (PAHRC)’s mission is to encourage people of all ages to ‘sit less and move more’, and enjoy the physical, mental and social health benefits of an active lifestyle. PAHRC research addressed the challenges of evidencing the health and economic benefits of walking and cycling, and of how to assess the effectiveness of physical activity policies to promote walking and cycling globally.
What did we do?
Dr Paul Kelly conducted research into the health benefits of walking and cycling. He conducted a systematic review and meta-analysis of 14 longitudinal studies involving more than 200,000 participants from Europe, the US, China and Japan. This research was the first to show that a weekly dose of 150 minutes of walking or cycling per week can reduce the risk of premature death by around 10%, regardless of overall levels of physical activity.
Kelly also contributed these findings to a later study which was the first to model them against air pollution data on a global scale. The team’s analysis indicated 150 minutes of walking or cycling each week outweighs the risks from air pollution in 98% of the world’s cities. The findings challenged previous 'assumptions to the contrary', which were a barrier to behaviour change.
Mutrie, Fitzsimons and Kelly’s analysis of data from the Scottish Government’s Scottish Health Survey 2013 suggests the ways people stay active vary by age group and circumstances. They found walking accounted for as much as 30% of weekly physical activity among Scottish adults who meet the UK Chief Medical Officer's (UK CMO) guideline of 150 minutes of physical activity each week, and this proportion increased with age. Team sports contributed less than 5% of people’s weekly activity. Meanwhile, domestic tasks made up more than 50% of insufficiently active people’s weekly activity. The research indicated efforts to encourage more people to meet the guideline levels of physical activity might be more effective if they focused on activities other than sports.
The researchers challenged previous analysis of UK data which suggested older adults are the most sedentary age group. Examining data on more than 14,000 Scottish adults, they found this was incorrect as previous studies did not consider the up to 45% of time people spend seated at work.
Mutrie, Fitzsimons and Kelly also found fewer Scottish adults meet the UK CMO’s weekly guidelines for muscle strengthening (<30%) or balance promoting (<15%) exercises than complete the recommended amount of aerobic activity (65%). The research indicated the need for policy adjustment to better support the Scottish Government’s stated goals for overall physical activity.
Kelly’s research also tested the validity of population health measurement across the UK. His findings challenged previous studies which suggested the proportion of children achieving the recommended level of weekly activity was higher in Scotland than in England. He demonstrated that the difference in Scottish Health Survey estimates (70%) and those in the Health Survey for England (25%) was the result of variation in data collection and analysis methods.
What happened next?
This research has had impact in a variety of ways.
Enhancing global economic assessment of the benefits of walking and cycling
Kelly’s research, which found 150 minutes of walking or cycling can reduce the risk of premature death by around 10%, has informed global transport policies to improve public health and promote sustainability. In 2014, the World Health Organization (WHO) adopted Kelly’s findings to critically underpin the calculations used in its Health Economic Assessment Tool (HEAT). HEAT employs unique statistical modelling to help policymakers, researchers and physical activity advocates answer the question: if X people cycle or walk Y distance on most days, what is the economic value of mortality rate improvements? The tool provides cost-benefit analyses and economic valuations of transport or infrastructure projects, which would not be possible without Kelly’s research.
In 2018, WHO introduced the results from the later study Kelly contributed to, which showed the benefits of walking and cycling outweigh the adverse health effects of exposure to air pollution, to enhance the tool’s economic modelling power further. Kelly’s research was central to the development of HEAT.
The HEAT has been applied in several countries and continues to inform and impact policy and planning decisions, making the case for better walking and cycling environments. The United Kingdom and Sweden have included the HEAT in their official national guidance, and the Austrian, Finnish and French governments have promoted the tool for in-country use.
Changing physical activity policy in Scotland
The Scottish Government introduced changes to how it measures people’s activity levels in the revised 2018 Active Scotland Outcomes Framework (ASOF), as a direct result of PAHRC’s research. Describing Scotland’s ambitions for sport and physical activity, the ASOF contributes to the delivery of the Scottish Government’s National Performance Framework, which aims to create a more prosperous, sustainable and inclusive country.
As a result of PAHRC’s research, Scottish Government is working to improve physical activity levels. Their published physical activity indicator set now tracks sedentary time and the proportion of adults in Scotland meeting muscle strengthening and balance and coordination recommendations. They are also considering opportunities to compare children’s physical activity measures across different parts of the UK.
Scottish Government also drew on Mutrie, Fitzsimons and Kelly’s analysis of Scottish Government data showing the importance of muscle strengthening and balance activity and the impact of sedentary time on health. The Evidence Group of the National Strategic Group for Physical Activity (NSG) used this evidence to develop recommendations for headline outcomes for the ASOF physical activity policy to drive improvements of physical activity for health across Scotland.
Developing UK Chief Medical Officers’ (UK CMO) Physical Activity Guidelines
Mutrie, Fitzsimons and Kelly’s research on the way people stay active and how this varies by age group and sex also played a vital role in the development of the 2019 UK CMO Physical Activity Guidelines. Their findings on the relatively low proportion of people who meet existing recommendations for muscle strengthening or balance promoting activities also contributed significantly to the new guidelines.
…changes have been made to the previous guidelines to take account of new evidence. Given the lower levels of physical activity amongst the population of older adults, small increases in the volume of daily physical activity can produce important health and functional benefits. …These revised guidelines for older adults therefore give greater emphasis to regular light activity… The value to older adults of activities which improve strength, balance and flexibility cannot be overstated, and therefore receive greater prominence in these revised guidelines.
The UK CMO appointed Mutrie to chair a working group of more than ten leading physical activity researchers, including Kelly, to develop recommendations on communicating the 2019 Physical Activity guidelines and monitoring their effectiveness. The working group’s 2018 Surveillance Technical Report cites Mutrie, Fitzsimons and Kelly’s work to challenge prior analysis which suggested people’s total sedentary increases with age, in its argument for improved measures for sitting time at work and total sedentary time.
The report calls for a more comprehensive set of recommended exercises to help people meet muscle strengthening and balance promoting activities, based on the researchers’ findings. It also includes Kelly’s discovery that differences in reported physical activity between children in Scotland and England could be explained by differences in analysis methods, among justifications for its recommendation for greater harmonisation in health research across the UK nations.
[Mutrie, Fitzsimons and Kelly’s research] strongly contributed to the communications and surveillance of the 2019 UK CMOs’ Physical Activity Guidelines. [The] UK is one of the leaders with guidelines for healthcare professionals to help people be more physically active, thanks to the work of [these] researchers.