Joint strategic needs assessment

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Topic titlePhysical Activity
Topic ownerRachel Sokal
Topic author(s)Duncan Goodall
Topic quality reviewedApril 2016
Topic endorsed byHealthy weight. Feb 2016
Topic approved by
Current versionApril 2016
Replaces version2012
Linked JSNA topicsObesity, Diet and Nutrition
Insight Document ID84106

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Executive summary

Introduction

Back up to the contents

Physical inactivity is a global public health problem.  Promoting an active lifestyle is a simple answer to many of the big health challenges facing our country. “Increasing physical activity has the potential to improve the physical and mental health of the nation, reduce all-cause mortality and improve life expectancy.” (Department of Health, 2011)

The largest gains are demonstrated in those who go from doing nothing to doing something and so promoting physical activity can save the NHS money and significantly ease the burden of chronic disease on public services.  It is everyone’s responsibility to be creative in encouraging an increase in physical activity at all stages in life.  These can be offered not just by sporting activity but also through a plethora of activities such as active travel, dance, gardening and encouraging use of exercise in a natural environment.

“Around one in two women and a third of men in England are damaging their health through a lack of physical activity.” (Public Health England, 2014).  From the Active People Survey in 2015 only 62.7% of male adults met the criteria for weekly physical activity compared to 67% in 2012.  The female rate is also down from 55% to 51.7%. Nottingham is comparable to the national average of 57% with a value of 56.5%.

There continues to be health inequalities nationally and locally.  Inequalities are demonstrated according to income, gender, age, ethnicity and disability.

Physical activity:

  • is higher in men at all ages
  • declines with increasing age for both genders and drops significantly for those over 65yrs
  • levels amongst children tend to drop off with the transition from primary to secondary school, particularly amongst girls.
  • amongst adults, is lower in Pakistani and Indian adults than the general population
  • is lower for people who have a long standing illness or disability.
  • Is lower in low-income household groups than in high-income household groups.

Physical inactivity in England is estimated to cost £7.4 billion a year. This includes both the direct and indirect costs.  The direct cost includes treating major, lifestyle-related diseases such as heart attacks, strokes, diabetes and falls. The indirect cost includes cost of sickness absence and the costs of social care arising from loss of functional capacity. 

Definition of Physical Activity:

 “Any force exerted by skeletal muscle that results in energy expenditure above resting level”.

Examples of physical activity include lifestyle activities such as active transport and play, sport and recreational activities, household chores and gardening (Department of Health, 2004). 

Physical Activity Diagram

Physical Activity Definition Diagram (Department of Health, 2009)3

 

Physical inactivity is defined as undertaking less than 30 minutes of physical activity a week.

Sedentary behaviour refers to activities that do not increase energy expenditure substantially above the resting level and includes activities such as sleeping, sitting, lying down, and watching television.

Physical Activity recommendations for health

In July 2011 Start Active, Stay Active: A report on physical activity from the four home countries’ Chief Medical Officers was released. This was “A UK-wide document that presents guidelines on the volume, duration, frequency and type of physical activity required across the life-course to achieve general health benefits.”  These are simplified for the physical activity levels below.  The full recommendation is in appendix 2 and includes the advice on muscle strengthening, balance and coordination and sedentary behaviour. This standardised the recommendations for physical activity across the UK.

Early years (under 5s)

  • 180 minutes per day spread throughout the day of physical activity

Children and young people (5-18years)

  • At least 60 minutes per day of moderate to vigorous activity

Adults (19-64years)

  • 150 minutes per week moderate activity or 75 minutes per week of vigorous

Older adults (65+ years)

  • 150 minutes per week moderate activity or 75 minutes per week of vigorous

Further national input with “The All Party Commission on Physical Activity report Tackling Physical Inactivity - A Coordinated Approach” (2014) offered five recommendations:

  1. A national action plan
  2. Getting the message out
  3. Designing physical activity back into our everyday lives
  4. Making physical activity a lifelong habit
  5. Proving success

Everybody active, every day report from October 2014 was further national input produced by Public Health England.

  1. Active society: creating a social movement
  2. Moving professionals: activating networks of expertise
  3. Active environments: creating the right spaces
  4. Moving at scale: scaling up interventions that make us active

Local action, to increase physical activity, in Nottingham has been coordinated with the Nottingham Plan and health and wellbeing boards.  They have recognized that having a healthy and active Nottingham is one of the cornerstones of the “overall strategic direction and long-term vision for the economic, social and environmental wellbeing of Nottingham.”

This chapter will look at how these strategies in Nottingham are delivering locally and how we can reverse the trends of increasing inactivity seen across the city.

Unmet needs and gaps

Back up to the contents

Since the last JSNA in 2012 there has not been a fundamental change in the areas of need in regard to physical activity.  National figures continue to suggest that future planning and commissioning should continue to focus and target those who are most likely to be physically inactive.  Broadly speaking they continue to be:

  • Women of any age
  • People >65years of age
  • The BME community
  • People living with a long term illness or disability
  • Those people living in the most deprived areas

Current provision needs to be strengthened for all at risk groups.

Women of any age in Nottingham

  • This Girl Can has recently started in the Nottingham area but it is too early to assess its success.

People >65 years of age

  • 11.8% of Nottingham population.  This is less that the National average.
  • Do national statistics match Nottingham statistics in this age group?
  • In the short to medium term, the City is unlikely to follow the national trend of seeing large increases in the number of people over retirement age, although the number aged 85+ is projected to increase. 

BME community

  • 35% from 2011 which is an increase from 19% in 2001
  • People from Pakistani and Indian communities have lower physical activity levels than the general population.  Particularly for women. Therefore addressing inequalities in access to physical activity interventions should particularly focus on these groups.

Disability

  • Pledge of Nottingham Council 2015-2019 to make Nottingham the fastest growing city for disability sport
  • The same importance should be placed on people with a disability who are looking to access physical activity services and not just those in high level disability sport

Long term conditions

  • Incorporating physical activity provision in the care pathways for the management of long term conditions
  • The importance of increased physical activity in pathways involved with population health and wellbeing

Most deprived areas

  • Have the lowest levels of physical activity and the highest levels of morbidity and mortality.
  • How do services in these areas correspond to need?
  • The proportion of participants meeting the current UK guidelines for aerobic activity increased as equivalised household income increased.  Therefore addressing inequalities in access to physical activity and sports clubs should also focus on this.

Other gaps identified

Children and Young People

Children under 5 - the 2011 guidelines were the first to make specific recommendations for children under 5.  The only information on uptake in this group comes from the Health Survey England 2012. 

  • We have no information of local values from Nottingham for this age group. 

Children 5-18

  • Nottingham statistics for physical activity, access to school Physical Education and sports participation require updating.

Male participation

  • Has been shown to be on the decrease from 28% to 21% in children 5-18 (2008-12)
  • The patterns of physical activity established in childhood continue in to adulthood and inactive men are at a higher cardiovascular risk

Adults

  • Usage of local leisure facilities and whether services meet the needs of the population
  • Access to local parks and open spaces
  • The Local Sustainable Transport Fund (LSTF).  The full impact evaluation of the programme is currently being carried out and will be finalised in early 2016
  • With a range of partners taking actions to increase physical activity – this may not be co-ordinated or the impact being monitored
  • The level of unmet need needs to be balanced with evidence of improving outcomes and value for money

A number of current commissioned services perform well to target and some exceed target. Other services like best foot forward and cycling for health through ridewise have not met targets for 2014/15.

Mental Health and Wellbeing

  • People with poor physical health are at higher risk of experiencing mental health problems.
  • Services should integrate prevention, mental wellbeing and lifestyle modification throughout a person lifetime.

Recommendations for consideration by commissioners

Back up to the contents
  1. Ensure Health and Social Care staff deliver evidence based messages and that “Physical Activity recommendations for health” are used to promote consistent messages concerning physical activity levels
  2. Frontline Sport and Leisure staff have access to training and CPD assessment in the promotion of physical activity
  3. Reduce sedentary rates at nursery and at home by education of families and frontline staff of the importance of active play
  4. Use transition periods from primary to secondary school and on to further education as key opportunities to promote active travel behaviour as part of increasing travel independence
  5. Access to high quality PE and monitored as part of local Education Improvement Strategies
  6. Remove barriers to physical activity amongst girls and young women and monitor the outcomes of This Girl Can strategies that have just started
  7. Ensure activities for teenage boys are provided and promoted
  8. Target small-scale infrastructure improvements (e.g. walking and cycling routes, street lighting, cycle parking) in areas where communities have low levels of physical activity to create safer walking and cycling environments allowing people to walk and cycle as part of their everyday lives.
  9. Ensure active travel options are at the forefront of transport plans and are targeted in areas where low physical activity exist
  10. Commission physical activity services for mental and physical health conditions with equal access for service users with a disability
  11. Review the evaluation and share learning regarding successful interventions for promoting active travel from the Nottingham Urban Area Local Sustainable Transport Fund programme
  12. Continue to target and engage inactive people from the priority groups – people >65 years, BME communities, people with disability and long term conditions using the health hub as a central point
  13. Signpost the use of healthy change hub as a central point for lifestyle services and encourage increased use and link with Community Smarter Travel Hubs activities to support travel behaviour changes
  14. Carry out local assessment of the physical activity on referral schemes during the healthy lifestyle review.
  15. Increase the range of options for maintenance of physical activity on completion of the 12 session course, for example subsidised membership at a wider range of facilities and promotion of parks and open spaces
  16. Incorporate the promotion of physical activity in management of medical conditions and consider increasing provision of physical activity in care pathways
  17. Brief interventions training in physical activity provider contracts
  18. Encourage business to have policies that provide facilities to staff to use active travel and encourage physical activity in the workplace
  19. Encourage schools and colleges to provide facilities for staff and students to use active travel and encourage physical activity
  20. Ensure equal access to opportunity and services for physical activity for disabled people

What do we know?

1. Who is at risk and why?

Back up to the contents

The health benefits of physical activity

Physical inactivity is currently known to be the fourth leading risk factor of global mortality (WHO, 2010). The leading risk is high blood pressure, followed by tobacco use and high blood glucose.  Many of the leading causes of ill health, such as coronary heart disease, cancer and type 2 diabetes could be prevented if more inactive people were to become active (WHO, 2010).

It is important to note the impact of physical activity is not exclusively linked to a specific condition or disease but can positively impact on a variety of conditions and risk factors simultaneously.

People who do regular physical activity have: (NHS Choices, 2015)

  • up to a 35% lower risk of coronary heart disease and stroke
  • up to a 50% lower risk of type 2 diabetes
  • up to a 50% lower risk of colon cancer
  • up to a 20% lower risk of breast cancer
  • 30% lower risk of early death
  • up to an 83% lower risk of osteoarthritis
  • up to a 68% lower risk of hip fracture
  • a 30% lower risk of falls (among older adults)
  • up to a 30% lower risk of depression
  • up to a 30% lower risk of dementia

There is a clear causal relationship between the amount of physical activity people do and all-cause mortality. While increasing the activity levels of all adults, who are not meeting the recommendations, is important targeting those adults who are significantly inactive will produce the greatest reduction in chronic disease.  This is crucial from a public health point of view.

The benefits of physical activity are not just noted with the above health improvements. Physical activity and sport is seen as making a significant contribution in diverse areas such as social inclusion, regeneration, community safety, crime reduction and lifelong learning (Nottingham Council 2008).  These areas help fight the negative impact of health inequalities.

Health costs and benefits for physical activity

  • From a public health perspective, helping inactive people to move to a moderate activity level will produce the greatest reduction in risk of ill health (Department of Health, 2009)
  • Physical activity in children under 5s not yet walking - develops motor skills, improves cognitive development, contributes to a healthy weight, enhances bone and muscular development, supports learning of social skills (Department of Health, 2011)
  • Physical activity in children under 5s walking - improves cardiovascular health, contributes to a healthy weight, improves bone health, supports learning of social skills, develops movement and co-ordination (Department of Health, 2011)
  • Physical activity in children and young people 5-18 - improves cardiovascular health, maintains a healthy weight, improves bone health, improves self-confidence, develops new social skills (Department of Health, 2011)
  • Physical Activity in adults 19-65yrs - reduces risk of a range of diseases, e.g. coronary heart disease, stroke, type 2 diabetes, helps maintain a healthy weight, helps maintain ability to perform everyday tasks with ease, improves self-esteem, reduces symptoms of depression and anxiety (Department of Health, 2011)
  • Physical Activity in adults >65yrs - helps maintain cognitive function, reduces cardiovascular risk, helps maintain ability to carry out daily living activities, improves mood and can improve self‐esteem, reduces the risk of falls. (Department of Health, 2011)
  • A positive association exists between academic attainment and physical activity levels of pupils (Public Health England, 2014)
  • Sport and physical activity can contribute to general positive health practices (e.g. non-smoking, healthy diet, etc.) as well as to the prevention of problematic behaviours such as early teenage pregnancies and antisocial or violent behaviour (WHO, 2011).
  • There is strong evidence that physical activity can make a fundamental difference to disabled people’s quality of life and it can increase independence (Disability Sport, 2015)
  • On average, an inactive person spends 38% more days in hospital than an active person, and has 5.5% more GP visits, 13% more specialist service and 12% more nurse visits than an active person (Sari, 2008)
  • Physical inactivity in England is estimated to cost £7.4 billion a year. These costs are predicted to rise. (Public Health England, 2014)

Children and young people

Physical Activity

  • In both boys and girls in England the proportion of children aged 5 to 15 years meeting recommendations fell between 2008 and 2012. (Health Survey England, 2012)
  • Between 2008 and 2012 surveys the CMO guidelines for physical activity were introduced.  For the first time, guidelines were published for children under 5.
  • Children aged 2-4yrs (based on 2012 Health Survey for England (HSE) the self-reported questionnaire of boys and girls participating in at least three hours of physical activity per day.)
    • 9% males met the guidelines
    • 10% females met the guidelines
    • This can not be compared to the figures from 2008 that used the old guidelines of one hour per day for children at this age

HSE 2012 – proportion of children meeting physical activity recommendations

HSE 2012

  • The gender gap begins at primary school and increase with age
  • Among both sexes the proportion of older children meeting the guidelines was lower than for younger children
  • 51% of girls are put off physical activity by their experiences of sport and PE at school (Woman Sport and Fitness Foundation, 2012)

Children meeting physical activity recommendations, by age, England 2008 and 2012

Children Physical Activity

  • For children 5-15 a higher proportion of boys than girls (21% and 16% respectively) were classified as meeting the CMO guidelines of at least one hour of moderate activity per day.
  • Males 5-15yrs dropped from 28% to 21% from 2008-20012
  • Females 5-15yrs dropped from 19% to 16% from 2008-2012
  • The largest declines were at age 13 to 15 years for both genders
    • Males from 28% in 2008 to 14% in 2012
    • Females from 14% in 2008 to 8% in 2012
  • There was no significant variation by equivalised household income in the proportion of children aged 5-15 achieving current recommendations

Physical Inactivity (HSE, 2012)

  • Aged 2-4 years
    • 85% of males can be classed as having low activity levels.
    • 83% of females can be classed as having low activity levels.
  • Aged 5-15 years
    • 39% male have low activity levels
    • 45% female have low activity levels

Sedentary Lifestyle (HSE from 2008-2012)

  • Average total sedentary time (excluding time at school) was similar for boys and girls
    • weekdays (3.3 hours and 3.2 hours respectively) 
    • weekend days (4.2 hours and 4.0 hours respectively).
  • Among children aged 2-10, mean number of sedentary hours on a typical weekday
    • Decreased from 3.0 hours to 2.9 hours for boys
    • Decreased from 3.0 hours to 2.8 hours for girls.
  • Among children aged 11-15, mean number sedentary hours on weekend day
    • Increased from 4.8 hours to 5.0 hours for boys
    • Decreased from 4.8 hours to 4.5 hours for girls
  • For both boys and girls, as household income decreases, the average number of hours spent watching TV increases

Active Travel

  • In the 2014 National Travel Survey,
    • 31% of all trips are undertaken by walking
    • Bicycle use by boys continues to be treble that of girls
    • The most common mode of transport to school was walking with 42 per cent of trips and the proportion of trips made by car was 34 per cent.
    • The proportion of children walking to school continues to fall.  In 2006, 52% of children aged 5-10 and 41% of those aged 11-16 walked to school, compared with 46% and 38% in 2014.
    • When distance to school is less than 1 mile however 80% aged 5-10 and 90% aged 11-16 walked.
    • Around 2% of children aged 5-10 and 3% of children aged 11-15 cycled to school
  • Health Survey for England 2012: Physical activity and fitness.
    • Participation in active travel on at least one day in the last week.
    • Boys (2-15yrs): walking 64%, cycling 6%
    • Girls (2-15yrs): walking 67%, cycling 1%

Sport

  • Taking Part Survey 14/15
    • 5-10 year olds that have done any sport (out of school data only)
      • in past 4wks 81%
      • in past week 69%
    • 11-15 year olds that have done any sport (both in and out of school data)
      • in past 4wks 95%
      • in past week 90%
  • Health Survey for England 2012
    • Among both girls and boys, 85% participated in informal sports and exercise at least once in the past week.

Participation on at least one day in the last week (England 2012)

 

Male

Female

Any type of physical activity

93%

92%

Walking

52%

54%

Informal Activity

85%

85%

Formal Sport

48%

38%

 

  • The number of young people participating in sports and exercise on at least one day increased according to income level.
    • Male from 1.2hrs in lowest quintile to 2.1hrs in highest income quintile
    • Female from 0.6hrs in lowest quintile to 1.6hrs in highest income quintile

Youth Sport Trust’s National PE, School Sport and Physical Activity Survey Report January 2015.  Some key results presented as below

  • The average number of minutes spent taking part in PE in a typical week.  2013/14
    • 102 for Key Stage 1.
    • 114 for Key Stage 2.
  • Respondents to a similar question in the 2009/10 survey indicated higher values of
    • 126 minutes in Year 1 and 2 (Key Stage 1) and
    • 127 minutes in Year 3, 4, 5 and 6 (Key Stage 2).
  • The 2013/14 survey found that on average pupils across all Key Stages were offered less than two hours of PE per week.
  • The 2013/14 survey found that on average schools had 5 links with community (or other) sport clubs. While the 2009/10 survey found that on average schools have 9.1 sport or activity links to clubs.

Adults

Physical Activity

Health Survey for England 2012

(The HSCIC is currently running a consultation on this report that will close on 8 January 2016)

  • New physical activity guidelines were introduced in 2011, and the HSE 2012 provided the first opportunity to measure the extent to which adults meet them
    • Occupational activity questions were introduced in 2008 to capture more accurate information about physical activity while at work.
    • In 2012 new additional questions on occupational activity and walking were introduced
  • In the HSE 2008, 39% of men and 29% of women aged 16 and over met the previous physical activity recommendation of 30 minutes or more per day of at least moderate intensity activities on at least five days per week
    • 65% of men and 53% of women would have met the new guidelines
    • This is thought to be related to being able to accumulate the minutes in 10minute bouts of activity and being able to count different combinations of duration and frequency to reach 150mins
  • In 2012, 67% of men and 55% of women aged 16 and over met the physical activity guidelines of 150min per week of moderate activity or 75mins per week of vigorous intensity.
  • Since the introduction of the new recommendations in 2011, there are no long‐term trends for individuals achieving these physical activity targets.
    • In England, the 2008 data have been reanalysed to measure against the 2011 recommendations.
    • This shows that there was no overall change between 2008 and 2012
  • The proportion of adults meeting the guidelines generally decreases with age (see graph below)

An image

Muscle strengthening

  • Also from the 2011 recommendations people should “undertake physical activity to improve muscle strength on at least two days a week.”
    • 34% of men and 24% of women aged 16 or over met this guideline
    • There is a sharp decline in this type of activity as age increased
  • Meeting both the aerobic and muscle-strengthening guidelines for physical activity among adults aged 16 and over
    • Men (33%) 
    • Women (23%)

Household Income

  • The proportion of participants meeting the current UK guidelines for aerobic activity increased as equivalised household income increased.
    • Male from 55% in lowest quintile to 76% in highest income quintile
    • Female from 47% in lowest quintile to 63% in highest income quintile

Exercise and Obesity

  • There was a clear association between meeting the guidelines for aerobic activity and body mass index (BMI) category.
    • Not overweight : 75% of men and 64% of women (meeting guidelines)
    • Overweight : 71% of men and 58% of women
    • Obese : 59% of men and 48% of women  

Obesity (Lavie, 2015) – see obesity chapter

  • Data suggest that metabolically healthy obesity, especially when combined with a high level of fitness, is associated with at most a minimal increase in overall risk of cardiovascular diseases and mortality

Dose Response

Dose Response

Source: Department of Health (2004) at least Five a Week: evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer

  • Helping people move from inactivity to low or moderate activity will provide the greatest benefit.

Balance and coordination

  • Also from the 2011 recommendations “Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week”
  • The proportion of older participants who met this guideline increased as levels of aerobic activity increased.
    • Those who met the guidelines for aerobic activity: 31% male, 22% female
    • Low/some levels of aerobic activity: 9% male, 10% female
    • Inactive: 3% male, 2% female

Active People Survey Jan 2014 – Jan 2015

  • 57% of adults achieved 150+ minutes of activity
    • 62.7% males
    • 51.7% females
  • 47.4% of Asian people achieved 150+ minutes of activity
  • Those with a limiting disability were in general less active
    • 34% achieved 150+ minutes

Occupational related physical activity

  • Self-rated physical activity at work
    • 61% male, 57% female describe being very or fairly physically active at work

Non occupational activity

  • Overall men averaged 388 minutes (6.5 hours) and women 324 minutes (5.4 hours) in any non-occupational physical activity per week.
  • Men spent more time than women in heavy manual/gardening/DIY activities and sports/exercise.
  • Women spent more time in heavy housework
  • Both sexes spent similar amounts of time walking

Physical Inactivity

  • 23.8% of male adults >16yrs have low activity levels
  • 31.5% of female adults >16yrs have low activity levels
  • 45.3% of adults >65yrs have low activity levels
  • 33% Asian people have low activity levels
  • Those with a limiting disability were in general less active
    • 50% achieved <30 minutes

Sedentary Lifestyle (BHF, 2015)

  • Average total sedentary time is generally greater on weekends than weekday for both male and female
  • Levels of sedentary behaviour tends to increase with age
  • Men were more likely than women to average six or more hours of total sedentary time.
    • Weekday (31% and 29% respectively)
    • Weekend days (40% and 35% respectively).
  • The average numbers of sedentary hours spent per weekday and weekend day were lower in 2012 for both men and women compared to 2008.
    • Weekday
      • Male: Decreased from 5.0hrs to 4.9hrs
      • Female: Decreased from 5.0hrs to 4.7hrs
    • Weekend days
      • Male: Decreased from 5.6hrs to 5.4 hrs
      • Female: Decreased from 5.3hrs to 5.1hrs
  • People from low socioeconomic status groups tend to be more sedentary than higher socioeconomic groups
  • For all age groups of adults aged 25 and older, more than half of the total sedentary time was spent watching television.

Active Travel

  • In the 2014 National Travel Survey walking and cycling accounted for 22% and 2% of trips respectively compared with 64% with cars
  • Walking trips have fallen significantly over time from 292 trips per person per year in 1995/97 to 200 trips in 2014, a 31 per cent decrease.
  • People who are unemployed and other inactives make more walking trips on average
  • 65% of people aged 5+ use a bicycle less than once a year or never
  • Sustrans report 2013 on the usage of the National Cycle Network
    • Usage of the cycle network increased by 7% to 748million between 2012 and 2013
    • In England that equates to 38million more journeys made by foot and bike in 2013
    • Over a quarter (27%) of journeys were to work

Sport and active recreation - Active People Survey from Sport England

  • The number of adults who play sport at least once a week is on the rise
  • 15.5 million adults now play sport at least once a week. That’s 1.4 million more than in 2005/6
  • Most adults – 58% – still do not play any sport
  • 35.5% population do one session of sport per week
  • Gender
  • 40.6% of men play sport at least once a week
  • 30.7% of women play sport at least once per week
  • At a younger age, men are much more likely than women to play sport.  This difference declines sharply with age.
  • Age
  • 54.8% of 16-to-25-year-olds take part in at least one sport session a week
  • 31.9% of older adults (>26) take part in at least one sport session a week
  • Socio-economic groups
  • Take-up is highest among managerial/professional workers and intermediate social groups. It is lowest among manual workers and unemployed people. 
  • Ethnicity
  • The number of both black and minority ethnic and white British adults playing sport is increasing.
  • Disability
  • More disabled people are taking part in sport – latest results show 17.2% are playing sport regularly, up from 15.1% in 2005/6.
  • Numbers
  • 9.6 million people (16 plus) are members of a sports club – 22% of the English population.
  • Around 6.9 million people (16 plus) received sports coaching in 2014/15 (a decline from 2005/6
  • 5.9 million took part in competitive sport (a decline since 2005/6)
  • There are also 5.6 million people (16 plus) who volunteer regularly in sport

Wellbeing (HSE, 2012)

  • Participants who met government guidelines for the recommended levels of physical activity had higher well-being scores, on average, than others.
    • Physically active people had average well-being scores of 53.6 for men and 53.5 for women,
    • Inactive people had average well-being scores of 50.0 for men and 49.1 for women

2. Size of the issue locally

Back up to the contents

This section looks to use the above national data and compare these figures to the population of Nottingham.  It also uses these figures to estimate the scale of the problem in target groups that may not have specific local results documented.

  • The latest estimate of the City’s resident population is 314,300 (Nottingham City Council, 2015)
    • Children aged 0-4             20,900
    • Children aged 5-15           37,200
    • Working age 16-64           219,100
    • Older age 65+                   37,000
  • The 2011 Census shows 35% of the population as being from BME groups; an increase from 19% in 2001
  • Nottingham is ranked 8th most deprived district in England in the 2015 Indices of Multiple Deprivation (IMD), a relative fall from 20th in the 2010 IMD
  • Health and Disability is the Indices of Deprivation domain on which Nottingham does worst
  • 34.2% of children and 25.8% of people aged 60 and over are affected by income deprivation
  • A higher proportion of people aged 16-64 in Nottingham claim some form of benefit than regionally and nationally.
  • The unemployment rate is lower than the recent peak in March 2012, but remains higher than the regional and national average.

With knowledge of these above city factors and what we know about physical activity from what was presented above including

  • The number of young people participating in sports and exercise on at least one day increased according to income level.
  • The proportion of participants meeting the current UK guidelines for aerobic activity increased as equivalised household income increased.
  • People from low socioeconomic status groups tend to be more sedentary than higher socioeconomic groups
  • 47.4% of Asian people achieved 150+ minutes of activity

It would seem likely that Nottingham would have great need for improving its citizen’s physical activity.

Children and Young People

  • Using the national proportions from the HSE 2012 and estimating using Nottingham population figures
    • Children < 5 years old boys and girls (9% and 10% respectively) were participating in at least three hours of physical activity per day
      • 2,090 meeting the recommendations
      • 18,810 not meeting the recommendations
    • For children 5-15 a higher proportion of boys than girls (21% and 16% respectively) were participating in at least 1hrs physical activity per day
      • 5952 – 7812 meeting the recommendations
      • 29,388 – 31,284 not meeting the recommendations
  • Age-standardised physical activity levels among children in the East Midlands
    • For children 5-15
      • 25% males and 16% females were active (at least 60minutes on all 7 days per week)
      • 40% males and 38% females did some activity (30-59 minutes on all 7 days)
      • 35% males and 46% females were low activity (<30 minutes)
      • 13,020 – 17,112 children aged 5-15yrs do less than 30 minutes moderate physical activity per day

There is no data to indicate how accurate this is locally in Nottingham

Children in Poverty

  • The number of young people participating in sports and exercise on at least one day increased according to income level.
    • Note high proportion of children under 16 in poverty
    • It may be expected then that Nottingham figures would be less that National figures for participation but we don’t know how accurate this is locally.

Walking and cycling (Nottingham City Council, 2011)

  • In 2011 Nottingham had the highest level of walking to school out of the Core Cities but there have not been any updated figures since then.

Adults

  • Using the national proportions from the Active People Survey 8
    • Adults aged >16years in Nottingham 56.5% had 150+ physical activity per week (256,100 citizens in this age group)
      • 144,697 meeting the recommendations
    • National average is 57%
      • 145,977 expected to meet recommendations
    • Adults aged >16years in Nottingham 29.1% did <30 minutes
      • 74,525 citizens are inactive
      • This is a very important group for public health and prevention strategies
  • Using the national proportions from the HSE 2012
    • Adults aged >16yrs doing >150 minutes per week Male 67% Female 55%
      • 140,855 - 171,587 meeting the recommendations
      • 61% gives an expected value of 156,221 citizens meeting the recommendations
    • Adults aged >16yrs doing <30 minutes per week Male 19% Female 26%
      • 57,623 citizens are inactive
  • Age-standardised physical activity levels among adults in the East Midlands
    • Adults aged >16yrs doing >150 minutes per week Male 66% Female 57%
      • 157,501 meeting the recommendations

This would appear to show that Nottingham is following national trends for meeting physical activity.  However we know that Nottingham has a young age structure and “28% of the population are aged 18 to 29” (Nottingham Council, 2015).  From the active people survey meeting the guidelines of 150 minutes per week in the 16-18 and 19-34 year age groups was 72.8% and 65.5% respectively.  This compares with national average of 57% across all ages.  Also within Nottingham of the 314,300 citizens 37,000 are over 65.  This represents 11.8% of the population.  This compares with the national average of 17.7% of the population aged 65 and over.  We again know from Active People survey 8 that only 39.9% of people over 65 undertake >150 minutes per week.  You would then expect that Nottingham with a higher proportion of people in the most active age group and a low proportion of people in the less active age group that the overall physical activity level would be greater than the national average.  From the current data it would appear that this is not the case. 

Sport and active recreation

  • Adult participation in sport and active recreation (NI8) in Nottingham.
    • The percentage of the adult (age 16 and over) population in a local area who participate in sport and active recreation, at moderate intensity, for at least 30 minutes on at least 12 days out of the last 4 weeks (equivalent to 30 minutes on 3 or more days a week).
    • APS7 Q3/APS9 Q2 (April 2013 - March 2015)
      • 23.2% all adults
      • 28.2% male
      • 18% female
      • 21.2% white
      • 29.2% BME
  • Change between APS1 (Oct 2005-Oct 2006) and APS7 Q3/APS9 Q2 (April 2013-March 2015)
    • A 2.5% increase but not significant
  • Number of days participation in the last 28 days
    • 51.2% had none
    • Using 256,100 citizens in this age group
      • 131,123 had no participation in sport or active recreation in the past 28 days

Sport England - the sports participation indicator measures the number of people aged 16 and over participating in at least 30 minutes of sport at moderate intensity at least once a week.

  • APS8 Q3 - APS9 Q2 (Apr 2014 - Mar 2015)
    • National : 35.5%
    • East Midlands : 34.6%
      • Statistically significant change from APS 1
    • Nottingham : 35.6%
      • No change from APS 1

Sport and active recreation is important areas for improving physical activity but may only play a small part in most people’s lives.  It may be more important then to continue to encourage physical activity as part of our everyday lives.

Adult walking and cycling

From the Big Idea – Greater Nottingham Local Transport Survey 2015.  A small local survey with sample size of 2000.

Local Transport Survey

These trends show the sustained growth in cycling although the figures are from a small sample size.

Taken from LTP Annual Report 2014/15

LTP

Cycling Index

3. Targets and performance

Back up to the contents

This section examines public health outcomes in relation to active and inactive adults.  It also examines statistics for early CVD mortality and life expectancy comparing Nottingham, East Midlands and England.

Public health outcomes

2.13i

Nottingham has a comparable level of active adults (56.5%) with England (57%) levels but only Leicester city has a lower rate within the East Midlands.

2.13ii

Nottingham has a comparable level of inactive adults with 29.1% of adults inactive and England levels of 27.7%.

Life expectancy at birth in Nottingham (ONS, 2012-14)

  • Male
    • Nottingham 77.1yrs (2.4yrs lower than England)
    • England average 79.5yrs
    • Rank 329 out of 346 regions
    • Health life expectancy at birth 2011-13 is 58.8 (England 63.3)
  • Female
    • Nottingham 81.6yrs (1.6yrs lower than England)
    • England average 83.2yrs
    • Rank 312 out of 346 regions
    • Health life expectancy at birth 2011-13 is 59.8 (England 63.9)

4.04ii

Source: PHOF

  • The directly standardised rate of early CVD mortality under 75 has come down in the past decade.
    • 2001-03: 129 per 100,000
    • 2012-14: 73.5 per 100,000
  • Although it has come down it remains above both the East Midlands local authority average and the national England figures
    • East Midlands 51.8 per 100,000
    • England 49.2 per 100,000

Strategic approach

One of the strategic priorities in the Nottingham Plan to 2020 looks at improving health and wellbeing and increasing physical activity.  This “sets the overall strategic direction and long-term vision for the economic, social and environmental wellbeing of the City of Nottingham.”

Other local strategies related to increasing physical activity include

  • Sport and Physical Activity Strategy 2015-2019.
  • Nottingham City Health and Wellbeing Strategy 2013-2016
  • Local Transport Plan 3.
    • Implementation plan 2015 to 2018
  • Breathing Spaces Strategy
  • Cycle Action Plan 2012 to 2015
  • All-party Commission on physical activity

The Sports and Physical Activity Strategy

  • “The strategy aims to by 2019 have significantly increased the number of physical active adults by 1% per annum undertaking the recommended 1x30mins of moderate intensity physical activity and sport a week, making a key contribution to the health and well-being of the city population”

4. Current activity, service provision and assets

Back up to the contents

There are many services and assets that can encourage physical activity in Nottingham.  Some of these are listed below and covers both children and adult services.  Nottingham City Council provides a number of these services but there are many more offered throughout the city by other service providers that may not be listed below.

Children and Young People

  • Children's Centres
    • Childcare, support and fun activities for children under 5 and their families.
    • Services vary at each centre according to local community needs but all centres provide links to childcare, family support and a range of parent and toddler activities.
    • Anyone who cares for or is expecting a child can register to use the centres.
  • Contact Adventure Playgrounds, Play Centres and Youth Centres
    • Balloon Woods Adventure Playground
      • Set in a hectare of natural woodland in Bramcote, this adventure playground is a hub for the forest schools initiative.
    • Bulwell Riverside Play and Youth Centre
      • Facilities including a play centre, recording studio, basketball courts, chill out area, 5 a side pitch, kitchen, health room and much more have been created for the young people of Bulwell to enjoy.
    • Clifton Young People's Centre
      • Including Dance on arcade style dance machines, Duke of Edinburgh award, Sports and Youth Council
    • Forest Fields Play Centre
      • Facilities on offer include an indoor Playcentre and a pirate ship themed outdoor play space
    • Phoenix Adventure Playground
      • The outdoor focus on den building, tree climbing and pond dipping at this Play Centre is complimented by indoor facilities which allow arts and crafts, cooking and much more to take place.
    • The Ridge Adventure Playground
      • There is lots of exciting play equipment for children to explore including a large pyramid tower and slide, timber tangle, zip slide, and Nottingham's first permanent urban beach. Arts and crafts, baking and much more will be taking place inside the eco-friendly Play Centre.
    • St Ann's Adventure Playground
      • There is lots of exciting equipment to play on, including the St Ann's slide.
    • William Olds Youth Centre
      • Including a sports arena, DJ booth, recording studio, dance studio and internet CafeHealthy Child Programme
    • The early identification and prevention of obesity is a key priority in the HCP
    • Families are given information and advice around the importance of physical activity and active play by health visitors, midwives, school nurses and other professionals
  • Healthy Schools Nottingham
    • The Nottingham Local Health Schools Programme is led and delivered through a partnership between Nottingham City Public Health and Early Intervention.
      • Personal, Social, Health and Economic Education
      • Healthy Eating
      • Physical Activity
        • All-party Commission on physical activity
      • Emotional Health and Wellbeing
    • Physical Activity
      • Have the opportunity to participate in a range of physical activities within and outside the school day.
      • The physical environment can encourage the whole school community to be active
  • School Sport Nottingham
    • Established between a partnership of the City Council Sport, Outdoor Learning and Sustainability Service, Ellis Guilford School and Sport College, Farnborough School and Technology College and NHS Nottingham City.
    • Focus on increasing high quality PE, out of hours school sport, competitions, leadership development and informal play.
    • Improve the attitude and behaviour of pupils and increase attainment and achievement of pupils in PE and across the whole school. 
    • Offer of training courses open to all schools across the East Midlands.
  • Swimming
    • Nottingham City Council operates 7 swimming pools across the city including a 50m swimming pool at the newly extended and refurbished Harvey Hadden Sports Village.
    • Nottingham Swim School caters for all swimming abilities from pre school to adults along with classes for complete beginners who need to build confidence and for those wanting to develop their technique or swim for fitness
    • There are currently (Nov 2015) 4190 swim school members
      • 3926 Children and 264 adults
  • Nottingham City Council Sport and Leisure Services
    • Sport and Leisure service provides a range of term time and holiday coaching and activities for children and young people aged 0-19years.
    • ‘Schools out’ - in partnership with Notts County Football in the Community.
      • A low cost school holiday coaching and activity programme for children and young people aged 8-15 years in Nottingham at 5 venues across the city including 3 city council leisure centres.
      • 13,800 hours of sport and physical activity provision was undertaken during the summer of 2015
    • ‘Activate’ memberships to children and young people aged 0-16years.
      • An exciting and fun membership scheme offering courses, play sessions, swimming and fitness classes.
      • Activate memberships are designed to encourage children to be active and healthy whilst developing life skills, confidence and self-esteem.
  • School travel plans
    • A key aspect of the City Councils sustainable school travel strategy
  • Lifecycle
    • Promotes cycle and road safety education awareness from an early age, operating in the city’s primary schools from year1 and linked to Bikeability levels 1 and 2
    • The scheme was delivered in 29 primary schools during 2013/14 delivering training to a total of 425 pupils of which 75 went on to progress to two wheel cycling without stabilisers.
  • Bikeability
    • The national cycle training programme for England, teaching three levels of cycling proficiency, with Levels 1 and 2 in Primary schools and Level 3 in Secondary.
    • This year (2015/16) anticipated delivering to 550 year 5/year 6 children, giving them on road skills for short journeys. Delivered to 33 primary schools this is 43% of the Nottingham City schools that have taken part
  • BikeIT (LSTF funded)
    • A linked programme being implemented in selected Secondary schools and their associated Primary school clusters, with an aim of raising awareness and promoting active travel through events and workshops.
    • To date the officer has worked with 6 secondary schools and 1 primary school over 3,000 pupils and 90 teaching staff through assemblies and directly engaging with 900 pupils and 50 teaching staff and parents through activities and events including cycle training.
  • Ucycle (LSTF funded)
    • Active travel partnership is collaboration with Further Education and Higher Education sites to encourage cycling to staff and students through infrastructure, promotion and training.
    • Has engaged with over 16,500 members of staff and students across the participating organisations (University of Nottingham, Trent University, Nottingham Universities Hospitals Trust, Central College Nottingham, Bilborough College and New College Nottingham).
    • During 2013/14, 425 Ucycle bikes were loaned to staff and students across the University campuses.
    • University Of Nottingham - Between spring 2010 and spring 2014 the number of parked bikes observed at University cycle parking facilities increased by 93%, from 927 to 1,791 parked bikes observed on an average day.
    • Nottingham Trent University - The proportion of staff trips to University made by car decreased over the lifetime of the project, from 46% in 2009 to 33% in 2013.
    • Nottingham Universities NHS Hospital Trust - The proportion of staff usually cycling to hospital sites increased from 3.0% in 2009 to 9.7% in 2014.
    • At Bilborough College- Since its inception in 2011 Phase 2 of the Ucycle project in partnership with Bilborough College has been successful in increasing levels of active travel, resulting in economic, environmental and health related benefits.
    • At Central College Nottingham - Based on travel diary results, the proportion of staff trips to college made by bicycle increased by three percentage points, from 3.1% in 2013 to 6.1% in 2014. Similarly, the proportion of student trips to college made by bicycle more than doubled, from 2.6% in 2013 to 7.3% in 2014
    • At New College Nottingham - Based on travel diary results, the proportion of staff trips to college made by bicycle increased by six percentage points, from 4.5% in 2013 to 10.6% in 2014. The proportion of student trips to college made by bicycle increased from zero in 2013 to 2.3% in 2014.
  • Footprints
    • Encourages children to walk to school
    • Re-launched in 2011, with over 11,000 children completing their 10 walks and receiving their prize badges
    • 2015 there are 40 Nottingham city primary schools agreed to take part
    • Park and stride encourages parents who find it necessary to take the car on the school run to park away from the school and allow 10 minutes walking time
  • This Girl Can (TGC)
    • Sport and Leisure are working on leading the local activation of the This Girl Can (TGC) programme
    • TGC is a national campaign from Sport England to encourage more women and girls into sport and physical activity.
    • To date, approximately 130 TGC Ambassadors have been recruited to help promote the campaign locally and encourage more women and girls to take part in sport and activity.
    • TGC Notts are also working with 5 large scale corporate businesses in Nottingham to encourage their female workforce to participate in activity and lead active lives.

Adults

  • Healthy Change: Lifestyle Referral and Support Hub
    • An advice service that supports people with one or more behavioural risk factors for Cardiovascular Disease (CVD) and/or other long-term conditions.
    • Direct people to the appropriate service for them to receive the support they need to make health improvement lifestyle changes including stopping smoking, improving diet, achieving a healthy weight and increasing physical activity.
    • Acts as a central referral hub to other commissioned prevention services to which it refers clients
    • Number of new clients registered with the Hub 2014/15
      • Forecast 4,000
      • Actual 4,585 (115% target achieved)
    • Number of new clients registered with the Hub, from priority groups and areas
      • Forecast 2000
      • Actual 1912 (96% target achieved)
    • This service has performed consistently well against targets, with an average of 81% of clients contacted 12 months after exiting the service maintaining at least one health improvement goal – far more than was ever anticipated.
    • Healthy Change has also been successful in engaging with the male population.
  • Slimming World on Referral: Slimming World
  • Body Magic – activity programme – help take small steps towards a more active lifestyle.
  • See obesity chapter
  • Active for Life Physical Activity Referral Service
  • 12 week physical activity programme provided by Nottinghamshire YMCA and commissioned by NHS Nottingham City.
  • Adult clients who have low physical activity levels with one or more other cardiovascular disease risk factors are referred via Healthy Change or recruited by the YMCA.
  • The programme includes the provision of group and individual exercise programmes run by qualified fitness staff who can adapt the programme in relation to any health problems a client may have. In addition, it uses behaviour change techniques to set goals and support people to be active outside of the exercise provision and after the 12 week programme.
    • Total number of people, from ALL groups and areas, completing 12 week exercise programme 2014/15
      • Forecast 1,140
      • Actual 1,306 (115% target achieved)
    • The service has been highly successful in engaging with clients from BME groups, and has shown significant improvement in engaging with male clients during 2014/15.
    • Number of people, from priority groups, benefiting from health improvement initiatives [BME only]
      • Forecast 200
      • Actual 562 (281% of target achieved)
    • The cost of this intervention over the twelve weeks equates to £178.00 per citizen. Or £15 per week.
    • Around 40% of clients have taken up the discounted membership offered by the YMCA after completing the 12 week programme
  • Be Fit
    • Be Fit is a free Leisure Centre usage scheme run by Nottingham City Council Sport and Leisure service and funded by NHS Nottingham City.
    • It offers the free usage of 3 city Leisure Centres for 4 hours a day to Nottingham City adult residents who are eligible to claim certain benefits.
    • It also enables clients accessing the Active for Life Physical Activity Referral Service to have free access to available leisure centre facilities during this time period.
    • Number of people, from priority groups and areas, benefiting from health improvement initiatives (i.e. New service users registered) 2014/15
      • Forecast 300
      • Actual 373 (124% target achieved)
    • Total accessing the scheme 2014/15 – 5392 members
    • Average attendance is 71 citizens per week. The cost is £20.00 per week per citizen.
    • The leisure centres report that the number of new service users accessing the service is beginning to slow down.
    • Total number of attendances
      • Forecast 18,755
      • Actual 55,983 (298% target achieved)
  • Best Foot Forward
    • Community based walking scheme provided by Age UK Nottinghamshire, which aims to increase the physical activity levels of adults from priority groups to support the primary and secondary prevention of cardiovascular disease.
    • Total number of people, from ALL groups and areas, benefiting from health improvement initiative (i.e. New service users registered) 2014/15
      • Forecast 380
      • Actual 329 (87% target achieved)
    • The service has struggled to meet targets but the service continues to be popular with regular attendees.
  • Cycling for Health: Ridewise
    • Nottingham based charity whose aim is to help and encourage as many people as possible to get on a bike and safely enjoy this wonderful form of transport.
    • Total number of adults from all groups and areas of Nottingham City completing three hours of Cycling for Health activity 2014/15
      • Forecast 240
      • Actual 170 (71% target achieved)
    • Performance has improved the last quarter, but is below annual targets.Local Initiatives to increase walking and cycling
  • Cycling in Nottingham
    • Nottingham City Council is strongly supportive of encouraging more people to cycle as part of their daily lives
    • The Nottingham Cycle Map
    • Cycle City ambitions
    • Citicard cycle
      • Can use your Citycard to hire a Citycard cycle for a day, week, month or year.
      • Hire is being made free for residents and visitors over 2015
    • Explore Nottingham
      • Free guided cycle rides around Nottingham and Nottinghamshire every week.
    • Breeze Cycling
      • The Breeze network is British Cycling's new national network of bike rides for women. Supported by Sport England
    • Cycle Training and Maintenance through Ridewise
  • The Local Sustainable Transport Fund (LSTF) provides complementary funding to support behaviour change until March 2016 to sustainable transport options.
    • Programme 2011 to 2015 was a £15.245 million Government funded programme of initiatives to helped local people connect to jobs and services and support the local economy through promoting greater use of sustainable travel choices. 
    • Included funding for high profile active travel events such as Cycle Live Festival and establishing a network of Community Smarter Travel Hubs to deliver a community engagement approach to travel behaviour change and provide local events and services to support active healthy travel options
    • In March 2014 Nottingham City Council secured further revenue funding of £1.18 million to continue key elements of the LSTF programme over 2015/16 including the three Community Smarter Travel Hubs in the City focusing around supporting access to employment, training and skills with a particular emphasis on young people
    • The Department for Transport published an interim meta-analysis of the impacts of the 12 large scale TSTF schemes which includes Nottingham Urban Area in November 2015
    • This will be complemented by the impact evaluation of the Nottingham programme in January 2016.
  • Nottingham City Council has secured £6.1million of Local Growth Funding through the D2N2 LEP to start delivery of its 10 point cycling action plan through Cycle City Ambition Programme in 2015/16 – 2016/17 providing in excess of £10 per head of population investment into the City’s cycle network
    • Comprises cross-city corridors, city centre cycle connections, enhanced cycle facilities in and around Colwick Park, The Embankment, Wollaton Park and Broxtowe Country Park and neighbourhood improvements to make local cycle journeys easier, safer and more attractive, particularly for less experienced cyclists.
  • Park activities
    • Park lives - summer to late September
      • 15,000 attendances in year 1
      • 450 activity session across 19 parks
    • Orienteering
    • Outdoor gyms
      • 20 located across the city
      • The equipment has a mixture of cardiovascular and toning stations and is free to use
    • Fitness bootcamp
    • Walk in the Park
      • There are 10 walks available in the Walk in the Park programme which each offering 2 routes of varying distances.
      • A further 2 new walks have been developed to encourage increased physical activity participation in parks; they are Martin’s Pond to Wollaton Park and Sneinton and Colwick Woods
    • Tree trails
    • Seasonal paddling pools and water parks
    • Parkour
      • Bulwell Forest Recreation Ground
    • Table Tennis
    • Parkrun
      • Walk, jog or run our 5km courses at Cowlick Country Park and the Forest Recreation Ground every Saturday
    • Park Rangers
      • Programme of environmental activities and workshops for schools and groups to suit different ages and abilities
  • Nottingham City Community Sport Support and Participation Programme
    • Sport and Leisure are working in partnership with Nottingham Community and Voluntary Service (NCVS) to capacity build and increase or sustain participation in sports clubs and community groups.
    • The project utilises the skills, knowledge and experience of the voluntary sector to support the development of Nottingham City sports clubs and community groups.  
    • The support for this infrastructure within Nottingham City will enhance the capacity for both sports clubs and community groups to increase the number of people within their group or club taking part in 1 x 30 minutes.
  • Fit in the Community
    • Sport and Leisure are working with Nottingham City Homes to test and develop an innovative project to increase sport and physical activity opportunities for NCH tenants over the next 3 years.
    • Nottingham City Homes manages around 29,000 homes across Nottingham, including more than 1,000 leasehold properties. These properties house over 55,000 residents, accounting for 25% of the City’s population.
    • Over half of NCH properties are located in areas with high levels of deprivation, where communities experience multiple barriers to taking part in sport and physical activity. The project aims to encourage tenants to become regular participants in sport and physical activity; target is to increase weekly participation for a minimum of 30 minutes by 10% of the city’s tenant population (approx. 5,500 people).

Nottingham City Council currently manages 8 leisure centres across the city of which 7 contain swimming pools. The Sport, Leisure and Community Service provides a wide range of affordable sport and physical activity opportunities for all ages and abilities. The service works closely with national and local partners to deliver programmes of activity too hard to reach communities as well as the general population. The service employs a range of officers who support and develop physical activity and sport opportunities across the city.

  • There were 2,000,766 attendances at Nottingham City Leisure Centres over the 2014/15 period
  • 36,490 Sport and Leisure Members (43.7% male and 56.3% female)

Active Travel

Through its LSTF program Nottingham City Council has established 3 Community Smarter Travel Hubs serving the North, Central and South localities of the city.  They provide an innovative community engagement approach to travel behaviour change with a focus on services to support walking and cycling.  Funding bids are being progressed to continue the Hubs with a focus on access to employment for 2016/17.

Disability sport

  • Nottingham City Council have committed in the Nottingham Plan (2015-2019) to make Nottingham the fastest growing city for disability sports participation in England43
  • What aim to offer
    • Disability specific sport events and projects within the city
    • Disability awareness training for coaches/leaders and leisure centre staff
    • More access to physical activity opportunities in Nottingham City improving physical and social health and wellbeing
    • More opportunities to participate in activities benefiting from support from Inclusion Support Buddies to access inclusive mainstream or dedicated activities
    • The opportunity to improve confidence and self-esteem through participation, volunteering and leadership
    • Better signposting and support to access physical activity and sports opportunities, helping to improve quality of family life
  • Nottingham Juniors
    • People aged 3-19 years
  • Nottingham Adults
    • Aim to inspire, motivate and engage Nottingham City residents aged >20 with a disability into physical activity and sport within Nottingham
  • Leisure Centre Disability Access
    • “Commitment to continuously improving the accessibility both in and around its leisure centres to ensure they meet the needs of all customers”

Notable changes since 2012

  • Motivate
    • De-commissioned by public health March 2015
    • Used to be strictly for overweight men
    • Now funded by Nottingham City Homes and open to everyone
  • Active Schools and active families are no longer available
  • Sport and Leisure working with Sport England
    • This Girl Can
    • Nottingham City Community Sport Support and Participation Programme
    • Fit in the Community
  • Disability Sport
    • Make Nottingham the fastest growing city for disability sports participation in England
  • Continued growth of cycling in the city
  • Continued uptake of the Healthy Change Hub, Be Fit and Physical Activity on Referral Schemes
  • Delivery of £16million Local Sustainable Transport Fund programme 2011/12 – 2015/16 including funding to provide walking and cycling services and promotions, establishing a network of Community Smarter Travel Hubs, cycle training and support in school, colleges and Universities and establishing 20mph limits across residential areas of the City.

5. Evidence of what works (what we should be doing)

Back up to the contents

In October 2014 Public Health England produced a document: Everybody active, every day: what works, the evidence. It looked at “the evidence base for what works to get people active at a population-scale”.  It again emphasised the co-ordinated approach

  1. Active society: creating a social movement
  2. Moving professionals: activating networks of expertise
  3. Active environments: creating the right spaces
  4. Moving at scale: scaling up interventions that make us active

National Institute for Health and Care Excellence (NICE) has produced a physical activity overview pathway.  The pathway looks at all areas of physical activity

http://pathways.nice.org.uk/pathways/physical-activity

Some examples of NICE guidelines that relate to physical activity.

  • Behaviour change: individual approaches NICE guidelines [PH49], Jan 2014

This guidance makes recommendations on individual-level interventions aimed at changing health-damaging behaviours among people aged 16 or over. It includes a range of approaches, from single interventions delivered as the opportunity arises to planned, high-intensity interventions that may take place over a number of sessions. The behaviours covered relate to: alcohol, diet, physical activity, sex and smoking. 

  • Across all interventions, those targeting the general population had better cost–utility results and were more likely to be cost effective than those aimed at vulnerable populations.
  • Exercise referral schemes to promote physical activity NICE guidelines [PH54], September 2014

This guideline makes recommendations on exercise referral schemes to promote physical activity for people aged 19 and older. It updates and replaces recommendation 5 in Four commonly used methods to increase physical activity NICE guideline PH2 (March 2006).

  • “The evidence suggests that these exercise referral schemes have only a marginal added effect relative to other ways of increasing physical activity. (Examples of other approaches include: giving brief advice and providing information about local facilities and opportunities to be physically active.) The economic evaluation suggests that this added benefit was not likely to be a cost effective use of resources.”
  • Exercise referral schemes are popular and they may offer other benefits aside from physical activity although this was not evaluated.
  • NICE support for commissioning for physical activity: encouraging activity in all people in contact with the NHS  NICE support for commissioning [SFCQS84], March 2015

This resource helps with quality improvement by providing information on key clinical, cost and service-related issues to consider during the commissioning process and signposting other implementation support tools. It has been produced to support NICE quality standard 84 for physical activity: encouraging activity in all people in contact with the NHS.

  • NICE’s physical activity return on investment tool enables the user to evaluate a portfolio of interventions in their geographical area.  It models the economic returns that can be expected in different payback timescales.
  • Physical activity NICE advice [LGB3], July 2012

This briefing summarises NICE's recommendations for local authorities and partner organisations on how to encourage people to be physically active. It is particularly relevant to health and wellbeing boards in improving mental health and wellbeing.

  • Physical activity: brief advice for adults in primary care NICE guidelines [PH44], May 2013

This guideline aims to support routine provision of brief advice on physical activity in primary care practice. It updates and replaces recommendations 1–4 in Four commonly used methods to increase physical activity NICE guideline PH2 (2006). The recommendations cover:

  • Identifying adults who are inactive
  • Delivering and following up on brief advice
  • Incorporating brief advice in commissioning
  • Systems to support brief advice
  • Information and training to support brief advice.

There is strong evidence for the effectiveness of counselling and brief advice in primary care to increase an individual’s physical activity

  • Physical activity: encouraging activity in all people in contact with the NHS NICE quality standard [QS84], March 2015

This quality standard covers encouraging physical activity in people of all ages who are in contact with the NHS, including staff, patients and carers. It does not cover encouraging physical activity for particular conditions; this is included in condition-specific quality standards where appropriate.

  • Physical Activity and the environment NICE guideline [PH8], January 2008

This guidance recommends that planning the physical environment should include plans to ensure that people are able to be physically active and assessment of planning on people’s ability to be physical active. When planning roads, prioritisation should be given to enabling people to be physical active over motor vehicle use. Ensuring that public open spaces are accessible by foot and bicycle, that internal design of buildings should make being active easy and that schools have an environment that is conducive to physical activity. This is due and update in April 2016.

  • Walking and cycling NICE advice [LGB8], January 2013

This briefing summarises NICE's recommendations for local authorities and partner organisations on walking and cycling. It is relevant to many areas of local authority work, including the development of local plans, core strategies and joint health and wellbeing strategies, including several areas highlighted in the Public Health Outcomes Framework.

  • Reduce air pollution and carbon emissions
  • Address congestion
  • Help people live active healthy lives and improve health and wellbeing
  • Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation NICE guidelines [PH41], November 2012

This guideline sets out how people can be encouraged to increase the amount they walk or cycle for travel or recreation purposes.

  • Workplace policy and management practices to improve the health and wellbeing of employees NICE guidelines [NG13], June 2015

This guideline makes recommendations on improving the health and wellbeing of employees, with a particular focus on organisational culture and context, and the role of line managers.

  • Promoting Physical Activity for Children and Young People NICE guidelines [PH17] January 2009

This guidance recommends promoting the benefits of physical activity and encouraging participation, ensuring high-level strategic policy planning for children and young people supports the physical activity agenda, consultation with, and the active involvement of, children and young people, the planning and provision of spaces, facilities and opportunities to be active, the need for a skilled workforce, promoting physically active and sustainable travel.

6. What is on the horizon?

Back up to the contents

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

Children and young people

 

  • Low activity rates are increasing
    • 85% of males and 83% of females aged 2-4 years can be classed as having low activity.
    • 39% male children aged 5-15 have low activity levels
    • 45% female children aged 5-15 have low activity levels
  • Physical Activity rates are declining
    • In both boys and girls in England the proportion of children aged 5 to 15 years meeting recommendations fell between 2008 and 2012
  • Sedentary time is higher at the weekends
  • The proportion of children walking to school continues to fall
  • Support and encouragement to get active is particularly important as children and young people progress through key transition periods.
  • The number of births has risen in recent years although the latest figures show a small decline.
    • 34.2% of children are affected by income deprivation

A key factor in sustainability is incorporating activities into an individual’s lifestyle. Inactive children often become inactive adults. If the patterns of physical activity are established during childhood then these patterns will often continue into adulthood. If the above current trends continue, there will be an increasing burden on public services and resources.

Adults

  • Despite its young age-structure, Nottingham has a higher than average rate of people with a limiting long-term illness or disability.
  • In the short to medium term, the City is unlikely to follow the national trend of seeing large increases in the number of people over retirement age, although the number aged 85+ is projected to increase.
  • Car journeys in the city have increased whilst walking has decreased which will put a pressure on the City infrastructure
    • Tram journeys would be expected to increase
  • Cycling continues to increase across the city
  • There is currently a Healthy Lifestyle Commissioning review taking place
    • To determine the most effective use of the available resource from the public health grant to support adult citizens to increase physical activity, improve diet and nutrition, reduce obesity and reduce smoking in the city.
  • The proportion of adults who meet recommendations for physical activity in 2012 (66% of men and 54% of women) has remained the roughly same as 2008 with 66% and 55% respectively.
    • The biggest increase in the proportion of men and women in meeting recommendations is in those aged 65 to 74 (from 46% to 51% for men and 37% to 42% for women from 2008-2012).
  • There has been a slight increase in sport participation in Nottingham but still 51.2% of adults >16 did none at all.
  • These target numbers are important to monitor trends but it is more important from a public health standpoint to get those not meeting the guideline to do a bit more and put physical activity back in to normal day to day lives.
  • Long term conditions
    • Cardiovascular (heart and circulatory) disease causes more than a quarter (27 per cent) of all deaths in the UK (BHF, 2014)
    • There are an estimated 7 million people living with cardiovascular disease in the UK
    • An ageing and growing population and improved survival rates from cardiovascular events could see this number rise still further.
    • It is estimated that more than one in 16 people in the UK has diabetes (diagnosed or undiagnosed) (Diabetes UK 2015)
    • Around 700 people a day are diagnosed with diabetes.
    • About a quarter of the population will experience some kind of mental health problem in the course of a year, with mixed anxiety and depression the most common mental disorder in Britain (Mental Health Foundation 2015)

7. Local views

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Children and Young People

In the HSE 2007 (which is the most up to date source from Health Survey England) children aged 11-15 were asked about their knowledge and attitudes to physical activity.  The key findings from 2007 showed

  • How much physical activity children should do:
    • Only 1in10 children said 60minutes on all 7 days per week
  • Most boys and girls perceived themselves to be either very or fairly physically active compared with other people their age (90 per cent and 84 per cent respectively).
  • Girls were more likely than boys to want to do more physical activity (74 per cent and 61 per cent respectively), regardless of age.

Children Society – 2014 report on Children’s Well-being. Bilborough Nottingham

The Bilborough Survey of Children and Young People 2014 children aged 8 to 16 living in Bilborough. 949 children in 5 primary schools and 2 secondary schools participated in the survey.

  • Consistent message from both primary and secondary children in Bilborough
    • They feel significantly happier with their prospects for the future and about the things they own compared to the national figures
    • Significantly less happy with their feelings about school and their health compared to the national picture.
  • The Good Childhood Index shows us that children in Bilborough show lower levels of satisfaction with their health than the national average.
    • Children identified relationships as something that impacts positively on their health, both physical and mental
    • They find it easier to maintain a healthy lifestyle when the people around them actively support and encourage them
  • Primary school areas for improvement
    • More sports – 17% (National Figures 37%)
    • More youth clubs – 15% (National Figures 42%)
  • Secondary school areas for improvement
    • More Sports – 22% (National Figures 38%)
    • More Youth Clubs – 28% (National Figures 60%)

This demonstrates the importance of physical activity for both physical and mental health.  It also shows the fundamental importance of active society and active environment to encourage a healthy lifestyle.

Nottingham City Childhood Wellbeing Survey is due to report its figures soon.

Adults

The most up to date source of information on perceptions and attitudes towards physical activity is in Chapter 4: Adult physical activity: knowledge and attitudes, of the HSE 2007. Some information from that:

  • Only 6 per cent of men and 9 per cent of women thought people their age should participate in physical activity for at least 30 minutes on at least 5 days per week
  • 44 per cent of men and 45 per cent of women agreed that they could get enough physical activity in their daily life without specific activities such as jogging or going to the gym.
  • The two most frequently mentioned barriers were work commitments and not having enough leisure time

Citizen Survey 2014

  • The average score for mental well-being in Nottingham is 52.2 which is slightly higher than the England average 51.6
  • Mental wellbeing is lowest amongst people with a disability or long term illness, and those ‘otherwise not in paid work’

Happier Healthier Lives: Have Your Say

  • The Nottingham City Health and Wellbeing Board are currently undertaking engagement process and how can work together to make Nottingham a happier and healthier city.  This will look at areas including:
    • Environmental factors like air pollution
    • Access to green spaces and leisure facilities
    • Lifestyle factors like smoking, diet and physical activity

The Big Idea was a small local survey with sample size of 2000. Greater Nottingham Local Transport Survey 2015 included journey satisfaction levels.

  • Cycling 83% good or very good
  • Train 81% good or very good
  • Tram 75% good or very good
  • Walking 59% good or very good
  • Driving 54% good or very good
  • Almost 20% of respondents stated that better quality walking and cycling links in their area would help to encourage them to change the way they travelled.  This is up from 7% in 2012

Department of Transport meta-analysis includes a case study of cycling in Nottingham and will be complimented when the LSTF impact evaluation is published in 2016.

https://www.gov.uk/government/publications/local-sustainable-transport-fund-interim-meta-analysis

What does this tell us?

8. Unmet needs and service gaps

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Since the last JSNA in 2012 there has not been a fundamental change in the areas of need in regard to physical activity.  National figures continue to suggest that future planning and commissioning should continue to focus and target those who are most likely to be physically inactive.  Broadly speaking they continue to be:

  • Women of any age
  • People >65years of age
  • The BME community
  • People living with a long term illness or disability
  • Those people living in the most deprived areas

Current provision needs to be strengthened for all at risk groups.

Women of any age in Nottingham

  • This Girl Can has recently started in the Nottingham area but it is too early to assess its success.

People >65 years of age

  • 11.8% of Nottingham population.  This is less that the National average.
  • Do national statistics match Nottingham statistics in this age group?
  • In the short to medium term, the City is unlikely to follow the national trend of seeing large increases in the number of people over retirement age, although the number aged 85+ is projected to increase. 

BME community

  • 35% from 2011 which is an increase from 19% in 2001
  • People from Pakistani and Indian communities have lower physical activity levels than the general population.  Particularly for women. Therefore addressing inequalities in access to physical activity interventions should particularly focus on these groups.

Disability

  • Pledge of Nottingham Council 2015-2019 to make Nottingham the fastest growing city for disability sport
  • The same importance should be placed on people with a disability who are looking to access physical activity services and not just those in high level disability sport

Long term conditions

  • Incorporating physical activity provision in the care pathways for the management of long term conditions
  • The importance of increased physical activity in pathways involved with population health and wellbeing

Most deprived areas

  • Have the lowest levels of physical activity and the highest levels of morbidity and mortality.
  • How do services in these areas correspond to need?
  • The proportion of participants meeting the current UK guidelines for aerobic activity increased as equivalised household income increased.  Therefore addressing inequalities in access to physical activity and sports clubs should also focus on this.

Other gaps identified

Children and Young People

Children under 5 - the 2011 guidelines were the first to make specific recommendations for children under 5.  The only information on uptake in this group comes from the Health Survey England 2012. 

  • We have no information of local values from Nottingham for this age group. 

Children 5-18

  • Nottingham statistics for physical activity, access to school Physical Education and sports participation require updating.

Male participation

  • Has been shown to be on the decrease from 28% to 21% in children 5-18 (2008-12)
  • The patterns of physical activity established in childhood continue in to adulthood and inactive men are at a higher cardiovascular risk

Adults

  • Usage of local leisure facilities and whether services meet the needs of the population
  • Access to local parks and open spaces
  • The Local Sustainable Transport Fund (LSTF).  The full impact evaluation of the programme is currently being carried out and will be finalised in early 2016
  • With a range of partners taking actions to increase physical activity – this may not be co-ordinated or the impact being monitored
  • The level of unmet need needs to be balanced with evidence of improving outcomes and value for money

A number of current commissioned services perform well to target and some exceed target.  Other services like best foot forward and cycling for health through ridewise have not met targets for 2014/15.

Mental Health and Wellbeing

  • People with poor physical health are at higher risk of experiencing mental health problems.
  • Services should integrate prevention, mental wellbeing and lifestyle modification throughout a person lifetime.

9. Knowledge gaps

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  • Statistics on Obesity, Physical Activity and Diet - The HSCIC is currently running a consultation on this report that will close on 8 January 2016.
  • Nottingham City Childhood Wellbeing Survey is due to report its figures soon.
  • Statistics on physical activity, physical education and sport participation in children in Nottingham area

Healthy Lifestyle Commissioning review taking place

What should we do next?

10. Recommendations for consideration by commissioners

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  1. Ensure Health and Social Care staff deliver evidence based messages and that “Physical Activity recommendations for health” are used to promote consistent messages concerning physical activity levels
  2. Frontline Sport and Leisure staff have access to training and CPD assessment in the promotion of physical activity
  3. Reduce sedentary rates at nursery and at home by education of families and frontline staff of the importance of active play
  4. Use transition periods from primary to secondary school and on to further education as key opportunities to promote active travel behaviour as part of increasing travel independence
  5. Access to high quality PE and monitored as part of local Education Improvement Strategies
  6. Remove barriers to physical activity amongst girls and young women and monitor the outcomes of This Girl Can strategies that have just started
  7. Ensure activities for teenage boys are provided and promoted
  8. Target small-scale infrastructure improvements (e.g. walking and cycling routes, street lighting, cycle parking) in areas where communities have low levels of physical activity to create safer walking and cycling environments allowing people to walk and cycle as part of their everyday lives.
  9. Ensure active travel options are at the forefront of transport plans and are targeted in areas where low physical activity exist
  10. Commission physical activity services for mental and physical health conditions with equal access for service users with a disability
  11. Review the evaluation and share learning regarding successful interventions for promoting active travel from the Nottingham Urban Area Local Sustainable Transport Fund programme
  12. Continue to target and engage inactive people from the priority groups – people >65 years, BME communities, people with disability and long term conditions using the health hub as a central point
  13. Signpost the use of healthy change hub as a central point for lifestyle services and encourage increased use and link with Community Smarter Travel Hubs activities to support travel behaviour changes
  14. Carry out local assessment of the physical activity on referral schemes during the healthy lifestyle review.
  15. Increase the range of options for maintenance of physical activity on completion of the 12 session course, for example subsidised membership at a wider range of facilities and promotion of parks and open spaces
  16. Incorporate the promotion of physical activity in management of medical conditions and consider increasing provision of physical activity in care pathways
  17. Brief interventions training in physical activity provider contracts
  18. Encourage business to have policies to that provide facilities to staff to use active travel and encourage physical activity in the workplace
  19. Encourage schools and colleges to provide facilities for staff and students to use active travel and encourage physical activity
  20. Ensure equal access to opportunity and services for physical activity for disabled people

Key contacts

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Rachel Sokal, Public Health Consultant, Nottingham City Council, Rachel.sokal@nottinghamcity.gov.uk

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Glossary

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Appendix1

EARLY YEARS (under 5s)

1. Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments.

2. Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day.

3. All under 5s should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).

 

CHILDREN AND YOUNG PEOPLE (5–18 years)

1. All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day.

2. Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.

3. All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods.

 

ADULTS (19–64 years)

1. Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 1⁄2 hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week.

2. Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week
or a combination of moderate and vigorous intensity activity.

3. Adults should also undertake physical activity to improve muscle strength on at least two days a week.

4. All adults should minimise the amount of time spent being sedentary (sitting) for extended periods.

 

OLDER ADULTS (65+ years)

1. Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Some physical activity is better than none, and more physical activity provides greater health benefits.

2. Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (21⁄2 hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week.

3. For those who are already regularly active at moderate intensity, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity.

4. Older adults should also undertake physical activity to improve muscle strength on at least two days a week.

5. Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week.

6. All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods.

Appendix 1