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We use the term 'physical activity' to mean any sort of movement of the body that uses energy. There are many, everyday ways in which physical activity can contribute to a healthy life. Walking all or part of the way to work, doing the housework or gardening, playing with the children or grandchildren, and activities such as sport and dancing can all contribute. Helping everyone be as active as they can be requires implementation of effective interventions designed to make being active easier and more fun, and the optimal balance of regulation and incentives to ensure that public, private and voluntary sector agencies work together to provide facilities for staff, clients and neighbourhoods.

While the motivations and needs of different population groups, such as older people and adolescent girls, are different, each group requires accessible facilities and services. Physical activity programmes including walking, cycling, and dance are facilitated by primary care, NHS, Local Authority and voluntary sector organisations. The type of activity does not matter. What is crucial is that we are all able to enjoy the health and social benefits that come from regular physical activity.

The design of the physical and built environment can have a major impact, either positive or negative, on physical activity and active living, and will impact on the whole population living in that environment. The availability, accessibility and convenience of services and facilities, and the general functionality and aesthetics of the neighbourhood are positively associated with overall levels of physical activity, particularly walking1,2. This is particularly important for those in society with more specific needs, for example, shift workers with young children and older people. They are considered in other countries, their needs are also important in Scotland and must be taken into account.

Recent NICE (National Institute for Clinical Excellence) guidance on physical activity and the environment identifies those features of the environment that support physical activity. It recommends that pedestrians and cyclists must be given the highest priority when developing and maintaining roads and that a comprehensive network of safe, segregated, well maintained cycle ways and footpaths should be provided. An important proportion of the population relies on pavements, footpaths and cycle ways for getting around. These should be a pleasure to use, not a constant reminder that policymakers consider them less important than car users. Public open spaces, public buildings, campuses and workplaces should be linked to cycling and walking routes. Staircases should be designed, positioned and made attractive to encourage their use3.

Supportive environments can make a significant difference too: well maintained green space, street layout, neighbourhood design and traffic calming can all increase activity. This is why we are working with planning, transport and housing colleagues in Local Authorities to look at the ways in which the built and natural environment can be managed to increase levels of physical and social activity.

The Scottish panorama

As a nation, Scotland is becoming more inactive, unfit and increasingly overweight or obese. Perhaps most worrying, this trend starts before young people have left school. Figure 1 shows data from the Scottish Health Survey5 highlighting this effect over the life-course of Scottish people. Inactivity accounts for over a third of deaths from heart disease; added to this is the disease, disability and poor mental health that come from the growing levels of obesity and a lack of physical strength.

[ Figure 1 ] Graph showing % physical activity levels in males and females, ages 2-74

Graph showing % physical activity levels in males and females, ages 2-74

*For both men and women, rates of participation were the same in 2003 and 2008.
Source: Scottish Health Survey 20034 & Physical Activity and Health Alliance 200814

Within this general picture of inactivity, there is a major issue of health inequality. The proportion of inactive adults from the lowest socio-economic groups is twice that of those from the highest socioeconomic groups. However, some people from the lowest socio economic groups are also amongst the most active - largely accounted for by more manual work and lack of access to private motorised transport. Research on physical activity for people with disabilities, people from ethnic minority groups, people over 74 and people with specific health conditions is limited but these groups appear to be less active than the general population6.

The national approach

Against such a background, Let's Make Scotland More Active7, Better Health Better Care8 (physical activity as a priority for health policy), the Scottish National Transport Strategy9 (promoting active travel such as cycling and walking), and Equally Well10 (physical activity as a means of reducing health inequality) all require organisations to act to increase levels of physical activity across the life course. The mutual responsibilities of all agencies and organisations to work together to increase physical activity levels are set out explicitly in Table 1.

[ Table 1 ]
Level of intervention Example of intervention
1. Population interventions Social Marketing campaigns to promote increased physical activity as a way to better health. Health related social marketing is "the systematic application of marketing, alongside other concepts and techniques, to achieve specific behavioural goals, to improve health and to reduce inequalities."12
  Use new development in housing and roadways to promote active modes of transport (e.g. walking to accessible public transport).
  Ensuring safe cycle routes across Lothian for commuting and leisure.
  Making physical activity such as walking and cycling easy, enjoyable and safe.
  Using woodlands and green space to promote physical activity.
2. Community / local intervention Implementing walking projects or other specific physical activity projects for targeted groups to make it easier for them to become more active.
3. Personal intervention 1:1 health coaching / exercise counselling linked to NICE guidance. Encouraging continuation of sporting activities beyond the school years.
  Using brief interventional approaches in primary care and other NHS settings to encourage behaviour change so people are more physically active.

Getting physically active in Lothian

NHS Lothian is working with key partners from the local authorities and the voluntary sector to combine our efforts to increase physical activity levels, particularly who are most inactive. Each of the four Lothian Local Authority and Community Health (and Care) Partnership areas has to deliver an action plan.

Each plan mirrors the national strategy in terms of the overall outcomes, but the actions differ according to the needs of the local area. Within these outcomes, priority groups are teenage girls, women, black and minority ethnic communities and people with disabilities, as they have particularly low levels of physical activity.

The three case studies (Boxes 2, 3, 4) provide a flavour of the work that is going on in Lothian to promote physical activity.

[ Box 1 ] The outcomes11
  1. Increase knowledge and awareness of the key physical activity messages - using websites, public-relation exercises and giving physical activity a similar status to other health topics such as smoking and alcohol.
  2. Increase physical activity levels of children and young people - children should accumulate (build up) at least 1 hour of moderate activity on most days of the week.
  3. Increase physical activity levels of adults of working age, particularly women - adults should accumulate (build up) at least 30 minutes of moderate exercise on most days of the week.
  4. Increase physical activity levels of older adults - for all adults over the age of 55, including those who are frail, 3 sessions a week of strength and balance are also recommended.
[ Box 2 ] Case Study: West Lothian on the Move!

'West Lothian on the Move' was established in September 2001 with funding from NHS Lothian through the Government's Health Improvement Fund. The main focus of 'West Lothian on the Move' is on increasing physical activity to reduce inequalities.

  • Increase awareness of physical activity and raise the profile of the benefits for the health and wellbeing (lifestyle) of those who live, work and play in West Lothian;
  • Provide a framework for joint working between services and agencies, making the best of available resources and enhancing existing services; and
  • Improved levels of physical activity for those who work and play in West Lothian.

'West Lothian on the Move' is a good example of key organisations in West Lothian taking on board their corporate responsibility to make physical activity the easy choice for the citizens of West Lothian. There is a West Lothian Physical Activity and Health Alliance which oversees the implementation of the West Lothian on the Move Strategy (2nd edition)13.

[ Box 3 ] Case Study: Lothian Cycle-2-Work Scheme

NHS Lothian has introduced a 'cycle- 2-work' scheme in partnership with Cycle Scheme Ltd. The scheme will be administered through a salary sacrifice/hire agreement and will be run in accordance with the Government's 'Green Travel Plan'. This scheme offers an attractive employee benefit by encouraging staff to maintain a healthy and active lifestyle whilst making substantial savings on the cost of a bike and safety equipment. Participants can select any make/model bike up to the value of £1000 through independent shops taking part in the scheme.
For more information visit or call 01225 448933

[ Box 4 ] Case Study: Case Study: Partnership between NHS Lothian, the City of Edinburgh Council and Paths to Health to promote walking

The NHS Health Promotion Service has developed a partnership with the City of Edinburgh Council and Paths to Health to develop a city wide action plan to promote walking. Funding from the Scottish Government's Health Improvement Fund is being match funded by Paths to Health, the national organisation which promotes walking, to help reach the targets of physical activity levels set out in the national strategy. This action plan brings together the NHS, voluntary sector, various council departments, such as planning, transport, local community planning teams and local businesses. Volunteer walk leaders will increase capacity to lead the walks and contribute towards the outcomes identified in the Joint Health Improvement Plan for Edinburgh.

Key messages

  • Everyone needs to be active every day.
  • Promoting active living is a sustainable method of helping people to become more active.
  • Excellent partnerships have developed action plans that cover all parts of Lothian.
  • The community level programmes already in place in Lothian such as the Active Schools programme, local health walk initiatives and the Ageing Well programme provide a good start but need to be scaled up, delivered systematically and sustainably.
  • Services designed to increase activity among individuals at increased risk of harm from physical inactivity remain important but are only part of the strategy.
  • Effective methods of increasing physical activity at population and individual level need to be fully implemented in Lothian. This means auditing implementation of the existing evidence, developing and testing new interventions with planning organisations, transport authorities and employers and applying improvement methods to accelerate progress.