Promoting physical activity in a public health context

In this special issue of theJournal of Sport and Health ScienceentitledPhysical Activity and Public Health,5 papers,1 commentary,and 1 research highlight discuss efforts using public health approaches to increase physical activity(PA)in global settings.Such efforts are warranted based on the prevalence of adults(23%)worldwide who are insufficiently active at levels recommended by the World Health Organization(WHO).This impact is substantial with 6%-10%of all deaths attributed to insufficient PA.1,2Insufficient PA also places adults at increased risk for a myriad of conditions,which include cardiovascular disease,type 2 diabetes,breast and colon cancer,bone and joint problems,among others.Steven Blair,known worldwide for his research on PA,aerobic fitness,and health refers to the physical inactivity pandemic as the“biggest public health problem of the 21st Century”.3This concern is mirrored by a recent report highlighting global increases in overweight and obesity and the impact on increased mortality and disability related to cardiovascular disease and type 2 diabetes.4Accordingly,public health governmental agencies5,6and nongovernmental organizations7-10have called for stepped up efforts to increase PA on a global scale.

Public health approaches to increasing PA often are organized into action plans based on the Ecological Systems Model,a framework used to understand the multiple levels of behavior,social systems,and interactions between people and their environments.11,12In 2006,Sallis et al.13presented an ecological model of the 4 domains of active living(recreation,transport,occupation,and household)that recognizes the importance of multiple influences on decisions to be physically active or not.They identify social cultural environments,informational environments,built and natural environments,perceived environments,and policy environments.Social cultural environments relate to the importance of interpersonal modeling,social support,the social climate,and advocacy by individuals and organizations.Informational environments involve information dissemination,counseling,and mass media efforts.Built and natural environments include considerations of climate,open space,air quality,and structures built for PA purposes.Policy environments relate to ordinances and laws that enable active transport,sports and recreation opportunities,and land use.Traditionally,public health approaches have been focused on built,natural,and policy environments;however,all levels of the ecological framework are important in promoting PA in a population setting.

The papers in this special issue are organized by this ecological model of active living.In a commentary,Fiona Bull14from the WHO discusses the global problems of physical inactivity and presents the2013-2020WHO Global Action Plan on Noncommunicable Disease Prevention and Controldesigned to reduce physical inactivity by 10%by 2025.She notes that reaching this goal will require leadership and contributions of the academic and scientific community to assist policy makers and practitioners.Two papers focus on the built and natural environment in relation to PA.Gadais et al.15identify strengths and gaps in research on PA and the built environment in Canada.They call for innovative research into political and sociocultural spheres of action,one of the gaps identified in the Canadian studies.Solbraa et al.16examine associations with objective measures of PA and the built environment,which includes rural communities along the Norwegian coast.They recommend locally customized approaches for walkability,active transport,and commuting.Y?ld?zer et al.17focus on the social cultural environment in exploring relationships between social capital and PA engagement in Turkish adolescents.They discuss the importance of gender and culture on perceptions of social capital and PA in a developing country.Flórez-Pregonero et al.18address the policy environment in presenting a feasibility study on the use of pedometers in a U.S.PA surveillance system.They highlight the opportunities and challenges of using pedometers to collect step data in a single state participating in the surveillance system.The last 2 papers focus on the information environment in presenting evaluations of public health projects designed to increase PA in healthcare and population settings,respectively.Beckvid-Henriksson et al.19describe a Swedish-Vietnamese project that trained healthcare providers in PA counseling,used mass media to promote PA,and helped to develop a Vietnamese PA plan.Brown et al.20share results from an evaluation of mass-media activities associated with a national walking program in the USA.

Collectively,the papers presented in this special issue provide a global snapshot of some of the efforts taken to increase PA in different countries.Clearly a public health problem,physical inactivity is largely solvable through population-based research followed by community education,population surveillance,policy actions,and community-wide interventions.As seen with the papers in this special issue on PA and public health,multi-disciplinary team approaches are needed to adequately address the multiple dimensions of physical inactivity.

1.Lee IM,Shiroma EJ,Lobelo F,Puska P,Blair SN,Katzmarzyk PT.Effect of physical inactivity on major non-communicable diseases worldwide:an analysis of burden of disease and life expectancy.The Lancet2012;380:219-29.

2.World Health Organization.Prevalence of insufficient physical activity among adults:data by WHO region.Global Health Observatory data repository.Available at:http://apps.who.int/gho/data/view.main.2482?lang=en;2015[accessed 25.09.2017].

3.Blair S.Physical inactivity:the biggest public health problem of the 21st century.Br J Sports Med2009;43:1-2.

4.GBD 2015 Obesity Collaborators.Health effects of overweight and obesity in 195 countries over 25 years.N Engl J Med2017;377:13-27.

5.U.S.Department of Health and Human Services.Step It Up!The Surgeon General’s Call to Action to Promote Walking and Walkable Communities.Washington,DC:U.S.Dept of Health and Human Services,Office of the Surgeon General;2015.

6.Tan X,Liu X,Shao H.Healthy China 2030:a vision for health care.Value Health Reg Issues2017;12:112-4.

7.International Society for Physical Activity and Health.The Toronto charter for physical activity:a global call for action.Available at:http://www.ispah.org/resources;2010[accessed 03.10.2017].

8.International Society for Physical Activity and Health.The Bangkok declaration on physical activity for global health and sustainable development.Available at:http://www.ispah.org/resources;2016[accessed 03.10.2017].

9.International Society for Physical Activity and Health.Global observatory for physical activity.Available at:http://www.globalphysicalactivityobservatory.com/;2017[accessed 03.10.2017].

10.National Physical Activity Plan Alliance.National physical activity plan.Available at:http://www.physicalactivityplan.org/index.html;2017[accessed 03.10.2017].

11.Bronfenbrenner U.The ecology of human development:Experiments by nature and design.Cambridge,MA:Harvard University Press;1979.

12.Ainsworth BE.Active aging:from cells to environment.Kinesiol Rev2016;5:1-3.

13.Sallis J,Cervero RB,Ascher W,Henderson KA,Kraft MK,Kerr J.An ecological approach to creating active living communities.Annu Rev Public Health2006;27:297-322.

14.Bull F.Translating science to inform global policy on physical activity.J Sport Health Sci2018;7:3-4.

15.Gadais T,Boulanger M,Trudeau F,Rivard MC.Environments favorable to healthy lifestyles:a systematic review of initiatives in Canada.J Sport Health Sci2018;7:7-18.

16.Solbraa AK,Anderssen SA,Holme IM,Kolle E,Hansen BH,Ashe MC.The built environment correlates of objectively measured physical activity in Norwegian adults:a cross-sectional study.J Sport Health Sci2018;7:19-26.

17.Y?ld?zer G,Bilgin E,Korur EN,Novak D,Demirhan G.The association of various social capital indicators on physical activity participation among Turkish adolescents.J Sport Health Sci2018;7:27-33.

18.Flórez-Pregonero A,Fulton JE,Dorn JM,Ainsworth BE.Feasibility of using pedometers in a state-based surveillance system:2014 Arizona Behavioral Risk Factor Surveillance System.J Sport Health Sci2018;7:34-41.

19.Beckvid-Henriksson G,Nguyen TH,Kilhed J,Nordstr?m A,Svensson S,Tran TTH,et al.Implementation and assessment of diverse strategies for physical activity promotion in Vietnam—a case report.J Sport Health Sci2018;7:42-9.

20.Brown DR,Carlson SA,Kumar GS,Fulton JE.Research highlights from theStatus report for step it up!The surgeon general’s call to action to promote walkingand walkable communities.J Sport Health Sci2018;7:5-6.