TOWARDS BEST PRACTICE IN THE PROMOTIOOF PHYSICAL ACTIVITY

Bill BeilewCentre for Disease Prevention and Health PromotionNSW Health Department

This article outlines recent NSW initiatives to promotephysical activity. These initiatives comprise:

the establishment of a high-level intersectoralPhysical Activity Task Force by the Premier ofNSW;release of the booklet, Towards Best Practice for thePromotion of Physical Activity in the Areas of NSW(1), which was recently published on behalf of theTask Force by the NSW Health Department and theNational Centre for Health Promotion; andthe establishment of the NSW Physical ActivityDemonstration Projects Grants Scheme.

The article also briefly describes 'Active Australia", anational collaborative venture involving the AustralianSports Commission, the Commonwealth Department ofHealth and Family Services, State Departments of Sportand Recreation, local government and the sport andrecreation industry. 'Active Australia" provides aframework for all physical activity promotion initiativesacross the country.

THE PHYSICAL ACTIVITY TASK FORCEThe Physical Activity Task Force was set up by the NSWPremier in May 1996. It was charged with recommending acomprehensive strategic plan for physical activity in NSWfor the period 1997-2002. Task Force members includerepresentatives of the NSW Government Departments ofHealth, Local Government, School Education, Urban Affairsand Planning, and Sport and Recreation, as well as theNational Heart Foundation, Australian Council for Health,Physical Education and Recreation (ACHPER), the fitnessindustry peak body Fitness NSW, and the National Centrefor Health Promotion.

The Task Force's terms of reference are to:

•develop a comprehensive strategic framework forthe promotion of physical activity in NSW in thelight of available resources, with specific goals,targets, and delineation of roles and responsibilities;

• develop a joint action plan identifying lead agenciesfor the achievement of agreed targets;

• consider gaps in current knowledge and the meansto address them;

• make recommendations for taking the plan forwardand for monitoring progress in achieving the specifictargets; and

• report to Cabinet Office within one year through theDeputy Premier, Minister for Health and Ministerfor Aboriginal Affairs, in his capacity as DeputyPremier.

The Task Force is chaired by Associate Professor AdrianBauman, University of NSW, and is supported by asecretariat from the NSW Health Department.

There is a clear recognition that many organisations otherthan those represented in the membership have an interestin the planning process. The Task Force is ensuring thatextensive consultation is incorporated into the schedule ofwork. For example, in November 1996 a broad consultation

retreat was convened with representation of stakeholciersfrom the education, health, sport and recreation, urban andlocal environment sectors, as well as the fitness industry;inputs were analysed and followed up with corerepresentatives from that consultation process. In February1997 another consultation retreat was convened, with anexplicit focus on the theme of equity and access. Fiveintersectoral consultation seminars were also planned, to beconvened across NSW in March and April 1997. Meetingswith other government and non-government stakeholdershave been scheduled.

The Task Force has stipulated four generic strategic themesfor the strategic planning framework:

• policy and guideline development;• program development and implementation;• information and education; and• monitoring and evaluation.

Each of these themes is flu-ther subdivided to emphasise theareas where the plan is expected to achieve improvement:

• people (target group participation in activelifestyles);

• organisations (quality organisations, services andproducts); and

• environments (supportive environments andfacilities - making it easier for people to be active).

A draft five-year strategic plan will be released for widepublic consultation. Comments will be analysed by thesecretariat and presented to the Task Force for considerationbefore the final report is submitted to the Deputy Premier.

Benefits from intersectoral collaboration in the Task Forcehave already accrued through clearer understanding amongthe partner organisations of each other's capacity to takeaction. This has already led to a strengthening ofcollaborative approaches on specific projects. The finalstrategic plan will facilitate this collaboration in asustainable and focused way. The work also links clearlywith the new national strategic framework "ActiveAustralia" (see below).

THE BOOKLET, Towards best practice for thepromotion of physical activity in the areasof NSWThe purpose of the booklet is to:

• provide data on the prevalence of physical activity inthe NSW population at both Statewide and AreaHealth Service levels;

• identify priority populations in NSW forintervention; and

• identify best practice approaches to the promotion ofphysical activity for implementation at local level.

While the booklet recommends vigorous physical exercisefor those who are willing and able to undertake it, itrecognises that most people simply will not - or cannot -exercise strenuously. Therefore the case for moderatephysical activity is clearly set out with a populationperspective, re-emphasising the special communication andrecommendation from the NSW Chief Health Officer that

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Continued from page 13

"every adult in NSW should accumulate 30 minutes or moreof moderate-intensity physical activity on most, preferablyall, days of the week".

The data presented in the booklet derive from the 1994Health Promotion Survey, conducted by telephone with16,000 adults (aged 18 years and over) living in privatehouseholds throughout 16 Area and then rural DistrictHealth Service clusters in the NSW health system. Onecomponent of the survey was designed to measure theprevalence of physical activity, assessing the frequency ofparticipation in walking, light and moderate activity andvigorous physical activities. These data comprise a baselineagainst which trends in physical activity participation maybe monitored in the NSW population.

Sixty-one per cent of males and 42 per cent of females inNSW reported physical activity of a level adequate toimprove or maintain their health. There were clearlysubstantial differences in rates of adequate physical activitybetween males and females.

Almost half (49 per cent) of adults in NSW failed to attainadequate levels of physica] activity; this proportion washigher in females (58 per cent) than in males (40 per cent)and was greater among older age groups than among thoseaged 18-29 (Figure 2). These differences persisted acrosssocio-economic, regional and other demographic variables(Figure 3). Those who had completed secondary education(52 per cent) or some tertiary education (54 per cent) weremore likely to have engaged in adequate physical activitythan people who had completed primary or some secondaryeducation. Only 41 per cent of people in the lowereducational attainment category engaged in adequatephysical activity (Figure 4).

An equity perspective suggests that certain groups mayhave particular barriers to participation, and requireinnovative physical activity promoting strategies. Prioritygroups in NSW include older people, women, people fromnon-English speaking backgrounds, Aboriginal communitiesand people with young children.

Prevalence data for Area Health Services are also presentedin the report, with an analysis of regional variations andsuggestions to assist Areas with the establishment oftargets and performance indicators.

'Best practice' interventions for Area Health Services areoutlined in the report, based on a thorough review of theliterature. These are summarised here as seven overallrecommendations:

1. Establish a clear strategic focusPromote moderate rather than vigorous intensity activities,concentrating on sedentary or insufficiently-active peoplerather than those who are already physically active.

2. Establish clear and achievable goalsFormulate Area goals, targets and indicators in line withlocal health needs assessments, addressing prioritypopulations.

3. Forge key partnershipsCollaborate with local councils, the Department of Sportand Recreation, and education and other sectors to ensure

PREVALENCE OF ADEQUATE ENERGY EXPENDITURE IN NSW.BY GENDER AND AGE (WEIGHTED TO NSW POPULATION)

70+

60-69

50-59

40-49

30-39

18-29

Females

Males

NSW Overall

49________

11148__- I I

49

1 j.1-H; i .

61

1 t .1111L_LLL10 20 30 40 50 60 70

PERCENTAGE OF SAMPLE

that environments and facilities support communityparticipation in walking and other moderate forms ofphysical activity; and coordinate action with these keypartners to avoid gaps or undesirable duplication of existingservice, research or resource provision.

4. Support interventions in primary care settingsEncom-age provision of advice by general practitioners,other health care providers, and a wide range of otherhealth and fitness professionals about the importance ofregular, moderate physical activity.

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PREVALENCE OF ADEQUATE ENERGY EXPENDITUREBY DEMOGRAPHIC VARIABLES (WEIGHTED DATA)

non-ATSI

ATS I

2+ cbiidren<5yrs

1 child yrs

None < 5yrs

N ESB

Other ESB

Country ofbirth Australia

ResidenceRural NSW

ResidenceUrban NSW

NSW Overall

PREVALENCE OF ADEQUATE ENERGY EXPENDITURE BY EDUCAAND EMPLOYMENT (WEIGHTED TO N5W POPULATION)

Retired

Student(not w)

Student (w)

Unable

Home

Unemployed

P/time

F/time

Tertiary

Completedsec

Primarysome sec

NSW Overall

0 10 20 30 40 50 60 70PERCENTAGE OF SAMPLE

5. Support interventions in youth settingsEncourage strategies designed to improve the quantity andquality of physical education for schoolchildren, particularlyto increase overall the time children spend being active.

6. Use marketing and publicity strategiesMaximise the use of opportunities to generate unpaid orinexpensive publicity, helping to achieve favourable changesin awareness and attitudes.

7. Use key principles to guide actionThe booklet identifies 11 key principles to guide local actionin the promotion of physical activity.

Additional readings in physical activity are suggested, ofwhich Physical Activity and Health; A Report of the SurgeonGeneral, is perhaps the most important'. (Professor StevenBlair, an editor of the US Surgeon General's Report,commented on a draft of Towards Best Practice. In July1995 Professor Blair provided a special briefing on physicalactivity and public health for the Deputy Premier, Ministerfor Health and Minister for Aboriginal Affairs, the Director-General, and the Chief Health Officer of the NSW HealthDepartment.)

Vol.8/No.3 15

0 0 20 30 40 50 60 70PERCENTAGE OF SAMPLE

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Continued from page 15

PHYSICAL ACTIVITY DEMONSTRATION PROJECTGRANTSThe NSW Health Department's Physical ActivityDemonstration Grants Scheme was designed to supplementand enhance the knowledge base required to specify bestpractice for the promotion of physical activity at Statewideand Area Health Service levels in NSW. Its first phase wasimplemented in 1996. Priorities for grants aredisadvantaged groups, systems and settings, andenvironments. Each grant is available for a minimum of twoyears. First-round applications were received from a widerange of organisations in metropolitan and rural NSW, andtwo projects were funded in the first phase. These aredescribed briefly below.

Evaluation of a general practice intervention - thephysical activity prescriptionA consortium of three Area Health Services working withlocal Divisions of General Practice and led by the SouthWestern Sydney Area Health Service will implement aproject entitled A controlled trial of physical activitypromotion through general practice. The project is designedto evaluate two different physical activity prescriptioninterventions, aimed at promoting physical activity amonggeneral practice patients. The project will concentrate onthree Area Health Services - Illawarra, South WesternSydney and Western Sydney.

Working with local councils to modify environmentsOvercoming the hurdles: removing barriers to womenwalking in Concord is a partnership project between theCentral Sydney Area Health Service and Concord Council.The major aim is to increase by 4.5 per cent the number ofwomen aged 20-50 in the Concord local government areawho accumulate 30 minutes or more of walking on mostdays of the week.

ACTIVE AUSTRALIAActive Australia is a collaborative venture between theAustralian Sports Commission, the Commonwealth

Department of Health and Family Services, StateDepartments of Sport and Recreation, local governmentand the sport and recreation industry. It provides aframework for all physical activity initiatives across thecountry, which are expected to include a major campaign onphysical activity. Subject to Ministerial approval, the firstphase of the campaign will begin in NSW in the spring of1997. The concept of Active Australia was launched onDecember 11, 1996 by the Federal Minister for Health andFamily Services, Dr Michael Wooldridge, and the FederalMinister for Sport, Territories and Local Government andMinister Assisting the Prime Minister for the Sydney 2000Games, Mr Warwick Smith.

The aspiration of Active Australia is for all Australians to beactively involved in sport, community recreation, fitness,outdoor recreation and other physical activities.

For the health sector, this translates into three specificgoals:

• increasing the proportion of Australians involved inregular physical activity;

• increasing overall the level of physical activity ineveiyday life; and

• encouraging the provision of quality infrastructure,opportunities and services to support participationin physical activity.

Further information:Information on Demonstration Project Grants, contacte-mail; pvita@doh.health.nsw.gov.au

The Publication Towards Best Practice for thePromotion of Physical Activity in the Areas of NSW,contact e-mail; bbell@doh.health.nsw.gov.au

For copies of the NSW Physical Activity Task ForceNewsletter contact e-mail: bbell@doh.health.nsw.gov.au

Alternatively, for all the above contacts, use facsimile(02) 9391-9579

The US Surgeon General's Report Physical Activity andHealth may be found at Web site http://www.cdc.gov/nccdphp/sgr/sgr.htm

PUBLIC HEALTH EDITORIAL STAFFThe editor of the N.SW Public Health Bulletin is Dr Michael Froinmer, Director, Centre for Research and Development,NSW Health Department. Dr Lymue Madden is production manager.

The Bulletin aims to provide its readers with population health data and information to motivate effective public health action.Articles, news arid comments should be 1,000 words or less in length and include a summary of the key points to be made in thefirst paragraph. References should be set out using the Vancouver style, the full text of which can be found in British Medical

Journal 1988; 296;401-5.

Please submit items in hard copy and on diskette, preferably using WordPerfect, to the editor, NSW Public Health Bulletin, Locked

Mail Bag 961, North Sydney 2059. Facsimile (02) 9391 9029.

Please contact your local Public Health TJnit to obtain copies of the NSW Public Health Bulletin. The Bulletin can he accessed via theInternet from the NSW Health Department's World Wide Website, athttp://www.health.nsw.gov.au/public-health/phb/phb.htnil

Back issues can be obtained from the Better Health Centre, Locked Mail Bag 961, North Sydney 2059.Telephone: (02) 9954 1193, Facsimile (02)9955 5196.

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