PHIAC took account of a number of factors and issues in making the recommendations.
3.1 Physical activity is influenced by a range of factors associated with individuals, workplaces and the wider environment. This guidance can only be one element of a broader strategy to increase physical activity.
3.2 The guidance needs to be considered within the context of a range of public health issues, including the high and increasing levels of overweight and obesity. It was noted that physical activity is an important way of helping maintain weight loss over several months or years. The Chief Medical Officer's report on physical activity (DH 2004) noted that: 'all substantial movement of body weight – such as steps walked per day, or stair climbing – contributes to energy expenditure and may help with weight management. People who need to avoid weight gain should reduce the amount of time they spend inactive'.
3.3 It is unrealistic to assume that a one-off intervention can be 'life changing', so PHIAC considers it important to provide ongoing interventions, support and encouragement.
3.4 PHIAC also considered whether some interventions may cause some individuals harm by reinforcing their determination to avoid being physically active.
3.5 Small and medium-sized organisations may have different needs from those of large organisations. PHIAC has tried to ensure the recommendations can be tailored to make them relevant to all business practices.
3.6 PHIAC recognised the importance of workplace ethos and the need for employers to lead efforts to promote and support initiatives to increase physical activity levels in the workplace.
3.7 There are particularly close links between this guidance and the guidance on promoting and creating built or natural environments that encourage and support physical activity (NICE public health guidance 8).
3.8 If an intervention is not included in the recommendations it does not necessarily mean it should be stopped. These recommendations are based on the available evidence and not all interventions may have been evaluated.
3.9 Increasing employee's physical activity levels may help reduce some illnesses and conditions that are important causes of sickness absence, resulting in improved productivity and reduced costs for employers.
3.10 The economic modelling used on the evidence is conservative and does not consider the long-term benefits of physical activity (such as the prevention of some cancers and other conditions), or the short-term benefits for people's mental wellbeing. The modelling is made difficult because many studies treat physical activity-related outcomes as permanent. However, assuming even modest uptake, the interventions in this guidance could be considered cost effective from an NHS perspective, and cost saving from an employer perspective, because they reduce absenteeism.
3.11 PHIAC considered the extent to which the recommendations could generally widen health inequalities, for example, by improving the health of the better off in society without improving the health of those who are worst off.
3.12 Increasing levels of physical activity in the workplace could have an impact on equality in the workplace, since not all employees may be able to participate in all the activities on offer (for example, shift workers or people with disabilities may be excluded from some activities). PHIAC emphasised the need to implement plans that give everyone an equal chance to improve their physical activity levels at work.
3.13 Although some of the evidence was not from the UK, PHIAC considered there was enough that was sufficiently applicable to the UK to inform the recommendations.
3.14 The evidence had a number of weaknesses:
the outcome measures of physical activity used are often based on self-reporting and frequently only report outcomes over a short period
generally it is not possible to determine which part of a multi-component programme is responsible for a particular change: the effect may be the result of an interaction between different components of the programme
the range of settings covered is very limited, in particular, evidence is lacking about small and medium-sized enterprises
there is a lack of evidence about inequalities.
3.15 PHIAC was aware that cycling to work instead of walking can increase the distance people may commute and can be an effective way to increase levels of physical activity. However, when cycling on busy, rush-hour roads, there is a risk of road traffic accidents. PHIAC did not consider evidence about road injuries. However, NICE guidance on promoting and creating built or natural environments that encourage and support physical activity (public health guidance 8) recommends the planning and provision of safe cycling and walking routes.