Part 1. The importance of physical activity in Australia (cont.)
1.4. Towards best practice: evidence and policy implications
Summary
Definitions of 'best practice' are necessary for policy makers and practitioners to have a good understanding of the types of programs and strategies that may result in increases greater participation in physical activity in Australia. Best practice is defined in terms of a scientific evidence base, and also the potential for programs to help achieve the goals of Active Australia partners and others interested in promoting activity. The evidence for the health benefits of activity, and trends suggesting no increases (and possibly declines) in physical activity in recent years, provides a strong case for increased attention and resources being devoted to this area.
1.4.1. Definitions of 'best practice'
This document is concerned with describing the state of the art with respect to increasing levels of physical activity among Australians. In order to achieve that, a 'best practice' approach is taken. This term is a misnomer, as it really implies 'better', rather than 'best' practice. It implies an improvement in current practices, to increase the likelihood of physical activity gains, or changes in likely antecedents of physical activity, as a result of programs and strategies.
The best-practice approach has its historical origins in the desire to promote effective and efficient programs to achieve a specific objective. A health-sector-derived framework is presented, that begins with the World Health Organization's (WHO) definition of health promotion in broader terms than disease prevention alone. Health promotion is viewed as a societal resource, which requires a comprehensive and lifespan approach across different groups and settings, and is enhanced through partnerships across multiple sectors (WHO 1998). The priorities in health promotion included the building of broad and comprehensive frameworks for multisectoral intervention, and the accumulation of knowledge about best practice.
A relevant WHO initiative was the program entitled 'Global Active Living' in 1997, which emanated from public health, health promotion, Sport for All and many other movements, and culminated in several WHO meetings in Geneva. This process was reported as a 'statement on Active Living', at the Jakarta Conference for Health Promotion (Kickbush 1998). This identified the centrality of physical activity programs and policies within health promotion. The position paper also stated that:
Experience so far suggests three pathways to successful development and implementation of active living programs:
- sound scientific basis leading to policy support and programs;
- development and evaluation of [community] programs with an intersectoral involvement; and
- effective advocacy as well dissemination and communication of information.
These elements provided different ways of describing 'successful'
initiatives, and encompassed ideas later described as 'best practice'.
To date, there is little in the academic literature on best practice,
and at the administrative levels, it has generally been used to imply
quality assurance. A group at the Center for Health Promotion in Toronto
has developed the definitions further, defining best practice as 'sets
of processes and actions consistent with [health promotion] values,
evidence and
All of these options are relevant to physical activity promoting efforts. Programs to increase physical activity among Australians should be based in scientific evidence of what works. One limitation is that innovative programs or collaborations across sectors initially may have little scientific evidence, and then require careful evaluation to assess their effects and wider applicability.
Best practice should start with careful identification of the problem, target populations or groups at risk, and the development of interventions that are consistent with the best available conceptual and theoretical models. Program planning and implementation should be accompanied by careful evaluation, so that effects - particularly for new programs or those that involve special population groups - can be understood.
One limitation to the advancement of best practice is a failure to disseminate positive scientific research findings and to translate them into practice (Nutbeam 1996). All of these elements contribute to best practice, in any efforts to increase participation in physical activity. In subsequent chapters, the current knowledge of physical activity programs is described, and the available evidence or suggestions for best practice in specific programs in each setting or with specific population groups is assessed.
1.4.2. Policy implications
There are substantial policy implications of the new epidemiological evidence, the recent population data and the notion of investing in best practice programs. Evidence is required by policy makers to identify programs and strategies which are most likely to result in increased activity levels, so that judicious investment of scarce resources can be directed to these programs. Accountability is required from physical activity program managers, to ascertain and report on the effective components of their practice. The case for physical activity is clear. There would be substantial health gain as well as health cost savings if more Australians became more physically active. Physical activity is now in the same context of public health priorities as controlling blood pressure or cholesterol, and almost as important to disease prevention as tobacco control. It has important implications for quality of life and community well being (Brown et al. 2000), as part of broader social health. The relative importance of physical activity is now identified, both in physical activity-specific reviews (USDHHS 1996) and in general reviews of the major contributors to mortality (McGinnis and Foege 1993).
One of the first policy developments has been the development of National Physical Activity Guidelines (DHAC 1999). These encompass the new moderate and incidental physical activity messages, based on the evidence described above. They were developed through community and professional consultation, guided by an expert steering committee to reflect current scientific evidence. The guidelines focus on enjoyment, and do not neglect the additional benefits to be gained from more prolonged or vigorous activity, especially among young adults. Nonetheless, the primary focus of these guidelines is to emphasise moderate intensity and incidental activity, and integrate these into the fabric of everyday life.
The guidelines now require intensive dissemination to health professionals and to the general community. The strategies for disseminating these guidelines will differ for health professionals, the general community or to special populations. Efforts at developing interventions should be preceded by efforts to increase awareness of these guidelines. Several of the key recommendations of the guidelines are shown in Table 6.
Table 6. National Physical Activity Guidelines for Australians
|
National Physical Activity Guidelines for Australians
Source: DHAC 1999 |
Despite this evidence, physical activity has to date been under-recognised and has globally received less attention and less funding as a health imperative. For many other agencies and sectors, it receives even less attention. In other sectors, the focus may be on, for example, encouraging organised sporting and recreation activities rather than total overall activity, or promoting transportation systems rather than the physical activity agenda of 'active commuting', or physical education curricula rather than 'active children', or building freeways rather than 'active communities'. There is a need to reframe and reorient health policy, and other policy, towards more emphasis on 'active living' in a range of sectors, through partnerships and combined action.
Although there have been several initiatives in recent years, these efforts have been moderately resourced and there have been insufficient successful outcomes in participation levels to date. On the contrary rates of physical activity appear to have declined in Australia since 1997. Although the Active Australia message is better recognised, and the message about moderate intensity is better understood by the general community, levels of actual participation are lower than in 1997 in most States and Territories (chapter 1.3). This section also outlined population groups who were less likely to be physically active; these groups are similar to those identified in previous population research 10-20 years ago. This suggests the need for equity focused programs, targeting teenage girls, people at social or economic disadvantage, as well as those from a non-English-speaking or Indigenous background.
To summarise these issues, better evidence exists for investment in physical activity, and there is a better rationale for developing programs and policies in this area. Nevertheless, and notwithstanding the promising start developed through the initial Active Australia communications programs, the trends in participation are not encouraging.
The central challenge is to turn this evidence into appropriately funded health policy and programs. The next step is the even greater challenge of implementing integrated and multi-sectoral strategies to increase activity across the whole population (Sallis et al. 1998). Partners from beyond the Health sector are essential to this process; increasing physical activity requires the contributions not only of health promotion and behaviour change specialists, but also of professionals in the recreation and leisure sector, educators, and those in departments of urban planning, transport, environmental design and local government. The establishment of good monitoring systems to assess the impact of these strategies is an important investment, with changes in the prevalence of physical activity as the key outcome indicator. The next steps will be the development of effective multisectoral collaborations around physical activity (see part 4).
References
Brown WJ, Mishra G, Lee C and Bauman A. Leisure time physical activity in Australian women: relationship with well being and symptoms. Research Quarterly for Exercise and Sport. 2000:71(3) 206-16
Department of Health and Aged Care (DHAC). (1999). National Physical Activity Guidelines for Australians. Canberra.
Kahan B, Goodstadt M. (2000). Best practices in health promotion working group. Toronto: Center for Health Promotion, University of Toronto.
Kickbush I. (1998). WHO Statement on Active Living. Fourth International Conference on Health Promotion, Jakarta, July 21-25 1997.
McGinnis JM, Foege WH. (1993). Actual causes of death in the United States. Journal of American Medical Association 270:2207-12.
Nutbeam D. (1996). Achieving best practice in health promotion - improving the fit between research and practice. Health Education Research 11:317-26.
Sallis JF, Bauman A, Pratt M. (1998). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine 15(4):379-97.
United States Department of Health and Human Services (USDHHS). (1996). Physical activity and health: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.
World Health Organization. (1998). Fifty-first World Health Assembly, policy initiative WHA51-12. Geneva: WHO.
Next: Part 2. Interventions to increase participation in physical activity in specific settings
Previous: Part 1 - 1.3 Recent physical activity participation data for Australian adults
