DG Research and Innovation invited five ongoing FP7 and Horizon 2020 research projects on health enhancing physical activity to share their experience with other stakeholders, to discuss how to enhance physical activity, to share best practices and to draw some conclusions and recommendations for policy makers.
Public Health Research Workshop – Exploring physical activity for health and fun 10th March 2016 at the National Football Stadium of Scotland Hampden Park, UK.
Summary Report
Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including overweight/obesity, major non-communicable diseases (such as coronary heart disease, type 2 diabetes, breast and colon cancers, and mental health), and shortens life expectancy. In addition, it puts pressure on national health care systems and has adverse impacts on the overall economy. As the world’s population is increasingly inactive, this not only leads to personal suffering but also represents a major public health, social and economic issue.
This event demonstrated the relevance of research to society and to improving our daily lives. It showed that the EU highly values cooperation and exchange of experience by bringing together different project teams in order to multiply the impact of their research and to ensure the best use of resources.
The workshop was organised by the research projects themselves, in collaboration with EC services, and took place at an inspirational venue, the National Football Stadium of Scotland Hampden Park in Glasgow. The project teams worked together to explore common themes and to learn from one another, enhancing their own knowledge with insights from their peers. This is an innovative model of knowledge translation for DG RTD.
To reflect the theme of the meeting, people were encouraged to move about when they liked, to stand up when giving feedback, and proposed standing ovations and applause for each speaker. These simple actions demonstrated how feasible it is to break up periods of sitting time and modify sedentary behaviour – a common theme across projects.
Opening Keynote
The workshop opened with a ‘keynote’ presentation from Nanette Mutrie from the University of Edinburgh, in which she presented the state of the art in the physical activity research area. She asked the participants to consider three things:
- Where and how do we get our 150 minutes recommended moderate intensity physical activity each week?
Answer: The best and easiest way is walking and cycling. Active travel has the best potential to get Europe moving.
- Are we missing promotion and evaluation of some elements of guidelines?
Answer: Yes! In particular, we should invest more in promoting and evaluating strength and balance training; these are critical to helping older people remain active for longer.
- Do we need other approaches to research?
Answer: Yes! In particular, we need a systems approach that will help us understand the complex ways in which individuals, social networks, organisations and environments influence physical activity. Such understanding would help us begin to model whole systems interventions. We also need to further understand the determinants of sitting down as well as being physically active and how people can be supported to stand more, sit down less and be more physically active.
She finished with three key messages:
- We need to focus on both physical activity and sedentary behaviour. Both are key determinants of health.
- Intervention evidence is needed on how to a) increase walking and active travel; b) support people to increase their strength and balance, especially as they age.
- We should invest in a systems approach which investigates the multiple ways in which behaviour is influenced and how components within systems might interact.
Project Presentations
The workshop continued with the presentation of the approaches used by five EU-funded research projects which have sought to increase physical activity in targeted communities.
Professor Sally Wyke from the University of Glasgow described progress to date within the EuroFIT[1] project. EuroFIT (Social innovation to improve physical activity and sedentary behaviour through elite football clubs) uses the allegiance and loyalty that many feel to the elite football club they support, to attract men at risk of ill health to lifestyle change. EuroFIT delivers a culturally-sensitised programme that engages inactive men aged 30-65, with BMI ≥ 27, in becoming more active, sitting less and eating a healthier diet.
Dr Elisabeth Raser from the University of Natural Resources and Life Sciences, Vienna presented the objectives of the PASTA[2] (Physical Activity through sustainable transport approaches’) project. The general focus of PASTA is on systematic promotion and analysis of active mobility (AM) and physical activity. AM has gained massive support in politics, also driven by the EC (Declaration on cycling, Luxembourg, October 7th, 2015) and the WHO, However, promoting AM measures in cities is still a great challenge, as walking and cycling policies often conflict with private cars.
Professor Maria Luisa Brandi from the University of Florence presented Credits4Health[3] (Credits-based, people-centric approach for the adoption of healthy life-styles and balanced Mediterranean diet in the frame of social participation and innovation for health promotion, C4H), which uses an ICT platform with personalised motivational paths, people empowerment, peer support, and material incentives provided by commercial partners, to improve diet and activity levels in the Mediterranean countries.
Professor Arja R. Aro from University of Southern Denmark, presented REPOPA[4] (Research into Policy to enhance Physical Activity), which focuses on translating research results into policy – a challenge of great interest to all the projects at the workshop. REPOPA explores the facilitators and barriers to integrating research and policy making, including (i) interventions carried out to enhance cross-sectoral evidence-informed policy making (EIPM); (ii) competences required by researchers and policy makers; (iii) best practices and available tools, such as measurable indicators for EIPM; and (iv) competences in communicating research to lay audiences.
Dr Laura Coll-Planas from Fundació Salut i Envelliment, – UAB presented SITLESS[5] (Exercise Referral Schemes enhanced by Self-Management Strategies to battle sedentary behaviour). SITLESS is a clinical trial testing whether existing Exercise Referral Schemes (ERS) enhanced by self-management strategies, are more effective at reducing sedentary behaviour in older people than either (a) ERS alone or (b) usual care. A particular focus, shared by the other projects, was on cross-country studies: from design, to implementation and impact – how to respect local contextual differences while keeping a common approach and protocol?
The project presentations were followed by three briefings from the European Commission services, delivering an overview of the policy activities and challenges in their respective areas.
Directorate-General Research and Innovation (DG RTD[6]) gave an overview of the different Directorates-General involved in physical activity i.e. DGs RTD, MOVE[7], EAC[8] and CONNECT[9], and available research opportunities in the physical activity/nutrition area under H2020. This highlighted the importance of this domain for DG RTD and of improving collaborations across the different DGs. Directorate-General Health and Food Safety (DG SANTE[10]) and its Consumers, Health, Agriculture and Food Executive Agency (CHAFEA[11]) welcomed the workshop as an event that reinforces the links between research and policy. It recognised that such inter-services collaboration helps to raise awareness across EU programme boundaries, and to inform participants about past and current projects under other European programmes. This would stimulate synergies and/or dissemination to other projects, and the wider use of project research results.
DG SANTE gave an overview of its policies and activities in the field of physical activity. DG SANTE supports the 28 EU Member States in the High Level Group on Nutrition and Physical Activity. This group has developed an Action Plan on Childhood Obesity 2014-2020, as well as a Joint Action on Nutrition and Physical Activity (‘JANPA’). The Action Plan explicitly “encourages physical activity” by strengthened promotion of physical activity policies and increased support to the role of urban design and planning. JANPA supports the Member States in the implementation of the Action Plan on Childhood Obesity by sharing good practices and developing tools on childhood obesity.
Within the EU Platform for Action on Diet, Physical Activity and Health European-level organisations (food industry, health NGOs, consumer organisations, research organisations and health professionals), develop voluntary actions that support the Member States in reaching their policy goals. Until now its members have developed 38 actions on physical activity.
Both groups are good opportunities to disseminate the results of projects in the field of physical activity
CHAFEA gave an overview of third EU Health Programme and its funded projects in the physical activity domain; these tend to be more oriented towards implementation than research. CHAFEA also gave an overview of the actions under the second EU Health Programme. Additional resources relevant to the workshop projects, and available on the CHAFEA website, were highlighted.
Lunch Break
During the lunch break, opportunities were taken to explore elements of the project interventions, to have informal discussions about project interactions, and also to tour the Hampden Court football ground.
The REPOPA project is focused on finding ways to balance research and real world policy making, and took as a symbol of its work the ‘wobble board’ or ‘balance board’. Participants actively practiced on the balance boards while listening to the presentations. Projects were challenged to communicate their work to a lay audience, while balancing on the board.
SITLESS took an alternative approach to exploring sedentary behaviour, by carrying out a photo elicitation exercise, using workshop participant photos with the common theme of “What does sitting less mean for you?”. The photos and their respective captions were discussed, exploring how everyday activities can be carried out in a healthier manner. The conclusion was that small changes are possible in a very big range of daily situations, and they make big differences. The aim is to incorporate these small changes in our daily routine.
CREDITS4HEALTH: In line with its incentive-focused research, C4H issued a challenge to the workshop participants, with an incentive prize for the top performers. 10 selected participants were given physical activity (PA) trackers at the beginning of the workshop and wore them all day. PA was tracked in real time. At the end of the workshop prizes were presented to the three best “walkers” – participants who took the most steps. Results ranged from 3,000 to 4,500 steps, demonstrating that even if participating in “sitting” conference all day long, there are always opportunities to move, walk around, and get closer to the recommended daily activity goal (10,000 steps).
The Rapid Motivation Quiz: in addition to the ‘steps contest’, C4H invited participants to take part in a short survey to assess their motivation, at quiz.credits4health.com. At the end of the survey, participants received personal feedback pertaining to their level of readiness to change their physical activity levels. They were also able to compare their own survey answers to those of the C4H project cohort, and to analyse their scores online. The exercise made participants aware of some constructs relevant to PA and showed examples of how they could be assessed by self-reporting.
EUROFIT: Participants from all the projects enjoyed an extended tour of Scotland’s National Football Stadium and the opportunity to try out EuroFIT’s new ‘SitFIT’, a self-monitoring device for decreasing sedentary behaviour. They measured steps and upright time, demonstrating that even 20 minutes’ walking at lunchtime can contribute upright time and steps to your daily count. Every step counts!
The new device provided immediate real-time feedback to users, enabling self-monitoring of time spent standing/sitting and stepping, without any use of additional technology. Self-monitoring is one of the most powerful tools for behaviour change. In EuroFIT men have said it is a very powerful tool for change and, combined with the aggregation of ‘team’ steps in virtual ‘matches’ using our MatchFIT app, has really helped men make changes happen.
As they explored Hampden Park, the participants were directly able to experience the atmosphere and ambience of a football stadium, and to appreciate the potential power of the group experience in driving behavioural change.
PASTA completed a small mobility survey among the workshop participants, about their usual mobility behaviour. A poster posed three questions
- Which mode of transport do you usually use to get to work?
- What is the approximate distance between home and your workplace?
- How long does it take you to get there?
The poster was hung up at the beginning of the workshop. Most participants (about 80%) answered by putting a sticker point on the poster. The exercise helped to make people aware that transport mode is directly connected to PA. Trips with a length up to 1.5 kilometres can easily be done by walking and trips between 1.5 to 5 km (or even longer) by (e-) cycling. The results were presented briefly at the PASTA breakout session.
Afternoon session
Title: Planning for sustainability: how can we plan and do research so that it is implemented and makes a lasting impact? (led by EuroFIT)
The EuroFIT approach is based on implementation research. The EuroFIT approach to sustainability was discussed:
- Working with end users throughout the programme, to ensure the programme will be acceptable and feasible to deliver;
- Involving intervention delivery teams (football coaches) and end-users (fans) in designing the intervention and how it is delivered;
- Identifying and harnessing peer support, group activities and the shared experience – particularly where participants may be uncomfortable or lack confidence;
- Exploring motivations that go beyond activity, weight loss, and health – helping participants to want to take part, by making interventions enjoyable through sharing, loyalty and camaraderie;
- Using research methods to understand the barriers and facilitating factors to delivering the programme as part of the research;
- Recommending specific strategies to overcome barriers or put in place facilitating factors, to be used by organisations that want to deliver the programme;
- Developing the best delivery model (for example, single delivery organisations, network models of delivery);
- Finding the money – identifying organisations (corporate, public – or football clubs!) whose aims and priorities are served by the intervention, and building relationships with them.
- Integrating replication into the research process – piloting the intervention without funding, in new locations, to gain a realistic understanding of how sustainable it is, in the longer term.
The discussion further focused around the usefulness of business planning and marketing for sustainability.
Title: PA is not only a matter of health … but of (transport) policies (led by the PASTA project)
This session explored inter-sectoral collaboration between the health sector and other policy domains.
PASTA found that such cooperation is just beginning; to date, actual implementation of political affirmations are rare. During the breakout sessions, we identified target domains (e.g. administrative departments, city planning) and sectors (e.g. transport, health insurance) to cooperate with, in order to increase physical activity. Some related topics (fields of cooperation, factors of success, barriers) were also explored. In PASTA the linkage and cooperation of transport planning and public health is of special interest. When talking to stakeholders and experts from both areas of responsibility, it turned out that there is little actual cooperation, despite widespread support.
The PASTA session emphasised the importance of providing an environment which is conducive to walking and cycling. Input from other projects on those issues was very valuable, learning about their approaches and experiences and exploring common issues, including the following:
- Retaining subjects in longitudinal studies of mobility and physical activity.
- Recruiting without bias, or controlling for bias.
- Learning from people who already use active mobility (walking, cycling) to commute.
- The importance of culture, infrastructure and traffic planning, in active mobility.
The session’s key conclusion was Let’s make walking and cycling the most convenient transport mode to get people more active.
Title: Physical Activity, incentives, and the nudge approach: how can we boost people’s motivation towards healthier lifestyles? (led by the CREDITS4HEALTH project)
This session engaged conference participants in identifying and prioritising future areas of research into the promotion of physical activity. It was structured into four sections:
- a pictorial review of current knowledge and questions in behavioural science;
- a brainstorming session, generating research concepts and posting these on an ‘ideas wall’;
- a (standing) discussion to organise the ideas into themes and add new ones;
- an opportunity for people to prioritise those research themes they would most like to invest in.
The pictorial review of current behavioural science knowledge was based on a systematic review of meta-analyses of physical activity behavioural interventions by the University of Ioannina, Greece. It was structured as follows:
- Objectives – Increasing physical activity, reducing sedentary behaviour, increasing strength and flexibility or all of these?
- Behaviour Change Theories – Which one? Any one? Does it matter?
- Points of Greatest Leverage – Built environment, cognitive behaviour change, or all of these?
- Behaviour Change Techniques – Which combinations are most powerful?
- Intrinsic vs Extrinsic Motivation – Do they compete? Are they sustainable? How can we move from one to another?
- Digital Platforms – Can they deliver low cost, population-wide behaviour change?
The brainstorming session created over 40 research ideas grouped into 8 themes as follows (listed in order of priority as selected by the participants):
- Inequality – have we been successful in developing interventions for the most disadvantaged?
- Cross-Discipline Working –mixed methods, multi-level interventions and multi-disciplinary work.
- Multiple Level Interventions – Acting on across environment, cognitive, and economics ‘nudge’)?
- Understanding (In)activity – Do we sufficiently understand the psychological role of inactivity?
- Learning from Others – Informing our interventions from other disciplines and contexts
- Personalised Interventions – How to tailor more sophisticated behaviour change regimens
- Integrating Technical Knowledge – What can technology help us to achieve?
- Capturing Research Data –can we design more visual interfaces for research and interventions?
Title: Are researchers from Mars and policy makers from Venus? Can we meet on Earth? (led by the REPOPA project)
There were three main topics of discussion in the REPOPA break-out session:
- Challenges in knowledge co-creation and communication in producing evidence-informed and effective policies in real life.
- International umbrella and country-specific platforms to support sustainable evidence-informed policy making.
- Exercise in producing lay summaries of research with the help of an internet-based tool.
These were supplemented by spontaneous and interactive discussions, including
- Making PA a part of normal life (health, social, transport, law, education, social care, construction, planning).
- Collaboration: researchers and practitioners/policy makers working together; not to do interventions for people, to do them with people).
- Multilevel (micro/meso/macro) interventions to enhance PA: individual, family setting, community, regional, national, etc.
- How context can be taken into account when planning interventions (culture, attitudes, needs assessment, context assessment etc).
- Sustainability: there is life after the intervention, too.
Title: Transferability issues in multi-country settings: what are the key challenges for health economic evaluations? (led by the SITLESS project)
The focus of this breakout session was complex interventions to reduce Sedentary Behaviour (SB) and increase PA in older people, conducted across national boundaries.
Co-morbidities linked to physical inactivity represent an enormous burden for health care systems, for society, and for carers. Health economic analysis is a critical tool for healthcare policy makers, and an important element of projects such as SITLESS.
Multi-national projects lead to particular challenges for health economists, due to different models for payment, for outcome recording, and differing social and economic contexts. To ensure transferability of multi-country studies, appropriate methodologies should be used, such as country-specific unit costs and country-specific weights to evaluate health preferences.
Involving the correct stakeholders in the economic analysis is also essential. This implies taking the perspective of the economic evaluation (the point of view from which the costs and benefits are recorded and assessed) into proper account. The most comprehensive approach considers a societal perspective, but other perspectives are also possible, e.g. from the point of view of the health system, social insurance, private health providers, etc.
The long-term sustainability of projects like SITless should also be discussed as part of the evaluation, i.e. whether the intervention participants are willing to pay for its implementation in the long term. This perspective will inform the economic evaluation, by identification, measurement and valuation of the project’s costs and benefits.
Conclusion
The workshop succeeded in bringing together European researchers and relevant stakeholders and in establishing networks among research groups in physical activity research.
Common themes across the workshop included
- Physical inactivity represents an enormous personal, social and economic burden for EU citizens, national health care systems and for the overall EU economy.
- The importance of active mobility as a source of regular exercise for the general population.
- The need to complete the value chain, from research to policy to implementation (of infrastructure, of transport/health cooperation).
- The requirement for cultural and contextual sensitivity in behavioural change and physical activity interventions (national, demographic, socio-economic, gender-specific…).
- Sustainability and replication of successful interventions.
- The importance of increasingly addressing and including disadvantaged
- Agreement to support each other in communication and dissemination activities.
Adnkronos (a press agency partner in the Credits4Health project) collected audio-visual materials aimed at the dissemination of the workshop, and filmed interviews of the European projects coordinators and the EU project officer. These will be disseminated through C4H and the other projects.
[2] http://www.pastaproject.eu/home/
[3] http://www.credits4health.com
[5] http://sitless.eu/
[6] http://ec.europa.eu/research/index.cfm?pg=home&lg=en
[7] http://ec.europa.eu/transport/index_en.htm
[8] http://ec.europa.eu/dgs/education_culture/index_en.htm
[9] https://ec.europa.eu/digital-single-market/en/dg-connect
[10] http://ec.europa.eu/dgs/health_food-safety/index_en.htm
[11] http://ec.europa.eu/chafea/index.html