Kent Joint Strategic Needs Assessment (Kent JSNA)
Kent ‘Adult Physical Activity’ JSNA Chapter Summary
Update ‘2015-16’
Contact: Andy Fairhurst
Website: www.kpho.org.uk
Introduction
Adult physical inactivity is now recognised as a distinct public health concern.
Physical inactivity is the fourth-leading risk factor for worldwide global mortality1 and
is responsible for more worldwide deaths every year than overweight and obesity 2. In
the UK, physical inactivity is responsible for 17% of annual all-cause mortality and
reduces life expectancy by three - five years3.
Physical inactivity is directly responsible for a range of non-communicable disease
conditions and has been identified as the cause of 10.5% of UK coronary heart
disease burden, 13% of Type II diabetes, 18% of breast cancers and 19% of colon
cancers4. An inactive person will also spend 38% more days in hospital than an
active person, requires 5.5% more GP visits and accesses 13% more specialist
services5.
The cumulative annual cost of physical inactivity to the national economy has been
estimated as £20bn per year6 and the annual cost to local authorities in Kent has
been calculated at just over £264million7.
Physical activity definitions and guidelines
These guidelines refer specifically to adults aged 19-74.
Physical inactivity is defined by the Chief Medical Officer as an adult who achieves
fewer than 30 minutes of moderate physical activity per week8.
The Chief Medical Officer recommends that adults achieve 150 minutes of moderate
physical activity or 75 minutes of vigorous physical activity per week in order to
maintain or improve health9.
To meet these guidelines, the total minutes per week must be achieved:


over at least two days
in bursts of 10 minutes or longer.
Moderate physical activity includes walking, cycling, gardening or other forms of
movement that elicit an increase in heart rate. Vigorous physical activity includes
exercise activities such as running, weight training, swimming and active sports.
For clarity, in this document:
a A physically inactive individual is a person achieving less than 30 minutes per
week of physical activity.
b A physically active individual is a person achieving more than 150 minutes of
physical activity per week.
c An individual achieving more than 30 minutes but fewer than 150 minutes is
classified as ‘Not Meeting Guidelines’ (NMG).
November 2015
2
Effect of physical activity on non-communicable disease
There is clear evidence that increasing levels of physical activity can be effective in
preventing the development of conditions as well as managing existing chronic noncommunicable disease conditions. Key conditions that physical activity levels can
impact include cardiovascular disease such as coronary heart disease and
ischaemic heart disease, stroke, diabetes and hypertension, cancers, overweight
and obesity, mental health, and musculoskeletal conditions10.
Individuals meeting physical activity guidelines can reduce all-cause mortality by
30%, reduce diabetes risk by 30-40%, lower risk of breast cancer by 20% and colon
cancer by 30%, and reduce risk of cardiovascular disease, coronary heart disease
and stroke by 20% to 35%. Physical activity also reduces the physical decline with
age, with a 30% risk reduction in the prevention or delay in loss of function and
physical limitation in older adults,11 including a 30% reduction in the risk of falls.
Physical activity can also reduce the risk of depression, dementia and Alzheimer’s,
improve self-esteem, mood and sleep quality, and reduce levels of anxiety and
fatigue12.
The higher an individual’s level of physical activity, the lower their level of health risk
and increasing levels of physical activity from any level will result in a reduction in
risk. The dose-response relationship for physical activity is greatest in the most
inactive people, meaning that for the most inactive people even a minor increase in
physical activity will show a significant reduction in risk, at all ages13.
National policy and strategy drivers
Public Health Outcomes Framework
The Health Improvement section of the Public Health Outcomes Framework contains
indicators directly relating to physical activity:


2.13(i) Number of physically active adults
2.13(ii) Number of physically inactive adults
Quality and Outcomes Framework
Since April 2013, there have been two Quality and Outcomes Frameworks (QOF)
targets for GPs related to physical activity listed under hypertension indicators;
QOF Indicator HYP004: The percentage of patients with hypertension aged 16 to 74
years in whom there is an annual assessment of physical activity, using General
Practice Physical Activity Questionnaire (GPPAQ), in the preceding 12 months.
QOF Indicator HYP005: The percentage of patients with hypertension aged 16 to
74 years who score 'less than active' on GPPAQ in the preceding 12 months, who
also have a record of a brief intervention in the preceding 12 months.
Everybody Active, Every Day
In October 2014 Public Health England published ‘Everybody Active, Every Day’, a
national implementation framework for physical activity14. Four domains identified for
action are:
November 2015
3




active society
moving professionals
moving at scale
active environments
This framework outlines the importance of creating environments and cultures that
support physical activity including the provision of leisure and sport facilities, outdoor
gyms, active travel and walking and cycling opportunities, business workforce
engagement and the role of the health sector in promoting physical activity.
Who’s at Risk and Why?
Current statistics
Figure 1: Population Physical Activity Status by Local Authority Area
100%
90%
Percentage of Population
80%
70%
60%
50%
40%
Active
30%
NMG
Inactive
20%
10%
0%
Source: Active People Survey (2015)
In Kent, 28.37%15 of adults are currently classed as physically inactive16, slightly
higher than the national average of 27.73%17. A total of 43.43% of the Kent adult
population do not currently meet the recommended levels of 150 minutes per
week18, including the 28.37% who are physically inactive.
Currently 56.57%19 of adults in Kent meet the guideline of 150 minutes per week of
physical activity in order to maintain or improve their health20, which is slightly lower
November 2015
4
than the national average of 57.04%21, meaning Kent performs poorly in comparison
to the national average on both measures.
Across all districts, there is a strong negative correlation between the number of
physically inactive individuals and the number of physically active individuals in a
district (r=-0.8458, p<0.001). Thanet has the highest percentage of physically
inactive people and the lowest number of physically active people, whilst Sevenoaks
has the highest percentage physically active and the lowest percentage physically
inactive of the adult population
Changes in physical activity levels since 2012
Physical activity is measured through Sport England’s Active People Survey 22, which
changed its’ methodology in 2012 to include physical activity for health and is now
the national measure recognised by Public Health England. Since 2012, the number
of physically inactive people in Kent has shown a net increase, and the number of
people achieving the recommended physical activity guidelines has fallen.
Figure 2: PHOF 2.13ii - Percentage of Physically Inactive Adults (Kent &
England, 2012-2014)
29.50
Percentage of Population
29.00
28.50
28.00
Kent
England
27.50
27.00
26.50
26.00
2012
2013
2014
Source: Active People Survey (2015)
The percentage of the Kent population failing to achieve the minimum 30 minutes
per week required has shown a net increase since 2012 from 27.46% to 28.31%.
This is in contrast to the national trend, which has shown a net decrease . After
being below the national average in 2012, the percentage of adults classed as
physically inactive in Kent is now higher than the national average for the first time.
November 2015
5
Table 1: PHOF 2.13ii - Percentage of Physically Inactive Adults (All Districts,
Kent & England, 2012-2014)
Area
Ashford
Canterbury
Dartford
Dover
Gravesham
Maidstone
Sevenoaks
Shepway
Swale
Thanet
Tonbridge and
Malling
Tunbridge Wells
Kent Average
England Average
November 2015
2012
27.37
27.37
29.73
30.04
30.32
26.90
21.29
35.12
28.42
31.15
2013
24.19
22.02
25.59
30.85
25.21
25.22
25.47
27.60
31.68
35.50
2014
29.12
30.91
27.29
26.31
29.11
25.37
20.90
28.42
32.38
34.50
22.58
19.87
27.46
28.51
24.40
23.83
26.81
28.86
23.14
31.48
28.37
27.73
6
Figure 3: PHOF 2.13ii - Percentage of Physically Inactive Adults (All Districts,
Kent & England, 2012-2014)
40.00
35.00
Percentage of Population
30.00
25.00
20.00
2012
2013
15.00
2014
10.00
5.00
.00
Source: Active People Survey (2015)
Most Kent districts show yearly variation in levels of physical inactivity. Sevenoaks,
Shepway and Canterbury have all reported large changes from year to year in levels
of physical inactivity; Tunbridge Wells has shown a consistent increase in levels of
physical inactivity from being the district with the lowest level of inactivity in 2012 to
the third worst in 2014.
Changes in levels of physical inactivity by district are likely to be due to the low
sample sizes collected by Active People Survey at district level. Error bars on Figure
3 show confidence intervals reported in the source data23. Actual values at district
level may be up to 5% above or below the reported figure. Care should therefore be
taken when interpreting Active People Survey figures for individual data collection
years at district level.
November 2015
7
Figure 4: PHOF 2.13i - Percentage of Physically Active Adults (Kent &
England, 2012-2014)
57.40
57.20
Percentage of Population
57.00
56.80
Kent
56.60
England
56.40
56.20
56.00
55.80
2012
2013
2014
Source: Active People Survey (2015)
The percentage of the Kent population achieving the 150 minutes required to
maintain or improve health24 has decreased yearly. This is in contrast to the national
trend, which has improved each year. After being above the national average in
2012, the percentage of adults achieving the recommended levels of physical activity
in Kent is now below the national average for the first time.
Table 2: PHOF 2.13i - Percentage of Physically Active Adults (All Districts,
Kent & England, 2012-2014)
Area
Ashford
Canterbury
Dartford
Dover
Gravesham
Maidstone
Sevenoaks
Shepway
Swale
Thanet
Tonbridge and
Malling
Tunbridge Wells
November 2015
2012
54.47
60.06
52.94
56.20
55.68
60.90
64.32
48.70
52.65
52.41
2013
57.35
58.38
56.63
54.75
58.99
58.72
62.75
56.90
50.71
48.42
2014
52.90
53.70
55.80
61.05
55.53
59.28
62.76
59.26
54.12
48.81
61.14
64.80
60.29
63.34
59.82
57.53
8
Kent Average
England Average
57.19
56.03
57.14
56.03
56.57
57.04
Figure 5: PHOF 2.13i - Percentage of Physically Active and Inactive Adults Active Adults (All Districts, Kent & England, 2012-2014)
70.00
Percentage of Population
60.00
50.00
40.00
2012
30.00
2013
2014
20.00
10.00
.00
Source: Active People Survey (2015)
Changes in levels of physical activity by district also show yearly variation.
Canterbury and Tunbridge Wells have shown a consistent reduction in the number of
physically active adults, whilst Shepway has shown a year-on-year increase. It is
likely that these variations are partly due to the low sample sizes collected by Active
People Survey. Error bars on Figure 5 show confidence intervals reported in the
source data25. Actual values at district level may be up to 5% above or below the
reported figure; care should be taken when interpreting Active People Survey figures
for individual data collection years at district level.
Populations at risk
Public health interest in physical activity is specific to populations where individuals
are at risk of ill health as a result of a lack of physical activity. There is a strong
relationship between levels of physical inactivity and socio-economic status26, so
much so that people living in the most deprived areas are twice as likely to be
physically inactive as those living in the least deprived areas27. Populations
experiencing high deprivation are likely to have additional disease burden that
increasing levels of physical activity will help to prevent or manage, including excess
weight, hypertension and mild to moderate depression. Physically inactive people
from populations in areas of highest deprivation should be considered the primary
target group for increasing levels of physical activity.
November 2015
9
Common characteristics of populations at high risk of physical inactivity include low
levels of employment low incomes and high levels of benefit need and state
dependency; reliance on social housing, supported housing and residential care; low
levels of qualification, and single-parent families. Physically inactive people often
also have a number of long-term health conditions that contribute to their low levels
of activity and that are exacerbated by low levels of activity.
Other physical activity concerns in key demographic groups include:
a Men are more active than women in virtually every age group28.
b Physical activity declines with age, to the extent that by the age of 75 years
only one in ten men and one in 20 women are active enough for good
health29.
c On average, disabled people are half as likely as non-disabled people to be
active with over 80% of people with learning disabilities failing to achieve the
minimum recommended level30 and only one in four people with learning
difficulties take part in physical activity each month31.
Opportunities for engaging populations Identified as being at risk
Opportunities to engage with at-risk populations are available through both
structured and opportunistic channels in health and community settings, including:
a Primary care, including during new patient registrations or through screening
existing disease registers or other practice records.
b Aligning with other NHS initiatives to measure health outcomes for example
blood pressure, body mass index or blood glucose levels.
c Existing community health and care services, for example NHS Health
Checks, the adult obesity care pathway, stop smoking clinics and community
pharmacies.
d Clinical condition-specific pathways such as cardiac rehabilitation, diabetes
management and stroke rehabilitation.
e Partnerships with organisations including local authorities, housing
associations, community groups, charities supporting physical or mental
health and wellbeing, police and community safety, and other community
welfare organisations.
f Other local authority health and social care services including family support
services, social workers, welfare or employment support services.
g Organisations with specific memberships of religion, faith, belief or ethnicity
groups.
h Disability groups, charities and residential services.
Identifying physically inactive individuals
Screening individuals for levels of physical activity should be done using a validated
physical activity screen, such as:

General Practice Physical Activity Questionnaire (GPPAQ) 32
GPPAQ is a validated screening tool, used in primary care to assess the physical
activity levels of adults (16 to 74 years). It provides a simple, four-level physical
November 2015
10
activity index. Practitioners can use this index to help them decide when to offer
interventions to increase physical activity.

International Physical Activity Questionnaire (IPAQ)33
IPAQ is a validated screening tool used internationally, thereby allowing comparison
of data across programmes, to assess physical activity levels of adults (15-69 years).
The IPAQ short form is a seven-question instrument and assigns one of three levels
of physical activity to indicate the level of risk in the individual.

Single-item screen
The single-item physical activity questionnaire was developed to assess
respondents’ eligibility for physical activity interventions34 and is recommended in the
Standard Evaluation Framework for Physical Activity35. The screen is a single
question and asks respondents on how many days in the last week they have been
active for 30 minutes or more.
Care should be taken over the selection of screening tools, including ensuring the
tool is validated for use with the participant cohort, and whether the tool is
appropriate for screening only or can be used for measuring pre and postintervention changes in physical activity levels.
The Level of Need in the Population
There is a high level of need for a county-wide service to reduce physical inactivity in
the most high-risk individuals.
An individual’s level of physical activity can be placed in one of three risk categories,
where risk refers to the likelihood of developing non-communicable disease caused
by or exacerbated by a lack of physical activity.
Table 3:
Risk
Level
High risk
Category
Inactive
Moderate Not Meeting
risk
Guidelines
Low risk
Meeting
Guidelines
% Kent
Definition
Population
28.37%
Fewer than 30 cumulative minutes per week of
moderate physical activity36
15.06%
Fewer than 150 cumulative minutes per week of
moderate physical activity or 75 minutes of
vigorous physical activity
56.57%
Achieving or exceeding 150 cumulative minutes
per week of moderate physical activity or 75
minutes of vigorous physical activity37
a The highest level of need for physical activity services, interventions and
support is in the highest risk group as inactive people are at high risk of
developing disease conditions as a direct result of inactivity.
November 2015
11
b Individuals not meeting guidelines are at moderate risk of disease conditions
but are not at high risk of developing disease conditions as a result of
inactivity.
c Individuals who meet or exceed physical activity guidelines are at no
significant risk of developing disease conditions as a result of physical
inactivity.
Conditions caused by physical inactivity
Level of need in the population can also be determined from disease burden directly
caused by inactivity.
Table 4: Incidence or Prevalence of Major Non-Communicable Conditions and
aAtributable Fraction Directly Caused by Physical Inactivity
Condition
Diabetes Mellitus
% Attributable to
Physical
Inactivity38
13%
Coronary Heart
Disease
10.5%
Breast Cancer
18%
Colon Cancer
19%
Kent Burden
74,894 total
patients on disease
register39
47825 total
patients on disease
register40
1,094 new
diagnoses in
201241
1,012 new
diagnoses in
201242
Inactivity
Attributable
Fraction
8763 total cases*
5022 total cases
197 new cases in
2012
193 new cases in
2012
*Diabetes Mellitus prevalence includes Type I diabetes, estimated to be 10% of
diabetes cases in the UK43. Attributable fraction adjusted to 90% to represent Type II
cases caused by inactivity.
It is estimated that over 8,700 patients on the diabetes register for Kent developed
their conditions as a direct result of physical inactivity. It is also estimated that 5,000
patients in Kent diagnosed with coronary heart disease developed their condition as
a direct result of physical inactivity; of the new cases of breast cancer diagnosed in
Kent in 2011, 196 were directly due to physical inactivity; and 193 new cases of
colon cancer were due to inactivity.
Physical inactivity is also a cause of high blood pressure, stroke, metabolic
syndrome, depression, falling, bone health, joint health and muscle health44,
however no reasonable calculation of the total disease burden of these conditions
attributable to physical inactivity can be made.
November 2015
12
Assessment of future need
Levels of physical activity are declining. The need for support in for the most inactive
people is expected to rise in future; there has been a 20% reduction in physical
activity levels over the last 50 years and projections suggest that a further 15% drop
is likely by 2030. By this time, the average British person will expend just 25% more
energy than if they had spent the day in bed45. This decline in levels of physical
activity is likely to impact rates of major non-communicable disease conditions.
Current Services in Relation to Need
Current provision of and access to physical activity opportunities and facilities
There are a range of services and opportunities to facilitate achieving the
recommended 150 minutes of physical activity per week, including free-to-use
natural environment assets, commercial and local authority sport and leisure
offerings, and specialist sports provision.
Sport England’s Active Places Power46 lists over 3,900 recognised sites for
recreational or competitive sport in Kent including over 2,300 grass pitches, 340
sports halls, 335 tennis courts, 150 swimming pools and 130 artificial grass pitches.
Flagship facilities in Kent include Cyclopark in Gravesend, Julie Rose Stadium in
Ashford and Royal St George’s golf course in Sandwich all of which host national
and international sporting events in addition to providing specialist sports facilities for
community and recreational use. There are also a number of private commercial
gyms and commercial health and fitness service providers.
Availability of built facilities for sport and recreation is generally higher in the urban
population centres such as Maidstone, Canterbury, Dartford and Gravesham with
lesser availability in areas with lower population density.
Kent has a particular strength in natural environment assets due to the diversity and
accessibility of natural environment settings including farmed land, woodland,
grassland, and both inland and coastal waterways 47. Kent has two Areas of
Outstanding Natural Beauty (AONB) in the Kent Downs and the High Weald, which
have UK statutory protection equivalent to that of National Parks. Kent also has a
number of managed country parks, local and urban parks, green infrastructure,
amenity grassland, and over 4,200 miles of public rights of way such as footpaths,
bridleways and byways. There are a number of structured opportunities for
increasing levels of physical activity through the natural environment, largely
delivered by organisations in the charities, community and public sector. There are
also a range of commissioned and led services made available to populations with
high physical inactivity including Sky Ride and Walking for health.
Large-scale or strategic changes to physical activity opportunities and facilities are
not necessary to increase population levels of physical activity in Kent. Addressing
the quality, accessibility and local provision of facilities or access in response to local
need and protecting existing sport and leisure assets such as local authority grass
fields are key issues, but must be locally driven and focussed in areas with
populations experiencing higher deprivation.
November 2015
13
Changing individual behaviour
There is currently no county-wide approach to reducing physical inactivity. Emphasis
on commissioning should be placed on programmes and services that engage with
individuals identified as physically inactive and support long-term behavioural
change.
Kent County Council Public Health does not currently commission a county-wide
service specifically for the purpose of reducing physical inactivity. A pilot project was
commissioned in 2015 to test a delivery approach based on the Department of
Health’s Let’s Get Moving (LGM) commissioning model48. Evaluation of this project
will support the development of a county-wide programme for Kent for physical
activity and wider health improvement services.
Evidence of What Works
NICE guidance
National Institute for Health and Care Excellence (NICE) has produced a number of
guidelines giving recommendations on how people can be encouraged to meet
physical activity guidelines.
Table 5: Summary of NICE Guidance on Increasing Levels of Physical Activity
PH2
PH8
PH13
PH41
Date of
Publication
2006
2008
2008
2012
PH44
PH54
2013
2014
Guideline
Title
Four commonly used methods to increase physical activity
Physical activity and the environment
Promoting physical activity in the workplace
Walking and Cycling: local measures to promote walking
and cycling as forms of travel or recreation
Physical activity: Brief advice for adults in primary care
Exercise referral schemes to promote physical activity
For the Department of Health, NICE produced guidance on four common methods
used to increase the population's physical activity levels. The four interventions
considered were: brief interventions in primary care, exercise referral schemes,
pedometers and community-based walking and cycling programmes49.
This guidance has been partially updated by ‘Walking and Cycling’50, and ‘Physical
activity: brief advice for adults in primary care’51. The brief advice document aims to
support routine provision of brief advice on physical activity in primary care practice.
A recent update on exercise referral schemes52 concluded that exercise referral is
less effective in increasing levels of activity in the population in comparison with
other methods, including brief interventions and signposting.
Guidelines have also been produced on physical activity and the environment53 and
promoting physical activity in the workplace54.
November 2015
14
Brief intervention and motivational interviewing
Let’s Get Moving 55 is a behaviour change intervention developed by the NHS and
Department of Health designed to provide a systematic approach to identifying and
supporting adults to become more active, for the purpose of both the prevention and
management of inactivity-related chronic disease.
An evaluation of the Let’s Get Moving pilot found brief intervention and motivational
interviewing to be a feasible method of reducing physical inactivity56. This approach
is also recommended in NICE commissioning guidance57. NICE also established that
brief intervention for physical activity in primary care is cost effective, with the
strength of cost-effectiveness increasing for patients over the age of 5458.
Everybody Active Every Day – A framework for increasing levels of physical
activity
The ‘Everybody Active, Every Day’59 national implementation framework published
by Public Health England describes a number of methods that may lead to increases
in physical activity in response to locally-identified demand.
Unmet Needs and Service Gaps
There is a requirement for a county-wide service to systematically identify those at
risk of developing long-term conditions as a result of physical inactivity. This needs
to be focussed in areas of high deprivation and population-level prevalence of
physical inactivity, and individuals should be supported to increase their levels of
physical activity.
Recommendations for Commissioning
It is recommended that programmes be commissioned to address physical inactivity
based on the brief intervention and motivational interviewing model60. The pathway
should include:
a A comprehensive recruitment and referral process focussing on at-risk
populations.
b Brief intervention, motivational interviewing and support for behavioural
change in an appropriate setting and delivered by an appropriate agent.
c Signposting to a range of local activity services, facilities and appropriate
opportunities based on patient preferences, confidence to change and level of
motivation.
d Ongoing support to patients over at least 12 months following intervention.
Services should be integrated where possible with pathways for other health
improvement and health promotion services.
Additional local action recommended to increase levels of physical activity include:
a Protecting and improving existing grass playing fields.
b Integrating physical activity into transport and environmental planning and
services.
November 2015
15
c Improving physical activity assets and facilities in response to local demand.
d Increasing use of the natural environment for physical activity and health
reasons.
Recommendations for Commissioning
Needs assessments are recommended in the following areas:
a Provision of green space and green infrastructure in Kent and possible areas
for improving provision, access and usage of green space.
b Provision of and efficacy of active travel strategies in raising general health in
the population, and possible areas for targeted investment in Kent.
Key Contacts
Andy Fairhurst, Physical Activity Programme Manager, Kent County Council Public
Health [email protected]
November 2015
16
References
1
World Health Organisation (2010). Global Recommendations on Physical Activity
for Health. http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/
2
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
3
Lee, I, et al. (2012). Effect of physical inactivity on major non-communicable
diseases worldwide: an analysis of burden of disease and life expectancy. The
Lancet. 380 (9838), 219-229.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61031-9/abstract
4
Lee, I, et al. (2012). Effect of physical inactivity on major non-communicable
diseases worldwide: an analysis of burden of disease and life expectancy. The
Lancet. 380 (9838), 219-229.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61031-9/abstract
5
Sari, N (2009). Physical inactivity and its impact on healthcare utilization. Health
Economics 18(8): 885-901.
6
All-Party Commission on Physical Activity (2014)
http://parliamentarycommissiononphysicalactivity.files.wordpress.com/2014/04/apco
pa-final.pdf
7
UKActive (2014). Turning the Tide of Inactivity.
http://www.ukactive.com/turningthetide/
8
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
9
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
10
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
11
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
November 2015
17
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
12
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
13
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
14
Public Health England (2014). Everybody Active Every Day.
https://www.gov.uk/government/publications/everybody-active-every-day-aframework-to-embed-physical-activity-into-daily-life
15
Public Health England (2014). Public Health Outcomes Framework.
http://www.phoutcomes.info/public-health-outcomesframework#gid/1000042/pat/6/ati/102/page/0/par/E12000008/are/E10000016
16
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
17
Public Health England (2014). Public Health Outcomes Framework.
http://www.phoutcomes.info/public-health-outcomesframework#gid/1000042/pat/6/ati/102/page/0/par/E12000008/are/E10000016
18
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
19
Public Health England (2014). Public Health Outcomes Framework.
http://www.phoutcomes.info/public-health-outcomesframework#gid/1000042/pat/6/ati/102/page/0/par/E12000008/are/E10000016
20
Public Health England (2014). Public Health Outcomes Framework.
http://www.phoutcomes.info/public-health-outcomesframework#gid/1000042/pat/6/ati/102/page/0/par/E12000008/are/E10000016
21
Public Health England (2014). Public Health Outcomes Framework.
http://www.phoutcomes.info/public-health-outcomesframework#gid/1000042/pat/6/ati/102/page/0/par/E12000008/are/E10000016
22
Sport England (2015) Active People Survey 9
http://www.sportengland.org/research/who-plays-sport/
November 2015
18
23
Sport England (2015) Active People Survey 9
http://www.sportengland.org/research/who-plays-sport/
24
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
25
Sport England (2015) Active People Survey 9
http://www.sportengland.org/research/who-plays-sport/
26
Public Health England (2013) Social and economic inequalities in diet and physical
activity
http://www.noo.org.uk/uploads/doc/vid_19253_Social_and_economic_inequalities_in
_diet_and_physical_activity_04.11.13.pdf
27
UKActive (2014). Turning the Tide of Inactivity.
http://www.ukactive.com/turningthetide/
28
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
29
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
30
Emerson, E. & Baines, S. (2010) Health Inequalities and People with Learning
Disabilities in the UK: 2010. Learning Disabilities Observatory.
http://www.improvinghealthandlives.org.uk/uploads/doc/vid_7479_IHaL20103HealthInequality2010.pdf
31
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
32
https://www.gov.uk/government/publications/general-practice-physical-activityquestionnaire-gppaq
33
https://sites.google.com/site/theipaq/
34
Milton K, Bull FC, Bauman A. (2011) Reliability and validity testing of a single-item
physical activity measure. British Journal of Sports Medicine 2011;45(3):203-8.
http://bjsm.bmj.com/content/45/3/203.abstract
November 2015
19
35
NHS National Obesity Observatory (2012) Standard Evaluation Framework for
Physical Activity Interventions
http://www.noo.org.uk/uploads/doc/vid_16722_SEF_PA.pdf
36
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
37
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
38
Lee, I, et al. (2012). Effect of physical inactivity on major non-communicable
diseases worldwide: an analysis of burden of disease and life expectancy. The
Lancet. 380 (9838), 219-229.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61031-9/abstract
39
No of Kent residents on disease register. QOF 2014 datasets
http://www.hscic.gov.uk/article/2021/WebsiteSearch?productid=16273&q=qof&sort=Relevance&size=10&page=1&area=both#top
40
No of Kent residents on disease register. QOF 2014 datasets
http://www.hscic.gov.uk/article/2021/WebsiteSearch?productid=16273&q=qof&sort=Relevance&size=10&page=1&area=both#top
41
No of new cases diagnosed in Kent in 2011, from most recent available dataset.
http://www.hscic.gov.uk/indicatorportal
42
No of new cases diagnosed in Kent in 2011, from most recent available dataset.
http://www.hscic.gov.uk/indicatorportal
43
Diabetes UK (2010). Key Statistics on Diabetes
http://www.diabetes.org.uk/documents/reports/diabetes_in_the_uk_2010.pdf
44
Department of Health (2011). Start Active, Stay Active: a report on physical activity
from the four home countries' Chief Medical Officers.
https://www.gov.uk/government/publications/start-active-stay-active-a-report-onphysical-activity-from-the-four-home-countries-chief-medical-officers
45
Nike (2012). Designed to Move: A Physical Activity Action Agenda.
http://e13c7a4144957cea5013f2f5ab26d5e83af3ea377013dd602911.r77.cf5.rackcdn.com/resources/pdf/en/fullreport.pdf
46
Sport England (2015) Active Places Power https://www.activeplacespower.com
November 2015
20
47
ARCH (2012) Kent Habitat Survey http://www.archnature.eu/assets/files/finalpdfs/KHS-Section-1-Executive-Summary.pdf
48
Department of Health (2012). Let’s Get Moving Commissioning Guidance.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21626
2/dh_133101.pdf
49
NICE (2006) Four commonly used methods to increase physical activity PH2.
http://guidance.nice.org.uk/PH2
50
NICE (2012) Walking and cycling PH41. http://guidance.nice.org.uk/PH41
51
NICE (2013a) Physical activity: brief advice for adults in primary care PH44.
http://guidance.nice.org.uk/PH44
52
NICE (2014) Exercise referral schemes to promote physical activity PH54.
https://www.nice.org.uk/guidance/ph54
53
NICE (2008) Physical activity and the environment PH8.
http://publications.nice.org.uk/physical-activity-and-the-environment-ph8
54
NICE (2008a) Promoting physical activity in the workplace PH13.
http://publications.nice.org.uk/promoting-physical-activity-in-the-workplace-ph13
55
Department of Health (2012). Let’s Get Moving Commissioning Guidance.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21626
2/dh_133101.pdf
56
Bull, F.C., Milton, K. & Boehler, C. (2008). Report of the Evaluation of the Physical
Activity Care Pathway London Feasibility Pilot
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/19204
1/Evaluation_of_the_Physical_Activity_Care_Pathway_London_Feasibility_Pilot__Report.pdf
57
NICE (2013a) Physical activity: brief advice for adults in primary care PH44.
http://guidance.nice.org.uk/PH44
58
NICE (2013a) Physical activity: brief advice for adults in primary care PH44.
http://guidance.nice.org.uk/PH44
59
Public Health England (2014). Everybody Active Every Day.
https://www.gov.uk/government/publications/everybody-active-every-day-aframework-to-embed-physical-activity-into-daily-life
60
Department of Health (2012). Let’s Get Moving Commissioning Guidance.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21626
2/dh_133101.pdf
NB To access some of the websites you might have to copy and paste the link above into your browser.
November 2015
21