Presentation Transcript

1. Dr Karen Martin School of Population Health, The University of Western Australia The Oxford Health Alliance Summit 2011 “Evidence into Action”: How to create societies that provide ongoing physical activity support and promotion  
2. Creating active communities requires a multidimensional approach Planning and place Programs Policies Sustainable??? Partnerships
3. Planning and place Basic environmental needs come first Before focusing on PA supportive environment - infrastructure for basic needs is priority (WHO Kobe Meeting Healthy Urban Planning) Local economic development Safe, affordable and appropriate shelter Appropriate sanitation and drainage systems opportunity for redevelopment to support health including physical activity… rather than just redevelopment…..
4. Developing country example Rio de Janeiro, Brazil Govt agreed to substitute the walls  combination of stretches of nature paths, including handrails for people with mobility problems bicycle and skating paths playgrounds
5. Planning and place How to plan environments to support PA? Prioritise infrastructure improvements Hoehner, 2011 comprehensive sidewalks medians crosswalks street lighting bike lanes plantings
6. Developing country example: focus on planning Bogotá, Columbia City of 7 million, of these 3 million live in poverty Bogota’s former mayor shifted budgets intended for highways to parks bike lanes mass-rapid public transit “I was almost impeached for getting cars off sidewalks which car owning upper classes had illegally appropriated for parking.”Enrique Peñalosa, Mayor
7. Active commuting plus increasing pedestrian access 300 km of bicycle lanes, stretch from the slums & suburbs into the capital Ongoing project under concurrent development Since lanes constructed, bicycle use increased by 5 x in the city Between 300,000 and 400,000 trips made daily in Bogotá by bike Bogotá, Columbia
8. Also some programs… Ciclovia... Street closures “I realized that we in the Third World are not going to catch up to the developed countries for two or three hundred years. If we defined our success just in terms of income per capita, we would have to accept ourselves as second- or third-rate societies – as a bunch of losers – which is not exactly enticing for our young people. So we are forced to find another measure of success. I think the only real obvious measure of success is happiness.”Enrique Peñalosa Bogotá, Columbia
9. Programs What works?? Point of decision prompts (Kahn 2002) strong evidence for effect effect sizes net increase from 2.5% to 128.6% (see U Tube; piano stairs, the fun theory and Fast lane, the slide Mass media campaigns (Leavy 2011) few studies show effective reduction in PA when combined with other strategies (such as community involvement) may be effective
10. more on mass media programs…. Recent review of mass media PA campaigns campaignsreported higher awareness women tertiary education physically active women women with active children (Leavy 2011) Messages and materials culturally adapted to specific populations improves intervention effectiveness (Müller-Riemenschneider 2008) Mass-media interventions create awareness but not good investment for changing behavior when used alone (Müller-Riemenschneider2008) Do mass media programs preach to the converted???
11. Programs 3. Community-wide programs/campaigns Mass media plus social support strong evidence for effect 4. School based programs ↑ PE class (number/length),↑ MVPA, mandating PE strong evidence for effect barriers: school or system based 5. Social support in community settings Support groups outside family, e.g. walking groups strong evidence for effect barriers: costly, target fewer people Individually adapted health behaviour change programs Teach participants specific skills relevant to their situation strong evidence for effect barriers: costly, target fewer people (Kahn 2002)
12. Isolated city example: focus on programs PA promotion in Perth, Western Australia Western Australia, 2.3 mill, Perth city 1.7 mill, temperate climate Various government and not-for-profit programs to promote PA Find 30 everyday (adult- encourage 30 minutes each day) Be active (Physical activity taskforce, beactive.wa.gov.au) Travelsmart (encourage active transport transport.wa.gov.au/14890.asp) 61% respondents in recent adult survey were aware that 30 minutes of moderate-intensity PA is required on most days for good health. s
13. PA trends in Perth, Western Australia Adults; proportion participating in sufficient activity    significant difference p< 0.05
14. PA trends in Perth, Western Australia Children’s physical activity remained stable between 2003 and 2008
15. Opportunities in Perth…. Planning and infrastructure Take advantage of climate and place: Eg programs, Nature Play natureplaywa.org.au
16. Congested city example: focus on programs PA promotion in London likeridingabike.org
17. Partnerships Promising strategies and partnerships Parks and recreation agencies (Bruton 2011) Partnerships with schools e.g. sharing facilities, access to oval out of hours(Bruton 2011) co-locating: with parks? community hub? 1. Maryland (co-location program) 2. Rosa Parks School, Oregon edfacilities.org/rl/community_use.cfm Community participation (Bruton 2011)
18. Developed country example: focus on partnerships San Diego County Childhood Obesity Initiative (COI) Public/private partnership advocacy policy development environmental change government, healthcare, school and after school, early childhood, community, media and business. Early policy change success (school, workplace policies, planning policies etc)
19. Childhood Obesity Initiative recommendations Find a common agenda and shared solutions effectively engages partners from different sectors. e.g. climate change Leadership and political will on multiple levels is critical (Linton 2011) (San Diego County COI)
20. Developed country example: multifaceted West Virginia University Department of Community Medicine Programs mass media involved local physician –prescription for walking walking clinic Place Upgrading and connecting local trails Adding rest rooms and telephones Improving overall safety & aesthetics planning for an urban state park University engineering team to develop walkable community plan (Reger-Nash 2005)
21. Partnerships: On-going Walkable Wheeling Task Force (initiated by mayor) Local schools to expand youth physical activity Local clubs to develop walking opportunities Engaged city agencies—mayor, streets, highways, parks, law enforcement, planning, local clubs, government, Schools, press, businesses, medical society, other stakeholders Community advisory committee helped plan campaign Wheeling Walks, West Virginia
22. Results of intervention Evaluation measures Media exposure Self reported walking Outcome 30% of Wheeling's sedentary residents increased their walking to the recommended level compared to a 16% increase in a control community (14% net increase in Wheeling) The cost pp to change sedentary to regular walker =$26.32 pp/per month. Wheeling Walks, West Virginia
23. Developed country example: multifaceted Blue Zones Vitality Project, Albert Lea Habitat Community Inner-self Social Networks http://www.bluezones.com/programs/vitality-cities/
24. Changes to the community City of 18 000 people 25% participated in program component Initial program cost = approx$750 000 Partnerships: AARP and the United Health Foundation funding Local government 60% city’s local restaurants, 51% largest employers, every school Social, commercial, communal and professional networks Albert Lea
25. Changes to the community Place Workplace modifications Space for community gardens Bike and walking paths connected Policies Amended school and workplace wellness policies Programs Walking school bus and adult walking teams Standing or walking meetings Albert Lea
26. Results of intervention Project longevity: 3.2 yrs PA and weight: Engaged in more PA lost average 1.5 kg (every member of the community) Other health benefits: 20% reduction in absenteeism for key employers 49% decrease in health care costs of city employees Successful interventions are run by people who know the community and recommendations are specific and appropriate (bespoke!) Sustainable??? Albert Lea
27. Example in developed country: multifaceted Agita São Paulo, Brazil 37 mill State of Sao Paulo, started in 1996 WHO praised program as model for developing countries Scientific board and executive board Outcomes Reach: 60% Recall and knowledge: well distributed different socioeconomic groups The prevalence of people reaching the PA recommendation was 54.8% Risk of being sedentary was smaller amongst those who knew the Agita message (7.1%) compared with those who did not know (13.1%).
28. Key elements for program success Simple message: “At least 30 min of PA per day” Linking existing policies Inclusion principle Participants choose enjoyable activities Culturallinks Specific messages relevant to intrapersonal factors Stakeholders Political and technical support Appropriateness of PA interventions Scientific based information (university research centre) Qualitativeand quantitative evaluation Agita São Paulo, Brazil
29. (Matsudo 2004)
30. AgitaGalera Day (Active Community Day) every year since 1997 Every public schools and hundreds of private schools students participate in sports events and a neighborhood walk Agita São Paulo, Brazil
31. Adult physical activity correlates SES education level program access overweight/obese (-) age (-) healthy diet race (white) physician influence sex (male) social support psychosocial (e.g. enjoyment, expected benefit) physical activity equipment recreational facilities: availability accessibility convenience having a companion Climate/season (Sallis 2002, Wendel-Vos 2007)
32. Child physical activity correlates previous physical activity perceived activity competence physical activity preferences program access healthy diet perceived barriers (-) sex (male) intention to be active parental overweight status (-) transport infrastructure (sidewalks/controlled intersections/ destination access / public transportation time spent outdoors recreational infrastructure (access to recreational facilities and schools). local conditions (crime, area deprivation) (-) transport infrastructure (N roads to cross/traffic density&speed) (-) (Sallis 2000, Davidson 2007)
33. Adolescent physical activity correlates ethnicity (white) age (-) direct help from parent & parent support physical activity preferences previous physical activity sex (male) intentions sibling physical activity sensation seeking sedentary after school and on weekends (-) recreational infrastructure (access to recreational facilities and schools). community sports transport infrastructure (sidewalks/controlled intersections/ destination access / public transportation local conditions (crime, area deprivation) (-) depression (-) support from others opportunities to exercise transport infrastructure (N roads to cross/traffic density&speed) (-) (Sallis 2000, Davidson 2007)
34. Be locally specific with….. 1. identifying health promotion priorities health issue/behaviour/target group 2. identifying strategy (i.e. program, planning and place/partnerships/policy) 3. identifying priority target Example (low SES suburb, WA) 1. overweight & obesity rates/physical activity/low SES adolescents 2. place and partnerships 3. improving perceptions of safety, increased maintenance of skate parks (local council), working with schools to promote sport Local Community specificity….
35. Lobbying/partnerships with policy makers Brief brochures summarising research findings to stakeholders/policy makers (plus journal publications) Partnerships to help identify priorities effective local strategies
36. Take home messages….. Opportunities within developing countries to plan for PA Remove barriers to physical activity Programs alone are not enough Identify and target correlates Community wide approaches with community ‘buy-in’ Ask how can we create sustainable changes in the local community?
37. What are barriers to implementing and sustaining effective programs? How can programs be developed in times of economic downturn? Need to build an evidence base about what works, what doesn’t ? Challenges for researchers.... How can governments and people in power be motivated to act and prioritise? More in-situ research (program evaluation) More emphasis on interventions
38. “Over the past 80 years we have been building cities for cars much more than for people. If only children had as much public space as cars, most cities in the world would become marvelous.” Enrique Peñalosa
39. References Bruton 2011 Active Living Research Annual Conference 2011 Hoehner 2011 Active Living Research Annual Conference 2011 Kahn 2002 Am J Prev Med 200222 (4s) 73-107 Linton 2011 Active Living Research Annual Conference 2011 Leavy 2011 Physical activity mass media campaigns and their evaluation: a systematic review of the literature 2003-2010 Health Education Research Accepted March 2011 Matsudo 2004 J Phys Act Health 2004; 81-97 Matsudo 2010 Med Sci Sports Exerc 2010; 45 (12); 2231 Reger-Nash 2005Fam Community Health 2005;28:64-78 Sallis 2000 Med Sc Sports Exerc2000; 32(5):963-975 Sallis 2002 Med Sc Sports Exerc2002 34(12) 1996–2001 Wendel-Vos 2007 Obesity reviews 2007 8 (5) 425 Enrique Peñalosahttp://www.pps.org/articles/epenalosa-2/ karen.martin@uwa.edu.au