The benefits of physical activity are widely recognized. The World Health organization identifies physical inactivity as the fourth leading risk factor for mortality—responsible for 6% of deaths globally after hypertension, (13%), tobacco use (9%) and high blood glucose (6%). Physical inactivity has been associated with 30% of the ischaemic heart disease, 27% of diabetes and, 21-25% of breast and colon cancer burden. Exercise has been described as the “best buy for public health”

Health includes physical, social, and psychological components, each one of equal value. If an individual exercises purely for physical health reasons, for example, to lose weight and they pursue this to the detriment of their psychological or social health, then exercise is detrimental to their health.

The shift from an ‘exercise training-physical fitness’ paradigm to include the ‘physical activity health’ paradigm developed recently. This shift was due to scientific studies that showed that there was a reduced morbidity and mortality with an increase in moderate amounts and intensities of physical activity.

This evidence became known as the dose-response curve, and from this the concept of lifestyle physical activity interventions began to develop.

There is now little debate over the minimum amounts, intensities, and frequencies of physical activity required to confer health benefits. Most recommendations state that the intensity of the activity should be of at least moderate or vigorous effort.

The World Health Organization’s global recommendations on physical activity for health state that children and young people should be active, at a moderate or vigorous intensity, for a minimum of 60min daily. For adults, and older adults, this recommendation changes to 30min of moderate or vigorous intensity physical activity five days per week (or equivalent to 150min per week).

Additional minutes of health enhancing physical activity will confer extra health benefits. All individuals should also build muscle strengthening exercises, flexibility, bone strengthening, or balance activities into their daily routine.

The recommendations change if, for example, an individual wants to maintain or lose body weight, or if an individual has a disability. To maintain a healthy body weight, and avoid gaining weight, an adult would need to spend the equivalent to 60min of moderate intensity activity. To lose weight, the amount of activity is dependent on how much weight an individual wants to lose, how well they can adhere to a physical activity regime and what their physical condition is like. A guideline is to try to accumulate at least 60-75min of moderate intensity physical activity daily. However, it is important to remember that any activity is better than none. Every minute counts.

For individuals with a disability, taking into account what their disability allows, they should aim to follow the adult guidelines of a minimum of 30 min moderate intensity physical activity daily.

Although recommendations may be appropriate for prevention of disease and health promotion, as viewed from a biomedical model of health, participation in regular physical activity can provide much more than this.

A more humanistic or biopsychosocial understanding of physical activity is one that sees physical activity as a mixture of physical, psychological, and social factors. Regular physical activity can:

The positive elements of physical activity such as enjoyment, learning new skills, gaining in confidence, getting to know your body better, developing your mind and body, or just having fun should not be forgotten.

An understanding of personal preferences in relation to participation in physical activity is vital if we are to encourage more people to be more active more minutes, more often.

Physical inactivity is now identified as the fourth leading risk factor for chronic disease mortality such as heart disease, stroke, diabetes, cancers. It contributes to 6% of deaths globally, and follows high blood pressure (13%), tobacco use (9%), and high blood glucose (6%). Overweight and obesity are responsible for 5% of global mortality.¹

In general, people appear to know that regular physical activity is good for them, but they choose to remain sedentary. Two-thirds of the European population has insufficient activity to meet current recommendations. However, over 90% of the population of every European country believes that physical activity has numerous health benefits. There is little variation in these beliefs by age or socio-economic status. The gap between beliefs, or intentions, and behaviour represents a challenge.

In conclusion, inactivity is a problem. A difficulty is how to intervene to increase the percentage of the population who are physically active. Unless this is achieved, all the potential health benefits from regular physical activity available to individuals, communities, and populations may remain unrealized.

The Toronto Charter for Physical Activity: A Global Call for Action (May 2010) provides the beginning of a solution to this problem. It was written by the Global Advocacy Council for Physical Activity, International Society for Physical Activity and Health and can be downloaded from www.globalpa.org.uk. It is a call for action and it provides organizations and individuals, interested in promoting physical activity, with an advocacy tool to help influence decision makers, at national, regional, and local levels. It explains why physical activity is a powerful investment in people, health, the economy and sustainability. It provides guiding principles and a framework for action for population based approaches to increasing participation in physical activity.

It is important to know a person’s reasons for being active, as well as any potential barriers that might prevent them from leading an active lifestyle.

Examples of reasons include:

Examples of barriers include:

Equally, it is important to understand the determinants that increase or decrease one’s likelihood of adhering to, or avoiding physical activity.

Factors, influences, or determinants, all interchangeable words, refer to variables for which there are established, reproducible associations or predictive relationships, rather than cause-and-effect connections.

It is important to know the determinants of physical activity so that we can:

The determinants can be divided into three key categories. These are:

The environmental determinants are made up of social (cultural, peers, family), physical (man-made/natural) and policy factors.

The social environment includes social support provided as formal and informal encouragement, assistance and/or information from individuals or groups. It can vary in frequency, durability, and intensity. It is provided by peers, family, friends or relatives, essentially significant others in your life.

The physical environment can actively and passively influence physical activity patterns. It represents an effective vehicle for increasing physical activity, as it has the potential to influence large groups, even entire populations.

Supportive physical environments possess features such as parks, cycling trails, and footpaths and are conducive to physical activity. Restrictive physical environments lack such relevant features and actively discourage physical activity

The policy environment examines how the presence or absence of, e.g. a national physical activity policy can impact on physical activity opportunities within a specific environment. A physical activity policy can provide direction, support, and coordination of the many different sectors involved in promoting physical activity. Without such a policy political commitment, at national, regional, and local level can be unclear.

One clear, single issue physical activity policy, accompanied by several related strands of physical activity policy embedded within other related agendas (e.g. in fields of education, transportation, parks and recreation, media, business and urban planning) will facilitate synergistic policy impacts. This will avoid duplication of effort, confusion about whose role or responsibility it is to promote physical activity and build partnerships for advocacy and action. If a population shift towards physical activity is to be achieved, this prioritization of physical activity is recommended.

The personal determinants are made up of cognitive/personality, demographics, and biological factors.

Change is a dynamic process that occurs over time. As an individual changes their behaviour they progress through a series of five stages of change. Each stage of change has two components, one is behaviour and the second is intention or readiness to change.

Very few individuals are physically unable to take part in moderate or light physical activity. However, high proportions are not psychologically ready to take on board the challenges of changing their lifestyle to accommodate physical activity.

There are five stages of exercise behaviour change. These are pre-contemplation (sedentary individuals who have no intention of changing), contemplation (sedentary individuals and 6-month intention to change), preparation (irregularly active and 30-day intention to become more regularly active), action (regular physical activity for the last 6 months), and maintenance (regularly physically active for longer than 6 months).

In order to ‘stage’ an individual you must know their exercise behaviour and their behavioural intention.

Ensure you define regular health enhancing physical activity using guidelines of the minimum requirements for disease prevention and health promotion mentioned earlier. This incorporates both the moderate accumulative message and the continuous fitness message, and is worded to include frequency, intensity, time, and type of activity.

An active lifestyle does not require a regimented vigorous exercise programme.

For an individual who wishes to develop and maintain aerobic fitness the continuous message recommends continuous aerobic activity 3-5 days per week, for a minimum of 20min per session, of at least a moderate intensity (60-90% of maximum heart rate).

Keeping these definitions in mind, an individual can be staged into one of the following five categories:

I currently …

The time to progress through the stages of change is variable, the ‘set of tasks’ that have to be accomplished at each stage of change (SOC) are less variable.