1. Updating the UK Physical Activity Guidelines
Dr Graeme Scobie
Public Health Adviser
NHS Health Scotland

2. Outline Background Process Consensus meeting Web Consultation
Way forward
- Surveillance

3. Background Recent PA evidence reviews carried out in USA and Canada
All four home countries have similar but different PA messages
Current PA messages are at least 5 years old (CMO report in 2004)
WHO developing global PA guidelines
New work - Be active Be healthy action plan in England, 5 year review of LMSMA, and a strategic plan for PA in Wales for 2009/10
Why the need for updating: Important to let people know what the process involved, who was involved and how it was done. It was open and transparent and we did try to let people know what was happening but we were working to a very tight deadline and budget!
In 2008 the U.S. Department of Health and Human Services published Physical Activity Guidelines for Americans ( The document is designed to provide information and guidance on the types and amounts of physical activity that provide substantial health benefits for Americans aged 6 years and older and is based on a large, comprehensive review of the scientific literature. Canada is currently engaged in a similar process and has conducted a comparable review of the evidence. This is being led by the Canadian Society for Exercise Physiology and Public Health Agency of Canada.
The World Health Assembly Action Plan urges Members States to, among other actions, develop and implement national guidelines on physical activity for health. It urges the World Health Organization (WHO) to provide countries with technical support in either implementing or strengthening nationwide actions to reduce risk factors for NCD and their determinants. In order to address these, WHO is currently developing Global Recommendations (Guidelines) on Physical Activity for Health. 3

4. Process Steering group: Kim Kensett – NI Elaine McNish – Wales
Paul Stonebrook – England
Graeme Scobie – Scotland
Fiona Bull - BHFNC
Charlie Watts - BHFNC
We started in July finding money and venue and over the next few weeks had to decide what and how we were going to do this as time was very short and we had a deadline of the 21st Oct. This was the first stage in the process – identifying lead persons in each of the home countries

5. Process Target groups: Young People 5-18 years Adults 19 – 64 years
Older adults 65+ years
Separate work being taken forward on
- Early years 0-5 years
- Sedentary behaviour and Obesity

6. Working groups Young people:
Dr Mark Trembley, Prof Stuart Biddle, Prof John Reilly, Prof Chris Riddoch
Adults:
Dr Bill Haskell, Prof Nanette Mutrie. Prof Marie Murphy, Prof Nick Wareham
Older Adults:
Dr Dave Buchner, Prof Ken Fox, Dr Dawn Skelton, Dr Richard Ferguson
Early years being led by John Reilly
Sedintary Behaviour by Stuart Behaviour. 6

7. Remit NOT to the review the evidence but –
In view of the recent evidence reviews from the USA, Canada and BASES, are the PA guidelines from each of the UK countries still valid and reflect the best available evidence

8. PROCESS

9. Expert working groups formed
Preparation of Draft Working Papers outlining a set of draft recommendations on the updating of current UK PA Guidelines,
1st draft by International experts based on scientific
evidenced from systematic reviews
Discussion and revision of draft working paper by national Working Groups - 2nd Draft
Circulation of all draft working papers to invited list of delegates
in preparation for the 2 day consensus meeting
This process basically started and finished within 2 months. Even recruiting the international experts was a huge achievement as well as getting the uk experts to give up considerable amount of time to produce the draft papers and join in with teleconference calls

10. UK Consensus Meeting
Invited delegates to discuss proposed recommendations on updating of the UK PA guidelines – based on draft working papers
21st / 22nd October 2009
Marlow

11. Consensus meeting
Draft papers circulated to ~ 60 invited delegates -Academics, Government and Communication people.
Series of plenary sessions and workshops on draft recommendations
Examples of communication strategies from USA/Canada
Consensus from delegates on the proposed draft recommendations

12. Important!
The objective was to review and agree the proposed SCIENTIFIC recommendations put forward by the international and UK experts and NOT to what the communication or public message would be (that is for later work) 12

13. 10 -12 key questions put to IE
Questions asked
key questions put to IE
Question 1: Does the scientific evidence continue to support the current physical activity guidelines for adults and older adults?
Recommendation #1
The current scientific evidence does continue to support 5 x 30 mins of moderate intensity activity per week.
However it is recommended that the current physical activity guidelines in each of the home countries should be reviewed and potential refining, clarification and or extensions should be considered to allow a better reflection of the scientific knowledge accumulated since 2004 on the health benefits of physical activity.
This was also asked of the young people

14. Questions asked:
Question 2 : Based on the current evidence on volume, intensity, duration and frequency of activity and their impact on health and disease, what modifications to existing UK guidelines are warranted?
Activity volume
Recommendation #2
The UK guidelines should maintain the focus on “5 sessions x 30 minutes of moderate-intensity physical activity per week” and note that this is equates to a volume of 150 minutes of moderate intensity per week.
Recommendation #3
The UK guidelines should note that there are multiple ways of accumulating the total of 150 minutes, and “5 x 30” is one way.

15. Recommendation #4
Note that the volume of physical activity associated with the prevention of different chronic diseases may vary but the evidence is currently insufficiently precise to warrant separate guidelines for each specific disease
Recommendation #5
The UK guidelines should recognise the health benefits of moving from ‘no activity’ to ‘low levels’ of activity
Recommendation #6
The UK physical activity guidelines should recognise that higher volumes of activity (> 150 minutes) are associated with increased health benefits (eg 300 mins)

16. Recommendation #7
The UK guidelines on physical activity for older adults should adopt the same key recommendation(s) on total amount of activity needed for health benefits as used for the adult population.
Activity intensity
Recommendation #8
The UK guidelines should include a specific statement recognising the health benefits of vigorous intensity activity
Recommendation #9
The UK guidelines should recognise that combinations of moderate- and vigorous- intensity activities can provide health benefits and this represents another way of achieving the recommended target volume of activity.

17. Session duration and accumulation of shorter bouts
Recommendation #10
The UK PA guidelines for older adults should place greater emphasis on moderate-intensity rather than vigorous intensity activities and should be based on lower absolute but similar relative intensity.
Session duration and accumulation of shorter bouts
Recommendation #11
The UK guidelines should retain a statement recognising that activity can be accumulated through shorter bouts of at least 10 mins or more of moderate intensity exercise.
Recommendation #12
The UK guidelines should acknowledge shorter bouts of activities that may not last the minimum required bout of 10 minutes (for example activities including walking up and down stairs) will add to total activity and may help sedentary people get started.

18. Recommendation #13
The UK guidelines should retain the recommendation that physical activity is undertaken regularly across the week (such as 5 or more times per week) because of the evidence of acute effects on biomedical markers and because it can encourage regular activities undertaken as part of daily lifestyle such as active travel through walking and cycling.

19. Recommendations for children
Guidelines for children should include a general overall guideline and a separate one for promoting strength/bone/flexibility
Recommendation 2
Specific recommendation for “vigorous activity on at least 3 days of the week”
Recommendation 3
Guidelines should recommend “daily physical activity”

20. Recommendations for children (cont)
Guideline should recommend at least 60 min of PA which is over and above the “normal” light daily activities
Recommendation 5
A statement should be included on ”for very inactive YP a progressive increase in activity to achieving 60 min is appropriate”
Recommendation 6
The term “accumulate” should be included in the guidelines

21. Other questions - 3. Sedentary
4. Muscle-strengthening, flexibility activities, and/or a separate guideline for balance activities?
5. PA and weight management
6. PA and mental health
7. Gender, race, ethnicity
8. Disability
9. Separate guidelines for older adults
10. Risks versus benefits of the physical activity

22. Additional questions:
Question 11. Please comment on the need for a coherent comprehensive communication strategy to disseminate physical activity guidelines to a variety of audiences (including education sector, health sector and others).
Question 12. What, if any, are the implications of adopting any of the proposed changes to the current UK PA guidelines on the data collected and how it is used and presented as part of ongoing population health monitoring and surveillance systems?

23. Additional questions:
Question 13. Would adoption of the proposed modifications to current UK PA guidelines influence the difficulty of meeting PA guidelines compared to the current PA guidelines for insufficiently active adults?
Question 14. What is the appropriate summary guideline for healthcare practitioners, as a basis for communicating brief advice on PA to patients

24. Outcome
After 2 days of presentations, workshops and debates, delegates agreed in principal to the amendments proposed for the new PA guidelines for all three age groups
Some attempt to refine the proposed recommendations into guidelines but not enough time

25. Where are we now?
Still need to finalise and capture outputs from the process and consensus meeting
Set up web consultation process

26. Summary of discussions from the Consensus Meeting.
Outputs are: Technical Report – draft 1 plus a draft set of proposed ‘Updated UK PA Guidelines’ for next step
Coordinating Group discuss edits – Technical Report draft nd-6th November
Technical Report draft 2 to upload onto web consultation
9th-13th November
Launch nation wide web consultation
Draft Technical Report draft 2 + Draft new PA Guidelines
16th November
This is where your input is needed

27. Close of web consultation 11th December
Collate web consultation responses - make changes - Technical Report draft 3
14th-18th December
Several editing steps with experts
BHFNC make final edits to Technical Report
Submit to Coordinating Group
8th February
This will give us a technical report on the process plus what the UK guidelines should contain based on the most recent evidence

28. Other key outputs
During the write up of the technical reports all 4 home countries will need to think about
1. Producing a report outlining the new guidelines and brief evidence for all 4 CMOs to sign up to
Work with governments and communication colleagues to develop new public messages and publications for different target groups
Implications for existing surveillance
However what we also need to be thinking about and liaising with colleagues in a variety of organisations and departments

29. Thank you