Preventive Health, Sport and Physical Activity

Preventive Health, Sport and Physical Activity
Preventive Health, Sport and Physical Activity

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Prepared by: Dr Ralph Richards, Senior Research Consultant, Clearinghouse for Sport, Australian Sports Commission
Evaluation by: Professor Tom Cochrane, Centre for Research & Action in Public Health, University of Canberra (February 2016)
Reviewed by network: Australian Sport Information Network (AUSPIN)
Last updated by: Ralph Richards (5 June 2017)

Please refer to the Clearinghouse for Sport disclaimer page for more information concerning this content. 

 


Introduction

Participation in physical activity, particularly among children, supports a number of life-long benefits, including: (1) development of fundamental motor skills, (2) improvement of current health and fitness, (3) contribution to long-term health and the prevention of chronic disease, and (4) promotion of more inclusive and engaged communities through social interaction.

Regular physical activity, including organised sport and active recreational pursuits, has many known benefits. Increasing the level of physical activity among the population is one of three key elements (along with improved nutrition and healthy lifestyle choices) in the overall preventive health strategy adopted by governments. Improved population health produces immediate and long-term social and economic benefits.


Key Messages

  1. Regular participation in sport and physical activity offers immediate and long-term personal health (i.e. physical and mental) benefits.
  2. Population-wide participation in sport and other forms of physical activity has been shown to reduce risk factors associated with some non-communicable diseases and other health problems, leading to population health benefits.
  3. Awareness that regular physical activity, that may include sport participation, makes a positive contribution to health and personal wellbeing, is an important public health message.

Background

The link between physical activity and good health is well established. The converse relationship, the link between physical inactivity and poor health, has also been shown to be significant.  Sedentary lifestyle is the fourth leading risk factor for deaths, worldwide.

  • Australia’s Health 2016, Australian Institute of Health and Welfare, Catalogue Number AUS 199 (2016). Every two years the Australian Institute of Health and Welfare (AIHW) compiles a national report card on the health of Australians. A comprehensive range of health metrics are reported, including population statistics on bodyweight (e.g. underweight, normal, overweight and obese) and compliance with physical activity guidelines. In 2014-15 just over one-quarter (26%) of Australian children aged 5 to 14 years were classified as either overweight (19%) or obese (7%). Slightly less than one-quarter (23%) of children did not meet the recommended national physical activity guidelines. Among young adults, age 18 to 24, the rate of overweight persons increased to 22% and obese to 15%. Also, 52% of young adults did not meet the recommended physical activity guidelines. Among the adult population, age 15 years and older, an estimated 35% of Australians were considered overweight, and 28% obese (i.e. 63% of the adult population). Overweight and obesity was greater among adult women (71%) than men (56%) and the rate of overweight persons increased (both genders) with age. Obesity rates were also higher among Indigenous adults, at 43%.
  • The costs of illness attributable to physical inactivity in Australia: A preliminary study (PDF  - 964 KB), Stephenson J, Bauman A, Armstrong T, Smith B and Bellew B, Australian Government, Department of Health and Aged Care and the Australian Sports Commission (2000). This discussion paper presents a preliminary analysis of the costs of illness attributable to physical inactivity, with particular emphasis on coronary heart disease, non-insulin dependent diabetes, and colon cancer. Other costs of illness attributable to physical inactivity are described, although in less detail.
  • Health benefits of physical activity: the evidence, Warburton D, Nicol C and Bredin S, Canadian Medical Association Journal, Volume 174, Number 6 (2006). An evaluation of current literature confirms that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. There appears to be a linear relationship between physical activity and health status, such that even small increases in physical activity and fitness will lead to additional improvements in health status. Health promotion programs using physical activity should target people of all ages, since the risk of chronic disease starts in childhood and increases with age.
  • Jakarta Statement on Active Living. The World Health Organisation (WHO) held its 4th International Conference on Health Promotion (Jakarta, Indonesia, July 1997) and considered ten priority health promotion areas. The Conference statement responded to these issues and challenges and contains several statements regarding the need for health promotion programs: (1) scientific evidence shows that daily moderate activity enhances health in its broadest sense; (2) sedentary lifestyles make it increasingly difficult for people to remain physically active; (3) experiences suggest three pathways for successful intervention programs – (i) sound policy that supports action, (ii) program evaluation, and (iii) effective advocacy; (4) a review of effective programs identifies these common themes – (i) the possibility of immediate results, (ii) action that is taken locally, (iii) programs targeting children and youth, (iv) realisation that interventions should be simple, and (v) documentation of results to determine transfer of experiences.
  • Sedentary behaviour and obesity: Review of the current scientific evidence (PDF  - 964 KB), Biddle S, et.al., The Sedentary Behaviour and Obesity Expert Working Group, Department of Health, United Kingdom (2010). This report was commissioned by the Department of Health to provide expert input into the process of developing recommendations on limiting time spent being sedentary. This report explores the evidence linking sedentary behaviour with health outcomes, and in particular overweight and obesity. The report also describes what has been done in other countries.

Increasing physical activity and reducing sedentary time are both important factors in the prevention of heart disease, stroke, type-2 diabetes, and some cancers. In addition, physical activity has been shown to contribute to healthy physical development and maintenance of bones, muscles, and joints; thus reducing injury risk. Participation in physical activity also contributes to improved mental health and wellbeing.

The Australian Government, Department of Health, has developed recommendations regarding the amount of physical activity that should be performed in order to gain health benefits. More information can be found in the Clearinghouse for Sport portfolio, Physical Activity Guidelines


The Case for Physical Activity as a Preventive Health Measure 

To advance the evidence base for a National Physical Activity Strategy in Australia, the National Public Health Partnership has compiled two reports that present a compelling case that physical activity has a significant impact on many health risk factors. Evidence regarding what intervention programs work (and which programs do not work as well) will also help to underpin action plans that use physical activity as a means of reducing health risk factors and improving the health status of individuals and populations.

  • Getting Australia Active: Towards better practice for the promotion of physical activity (PDF  - 1.3 MB), Bauman A, Bellew B, Vita P, Brown W and Owen N, National Public Health Partnership (2002). Engaging in regular physical activity, even of moderate intensity, reduces the risk of diseases such as cardiovascular disease, type II diabetes, osteoporosis, colon cancer, and obesity and injury. The benefits, however, go well beyond those of disease prevention. Regular physical activity has also been shown to facilitate better stress management, alleviate depression and anxiety, strengthen self-esteem, enhance mood and boost mental alertness. Additionally, it provides social benefits through increased social interaction and integration. Among children and adolescents, regular physical activity and exercise has been associated with improved school performance, a greater sense of personal responsibility and group cooperation, and less drug and alcohol consumption. This report summarises the evidence linking physical activity to better health outcomes. It will help stakeholders to guide practice and advance the physical activity agenda in Australia.
  • Getting Australia Active II: An update of evidence on physical activity for health (PDF  - 819 KB), Bull F, Bauman A, Bellew B and Brown W, National Public Health Partnership (2004). This report updates the literature review in, Getting Australian Active: Towards better practice for the promotion of physical activity, and provides further evidence for stakeholders. It strengthens the epidemiological evidence-base for physical activity and health, with additional information in the diabetes prevention realm. Key evidence has accumulated about diabetes prevention since the first review of literature. There are now large scale prevention trials in China, Finland and the United States that have demonstrated success in reducing risk factors. This second report also includes evaluations of national strategies and documentation (where available) as an indicator of success.

On the basis of available evidence, Governments see preventative health strategies involving increased physical activity and reduced sedentary behaviour as an effective means of both reducing long-term health care costs while improving immediate and long-term personal health. This translates to improved population health and also contributes to social wellbeing. Programs that deliver a ‘sufficient’ level of physical activity to stimulate health benefits can return long-term savings on health care costs.

  • A life-long approach to physical activity for brain health, Macpherson H, Teo W, Schneider L and Smith A, Frontiers in Aging Neuroscience, Volume 9 (2017). Growing evidence documents the importance of physical activity (PA) for brain health, with numerous studies indicating regular engagement in physical activities throughout life may be protective against cognitive decline and dementia in later life. The link between PA and brain health may be different at each stage of life from childhood, mid-life, and late life. This review summarises the current body of evidence linking regular PA and brain health across the lifespan.
    1. During Childhood – Throughout infancy, childhood and adolescence, the brain undergoes dramatic change, with maturational processes occurring concurrently with, and in response to, functional gains in sensory, cognitive and behavioural domains. In particular, the first 5 years of life correspond with significant neurodevelopmental processes. There is growing evidence that regular engagement in PA during childhood can influence gray and white matter integrity, and this may have implications for cognitive development. Bilateral hippocampal volumes have been shown to be markedly increased in fitter, compared to less fit, 9 and 10 year old children and associated with better relational memory performance. PA interventions in childhood have the potential to improve white matter microstructural integrity.
    2. Mid-life – The mid-life stage represents another critical period during which regular engagement in PA may preserve or even improve cognitive health later in life. The key findings from several studies revealed a positive association between PA and larger total brain volume, specifically attributed to increased cerebral gray matter volume, after adjustment for confounding variables (e.g. education, nutrition, socio-economic status). These findings indicate that PA is important and likely influences a range of different biological processes. Whilst the direct relationship between mid-life PA and brain structure is yet to be confirmed, there are a number of other well established indirect relationships between PA and vascular function that should be taken into account.
    3. Older people – Declines in cognitive function can accelerate after age 60, with fluid cognitive processes such as working memory, processing speed and executive function particularly vulnerable to age-related impairment. In a recent investigation using data from a longitudinal heart study, individuals over the age of 60 who scored in the lowest quintile of a PA index also had an increased 10 year risk of dementia incidence compared to those with higher PA. Importantly, results from this study also indicate that greater global and hippocampal brain volume is related to higher levels of PA. These findings are consistent with observations of the neuroprotective effects of exercise from other cross-sectional and longitudinal investigations. The premise that regular participation in PA can exert a neuroprotective effect on the aging brain is supported by research examining the relationship between PA, cardiorespiratory fitness, and the microstructural integrity of the brain white matter.
  • A snapshot of physical activity programs targeting Aboriginal and Torres Strait Islander people in Australia [article accepted for publication – abstract published ahead of print], Macniven R, Elwell M, Ride K, Bauman A and Richards J, Health Promotion Journal of Australia (accepted 11 November 2016). Physical activity programs can reduce chronic disease risk factors and may also improve broader social outcomes. This study looked at the extent of current practice in physical activity programs targeting Aboriginal and Torres Strait Islander communities. A total of 110 programs were identified across urban, rural and remote locations within all states and territories; however, only 11 programs were located through bibliographic sources. The majority of programs were only identified through the grey literature. Sixty-five programs took place in community settings and most involved multiple sectors; such as sport, health and education; and almost all were free for Indigenous stakeholders. The majority of programs received Government funding. More than 20 programs serviced over 1000 people and 14 programs reached 0-100 participants. Most programs included an evaluation process, assessing outcomes against stated objectives, but evaluation data was under represented in academic literature. The authors observe that capturing current practice can inform and influence future programs and increase the impact of such physical activity programs to improve health and social indicators.
  • Be Active Eat Well: Three-year follow-up report (PDF  - 854 KB), Swinburn B, et.al., Deakin University (2009). The Be Active Eat Well program was a 3-year (2003-2006) community-wide childhood obesity prevention demonstration program, conducted in Colac, Victoria. The program successfully reduced unhealthy weight gain in children aged 4-12 years compared to control subjects resident in the Western Region of Victoria. Program impacts were greatest in children from more disadvantaged households. Post intervention analysis showed that the program was cost-effective in terms of reducing overweight and obesity outcomes, using standard benchmarks for cost-benefit. However, maintenance of benefits is a key assumption in the cost-benefit analysis. Modeling indicates that to remain cost effective, around 70% of the program’s effect (in terms of lower body weight) would need to be maintained by participants into adulthood.
  • Cost-effectiveness of interventions to promote physical activity: A modeling study, Cobiac L, Vos T and Barendregt, PLOS Medicine, published online 14 July 2009. This study evaluated the cost-effectiveness of physical activity intervention programs in Australia. There are many options for intervention; from individually tailored counselling, to population-wide mass media campaigns. Based on current evidence, interventions that encourage use of pedometers (i.e. tracking daily physical activity) and mass media-based community campaigns are the most cost-effective strategies and are very likely to be cost-saving in the long-term. Programs that encourage more active transport also have a high probability of being under the cost-effectiveness threshold. The least cost-effective strategies included referrals by a medical professional to specific programs; these interventions involved high time and travel costs for patient screening, consulting, and counseling. This review concluded that despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that a package of intervention strategies can lead to substantial improvement in population health at a cost saving to the health sector. The exact composition of multiple strategies which may be ‘most’ cost-effective is still unknown.
  • Economic analysis of physical activity interventions, Williams C, Chung-Wei C and Jan S, British Journal of Sports Medicine, Volume 46, Issue 6 (2012). This systematic review investigated the cost effectiveness of physical activity intervention programs. Ninety-one studies met the review criteria and were evaluated. An expenditure of US$0.50–US$1.00 per metabolic equivalent (MET) hours gained per person per day was used as the benchmark for cost effectiveness. In general, physical activity interventions met or exceeded the cost effectiveness benchmark. The review identified that while low-cost strategies designed to reach large masses of the public are more cost effective in increasing participation, they are limited by the amount of physical activity they increase. As such, intensive interventions may be more appropriate for populations where higher levels of physical activity are desired. The authors caution that results are based on a narrow economic model, with costs associated with the interventions only. Also, potential benefits of intervention programs may extend beyond increased physical activity alone.

Intervention programs designed to inspire and educate are important, but changing the culture of 'activity' (i.e. the desire to be physically active and adopt positive lifestyle behaviours) among the population is more important and perhaps more difficult to achieve. A great deal of emphasis has been placed on changing the activity patterns and attitudes of young people (i.e. children and adolescents), particularly those identified as ‘less likely’ to engage in physical activity and sport (e.g. young women, persons with disability, CaLD and Indigenous groups). The Australian Government is committed to promoting healthy lifestyles and encouraging preventive measures that improve the health of all Australians; examples of past campaigns are Life, Be in it [Wikipedia] and Get Moving. One of the current campaigns is Girls Make Your Move, inspired by the success of, This Girl Can, Sport England’s campaign to encourage women to be more active.

Girls Make Your Move. This Australian Government initiative, through the Department of Health, responds to research that shows young girls in Australia have a lower participation rate in physical activity, with higher amounts of sedentary time then young men. The Australian Physical Activity and Sedentary Behaviour Guidelines recommend that 13 to 17 year-olds should maximise their physical activity in as many ways as possible, accumulating at least 60 minutes of moderate-to-vigorous activity every day, while limiting sedentary behaviour. Research has shown that many young Australians fall well short of this recommendation, particularly young Australian females. Girls and young women are twice as likely to be sedentary or less active than their male counterparts. In response to the many public health issues associated with risk factors linked to physical inactivity, the Australian Government has launched Girls Make Your Move. This campaign is designed to communicate with young women and generate greater interest about participation in a wide range of physical activities and sport. The campaign targets girls/women across an age range of 12 to 19 years.

  • ‘Girls Make Your Move’ exercise ads look good but are unlikely to deliver on their own, Jones S, The Conversation (9 March 2016). The TV ads show young women engaged in a range of sports and activities, with motivating music and catchy hashtags; there are also a series of print ads featuring different sports or activities. The reaction to these ads has been largely positive, with praise for its positive tone and the inclusion of girls of different cultures, body shapes and abilities. Images portrayed reflect the underpinning research, that girls want to see positive messages about having fun rather than hearing about the health risks of being inactive. This is also consistent with evidence that traditional approaches of scaring people into changing their health behaviours generally does not work with young people. It’s not just an ad campaign, there are local events for girls to engage with on-the-ground. The Insights Report underpinning the campaign emphasised the use of multiple media channels, particularly social media, to get the message across. So, what did we get? The campaign’s website looks and feels like a government website, hardly a motivational tool for social media ‘savvy’ teenagers; links to further ‘tips, apps and activities’ are similarly bland. The government website fails to inspire and empower and the ‘social media’ connected to the campaign isn’t very social (i.e. connecting to the Department of Health’s Facebook page and Twitter page).
  • Stand-alone mass media campaigns to increase physical activity: a Community Guide updated review, Brown D, Soares J, Eping J, Lankford T, Wallace J, Hopkins D, Buchanan L and Orleans C, American Journal of Preventive Medicine, Volume 43, Number 5 (2012). This systematic review summarises the effectiveness of stand-alone mass media campaigns to increase physical activity at the population level. This systematic review is an update on the Community Guide published by the National Center for Chronic Disease Prevention and Health Promotion in the United States. Ten studies using comparable outcome measures documented a median absolute increase of 3.4% and a median relative increase of 6.7% in self-reported physical activity levels. Six studies used alternative outcome measures that evaluated changes in self-reported time spent in physical activity, reporting a median relative change of 4.4% (range of values from 3.1% to 18.2%). Two studies used a single outcome measure and found that participants reported being more active after the campaign than before it. This systematic review concluded that intervention effects, based wholly on self-reported measures, were modest or inconsistent.
  • The CDC guide to strategies to increase Physical Activity in the community (PDF  - 1.1 MB), United States Department of Health and Human Services (2011). This document provides guidance for policy makers and program managers on selecting strategies to increase physical activity in the community. Physical activity is one of the key elements in any preventive health strategy. From a public health perspective, some strategies merit a higher priority than others—such as community wide campaigns that increase access to places and spaces for physical activity; programs integrating a socio-ecological perspective; and programs that enhance physical education in schools. Campaigns characterised by a ‘brand’ message or ‘tag line’ that is used consistently through all means and channels of communication also should include on-the-ground components; such as: support and self-help groups; physical activity counseling; risk factor screening; education at work sites and in schools; community health fairs and other community events. Ideally, they should also include policy and environmental changes, such as opening school facilities to public use and creating walking or cycling trails.  

Young and physically active: A blueprint for making physical activity appealing to youth (PDF  - 3.3 MB), Kelly P, Matthews A and Foster C, World Health Organisation (2012). Scientific evidence shows that physical inactivity is a leading risk factor for ill health, going well beyond issues related to weight control and influencing both physical and mental wellbeing. The World Health Organization (WHO) advocates the promotion of physical activity as a public health priority. Many member countries have responded through the development of policies, information programs, and interventions. This report is intended to be a resource for physical activity promoters, with a focus on children and young people.   

The Australian Sports Commission (ASC) has developed a participation game plan, Play.Sport.Australia. The health benefits of sports participation provide an important rationale for implementing this strategy, with the aim of: (1) getting more Australians, particularly young Australians, participating in sport more often; (2) achieving year-on-year membership and participation growth for all sports, and; (3) helping sporting organisations develop the capacity to deliver the products and opportunities Australians want.

Substantial evidence suggests that sport and active recreation participation can contribute to achieving the recommended level of physical activity which has been shown to be a preventative measure in avoiding, delaying, or reducing the impact of non-communicable diseases. Participation in sport and physical activity can also have many personal and social benefits.

More information can be found in the Clearinghouse for Sport portfolios, Physical Literacy and Sport, Sport Participation in Australia and Sport for Community Development.


Statistics

Australian Bureau of Statistics

The Australian Bureau of Statistics (ABS) has published a number of statistical studies relating to overweight and obesity as a health risk factor. Increasing physical activity is one of several strategies used to address the risk factors associated with overweight and obesity.

  • Profiles of Health, Australia 2011-13, Australian Bureau of Statistics, Catalogue Number 4338.0 (2013). 62.8% of Australians aged 18 years and over were overweight or obese; this total is comprised of 35.3% overweight and 27.5% obese. A further 35.5% of the adult population were of normal weight and 1.7% were underweight. The prevalence of adult overweight and obesity has increased in Australia over the past twenty years.
  • National Health Survey, First Results 2014-15 (children’s risk factors), Australian Bureau of Statistics, Catalogue Number 4364.0.55.001 (2013). Around one in four (27.4%) of Australia's children aged 5 to 17 years were overweight or obese; this total is comprised of 20.2% overweight and 7.4% obese. The proportion of children who were overweight or obese has increased slightly since the 2011-12 survey (25.7%), the long-term trend is upward.

Data from the 2013-14 ABS Multi-Purpose Household Survey (MPHS), Participation in Sport and Physical Recreation module provides an estimate of participation rates in sport and physical activity for adults. Among the Australian population, aged 15 years and over, an estimated 60% reported that they had participated in sport and physical recreation at least once during the 12 months prior to the survey. This is down from 65% in the 2011-12 survey. Adult participation generally decreased with age, peaking during the 15–17 age-group at 74% and declining to 47% in the 65 years and older group. Walking for exercise continued to be the most popular physical recreational activity for adults (15 years and over); women were more likely to walk for exercise than men. The overall participation rate in organised sport, as a player or in a non-playing role (such as a coach or official) was 28% of all adults. There were variations by age-group and gender, with the 15-24 year age-group having the highest participation and the 65 years and over the lowest, at 44% and 17% respectively. The report also provides a more detailed breakdown of statistics for ‘organised’ and ‘non-organised’ sport and physical recreation activities. Walking as a recreational activity or as a means of active transport (e.g. adults walking to work or children walking to school) is an excellent means of achieving the recommended daily physical activity.

The most recent ABS survey of children’s sport and physical activity participation indicated that, in the 12 months prior to the survey, an estimated that 60% of all children aged 5 to 14-years participated in at least one organised sport activity outside of school hours. The highest participation rate, 66%, was among the 9-11 age-group and the lowest participation rate, 56%, was among children aged 5-8 years. On average, children who participated spent five hours per fortnight playing and/or training in organised sport outside of school hours. Participation rate varied among the States and Territories, with the Australian Capital Territory the highest (73%) and the Northern Territory the lowest (54%). Children’s participation was higher when both parents were born in Australia, compared to both parents born in other countries.

The ABS also provides extensive surveys on the physical activity and sedentary activity of Aboriginal and Torres Strait Islander people, across a range of ages, living in either remote or non-remote locations.

  • Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity 2012-13, Australian Bureau of Statistics, Catalogue Number 4727.0.55.004 (2014). This ABS survey looked at the level of physical activity and sedentary activity of pre-school children age 2 to 4 years; children and young people age 5 to 17 years and; adults 18 years and older. This ABS report found that toddlers and pre-schoolers in non-remote areas spent an average of 6.6 hours per day on physical activity and more time outdoors than non-Indigenous children of the same age (3.5 hours compared to 2.8 hours). They also averaged 1.5 hours of sedentary screen-based activities such as watching TV, DVDs or playing electronic games. Aboriginal and Torres Strait Islander children and youth in non-remote areas spent 2.5 hours per day on physical activity, 25 minutes more than non-Indigenous children of the same age and well above the recommended one hour per day. Almost half (48%) of Indigenous children living in non-remote areas met the physical activity level recommended for health. 

Results for Aboriginal and Torres Strait Islander adults living in non-remote areas showed that they spent much less time on physical activity compared with children. Only 38% of Aboriginal and Torres Strait Islander adults were sufficiently active for health, meeting the recommended 150 minutes of physical activity in five or more sessions over a seven day period. Aboriginal adults spent (on average) 5.3 hours per day on sedentary activities. Adults participating in the pedometer study recorded (on average) 6,963 steps per day, with only 17% meeting the recommended threshold of 10,000 steps or more. When compared with the non-Indigenous adult population (after adjusting for age differences among studies), Aboriginal and Torres Strait Islander adults were less likely to be sufficiently active for health.

This ABS survey also reported activity levels for Aboriginal and Torres Strait Islander people living in remote communities. 82% of children aged 5-17 years did more than 60 minutes of physical activity on the day prior to the interview. Other than walking the two most common activities for children were running (53%) and playing football or soccer (33%). Over half of adults (55%) living in remote areas did more than the recommended 30 minutes of physical activity on the day prior to the interview. The most common type of physical activity for adults was walking. One in five adults (21%) reported they did not participate in any physical activity.

Australian Sports Commission

The AusPlay Survey (AusPlay) is a key pillar of the Australian Government's policy Play.Sport.Australia, which is the Australian Sports Commission’s (ASC) game plan to get more Australians participating in organised sport more often. AusPlay is an independent research project at the population level which measures all types of activities in a consistent and comparable way. The ASC will use AusPlay information to fill in the gaps in national sport and physical recreation data on children, following the Australian Bureau of Statistics’ decision in 2014 to cease data collection.

More information about AusPlay data can be found in the Clearinghouse for Sport portfolio, Sport Participation in Australia.

Australian Institute of Health and Welfare

The Australian Institute of Health and Welfare (AIHW) provides regular information and statistics on Australia's health and welfare.

  • Australia’s Health 2016, Australian Institute of Health and Welfare, Catalogue Number AUS 199 (2016). Every two years the Australian Institute of Health and Welfare (AIHW) compiles a national report card on the health of Australians. A comprehensive range of health metrics are reported, including population statistics on bodyweight and compliance with physical activity guidelines.
  • Prevention of cardiovascular disease, diabetes and chronic kidney disease: targeting risk factors (PDF  - 2.2 MB), Australian Institute of Health and Welfare, Catalogue Number PHE 118 (2009). Cardiovascular disease, diabetes, and chronic kidney disease account for about one-quarter of the burden of disease in Australia, and just under two-thirds of all deaths. These three diseases often occur together and share common risk factors, including physical inactivity. This report includes information on the national prevalence of the main risk factors.

The Department of Health also provides data analysis and statistical reports for Aboriginal and Torres Strait Islander populations.

  • Aboriginal & Torres Strait Islander Health Performance Framework, 2012 Report (PDF  - 6.4 MB), Australian Government, Department of Health and Ageing (2012). Relevant sections of this report include: Section 2.18, physical activity; and Section 2.22, overweight and obesity.
  • Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011, Australian Institute of Health and Welfare (2016). This comprehensive report aims to provide detailed information about the burden of disease experienced by the Aboriginal and Torres Strait Islander population in 2011 (the year with the best data available when this study commenced), how it has changed since 2003, and how it compares to the non-Indigenous population. This study looked at 29 different risk factors and found that the most important were: (1) tobacco and alcohol use; (2) dietary factors; (3) overweight; (4) lack of exercise; (5) high blood pressure, and; (6) high blood sugar. These risk factors led to increased rate of diabetes, cardiovascular diseases, kidney disease, and some cancers among Aboriginal and Torres Strait Islander populations. The health risk attributed to physical inactivity decreased by 8% from 2003 to 2011, but the gap (Indigenous vs non-Indigenous) in non-fatal health burden remains.
  • Review of physical activity among Indigenous people (PDF  - 1.0 MB), Gray C, Macniven R and Thomson N, Australian Indigenous Health Reviews, Number 13 (2013). For some Indigenous people, concepts of space, time and activities differ from those for most non-Indigenous people. Therefore, physical activity guidelines that specify regular frequency, duration and types of activity can be inappropriate for some Indigenous people. Culturally inclusive ways of incorporating physical activity (such as caring for country, and offering culturally inclusive school activities) developed in consultation with Indigenous communities could be more relevant and have increased likelihood of success as a preventive health measure. It is important to note that some components of the Indigenous population are relatively transient, which also makes regular and sustainable participation in programs more difficult. Many complex factors contribute to the high levels of physical inactivity and the associated chronic disease burden among Indigenous people.

Concern about Childhood Obesity

About one-in-four Australian children are overweight or obese. We know that doing nothing is likely to result in increased health problems as children mature into adults. Because obesity increases the risk of acquiring type-2 diabetes and heart disease, it's critical that the proportion of Australia’s children who are overweight and obese be reduced. Physical activity programs have been shown to be an effective strategy in improving childhood weight management and health; and thus, reducing many long-term health risks.

Professor Elizabeth Waters, of the McCaughey Centre at the University of Melbourne, said there is ample evidence to show that obesity in children can be prevented. “Our findings show that obesity prevention is worth investing in. The strategies to focus on are those that change environments rather than individuals. We need to embed effective interventions into health, education, and care systems, so that we can make population-wide, long-term impacts on obesity levels”. [source: Evidence shows childhood obesity can be prevented, VicHealth, December 2011, last updated 30 November 2014]

Physical Literacy: Do our Kids Have all the Tools? (PDF  – 3.2 MB), Active Healthy Kids Australia (2016). This year marks the release of the second full AHKA Report Card on Physical Activity of Children and Young People which assesses 12 physical activity indicators (i.e. physical activity behaviours, traits, and the settings and sources of influence, and strategies and investments, which have the potential to impact these behaviours and traits). As in 2014, Australia was assigned a failing grade (D−) for overall physical activity levels. This report highlights the concept of 'Physical Literacy', specifically the ‘tools’ children need to be physically active for life. The results of the 2016 Report Card will contribute to the second global matrix of grades that benchmarks Australia against 37 other countries.

Is Sport Enough? Active Healthy Kids Australia (PDF  - 5.3 MB), Tomkinson G, and Schranz N (lead investigator and lead author), et.al., Report Card on physical activity for children and young people (2014). The ‘Active Healthy Kids’ physical activity report card was first developed in Canada in 2005. The Australian Research Working Group has used this model to profile the physical activity and sedentary behaviours of Australian children and youth. This report states that while it is encouraging that a large number of children are obtaining some of their weekly physical activity from organised sport, we need to ask ‘Is sport enough?’ Considering the overall physical activity levels of our children, as well as the fitness and obesity levels of Australian children, the answer is clearly ‘no’. Overall physical activity levels rate a ‘D-‘ on this report card. A total of 12 indicators (grouped into four categories) are assessed in this report card format.

Australia's health care expenditure continues to rise and is now estimated at 9.5% of gross domestic product (GDP).  It’s also estimated that the cost of obesity in Australia, not including liabilities due to overweight, is $8.3 billion. Cardiovascular diseases, also related to overweight and sedentary lifestyle, accounted for a further $7.9 billion in health care costs. Many other chronic diseases are linked to health risk factors that may be mediated by increasing physical activity and decreasing sedentary activity at all ages. Various estimates have been made regarding the potential ‘savings’ in population health care costs that would result from incremental decreases in behavioural health risks.

Prevention of childhood obesity is an international public health priority, given the effects of obesity on chronic diseases; general health; physical and psychological development; and personal wellbeing. The international evidence base is substantial and has been used to underpin many government strategies. The Cochrane Library review and other meta-analyses of research demonstrates the scope of world and national health organisations’ concern about childhood obesity. A review of obesity research highlights the need to use multiple strategies to address the obesity problem. Physical activity (including sport) is a key factor in most preventive health programs in Australia and globally.

More information can be found in the Clearinghouse for Sport portfolio, Childhood Obesity.


Using Sport and Physical Activity to Promote Health Outcomes

The benefits of physical activity in the prevention of a range of chronic health conditions have been well documented. The ways in which we choose to be physical active may vary: organised sport; informal social sport; leisure-time recreation; physical education (as part of the school curriculum); active transport to school or work; and physical activity for exercise or play. In all forms of physical activity, at every age, there is compelling evidence of the valuable contribution to physical and mental health outcomes.

Physical health

  • Australian Indigenous youth's participation in sport and associated health outcomes: Empirical analysis and implications (PDF  - 177 KB), Dalton B, Wilson R, Evans J and Cochrane S, Sport Management Review, Volume 18, Issue 1 (2015). Analysis of the 2012 Mission Australia Youth Survey (MAYS) finds that among Indigenous youth aged 15–19 years there is a positive relationship between self-reported participation in sport and two health outcomes – rating of overall health and risk of mental health disorder. Indigenous youth who participate in sport are 3.5 times more likely to report good general health and 1.6 times more likely to have no probable serious mental illness. The significance of these findings may address the current gaps in preventive health service delivery to Indigenous communities, and for the development of grassroots, evidence-based, well resourced, culturally sensitive, inclusive and community-led programs.
  • Contribution of physical education and sport to health-related fitness in high school students (abstract), Beets M and Pitetti K, Journal of School Health, Volume 75, Issue 1 (2005). This study reports that in comparison to physical education alone, participation in school-sponsored sport increases cardiovascular fitness.
  • Does sports club participation contribute to health-related quality of life? Eime R, Harvey J, Brown W and Payne W, Medicine and Science in Sports & Exercise, Volume 42, Issue 5 (2010). This research looks at how community sports clubs provide opportunities for social interaction through both structured (organised and competitive) and unstructured (social) participation in sport, it has been suggested that involvement in club sport may impact positively on social wellbeing and mental health.
  • Fitness and health of children through sport: the context for action (PDF  - 139 KB), Micheli L, et.al., British Journal of Sports Medicine, Volume 45, Issue 11 (2011). This report reviews a number of international, national and governmental programs that promote health in children and youth through sports and physical activity. The authors provide recommendations for action to increase youth participation in sport.
  • Health impact assessment of active transportation: A systematic review (abstract), Mueller N, Rojas-Rueda D, Cole-Hunter T, de Nazelle A, Dons E, Gerike R, Gotschi T, Panis L, Kahlmeier S and Nieuwenhuijsen M, Preventive Medicine, Volume 76 (July 2015). Walking and cycling for transportation (i.e. active transportation, AT) provide substantial health benefits from increased physical activity (PA). However, there are risks of injury from exposure to motorized traffic and their emissions (i.e. air pollution). The objective of this study was to systematically review studies that looked at the associated health benefits and risks of a mode shift to AT. Thirty studies met the analysis criteria, originating predominantly from Europe, but also the United States, Australia and New Zealand. Despite different methodologies being applied and different assumptions, AT was shown to provide substantial net health benefits, irrespective of geographical context. 
  • Physical activity and health in adolescence (PDF  - 331 KB), Kumar B, Robinson R and Till S, Clinical Medicine, Volume 15, Number 3 (2015). Adolescence represents a critical period of development during which personal lifestyle choices and behaviour patterns are established, including the choice to be physically active. This article reviews the literature on physical activity (PA), health, and physical fitness, and makes a number of observations; including:
    • The proportion of active individuals declines significantly in adolescence, with girls tending to be less active than boys.
    • Studies indicate continuous periods of sedentariness pose more potent health risks than obesity.
    • If everyone (in the population) had a ‘moderate’ level of cardio-respiratory fitness, overall mortality would be reduced by about 17%, whereas if no one were obese, the risk reduction would be approximately 2–3%.
    • There is an inverse correlation between PA and all-cause mortality. Regular PA in youth improves cardiovascular physiology, including blood pressure, lipid profile, insulin sensitivity and endothelial function.
    • The authors advocate a PA ‘prescription’ for all young people as part of their individual healthcare plan.
  • Physical activity and sedentary behaviour: Evidence summary (PDF  - 869 KB), VicHealth (2016). Regular physical activity contributes to good health across all life stages, whereas inactivity is one of the most significant risk factors, contributing to the global burden of disease. This evidence summary builds upon previous work and includes publications between 2009 and 2014. This report also includes physical activity statistics and trends for Victoria and Australia.
  • The role of health literacy in parents’ decision making in children’s sporting participation. (PDF  - 70 KB) Velardo S, Elliott S, Filiault S, and Drummond M, Journal of Student Wellbeing, Volume 10, Number 2 (2010). Research conducted at the University of South Australia links health literacy and sports participation, indicating that the choices of parents for their children may depend on their understanding of the health benefits of physical activity and sport.
  • Sustaining health promotion programs within sport and recreation organisations (PDF  - 73 KB) Casey M, Payne W, Eime R, and Brown S, School of Human Movement and Sport Sciences, University of Ballarat, Australia. This research explores the role of health promotion by sport and recreation organisations; analysing the design, implementation and sustainability of such programs. The authors suggest that health promotion activities through sports organisations can be successful, however capacity building programs for staff may be necessary and persistence is required for ongoing success.
  • A systematic review of the evidence that swimming pools improve health and wellbeing in remote Aboriginal communities in Australia, Hendrickx D, Stephen A, Lehmann D, Silva d, Boelaert M, Carapetis J and Walker R, Australian and New Zealand Journal of Public Health, Volume 40, Issue 1 (2016). Peer-reviewed and grey literature scans from 1990 to 2014 were used to identify studies set in remote Australia that evaluated health and wellbeing benefits associated with swimming pools located in Aboriginal communities in Australia. Twelve studies met the search criteria, having collected data on skin infections and access to swimming pools. Results showed a drop of skin sore prevalence, and where measured the severity of skin irritation, in communities with swimming pools. Studies documenting ear and eye infections showed mixed outcomes. Many wider community health and wellbeing benefits were also documented in various studies, although some of these were anecdotal in nature. This review of literature concluded that a case can be made regarding skin infections and the broader wellbeing benefits that swimming pools may bring to remote Aboriginal communities, the benefit to ear and eye health remains unresolved.

More information can be found in the Clearinghouse for Sport portfolios, Active Transport, Mature-age Sport and Physical Activity, Physical Literacy and Sport, and Sport in Education.

Mental health

Physical activity, including organised sport and informal/social recreational activities, can also contribute to one's mental health and wellbeing.  

  • Don't worry, be happy: cross-sectional associations between physical activity and happiness in 15 European countries, Richards J, Jiang X, Kelly P, Chau J, Bauman A and Ding D, BMC Public Health, published online 31 January 2015. The association between physical activity and a number of markers of mental health (depression, anxiety, self-esteem, etc.) has been widely studied. This research analysed data collected in 2002 from 15 European countries (N=11,500). Self-reported physical activity and happiness were assessed using survey methods. Results showed a dose-response association with higher volumes of physical activity associated with higher levels of happiness. Subjects who were ‘very active’ had a happiness score that was 52% higher than those who were ‘inactive’. Also, when taking into account possible confounding factors, associations remained significant. The intensity of activity didn’t seem to matter too much. However, this study could not determine causation, it may be that happier people choose to be more physically active.
  • Happier people live more active lives: Using smartphones to link happiness and physical activity, Lathia N, Sandstrom G, Mascolo C and Rentfrow P, PLOS One, published online (4 January 2017). It appears that physical activity, both exercise and non-exercise, has far-reaching benefits to both physical and mental health. This study examined the relationship between physical activity (measured broadly) and happiness using a smartphone application. This app was used to collect self-reports of happiness and physical activity from over ten thousand participants, while passively gathering information about physical activity from the accelerometers on users' phones. The findings reveal that individuals who are more physically active are happier. Further, individuals are happier in the moments when they are more physically active.
  • Mental health charter for Sport and Recreation (PDF  - 394 KB), Sport and Recreation Alliance, United Kingdom (2015). Sports and recreational activities must aim to create a welcoming, inclusive and positive environment for everyone – encouraging people to discuss mental health and to seek help and support when it is needed. Sport and recreation can be used to: (1) promote wellbeing by encouraging social interaction for good mental health; (2) promote and adopt best practice policies for mental health; (3) promote positive health messages using diverse role models and ambassadors to reduce the stigma attached to mental health problems; (4) actively tackle discrimination on the grounds of mental health to insure that everyone is treated with dignity and respect; (5) support a pan-sport platform to work closely with the mental health sector to develop and share resources and best practice, and; (6) assess progress and take positive action on mental health issues.
  • Physical Activity 2014, Australian Medical Association, Position Statement. While physical activity forms part of the body’s energy balance equation, all too often the benefits of physical activity are only considered in relation to obesity and weight loss. The benefits of physical activity extend much further. Regular participation in physical activity is known to reduce the risk of physical health problems such as cardiovascular disease and stroke, type 2 diabetes, hypertension, some cancers and osteoporosis. There is also evidence that regular participation in physical activity improves both short- and long- term psychosocial wellbeing by reducing feelings of stress, anxiety and depression.
  • Physical activity and mental well-being in a cohort aged 60–64 years (PDF  - 235 KB), Black S, Cooper R, Martin K, Brage S Kuh D and Stafford M, American Journal of Preventive Medicine, Volume 49, Number 2 (2015). This study investigated the associations between physical activity in the form of walking for pleasure with mental wellbeing in a large sample of men and women age 60–64 years. The results showed that participation in walking for pleasure was associated with higher levels of mental wellbeing. Associations were robust when adjustment for gender, long-term limiting illness, educational attainment, financial status, smoking, work status, and personality were considered. 
  • The relationship between organised recreational activity and mental health, Street G and James R, Centre for Behavioural Research in Cancer Control, Curtin University, Government of Western Australia, Department of Sport and Recreation. A review of current literature indicates that people who participate in sports clubs and organised recreational activity enjoy better mental health, are more alert, and more resilient against the stresses of modern living. Participation in recreational groups and socially supported physical activity is shown to reduce stress, anxiety and depression, and may reduce some symptoms of Alzheimer’s disease.
  • A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport, Eime R, Young J, Harvey J, Charity M and Payne W, International Journal of Behavioral Nutrition and Physical Activity, Volume 10 (2013). Specific guidelines exist that recommend the level of physical activity required to provide health benefits. However, most of the research underpinning these guidelines does not address the element of social health or psychological health. This paper presents the results of a systematic review of the psychological and social health benefits of participation in sport by children and adolescents and goes on to develop a conceptual model, ‘Health through Sport’.
  • Yet another reason sport is good for you! Roy Morgan Research, Article 6118, published online (17 March 2015). The latest findings from Roy Morgan Research show that the 1.35 million Australian adults who participate regularly in some kind of team sport are noticeably less likely than the average Aussie to experience depression, anxiety or stress. Between 2013 and 2014, 25% of Australians aged 18+ reported experiencing stress at some point in the preceding 12 months, compared with 21% of those who regularly play a team sport. This difference is most striking among the under-25 age group, with all three conditions being far less common among those who play team sport on a regular basis. Incidence of anxiety fell from 31% to 17%, depression from 17% to 8%, and anxiety from 20% to 10%.

More information can be found in the Clearinghouse for Sport portfolios, Sport and Mental HealthSocial Sport, and Mature-age Sport and Physical Activity.

How much physical activity? 

Research suggests that physical activity thresholds (i.e. frequency, duration and intensity of activity) may exist to achieve positive health outcomes. Research also suggests that maintaining (through a lifetime) even modest amounts of regular physical activity can promote positive health outcomes.

  • Physical activity and incident chronic diseases: A longitudinal observational study in 16 European countries, de Souto Barreto P, Cesari M, Andrieu S, Vellas B and Rolland Y, American Journal of Preventive Medicine, published online ahead of print (13 October 2016). This study examined a large sample of people from 16 European countries to determine the predictive value of physical activity frequency and intensity on the incidence of heart diseases, cardiovascular diseases, diabetes, and various types of cancer. This study concluded that doing moderate-to-vigorous physical activity at least once a week (which is less than current recommendations in terms of frequency) is associated with reduced risk of developing cardiovascular diseases and diabetes among middle-aged and older adults. In addition, the magnitude of the associations increased with higher frequencies (i.e. more than once per week) for both moderate and vigorous physical activity. 

More information can be found in the Clearinghouse for Sport portfolio, Physical Activity Guidelines.  

However, it is also true that 'excessive' commitment to physical activity and sport may increase the risk of physical injury (i.e. stress and overuse injuries) and psychological pressure (mental stress) to perform. Of special interest to the sports sector is the reality that mental health benefits from physical activity can be ‘undone’ if sports participation places too great a stress on an athlete. Potential mental stress related problems have been identified among emerging, elite and professional athletes. In response to the specific demands of a sport, sporting organisations have developed strategies and programs to help athletes cope with the stress of competitive sports performance.

  • Debilitative interpretations of competitive anxiety: A qualitative examination of elite performers, Hanton S, Wadley R and Connaughton D, European Journal of Sport Science, Volume 5, Number 3 (2005). There is a small but significant proportion of elite performers who consistently report debilitative symptoms of competitive anxiety. A small sample of elite athletes were studied; the data identified common dimensions related to athlete’s precompetitive mental state and past competitive experiences that triggered competition anxiety. Possible explanations as to why these elite performers consistently reported negative emotions were related to inadequate mental preparation and ineffective use of psychological skills, coping strategies, perceptions of control, and perceived self-confidence levels. Associated research has consistently shown that successful performers, when compared to unsuccessful performers, demonstrate greater mental preparedness. Athletes can apply a variety of psychological strategies to actively challenge competitive anxiety-related symptoms and overcome them.
  • The mental health of Australian elite athletes, Gulliver A, Griffiths K, Mackinnon A, Batterham P and Stanimirovic R, Journal of Science and Medicine in Sport, Volume 18, Issue 3 (2015). This study aimed to investigate Australian elite athletes’ symptoms of general psychological distress and common mental disorders. The survey research found that the level of symptoms of mental health problems reported by elite athletes appears similar to that observed in the community. However, caution must be exercised in interpreting these findings, as possible demographic differences between elite athletes and the general population datasets may exist. Athletes, particularly those currently injured, are most vulnerable to depression and should be well-supported to seek help from mental health professionals.

More information can be found in the Clearinghouse for Sport portfolio, Sport and Mental Health.


Exercise is Medicine

The 'exercise is medicine' movement is a global initiative. There is a growing body of evidence that supports the use of physical activity and exercise as a standard part of disease prevention and treatment strategies.

Exercise is Medicine Australia. In Australia the concept that exercise can be used as a prescriptive tool is advocated by the professional association, Exercise & Sports Science Australia (ESSA). The focus is on encouraging health care providers, regardless of their specialty, to review and assess every patient's physical activity level and needs at every consultation. Patients should be counselled about exercise regimens, and provided with an exercise prescription or referral to an accredited exercise physiologist or appropriately qualified allied health professional.

There are three guiding principles that Exercise is Medicine Australia advocates to the medical profession; they are intended to improve the individual health and well-being of all persons, as well as improving population health.

  1. It should be recognised that physical activity and exercise are important to health and the prevention and treatment of many chronic diseases.
  2. More should be done to address physical activity and exercise in health care settings.
  3. Support the referral of patients to appropriately trained allied health professionals who can deliver exercise treatment services.
  • Exercise is Medicine: fact sheets, Exercise is Medicine Australia. Exercise has a well-established role as medicine to reduce the side effects of many chronic diseases. The factsheet series helps health care providers, patients and every-day Australians understand the role of exercise in the treatment and slowing the progression of disease.

Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases, Pedersen B and Saltin B, Scandinavian Journal of Medicine & Science in Sports, Volume 25, Issue Supplement S3 (2015). This review provides an up-to-date evidence-based assessment for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed.

  • Comparative effectiveness of exercise and drug interventions on mortality outcomes: epidemiological study, Naci H and Loannidis J, British Medical Journal, published online ( 22 August 2013). This study conducted a meta-analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise treatments and drug interventions with each other, or with a placebo control. Although limited in number, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions produce similar outcomes in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes. The conclusion is that exercise or increasing physical activity can be an effective treatment or preventive measure for some diseases.
  • Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative, Hamlin M, Yule E, Elliot C, Stoner L and Kathiravel Y, Public Health, abstract published online ahead of print (October 2016). New Zealand’s Green Prescription program has gained international recognition; it addresses the physical activity needs of persons demonstrating health risk factors. Patients are assessed by a General Practitioner or nurse who recommends an activity prescription. Patients are then referred to the regional sports trust who act as facilitators for behaviour change by connecting the patient to activities and providing support and motivation over a 3-month period. This study examined the longer term effectiveness of the program. A 3 year follow up showed a long-term benefit beyond the initial three month period; however dropout rates were high. 42% of persons who stayed in the program met the recommended physical activity guidelines for adults after three years.
  • Physical activity in the prevention and treatment of disease (PDF  - 3.6 MB), Swedish National Institute of Public Health (2010). This research summary presents a synopsis of the latest published research examining participation in physical activity. Specifically, the summary focuses on physical activity rates, impacts, barriers and facilitators to participation.

International evidence suggests that participation in sport and physical activity has a preventive health affect. Medical professionals are using physical activity as a prescriptive tool to reduce health risk factors, combat the effects of disease, and improve general health and wellbeing. Recent surveys in Australia and Canada indicate that medical practitioners can do more to counsel their patients about the use of physical activity to maintain/improve health and wellbeing.

  • Physical activity recommendations from general practitioners in Australia. Results from a national survey, Short C, Hayman M, Rebar A, et.al., Australian and New Zealand Journal of Public Health, Volume 40, Issue 1 (2016). What type of physical activity advice are Australian adults likely to receive from their general practitioner? This online survey of patients (N=1799) looked at the type of health advice they were provided; patients were divided into eight different population subgroups, based upon body mass index and health risk factors. Overall, only 18% of patients received a physical activity recommendation from their general practitioner (GP) during the past 12 months. However, 54% of the subgroup with the highest risk factors received a physical activity recommendation. The most commonly prescribed physical activity type was aerobic activity. Few participants received specific physical activity advice on strength training and flexibility training. Most patients did not discuss daily sitting-time and other sedentary behaviours with their GP. Overall, these finding suggest that general practitioners are incorporating physical activity promotion into their practice based on patient’s health status, as a secondary prevention or disease management tool, with limited specificity (i.e. type of activity, frequency and duration, intensity, etc.) in their advice.
  • Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: A position statement by the Canadian Academy of Sport and Exercise Medicine, Thornton J, Fremont P, Khan K, Poirier P, Fowles J, Wells G and Frankovich R, British Journal of Sports Medicine, Volume 50, Issue 18 (2016). Non-communicable disease is a leading threat to global health and physical inactivity is a large contributor to this problem. Canadian Physical Activity Guidelines (in line with World Health Organization guidelines) for adults, recommend 150 minutes of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors each year, and prefer to get health information directly from them. Unfortunately, most Canadian physicians do not regularly assess or prescribe PA as part of routine health care; and even when discussed, few physicians provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary and secondary prevention of chronic disease. This position statement by the Canadian Academy of Sport and Exercise Medicine provides an evidence-based, best practices summary to better equip primary care physicians in prescribing PA and exercise for the prevention and management of non-communicable disease.

The training that medical school students receive regarding the assessment of patient physical activity and the use of PA as a prescriptive health intervention may not be keeping pace with the evidence supporting the lifelong health benefits.

  • Future doctors unprepared to deliver physical activity advice, Exercise & Sports Science Australia, published online (15 February 2017). The level of physical activity (PA) training taught across medical schools in Australia is not keeping pace with the growing incidence of non-communicable disease (e.g. obesity and type 2 diabetes). Physical activity has been shown to have a mediating effect on the incidence and severity of many lifestyle influenced medical conditions. Future doctors may be unprepared to help patients meet recommended guidelines, according to a study led by the University of Sydney and Exercise & Sports Science Australia (ESSA). The study surveyed 17 of the 19 medical schools across the country to produce the first national snapshot of PA training across medical school curricula. The study found PA counseling was virtually non-existent as part of medical students’ total training, with almost half of all medical schools surveyed reporting the level of PA training was ‘insufficient’ to prepare future doctors in their ability to counsel their future patients. The results of this study have been published. [source: An evaluation of physical activity training in Australia medical school curricula, strong A, Stoutenberg M, Hobson-Powell A, Hargreaves M, Beeler H and Stamatakis E, Journal of Science and Medicine in Sport, published online (28 October 2016)]
     

Injury Related to Sport and Physical Activity 

Increasing participation in physical activity and sport, within and across all segments of the population, is a key policy objective of Governments. Increased physical activity is linked to improved health and this offers potential saving in future Government health care spending, as well as current and ongoing improvement in quality of life. However, physical activity and sport participation will always carry a risk of acquiring activity related injuries. The evidence suggests that the benefits (immediate and long-term) of increasing physical activity and sports participation in the population exceed the additional risks.

More information can be found in the Clearinghouse for Sport portfolio, Cost of Sports Injuries

  • Sport-related community injury (PDF  - 128 KB), Australian Institute of Health and Welfare, Hospital separations due to injury (2004-05). Data from the Australian Institute of Health and Welfare (AIHW) identifies sport-related injury requiring hospitalisations. 

Government Departments and Agencies

Australian Government, Department of Health

The Department of Health and its predecessor Government Department(s) have developed successive preventive health strategies. Key components of current and past strategies are the recognition that diet, physical activity, and several lifestyle choices have a direct impact upon health and wellbeing. Intervention programs are generally aimed at providing education, shaping attitudes, and influencing environmental factors that produce behavioural change.

  • Australia's Physical Activity and Sedentary Behaviour Guidelines, Department of Health. The revised guidelines are supported by a rigorous evidence review process. A review of the evidence relating to the Australian physical activity guidelines for children, adolescents and adults was conducted in 2012. This review looked at and modified previous Guidelines to consider the scientific research in relation to physical activity and sedentary behaviour relationships.
  • 'Developing an Active Australia: A framework for action for physical activity and health', Department of Health and Family Services (1998). In December 1996, the Federal Minister for Health and the Federal Minister for Sport, Territories and Local Government, jointly launched the Active Australia concept. The Active Australia framework recognises the need to develop evidence-based population-wide strategies and public policies to promote higher levels of involvement in regular physical activity. This was one of the first Australian initiatives to combine the objectives of health and community sport.

National Preventive Health Taskforce

The National Preventive Health Taskforce provides evidence-based advice to government and health providers, both public and private, on preventative health programs and strategies. The Taskforce’s terms of reference focus on obesity, tobacco, and excessive alcohol consumption issues. Reports, discussion papers, and submissions of the Taskforce are published; they are intended to provide a blueprint for tackling these issues. The ‘National Preventative Health Strategy’ is outlined in the publication, Australia: the Healthiest Country by 2020, and the Taskforce’s report, Taking Preventive Actions, is intended to guide policy toward meeting Australia's health objectives.

  • Australia: the Healthiest Country by 2020 (PDF  - 835 KB), Australian Government, National Preventive Health Taskforce, Department of Health and Aging (2009). Interventions that address behavioral change are a central part of the Government’s preventative health strategy. Seven strategic directions are identified: (1) shared responsibility at all levels of government and developing strategic partnerships with non-government sectors; (2) acting early and throughout life with intervention programs; (3) engaging communities in settings where they live, work, play, and go to school; (4) influencing markets; (5) reducing inequity, (6) Indigenous Australians, and; (7) refocus of primary healthcare towards prevention.
  • Taking preventive action (PDF  - 1.2 MB), a response to Australia: the Healthiest Country by 2020, National Preventive Health Taskforce (2010). This report proposes a phased approach to the implementation of recommended actions. The first phase of four years initiates priority actions; the second phase builds on these actions, learning from new research and the experiences of program implementation and trials; and the third phase ensures long-term sustained action.

Australian National Preventive Health Agency

The Australian National Preventive Health Agency (ANPHA) was established in 2011 and decommissioned from 30 June 2014. All of the essential functions of the ANPHA have been transferred to the Federal Government’s Department of Health. A record of ANPHA publications is stored with the National Archives. A major part of the ANPHA’s activities were concentrated on childhood obesity and moderating excessive alcohol consumption.

  • Shape Up Australia. This ANPHA initiative addressed the nation’s epidemic of overweight and obesity. The campaign offered co-branding partnership opportunities to promote messages and services, and encourage a nationally consistent and evidence-based approach to overweight and obesity prevention. The program also sought to reduce community confusion in relation to recommended healthy eating and lifestyle behaviours.
  • Be the Influence – Tackling Binge Drinking. This initiative was part of the overall National Binge Drinking Strategy and used the connection between sport and sports-personalities to encourage young people to develop responsible attitudes toward alcohol consumption.

Commonwealth Scientific and Industrial Research Organisation (CSIRO)

CSIRO applies a multidisciplinary research approach to developing preventive health strategies to address obesity and its related diseases. CSIRO delivers innovation to Australia's food, health and wellness industries, resulting in significant health and economic benefits for Australians.

  • Health Heart Program. This is one example of how CSIRO research underpins evidence on dietary patterns and foods.

States and Territories

Each State and Territory government has an appropriate department, branch or unit that works in the preventive health sector to develop strategies and implement programs. State and Territory governments work across a number of portfolios to influence the determinants of health or focus on the health needs of particular populations. Successful health promotion programs and initiatives usually require collaboration across many sectors, including sport and active recreation.

  • ACT Health. The Health Improvement Branch is responsible for improving the health and well being of the ACT population through promoting healthy behaviours and lifestyles and providing ongoing monitoring and evaluation of health programs and policy.
  • NSW Premier's Council for Active Living (PCAL). The Council aimed to build and strengthen the physical and social environments in which communities engage in active living. Senior representatives from across government, industry, and the community sector made up the Council. It was established in 2004 as a legacy of the NSW Physical Activity Taskforce (1996 – 2002). In August 2016 the NSW Government made a decision to discontinue PCAL at the end of the year, with transition arrangement in place. An ‘Expert Advisory Panel’ implementation committee and cross-government working group have been established to drive the implementation of the NSW Healthy Eating and Active Living (HEAL) strategy and ensure that the Government's target to reduce childhood overweight and obesity by 5% in 10 years is met. The NSW Ministry of Health will work with the National Heart Foundation to deliver new programs to support this focus.
  • Northern Territory Department of Health (Health Promotion Unit). The Unit is part of the Health Development Branch in the NT Department of Health. It provides strategic advice on a range of issues, strategies and policies across the NT Government.
  • Queensland Government (Health Campaigns). Queensland Health addresses key risks factors for chronic diseases through prevention, promotion and early intervention, to create supportive environments for health in the community. 
  • SA Health - Eat Well, Be Active Strategy. The Health Promotion Branch is committed to protecting and improving the health of all South Australians by providing leadership in policy development and planning, with an increased focus on wellbeing, illness prevention, and early intervention strategies.
  • Department of Health and Human Services (Tasmania). Health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to personal and community wellbeing. The Department works across all Government sectors to achieve this goal.
  • Victoria, Preventive Health, Victorian Government. Public health and wellbeing plans establish a new and ambitious health vision for a Victoria free of the avoidable burden of disease and injury, so that all Victorians can enjoy the highest attainable standards of health, wellbeing, and participation at every age.
    VicHealth (Victoria). VicHealth is a pioneer in health promotion. Its primary focus is promoting good health and preventing chronic disease. VicHealth creates and funds world-class interventions, conducts research, and produces and supports public campaigns to promote a healthier Victoria. It also provides transformational expertise and insights to Government.
  • Department of Health, Western Australia (Health Promotion). Health promotion is the process of enabling people to take control over the determinants of their health and thereby improve their health.
    Healthway (Western Australia). Healthway is a health promotion foundation with a legislated obligation to promote good health and encourage healthy lifestyles. It fulfils this obligation by promoting and facilitating policies and environments, and empowering individuals, groups, and communities to be healthier. 

Case Studies

Victorian Health Promotion Foundation (VicHealth)

VicHealth was created as an independent statutory authority under the Tobacco Act to replace tobacco sponsorship of community organisaitons. It now focuses on promoting good health and preventing chronic disease through interventions, conducting research, and supporting public campaigns to promote a healthier Victoria. VicHealth also provides expertise and insights to governments, working across political parties and partnering with community groups representing a range of sectors, including: sport, health, education, arts and media.

VicHealth has partnered with sport and active recreation organisations to address many health inequalities that exist in the community. A collection of case studies show how the Participation in Community Sport and Active Recreation (PICSAR) program helps to deliver health messages and change behaviours that make a real difference in the lives of people. The PICSAR program focuses on engaging priority populations; such as Indigenous Australians, people with disabilities, people from low socioeconomic backgrounds, and people from culturally and linguistically diverse backgrounds. The case studies demonstrate how a number of Victoria’s sporting organisations have combined their services with health promotion objectives to support community participation and community health objectives; examples from Badminton, Baseball, Blind Sports, Boxing, Canoeing, Cycling, Football, Orienteering, Pony Club, Squash, Tennis, Water Polo, Wheelchair Sports, and Yachting.

Western Australian Health Promotion Foundation (Healthway)

Healthway was established in 1991 as an independent statutory authority. Initially Healthway provided sponsorship support to sports, arts, and community organisations to replace tobacco sponsorship and create tobacco free environments. Healthway is now involved in promoting a range of health messages and healthy lifestyle promotions through sports, arts and other community-based organisations. Healthway has published a series of case studies that showcase its successful health promotion projects.

  • Let’s get physical Broome style (PDF  - 371 KB). This pilot program offered a culturally appropriate physical activity program to Indigenous women with diabetes or those at risk of the disease. The exercise program was coordinated by a local Indigenous leader and used local Indigenous women as group facilitators. Two exercise classes were held each week and information about nutrition and health was integrated into the program. The program was considered successful because it engaged the women in regular exercise by making it enjoyable and sociable.
  • Kalgoorlie to Perth Pipeline Challenge (PDF  - 373 KB). The Challenge was a physical activity and nutrition education program for schools in the Goldfields region that targeted Aboriginal children to dispel the widely held belief that diabetes was inevitable.
  • Healthway WA: Health Promotion Projects Review (PDF  - 459 KB). Healthway’s Health Promotion Project funding offers incorporated organisations and community groups opportunities to run or trial innovative health promotion activities. Healthway projects aim to increase the knowledge and skills of participants, change health-related behaviours, and develop community and organisational policies to create environments that improve health. The Health Promotion Evaluation Unit at the University of Western Australia has reviewed a number of projects and identified common features of successful projects in the areas of planning, implementation, evaluation and sustainability.

New South Wales Government

  • Healthy Kids NSW. Several school-based programs link sport and physical activity to 'healthy living' messages; physical activity, good nutrition, and lifestyle choices that help to build healthy kids.
  • NSW Office of Preventive Health: the first year (2012-13) in review (PDF  - 4.6 MB), NSW Government, Department of Health (2013). There are four major components of the NSW Office of Preventive Health; they are: (1) the Healthy Children Initiative, (2) the Get Healthy Information and Coaching Service, (3) the Healthy Worker Initiative, and (4) Evaluation and Special Projects.  This report updates the status of each program area after the first year of operation.  The Healthy Children Initiative reaches into children’s settings across NSW and the past year has seen increased participation in the Live Life Well at School, Crunch & Sip®, Munch and Move® and Go4Fun® programs. The Office of Preventive Health has forged partnerships with key stakeholders in the junior community sport and disadvantaged youth settings and begun formative work in the supported playgroup setting.  Sporting organisations have been successfully used to promote the suite of healthy children initiatives.

Partnerships

  • Build Your Game. This program represents a partnership among the Australian Drug Foundation’s ‘Good Sports’ initiative, the Tasmanian Government, and Beyond Blue. The program uses sports clubs to help change attitudes toward mental health, particularly an awareness about depression and anxiety caused by alcohol and drug problems. Beyond Blue partners with sports clubs because they are community hubs and provide an ideal setting to change the way people think about drinking.
  • Be the Influence – Tackling Binge Drinking. Although this program is no longer funded, it provides an example of the partnership between the Australian National Preventive Health Agency and 16 National Sporting Organisations (i.e. governing bodies for their respective sport) to tackle the problem of binge drinking, particularly among youth. Promotional programs, sponsorships, and sport ambassadors were used to deliver health promotion messages.  

Non-government Organisations

  • Australian Council for Health, Physical Education and Recreation (ACHPER). Australia’s professional association advocating for quality health and physical education curriculum, supporting professional development of teachers and promoting active and healthy lifestyles for all Australians.
  • Australian Health Promotion Association. This is Australia’s peak health promotion body and the only professional association in Australia specifically for people interested or involved in the practice, research, and study of health promotion.
  • Australian Research Alliance for Children and Youth (ARACY). The Alliance aims to progress and promote evidence-based programs and strategies to improve the wellbeing of children and young people by collaborating with researchers, policymakers, and practitioners to turn 'what works' into practical, preventative action.
  • Diabetes Australia. The organisation delivers products, information, and services to Australians with diabetes; as well as preventive health information.
  • Exercise is Medicine Australia. In Australia, the concept is advocated by the professional association, Exercise & Sports Science Australia (ESSA).
  • Heart Foundation Australia. The Foundation provides information about the risk factors associated with heart disease and supports programs to encourage 'healthy heart' practices.
    • Blueprint for an active Australia (second edition) (PDF  - 12.7 MB), National Heart Foundation of Australia (2014). Physical inactivity is a major risk factor that contributes to Australia’s growing and significant burden of chronic disease. In recognising the significant challenges of getting more people more active, the Blueprint for an active Australia outlines a holistic approach to physical activity. Example initiatives found in the Blueprint cover: (1) built environments and planning reforms to create places that promote walking and cycling; (2) incorporation of physical activity programs in schools, workplaces and age-care settings; (3) delivery of affordable and accessible evidence-based physical activity programs; (4) increased support for sporting and active recreation clubs. Overcoming the many barriers to physical activity requires a multi-sector response, led by governments and implemented at the community level.
  • Obesity Australia. The mission of Obesity Australia is to drive change in the public perception of obesity. The organisation provides leadership and advice regarding what works and what doesn’t work in an Australian context.
  • Reclink Australia. Reclink Australia is a non-profit organisation whose mission is to provide and promote sport and art programs for people experiencing disadvantage. Established in Victoria in 1990, Reclink Australia operates nationally providing over 4500 activities and 80,000 participation opportunities for disadvantaged Australians annually. Programs target some of the most vulnerable and isolated people and communities; including people experiencing significant mental health challenges, disability, homelessness, substance abuse, culturally and linguistically diverse communities, correctional services, and people experiencing economic hardship. Reclink Australia partners with sporting associations and clubs; governments; community welfare and health agencies; corporate and philanthropic organisations to deliver its programs.

International Practice

In January of 2011, the International Olympic Committee (IOC) assembled an expert group to discuss the role of sport on the health and fitness of young people and to critically evaluate the scientific evidence as a basis for decision making. Following this, a consensus paper was produced to identify potential solutions through collaboration between sport and existing programs and to review the research gaps in this field.

Many governments and international organisations recognise the value of sport and physical activity as a means of promoting health and a healthy lifestyle.

  • The Bangkok Declaration on Physical Activity for Global Health and Sustainable Development (PDF  - 420 KB), 6th International Society for Physical Activity and Health (ISPAH) Congress on Physical Activity and Public Health, Bangkok, Thailand 16-19 November 2016. The Bangkok Declaration calls upon governments, policy makers, donors and stakeholders; including the World Health Organization (WHO), the United Nations (UN), and all relevant government and non-governmental organisations to:
    1. Renew their commitment to, and increase investment in, the implementation of policy actions to increase physical activity as a contribution to reducing the global burden of non-communicable diseases and achieving the 2030 Sustainable Development Goals.
    2. Establish national multi-sector engagement and coordination platforms. Physical activity can contribute to achieving key objectives in health, education, urban planning, transportation, sports, recreation, and sustainable development; as well as addressing inequities related to gender, age, race/ethnicity, socioeconomic status, and disability.
    3. Develop workforce capabilities across all sectors that support physical activity.
    4. Increase technical assistance and share experiences. Develop mechanisms to support knowledge transfer and increase the effectiveness of implementation of national plans and each country’s capacity to reach their physical activity targets.
    5. Strengthen monitoring, surveillance and reporting the progress of physical activity and its determinants; so that countries can hold agencies accountable to their commitments and guide effective resource allocations.
    6. Support and promote research and evaluation to further develop the evidence base, with a particular focus on addressing gaps in knowledge at the population level.
  • Health-enhancing physical activity policy audit tool (PDF  - 74 KB), Bull F, Milton K and Kahlmeier S, World Health Organisation (2011). The promotion of physical activity across the life course requires a multi-faceted response across many sectors. This document provides a protocol and method for a detailed compilation and communication of country level policy responses on physical inactivity. It is structured around a set of 17 key attributes identified as essential for successful implementation of a population-wide approach to the promotion of physical activity across the life course.
  • Sport and Health. The Sport and Development International Platform provides information about the relationship between Sport and Health.

Canada

  • Moving Ahead: The economic impact of reducing physical inactivity and sedentary behaviour, The Conference Board of Canada (2014). Canadian physical activity guidelines indicate that adults should get at least 150 minutes of moderate-to-vigorous physical activity per week. This report explores the potential benefits that would ensue if 10% of the adult population improved their activity levels, in line with government recommended guidelines. It is estimated that such a change would significantly reduce the rates of major chronic health conditions, gross domestic product would increase by $7.5 billion, and health care spending would be reduced by $2.6 billion during the period 2015 to 2040.

Europe

  • The economic cost of physical inactivity in Europe (PDF  - 2.6 MB), International Sport and Culture Association (ISCA) and Centre for Economics and Business Research (2015). This report examined the prevalence of physical inactivity in six European countries – Poland, Germany, France, Spain, Italy and the United Kingdom, using World Health Organization (WHO) physical activity guidelines as a benchmark. Inactivity contributes to obesity, but has far-reaching impacts on health. Understanding physical activity’s role in achieving energy balance and preventing obesity is an important part of effective public health policy. However, the consequences of physical inactivity are not solely related to weight gain. Individuals who are normal weight, but who are physical inactive, are still at increased risk of non-communicable diseases such as stroke, type two diabetes, some cancers and coronary heart disease. The direct cost of population-wide physical inactivity among the six focus countries in this study was estimated to be €7.6 billion in 2012. It’s estimated that a 20% reduction in the rate of physical inactivity could save 100,000 deaths annually and €11.8 billion across the 28 European Union countries.

United Kingdom

  • One You. This is a Public Health England campaign designed to encourage better personal health by focusing on seven key lifestyle/behaviours: (1) regular health checks (particularly for persons past the age of 40); (2) quit smoking; (3) responsible alcohol consumption; (4) health food choices; (5) increasing physical activity; (6) quality sleep, and (7) reducing stress (mental and emotional pressure).
  • Sporting Future: A new strategy for an active nation (PDF  - 1.2 MB), Ministry for Sport, Tourism and Heritage, United Kingdom (December 2015). At the heart of the Government’s strategy are five simple, but fundamental outcomes of participation in sport and physical activity: (1) physical health; (2) mental health; (3) individual development; (4) social and community development, and: (5) economic development. It is these outcome that will define how governments (federal and local) prioritise and fund programs.
  • Government response to the House of Commons Health Select Committee report on the impact of physical activity and diet on health, Sixth Report of Session 2014-15, Department of Health, United Kingdom (July 2015). The Government recognises the seriousness of public health issues, and the need to increase levels of physical activity, improve diet and reduce obesity as key public health priorities. For too long, physical activity has been seen merely in the light of its benefits in tackling obesity. However, there is compelling evidence that physical activity in its own right has huge health benefits totally independent of a person’s weight. It has been suggested that increasing physical activity levels could have greater impact on reducing mortality than reducing weight. The Chief Medical Officer’s guidelines for recommend levels of activity will help people derive the greatest health benefits; but even small increases in activity levels can have a dramatic positive impact on health.
  • Fitness and health of children through sport: the context for action, Micheli L, et. al., British Journal of Sports Medicine, Volume 45 (2011). In response to declining levels of physical activity and fitness in children and youth, which are associated with adverse health impacts, a number of governmental and non-governmental organisations have instituted programs to promote health in children and youth through sports and physical activity. Many of these programmes have achieved success in increasing participation in sports, and by extension improving the health of these young people. This article discusses the setting and context of ways in which international organisations may have an impact.
  • A critical analysis of the cycles of physical activity policy in England, Milton K and Bauman A, International Journal of Behavioral Nutrition and Physical Activity, Volume 12 (2015). Overall, physical activity policy in England has fluctuated over the past two decades. The variations and cycles in policy reflect some of the challenges in implementing and sustaining physical activity policy in the face of political changes, changes in government direction, and changing opportunities to promote active lifestyles. Physical activity recommendations are an area where England has demonstrated a robust scientific approach and good practice; however, many of the physical activity campaigns in England have not been sufficiently sustained to achieve changes in social norms and behaviour. The setting of physical activity targets has (in some cases) been unrealistic, and continuous changes to national surveillance measures have presented challenges for monitoring trends over time.
  • Value of Sport Monitor. Sport England provides a review of evidence regarding the value of sport. Besides commissioning its own research on the value of sport, Sport England also works with other organisations  to collect and review data from across the world.

United States

  • Healthy People 2020. This is an initiative of the Office of Disease Prevention and Health Promotion. Healthy People provides a science-based, 10-year national objectives for improving the health of all Americans. Benchmarks and monitored progress over time is provided to: (1) encourage collaborations across communities and sectors; (2) empower individuals to make informed health decisions, and; (3) measure the impact of prevention activities. The physical activity objectives for Healthy People 2020 reflect the strong state of the science supporting the health benefits of regular physical activity among youth and adults. Regular physical activity includes participation in moderate and vigorous physical activities and muscle-strengthening activities.
  • Modeling the economic and health impact of increasing children’s physical activity in the United States (abstract), Lee B, Adam A, Zenkov E, et.al., Health Affairs, Volume 36, Number 5 (2017). Quantifying the economic and health effects of physical activity intervention programs would help decision makers understand its impact and priority. Using a computational simulation model developed to represent all US children ages 8–11 years, this study estimated that maintaining the current physical activity levels (only 31.9% of children in the U.S. get twenty-five minutes of high-calorie-burning physical activity three times a week) would result each year in a net present value of $1.1 trillion in direct medical costs and $1.7 trillion in lost productivity over the course of their lifetimes. If 50% of children would exercise, the number of obese and overweight youth would decrease by 4.18%, averting $8.1 billion in direct medical costs and $13.8 billion in lost productivity; increasing the proportion of children who exercised to 75% would avert $16.6 billion and $23.6 billion, respectively.
  • Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association, Colberg S, Sigal R, Yardley J, Riddell M, Dunstan D, Dempsey P, Horton E, Castorino K and Tate D, Diabetes Care, Volume 39, Number 11 (2016). In this Position Statement the American Diabetes Association provides a clinically oriented review and evidence-based recommendations regarding physical activity and exercise in people with type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and prediabetes. Physical activity includes all movement that increases energy use, whereas exercise is planned and structured physical activity. Regular exercise has considerable health benefits, including (but not limited to): improved blood glucose control in type 2 diabetes; reduced cardiovascular risk factors; a contribution to weight loss and weight management, and; improved wellbeing. Physical activity and exercise recommendations should be tailored to meet the specific needs of each individual.
  • Sports and Health in America (PDF  - 423 KB), Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health (2015). A nationally representative sample, N=2506, of adults in the United States were surveyed about their sport and health status. This report summarises the survey findings.
  • State School Health Policy Matrix (PDF  - 1.5 MB), National Association of Chronic Disease Directors; National Association of State Boards of Education; and American Alliance for Health, Physical Education, Recreation and Dance (2014). The way in which each state adopts policies related to public school health varies significantly, and often differs by topic (e.g., physical education, physical activity, or school nutrition) within an individual state. Given this complexity; policymakers, public health professionals, educators and school health advocates often need assistance in understanding diverse but inter-connected policies. The Matrix distills a large amount of research into a grid format that allows users to look across state lines and across topics within a single state. As many non-governmental organizations and school health advocates seek to inform and improve state policy to advance student health.

 


Further Resources and Reading

Government Reports

  • Australia: the Healthiest Country by 2020 (PDF  - 835 KB), Australian Government, Preventative Health Taskforce (2009).  This strategy document outlines a comprehensive approach to preventative health measures.  The strategy has seven directions: (1) shared responsibility, (2) acting early and throughout life, (3) engaging communities, (4) influencing markets and developing connected policies, (5) reduce inequity through targeting disadvantage, (6) contribute to ‘Close the Gap’ for Indigenous Australians, and (7) refocus primary healthcare towards prevention.
  • Chronic conditions prevention and management strategy, 2010-2020 (PDF  - 3.4 MB), Northern Territory Government, Department of Health (2012). This report assesses the extent to which activities relevant to the strategy are being implemented across the Northern Territory.
  • Evidence update on obesity prevention across the life-course (PDF  - 1.1 MB), Hector D, et.al., University of Sydney, prepared for the NSW Ministry of Health, Physical Activity Nutrition Obesity Research Group (2012). This report identifies the most promising approaches for action based on the range of evidence across age groups within the key settings of: childcare, schools, workplaces, home and family, primary health care, and community. Programs are assessed under five criteria: rationale, policy and program content, evidence of effectiveness, areas for further investigation, and promising approaches.
  • A framework for monitoring overweight and obesity in NSW (PDF  - 826 KB), Physical Activity, Nutrition, Obesity Research Group (PANORG), NSW Health (2009). This document proposes a framework for monitoring overweight and obesity that covers these areas: (1) prevalence; (2) dietary behaviours; (3) physical activity; (4) socio-demographic factors, and (5) other factors (e.g. health knowledge, perception of bodyweight, lifestyle choices).
  • A Healthy Tasmania: Setting new directions for health and wellbeing (PDF  - 4.7 MB), Tasmanian Government, Department of Health and Human Services (2012). This report outlines a whole of government approach to building a healthier community, including health promotion programs targeting increased physical activity.
  • Getting Australia Active : Towards better practice for the promotion of physical activity (PDF  - 1.6 MB), Bauman A, Bellew B, Vita P, Brown W and Owen N, National Public Health Partnership (2002). This report updates the epidemiological evidence on physical activity and health and the effectiveness of intervention strategies used to increase physical activity – what works?
  • National Aboriginal and Torres Strait Islander health plan 2013–2023 (PDF  - 16.8 MB), Australian Government, Closing the Gap (July 2013). This health plan provides a long-term, evidence-based policy framework as part of the overarching Council of Australian Governments’ (COAG) approach to Closing the Gap in Indigenous disadvantage, which has been set out in the National Indigenous Reform Agreement.
  • National preventive health research strategy 2013-2018 (PDF  - 1.0 MB), Australian National Preventive Health Agency (2014). The primary purpose of this strategy document is to foster approaches to research and evaluation which better enable all sectors, whether they are workplaces, schools, or other institutions, to implement the most effective preventive health programs and enable individual choices to be evidence-informed. The strategy builds on Australia’s already strong research and evaluation capacity in preventive health and extend this to better support and build policy and program capacity.
  • NSW Healthy Eating and Active Living Strategy: Preventing overweight and obesity in New South Wales 2013-2018 (PDF  - 2.1 MB)
  • Primary Prevention Plan, 2011-2016 (PDF  - 578 KB), Government of South Australia, Department of Health (2011). This document outlines the Government’s primary prevention aims to support and promote good health and eliminate or reduce factors that contribute to poor health. It is directed at both the whole population and certain subgroups (e.g. young people).
  • Progress to preventive health: Toward Q2 goals in 2011 (PDF  - 80 KB), Queensland Health (2012). This document contains graphs of performance trends on health risk factors against performance targets; including the indicators of overweight and obesity and physical activity.
  • Western Australian Health Promotion Strategic Framework 2017–2021 (PDF  - 5.4 MB), Government of Western Australia, Department of Health (2017). This is a five-year plan to reduce preventable chronic disease and injury in Western Australian communities; section 4.3 ‘A More Active WA’.

Resources 

  • A Healthy and Active Australia. The Australian Government, Department of Health, provides a range of information and initiatives on healthy eating, regular physical activity, and the risks of overweight and obesity, to assist all Australians in leading healthy active lives.
  • Australian Indigenous HealthInfoNet. This online resource provides information on a variety of health topics, including the value of physical activity.
  • Cancer Council Australia. Online information about cancer – incidence, prevention and treatment. Meeting the recommended physical activity guidelines has been shown to reduce certain cancer risk factors.
  • Diabetes Australia. Online information about diabetes – incidence, prevention and treatment. Anyone who has diabetes, or is at risk of diabetes can benefit from regular physical activity.
  • Food, Nutrition, Physical Activity, and the Prevention of Cancer: a global perspective (PDF  - 13.5 MB), World Cancer Research Fund and the American Institute for Cancer Research (2007). This report systematically reviews and assesses the worldwide body of evidence on food, nutrition, physical activity and 17 cancers. An Expert Panel of 21 world-renowned scientists reviewed the findings and made judgements based on the evidence; overall, about 200 scientists and other experts were involved. Chapters 5 and 6 are concerned with physical activity and with body composition, growth, and development. The general recommendation is that persons should be physically active as part of everyday life across the entire lifespan. Adults should be at lease moderately active, equivalent to brisk walking for at least 30 minutes every day; as fitness improves, moderate activity should extend to 60 minutes per day or 30 minutes of vigorous physical activity. All forms of physical activity protect against some cancers, as well as against weight gain, overweight, and obesity; correspondingly, sedentary lifestyle increases the risk of many cancers, overweight and obesity.
  • Game of Life: how sport and recreation can help make us healthier, happier & richer(PDF  - 4.2 MB), Cox S, Sport and Recreation Alliance, United Kingdom (2012). “Sport and recreation are good for you”, this statement instinctively seems right, but where is the supporting evidence? The ‘Game of Life’ is a document that brings together current evidence from the United Kingdom to support the underlying belief that participation in sport and recreation can benefit society and individuals.
  • Healthdirect Australia. This online resource provides information on a variety of health topics, including physical activity for older adults.
  • Making the case for public health interventions (PDF  - 3.1 MB), The King’s Fund and the Local Government Association, United Kingdom (2014). Infographics that help to illustrate the case that funding preventive health programs makes good economic sense. The return on investment for the ‘Be Active’ program is estimated to be £23 for every £1 spent.
  • Mind for better health. Mind is a United Kingdom based organisation that provides information, advice and support to empower anyone experiencing a mental health problem. Physical activity can reduce depression and anxiety, and increase self-confidence. It also releases hormones that help people feel more active.
  • Physical activity/exercise and diabetes: A Position Statement of the American Diabetes Association, Colberg S, et.al., BMJ Open Diabetes Research & Care, Volume 39, Number 11 (2016). The adoption and maintenance of physical activity are critical factors for blood glucose management and overall health in individuals with diabetes and prediabetes. Recommendations and precautions vary depending on individual characteristics and health status. In this Position Statement, the American Diabetes Association provides a clinically oriented review and evidence-based recommendations regarding the role of physical activity and exercise for people with type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and prediabetes.
  • Preventive Health Matters. This web-based tool has been developed to facilitate the knowledge transfer between Medicare Locals and to harness the use of research and evidence to improve the planning, implementation and evaluation of preventive health initiatives.
  • Prioritizing functional capacity as a principal end point for therapies oriented to older adults with cardiovascular disease: A Scientific Statement for healthcare professionals from the American Heart Association, Forman D, Arena R, Boxer R, et.al., Circulation, Volume 135, Issue 12 (2017). This statement reviews the essential physiology underlying functional capacity on systemic, organ, and cellular levels, as well as critical clinical skills to measure multiple realms of function (e.g., aerobic, strength, balance, and even cognition) that are particularly relevant for older patients. Clinical therapeutic perspectives and patient perspectives are enumerated to clarify challenges and opportunities across the caregiving spectrum, including patients who are hospitalized, those managed in routine office settings, and those in skilled nursing facilities. Overall, this scientific statement provides practical recommendations and vital conceptual insights. Not only are strategies to better preserve physical capacity and to minimize declines important steps to reduce disease-related mortality and morbidity, but many older patients regard preserved function, independence, and related self-efficacy as their primary goals of care; that is, for many patients, conserved functional capabilities become more important than traditional disease-specific therapeutic end points. Exercise is an important component in preserving cardiorespiratory fitness, muscle strength, and neuromuscular function.
  • Raising Children Network (the Australian parenting website). This online resource provides information on the value of physical activity for young children (0 to 5 years), school-age children, older children and teenagers.
  • What is Sedentary Behaviour? Sedentary Behaviour Research Network (SBRN). This organisation provides evidence for health professionals which focuses specifically on the health impact of sedentary behaviour.

Research and Reading

  • 12 minutes more: The importance of physical activity, sports and exercise in order to improve health, personal Finances and the pressures on the NHS (PDF  - 1.6 MB), Lordan G, Pakrashi D and Jones A, Nuffield Health, UK (2013). This report cites current research that supports the value of sport and physical activity for long-term health benefits. The report also links sport and physical activity to personal financial and population-wide economic benefits. Realising the benefits of sport, exercise and physical activity does not require expensive structural change to the public sector or government legislation. We simply need a more exercise friendly environment and a change of attitude, asking ourselves ‘How do we get an extra 12 minutes of physical activity into our day?’
  • 2014 Consensus Statement from the first Economics of Physical Inactivity Consensus (EPIC) Conference, Vancouver (PDF  - 230 KB), Davis J, Verhagen E, Bryan S, et.al., British Journal of Sports Medicine, Volume 48, Issue 12 (2014). The 'Economics of Physical Inactivity Consensus Workshop' (EPIC) was held in Vancouver, Canada, in April 2011. Goals of the workshop were to: (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence, and; (4) provide insight into interpretation of economic evaluations. Investment decisions for promoting physical activity are based upon evidence and estimated return on investment. Program settings include schools, transportation systems, urban design, public education, primary care strategies, community programs and ‘sport for all’ initiatives. The economic burden of physical inactivity can be quantified in terms of health care costs and loss of productivity due to preventable or controllable diseases. Evaluation of evidence produced consensus on these points:
    • Physical inactivity is a well-established health problem.
    • The economic burden of physical inactivity accounts for 1–3% of total healthcare costs annually.
    • There is high-quality evidence to suggest that physical inactivity can be mitigated; thus costs can be saved.
    • It is currently difficult to determine how much can be saved. This is difficult to determine because of methodological challenges specific to conducting economic evaluations of physical inactivity interventions both at an individual and population level.
    • Further research must focus on alignment with decision-making priorities and use of cost-utility analysis methodology.
  • A Widening Gap? Changes in multiple lifestyle risk behaviours by socioeconomic status in New South Wales, Australia, 2002–2012, Ding D, Do A, Schmidt H and Bauman A, Plos One, published online (20 August 2015). Socioeconomic inequalities impact upon health outcomes and these inequities have increased over time in some countries. This study examined the trends in four individual health risk behaviours (insufficient physical activity, smoking, alcohol consumption, and insufficient fruit and vegetable intake) in the New South Wales population. Data was taken from the annual New South Wales Adult Population Health Survey during the period of 2002–2012. The study found significant downward trends overall in physical inactivity, 52.6% to 43.8% (i.e. less sedentary behaviour) and smoking, 22% to 17.1%. The improving physical activity levels in NSW appear to deviate from the national trend, which shows increased sedentary activity. Regression models examined whether the degree of absolute and relative inequalities between the most and least disadvantaged subgroups have changed over time. For physical inactivity, inequalities related to socioeconomic status remained. Substantial socioeconomic gaps in health behaviours and outcomes continue over time and no explicit quantifiable goals for reducing health inequalities (among the most disadvantaged) have been proposed.
  • The ABC of physical activity for health: A consensus statement from the British Association of Sport and Exercise Sciences (PDF  - 293 KB), O’Donovan G, et.al.,Journal of Sports Sciences, Volume 28, Number 6 (2010). The British Association of Sport and Exercise Sciences convened a panel of experts to review the literature and produce guidelines that health professionals might use.
  • An international perspective on the nexus of physical activity research and policy, Pratt M, Salvo D, Cavill N, Giles-Corti B, McCue P, Reis R, Jauregui A and Foster C, Environment and Behavior, Volume 48, Number 1 (2016). The process of translating research to policy is influenced by a complex interplay of factors. The authors contend that physical activity is the “best buy” in public health; yet widespread application of this evidence occurs infrequently, from an international perspective. Evidence on how to increase physical activity at the community level has mounted steadily over the past decades and many reports and papers conclude with calls for better translation of research into policy and practice. There are good examples of research guiding physical activity policy and practice, but more often public policy that influences physical activity is driven from outside a public health rationale. Policy decisions tend to be made independent of research and often use different data sets. Active living research may not always resonate with policy makers, but this does not suggest that research has no role in guiding public policy. Compounding the research-policy nexus is a lack of international consensus on which interventions are most effective. This report offers case studies from four countries – United Kingdom, Australia, Brazil and Mexico to illustrating the research-policy relationship. The authors conclude that in Australia the translation of research to policy has been facilitated by explicitly brokering the relationship across several sectors (e.g. health, sport/recreation, education, community development, etc.). As a result of this process there are many good examples in Australia of research findings systematically being incorporated into national, state, and local policy.
  • Australia’s health: being accountable for prevention, Moodie R, Tolhurst P and Martin J, The Medical Journal of Australia, Volume 204, Number 6 (2016). As a member state of the World Health Organization (WHO), Australia is committed to the global action plan for preventing and controlling non-communicable diseases (NCDs). This article reviews Australia’s progress against targets set in 2009 for reductions in NCDs by 2025. Australia has had some outstanding successes in areas such as reducing smoking (world leading practices), road trauma and heart disease. However, Australia lacks a sustained, comprehensive and strategic approach to prevention; there appears to be inadequate funding, coordination, and monitoring in areas that address alcohol consumption, physical inactivity and poor nutrition. With the exception of tobacco control, the data suggest there is insufficient progress being made in preventing and controlling risk factors for chronic diseases in Australia. NCDs have a high personal, social and national economic impact. If we seek to achieve significant reductions in the burden of chronic disease in Australia, sustained, comprehensive and courageous approaches are required.
  • Does physical activity moderate the association between alcohol drinking and all-cause, cancer and cardiovascular diseases mortality? A pooled analysis of eight British population cohorts, Perreault K, Baumann A, Johnson N, Britton A, Rangul V and Stamatakis E, British Journal of Sports Medicine, published online (31 August 2016). This study used data from eight population-based surveys in the United Kingdom, conducted from 1994 through 2006. A total of 36,370 men and women age 40 years and over were assigned to six alcohol consumption categories: never drinkers, ex-drinkers, occasional drinkers, within guidelines drinkers (differentiated by gender), hazardous drinkers, and harmful drinkers. Alcohol consumption was compared to three categories of physical activity: inactive (less than 7 MET-hours per week), low-active (greater than 7 MET-hours per week, with an upper limit of 15 MET-hours), and recommended-active (greater than 15 MET-hours per week). Incidence of cancer and cardiovascular disease was assessed by alcohol consumption and physical activity. The results indicate that alcohol consumption for 'within guideline' drinkers or higher, significantly increased cancer risk. However, this association was attenuated among individuals who met the recommended physical activity guidelines. Physical activity may offset some of the risk of cancer and all-cause mortality associated with alcohol consumption.
  • The dose–response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies, Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J, Deng Y, Chen Q, Wei S, Nie S and Liu L, British Journal of Sports Medicine, published online (18 September 2015). Physical activity is recommended by the World Health Organization (WHO) to combat the increasing risk of death from chronic diseases. A meta-analysis was conducted to assess the association between physical activity and cancer mortality and the WHO recommendations to reduce the latter. A total of 71 cohort studies met the inclusion criteria and were analysed. The meta-analysis supports the current physical activity recommendations from WHO to reduce cancer mortality in both the general population and in cancer survivors. The data infer that physical activity after a cancer diagnosis may result in significant protection among cancer survivors.
  • Estimating the future burden of cancers preventable by better diet and physical activity in Australia, Baade P, et.al., Medical Journal of Australia, Volume 196, Number 5 (2012).
  • Examining the relationship between sport and health among USA women: An analysis of the Behavioral Risk Factor Surveillance System, Pharr J and Lough N, Journal of Sport and Health Science, published online ahead of print (18 July 2016). This study examined the relationship between sport and women's health in the USA by analysing data from the Behavioral Risk Factor Surveillance System (BRFSS). Participants were questioned extensively about their physical activity behaviours and 76 different activities were identified and broadly categorised as: (1) sport; (2) conditioning exercise; (3) active recreation, and; (4) household tasks. Analysis of data was used to determine whether women who participate in sport reported fewer chronic conditions and better health than women who participated in other forms of physical activity. The core component of the BRFSS questionnaire includes questions that are asked of all respondents about their demographics, preventative health practices, chronic diseases, and health risk behaviours. The data showed that women who participated in sports had better health outcomes (i.e. self-reported good or excellent health) than women who participated in other forms of unstructured physical activity. Although women participating in sport, recreation or household tasks met or exceeded the recommended weekly aerobic exercise recommendations, the women in the sport group had significantly higher METs (i.e. a metabolic measure of exercise intensity) than the other groups. There were also significant differences between the groups on social and economic indicators; women who participated in sport had a higher percentage of college graduates in higher income categories. When demographic variables were statistically controlled for, many of the reported health differences remained. There were limitations with this study and causation cannot be determined. However, the large sample size and the findings from this initial study merit consideration and point to the need for additional research.
  • Exercise as treatment for alcohol use disorders: Systematic review and meta-analysis, Hallgren M, Vancampfort D, Giesen E, Lundin A and Stubbs B, British Journal of Sports Medicine, published online (January 2017). This review looked at studies investigating the effects of exercise for people with alcohol use disorders across multiple health outcomes. 21 studies representing 1,204 unique persons with an alcohol use disorder, mean age 37.8 years and mean illness duration 4.4 years, were included in this review. The available evidence indicates that exercise has no significant impact on reducing alcohol consumption. However, persons with an alcohol use disorder who exercised had significant improvements in other health outcomes, including less depression and improved physical fitness.
  • Getting Australia moving: establishing a physically literate and active nation (game plan) (PDF  - 2.32 MB), Keegan R, Keegan S, Daley S, Ordway C, Edwards A, University of Canberra, National Institute of Sport Studies (2011). Estimates put the cost of physical inactivity to the Australian economy at $13.8 billion per year, as a result of healthcare costs, lost productivity, and premature mortality. Australia needs to ensure its citizens are willing and able to be more physically active, and this can start at pre-school and primary school. Early years physical education (PE) is, by necessity, often delivered by teachers with limited training in PE; limited access to trained PE professionals, and severe constraints on time and resources. As a solution to this problem, this report presents the case for increasing physical literacy amongst children in Australia, with a view to promoting physical activity and healthy lifestyles. Physical literacy is distinct from sporting prowess, athleticism, cardiovascular fitness, or time spent being active, which are amongst a long list of positive outcomes produced by becoming physically literate from a young age. This report reviews the evidence for the above relationships and builds a physical literacy framework. Successful models from other countries are reviewed and evaluated and ten recommendations are made for any future Australian program for promoting physical literacy.
  • Health and Physical Education in Australia: A defining time? Penny D, Asia-Pacific Journal of Health, Sport & Physical Education, Volume 1, Issue 1 (2010). This paper explores the Health and Physical Education curriculum in Australia in the context of the ongoing development of a national curriculum. Attention is drawn to curriculum strengths that have emerged from state and territory based development, and the ongoing difficulties in reaching a national consensus.
  • Her life depends on it III: Sport, physical activity, and health and wellbeing of American girls and women (PDF  - 1.5 MB), Women’s Sports Foundation (2015). This comprehensive report reviews the content of over 1,500 studies (including nearly 400 additional references since the previous edition) and summarises existing and emerging research on the links between participation in sport and physical activity and the health and wellbeing of American girls and women. As with the previous editions in 2004 and 2009, this analysis confirms that physical activity and sport provide the critical foundation that allows girls and women to lead healthy, strong, and fulfilled lives.
  • Human development, occupational structure and physical inactivity among 47 low and middle income countries, Atkinson K, Lowe S and Moore S, Preventive Medicine Reports, Volume 3 (2016). This study assessed the relationship between a person's occupational category and their physical inactivity, within the context of a country’s Human Development Index (HDI) – a measure of economic development and degree of urbanization. During 2002-03 a World Health Survey was administered to over 196,000 participants in 47 low- and middle-income countries. Among these countries, HDI increases were associated (outside of the agricultural sector) with decreased levels of physical activity (i.e. more time spent in sedentary activity). This study is one of the first to adjust for within-country differences, specifically occupation while analysing physical inactivity. As countries experience economic development, changes are also seen in their occupational structure which may result in greater physical inactivity. The World Health Organization (WHO) identifies physical inactivity as the fourth leading risk factor for mortality throughout the world.
  • Interrelation of sport participation, physical activity, social capital and mental health in disadvantaged communities: A SEM-analysis, Marlier M, Van Dyck D, Cardon G, De Bourdeaudhuij I, Babiak K and Wilem A, Plos One, published online (9 October 2015). The present study aims to uncover how sport participation, physical activity, social capital and mental health are interrelated by examining these outcomes in one model. A cross-sectional sample from disadvantaged communities in Antwerp, Belgium were surveyed. Adults, aged 18–56 (N=414) were randomly selected and visited at home to fill out a questionnaire on socio-demographics, sport participation, physical activity, social capital and mental health. This study highlighted the importance of sport participation and individual social capital to improve mental health in disadvantaged communities. It further gives additional insights into the interrelated nature of these factors. Implications for policy are that cross-sector initiatives between the sport and the social and health sectors need to be directly linked to one another.
  • Investing in a healthy lifestyle strategy: is it worth it? Benmarhnia T, Dionne P, Tchouaket E, Fansi A and Brousselle A, International Journal of Public Health, published online (1 September 2016). The objective of this study was to evaluate the cost effectiveness of ‘healthy lifestyle habits promotion’ (HLHP) strategies. In 2010-11 an estimated $110 million was spent in Quebec on HLHP strategies. During the same time period direct healthcare expenditures associated with non-communicable disease risk factors were estimated at $4.16 billion; however, after adjusting for multiple risk exposures, the sum of all direct healthcare expenditures attributable to behavioural risk factors was estimated at $1.96 billion. Given the scope and complexity of the analysis, two models were constructed; one representing the resources, activities, and key effects of HLHP, and another depicting the chain of effects resulting from the adoption of healthy lifestyle habits. Also, the economic benefits (savings from disease avoidance) are assumed to occur 10, 15, or 20 years after the HLHP activities, time and population adjustments must be considered. Although it is difficult to change people’s lifestyle habits, investments in HLHP activities seem relatively small. The modeling used in this study indicate it is likely that even a small effectiveness in risk reduction will produce important long-term savings for the healthcare system. The financial risk of investing in HLHP is minimal when compared with the public cost of diseases associated with the targeted risk factors.
  • Participation in physical activity: A determinant of mental and physical health, Research Summary (PDF  - 261 KB), VicHealth (2010).
  • Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis, Mantzari E, Vogt F, Shemilt I, Wei Y, Higgins J and Marteau T, Preventive Medicine, Volume 75 (2015). Can financial incentives achieve sustained changes in health-related behaviours? This review looks at studies that used some form of financial incentive to achieve changes in four behaviours; physical activity, smoking, excessive eating and alcohol consumption. Over 24,000 published articles were identified, with 34 meeting the analysis criteria. The analysis indicated that financial incentives did increase behavioural change until 18 months from baseline and were significant three months post-incentive removal. However, the effectiveness of financial incentives in reducing long-term health risks was potentially limited, given the current evidence. Effects appear to dissipate beyond three months post-incentive removal.
  • Physical activity and type 2 diabetes (PDF  - 200 KB), Diabetes Australia fact sheet.
  • Physical activity, sports participation, and suicidal behavior among college students, Brown D, Blanton C, Medicine and Science In Sports And Exercise, Volume 34, Number 7 (2002). This study found that sports participation was protective against suicidal behavior among college students in the United States.
  • Physical education and physical activity: results from the School Health Policies and Programs Study 2006, Lee S, Burgeson C, Fulton J and Spain C, The Journal Of School Health, Volume 77, Number 8 (2007). This article describes the characteristics of school physical education and physical activity policies and programs in the United States.
  • Preventive health: How much does Australia spend and is it enough? (PDF  - 2.9 MB) Jackson H and Shiell A, La Trobe University Department of Public Health (2017). This report was commissioned by the Heart Foundation Australia; Kidney Australia; Alzheimer’s Australia, the Australia Health Promotion Association; and the Foundation for Alcohol Research and Education. Australia allocates approximately 1.3% of all health spending on prevention. While this is close to the average among OECD nations, it is substantially less than Canada, UK and New Zealand. The evidence suggests a strong case for increasing spending on preventive health programs. The proposed indicators of public health (i.e. the Australian Health Tracker) are grouped into four general categories – premature mortality risks, behavioural risk factors; biological risk factors; and other indicators (principally related to mental health issues that may have behavioural or biological origins). Physical inactivity is identified as a key behavioural risk factor, with the benchmark for achieving health outcomes being achievement of the age-related physical activity / sedentary behaviour guidelines. Although Australia does appear to spend less on preventive health than similar countries in the OECD, this fact alone is not enough to justify the need to spend more. Cost-benefit must be established to determine whether the outcomes of preventive health programs will exceed the benefits that investment in other health initiatives might return.
  • The relationship between sedentary behaviour and physical activity in adults: A systematic review (abstract), Mansoubi M, Pearson N, Biddle S and Clemes S, Preventive Medicine, Volume 69 (2014). This systematic review of published literature looked at the associations between sedentary behaviour and physical activity among adults aged 18 to 60 years. The most commonly assessed subtype of sedentary behaviours were television viewing, total sedentary time, total sitting time, general screen time and occupational sedentary time. All studied types of sedentary behaviour were associated with lower levels of physical activity in adults. 
  • Report Card, the wellbeing of young Australians (PDF  - 4.6 MB), Australian Research Alliance for Children and Youth (March 2013). This report compares the status of Australian children and youth (ages 5 to 24 years) against the Organisation for Economic Co-operation and Development (OECD) nations, and notes trends over time. In the section ‘what does it mean to be healthy’ the report states that 30 per cent of Australian children and youth are overweight or obese and 57 per cent do not achieve the recommended level of daily physical activity.
  • Sport, physical activity and antisocial behaviour in youth (PDF  - 592 KB), Morris L, Sallybanks J and Willis K, Australian Institute of Criminology Research, Public Policy Series, Number 49 (2003). This report presents the findings from a study commissioned by the Australian Sports Commission to investigate whether sport and organised physical activity programs have a positive effect on youth antisocial behaviour. Over 600 programs were studied. The evidence suggests that sport and physical activity programs can provide a useful vehicle through which personal and social development may occur, which positively impacts on potential antisocial behaviour.
  • Steps to solving inactivity (PDF  - 2.8 MB), UK Active (2014). Official government data to show that 29 per cent of people in England are classed as physically inactive, failing to achieve 30 minutes of moderate intensity activity per week. This report provides an evidence base on the link between physical inactivity and long-term health issues. It offers practical guidance on how to best prove the benefits of physical activity programs, so that successful programs can be continued and scaled up. A total of 952 physical activity programs receive some level of government funding in the United Kingdom; delivered through schools, workplaces, community groups, outdoor settings, and primary care venues. These programs reach 3.5 mission people annually. Recommendations made in this report include: (1) improve the collection, coordination and analysis of data through a single UK-wide framework; (2) increase investment into research on physical inactivity interventions in a number of settings; (3) establish a UK-wide framework that sets benchmarks across the physical activity sector; (4) encourage local government authorities to prioritise physical inactivity interventions as a public health issue; (5) integrate physical activity programs into planning across public health, social care, education, environmental and transport policies, and; (6) encourage all local Health and Wellbeing Boards to have a ‘physical activity champion’ who can coordinate and integrate programs across government portfolios.
  • Tackling Childhood Obesity - whose responsibility is it? (PDF  - 254 KB), British Association of Sport and Exercise Science, BASES (2011). In this discussion paper a number of experts look at the responsibilities of government, parents, schools, health care professionals, exercise scientists, and the corporate sector (food and drink companies) in the battle against childhood obesity.
  • Why is changing health-related behaviour so difficult? Kelly M and Barker M, Public Health, Volume 136 (July 2016). The authors suggest that six common errors are made in policies that prevent the successful implementation of health-related behaviour change in areas such as physical inactivity and poor diet. Behaviour takes place in social environments and efforts to change it must therefore take into account the social context, political and economic forces which act directly on people's health, regardless of any individual choices that they may make about their own conduct. The six errors are:
    1. An appeal to ‘common sense’ – by common sense the authors mean that understanding human behaviour is so obvious that it needs little or no serious analysis. The authors suggest that an appeal to common sense is not specific or grounded in evidence. If changing behaviour was simply about making common sense changes and good choices, then individuals would all be able to make changes themselves. This thinking ignores that human behaviour is the result of the interplay between habit, automatic responses to the immediate and wider environments, conscious choice and calculation, and is located in complex social environments and cultures.
    2. Changing behaviour is about getting the message across. This strategy, although strong on rhetoric, remains firmly located in simple non-evidence-based models of behaviour change in which messaging is the principal mechanism – if you get the message out there, people will respond to it.
    3. Knowledge and information drive behaviour. This model assumes is that if we tell people the negative consequences of eating too much or exercising too little, they will change their behaviour accordingly. However, giving people information does not necessarily make them change.
    4. People act rationally. This approach assumes that people act rationally to change their behaviour when provided with evidence. However, even where people are in possession of compelling information, behaviour change can be very difficult.
    5. People act irrationally. The converse to the above is equally true, people often have very unique reasons for their decisions – behaviours that persist tend to be functional for the individuals themselves. A decision to drive car for a short distance trip (over walking or cycling as a means of active transport) shows that one person's rationality is another's irrationality. Therefore, it’s important not to dismiss the explanations people give of what they do just because the epidemiological evidence demonstrates that what they do carries a health risk.
    6. It is possible to predict accurately. The final common mistake in designing public policy is to assume that we can predict the result. Even in the most carefully designed models, a great deal of variance in individual behavioural outcomes exists. Public health policy is often driven by a naïve desire to predict things (i.e. if we run campaigns using simple words that people will understand about their choices, then they will change their behaviour for the better); rather than understanding what led to the current behaviour in the first place. Prediction is simple; it is far less effective and accurate than unravelling the cause.
  • Youth Sports: Implementing findings and moving forward with research, Fraser-Thomas J and Cote J, Athletic Insight, The Online Journal of Sport Psychology, Volume 8, Issue 3 (2006). This paper reviewed the literature on youth sport programs, within a framework of positive and negative outcomes. While youth sport programs are generally assumed to foster positive youth development, improved health, and psychosocial skills leading to lifelong sport participation, this is not always the case. Programs have a greater probability of achieving positive long-term outcomes when they initially focus on deliberate play activities, enjoyment, multi-skill development and the sampling of various activities. Sports participation can eventually promote the development of self-regulation, decision-making skills, and feelings of competence in children. These outcomes are important to future self-determined behaviour and lifelong activity.

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