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JSNA Chapter : Physical Activity

Section: Health Related Behaviour
Next Review Date: 04/12/2015
Date Published: 04/12/2013

Return to JSNA contents


Contents

  1. Introduction
  2. Who's at risk and why?
  3. The level of need in the population
  4. Current services in relation to need.
  5. Projected service use and outcomes in 3-5 years and 5-10 years.
  6. Evidence based (what works and what does not work)
  7. Unmet needs and service gaps
  8. Equality Impact Assessment
  9. Recommendations for Commissioning
  10. Recommendations for needs assessment work
  11. Key contacts
  12. Chapter References
  13. Signed off by


Introduction

Definition of Physical Activity: 

Physical activity is defined as “any body movement produced by skeletal muscles that results in a substantial increase over resting energy expenditure” [1]. Physical activity therefore includes the full range of human movement, from competitive sport and exercise to active hobbies, walking, cycling, or activities of daily living.[2]

Figure 1. Physical Activity Definition Diagram [3] 
Physical Activity Defeinition Diagram.jpg
Physical Activity Definition Diagram (Department of Health, 2009a)

Physical activity recommendations

In July 2011, The Chief Medical Officers (CMO’s) of England, Scotland, Wales and Northern Ireland published new guidelines for physical activity.[2] The report emphasises the importance of physical activity for people of all ages and also highlights the risks of sedentary behaviour. The recommendations for different age groups are as follows:

EARLY YEARS (under 5s)

Physical development involves providing opportunities for babies and young children to be active and interactive and to improve their skills of coordination, control, manipulation and movement. Children should be supported in developing an understanding of the importance of physical activity.

  1. Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments.
  2. Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day.
  3. All under 5s should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).

CHILDREN AND YOUNG PEOPLE (5–18 years)

  1. All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day.
  2. Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.
  3. All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods.

ADULTS (19–64 years)

  1. Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week.
  2. Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous intensity activity.
  3. Adults should also undertake physical activity to improve muscle strength on at least two days a week.
  4. All adults should minimise the amount of time spent being sedentary (sitting) for extended periods.

OLDER ADULTS (65+ years)

  1. Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Some physical activity is better than none, and more physical activity provides greater health benefits.
  2. Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week.
  3. For those who are already regularly active at moderate intensity, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity.
  4. Older adults should also undertake physical activity to improve muscle strength on at least two days a week.
  5. Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week.
  6. All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods.[2]

National Ambition for Physical Activity

The Public Health Outcomes Framework is part of the Healthy Lives, Healthy People: Update and way forward [4] series of updates that set out what the Department of Health wants to achieve in a new and reformed public health system. The framework focuses on the two high-level outcomes: 

  • increased healthy life expectancy
  • reduced differences in life expectancy and healthy life expectancy between communities.

The Public Health Outcomes Framework sets out four public health indicator domains that will help focus understanding of progress year by year nationally and locally on priority areas: 

  • improving the wider determinants of health
  • health improvement
  • health protection
  • healthcare public health and preventing premature mortality

Within these, physical activity related indicators include: 

  • 1.16 - Utilisation of Green Space for exercise/Health Reasons (Improving Wider Determinants of Health Domain)
  • 2.13 - Proportion of physically active (2.13i) and inactive (2.13ii) adults measured by Active People Survey (Health Improvement Domain)

It should be recognised that sport and physical activity have an important role to play in contributing to a number of priorities that the indicators represent.

Alongside the publication of the Public Health Outcomes Framework for England, in February 2012 the Government set a new national ambition for physical activity that will be measured via the Active People Survey. The ambition is to deliver:
“A year on year increase in the number of adults doing 150 minutes of physical activity per week (in bouts of 10 minutes or more); and a year on year decrease in those who are inactive (defined as doing less than 30 minutes of physical activity per week, in bouts of 10 minutes or more)”.

A core focus of the Sport England Youth and Community Strategy 2012-17 [5] is a year on year growth in regular participation for all those aged 14+, this will be measured via Active People focusing on the percentage of people achieving 1 x 30 minutes of sport. Health is firmly back on the agenda for sport within the strategy and the new target aligns the delivery of sport more closely with the Public Health Outcomes of reducing inactivity (the percentage of people undertaking less than 30 minutes of physical activity per week) and maximising public health gains from moving people from 0 – 1 x 30 minutes of activity.

Benefits of physical activity

  • Prevents and helps to manage over 20 conditions and diseases including coronary heart disease, type 2 diabetes, stroke, mental health problems, musculoskeletal conditions and some cancers (NICE, 2013) [6]
  • Has a positive effect on wellbeing, mood, sense of achievement, relaxation and release from daily stress (NICE, 2013) [6]
  • Evidence shows that physical activity can reduce the risk of depression, dementia and Alzheimer’s
  • In a recent systematic review, Macmillan Cancer Support concluded that there is good evidence to support the promotion of physical activity across the whole cancer care pathway [7].
  • Physical activity in childhood aids healthy growth and development, maintenance of energy balance, mental well-being and social interaction. In adolescence physical activity, particularly those activities that stress the bone, is important for bone health and reducing the risk of osteoporosis in later life [1].
  • Physical activity in childhood may also improve cognitive function [8] and improve academic achievement [9] as well as drawing the blueprints for an active adult life. [10]
  • Active children are less likely to smoke, or to use alcohol/get drunk or take illegal drugs [11]
  • There is also strong evidence that physical activity can improve the health of those with a physical or cognitive disability. [12]
  • The health benefits of sport have recently been estimated at £1.7bn in terms of health care costs and £11.2bn in total economic value. [13]
  • Participation in sport can improve the wellbeing and happiness of individuals as well as improve educational attainment [13].

Definition of physical inactivity

Physical inactivity is described as doing no or very little physical activity at work, at home, for transport or during discretionary time and not reaching physical activity guidelines deemed necessary to benefit public health[1]. Note sedentary behaviour is a separate behaviour in its own right and is not the same as physical inactivity, see below for more details.

Human costs of physical inactivity

  • Physical inactivity is known to be the fourth leading risk factor of global mortality, accounting for 6% of deaths globally. [14]
  • A recent research[90] study found that low cardio respiratory fitness was the leading cause of mortality (see graph below)
    Blair - attributable fractions.jpg 

Reproduced with consent of Intelligent Health 

  • The effects of physical inactivity start early and have dramatic consequences over the lifetime of an individual as the costs compound across generations. The next generation are predicted to live up to 5 years less than their parents.[10]
  • Many of the leading causes of ill health in today’s society, such as coronary heart disease, cancer and type 2 diabetes, could be prevented if more inactive people were to become active [14].
  • The benefits of physical activity extend further to improved productivity in the workplace, reduced congestion and pollution through active travel. [3]

Economic costs of physical inactivity

  • Physical inactivity also has a significant burden on healthcare costs and the economy. In 2009/2010 primary care trusts (PCTs) in England spent in excess of £940 million on physical inactivity, an average of £6.2 million per PCT.[15]
  • On average, an inactive person spends 38% more days in hospital than an active person, and has 5.5% more GP visits, 13% more specialist service and 12% more nurse visits than an active person. [16]
  • Physical inactivity in England is estimated to cost £1.06 billion a year through the direct costs of treating major, lifestyle-related diseases. Additional costs resulting from physical inactivity through sickness absence and premature death add up to an estimated £6.5 billion [2]. These costs are predicted to rise. In 2009, inactivity was estimated to cost NHS Surrey £12.8 million a year. [3]

Sedentary behaviour

Sedentary behaviour (such as sitting and lying) is not defined as a lack of physical activity (‘inactivity’) but as a separate behaviour in its own right. Even individuals who meet the recommended levels of physical activity may be susceptible to the adverse effects of prolonged bouts of sedentary behaviour such as increased risk of type 2 diabetes, cardiovascular disease and lower levels of aerobic fitness. Public Health guidelines recommend that people of all ages should avoid prolonged periods of sedentary behaviour such as occupational sitting, TV viewing, and screen based behaviours. However, this remains a relatively new field of research, and it is not yet possible to give precise recommendations. [17]


Key issues and gaps

Key Issues

In 2012 – 2013, 39.9% adults did not undertake enough physical activity to benefit their health, with 23.1% participating in less than 30 minutes of physical activity each week. Spelthorne, Elmbridge and Reigate and Banstead are the Surrey boroughs that are least active, with the lowest proportion of active adults (reaching 150 minutes each week) and the highest proportion of inactive adults (participating in less than 30 minutes each week).

Groups that are more likely to be less active are females, older adults (aged 65+), people with a limiting illness or disability, people from BME communities, people living in areas of deprivation (Stanwell in Spelthorne, Maybury and Sheerwater in Woking, Preston and Merstham in Reigate and Banstead, Stoke and Westborough in Guildford) and those on lower incomes.

637 deaths could be prevented if 100% of the Surrey population were to become active. The total primary and secondary care costs that are attributable to physical inactivity in Surrey is £17,959,001 (2013).

Car ownership in Surrey is one of the highest in England and as a result the number of people using active modes of transport such as walking and cycling is lower than the national average.

35% of people surveyed in 2011-12 accessed green space for exercise or health reasons, with lower levels in females, young people aged 16 – 24, unemployed people and BME groups.

Gaps

  • There is no current national or local data that identifies children’s physical activity levels in line with the government guideline levels.
  • Whilst examples of services for the least active groups (females, older adults, people living in areas of deprivation, people with a limiting illness or disability, people from BME communities) have been outlined, there is a gap in the consistency of service availability and accessibility for these groups across Surrey. Particular gaps are identified for BME groups, for people with a limiting illness or disability in West Surrey and for adults living in areas of deprivation.
  • There is a lack of thorough evaluations of interventions in Surrey, especially those that measure the impact in relation to increasing levels of physical activity.
  • There is a lack of screening and referral/recommendations of physical activity within primary care.
  • There is a lack of interventions that are developed using social marketing techniques and insights.
  • Many physical activity services exist, but there is a lack of a single point of access to all of this information and a lack of a co-ordinated approach from all partners to signpost to and promote all services that increase physical activity for those who are most in need.
  • Leisure contracts do not maximise the potential to provide evidence based interventions that address the identified physical activity needs.
  • There is a lack of joined up working across physical activity sectors i.e. sport, green space, physical activity and active travel.

Recommendations for Commissioning

  • Collect children’s activity data in line with the government guidelines for physical activity in children.
  • Commission physical activity services that aim to address the needs identified in this chapter, in particular those that reduce the number of people achieving less than 30 minutes of physical activity each week and increase the number of people achieving 150 minutes or more of physical activity each week.
  • Commission physical activity services that target the least active groups such as females, older adults, BME groups, people with limiting illness or disability, people living in areas of deprivation; and ensure the effectiveness is evaluated.
  • Commission and signpost to services that encourage people to use outdoor space for exercise/health reasons.
  • Particular attention to commission physical activity services for people from BME groups such as ‘fit as a fiddle’ faith and community strand project[88] and for people with limiting illness or disability such as ‘steps to fitness’ health and wellbeing pilot project [89].
  • Build evaluation into existing services using the Standard Evaluation Framework for physical activity[86], ensuring that the single-item measure physical activity questionnaire is used.
  • Review or de-commission services that don’t evaluate the impact that service has on physical activity levels
  • When developing new physical activity interventions use social marketing techniques, making use of existing insights as highlighted in this chapter and using tools such as Change4Life, promoting Activity Toolkit.
  • Ensure a co-ordinated approach to activity, including all activities (not just sport) to be included on the Active Surrey Activity Finder
  • Support the national Change4Life physical activity campaign locally, with all partners on board.
  • Provide a forum for better partnership working between various sectors and organisations that impact upon physical activity levels, ensuring that increasing physical activity levels is everybody’s business.
  • When leisure centre contracts are re-tendered, ensure that the JSNA physical activity chapter guides the re-tendering.
  • Provide educational support and training to staff that are involved in changing people’s physical activity behaviours.
  • Develop local transport plans that encourage and facilitate walking and cycling
  • Commission personalised travel planning programmes to support willing individuals to make daily changes.
  • Ensure that all planning applications for new developments always prioritise the need for people to be physically active as a routine part of their daily life. Comprehensive networks for active modes of transport including those to public open spaces and parks, and other major destinations.
  • Ensure that workplace health initiatives support employees to become more physically active.
  • Ensure that County and Borough and District strategies for physical activity and open space/parks incorporate the needs identified in this chapter, with particular focus on targeting inequalities and evaluating physical activity outcomes.
  • Assist the Family Support Programme in Surrey to work with those families most at need to increase their physical activity levels by providing staff with training and up to date information on local physical activity opportunities.

Primary Care

  • Ensure that a brief intervention, such as Let’s Get Moving, is undertaken and evaluated for effectiveness in primary care. Patients should be screened for physical activity levels in primary care using GPPAQ[85] and referred onto or recommended appropriate services for anyone identified as less than active.
  • Ensure brief advice on physical activity is included in care pathways for mental health, particularly services for groups that are more likely to be inactive i.e. people aged 65 years and over, people with a disability and people from certain minority ethnic groups.
  • Provide information and training for primary care practitioners that address how physical activity promotion can help prevent and manage a range of health conditions.
  • Ensure systems such as Read Codes are being used to identify opportunities to assess people’s physical activity levels and that information and resources about local opportunities to be active are up to date.

Physical activity profiles

Physical activity profiles have been produced by borough and district. The data is not yet available by Clinical Commissioning Group (CCG) and therefore profiles are not available at this level at the time of writing.  

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Who's at risk and why?

There are clear and significant health inequalities in relation to the prevalence of physical inactivity according to income, gender, age, ethnicity and disability. [3]

According to the Health Survey for England (2004 [18], 2006 [19], 2008 [20]) and analysis of the Active People Survey 1 to 5 [21] the following groups have lower levels of physical activity: 

  • Females, starting from adolescence
  • Adults, especially older adults
  • BME groups
  • People living in low-income household groups
  • People living with a disability

The extent of people meeting the recommended levels of physical activity decreases with age, which has been related to specific life transitions such as moving schools (in particular primary to secondary), adolescence, leaving school, moving house, having children and retirement. [91,55] According to Popkin and Ng (2012) the greatest drop-off in activity levels is seen in the teenage years, in particular in girls. [92]

Children and young people with a disability take part in physical activity and sport less frequently and their experiences are less positive than their non-disabled peers. [22]  

Return to chapter contents


 

The level of need in the population

Children (0-16 years)

There is no current data on physical activity levels in line with the 2011 CMO guidelines. The latest data available in line with this is from the 2008 Health Survey for England and this did not provide local Surrey figures.

Health Survey for England, 2008

Based on 2008 Health Survey for England (HSE)[20] self-reported measures, a higher percentage of boys than girls aged 2-15 years were classified as meeting the CMO’s recommendations for physical activity (32% and 24% respectively).

Figure 1. Proportion of children meeting government recommendations for physical activity, by sex and age, 2008.
HSE 2009 Childrens activity levels.jpg
Source: Health Survey for England, 2008 [20]

There was a clear decrease with age in the number of girls meeting the recommendations, from 35% aged 2 to 12% aged 14 (and no such pattern for boys). [20]

Early Years Foundation Stage Profile [23]

All providers of education and care to children from birth to the age of five must follow the standards set in the Early Years Foundation Stage (EYFS) framework. Assessment, based on observation of children's learning and development, is an integral part of the EYFS. All early years providers must complete an EYFS profile for each child during the academic year they reach the age of five.

The profile describes the child's level of attainment at the end of the EYFS and identifies their learning needs.

Physical development is one of the prime areas which are measured making judgments on the level of achievement in areas of moving and handling and Health and self-care.

Half of all seven-year-olds in the UK are at risk of suffering from poor health in later life due to sedentary lifestyles. Figures published in the BMJ Open journal show that 50 per cent of children spend an average of 6.4 hours a day sitting down and fail to reach the recommended levels of exercise per week. The report – the first objective, UK-wide study of children's physical activity levels – also shows that girls are significantly more inactive than boys. Only 38 per cent of all girls achieve current recommendations for daily exercise, compared to 63 per cent of boys. There are social and demographic variations too - overall activity levels were lowest in Asian children (Indian, Pakistani and Bangladeshi). [24]

Physical Education, School Sport and Young People’s Survey (PESSYP)

The Physical Education, School Sport and Young People’s (PESSYP) Survey was collected until 2010 and provided data at a local level on activity levels of children and young people in school with regards to achieving 2 or 3 hours of physical education each week.

Figure 2. The percentage of school children participating in at least 3 hours of PE and school sport a week
Physically active children - 3 hours a week
Dataset: Physically active children (three hours a week), Source: NHS Association of Public Health Observatories (2009 – 2010)

The 2009 -2010 PESSYP survey measured participation in three hours of PE and school sport. The survey showed that 47% of pupils within Surrey schools participated in more than three hours of PE and sport per week. This rate was below the 2009 national average of 50%. Figure 2 shows the Surrey boroughs and districts compared to the national average. Waverley had the highest percentage with 61% children achieving 3 hours each week on high quality PE and school sport and Mole Valley had the lowest with 35%. Only four out of the 11 Surrey local authorities were above the national average, and were significantly so.

In 2009 -10, Epsom and Ewell, Guildford, Mole Valley, Runnymede, Surrey Heath and Tandridge had significantly lower levels of activity than the national average.

It is worth noting that the School Sports Survey (PESSYP) did not measure activity levels in independent schools.

Adults (aged 16+)

Active Colleges Data

In October 2012 Sport England commissioned CFE Research to undertake an evaluation of the Active Colleges investment and the research found that 77.5% of respondents took part in 1 x 30 minutes of sporting or physical activity in the past week, with 25% taking part on one or two days in the past week and 52% taking part on three or more days in the past week.

The number of young people aged between 16 and 25 playing sport regularly has reached 3.86 million. This is an increase of nearly 63,000 on the previous 12 months. [25]

Active People Survey (APS)  

The Active People Survey is a large telephone survey of sport and active recreation, commissioned by Sport England. The survey measures participation in sport and active recreation and provides details of how participation varies from place to place and between different groups in the population. The data below is from APS 6 Quarter 2 to APS7 Quarter 1 (January 2012 – January 2013) and shows the percentage of individuals who met the Chief Medical Officer’s recommended guidelines on levels of physical activity (at least 150 minutes a week) and the percentage of individuals who were inactive (less than 30 minutes a week). These data are used to inform the progress towards the National Ambition for physical activity and the Public Health Outcomes Framework (PHOF) indicator for physical activity (2.13i – 150mins+; and 2.13ii - <30mins).

It is not possible to compare APS6 (2012) with results from APS5 (2011) due to differences in collecting data on physical activity – APS5 collected information on physical activity that was conducted in 30 minute blocks, while APS6 collected information on physical activity conducted in 10 minute blocks. This is so that the physical activity measure in APS6 is more in line with the Chief Medical Officer’s (CMO) recommendations for physical activity.

Table 1. Active People Survey results from January 2012 – January 2013 (APS6 Quarter2 to APS7 Quarter 1) by bands of activity, highlighting which data are used for PHOF indicators

 

<30 mins

30-89 mins

90-149 mins

150+ mins

Sample size

PHOF Indicator

2.13ii

2.13i

England

28.5%

8.1%

7.3%

56.0%

151912

Surrey

23.1%

8.4%

8.4%

60.1%

5204

Elmbridge

25.9%

8.0%

8.5%

57.7%

461

Epsom and Ewell

23.0%

8.4%

8.6%

59.9%

473

Guildford

23.2%

7.7%

9.7%

59.4%

471

Mole Valley

23.2%

9.2%

8.0%

59.6%

467

Reigate and Banstead

23.9%

8.7%

9.5%

57.9%

478

Runnymede

22.8%

9.5%

9.0%

58.7%

500

Spelthorne

28.0%

9.1%

5.2%

57.6%

469

Surrey Heath

21.4%

9.6%

9.3%

59.8%

460

Tandridge

18.7%

8.7%

7.7%

64.9%

484

Waverley

19.5%

6.4%

8.9%

65.1%

469

Woking

23.3%

8.1%

6.8%

61.8%

472

Dataset: Active People Survey 6 Quarter 2 to Active People Survey 7 Quarter 1, January 2012 – January 2013. Source: National Obesity Observatory

The data in Table 1 show that 56.0% of adults in England do at least 150 minutes of moderate equivalent physical activity per week, while 28.5% of adults in England do less than 30 minutes of moderate equivalent physical activity per week. It is important to note that this does not include occupational activity or work in the home.

The APS data is available at County level and borough and district level. Sport England will be replacing the Active People Diagnostic tool with the Active People Interactive tool in late 2013 which will allow for easy analysis of the Active People data sets across multiple determinants, including local authorities, demographics, activity levels and many more options. Sport England are currently exploring the possibility of the breakdown of the data by CCG and also middle super output area (MSOA). [26]

In Surrey, 60.1% of adults are active, doing at least 150 minutes of moderate equivalent physical activity per week, while 23.1% are inactive, doing less than 30 minutes of moderate equivalent physical activity per week.

The Surrey borough or district with the highest proportion of active adults (150+ minutes of physical activity) was Waverley (65.1%) closely followed by Tandridge (64.9%) and Woking (61.8%). Spelthorne and Elmbridge have the lowest proportions of active adults (57.6% and 57.7% respectively).

The Surrey borough or district with the highest proportion of inactive adults (less than 30 minutes of physical activity) was Spelthorne (28%), followed by Elmbridge (25.9%) and Reigate and Banstead (23.9%).

Table 2. Key national demographics of people within each band of activity from the Active People Survey 6 Quarter 2 to Active People Survey 7 Quarter 1, January 2012 – January 2013

 

<30 mins

%

30-89 mins

%

90-149 mins

%

150+ mins

%

Sample size

Respondent Gender

Male

25.0%

7.1%

6.6%

61.4%

61875

Female

31.9%

9.1%

8.1%

50.9%

90037

Age Bands

16-18

16.7%

5.7%

5.9%

71.7%

4592

19-34

20.2%

7.3%

6.9%

65.6%

21320

35-54

24.2%

8.7%

7.9%

59.2%

50966

55-64

31.5%

8.6%

8.1%

51.7%

26877

65+

47.6%

8.5%

6.9%

37.0%

47489

Ethnic Group

WHITE

28.1%

8.0%

7.3%

56.6%

141420

NON WHITE

31.7%

9.1%

7.5%

51.8%

10492

Limiting illness or disability

YES

49.0%

8.7%

6.4%

35.9%

31651

NO

24.3%

8.0%

7.5%

60.1%

120261

Key demographic break

NS SEC 1,1.1,1.2,2 Managerial and professional

21.4%

7.9%

7.4%

63.3%

57572

NS SEC3 Intermediate

28.8%

9.3%

8.1%

53.8%

16039

NS SEC4 Small employers / own account workers

28.1%

8.0%

7.1%

56.8%

13971

NS SEC5,6,7,8 Lower supervisory/technical/routine/semi-routine

36.4%

8.4%

7.3%

47.9%

50774

NS SEC9 Not classified

23.8%

7.0%

6.8%

62.5%

13556

Dataset: Active People Survey 6 Quarter 2 to Active People Survey 7 Quarter 1, January 2012 – January 2013. Source: National Obesity Observatory

Table 2 displays key national demographic data, showing that in general men do more physical activity than women. A greater proportion of men achieved 150+ minutes of physical activity per week than women (Males: 61% versus Females: 51%).

Nationally, younger age groups did more physical activity than older age groups. A higher proportion of those aged 16-18y and 19-34y achieved 150+ minutes of physical activity (72% and 66% respectively) compared to those aged 55-64y and 65y+ (52% and 37% respectively).

Those with a limiting disability were in general less active (49% achieved less than 30 minutes and 36% achieved 150+ minutes) compared to those without a limiting disability (24% achieved less than 30 minutes and 60% achieved 150+ minutes).

People living in low-income households (NS SEC 5, 6, 7 and 8) were less active (36.4% undertook less than 30 minutes of activity and 47.9% achieved 150+ minutes) compared to those on higher incomes (21.4% undertook less than 30 minutes of activity and 63.3% achieved 150+ minutes).

Non-white people (31.7% undertook less than 30 minutes of activity and 51.6% achieved 150+ minutes) were less active compared to white people (28.1% undertook less than 30 minutes of activity and 56.6% achieved 150+ minutes).

The Active People Survey small area estimates tool [27] (Active People Survey 3/4 2008-2010) provides data at middle super output area (MSOA) level for adults achieving 3 x 30 minutes of sport and active recreation (formerly NI8). This is currently being updated in line with the new CMO physical activity guidelines, however, data from 2008-2010 showed a clear link between areas of deprivation and lower levels of physical activity.

Table 3. The seven Middle Super Output Areas (MSOAs) with the lowest levels of people achieving 3 x 30 minutes of sport and active recreation (formerly NI8) from APS 3/4 (2008-2010) in Surrey

MSOA

Nearest wards to MSOA boundary

% achieving 3 x 30 minutes of sport and active recreation (formerly NI8).

Surrey

24.7%

E02006404

Ashford North and Stanwell South, Spelthorne

16.1%

E02006459

Maybury and Sheerwater, Woking

16.8%

E02006403

Stanwell North, Spelthorne

17.5%

E02006379

Preston, Reigate and Banstead

17.5%

E02006350

Stoke, Guildford

17.7%

E02006355

Westborough, Guildford

18.5%

E02006382

Merstham, Reigate and Banstead

19.3%

Source: Sport England Small Area Estimates Tool (based on Active People Survey 3/4 2008 – 2010)

The least active MSOA was Ashford North and Stanwell South in Spelthorne (16.1% achieving 3 x 30 minutes of sport and active recreation), closely followed by Maybury and Sheerwater in Woking (16.8%), Stanwell North in Spelthorne (17.5%), Preston and Merstham in Reigate and Banstead (17.5% and 19.3% respectively) and Stoke and Westborough in Guildford (17.7% and 18.5% respectively). All of these areas have been highlighted as areas of higher deprivation. The Surrey average in 2008-2010 for achieving 3 x 30 minutes of sport and active recreation (previously NI8) was 24.7%, thus highlighting the link between deprivation and low physical activity levels. For more information on deprivation please see health inequalities/priority place JSNA chapters.

Sport England Market Segmentation Tool  

Data is available from the Sport England Market Segmentation Tool [28] on participation rates and attitudes of individuals to sport and their motivations for taking part. It also provides useful information on what people believe would encourage them to take part in more sporting activities and what type of marketing and promotion they respond to. The tool divides the England population into 19 segments and information is provided on which are the predominant sporting segments.

Figure 3. The percentage of each Sport England segment in Surrey compared to the South East and England (based on Active People Surveys 3/4 2008 – 2010)
Fig 3. Sport England segments in Surrey.jpg
                                Fig 3. Legend.jpg                        
Source: Sport England Market Segmentation Tool (2010) [29]

Table 4. The dominant Sport England segments in Surrey with their characteristics, socio-economic group and percentage sports participation (based on Active People Surveys 3/4 2008 – 2010)

Segment

Percentage of the Surrey population

Key characteristics

Main age band

Socio-economic group

Sports participation

Tim

Settling Down Males

14.5%

Sporty male professionals, buying a house and settling down with partner.

Professional, may have children, married or single.

26-45

ABC1

Tim is an active type that takes part in sport on a regular basis.

Tim’s top sports are cycling (21%), keep fit/ gym (20%), swimming (15%), football (13%) and golf (7%)

Philip

Comfortable Mid-Life Males

9.6%

 

Mid-life professional, sporty males with older children and more time for themselves.

Full-time job and owner occupier, children, married.

46-55

ABC1

Philip’s sporting activity levels are above the national average.

Philip’s top sports are cycling (16%), keep fit/ gym (15%), swimming (12%), football (9%), and golf (8%)

Ralph and Phyllis

Comfortable Retired Couples

9.3%

Retired couples, enjoying active and comfortable lifestyles.

Retired, married or single.

 

66+

ABC1

Ralph and Phyllis are less active than the average adult, but sportier than other segments of the same age group.

Ralph and Phyllis’ top sports are keep fit/ gym (10%), swimming (9%), golf (7%), bowls (4%), and cycling (4%).

Chloe

Fitness Class Friends

8.9%

Young image-conscious females keeping fit and trim.

Graduate professional, single.

18-25

ABC1

Chloe is an active type that takes part in sport on a regular basis.

Chloe’s top sports are keep fit/ gym (28%), swimming (24%), athletics including running (14%), cycling (11%) and equestrian (5%)

Source: Sport England Market Segmentation Tool, 2010.[29]

In Surrey the most dominant segment is Tim (14.5%) with a higher proportion than England (8.8%). This is closely followed by Philip (9.6%) compared to England (8.7%) and Ralph and Phyllis (9.3%) compared to England (4.2%).

The dominant segments differ for the MSOAs in Surrey that have the lowest levels of people achieving 3 x 30 minutes of sport and active recreation from APS 3/4 (2008 – 2010).

Table 5. The percentage of the dominant Sport England segments in the least active MSOAs in Surrey (based on Active People Surveys 3/4 2008 – 2010)

Area

Dominant segments

% in the MSOA

% in Surrey

Key characteristics

Ashford North and Stanwell South, Spelthorne

Philip - Comfortable Mid-Life Males

 

9.7%

 

9.6%

 

Mid-life professional, sporty males with older children and more time for themselves

Full-time job and owner-occupier, children, married

Kev – Pub League Team Mates

 

6.4%

 

1.9%

 

Blokes who enjoy pub league games and watching live sport.

Vocational job, may have children, married or single.

Roger and Joy - Early Retirement Couples

 

6.2%

 

6.3%

 

Free-time couples nearing the end of their careers.

Full-time job or retired, married.

Elsie and Arnold - Retirement Home Singles

9.3%

5%

Retired singles or widowers, predominantly female, living in sheltered accommodation

Retired, widowed

Maybury and Sheerwater, Woking

Kev - Pub League Team Mates

13%

1.9%

 

Jamie - Sports Team Lads

13%

2%

Young blokes enjoying football, pints and pool.

Vocational student, single

Stanwell North, Spelthorne

Tim

9.9%

14.5%

Sporty male professionals, buying a house and settling down with partner.

Professional, may have children, married or single.

Preston, Reigate and Banstead

Elsie and Arnold

11.3%

5%

 

 

Paula – Stretched Single Mums

8.6%

1.4%

Single mums with financial pressures, childcare issues and little time for pleasure.

Job seeker or part time low skilled worker, children, single.

Stoke, Guildford

Elsie and Arnold

10.5%

5%

 

Philip

7.6%

9.6%

 

Tim

6.8%

14.5%

 

Paula

6.6%

1.4%

 

Westborough, Guildford

Paula

11.5%

1.4%

 

Elsie and Arnold

9.4%

5%

 

Ben

5.1%

8.3%

Male, recent graduates, with a ‘work-hard, play-hard’ attitude.

Graduate professional, single

Tim

4%

14.5%

 

Merstham, Reigate and Banstead

Elsie and Arnold

10%

5%

 

Kev

7.3%

1.9%

 

Source: Sport England Market Segmentation Tool, 2010.[29]

The dominant segments in the least active MSOAs in Surrey are Elsie and Arnold, Kev and Paula. There is a much higher proportion of these segments in these MSOAs than for the rest of Surrey.

Figure 4: The top 20 sports & physical activities that the top 4 segments in Surrey would most like to take part in (data taken from Sport England Market Segmentation 2010 [29])
Fig 4. Top 20 sports and physical activities.jpg

The sports and physical activities that the most dominant segments in Surrey would most like to participate in are swimming, cycling, keep fit/gym and athletics. The latent demand differs between segments with Tim’s latent demand being highest for cycling and Ralph & Phyllis, Chloe and Phillips’ for swimming. Furthermore, the dominant segments vary between boroughs and therefore the latent demand for sports will differ across boroughs.

Figure 5: Reasons why the top 4 segments in Surrey do less sport and physical activity (data taken from Sport England Market Segmentation 2010 [29])
Fig 5. Reasons for doing less sport.jpg

The main barriers to doing more sport and physical activity for the dominant segments in Surrey are health/injury/disability and work commitments. The most influential barrier differs between segments with health/injury/disability being the biggest barrier for Ralph and Phyllis, work commitments for Tim and Philip and other (left school, no opportunity, economy/work) being the biggest barrier for Chloe.

Figure 6: Reasons why the top 4 segments in Surrey want to do more sport and physical activity (data taken from Sport England Market Segmentation 2010 [29])
Fig 6 - reasons for doing more..jpg

The main motivations to doing more sport and physical activity for all of the dominant segments in Surrey are enjoyment and keeping fit. The most influential motivation does not differ between segments.

Figure 7: Factors that would encourage the top 4 segments in Surrey to do more sport and physical activity (data taken from Sport England Market Segmentation 2010 [29])
Fig 7. - Encouraging factors.jpg

The main factors that would encourage people to do more sport and physical activity for the dominant segments in Surrey are being less busy and cheaper admissions. The most influential factor does not differ between segments but the second most influential differs with cheaper admission influencing Tim, Chloe and Philip and people to go with influencing Ralph & Phyllis to do more sport and physical activity.

Table 6. Key characteristics and messages for sport and physical activity sessions targeting the dominant segments in Surrey (data taken from Sport England Market Segmentation 2010 [29])

Segment

Sports and physical activities

Activity organisation

Key marketing messages

Marketing media

Chloe

Swimming, Keep fit/Gym, Cycling, Athletics

Straight after work / during lunch hour, short format, low cost / discount, Back 2 / tasters

Get fit and have fun, low cost and convenience

Magazines, text, post

Tim

Cycling, Swimming, Keep fit/Gym and Athletics

Straight after work / during lunch hour, short format, low cost / discount.

Get fit and have fun, convenience and low cost

Internet, email

Philip

Swimming, Cycling, Keep fit/Gym and Athletics

Straight after work / during lunch hour, short format, low cost / discount.

Get fit and healthy, have fun, convenience and low cost

Internet, email

Ralph & Phyllis

Swimming, Keep fit/Gym, Golf and Cycling

Shorter sessions, sociable activities

Get fit & healthy and stay fit & healthy, have fun with friends, convenience

Newspaper ads, magazines, post

The Health Impact of Physical Inactivity [30]

Health Impact of Physical Inactivity (HIPI) has been developed to estimate how many cases of certain diseases could be prevented in each local authority in England, if the population aged 40-79 were to engage in recommended amounts of physical activity.

Table 7. The number of preventable deaths/cases of disease in Surrey in 2013 if 100% or 75% of the population became more active, including the total cost of physical inactivity for each condition

Surrey

Number19

Number of preventable if 100% of population becomes active19

Number of preventable if 75% of population becomes active19

Total Cost of physical inactivity in Surrey20

Deaths (39-79)

3597

637

429

 

Coronary Heart Disease (emergency admissions)

1740

190

128

£8, 313, 140

Breast Cancer (new cases)

738

149

101

£1, 272, 579

Colorectal Cancer (new cases)

487

96

65

£1,457, 261

Diabetes (prevalence)

41745

5557

3748

£3, 236, 868

Cerebrovascular Disease

 

 

 

£3, 679, 001

Total Cost

 

 

 

£17, 959, 001


Sources: Association of Public Health Observatories: Health Impact of Physical Inactivity [29]
British Heart Foundation, The primary and secondary care costs attributable to physical inactivity.[15]

If 75% of the population aged 39-79 in Surrey were to meet the recommended levels of physical activity, 429 deaths could be prevented, 128 emergency admissions for coronary heart disease, 101 new cases of breast cancer, 65 new cases of colorectal cancer and 3748 cases of diabetes could be prevented.

Sport England commissioned the BHFNC to examine the primary and secondary care costs attributable to physical inactivity. This builds upon work previously undertaken on behalf of the Department of Health in 2009.

The overall figure for Surrey was £17,959,001, based on the proportion of the cost of treating five major diseases that can be attributed to people being inactive. The total cost for treating these diseases is much higher; this is the proportion that can be related to physical inactivity.[15]

Screening for physical activity in Primary Care

The Quality and Outcomes Framework (QOF)[93] is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice.

From April 2013, two indicators were included in QOF regarding physical activity screening and intervention for hypertensive patients within primary care. These indicators can be seen in table 8.

Table 8. QOF indicators

Indicator description

Points

%

HYP004. The percentage of patients with hypertension aged 16 or over and who have not attained the age of 75 in whom there is an annual assessment of physical activity, using GPPAQ[85], in the preceding 12 months

NICE 2011 menu ID: NM36

5

40-80%

HYP005. The percentage of patients with hypertension aged 16 or over and who have not attained the age of 75  who score ‘less than active’ on GPPAQ[85] in the preceding 12 months, who also have a record of a brief intervention in the preceding 12 months

NICE 2011 menu ID: NM37

6

40-80%


READ CODES:
a. 138b active
b. 138a mod active
c. 138Y mod inactive
d. 138X inactive

Table 9 shows the number of patients in Surrey with hypertension to be 147871 (HYP004) and the estimated number of inactive hypertensives to be 58,995 patients and thus eligible for a brief intervention in physical activity (HYP005).

Table 9. Hypertension prevalence and estimated number of hypertensive patients eligible for HYP004 and HYP005 by Borough and District Council in Surrey (based on 2011/12 QOF data)

Number with established hypertension

Hypertensive prevalence (%)

Proportion that are less than active (<30 mins, 30-90 mins, 90-149 mins)

Estimated less than active hypertensives (Number of hypertensives / proportion of the population that are less than active)

England

7567965

13.6%

44%

3329905

Surrey

147871

12.8

39.9%

58,995

NHS East Surrey CCG

20606

12.1

N/A

N/A

NHS Guildford and Waverley CCG

26723

12.5

N/A

N/A

NHS North West Surrey CCG

44453

12.7

N/A

N/A

NHS Surrey Downs CCG

40030

13.8

N/A

N/A

NHS Surrey Heath CCG

11788

13.0

N/A

N/A

 

 

 

 

Elmbridge

16706

12.00

42.3%

7067

Epsom and Ewell

10443

14.00

40.1%

4188

Guildford

16519

11.60

40.6%

6707

Mole Valley

12996

14.50

40.4%

5250

Reigate and Banstead

17304

13.10

42.1%

7285

Runnymede

9584

13.00

41.3%

3958

Spelthorne

14047

14.20

42.4%

5956

Surrey Heath

11294

12.70

40.2%

4540

Tandridge

9652

12.10

35.1%

3388

Waverley

16839

13.30

34.9%

5877

Woking

12486

11.80

38.2%

4770

Sources: QOF (Quality and Outcomes Framework) disease prevalence (2011/12)[93]
Source: Active People Survey 6 Quarter 2 to Active People Survey 7 Quarter 1 (January 2012- January 2013)

Active Travel


The County of Surrey has one of the highest levels of car ownership in the England, with 87% [31] of households owning a vehicle, compared to national average of 75% [32]. Surrey also has more than double (46.4%) [33] the number of 2 or more car households compared to the national average.

As a consequence of this, the percentage of people walking and cycling to work is lower than the national average, with 8.6% [34] of people walking and only 2.2% [35] cycling, compared to a national average of 10.7% [36] and 3% [37] respectively.

Not only does this mean that some of the country’s most congested roads are based in the County, but also the residents of Surrey are not taking full advantage of the opportunities for active travel, and therefore exercise, as part of their daily commute.

In 2001, Census data established that 52% of Surrey residents travelled 5km or less to work, presenting a compelling argument for greater promotion of active travel as a means of getting to work.

Those that live in areas of deprivation tend to have greater difficulty in accessing travel options and, according to DfT audience segmentation research, are less susceptible to changing their behaviour to more sustainable modes of travel.

Walking and cycling


8.6% of Surrey’s population in employment walk to work and 2.2% cycle. The highest proportion of walkers is in Guildford (12.0%) and lowest in Elmbridge (6.2%). The highest proportion of cyclists is in Elmbridge (3.2%) and the lowest in Tandridge (0.9%).

A small number of people (0.6%) travel by another active method.

The proportion of the workforce walking and cycling to work is lower in Surrey than England as a whole where 10.7% walk and 3.0% cycle.

Table 10: Commuting on foot, by cycle and other methods 2011

 

On foot

Cycle

Other method

Surrey

8.6%

2.2%

0.6%

Elmbridge

6.2%

3.2%

0.7%

Epsom and Ewell

8.2%

2.5%

0.6%

Guildford

12.0%

2.6%

0.6%

Mole Valley

9.7%

1.9%

0.7%

Reigate and Banstead

9.0%

1.7%

0.5%

Runnymede

9.9%

2.9%

0.7%

Spelthorne

6.3%

2.7%

0.5%

Surrey Heath

7.3%

1.7%

0.8%

Tandridge

7.0%

0.9%

0.7%

Waverley

9.2%

1.5%

0.7%

Woking

8.9%

2.7%

0.5%

South East

10.9%

3.0%

0.7%

England

10.7%

3.0%

0.6%

Source: Census 2011

Figure 8: Commuting on foot or cycling 2011
Fig 8. - Commuting on foot or cycling 2011.jpg
Source: Census 2011

Access to outdoor space

In 2009, Natural England, Defra and the Forestry Commission commissioned a new survey called Monitor of Engagement with the Natural Environment (MENE) [38] to provide baseline and trend data on how people use the natural environment in England. This survey includes a question regarding utilisation of outdoor space for exercise or health reasons. This measure is used for the Public Health Outcomes Framework (PHOF) indicator 1.16.


Table 11. A summary of the demographic breakdown of those who accessed open space for exercise or health reasons in response to the MENE survey (2009 – 2012). Data for England and Surrey

 

England

Surrey

2009-2010

2010-2011

2011-2012

2009-2010

2010-2011

2011-2012

Total

 

34%

37%

37%

25%

3%

35%

Gender

Male

36%

35%

39%

28%

0%

48%

 

Female

32%

38%

36%

23%

12%

27%

Age

16-24

26%

30%

25%

4%

0%

7%

25-34

26%

25%

29%

23%

0%

48%

35-44

32%

25%

37%

17%

0%

 28%

45-54

36%

32%

36%

28%

0%

37%

55-64

37%

49%

44%

39%

0%

32%

65+

43%

51%

50%

39%

16%

46%

Socio-economic group

AB

38%

44%

47%

30%

0%

39%

C1

35%

40%

36%

11%

8%

24%

C2

31%

33%

36%

46%

0%

28%

DE

30%

22%

28%

27%

0%

49%

Working status

Working FT/PT

34%

35%

36%

27%

0%

35%

Retired

40%

47%

46%

42%

7%

46%

Still in education

29%

24%

26%

8%

0%

38%

Unemployed

26%

25%

34%

4%

0%

0%

Disability

Yes

39%

34%

40%

38%

0%

30%

No

33%

37%

37%

24%

4%

36%

Ethnicity

White

34%

36%

38%

26%

3%

37%

Not white

29%

45%

33%

7%

0%

0%


Source: Natural England, Monitor of Engagement with the Natural Environment, 2012 [39]

35% of adults in Surrey accessed the natural environment for exercise or health reasons in 2011 – 2012. This is similar to the England figure of 37% and is a 10% increase from 2009 – 2010 when 25% of adults in Surrey accessed for exercise or health reasons.

In Surrey (2011 – 2012) fewer females (27%) than males (48%) accessed the natural environment for exercise or health reasons compared to England (39% and 36% respectively). Young people aged 16 – 24 years were least likely to access for this reason (7%) compared to England (25%). Socio-economic groups C1 (24%) and C2 (28%) were least likely to utilise open space for exercise or health reasons and no unemployed or those categorised as not white stated exercise or health as their reason for visiting.

Whilst this highlights certain groups that have a low percentage accessing open space for exercise, further analysis is required of all MENE data to ascertain whether these groups are accessing for other reasons and are not identifying their physical activity with exercise or health.

Summary

Table 12. Summary of the PHOF physical activity indicators comparing Surrey to England (2013)

PHOF indicator

Surrey

England

1.16 - Utilisation of Green Space for exercise/Health (Mar 2009 - Feb 2012)

8.9%

14.0%

2.13i - Proportion of physically active adults (active) (2012)

60.1%

56.0%

2.13ii - Proportion of physically active adults (inactive) (2012)

23.1%

28.5%


The physical activity needs in Surrey are: 
  • Reduce the number of inactive people (those participating in <30 mins activity)
  • Increase the number of active people (those participating in 150mins+ activity)
  • Adults living in Spelthorne, Elmbridge and Reigate and Banstead, in particular those living in areas of deprivation.
  • Females
  • Older adults (aged 65+)
  • People with a limiting illness or disability
  • People from BME communities
  • People on lower incomes
  • To have access to up-to-date data is required that provides children and young people’s activity levels
In Surrey groups to target to specifically increase utilisation of outdoor space for exercise or health reasons:
  • Females
  • Young people aged 16 - 24 years
  • Unemployed people
  • People from BME communities.

Notable changes in need since the 2011 JSNA

  • Change in the government recommendations for physical activity and subsequent change in data collection via the Active People Survey means that a comparison of current data with past data is not possible.
  • PESSYP survey ceased to be collected, leaving limited data on children’s activity levels.
  • Inclusion of demographic breakdown, including MSOA data, which highlights groups that are most likely to be inactive.
  • Inclusion of utilisation of outdoor space for exercise/health reasons data from MENE[39] has identified needs of certain groups with regards to accessing outdoor space.
  • Inclusion of active travel data highlights the need to reduce car usage and increase active modes of travel.
 Return to chapter contents

 

Current services in relation to need.

Strategic overview of Physical Activity and Sport in Surrey

The need in Surrey is to increase physical activity levels in all of the population with particular attention on targeting services to address health inequalities. These include targeting females, young people (16-24 years), older adults (65+), people living with a limiting illness or disability, BME communities and people on a lower income. The main focus is to reduce the proportion of inactive adults (those achieving less than 30 minutes of activity per week) and increase the proportion of active adults (those achieving 150 minutes or more each week).

National strategies: 

Local Strategies:
Physical Activity is a key element of the prevention arm of the Surrey Health and Wellbeing Board Strategy [41] with three public health outcomes framework (PHOF) [42] indicators identified for physical activity:

  • 1.16 Utilisation of outdoor space for exercise/health reasons;
  • 2.13i Percentage of physically active and inactive adults – active adults
  • 2.13ii Percentage of physically active and inactive adults – inactive adults

Increasing physical activity levels is a key component in two main Surrey Strategies: The Surrey Obesity Strategy and the 2011 – 2016 Surrey Sport and Physical Activity Strategy. The Surrey Transport Plan: Travel Planning Strategy (2011) also includes elements of physical activity.

Strategies in development that will impact upon increasing physical activity levels include: Surrey Cycling Strategy, Surrey Countryside Strategy and Surrey Walking Strategy.

The Active Surrey Board is a stakeholder representative group/forum, set up to shape and influence the strategic direction of sport and physical activity in the county of Surrey. The Board aims to be the voice of sport and physical activity for Surrey on local, regional and national consultative matters and is made up of 20 representatives from the network. The group are working together to create a “more active and successful sporting county” and have regular meetings as well as thematic working groups who are working towards targeted action plans aligned with the outcomes of the 2011-16 Surrey Sport & Physical Activity Strategy.

Borough and District Councils

The 11 district and borough councils in Surrey each have a strategy that includes physical activity, sport or play. These detail plans to meet the physical activity needs of their residents including specific target groups such as females, young people, people from BME communities, people with a limiting illness or disability and people on a low income.

The borough and district councils also produce a directory highlighting all of the leisure opportunities available to residents. The activities on offer will range from specialist schemes (such as exercise referral), organised activities (such as sports clubs) and those that can be undertaken as part of daily life (such as walking routes).

Table 13. Links to strategies and directory of activities of each of the Surrey Borough and Districts (all links accessed on 03/10/13)

Borough / District

Link to strategy/directory

Elmbridge

- Sport and Physical Activity Strategy 2011 - 2014

- Leisure and Cultural Services

Epsom and Ewell

Leisure and Cultural Services

Guildford

- Leisure and Cultural Services

Mole Valley

- Leisure and Cultural Services

Reigate & Banstead

- Clubs, holiday activities, leisure centre info and “ageing well” activities

- Activities, holiday clubs and classes in East Surrey

 

Runnymede

- Leisure directory

- Sports clubs

Spelthorne Leisure Services

- Leisure directory

 

Surrey Heath

- Leisure organisations, sports groups, environment & nature groups

Tandridge

- Leisure and Cultural Services

Waverley

- Sport and leisure directory

Woking

- Sports directory

- Health and Wellbeing activities and courses

- Directory of Youth centres and youth clubs

Surrey Children’s Centres

- Information and activities for families with children under the age of 5


In Surrey, there are 26 public sector leisure facilities and the majority of all parks and leisure centres are contracted out to private providers with varying levels of physical activity services/intervention included in the contracts between the councils and the contractor.

Activity Finder

Active Surrey hosts an Activity Finder on their website which includes data about Surrey based physical activity providers that is inputted and updated by individual providers. The Activity Finder includes information on sports clubs, leisure centres, education settings, commercial providers, charities, local authorities and national governing bodies of sport. The Activity Finder allows people to search for physical activity by various filters such as borough, type of activity, accreditation status and access for people with disabilities. In 2012 the Activity Finder had 2,012 free taster sessions listed and was used by 6,118 people.

Active Surrey has created an Inclusive Sport Map which shows the location and contact details of physical activity opportunities which are accessible for people with disabilities.

Family Information Service is a free, impartial information service for families with children aged 0 to 19 (up to 25 for young people with a disability or special educational need). They hold a directory on activities for families.

Physical activity services for children aged 0 – 5 years

ActivKids: doing what comes naturally
ActivKids lessons are 45 to 60 minutes of natural exercise, using children’s natural enthusiasm and energy to inspire health and fitness. For pre-school children, ActivKids teach imaginative exercise: mixing play and story telling to create health and fitness classes.

The pre-school programme, ActivTots, has been delivered in 23 children’s centres and nurseries throughout Surrey. This has either been delivered directly to the children and families by an ActivKids instructor (either regular weekly classes or holiday classes), or by training staff to teach the classes themselves. The ActivTots programme has been delivered in Runnymede, Surrey Heath, Waverley, Guildford, Redhill and Reigate, Tandridge and Woking.

Physical activity services for children and young people (5-13 years)

ActivKids

For primary aged children, ActivKids teach creative exercise: mixing games and recognized fitness drills to create health and fitness classes.

ActivKids has been delivered in over 60 schools throughout Surrey, taking place in each Borough. This has either been delivered directly to the children by an ActivKids instructor (after school, before school, during lunchtime or PE sessions), or by training teachers to use the idea and programme content.

School Sports Development
In 2012 the London Olympics helped to keep the profile of physical education and sport high on all schools' agenda. Many schools promoted more opportunities and other schools engaged in the School games and participated in new sports and physical activities. However, since 2010 there has been a shift in the focus as funding for Primary Link Teachers and School Sport Coordinators has disappeared. The Healthy Schools programme and 2 hours of high quality PE were also no longer mandatory programmes. There has also been an increasing trend in buying in external providers to lead on physical education and games-based sessions during PPA time at primary level.

Since 2010, many schools have made Physical Education a much lower priority. With the introduction of the Sport Premium in September 2013, primary schools will be held more accountable to developing appropriate programmes of opportunity and promoting participation at all levels. A new National Curriculum will also be in place for September 2014, thus schools are currently preparing for this. 

P&G Surrey Youth Games [43]
The P&G Surrey Youth Games is a multi-sports competition, spread over two days, in which all eleven districts and boroughs in Surrey enter teams into fifteen different sporting events. There are events for all ages, including events for young people with disabilities. 

P&G Surrey School Games [44]
The P&G Surrey School Games is part of the national Sainsbury’s School Games programme and Surrey's Olympic legacy. Over 10,000 young people representing over 300 schools, take part in the year round programme of over 75 events and competitions. As well as mainstream sports, there are opportunities to take part in alternative competitions such as dodgeball and motorsport. 

Change4Life Clubs [45]
Change4Life Sports Clubs are a new type of extracurricular sports club, designed to increase physical activity levels in less active children in primary and secondary schools. In Surrey, the School Games Organisers are supporting the set up of Change4Life Sports Clubs in both primary and secondary schools which are supported by both Young Leaders and Teacher Training.

Physical activity services for females

Sport National Governing Bodies provision
With 12 million women nationally telling Sport England that they want to do more sport and over half of these currently inactive, the National Governing Bodies of Sport have recognised that girls and women are the biggest growth opportunity and have developed programmes specifically aimed at females. Sports including Netball and Hockey have created products that target women and girls to get back to playing the sport they once enjoyed in their youth. For more information contact Active Surrey. [46]

Physical activity services for young people (16 – 24 years) in particular access to the natural environment 

Surrey Outdoor Learning & Development (SOLD) [47]
SOLD service works in nature’s ‘outdoor classroom’ which is a complementary setting to young people’s usual surroundings and in which to develop vital life skills through direct and unique experiences. It has been well documented that when outdoor learning becomes an integral part of a well planned curriculum, higher achievement is attained as well as significantly improving personal, social and emotional development of young people. SOLD deliver outcome driven, experiential learning visits in three outdoor education centres in Mickleham near Dorking, Guildford and Ham near Richmond, a canal boat moored on the River Wey and an Outreach Team that can deliver outdoor learning. SOLD offers a bespoke service to Schools (Primary, Secondary & Special), FE & HE, Youth Organisations, Community Groups, Businesses and Families and operates throughout the year. 

Sportivate [48]
Sportivate sessions are free or low cost introductory 6-8 week sports courses for 14 – 25 year olds. After two years 3,096 young people aged 14-25 have been retained for six hours of physical activity. After the Sportivate course finishes young people are given incentives to continue participating within community clubs and leisure providers. Sportivate will run until 2017.

Sustrans ‘Bike It’ scheme in Reigate and Banstead Borough
The Royal Alexandra and Albert School in Reigate is the first secondary school in the country to be awarded the Gold Sustrans School Mark Award [49] for increasing the number of children regularly cycling to school from 9% to 31% since September 2010. The project encouraged cycling by using cross-curricular initiatives, running competitive cycling events, linking with local primary schools and having bike maintenance classes.

British Cycling Go Ride programme
The is a programme operating with secondary schools Guildford and Woking to encourage children to participate more in cycling, developing a pathway towards competitive cycling.

Physical activity services for older adults (65+)

Community Centres
The community centres in Surrey provide a wide range of opportunities for older adults to become active. 

Age UK
Age UK provides a wide range of physical activities for adults over 50 in Surrey.

NGBs
Many of the NGBs offer sports products that are suitable for older adults. An example includes the Football Association’s Walking Football which is available in Guildford and Surrey Heath.

Health Walks 
Health walks are currently available across all of Surrey apart from Mole Valley. Whilst the walks are not exclusively targeted at older adults, they are an appropriate activity for this group and tend to attract older people to the walks due to their social and inclusive nature.

Physical activity services for people with a limiting illness or disability

Para Games
The Para Games is an annual multi sports event for students from state and independent schools in years 7-9 (Key Stage 3) with physical and intellectual impairments, from special and mainstream schools. Participants are split into groups on the day and rotate around 4 different sports (e.g. cricket, canoeing, sitting volleyball, and athletics) at one central venue. Although it is a non scoring event, medals are awarded to the top 3 places in each sport using the Olympic values.

Surrey Exercise and Weight Management Referral Scheme
Adult patients can be referred by a healthcare professional to take part in a 12 week exercise programme to help to manage their medical condition. In Surrey exercise referral schemes exist in all boroughs and districts apart from Epsom and Ewell.

NGBs
Forty-two National Governing Bodies of Sport have committed to deliver physical activity opportunities to disabled people from 2013-17. Fifteen of them will provide disability-specific programmes and interventions and 23 of them have committed to delivering inclusively. For more information contact Active Surrey at active.surrey@surreycc.gov.uk.

Young Health Champions
This is a national health project, which acts to try and reduce health inequalities amongst young people. Reigate and Redhill YMCA (RRYMCA) is one of five YMCA centres piloting the project until September 2014. At RRYMCA, there is specific focus on disability, recruiting a group of young people with disabilities aged 16-24. This group of young people are currently undergoing a Level 1 award in Sports Leadership, and will soon be going out to deliver sport and physical activity sessions to groups of other young people with disabilities. There are plans to incorporate other health topics such as alcohol awareness, into these sessions.

Active Living
Active Living is a three year project funded by Comic Relief. The project uses sport as a way of engaging young people (aged 16-28) with disabilities, before supporting them towards their long term goals. Young people are consulted about how they might like to progress in the future, and are encouraged and supported to engage in these activities. Examples of activities that young people engage in include additional qualifications, volunteering and, in some cases, paid employment.
 
Inclusive Sports
This is a new project for young people with disabilities aged 14-30. The project will run in and around the seven youth centres in East Surrey, and will offer the opportunity to take part in a range of sports, including boccia, table cricket and more.

Physical activity services for people from BME groups

Sheerwater Cycling Group
See case study in the evidence-based section: Using social marketing to increase physical activity in Asian women.

Physical activity services for people living on a lower income or in areas of deprivation

Family Support Programme
Surrey County Council Public Health team are working with the Family Support Programme to train frontline staff so that they are equipped to support the most vulnerable families in Surrey to make changes. This will include brief intervention training for physical activity.

Street Games Doorstep Clubs
There are two doorstep clubs in Surrey offering active opportunities for young people from areas of deprivation, one in Spelthorne run by SC Academy and one in Woking run by Reflex Woking. There will be more starting in Surrey shortly. See evidence based section for further information.

Leisure cards
All boroughs and districts offer a concessions card for access to Leisure Centres for those on low incomes or in receipt of benefits.

Physical activity services within primary and secondary care

Screening for inactivity using GPPAQ [85]
In Guildford and Waverley CCG area GP practices are piloting the use of GPPAQ to screen patients for activity. For any patients that are less than active and have one other medical condition (in particular hypertension) they then ‘refer’ to the Surrey Exercise and Weight Management Referral Scheme. For patients without an existing medical condition that are inactive the GP will ‘recommend’ local physical activity services.

Referring to interventions
Many primary care practitioners in Surrey refer patients to the Surrey Exercise and Weight Management Referral Scheme under the schemes protocol.

Active sustainable transport services

Travel SMART
Travel SMART is a multi million pound infrastructure and behaviour change programme designed to increase levels of sustainable travel. Promoting and providing infrastructure for greater levels of Active Travel throughout the County is a key part of this programme, including the following initiatives:

  • New cycle routes and walking environment improvements
  • New journey planning website including calorie counter
  • Major upgrade of walking and cycling information including town centre maps, new pedestrian signage and online tips and advice
  • Social marketing campaign in partnership with local press, including free pedometer give away.
  • Cycle Festivals attracting over 2,000 people each
  • Support in deprived communities to set up physical locations where people can get advice about travel. Also a location where health referrals can be catered for with guided walks and cycle rides.
  • Encouraging children to cycle more through the Bike IT and GO-Ride cycling programmes
  • Travel planning initiatives for local businesses, providing incentives and opportunities for local employers to promote active travel to their staff
Funding for this programme is available until March 2015, targeting Guildford, Woking,Redhill and Reigate.

Bikeability cycle training
The County Council has over 70 fully trained bikeability cycle instructors who can provide cycle training for people of all ages. Cycle training encourages people to get on their bike more, and provides people with the skills and confidence to enable regular cycling. The initiative includes: 
  • Customised cycle training for businesses and families – subsidised in some areas by Travel SMART
  • Cycle training offered to all schools throughout the County for both primary and secondary pupils. Aspects of this training are subsidised, by a central government grant, to encourage as many children to take up the training as possible.
Sustainable Modes of Travel (SMOTS) schools funding
This is funding currently provided by central Government. SMoTS is a statutory duty which the County Council uses to target specific schools in more deprived areas and locations where the greatest potential for sustainable travel exists to assist with the planning and promotion of sustainable travel. Statistically, children living in deprived areas are more likely to be involved in a road traffic accident than children in more affluent areas.

Golden Boot and Surrey Cycle Challenge
The County Council undertakes two online behaviour change campaigns each year. The Surrey Cycle Challenge focuses on encouraging employees who haven’t cycled before to give it a go during the challenge period, and is run annually in September. The Golden Boot Challenge is focussed on schools, encouraging children to travel sustainably to school, particularly by walking, cycling or scooting. The challenge is offered to all primary schools and in 2013 224 schools took part.

Workplace Travel Planning
As part of the planning process, workplace travel planning requires the occupiers of new commercial developments to reduce the number of people arriving at their site by single occupancy vehicles. A key element of this work is providing businesses with the tools to encourage staff who live within walking and cycling distance of work to travel by walking or cycling. Within Surrey, there are currently 35 businesses that are required to produce and monitor travel plans.

Notable changes since previous JSNA

Services have been mapped against the need highlighting inconsistencies in services for all target groups, with particular gaps in service for BME groups across the whole of Surrey and for people with a limiting illness or disability in the West of Surrey.



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Projected service use and outcomes in 3-5 years and 5-10 years.

The proportion of the population aged 65 years and over is very similar in both England and Surrey. Both are projected to increase from around 16 to 16.5% to between 22.5 and 23% of the population by 2033. [50] As older adults have been identified as a group with low activity levels in Surrey, the percentage of inactive people in Surrey is likely to increase.

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Evidence based (what works and what does not work)


The National Institute for Health and Clinical Excellence (NICE) is a special health authority that provides evidence-based guidance for all stakeholders to ensure the best possible quality of care is provided to prevent, diagnose and treat disease and ill health, whilst offering the best value for money to help reduce inequalities and variation in public health.

NICE guidance summaries
Four Commonly used Methods for Increased Physical Activity [51]

This guidance focuses on brief interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling. It is recommended that adults in primary care, who are inactive, need to be identified, supported and followed up, commissioning services should incorporate this brief advice on physical activity, resources and systems made available to monitor the provision of brief advice and information and training provided for primary care practitioners (i.e. motivational interviewing techniques). There is insufficient evidence to support the use of Exercise referral schemes to promote physical activity and these schemes should only be endorsed when part of a robustly designed, controlled study. For walking and cycling, it is recommended that high-level support should be received from the health sector and ensure all relevant policies and plans consider walking and cycling. Local authority directors are advised to develop coordinated, cross-sector programmes and transport planners should provide personalised travel planning and promote cycling programmes.


Behaviour Change [52]
This guidance provides a set of generic principles that can be used as the basis for planning, delivering and evaluating public health activities aimed at changing health-related behaviours. Principle 1 (Planning) recommends assessing social context to minimise health inequalities and provide educational support and training to those involved in changing people's health-related behaviour so that they can develop the full range of competencies required. Principle 2 (Delivery) recommends, at an individual-level, to select interventions that motivate and support people in their understanding of the consequences of their health-related behaviour, and to build positivity on the health benefits whilst providing coping strategies to prevent relapse. At a community-level, NICE recommends to invest in interventions and programmes that identify and build on the strengths of individuals and communities and the relationships within communities by promoting good parental skills, positive social networks and access to the financial and material resources needed to facilitate behaviour change. At population-level, policies, interventions and programmes delivered should be tailored to change specific health-related behaviours which should be based on information gathered about the context, needs and behaviours of the target population(s). Principle 3 (Evaluation) recommends evaluating the effectiveness, acceptability, feasibility, equity, safety and assessing cost effectiveness (particularly for research on mid- to long-term behaviour change and interventions delivered to different population groups).

Physical Activity and the Environment [53]
This guidance offers the first evidence-based recommendations on how to improve the physical environment to encourage physical activity which cover strategy, policy and plans, transport, public open spaces, buildings and schools. NICE recommends ensuring that planning applications for new developments always prioritise the need for people (including those whose mobility is impaired) to be physically active as a routine part of their daily life; ensuring pedestrians, cyclists and users of other modes of transport that involve physical activity are given the highest priority when developing or maintaining streets and roads; planning and providing a comprehensive network of routes for walking, cycling and using other modes of transport involving physical activity; and finally ensuring public open spaces and public paths can be reached on foot, by bicycle and using other modes of transport involving physical activity.

Promoting Physical Activity in the workplace [54]
This guidance recommends that employers develop an organisation-wide plan and introduce and monitor an organisation-wide, multi-component programme to encourage and support employees to be more physically active. (This could be part of a broader programme to improve health.) Employers are also recommended to encourage employees to walk, cycle or use another mode of transport involving physical activity to travel part or all of the way to and from work (for example, by developing a travel plan). Help and support should also be provided to employees to be physically active during the working day, for example, by encouraging them to take the stairs or walk to external meetings. (See the Workplace Health JSNA Chapter for further information).


Promoting Physical Activity for Children and Young People [55]
This guidance recommends delivering a long-term national campaign to promote physical activity by actively involving children, young people and their parents, in order to determine the most effective messages that address any concerns parents/carers may have about their child’s safety. Raising awareness of the importance of physical activity should be endorsed by ensuring there is a coordinated local strategy to increase physical activity to help achieve local area agreement targets and that physical activity initiatives are regularly evaluated. Developing physical activity plans are recommended to identify target groups and to involve these children and young people in the design planning and delivery of physical activity opportunities. Planning the provision of spaces and facilities is recommended to ensure physical activity facilities are available and suitable for children and young people with different needs and their families and to ensure they meet recommended safety standards. It is recommended that local transport plans continue to be fully aligned with other local authority plans which may impact on children and young people's physical activity. Responding to children and young people by identifying and removing local barriers to participation is suggested to help promote physical activity. Leadership and instruction is recommended to ensure staff and volunteers have the skills to design, plan and deliver physical activity sessions and training and continued professional development should be established for people involved in organising and running physical activities. Multi-component school and community programmes should be delivered and children and young people should have access to facilities and equipment and the opportunity to explore different physical activities. It is recommended that support is given to girls, young women, children and families to be active by supporting participants of all abilities in a non-judgemental and inclusive way and to make parents/carers aware of government guidelines for physical activity.

Walking and Cycling [56]
This guidance considers walking and cycling as forms of transport, for example, to get to work, school or the shops. It also considers them as recreational activities, for example, as a means of exploring parks or the countryside. The guidance suggests high-level support from the health sector as well as ensuring all relevant policies and plans support and encourage through a commitment to invest sufficient resources to promote walking and cycling. Coordinated cross-sector programmes should be developed to promote walking and cycling for recreation as well as for transport purposes, based on a long-term vision of what is achievable and current best practice. Commissioning personalised travel planning programmes will help those interested in changing their behaviour to make small, daily changes. Town-wide programmes should be implemented to promote cycling for both recreational and transport purposes by addressing infrastructure/planning issues that may discourage cycling and to ensure programmes are based on a theoretical framework for behaviour change. With regards to walking, community-wide programmes should be implemented to promote walking as well as providing individual support including the use of pedometers. With regard to schools, a culture that supports physically active travel for journeys to school should be fostered by implementing school travel plans, mapping safe routes to school, developing parents' and carers' awareness of the wider benefits of walking and cycling and many more. With regard to the workplace, strategies should be developed to promote walking and cycling in and around the workplace and that programmes are developed using an evidence-based theoretical framework for behaviour change. The NHS should incorporate information on walking and cycling into all physical activity advice given by health professionals.

Physical activity: brief advice for adults in primary care [57]
This guidance aims to support routine provision of brief advice on physical activity in primary care practice. In response to NICE ph2 (2006), the DH launched the ‘Let’s get moving’ physical activity care pathway[58] which endorsed use of GPPAQ[85] to identify inactive patients in primary care. However there is a lack of evidence on the impact of the current infrastructure, processes and systems on both the delivery and uptake of brief advice in this care pathway. It is recommended to identify adults who are not currently meeting the UK physical activity guidelines and to ascertain the most appropriate time to discuss physical activity with them i.e. consultation with a member of the primary care team. It is also recommended that when delivering and following up on brief advice that inactive adults are provided tailored advice according to their motivations/goals, health status and circumstances with an emphasis on the benefits of physical activity. When commissioning services to prevent or treat conditions or to improve mental health, ensure brief advice on physical activity is incorporated into the care pathway, particularly services for groups that are more likely to be inactive i.e. people aged 65 years and over, people with a disability and people from certain minority ethnic groups. Ensure systems such as Read Codes are being used to identify opportunities to assess people’s physical activity levels and that resources and information about local opportunities to be active are available and up to date. Information and training should also be provided for primary care practitioners, addressing how physical activity promotion can help prevent and manage a range of health conditions, the definition of physical activity, misconceptions about who needs to increase their physical activity and the needs of specific groups i.e. disabilities.

Case study: Securing funding for a research project that supports NICE guidance and contributes to the evidence base

The University of Surrey secured funding in 2013 to undertake a randomised controlled trial (RCT) testing two types of exercise referral intervention (one sport based and one gym-based) that are intended to increase physical activity in adults with hypertension, suspected hypertension, pre-hypertension or high-normal blood pressure.  This supports the NICE guidance PH2 recommendation to endorse exercise referral schemes only when part of a robustly controlled study.  This evidence base will contribute to the national understanding of sports participation links to primary care.  The study is due to be completed in 2015.


Social Marketing 

Sport England Market Segmentation [28]
Sport England has produced some key insight information to inform commissioning and communications promoting physical activity to target groups. Sport England has developed nineteen sporting segments to help activity providers understand the nation's attitudes to sport, their motivations and barriers. The tool can be used to identify the more dominant type of people in an area, explore which type of people will want to take part in certain activities or to find out more about the preferences and habits of certain types of people. 

Promoting Activity Toolkit [59]
The promoting activity toolkit is a series of practical tools to assist with the promotion of sport and activity quickly, cheaply and easily in your area. There is a strategic planning tool, communication plans, marketing materials and a photo gallery with free photos for use in promotional material. 

Change4Life [60]
Change4Life is the social marketing campaign outlined in the Healthy Lives, Healthy People: A call to action on obesity in England. [61] Change4Life is based on the latest research evidence and provides a national advertising campaign to promote behaviour change in families to tackle obesity. Families are encouraged to sign up to the programme to receive support to change and professionals sign up to receive access to a wide range of resources. 

Climate change and Transport Choices: segmentation study [62]
This report outlines a segmentation of public attitudes to climate change and transport choices.

Case Study: Using social marketing to increase physical activity in Asian women in Woking

In 2010 funding was secured from the Department of Health to take a social marketing approach using Change4Life and Sport England Market segmentation insights along with resident feedback to develop a project to increase physical activity participation in families with children aged 2-11 years in Sheerwater, Woking.  A cycling project was developed providing cycle training and led rides for women in Sheerwater based on addressing the barriers and enhancing the motivators for participation.   

Cycle Woking funded the subsequent project delivery and, using the marketing plans from the Promoting Activity Toolkit to target families, enabled 8 regular female cyclists and their families from the local BME community to access the training and the new cycle network in Woking.  The cycle rides are led by members of the community and continue today (Aug 2013).

The full social marketing report can be found here. [63]


Evidence based physical activity services for young people (16 – 24 years) in particular access to the natural environment 
Well being and the natural environment: a brief overview of the evidence [64]
There is an increasing emphasis on wellbeing as a key indicator of societal progress – this paper summarises the evidence for the contribution of the natural environment to well being. 

Health, Well-Being and Open Space [65]
Literature Review about the benefits of being outdoors, by Nina Morris, OPENspace Research Centre, 2003
Key points from this review of research include: 
  • Exposure to the natural environment can have a positive effect on human health.
  • Exposure and access to green spaces can also have a wide range of social, economic, environmental and health benefits
  • Urban green spaces are major contributors to the quality of the environment and human health and well-being in inner city and suburban areas.
  • Outdoor recreation provides an opportunity to increase quality of life and heighten social interaction.
  • Physical activity in the natural environment not only aids an increased life-span, greater well-being, fewer symptoms of depression, lower rates of smoking and substance misuse but also an increased ability to function better at work and home.
  • Health Walk and Green Gym participants cited being ‘in the countryside’ and ‘contact with nature’ as key motivating factors to be active.
  • Short-term strategies must begin by establishing a clearer link between accessible urban green space and healthy living in the minds of politicians, policy-makers ad the general public.

Wild Adventure Space
[66]
The OPENspace Wild Adventure Space Project Review (2006) draws on evaluations of projects of many types and sizes. It illustrates the range of likely benefits to young people, as well as illustrating some of the many forms that Outdoor Learning can take. 

Intelligent Health’s walking projects [67]
Intelligent Health uses behaviour change expertise and technology to create walking and other activity schemes to help large numbers of people get moving again. They have worked with public sector health organisations and corporate partners both in the UK and around the world to tackle the massive global problem of inactivity. They have run a number of successful projects looking at increasing walking to school and general community walking.

Evidence based physical activity services for females 

Sweat in the City [68]
Sweat in the City was a social marketing research project designed to gain a better understanding of how to motivate women to become more active. The research provides key insights into what motivates – and de-motivates – young women. It also provides pointers for anyone delivering a project for young women and guidance for policy makers.

Us Girls [69]
Us Girls is an initiative to get 30,000 young women from disadvantaged areas more active, by providing them with fitness and sport opportunities within their local communities. It is funded by Sport England and delivered by Street Games. The project is still running so evaluation is not yet available, however the initiative itself is based on evidence.

Case study: Sweat in the City. Research project to find out why young women are half as active as men.

Sweat in the City (SitC) was an innovation research project to help to find out why 16-24 year old women are half as active as men of the same age. With the help of a feminine brand, celebrity ambassadors and a chance to discover a ‘fitter and healthier you’, over 2000 young women across London were recruited and provided with a three-month free and mentored gym membership. The membership included an online social network, a mentor for help and advice and programme specific fitness classes. All that was asked in return was for the women to share their highs and lows in an online diary. 

A full case study can be found here.[68]

Evidence based physical activity services for older adults (65+)

NICE public health guidance: Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care. [70]
The NICE (2008) public health guidance Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care recommends physical activity interventions including led health walks, education and tailored programmes. 

The Older Men’s Network [71]
In Nottingham and Liverpool the Older Men’s Fit as a Fiddle projects enlisted local football clubs to deliver football related sessions and used a buddy system to help older people live more healthy, active and fulfilling lives.

Fit as a Fiddle [72]
Fit as a Fiddle is a nationwide programme‚ funded by the Big Lottery Fund well-being programme, supporting older people with physical activity‚ healthy eating and mental well-being. Fit as a Fiddle hosts innovative projects, run in partnership with regional and national organisations, promoting healthy ageing‚ based around the needs and ideas of local people. They have developed a range of useful resources to assist organisations in promoting their wellbeing activities to Health and Wellbeing Boards, Commissioners and local funders. 

Active for Life - 60+ Free Leisure Offer in Barking & Dagenham [73]
In 2010/11 residents aged 60 and over were given the opportunity to access the Borough’s leisure centres for free during a year-long Active for Life pilot project. A budget of £130,000 was provided by Adult Social Care to pay for the programme.

Due to the success of the offer, funding was committed to continue the programme in 2011/12 and 2012/13. From 2013/14 the scheme will be funded by the Public Health grant. In 2012/13, there were 60,217 visits to the leisure centres by Active for Life members. On average 57% of individuals who attended the leisure centres participated at least 5 times per month, 27% participated at least 10 times and 7% participated at least 20 times per month.

Walking Football – Football Association
Walking football is a version of football aimed predominantly at the over 50’s demographic. There is no running allowed. The game is very much an ‘activity for health’ based project that looks to actively engage participants who have lapsed in their physical activity commitments.


Evidence based physical activity services for people with a limiting illness or disability

Randomised Controlled Trial of the Welsh National Exercise Referral Scheme [74]
A randomised controlled trial of the Welsh National Exercise Referral Scheme proved effective in increasing activity and improving health outcomes in referred patients, increasing adherence to activity post the intervention and economic analysis concluded that the scheme was 89% likely to be cost effective at just over £12,000 per QALY. 

Surrey Exercise and Weight Management Referral Scheme [75]
A case study evaluation of Surrey Sports Park Exercise and Weight Management Referral Scheme proved the intervention was effective at improving health outcomes for referred patients that completed the 12 week intervention of safe and effective exercise supervised by an appropriately qualified instructor. Further data collection is required to evaluate the effectiveness of the scheme at increasing physical activity levels.

Healthy Living/Steps to Fitness Project for adults with a learning disability
Eight ‘Healthy Living’/’Steps to Fitness’ groups have been delivered to adults with a learning disability and their carers or support workers by Surrey and Borders Partnership NHS Foundation Trust Community Learning Disability Teams in partnership with leisure providers. All groups showed positive outcomes in physical measurements e.g. body mass index (BMI), waist circumference, making positive changes in behaviour and in emotional and psychological aspects. Groups varied in size with attendance of clients ranging from 7 – 12 plus carers and support workers. The Steps to Fitness group delivered in 2012 at Rainbow Leisure Centre, Epsom had an attendance of 26 – 30 clients each week plus carers and support workers. 

Macmillan Cancer Support and physical activity marketing in Luton [76]
Make Sport Fun were appointed by Macmillan Cancer Support to find out how to market physical activity programmes to people living with and beyond cancer, specifically the over 50′s, and then to create a proven system for doing that. They used the Physical Activity Care Pathway to actually test all this out in a Macmillan project in Luton and hit their target of getting 120 cancer survivors active in 12 months. As a result of the project they developed some fantastic insights for Macmillan, and have been able to tell them what the most effective messages are, and which ones you shouldn’t use at all. They also developed a system for how to promote a cancer specific physical activity programme, and template resources for putting that into practice as well as supported one of Macmillan’s projects in Luton to implement this programme which allowed them to hit all their marketing targets.

Evidence based physical activity services for people from Black and Minority Ethnic (BME) communities

Re-Shape, Blackburn [77] 
Re-shape Blackburn is an eleven week pilot project providing ladies only activity sessions twice a week with an average of 35 Asian ladies attending each week.

A Sport England review [78] of research of BME communities and sport found relatively low numbers of people from ethnic minorities in sport. This was true of spectators, volunteers and administrators as well as players.

The paper recommends good practice for sports providers, including: 
  • training for those working in sport on the needs of other ethnic communities and on challenging exclusion
  • ensuring that racial equality objectives in policies are converted into practice
  • training sports facilitators from BME communities
Sporting Equals
Sporting Equals exists to actively promote greater involvement by all communities that are disengaged especially the black and minority ethnic population in sport and physical activity. Sporting Equals has a dedicated research function that includes over 20 years of experience in delivering high quality and perceptive information surrounding BME communities and race equality in sport. Sporting Equals are the primary driver and funding channel for national and regional programmes in this field and work closely with providers of sporting and physical activity opportunities to provide services for people from BME communities.

Evidence based physical activity services for people living on a lower income or in areas of deprivation

World Health Organization (WHO) – Physical activity promotion in socially disadvantaged groups [79]
The WHO report presents suggestions for national and local action on interventions and policy formulation to support physical activity in socially disadvantaged groups based on a robust evidence review. The report acknowledges a need for further strengthening of evidence and outlines gaps for research. 

Street Games Doorstep Sports Clubs [80]
Doorstep Sports Clubs provide young people living in areas of high deprivation aged 14 – 25 years with the opportunity to play a number of sports right on their doorstep. Initial evaluation has proven to increase activity providing young people with a low cost way to enjoy a variety of social activities without the focussing on talent. They are developed locally by people who understand the needs of the communities. 

Family Support Programme [81]
In December 2012 the Coalition Government published a report endorsing family intervention as the most effective way to support troubled families. The report outlines key ways how family intervention is shown to reduce involvement in anti-social behaviour and crime and outlines effective ways to intervene with families.

Inspired by 2012

In August 2013, the Government and Mayor of London published a report ‘Inspired by 2012: The legacy from the London 2012 Olympic & Paralympic Games’ [82] which describes the activities since the Games to build a lasting legacy across a number of commitments including: sport and healthy living, the regeneration of east London, bringing communities together, the Paralympic legacy and economic growth. The report shows that 1.4 million more people are playing sport at least once a week than in 2005 when the bid was won.

Sustainable Transport 

Evidence based tools for use in Primary Care

The General Practice Physical Activity Questionnaire (GPPAQ) [85] is a validated screening tool, used in primary care to assess the physical activity levels of adults (16 to 74 years). It provides a simple, 4-level physical activity index (PAI). Practitioners can use this index to help them decide when to offer interventions to increase physical activity.

Evidence based tools for use to support the evaluation of interventions and services

Standard Evaluation Framework for Physical Activity Interventions [86]
The SEF for physical activity interventions aims to describe and explain the information that should be collected in any evaluation of an intervention that aims to increase participation in physical activity. It is aimed at interventions that work at individual or group level, not at population level. It provides detailed, specific guidance on the following areas: 
  1. How to identify appropriate physical activity outcomes for evaluating different types of intervention.
  2. How to define suitable measures for different types of physical activity outcome.
  3. How to approach the challenges of assessing and measuring physical activity and energy expenditure.
Health Economic Assessment Tool for Walking and Cycling [87]
HEAT is an online resource designed to help you conduct an economic assessment of the health benefits of walking or cycling by estimating the value of reduced mortality that results from specified amounts of walking or cycling.

Validated single-item measure of physical activity
This question can be used to capture point in time activity levels which if done pre- and post intervention can support evaluation to assess if activity levels increased during the course of the programme:

In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate?
This may include sport, exercise, and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job. 
                                            
        0      1      2      3      4     5      6      7

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Unmet needs and service gaps

  • There is no current national or local data that identifies children’s physical activity levels in line with the government guideline levels.
  • Whilst examples of services for the least active groups (females, older adults, people living in areas of deprivation, people with a limiting illness or disability, people from BME communities) have been outlined, there is a gap in the consistency of service availability and accessibility for these groups across Surrey. Particular gaps are identified for BME groups, for people with a limiting illness or disability in West Surrey and for adults living in areas of deprivation.
  • There is a lack of thorough evaluations of interventions in Surrey, especially those that measure the impact in relation to increasing levels of physical activity.
  • There is a lack of screening and referral/recommendations of physical activity within primary care.
  • There is a lack of interventions that are developed using social marketing techniques and insights.
  • Many physical activity services exist, but there is a lack of a single point of access to all of this information and a lack of a co-ordinated approach from all partners to signpost to and promote all services that increase physical activity for those who are most in need.
  • Leisure contracts do not maximise the potential to provide evidence based interventions that address the identified physical activity needs.
  • There is a lack of joined up working across physical activity sectors i.e. sport, green space, physical activity and active travel. 

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Equality Impact Assessment

An equality impact assessment was completed for the Health Improvement Unit of the Public Health Directorate which included physical activity. No known negative impacts were identified.

No other known Equality Impact Assessments have been undertaken on individual services/strategies.


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Recommendations for Commissioning

  • Collect children’s activity data in line with the government guidelines for physical activity in children.
  • Commission physical activity services that aim to address the needs identified in this chapter, in particular those that reduce the number of people achieving less than 30 minutes of physical activity each week and increase the number of people achieving 150 minutes or more of physical activity each week.
  • Commission physical activity services that target the least active groups such as females, older adults, BME groups, people with limiting illness or disability, people living in areas of deprivation; and ensure the effectiveness is evaluated.
  • Commission and signpost to services that encourage people to use outdoor space for exercise/health reasons.
  • Particular attention to commission physical activity services for people from BME groups such as ‘fit as a fiddle’ faith and community strand project[88] and for people with limiting illness or disability such as ‘steps to fitness’ health and wellbeing pilot project [89].
  • Build evaluation into existing services using the Standard Evaluation Framework for physical activity[86], ensuring that the single-item measure physical activity questionnaire is used.
  • Review or de-commission services that don’t evaluate the impact that service has on physical activity levels
  • When developing new physical activity interventions use social marketing techniques, making use of existing insights as highlighted in this chapter and using tools such as Change4Life, promoting Activity Toolkit.
  • Ensure a co-ordinated approach to activity, including all activities (not just sport) to be included on the Active Surrey Activity Finder
  • Support the national Change4Life physical activity campaign locally, with all partners on board.
  • Provide a forum for better partnership working between various sectors and organisations that impact upon physical activity levels, ensuring that increasing physical activity levels is everybody’s business.
  • When leisure centre contracts are re-tendered, ensure that the JSNA physical activity chapter guides the retendering.
  • Provide educational support and training to staff that are involved in changing people’s physical activity behaviours.
  • Develop local transport plans that encourage and facilitate walking and cycling.
  • Commission personalised travel planning programmes to support willing individuals to make daily changes.
  • Ensure that all planning applications for new developments always prioritise the need for people to be physically active as a routine part of their daily life. Comprehensive networks for active modes of transport including those to public open spaces, parks and other major destinations.
  • Ensure that workplace health initiatives support employees to become more physically active.
  • Ensure that County and Borough and District strategies for physical activity and open space/parks incorporate the needs identified in this chapter, with particular focus on targeting inequalities and evaluating physical activity outcomes.
  • Assist the Family Support Programme in Surrey to work with those families most at need to increase their physical activity levels by providing staff with training and up to date information on local physical activity opportunities.

Primary Care

  • Ensure that a brief intervention, such as Lets Get Moving, is undertaken and evaluated for effectiveness in primary care. Patients should be screened for physical activity levels in primary care using GPPAQ[85] and referred onto or recommended appropriate services for anyone identified as less than active.
  • Ensure brief advice on physical activity is included in care pathways for mental health, particularly services for groups that are more likely to be inactive i.e. people aged 65 years and over, people with a disability and people from certain minority ethnic groups.
  • Provide information and training for primary care practitioners that addresses how physical activity promotion can help prevent and manage a range of health conditions.
  • Ensure systems such as Read Codes are being used to identify opportunities to assess people’s physical activity levels and that information and resources about local opportunities to be active are up to date. 
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Recommendations for needs assessment work

  • Include the 2012 Health Survey for England physical activity data in the next needs assessment once it is published.
  • Analyse School Travel Survey data.
  • Make use of the new Active People Survey Interactive tool.
  • Undertake a more detailed analysis of physical activity in children, including data and current services.
  • Include QOF data for HYP004 and HYP005.
  • Explore the MENE data further to gain better intelligence regarding access to green space.
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Key contacts

Victoria Heald - Public Health Development Worker 
Victoria.Heald@surreycc.gov.uk

Hannah Sprake – Active Surrey Sports Partnership 
Hannah.Sprake@surreycc.gov.uk

Jon Walker – Public Health Analyst
Jon.Walker@surreycc.gov.uk

Active Surrey Partnership Forum / Active Surrey Partnership Forum Participation Thematic Working Group

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  34. Ibid
  35. Ibid
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Active Surrey Partnership Forum

If you have any feedback/comments please send it to jsnafeedback@surreycc.gov.uk

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Updated: 01 December 2014 | Owner: Adwoa Owusu
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