Physical activity has significant benefits for physical and mental health and wellbeing. Despite this, as a nation we are 20% less active than we were in the 1960s (Public Health England (PHE), 2016). Consequently, 1 in 6 of us will die from a physical inactivity-related cause of death. Inactivity costs the UK around £7.4 billion each year, including up to £9.4 million to each NHS clinical commissioning group (CCG) in England for the treatment related to five preventable diseases—ischaemic heart disease, cerebrovascular disease, breast cancer, colon cancer and type 2 diabetes. Other costs associated with this include the indirect costs of inactivity, including demands on the wider health and social care sector and lost productivity in work (Brannan, 2018).
Increasing an individual’s daily physical activity is an aspiration of UK health policy. This is because of the important contribution it makes to managing some long-term conditions and reducing the risk of chronic conditions, including some cancers, heart disease, type 2 diabetes and depression (Department of Health and Social Care (DHSC), 2019; Reid et al, 2021). Using the term ‘physical activity’, in place of physical exercise, aims to convey to the public that daily movement, such as climbing the stairs, walking to the shops, to work or to the bus stop and carrying shopping bags all counts. Moving more throughout life will reduce physical and mental ill health, help maintain a healthier weight and create longer, happier, and healthier lives (DHSC, 2019).
The decision to be active for many people is complicated by the fact that it involves addressing a myriad of cultural, environmental, and emotional choices and considerations (Piggin, 2020). Many people are far from achieving the levels of physical activity desirable for health. There exist stark inequalities in activity levels, which are most pronounced in older people, people living with long-term conditions, people from certain ethnic minority communities and people from more deprived areas (World Health Organization (WHO), 2018, DHSC, 2019) (Table 1).
Table 1. UK rates of physical activity
| Physical activity and sex |
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| Physical activity and age |
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| Physical activity by those with a disability and long-term conditions (LTCs) |
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| Physical activity and ethnicity |
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| Physical activity and socioeconomic status |
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People live and work in a range of environments that present challenges and opportunities for physical activity. The more people feel safe in an environment, the more likely they are to engage in physical activities including walking, running and cycling; however, access to safe spaces is not equally distributed to all. The process of getting active is complex because it is further influenced by an individual’s level of motivation, interests, emotions, ideas, beliefs and relationships. This means that each person’s journey towards increasing their physical activity is different. Such complexity requires multi-sector action, which is characterised through the ‘Everybody active every day’ framework. This framework enables system-wide action at scale to deliver an active environment, equip professionals with knowledge to support people to move more and create an active society (PHE, 2014; 2021).
Guidance from the UK Chief Medical Officers (CMOs) recommends that people avoid inactivity and encourages people to engage in activities involving muscle and bone strengthening, as well as moderate and vigorous activity on a weekly basis (DHSC, 2019) (Table 2). Guidance is provided for people of all ages and includes specific recommendations for pregnant women and people with a disability.
Table 2. UK Chief Medical Officers’ physical activity guidelines for adults
| Duration (per week) | Activity |
|---|---|
| At least 2 days | Muscle and bone-strengthening activities |
| Examples: gardening, yoga, gym exercises | |
| 150 minutes | Moderate intensity activity that increases breathing but the person is still able to talk and have a conversation |
| Examples: swimming, going for a brisk walk or cycling | |
| 75 minutes | Vigorous intensity activity, which means breathing fast to the extent to which it is difficult to hold a conversation |
| Examples: running, walking upstairs, playing sport |
Promoting physical activity
As with many of the behavioural elements of public health, people experience better outcomes when physical activity habits are formed early in life and continue into adulthood and old age. Commonly referred to as a life-cycle approach, nurses and midwives are well placed to help people understand the health benefits of physical activity because they see people from birth into early childhood (midwife, health visitor and school nurse) and again as an older adult (district nurse). Research shows that people are more likely to take up a physical activity intervention if a health professional takes the time to explain the reasons for so doing (PHE, 2020).
The Office for Health Improvement and Disparities (OHID) has joined forces with Sport England to deliver the ‘Moving Healthcare Professionals’ programme. This is helping nurses, midwives, and other health professionals to develop knowledge and skills around talking to people about the benefits of physical activity (Sport England, 2017).
Enhancing our knowledge and action on physical activity
To support all health and care professionals to enhance their knowledge and, more importantly, to take greater action on key public health issues such as physical activity, the OHID has published free online e-learning resources as part of a programme entitled All Our Health (PHE, 2019). The physical activity e-learning resource aims to support professionals by providing bite-sized learning, focusing on the evidence for what works, and provides links to helpful data sources, guidance, and further training resources.
Building back better and fairer
As we start to focus on the recovery phase of the COVID-19 pandemic, it will be essential for the nursing and midwifery workforce to appraise the lessons learnt and consider what changes need to be made to ensure that we genuinely build back better and fairer. This will require our professions to use the 2020s as a decade that sees transformation across the nursing and midwifery workforce, placing as much focus on preventing, protecting and promoting the public’s health as we do on managing and treating disease. Given the need to focus on physical activity and keeping everybody active, nurses must prioritise this area of practice as we move forward. The All Our Health programme provides a useful framework, allowing our profession to consider the evidence-based interventions nurses can implement or champion at individual, community, and population levels.
CASE STUDY
As the respiratory nurse specialist in a GP surgery, Sally has become a physical activity clinical champion for the Office for Health Improvement and Disparities and is a strong advocate for physical activity within the team. She has been working with Edward Thomas (not his real name), a 50-year-old man with newly diagnosed chronic obstructive pulmonary disease. As a smoker, Edward finds it difficult to engage in physical activity, especially because he has been overweight since childhood and sport has never been an interest. During a recent appointment, he reported finding it increasingly difficult to walk upstairs. Sally suggests a physical activity programme, locally known as the ‘gym pass’. Reluctantly, Edward agrees to try it.
Having taken this first step to becoming more physically active, 4 weeks into the gym programme, Edward decides to give up smoking. He tells Sally that because his breathing is much better, he has agreed to do a European motorbike holiday with his best friend and doesn’t want to be unwell when he is in a different country.
Six months after Edward started the physical activity programme, a new patient attends for a health check and asks to see Sally for a ‘gym pass’. Sally is pleased to find that the new patient is Edward’s best friend. He is 55 years old, overweight and has hypertension. He says it is time to take care of his body and seeing first-hand the difference it has made to Edward’s life, he wants it to do the same for him.
As Sally’s reflects on the outcome, she is delighted because she can see that, by helping his friend, Edward has strengthened his commitment to continuing to be physically active. She can see that her role has been more facilitative than directive and she has enabled both people to make important lifestyle changes that will help them feel healthier for longer.