2 Public health need and practice
Increasing physical activity has the potential to significantly improve both physical and mental wellbeing, reduce all-cause mortality and improve life expectancy. For example, increasing activity levels will help prevent and manage many conditions including coronary heart disease (CHD), cancer, diabetes, musculoskeletal disorders, obesity and stroke (Department of Health 2011). Physical activity can lower the risk of Alzheimer's disease (Scarmeas et al. 2009). It has also been shown to improve symptoms in those diagnosed with depression (Rimer et al. 2012). Physical activity also has a role in enhancing psychological wellbeing by improving mood, self-perception, self-esteem and reducing stress (Department of Health 2011).
The majority of adults and many children in England do not meet the Chief Medical Officer's (CMO) recommendations for physical activity. In 2008, based on self-reporting, 39% of men and 29% of women aged 16 and over met the CMO recommendations on minimum physical activity levels (The Health and Social Care Information Centre 2011).
Physical activity levels vary according to income, gender, age, ethnicity, socioeconomic status and disability. People tend to be less physically active as they get older and levels of physical activity are generally lower among women than men. Physical activity levels are also lower among certain minority ethnic groups, among people from lower socioeconomic groups and among people with disabilities (Department of Health 2011).
Inactivity costs the NHS an estimated at £1.06 billion based on national cases of CHD, stroke, diabetes, colorectal cancer and breast cancer (all conditions that are potentially preventable or manageable through physical activity). This is a conservative estimate, given the exclusion of other health problems that physical activity can help manage and prevent. Examples include osteoporosis, falls and hypertension (Allender et al. 2007).
The total cost of inactivity further increases when considering the wider economic costs. These include sickness absence, estimated at £5.5 billion per year, and the premature death of productive people of working age from 'lifestyle-related' diseases, estimated at £1 billion per year (Ossa and Hutton 2002). In 2008, the Be active, be healthy plan (Department of Health 2009a) estimated that the average cost of physical inactivity for every primary care trust (PCT) in England was £5 million.
In response to NICE public health guidance 2 (2006), which endorsed brief interventions in primary care to increase physical activity, the DH developed and launched the 'Let's get moving' physical activity care pathway (DH 2009b). This care pathway endorses use of the general practitioner physical activity questionnaire (GPPAQ) to identify inactive patients in primary care. It also includes a brief intervention based on the principles of motivational interviewing to help all those classified as less than active to change their behaviour.
Two additions to the hypertension quality outcomes framework (QOF) indicator set (HYP004 and HYP005) relate to physical activity (NHS Employers 2013). Both include the use of GPPAQ and assessment of physical activity levels in relation to hypertension in a programme aimed at the prevention of CVD (see the NHS Employers website for further information).
 The recommended level of activity for adults at that time was 5 episodes of at least moderate-intensity activity on at least 5 days a week. In 2011, this was changed to being active daily and accumulating at least 150 minutes of moderate-intensity activity, or 75 minutes of vigorous activity, in bouts of 10 minutes or more over a week. Additional recommendations on strength and balance, and for older people and children, were also developed (Department of Health 2011).