Temporal trends in adults’ sports participation patterns in England between 1997 and 2006: The Health Survey for England

Emmanuel Stamatakis1, Moushumi Chaudhury1

1 Department of Epidemiology and Public Health, UCL

Br J Sports Med 2008;0:1-8. doi:10.1136/bjsm.2008.04082

What am I going to talk about

• Introduction• Data • Measurements• Sports and exercise groupings• Statistical analysis• Results

– Trends in participation overall and particular sports

• Conclusion

Introduction: What we already know

• Participating in PA shown to reduce many chronic conditions e.g. Ischaemic heart disease, type II diabetes, obesity, certain cancers

• Adults are recommended that on at least five days a week, they should be active at moderate or greater intensity for at least 30 minutes a day1

• Additional benefits of sports and exercise (SPEX)?– enhanced social well being, general sense of belonging,

lower employment less crime and stronger community cohesion

1 Donaldson L. At least five a week: evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. Department of Public Health, London, 2004

Definitions

• Physical activity - any bodily movement produced by skeletal muscles that results in energy expenditure above resting level. This broad definition involves virtually all types of activity like: walking, cycling, dance, gardening, housework and sports

• Sports - is an activity that is governed by a set of rules or customs and often engaged in competitively

• Exercise - Exercise is physical activity that is planned, structured, and repetitive for the purpose of conditioning any part of the body

Objective

To examine temporal trends in participation in

sports and exercise activities in England between

1997 and 2006,taking into account wider societal

changes

Data

• Health Survey for England (HSfE) 1997/98 2003/04, 2006

• Nationally representative annual cross-sectional study

• Face-to-face interview

• Analyses conducted on 60,938 adults aged 16 & over– Men n = 27 217– Women n= 33 721

Measurements & data collected on:

• Physical activity (questionnaire)

• Sports and exercise (SPEX) - response from show cards

• Questions on age, sex, ethnicity, social class, income, education, smoking habits, self-reported health, car ownership

• Body mass index (BMI) W/H2

Sports and exercise grouping

• Individual spex– Swimming, dancing, cycling & running

• Grouped spex– Team sports e.g. football/rugby, netball, volleyball– Racquet sports e.g. badminton/tennis, squash– Gym/fitness club based e.g. gym workout, weight

training, keep fit, aerobics

Show card exampleCARD O

1 Swimming2 Cycling3 Workout at a gym / Exercise bike / Weight4 Aerobics / Keep fit / Gymnastics / Dance for fitness5 Any other type6 Running / Jogging7 Football / Rugby8 Badminton / Tennis9 Squash10 Exercises (e.g. press-ups, sit-ups)

Please also include teaching, coaching and training/ practice session

Definition of any and regular sports and exercise participation (SPEX)

• Any SPEX participation:– At least once in the previous 4 weeks in any spex

grouping

• Regular SPEX participation:– At least once a week in any spex grouping

Statistical analyses

• Age-standardised sports and exercise rates and 95% CI by time point (1997/8 combined, 2003/4 combined, 2006)

Data driven• Logistic regression models

– Step 1: Merge HSfE data– Step2: X2 test– Step 3:Develop several sex-specific multiple LR models

Table 1a: Characteristics of the sample by survey year

Men Women Data for survey year, % Data for survey year, % 1997-8 2003-04 2006 1997-8 2003-04 2006 (n =11

091) (n = 9798)

(n = 6324)

p * (n = 13 399)

(n = 12 504)

(n = 7818) p *

Age, mean 46.1 48.1 49.2 <0.001 47.1 48.7 49.3 <0.001 Obesity 17.2 23.0 24.9 <0.001 20.7 23.6 25.2 <0.001 Non-sporting/non-0ccupational activity ≥5 30 minute sessions/week

21.7 20.8 22.9 <0.001 23.3 20.6 24.8 <0.001

* Based on x 2 tests. Data from the Health Survey for England, men and women ≥ 16 years

Table 1b: Characteristics of the sample by survey year

Men Women Data for survey year, % Data for survey year, % 1997-8 2003-04 2006 1997-8 2003-04 2006 (n =11 091) (n =

9798) (n = 6324)

p * (n = 13 399)

(n = 12 504)

(n = 7818)

p *

Ethnicity, White 94.0 90.7 91.0 <0.001 94.4 90.4 91.0 <0.001 Social Class: Manual

51.6 46.2 43.2 <0.001 48.5 39.8 40.4 <0.001

Self-reported health status: Fair or better

93.7 92.9 92.4 0.002 93.2 93.2 93.1 0.9

Work activity level: At least moderate level

20.7 19.2 18.5 <0.001 11.7 11.2 11.2 0.4

* Based on x2 tests. Data from the Health Survey for England, men and women ≥ 16 years

Participation in sports and exercise, England (1997, 1998, 2003, 2004 and 2006 combined)

05

10152025303540

%

Men

Women

Figure 1: Age-standardised and multivariable-adjusted odds for any and regular sports and exercise participation in 2003/04 and 2006 (compared with the 1997/98 referent time point). Adults aged 16 and over living in England

0.80

0.90

1.00

1.10

1.20

1.30

1.40

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03

/4

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06

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/4

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Any participation Regular participation Any participation Regular participation

MEN WOMEN

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Table 2: Age-std participation rates between 1997/8 & 2006 adults aged ≥16 years living in England

MEN WOMEN Data for survey p Data for survey p 1997/8

(referent) 2003/04, %

2006, %

Adjusted* 1997/8 (referent)

2003/04, %

2006, %

Adjusted*

Regular participation (> once a week on average

40.8 42.0 41.2 <0.001 31.2 34.0 33.9 <0.001

Sports groupings participation: Regular participation ((≥ once a week on average) Cycling 10.2 9.9 9.7 0.967 4.3 4.3 4.1 0.467 Swimming 6.9 7.1 6.6 0.286 8.8 9.0 9.1 0.963 Dance 3.7 2.8 2.3 <0.001 ↓ 6.1 6.0 6.1 0.696 Run 9 8.1 8.0 0.138 2.4 3.2 4.0 <0.001↑ Team sports 8.9 8.3 8.6 0.285 0.5 0.4 0.5 0.706 Racquet sports 3.5 2.8 2.9 0.039 ↓ 1.8 1.6 1.5 0.136 Golf 3 3.1 2.8 0.327 0.4 0.6 0.4 0.091 Gym/health club 17 18.7 19.0 <0.001 ↑ 15.9 18.7 18.7 <0.001 ↑

*Using 1997/8 as the ref time point: adjusted for ethnicity, social class, income, education, obesity status, car ownership, smoking status, general health, occupational activity, and non-sporting/non-occupational physical activity

Table 2: Age-std participation rates between 1997/8 & 2006 adults aged ≥16 years living in England

MEN WOMEN Data for survey p Data for survey p 1997/8

(referent) 2003/04, %

2006, %

Adjusted* 1997/8 (referent)

2003/04, %

2006, %

Adjusted*

Sports groupings participation: Any participation ((≥ once in the last 4 weeks) Cycling 16.5 15.2 14.4 0.093 ↓ 8 7.1 6.6 0.002 ↓ Swimming 13.7 12.8 12.8 0.087 15.7 15.0 15.3 0.101 Dance 7.4 6.0 4.7 <0.001 ↓ 11.6 10.6 10.5 0.106 Run 12.7 11.8 11.0 0.075 4 5.1 6.0 <0.001 Team sports 15 14.0 13.6 0.331 1.4 1.5 1.7 0.459 Racquet sports 7 5.7 5.4 <0.001 ↓ 3.5 3.1 3.0 0.061 ↓ Golf 5.3 5.3 4.7 0.133 0.133 0.7 0.9 0.007 Gym/health club 23.5 26.0 25.5 <0.001 ↑ <0.001 23.3 26.4 <0.001 ↑

*Using 1997/8 as the ref time point: adjusted for ethnicity, social class, income, education, obesity status, car ownership, smoking status, general health, occupational activity, and non-sporting/non-occupational physical activity

Table 3: Overall sports and exercise participation at two levels by age group Men Women % % Age group, years, & sports participation

1997/8 2003/4 2006 Adjusted p value for trend*

1997/8 2003/4 2006 Adjusted p value for trend*

16–29 Any† 75.6 74.5 73.4 61.0 62.4 61.5 0.454 Regular‡ 63.0 63.5 63.1 0.932 46.7 48.9 48.7 0.139 30–44 Any† 58.9 60.6 59.0 0.555 50.8 54.8 53.4 0.007 Regular‡ 44.3 48.5 46.7 0.041 36.4 41.1 40.7 <0.001 45–64 Any† 39.4 42.7 44.2 0.026 37.7 39.5 42.7 0.038 Regular‡ 29.6 32.6 34.0 0.014 27.1 32.8 0.001 65+ Any† 23.2 25.9 28.3 0.026 16.1 21.4 20.1 <0.001 Regular‡ 18.5 21.3 22.9 0.039 13.0 17.0 16.1

*Adjusted for ethnicity, social class, income, education, obesity status, car ownership, smoking status, general health, occupational activity, and non-sporting/non-occupational physical activity . †At least once in the last 4 weeks. ‡At lest once/week on average

Figure 2a: Multivariable-adjusted odds for regular participation in sport and exercise groupings in 2003/04 and 2006 (compared with the 1997/98 referent time point). Men aged 16 to 29 living in England

0.40

0.60

0.80

1.00

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† Cycling Sw imming ∫ Dancing ∫ Running † TeamSports

† RacketSports

Golf FitnessClub/Gym

Od

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rati

o

† Trend p <0.05 ∫ Trend p <0.001

Figure 2b Multivariable-adjusted odds for regular participation in sport and exercise groupings in 2003/04 and 2006 (compared with the 1997/98 referent time point). Women aged 16 to 29 living in England.

0.40

0.60

0.80

1.00

1.20

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1.80

2.00

2003/4

2006

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2003/4

2006

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2003/4

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2006

† Cycling Sw imming ∫ Dancing † Running Team Sports Racket Sports FitnessClub/Gym

Od

ds r

ati

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† Trend p <0.05 ∫ Trend p <0.001

Figure 3a: Age-standardised odds for regular sports and exercise participation in 2003/04 and 2006 (compared with the 1997/98 referent time point). Men aged 16 and over living in England.

.

0.60

0.80

1.00

1.20

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1.80

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/4

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† Non-Manual Manual ∫ White Non-White ∫ Top quintiles Bottom quintiles

Social Class Ethnicity Income

Od

ds

rati

o

† Trend p <0.05 ∫ Trend p <0.001

Figure 3b: Age-standardised odds for regular sports and exercise participation in 2003/04 and 2006 (compared with the 1997/98 referent time point). Women aged 16 and over living in England

0.60

0.80

1.00

1.20

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1.80

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/4

2006

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∫ Non-Manual † Manual ∫ White † Non-White ∫ Top quintiles ∫ Bottom quintiles

Social Class Ethnicity Income

Odd

s ra

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† Trend p <0.05 ∫ Trend p <0.001

Main Findings• Age std overall regular participation increased

– Men 40.8% to 41.2% (1997/98 to 2006)– Women 31.2% to 33.9% (1997/98 to 2006)

• Regular G/FC increased– 17.0% to 19.0% for men (1997/98 to 2006)– 15.9 to 18.7% for women (1997/98 to 2006)

• Regular running increased for women only– 2.4% to 4.0% (1997/98 to 2006)

• Overall increases were apparent in older adults (≥45years)

• Increase in participation among men from non manual social class, higher income households and white ethnic background

Conclusions

1. This is the first time trend analysis of SPEX in England

2. Overall regular SPEX in England has increased between 1997 and 2006

3. Middle aged and older adults show, main increase individual activity, e.g. gym/ fitness clubs

4. Bad news! Younger male adults (16-29years) shows decrease in all sports e.g. cycling, swimming, running and racquet sports

Conclusions

5. There are no signs that the participation between lower and higher socioeconomic strata and between white and ethnic minority groups is narrowing.

Therefore sports promoting and health policy efforts

should focus on these groups and try to expand

participation.

Future work

• Better understanding of the mechanisms behind the “success story” of middle-aged and older adults

• HSfE 2007: I am looking at Knowledge of & Attitudes to physical activity (results due out December 2008)

• HSfE 2008 first time Objective measurements– Step test– Accelerometer