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Introduction
The need to increase global levels of physical activity to benefit population health is now incontrovertible.1 ,2 Policy that recommends a voluntary target by countries to reduce global inactivity by 10% by the year 2025 has been adopted by the WHO.
A route map to increase physical activity
Given the compelling argument, and clear aim to increase physical activity, what is required are methods and tangible actions to achieve this goal. Global experts reviewed the evidence for the most effective ways to increase population levels of physical activity and produced a guide to investments that work.3 This has provided a north star for many individuals, organisations, communities and countries aiming to increase physical activity levels. However, there is still a need for examples of how these investments have been implemented and evaluated. Here we offer Scotland's experiences.
Scotland's efforts to increase physical activity
Policy
In 2003 a long-term, cross-sector and cross-party policy called ‘Let's make Scotland more active’ was endorsed by the Scottish Government.4 This set a 20-year framework and aimed to have 80% of children achieving 60 min of activity every day and 50% of adults achieving 30 min of moderate activity on 5 days of the week by the year 2022. A review of this policy in 2008 created further impetus for action.5
In 2011 increasing physical activity was made a national indicator, with community and local planners signing an agreement to prioritise increasing physical activity in 2012. The year 2014 saw the launch of the National Physical Activity Implementation Plan,6 and an outcomes framework building substantially on ‘Investments that Work’, and input from experts on five continents.
Actions across sectors are coordinated through the National Strategic Group for Sport and Physical Activity which comprises government ministers, Scotland's Chief Medical Officer, the Chief Executives of Scotland's public bodies in health, sport, education, transport and environment, political and official representatives from local government. The Active Scotland Outcomes Frameworki (figure 1) define key outcomes sought for sport and physical activity in Scotland.
The Active Scotland Outcomes Framework.
Concrete actions
While not everything is known about physical activity, the major deficit is not in knowledge or in policy. It is in implementation. We know that further concrete actions are required to bring about real change and improvement, but share three successful actions:
‘Whole-of-school’ programmes: In the 2003 strategy4 a goal for all school-aged children to receive 2 h or 2 school periods of quality physical education was set. In 2005 <10% of schools achieved this target but by 2014 this rose to 98%.
Physical activity and non-communicable disease (NCD) prevention integrated into healthcare: In 2011, 40% of our medical schools were teaching about physical activity, and knowledge among students7 and health professionals was poor. In 2015, all our medical schools included some teaching on physical activity, with all nursing and Allied Health Professional curricula planning to do so.
Transport policies and systems that prioritise walking, cycling and public transport: Scotland now has cycling and walking strategies, while our capital Edinburgh will reduce speed limits on 80% of its streets by 2017 to 20 mph.
Measurement
Without measurement, how will we know if a change is an improvement? The Scottish Health Survey monitors progress against targets to increase physical activity. A dashboard of key indicators (figure 2) shows Scotland's progress towards the vision of more people, more active, more often.
Dashboard—Active Scotland Outcomes. CWG, Commonwealth Games; MVPA, moderate-to-vigorous physical activity; PE, physical education.ii
The recent data show some progress towards national goals for children and adults since 2003. The target for adults has now been adapted following changes in guidelines. Levels of recreational walking are increasing in Scotland.8
Change when change is difficult
Efforts to increase physical activity can deliver improvement and are gathering pace in the four corners of the globe, but much more needs to be done in Scotland, and further afield or we will consign our children to poorer health outcomes and a darker economic future than is necessary. The world's experts have been generous in sharing their knowledge with us in Scotland. We now share some of our experiences and urge others to seek out ideas that work, and implement and measure concrete actions that aim to increase physical activity.
Acknowledgments
The authors wish to thank Fiona Bull, Karim Khan, Heather McKay, Adrian Bauman, Marie Murphy and many other international experts for their advice and support in identifying policies and practices that work in increasing physical activity.
Footnotes
Twitter Follow Andrew Murray at @docandrewmurray and Nanette Mutrie at @nanettemutrie
Contributors AM and NM had the idea. All the authors developed the first, and subsequent drafts of the manuscript. All the authors reviewed and approved the final manuscript.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
↵i http://www.gov.scot/Topics/ArtsCultureSport/Sport/Outcomes-Framework
↵ii The measures are drawn from Scotland's major national population surveys and key administrative sources: Scottish Health Survey; Scottish Household Survey; Healthy Living Survey; and Audit Scotland. The four data points on the majority of the indicators are annual data points from 2011 to 2014. For some indicators only 3 data points are available because of the change to UK Physical Activity Guidelines in 2011. Full detail on all indicator data, including original source, method of collection, and definition is available at: http://www.gov.scot/Topics/ArtsCultureSport/Sport/Outcomes-Framework