Evidence for interventions
It is difficult to summarise the evidence for interventions as it is such a broad topic area. However, the evidence is clear that being more active is good for us, yet many people do not get enough activity in their day-to-day lives to realise those benefits. Physical inactivity is responsible for one in six deaths in the UK, which is the same as smoking. It is estimated to cost the economy over £7 billion per year. This includes direct costs to the NHS of almost £1 billion and wider costs (e.g. lost workplace productivity from conditions associated with inactivity, such as musculoskeletal (MSK) issues). Investing in physical activity and supporting residents to lead more active lives is key to improving quality of life and health outcomes.
The benefits of physical activity are well documented for individuals, populations and society, but there is less robust evidence on what works to make people more active and whether this improves outcomes. Many community-wide programmes fail to reach all of the target population or the lead time to see improvements in metrics such as life expectancy or healthy life expectancy is too long with many other confounding factors to be able to draw robust conclusions.
Data from Sport England suggests that every £1 spent on sport and physical activity generates almost £4 for society and economy. However, funding pressures mean that local authorities, other organisations and individuals are disinvesting in physical activity. Sport England also estimate that sport and physical activity had a social value of £107.2 billion in 2022/23, including over £2 million in Tyne and Wear. However, funding pressures mean that local authorities, other organisations and individuals are disinvesting in physical activity.
Evidence-based and evidence informed interventions for increasing physical activity encompass a range of strategies, including individual behavioural changes, environmental modifications and community-wide approaches. Studies focusing on behaviour change more broadly show that methods such as goal setting, building social support and behavioural reinforcement can be effective. Studies focusing on the impact of modifying the built and wider environment show the benefits of creating accessible environments (to make it easier for people to be more active) and improving infrastructures to promote active travel.
Evidence relating to other health promotion and health improvement interventions shows that family- and school-based programmes can support positive change, as can workplace interventions. Offering a range of options (e.g. group classes, individual programmes, digital and face-to face options, counselling, educational materials etc.) can help people feel more empowered and provide choices based on their individual preferences and accessibility.
The International Society for Physical Activity for Health (ISPAH) defined eight investments that work for physical activity. This is based on an overview of the best available evidence and the aim of the work is to advocate, inform and lead physical activity policy and discussion. Their evidence is clear that there is no single solution as physical inactivity is a complex public health issue, with multiple influencing influences. Therefore, a systems-based approach is needed rather than solely focusing on short-term individual behaviour change. The eight investments set out by ISPAH are shown in Figure 1 below and were used as part of a regional sector-led improvement approach for physical activity.
Figure 1 – ISPAH’s eight investments that work for physical activity
Any future interventions delivered in the Borough should take the above into account. The sustainability of interventions is essential to support residents to maintain long-term physical activity habits. Key to this will be supporting residents to find activities that they find enjoyable, accessible and appropriate to their individual needs.
A review of studies of physical activity interventions in primary healthcare settings was recently published. This showed that physical activity interventions delivered or prompted by health professionals appear effective at increasing participation. For some studies, the increase was modest, however even small increases in physical activity are clinically important. The reviewers concluded that such interventions should be considered for routine implementation to increase levels of physical activity and improve health outcomes in the population. The authors noted that patients needed multiple contacts with professionals to support an increase in activity levels. The authors also noted that many health professionals are reluctant to promote physical activity as they feel they lack specialist knowledge or skills and that some patients may be concerned about adverse health outcomes. Northumbria Healthcare NHS Foundation Trust is currently delivering Physical Activity Champion training to healthcare professionals in the Borough, and this approach has worked elsewhere in the region.
The Cochrane Library is a collection of databases that contain high quality, independent evidence to inform healthcare decision-making. There have been six relevant Cochrane Evidence Reviews (e.g. interventions, strategies and policies operating at the population level and in settings outside healthcare and not targeted at specific clinical conditions) published in the last 10 years. More detail is provided in Appendix 1. Overall, reviewers found that there is some evidence that the interventions studied either helped people to be more active or improved their health and well-being. However, the reviewers also questioned the quality of the evidence, which often made it difficult to draw strong conclusions. It is difficult to design a robust scientific experiment on this subject as there are a lot of confounding factors and lots of variables. More research is needed to establish which methods of exercise promotion work best in the long term to encourage specific groups of people to be more physically active.
The National Institute for Health and Care Excellence (NICE) produces evidence-based guidance, advice and clinical standards for healthcare professionals to aid decision making. Appendix 1 contains more detail on relevant evidence-based products from NICE.