Section 1: Target groups

Section 1: Inactivity – a global issue

Introduction

More than a quarter of the world’s adult population (1.4 billion adults) are insufficiently active. Worldwide, around 1 in 3 women and 1 in 4 men do not do enough physical activity to stay healthy (WHO, 2020). In England 1 in 4 people do less than 30 minutes of physical activity a week, according to survey results from Sport England, (2020). As an exercise instructor, it is important to understand individuals and groups that are likely to be inactive and some of the key barriers to participation in physical activity. WHO, (2020) define physical activity as “Any bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity refers to all movement including during leisure time, for transport to get to and from places, or as part of a person’s work. Both moderate- and vigorous-intensity physical activity improve health”.

Benefits of physical activity to the individual

Health benefits

The benefits of physical activity such as improved sleep, reduced stress, improved sense of purpose and quality of life, as well as improved posture and weight management, are all widely acknowledged and well evidenced. Numerous studies show a significant positive relationship between physical activity and reduced risk of developing a major disease such as coronary heart disease and the reduced risk of premature death. Physical activity is now recognised as an independent factor of health, regardless of other risk factors. Regular physical activity can help to prevent and manage over 20 chronic conditions and diseases. Many of these conditions and diseases are on the rise and affecting people at an earlier age; 1 in 3 of the working age population have at least 1 long term condition and 1 in 7 have more than one. More information can be found here: tinyurl.com/24davjnd.

Figure 1: Benefits of Exercise image taken from Health matters: getting every adult active every day - GOV.UK (www.gov.uk)

When promoting and enabling inactive people to make changes to their behaviour, it is important that the sociological, physiological and psychological benefits, as well as the physical benefits are emphasised.

Sociological benefits

• Participating in regular social activity enhances a sense of community and can be a powerful motivator for individuals, offering them opportunities to speak with a wide range of people and participate in fun activities with friends.

• Where a person may have moved to a new town or city they may find participating in regular physical activity an effective way to help them adjust to new surroundings and meet like-minded people.

• Older or less mobile people may struggle with managing at home alone. Developing strength or flexibility can support them living independently for longer.

• Teamwork skills like problem solving, cooperation or communication are all transferable from the physical activity environment into the workplace and can enhance relationships and work satisfaction as well as productivity.

• Antisocial behaviours including aggressive or disruptive actions can be reduced through group activity where new relationships can be formed, or anger or stress can be positively addressed and managed.

• More information can be found in the Active Lives survey: www.sportengland.org/know-youraudience/data/active-lives.

Physiological benefits

Promoting the physiological benefits of an active lifestyle can provide further incentives for participants. By using regular health assessments, initial baselines can be established, and trackable physiological changes can be monitored. This provides precisely measurable evidence of their progress helping motivate them to continue. Health assessments could include:

• blood pressure

• heart rate

• blood glucose levels

• BMI

• fitness testing (strength test, bleep test, sit and reach etc)

• heart rate monitors during exercise

• pedometers.

Psychological benefits

There is strong scientific evidence that being physically active can support people to lead healthier and happier lives. The research shows the psychological benefits associated with being physically active can boost self-esteem, provide a sense of purpose and value, improve mood, memory, sleep quality and increase energy, as well as reducing the risk of stress, depression, dementia and Alzheimer's disease. More information can be found on the NHS website: www.nhs.uk/live-well/exercise/exercisehealth-benefits/. Research has proved the benefits of ecotherapy and being active outdoors. Getting outside to enjoy some fresh air and sunshine is great for your mental and physical health, helping you produce the Vitamin D essential for the absorption of calcium and good bone health. Although measuring the psychological benefits of physical activity may seem more challenging than weight loss or fitness testing, encouraging participants to keep a diary or a log of the activity they have undertaken and recording how they feel about it can be useful. An example of a basic (completed) log is shown below:

Client activity log week 1 Were the goals

Activity Time of day Duration met? Reflection on how you felt Amendments or other notes

Brisk walk Early evening 20 minutes every day

Exercise class Morning 45 minutes

Stretching Before breakfast 10 minutes at least 5 days a week I only managed to do it 5 times this week, but I did hit the full 20 minutes each time. I missed 2 days as I was late home from work which was disappointing, but I felt good on the days I did it!

Yes, I did the whole class!

I felt nervous to start but as I go into it, I felt less self-conscious and enjoyed it. Mostly! I found it a bit of a rush some days but when I did it, I felt great and it helped with my backache.

Mindfulness Lunchtime 5-10 minutes every day Mostly! It was hard to find a quiet space at work, so I went for a little walk outside and did some breathing exercises. Extend the walk the following day if I miss one the evening before.

Book a 6-session block for Saturday mornings.

Set alarm for 10 minutes earlier so I make sure I have time.

Giving myself 10 minutes break at lunchtime really helped me concentrate in the afternoon.

This can be used as a discussion point with participants to help them to adhere to their goals and can support them to stay focussed throughout the week. They could also be offered a questionnaire to track progress or use an online tool such as www.bemindfulonline.com/test-your-stress to measure perceived stress scale (PSS) improvements over time.

Figure 2: Image taken from Health matters: getting every adult active every day - GOV.UK (www.gov.uk)

Groups that are likely to be inactive

The specific groups that have been identified through a variety of data sources as most likely to be inactive. These include those who have:

• Low numbers of participation in physical activity.

• Historically and/or culturally no history of participation.

• Falling numbers of participation creating ‘at risk’ groups.

Groups that are likely to be inactive

People from socially deprived areas People in key transition periods eg, leaving education

People with disabilities Young women and girls

Specific cultural groups

People with medical conditions

Older adults People in rural communities

Overweight or obese people People with mental health issues

In addition, significant health benefits of increasing participation can be gained by those in specific groups such as those on exercise referral programmes or overweight or obese individuals, people with long-term conditions like type II diabetes and people who suffer from mental health conditions.

Inactivity

According to UK Chief Medical Officers' Physical Activity Guidelines (2019), inactive and sedentary behaviours are related to sitting, reclining or lying down during waking hours, undertaking little movement or activity and using little energy above what is used at rest ie, inactive people do not achieve the recommended amount of physical activity of 150 minutes per week and many are doing less than 30 minutes per week.

How the target groups have been identified

Information and research are gathered in several ways to support the identification of the target groups. The UK Government Department of Health of Social Care, Sport England and Public Health England all work in partnership to support the ongoing collation of data and insights into the health and activity levels of the nation.

A national statistics publication, Scholes (2016) outlines the results of leisure and occupational physical activity data from adults who participated in the Health Survey for England. It shows the frequency and duration of participation across a range of activities and compares the levels with the UK guidelines for aerobic and muscle strengthening. For older people, exercise aimed at improving balance and coordination was also included.

The report also presents sedentary behaviour data showing only 66% of men and 58% of women aged 16 and over met the aerobic guidelines of at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week (or an equivalent combination of both) in bouts of 10 minutes or more.

Barriers to, and enablers for, participation in physical activity

Barriers

As far as barriers to physical activity are concerned, it is understood that there can be multiple reasons why a person cannot participate more in physical activity. Some of the most common factors that can decrease access to being active are: • time constraints

• age, injury, ill-health or disability

• friends and family don't share the same interest in physical activity

• lack of motivation and/or energy

• family caregiving obligations

• lack of resources/equipment/accessibility

• transport issues

• finance to access classes or support services

• religious or cultural beliefs

• perception or fear of discrimination.

When attempting to fully understand the many factors and barriers to an inactive lifestyle, the exercise instructor must always ensure that they operate within the boundaries of safe and effective practice ie, only working with apparently healthy adults and who have successfully completed PAR-Q+ and informed consent forms.

NB: For more information on barriers to exercise see section 3 in the Lifestyle Management and Health Awareness manual.

Enablers

An enabler is something that encourages or supports a person to be able to do something and is often directly linked to breaking down the barriers or challenges to participation. Every individual is likely to have different motivation levels and therefore will respond to enablers in their own way. Examples of enablers include: • social support or building new relationships and friendships.

• professional support from exercise instructors or community healthcare team.

• personal drivers, benefits or specific goals.

• maintaining independence. • control of a physical or medical condition.

Significant health benefits of increasing participation levels have been shown for groups of people such as those on an exercise referral programme, overweight or obese or those with long-term conditions such as type II diabetes or mental health conditions.

Summary

• A barrier is something that decreases access to something.

• An enabler is something that encourages or supports a person to be able to do something.

Access to information and insight on barriers and enablers

Many organisations aim to gather insights on activity, reduce barriers and enable more people to be more active. British Universities and Colleges Sport (BUCS) is an example of a digital ideas, inspiration and resources platform which uses research-based evidence and partner collaboration to promote and support physical activity. More information can be found here: www.bucs.org.uk/. According to Sport England, 1 in 4 people in England do less than 30 minutes of physical activity a week. However, their research also shows that participants who do the least activity can benefit the most by making even the smallest changes and introducing regular activities. The Sport England ‘Active Lives Adult’ survey collects data on engagement and attitudes to sport and physical activity which provides useful feedback from different groups of people, ages, gender, trends etc, on how they engage with physical activity. It gives a comprehensive overview of adult (age 16+) sport and physical activity in England in the 12 months from May 2018 to May 2019. Although the results show 28.6 million adults are regularly active (the highest number ever recorded), the findings show persistent inequalities for those from the lowest income families and those from black and south Asian backgrounds.

The survey also showed that 1 in 20 adults have been put off doing physical activity because they found it too hard to book online. The OpenActive platform has been created to remove this barrier and make it as easy as possible for people to access activity. More information can be found here: activelives.sportengland.org/. There are 43 active partnerships across England that work together with local partners aiming to engage communities to transform lives. They seek to make active lifestyles the social norm for everyone and address the worrying levels of inactivity in society. They offer a wide range of information, initiatives and resources to support people in getting more active. More information can be found here: www.activepartnerships.org/. ukactive have a range of information on breaking down barriers and enabling positive changes: www.ukactive.

Other organisations that offer insights and useful information are National Governing Bodies (NGBS) and charities such as Activity Alliance, StreetGames and Richmond Group.

Ways to provide support in overcoming barriers to participation

Understanding specific challenges and then offering a plan to help an individual is the best way to improve uptake and retention and help them achieve their goals. To support inactive people in overcoming barriers to participation the exercise instructor should aim to take a personalised approach, which may be by either working with one of the organisations or resources discussed above or on a 1 to 1 or group exercise basis. In addition to identifying an individual's personal priorities, and setting and adjusting goals to meet those priorities, promoting physical activity or focusing on activities that are engaging and in a social environment are some of the most tried and tested methods of increasing participation. These approaches can make individuals more inclined to continue physical activity. Additionally, an exercise instructor with strong empathy, non-judgemental skills, and effective listening skills can greatly influence an inactive individual to become active if they can set appropriate, achievable goals and be a good role model for them.

It is also helpful to consider linking participants with others to maximise progress and motivate inactive individuals, as they could offer encouragement or social influence, provide transportation or childcare, or just be an exercise buddy.

Examples of these include:

• family

• friends

• teachers

• health or social care workers.

• To further support participants through breaking down barriers and supporting behaviour change, see the Lifestyle Management and Health Awareness manual, Section 3.

Physical activity-promoting initiatives

Physical inactivity, along with obesity and smoking, is one of the main causes of early death and illhealth.

The government paper titled Health matters: physical activity - prevention and management of longterm conditions (2020) states that “for good physical and mental health, adults should aim to be physically active every day. Any activity is better than none, and more is better still. ” As previously mentioned, regular physical activity provides a range of physical and mental health, and social benefits, many of which are increasing issues for individuals, communities and society. These include:

• Reducing the risk of many long-term conditions

• Helping manage existing conditions

• Ensuring good musculoskeletal health

• Developing and maintaining physical and mental function and independence

• Supporting social inclusion

• Helping maintain a healthy weight

• Reducing inequalities for people with long-term conditions.

Their ambition is to get everybody active during the 2020s. This includes the 1 in 3 adults who are already living with a health condition. New technologies and data held by the NHS, and generated by smart devices worn by individuals, will support a new wave of intelligent public health. Everyone will have access to their health information and health interventions will become more personalised and each person will become a co-creator of their own health plan. They will be promoting further the key evidence showing that regular physical activity can help prevent or manage many common conditions such as type II diabetes, cardiovascular disease and some cancers. It also promotes how being active helps keep symptoms under control, prevents additional conditions from developing, and reduces inequalities. More information can be found here: tinyurl.com/xv37v9jp.

Across the UK there is a range of local, regional and national initiatives aimed at increasing physical activity levels. The NHS advise that “Adults should do some type of activity every day” and they explain that any activity is good and generally the more people do the more benefits they can achieve. The NHS The Let’s Get Moving support pack gives advice and guidance and easy to follow information on how to start activity and become healthier. Information on this initiative can be found here: tinyurl.com/79kt34en. Public Health England (PHE) is an executive agency of the Department of Health and Social Care who exist to protect and improve the nation’s health and wellbeing and reduce health inequalities. They offer a range of initiatives aimed at specific target audiences. More information can be found on this website: tinyurl.com/24davjnd.

In addition, there are many local and regional organisations and partnerships that work together to identify target groups of inactive people and they often support local initiatives aimed at supporting behaviour change. Sport England is partly funded through the National Lottery. They have a 10-year strategy called Uniting the Movement to transform lives and communities through sport and physical activity. They aim to do this by gathering data, providing insights and awarding funding to initiatives. This Girl Can is a well-known initiative to support and inspire females to become more physically active and make physical activity a way of life. More information and access to resources can be found here: www.thisgirlcan.co.uk/. Towards an Active Nation is another Sport England initiative that ran from 2016-2020. The aim was to get everyone in England, regardless of age, background or level of ability to feel able to engage in sport and physical activity. The aspiration was to ensure the sport sector welcomed everyone – meeting their needs, treating them as individuals and valuing them as customers. More information can be found here: tinyurl.com/3ju8wu7b. We are Undefeatable is a national campaign supporting approximately 15 million people in England living with 1 or more long-term health conditions. Started in 2019, the target is to help those with conditions such as diabetes, cancer, arthritis and Parkinson’s to build physical activity into their lives. 15 leading health and social care charities are working together with Sport England expertise and National Lottery funding to deliver this initiative. More information can be found here: tinyurl.com/nxvftcvu.

NHS Couch to 5K is aimed at absolute beginners and has helped over 4 million people start running. The Active 10 app is easy to download and anonymously records every minute of walking a person does. It is designed to support ways to increase daily physical activity, with simple and achievable milestones and rewards along the way. Walking for Health is one of the simplest and easiest ways to get more active but yet is sometimes undervalued. Brisk walking can build stamina and burn excess calories and a 10-minute walk counts towards the recommended 150 minutes a week. Helping individuals to build this into their routine can be a simple yet positive step. The NHS suggest using the Active 10 app alongside this to record activity, build up gradually and support motivation. More information can be found here: www.walkingforhealth.org.uk/. InstructorLive is an on-demand platform with over 800 fitness sessions readily available, including a free 3-month beginner programme. More information can be found here: www.instructorlive.com/. Healthy Lifestyle services are run by many local authorities, offering free coaching, advice and help to support people to move more and become healthier. More information can be found through local authority websites. ukactive exists to improve the health of the nation by getting more people, more active, more often. They provide services and facilitate partnerships for a broad range of organisations. They are committed to promoting active lifestyles, offering a supportive, professional and innovative platform for partners to succeed in achieving their goals and create the conditions in which our sector can grow. More information can be found here: www.ukactive.com/. Local leisure centres are usually owned and operated by the town, city, borough or district council. Many leisure centres have a range of activities on offer which may include a pool, fitness suite and studio where people can participate in physical activity or relax.

Summary

There are a number of local, regional and national organisations and initiatives aimed at increasing physical activity levels eg, Sport England, Public Health England and local councils.