Promoting physical activity in a public health context

In this special issue of the Journal of Sport and Health Science entitled Physical Activity and Public Health, 5 papers, 1 commentary, and 1 research highlight discuss efforts using public health approaches to increase physical activity (PA) in global settings. Such efforts are warranted based on the prevalence of adults (23%) worldwide who are insufficiently active at levels recommended by the World Health Organization (WHO). This impact is substantial with 6%–10% of all deaths attributed to insufficient PA.1, 2 Insufficient PA also places adults at increased risk for a myriad of conditions, which include cardiovascular disease, type 2 diabetes, breast and colon cancer, bone and joint problems, among others. Steven Blair, known worldwide for his research on PA, aerobic fitness, and health refers to the physical inactivity pandemic as the “biggest public health problem of the 21st Century”.³ This concern is mirrored by a recent report highlighting global increases in overweight and obesity and the impact on increased mortality and disability related to cardiovascular disease and type 2 diabetes.⁴ Accordingly, public health governmental agencies5, 6 and non-governmental organizations7, 8, 9, 10 have called for stepped up efforts to increase PA on a global scale.

Public health approaches to increasing PA often are organized into action plans based on the Ecological Systems Model, a framework used to understand the multiple levels of behavior, social systems, and interactions between people and their environments.11, 12 In 2006, Sallis et al.¹³ presented an ecological model of the 4 domains of active living (recreation, transport, occupation, and household) that recognizes the importance of multiple influences on decisions to be physically active or not. They identify social cultural environments, informational environments, built and natural environments, perceived environments, and policy environments. Social cultural environments relate to the importance of interpersonal modeling, social support, the social climate, and advocacy by individuals and organizations. Informational environments involve information dissemination, counseling, and mass media efforts. Built and natural environments include considerations of climate, open space, air quality, and structures built for PA purposes. Policy environments relate to ordinances and laws that enable active transport, sports and recreation opportunities, and land use. Traditionally, public health approaches have been focused on built, natural, and policy environments; however, all levels of the ecological framework are important in promoting PA in a population setting.

The papers in this special issue are organized by this ecological model of active living. In a commentary, Fiona Bull¹⁴ from the WHO discusses the global problems of physical inactivity and presents the 2013–2020 WHO Global Action Plan on Noncommunicable Disease Prevention and Control designed to reduce physical inactivity by 10% by 2025. She notes that reaching this goal will require leadership and contributions of the academic and scientific community to assist policy makers and practitioners. Two papers focus on the built and natural environment in relation to PA. Gadais et al.¹⁵ identify strengths and gaps in research on PA and the built environment in Canada. They call for innovative research into political and sociocultural spheres of action, one of the gaps identified in the Canadian studies. Solbraa et al.¹⁶ examine associations with objective measures of PA and the built environment, which includes rural communities along the Norwegian coast. They recommend locally customized approaches for walkability, active transport, and commuting. Yıldızer et al.¹⁷ focus on the social cultural environment in exploring relationships between social capital and PA engagement in Turkish adolescents. They discuss the importance of gender and culture on perceptions of social capital and PA in a developing country. Flórez-Pregonero et al.¹⁸ address the policy environment in presenting a feasibility study on the use of pedometers in a U.S. PA surveillance system. They highlight the opportunities and challenges of using pedometers to collect step data in a single state participating in the surveillance system. The last 2 papers focus on the information environment in presenting evaluations of public health projects designed to increase PA in healthcare and population settings, respectively. Beckvid-Henriksson et al.¹⁹ describe a Swedish–Vietnamese project that trained healthcare providers in PA counseling, used mass media to promote PA, and helped to develop a Vietnamese PA plan. Brown et al.²⁰ share results from an evaluation of mass-media activities associated with a national walking program in the USA.

Collectively, the papers presented in this special issue provide a global snapshot of some of the efforts taken to increase PA in different countries. Clearly a public health problem, physical inactivity is largely solvable through population-based research followed by community education, population surveillance, policy actions, and community-wide interventions. As seen with the papers in this special issue on PA and public health, multi-disciplinary team approaches are needed to adequately address the multiple dimensions of physical inactivity.