Lincolnshire JSNA: Physical Activity

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1 What do we know? Summary Promoting active lifestyles can help us address some of the important challenges facing the population today. Increasing physical activity has the potential to improve the physical and mental health and wellbeing of the population. It has the potential to save money by easing the burden of chronic disease on the health and social care services. Increasing cycling and walking can reduce transport costs, save money and help the environment. Fewer car journeys reduce traffic congestion and pollution. Other potential benefits linked to physical activity in children and young people include the acquisition of social skills through active play (leadership, teamwork and cooperation), better concentration in school and displacement of anti-social and criminal behaviour. It is important for people to be active throughout our lives. Physical activity is central to a baby s normal growth and development. This continues through school, and into adulthood and older years. Being physically active can bring substantial benefits and there is consistent evidence of a dose response relationship, i.e. the greater the volume of physical activity undertaken, the greater the health benefits that are obtained. Revised physical activity recommendations for adults are that they should achieve a minimum total of at least 150 minutes over a week of moderate activity, in bouts of at least 10 minutes duration. Moderate activity can be achieved through brisk walking, cycling, gardening and housework, as well as various sports and exercise. Alternately, 75 minutes of vigorous intensity activity across the week such as running, football or swimming. All adults should also aim to improve muscle strength on at least two days a week and minimise sedentary activities. Facts and Figures Physical activity includes all forms of activity, such as everyday walking or cycling to get from A to B, active play, work-related activity, active recreation (such as working out in a gym), dancing, gardening or playing active games, as well as organised and competitive sport. 1 of 16 August 2014 (v3.0)

2 There are many independent risk factors for chronic disease, e.g. smoking, excessive alcohol consumption and poor nutrition. Physical inactivity is the fourth leading risk factor for global mortality (accounting for 6% of deaths globally). This follows high blood pressure (13%), tobacco use (9%) and high blood glucose (6%). Overweight and obesity are responsible for 5% of global mortality. The benefits of regular physical activity have been clearly set out across the life course. In particular, for adults, doing a minimum 30 minutes of moderate intensity physical activity on at least 5 days a week helps to prevent and manage over 20 chronic conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions. The strength of the relationship between physical activity and health outcomes persists throughout people s lives, highlighting the potential health gains that could be achieved if more people become more active throughout the life course. There is a clear causal relationship between the amount of physical activity people do and allcause mortality. While increasing the activity levels of all adults who are not meeting the recommendations is important, targeting those adults who are significantly inactive (i.e. engaging in less than 30 minutes of activity per week) will produce the greatest reduction in chronic disease. Physical activity has an important role to play in promoting mental health and well-being by preventing mental health problems and improving the quality of life of those experiencing mental health problems and illnesses. For example, evidence shows that physical activity can reduce the risk of stress, depression and dementia. Physical activity can enhance psychological well-being, by improving self-perception and self-esteem, mood and sleep quality, and by reducing levels of anxiety and fatigue. The evidence suggests a growing concern over the risks of sedentary behaviour. Although most of this research has focused on the relationship between sedentary behaviour with overweight and obesity, research also suggests that sedentary behaviour is independently associated with allcause mortality, type 2 diabetes, some types of cancer and metabolic dysfunction. Sedentary behaviours in adults are impacted by age, gender, socio-economic conditions, occupation, weight status and some characteristics of the physical environment. These relationships are independent of the level of overall physical activity. For example, spending large amounts of time being sedentary may increase the risk of some health outcomes, even among people who are active at the recommended levels. Levels of physical activity in both adults and children are regularly measured throughout the country, although there are some differences in the methods used to collect the data. Despite the multiple health gains associated with a physically active lifestyle, there are high levels of inactivity across the UK. Source: Start Active, Stay Active. Department of Health Trends The Health Survey for England (HSE) is a main source of population data. The HSE reports on adults` physical activity in the four weeks prior to interview by examining overall self-reported participation in activities and by describing frequency of participation and type of activity. The HSE 2 of 16 August 2014 (v3.0)

3 is used as the primary source to measure progress towards achieving physical activity guidelines. This type of survey is a cross-sectional study of a sample of the population and is based on selfreported behaviour / responses. Such a survey is not without error and bias. They are often used for describing trends. Highlights from HSE, 2012, for the nation are listed below: Self-Reported In 2012, 67% of men and 55% of women aged 16 and over met the recommendations for aerobic activity. 26% of women and 19% of men were classed as inactive. For both sexes the proportion meeting the aerobic activity guidelines generally decreased with age. The proportion of participants meeting the current UK guidelines for aerobic activity increased as equivalised household income increased. 76% of men and 63% of women in the highest income quintile met the new guidelines, falling to 55% of men and 47% of women in the lowest quintile. There was a clear association between meeting the guidelines for aerobic activity and body mass index (BMI) category. 75% of men who were not overweight or obese met the guidelines, compared with 71% of overweight men and 59% of obese men. The equivalent figures for women were 64%, 58% and 48%, respectively. Physical Fitness Men had higher cardiovascular fitness levels than women. In both sexes, the mean VO 2 max decreased with age. Cardiovascular fitness was lower on average among those who were obese than among those who were neither overweight nor obese. Virtually all participants were deemed able to walk at 3 mph on the flat but 84% of men and 97% of women would require moderate exertion for this activity. Thirty two per cent of men and 60% of women were not fit enough to sustain walking at 3 mph up a 5% incline. Lack of fitness increased with age. Physical fitness was related to self-reported physical activity. Average VO2max decreased, and the proportion classified as unfit increased, as self-reported physical activity level decreased. The HSE Survey in 2012 also reported upon children's physical activity: A similar proportion of boys and girls aged 2-4 (9% and 10% respectively) were classified as meeting the current guidelines for children under 5 of at least three hours of physical activity per day. A higher proportion of boys than girls aged 5-15 (21% and 16% respectively) were classified as meeting current guidelines for children and young people of at least one hour of moderately intensive physical activity per day. Among both sexes, the proportion meeting guidelines was lower in older children. The proportion of boys meeting guidelines decreased from 24% in those aged 5-7 to 14% aged Among girls the decrease was from 23% to 8% respectively. 3 of 16 August 2014 (v3.0)

4 Amongst all children (5-15 year olds) the rate of those who had taken part in any sport in the 4 weeks before being interviewed decreased from 2008/09 (91%) to 2012/13 (88%). Around two thirds of both boys and girls aged 2-15 walked to or from school on at least one occasion in the last week (64% and 67% respectively). More boys than girls aged 2-15 (6% and 1% respectively) cycled to or from school on at least one day in the last week. Overall, 93% of boys and 92% of girls had participated in any type of physical activity in the last week. Boys were more likely than girls to have participated in formal sports (48% and 38% respectively) on at least one occasion in the last week. Participation in walking (52% of boys and 54% of girls) and informal activity (85% among both sexes) were similar. The Taking Part Survey collects data on many aspects of leisure, culture and sport in England, as well as an in-depth range of socio-demographic information on respondents. The latest data show that in the four weeks prior to being interviewed, 81% of 5-10 year olds took part in sport outside of school and 95% of year olds took part in sport in or outside of school. These results have remained stable since 2008/09. In the week prior to being interviewed, 67% of 5-10 year olds took part in sport outside of school and 89% of year olds took part in sport either in or outside of school. This represents a significant decrease since 2008/09 for 5-10 year olds from 75%, but no significant change for year olds. 83% of 5-15 year old children reported they had participated in some form of competitive sport in the last 12 months. 79% had taken part in competitive sport in school, whilst 37% had taken part outside of school. There have been no significant changes recorded in these figures since 2011/12, which was the first full year this question was asked. The HSE Survey 2012 asked children about the amount of time spent in sedentary pursuits including time spent watching television, other screen time, reading and other sedentary pursuits. The key findings show: Average total sedentary time (excluding time at school) was similar for boys and girls on weekdays (3.3 hours and 3.2 hours respectively) and weekend days (4.2 hours and 4.0 hours respectively). For both boys and girls, the average number of hours spent watching TV on both weekdays and weekend days increased as equivalised household income decreased. Among children aged 2-10, the mean number of sedentary hours on a typical weekday decreased from 3.0 hours for both sexes in 2008 to 2.9 hours for boys and 2.8 hours for girls in Among boys aged 11-15, mean sedentary time on weekend days increased from 4.8 hours in 2008 to 5.0 hours in 2012; for girls of similar age, mean sedentary time decreased from 4.8 to 4.5 hours. Source: Statistics on Obesity, and Diet: England of 16 August 2014 (v3.0)

5 Public Health Outcomes Framework The new Public Health Outcomes Framework indicators utilise the information from the HSE surveys and now reports annually upon active and inactive adults at a county level. Tables: PHOF Indicators Active and Inactive Adults In comparative terms Lincolnshire has disproportionately less active adults and more inactive adults, when compared with some of its East Midlands and Anglian neighbours; neighbours with greater levels of deprivation and inequalities than Lincolnshire. The Active People Survey (APS) is a landline telephone of adults conducted annually on 1,000 people per district authority area. The survey tracks the number of people taking part in sport and physical activity at local authority level. The survey does not ask about activities of daily living, e.g. walking, gardening or household chores. Since 2005/06, the survey has measured participation levels in adults aged 16+ (although since Oct 2012 the survey has been adapted to measure 14+). The current national average for Sport England s 1x30 sports participation indicator is 35.2%. The survey also measures wider sporting indicators such as volunteering and club membership levels, details of which can be found on Sport England s website. Source: Active People survey results - new Active People tool In Lincolnshire, the Active People survey in 2005/06 found that 31.3% of the adult (16+) population were taking part in sport for 30 minutes once per week. Data released in June 2013 (Active People 7) shows that 32.4% of adults in Lincolnshire are now taking part in sport for 30 minutes once per week. This is an increase of 1.1%, circa 23,000 people. The most recent data release shows that there has been no significant change across Lincolnshire in participation rates (increase or 5 of 16 August 2014 (v3.0)

6 decrease), with the exception of West Lindsey who has seen an increase from 31.3% in 2005/06 to 38.9% in 2012/13. Over the time period of the survey the population size of the county has changed. When the percentage figures are graphed in absolute numbers the trend over time highlights the peak participation period in the pre and immediate post-olympics Since the Active People Survey began there have been a consistent 10,000 and a peak of 26,000 people participating in 30 minutes activity once a week. See the table below. Tables: Active People Survey7: 1x30 min per week In Lincolnshire, the Active People survey in 2005/06 found that 20% of the adult (16+) population were taking part in sport for 30 minutes 3 times a week. The latest data released in June 2013 (Active People 7) shows that 23% of the adult population are now taking part in sport for 30 minutes 3 times per week. This equates to an increase of 3%, circa 18,000 people. There have also been increases in participation for Boston and South Kesteven. 6 of 16 August 2014 (v3.0)

7 Table: Active People Survey7: 3x30 min per week In absolute numbers there have been a range of 26,000-37,000 more people active on a 3x30 min level consistently during a period of recession, Olympics 2012 and to-date. Information provided by England Federation of Disability Sports demonstrates the proportion of people playing sport at a moderate intensity at least once a week for 30 mins (Active People survey 6). Lincolnshire has notably more disabled people taking part in sport once a week (23.3%) than the national average. Table: Proportion of People Playing Sport 7 of 16 August 2014 (v3.0)

8 The Active People Toolkit provides information on the types of sports the survey reports the people are engaged upon. The top five sports in Lincolnshire are: Gym use. Swimming. Cycling. Football. Athletics (including Running for Fitness). Targets The national goal is to see more people more active, more often. Locally, the county sports partnership, Lincolnshire Sport, is seeking to move more than 30,000 sedentary people to 1x30 min participation (to 36%) and a 2% increase in people being 3x30 min participation over the coming years. Performance However, despite this recent good news on increased participation when benchmarked against other counties in England Lincolnshire is well down in the lower quintile for participation. Lincolnshire has and continues to be a county where proportionally more adults are inactive. Table: Active People Survey 7: By County Sports Partnerships 8 of 16 August 2014 (v3.0)

9 Lincolnshire County Council, with its new responsibility for Public Health, supports sedentary people to become active and stay active through a series of commissioned physical activity schemes throughout the county, in collaboration with district councils and community groups: Exercise referral from GPs and selected health professionals - every district in Lincolnshire offers exercise on referral. If you have a medical conditions that would benefit from exercise, patients are able to get an exercise referral prescription from their GP or selected hospital health professionals. Over 50% of clients are referred for obesity 4,157 referrals. (2012/13) Walking for Health schemes - the Walking for Health Programme is part of a national initiative to encourage inactive adults towards an active and healthier lifestyle across the country 1,500-1,800 active walkers. (2012/13) Vitality physio-like seated exercise and movement to music classes for older people or people with disability. Over 5,000 participants. (2012/13) Health Trainers they work with people to assess their health and lifestyle risks, helping them to build their motivation to change. They facilitate behavioural change and provide motivation and practical support to individuals - 4,217 people. (2012/13) Over 15,000 inactive and sedentary people utilise such services to become active more often. For further information District councils have the responsibility for leisure, culture and recreation and provide publicly funded leisure services, parks and open spaces for general use. In addition to this local clubs utilise and may manage facilities for dedicated sports. Sport England undertakes an annual survey of county's facilities (where 80% of sports take place). Sport England also offers grants to local clubs and communities to develop and upgrade facilities. Recently, Lincolnshire Sport has enabled local clubs and societies to access in excess of 1.1 million of grants. Table: Sports Facilities in Lincolnshire There have also been count-wide schemes to support inactive people to be more active, e.g. Couch to 5k app development, Jog Lincolnshire web tools, cycling programmes, workplace challenges and back to sport programmes. 9 of 16 August 2014 (v3.0)

10 What is this telling us? Summary In recent year's efforts to engage inactive and sedentary people, particularly adults with at-risk health conditions, chronic disease or disability have contributed to the increases in the county's participation figures. In addition to the Olympics 2012 effect, sports and physical activity participation have continued to increase at the 3x30 min participation levels, but this may have peaked post Olympics. In recent years there has been a particular emphasis on enabling people with disability to access sports and leisure facilities. 14 leisure centres are Inclusive Fitness Initiative accredited to enable improved access. Consequently, Lincolnshire has greater disability sport participation. Lincolnshire's lower levels of participation have been analysed. Insight on why this may be the case, includes a number of factors: Large geographical area and low population density, linked with transport and infrastructures that may limit access. An ageing population and a decrease in younger age adults resident in Lincolnshire (younger adults being a more active population). Economy lower incomes with related economies and pensions/benefits limit disposable incomes for sport and recreation. Ageing facility stock and public service pressures will limit refurbishments / replacements. National Governing Bodies for Sports (NGBs) have a wider coverage than Lincolnshire and the county is viewed as having little to attract such NGBs to the area. Club membership levels are falling. A movement towards a `pay as you go` culture is proliferating. However, 42-52% of adults across the county report a desire to do more sport in Lincolnshire. The relatively lower active participation levels in the county are a contributor towards the relatively poorer health status of the population. 10 of 16 August 2014 (v3.0)

11 Local Views In 2011/12 local sports and leisure professionals across the public and private sectors were consulted upon their insights on improving sports and physical activity. They offered views as residents and practitioners. Their recommendations include: Involve multiple sectors of the community to help change community norms towards physical activity. Clearly define what are physical activity ways individuals can become active and ways organisations can facilitate an individual s physical activity experience. Market existing resources and implement a physical fitness campaign. Increase awareness of physical activity benefits and the variety of ways one can be physically active. Acknowledge and promote physical activity role models regionally and locally. Develop social support systems for physical activity. Balance the emphasis on sports participation, competition and increase physical activity opportunities. Accessibility: Ensure equal access race, age, gender, disability. Enhance the use of public facilities/spaces, including schools facilities. Encourage children to be physically active. Encourage active travel, including walking and cycling in communities. Maintenance and safety of public spaces. National and Local Strategies Public Health White Paper Start Active, Stay Active Joint Health & Wellbeing Strategy Cultural Strategy Change4Life 11 of 16 August 2014 (v3.0)

12 Current Activities and Services Listed below are local authorities' leisure and sports links in the county. Also the physical activity and county wide sports opportunities: Schools have the primary responsibility for PE, sports and physical activity for their students. This is a component of Ofsted inspections. A variety of partners locally are commissioned to support the county's schools and academies. A plethora of national charities and commercial agencies are also available to support schools. There is a mixed economy of providers. From within Lincolnshire there is a history of collaboration of providers working together to enhance PE, sport and physical activity - the School Sport Partnerships of Lincolnshire: Lincolnshire County Council contracts CfBT Education Services to undertake a school improvement function for Lincolnshire schools. Schools sports partnerships sport continued professional development, peer mentoring, volunteering, parent engagement, provision of specialist coaches, Gifted and Talented support to schools. School games organisers Youth Sport Trust funded support for developing competitive opportunities in sport, sustainable participation in clubs and school games, workforce development for the school games across teaching and non-teaching partners. Lincolnshire Sport to coordinate and manage programmes and events which encourage people to become active and stay active, e.g. Level 3 sports festivals, Lincolnshire Coaches Network and community sports networks. Lincolnshire County Council: Public Health commissioning of health improvement interventions, the Healthy Schools Programme. In 2013 the coalition government announced there would be a ring-fenced fund of 150m a year for up to 2019/2020 to allow primary schools to enhance their PE, sport and physical activity provision. 12 of 16 August 2014 (v3.0)

13 Public Health Interventions In recent years Public Health has been able to commission county-wide interventions through the partnerships, e.g. Rowed to Fitness: 2007, Wheelchair Basketball: 2009, Multi-skill Training Package (MSTP): This year Inspire Plus has been commissioned to implement the Legacy Challenge across the county's primary schools. The Legacy Challenge is a resource for primary schools that seeks to: Encourage children and families to be more active and healthier at school and in their community. Increase pupil numbers participating in intra and inter-school competition. Provide evidence for Ofsted and Sport Premium. Develop leadership skills among young people. Schools are able to access training for teachers and students (Legacy Ambassadors) to implement the intervention in their school. The student-led intervention challenges pupils (and their families) to undertake up to six legacy challenges: Demonstrate Olympic and Paralympic values of friendship, respect, excellence, equality, courage, determination, inspiration. Complete 10 hours of volunteering at school, at home, in your community. Undertake regular activity and healthy eating. Join a sports club. Take part in inter or intra school competition. A personal challenge. The completion of two challenges equates to a bronze medal; four challenges a silver and six completed challenges a gold medal. As well as personal success being recorded through medals tables, classroom surveys pre and post intervention are available to demonstrate the scales of behaviour change within schools. For an example, a primary school has recently undertaken the baseline survey. Following the intervention the school will undertake a post-intervention survey to assess the school impact. As of April 2014, 7,000 children are engaged with Challenge. It is the plan for 30,000 children to engage with Challenge by August In 2014, the Legacy Challenge will encompass the support to primary schools to develop Change4life Sports Clubs. 13 of 16 August 2014 (v3.0)

14 Key Inequalities Analysis from the HSE Survey, 2012 and the Taking Part Survey indicate that the likelihood of greater sports participation and physical activity is directly associated with higher household incomes. Information drawn from the Lincolnshire Research Observatory on the annual working wage in the county describes Lincolnshire average annual earnings at 24,556. This value is lower than the East Midlands value ( 25,339) and the England average ( 27,193). Within Lincolnshire, Boston has the lowest average annual earnings ( 20,914) and the lowest adult participation rate. Source: Locally commissioned services seek to engage local communities to improve health and tackle health inequalities. This engagement is monitored with the principle of 60% of clients coming from the 40% most disadvantaged wards in Lincolnshire. For example, Health Trainers in 2012/13 saw 4,217 clients of whom 55% were from such wards. The county-wide GP-based exercise referral programme has worked with over 4,000 adults of whom 58% of their clients were from such wards and with no difference in their respective completion rates. The Walking for Health programme annually assesses client engagement against district inequalities profiles. The chart below shows how districts are engaging with communities from areas of deprivation. For the most part, attendance reflects the level of inequality in line with the whole population. Commissioners have always looked for "Universal Proportionalism", which means investment, everywhere, but more in areas that need it the most. Boston and East Lindsey have done an exceptional job in areas of deprivation this year. Source: Walking for Health Annual report Key Gaps in Knowledge and Services The Sport England insight tools comprehensively describe the profiles of the Lincolnshire population in term of participation. The Active People surveys describe trend over time. Commissioned services monitor participation. Local authorities provide or contract with leisure providers. Schools provide PE and sport. National governing bodies for sport facilitate local sport provision. An independent, voluntary and commercially driven market exists for sport and 14 of 16 August 2014 (v3.0)

15 participation. Individuals can simply be more active. This is the nature of the leisure, sports and physical activity settings diverse, disparate and partially regulated. There is the potential for a wealth of intelligence on real-time local participation trends from within local authority leisure and recreation provision. This remains an untapped resource locked away behind commercial and contractual sensitivities. Risks of not doing anything Obesity levels in adults and, to a lesser extent, in children continue to rise in Lincolnshire, following national trends. Interventions to increase physical activity levels are effective but not widespread enough to have an impact on whole populations. Whilst activity levels continue to rise, particularly in unorganised and informal exercise, we need to do more as obesity levels continue to increase and 76% of the population are not active enough to benefit their health. The risk of not continuing to support the physical activity agenda will cause a reverse in the improved physical activity levels. What is coming on the horizon? Numerous national and international sporting events, e.g. the Rugby World Cup typically generate greater sporting participation for a period of time. Local authority grant allocation reduction over the coming years that will impact at a county and district level. What should we be doing next? Lincolnshire Sport has produced a draft strategy for sport and physical activity `Inspiration to Participation`. The strategy has a vision and four themes Events, Communications, Workforce and Facilities. Lincolnshire Sport is seeking: To utilise the Active People survey and market segmentation data for Lincolnshire's population to inform partners and clubs. Generate close ties with NGBs on specific insight work. Secure funds and grants for local participation. Secure a larger scale of national funds in to Lincolnshire. Build partnerships with local authorities and communities where participation is low. 15 of 16 August 2014 (v3.0)

16 The School Sport Partnerships of Lincolnshire will seek to enhance participation in sports within and between schools and secure the increased offer of support, e.g. School Games, the Legacy Challenge and Change4Life Clubs. Local authorities and partners should explore the opportunities within the role of planning departments for providing greater opportunities and incentives for the population to be more active, e.g. increase active travel (walking & cycling rather than using the car). All partners in Lincolnshire should actively seek opportunities to embed community physical activity initiatives for all. 16 of 16 August 2014 (v3.0)