Introduction

This quality standard covers encouraging physical activity in people of all ages who are in contact with the NHS, including staff, patients and carers. It does not cover encouraging physical activity for particular conditions; this is included in condition‑specific quality standards where appropriate. For more information see the topic overview.

Why this quality standard is needed

Physical inactivity costs the NHS alone an estimated £0.9 billion per year based on national cases of ischaemic heart disease, ischaemic stroke, breast cancer, colorectal cancer and diabetes[1] (conditions that are potentially preventable or manageable through physical activity).

According to the Network of Public Health Observatories Health Impact of Physical Inactivity, it has been estimated that physical inactivity leads to around 37,000 premature deaths a year in England alone. Despite the multiple health gains associated with a physically active lifestyle, there are high levels of inactivity in England. The Health Survey for England 2012 found that, based on self‑reporting, 67% of men and 55% of women aged 16 and over met the Department of Health's UK physical activity guidelines. However, people often overestimate the amount of physical activity they undertake, meaning the real figures may be lower. The survey also found that 26% of women and 19% of men were classed as 'inactive'.

For children, the Health Survey for England 2012 found that, based on self‑reporting, 21% of boys and 16% of girls aged 5–15 years met the UK physical activity guidelines for children and young people. Among both sexes, the proportion meeting the recommendations in the guidelines was lower in older children. For boys and girls aged 2–4 years, a similar proportion (9% and 10% respectively) was classified as meeting the UK physical activity guidelines. In this age group, 84% of children fell into the 'low activity' group, meaning that they did less than an hour of activity a day, or did not do sufficient activity each day.

There are clear and significant health inequalities in relation to physical inactivity according to income, gender, age, ethnicity and disability (Department of Health, Start active, stay active). People tend to be less physically active as they get older, and physical activity levels are generally lower in women than in men. Physical activity levels are also lower among certain minority ethnic groups, people from lower socioeconomic groups and people with disabilities.

Increasing physical activity has the potential to improve physical and mental health, reduce all‑cause mortality and improve life expectancy. It can also have a positive impact on health and social care services by significantly reducing the prevalence of chronic disease (Department of Health, Start active, stay active).

The quality standard is expected to contribute to improvements in the following outcomes:

  • cardiovascular health

  • excess weight in adults

  • excess weight in children and young people under 18 years

  • mental health

  • physically active adults

  • physically active children

  • self-reported wellbeing

  • social isolation

  • use of outdoor space for exercise and health reasons.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors which affect health and wellbeing and health inequalities

Indicators

1.9 Sickness absence rate

1.16 Utilisation of outdoor space for exercise/health reasons

1.18 Social isolation* (ASCOF 1I)

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.5 Child development at 2–2½ years

2.6 Excess weight in 4–5 and 10–11 year olds

2.8 Emotional wellbeing of looked after children

2.12 Excess weight in adults

2.13 Proportion of physically active and inactive adults

2.17 Recorded diabetes

2.22 Take up of the NHS Health Check programme – by those eligible

2.23 Self-reported wellbeing

2.24 Injuries due to falls in people aged 65 and over

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.4 Under 75 mortality rate from all cardiovascular diseases (including heart disease and stroke)** (NHSOF 1.1)

4.5 Under 75 mortality rate from cancer** (NHSOF 1.4i)

4.7 Under 75 mortality rate from respiratory diseases** (NHSOF 1.2)

4.11 Emergency readmissions within 30 days of discharge from hospital** (NHSOF 3b)

4.13 Health-related quality of life for older people

4.14 Hip fractures in people aged 65 and over

Alignment across the health and social care system

* Indicator shared with Adult Social Care Outcomes Framework (ASCOF)

** Indicator shared with NHS Outcomes Framework (NHSOF)

Table 2 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

1b Life expectancy at 75

i Males ii Females

Improvement areas

Reducing premature mortality from the major causes of death

1.1 Under 75 mortality rate from cardiovascular disease* (PHOF 4.4)

1.2 Under 75 mortality rate from respiratory disease* (PHOF 4.7)

1.4 Under 75 mortality rate from cancer* (PHOF 4.5)

i One- and ii Five-year survival from all cancers

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Patient experience and safety issues

NICE has developed guidance and associated quality standards on patient experience in adult NHS services and service user experience in adult mental health services (see the NICE pathways on patient experience in adult NHS services and service user experience in adult mental health services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that impact on patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for physical activity specifies that services should be commissioned from and coordinated across all relevant agencies. An integrated approach is fundamental to encouraging physical activity in all people who are in contact with the NHS.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing high‑quality services that encourage physical activity in all people who are in contact with the NHS are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in encouraging physical activity in all people who are in contact with the NHS should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Healthcare professionals delivering the NHS Health Check should demonstrate competence in line with the NHS Health Check competence framework (2014).

British Medical Journal (BMJ) Learning has developed a suite of free, continuing professional development (CPD)‑accredited modules covering motivational interviewing techniques, and modules on physical activity and health covering the science and specific clinical conditions in association with Public Health England.

The Department of Health's (2012) report on The NHS's role in the public's health states that every healthcare professional should 'make every contact count'. This means that they should use every contact that they have with a person to maintain or improve their mental and physical health and wellbeing where possible, whatever their specialty or the purpose of the contact. The report also emphasises the importance of the NHS workforce improving their own health in order to enable them to act as role models. It is easier for people in contact with the NHS to accept messages from its staff if it is clear they follow these messages for their own health.

Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training will be considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in encouraging physical activity in all people who are in contact with the NHS. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about interventions and initiatives that encourage physical activity.



[1] Scarborough P et al (2011) The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs. Journal of Public Health 33(4):527–35.