Physical Activity

Physical activity has been described as ‘the miracle cure’. Being active has enormous health and wellbeing benefits for us all – Regular exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions – reducing the risk of each by at least 30%. This is better than many drugs (Source: Academy of Medical Royal Colleges). 

Regular physical activity, in combination with standard medical care, has an important role in the prevention and management of many long-term conditions including mental ill health. The consensus statement released by health experts in November 2021 states that physical activity benefits outweigh risks for people with long-term health conditions, and determines that physical activity is safe, even for people with multiple conditions. One in four people in England live with long-term health conditions and, according to the national Active Lives survey, this group is twice as likely to be inactive compared to those without a long-term condition. Furthermore, the likelihood of being inactive increases for people with multiple conditions. 

Physical activity is defined as movement and force upon the body that results in raised heartbeat and energy expenditure. The Office for Health Improvement & Disparities recognises four main categories of physical activity: 

• Active Living: housework*, gardening*, walking and play. 
• Active Travel: walking, cycling and running. 
• Recreation: exercise, dance and swimming. 
• Sport: informal sport, organised sport, structured competition, elite and professional sport. 

*These activities are not recorded in Active Lives data. 

Physical inactivity is both a determinant and a product of complex and interacting environmental, physical, economic and socio-cultural factors. Uptake of physical activity is known to be greater in groups with more resource (such as physical health, finance and leisure time) and, consequently, higher levels of inactivity typically correlate with areas of higher deprivation, ill-health, unemployment, lower social and community cohesion.  Physical activity is therefore an important causative factor for the significant health inequalities seen across Lincolnshire. It is associated with 1 in 6 deaths in the UK and is estimated to cost the UK £7.4bn annually. It has significant benefits for both physical and mental health. As a return on investment, every £1 spent on community physical activity generates nearly £4 for the economy and society (Source: OHID). 

The Chief Medical Officers’ (CMO) physical activity guidelines recommend that, for good physical and mental health: 

• Adults undertake at least 150 minutes of moderate intensity, or 75 minutes of vigorous activity, per week. 
• Under-fives should do 180 minutes of any intensity per day, spread across the day. 
• Those aged 5-18 years should average at least 60 minutes per day across a week. 
• Children and young people with a disability should do 20 minutes exercise per day, as well as strength and balance activity 3 times a week. 

Sporting Future (DCMS, 2015) is the government strategy for physical activity focused on engaging groups who typically do less activity, including women, older adults, disabled people, ethnically diverse communities and lower socioeconomic groups. The strategy aims to improve five outcomes: physical wellbeing, mental wellbeing, individual development, social and community development, and economic development. 

Sport England are responsible for developing and growing grassroots sport, getting more people active across England. Uniting the Movement (2021-31), is a 10-year vision to transform lives and communities through physical activity and sport as the country adapts and rebuilds following the pandemic. The strategy focuses on five big issues: 

1. Recover and Reinvent: Supporting the physical activity sector to recover from the pandemic and adapt as a relevant and sustainable network of organisations. 
2. Connecting Communities: Utilising physical activity’s ability to make better places to live. 
3. Positive experiences for children and young people: Creating the foundations for a lifelong positive relationship with physical activity. 
4. Connecting with health and wellbeing: Strengthening connections between physical activity and the health and wellbeing sector. 
5. Active Environments: Creating the places and spaces for people to be active. 

Let’s Move Lincolnshire physical activity strategy was refreshed in 2022. The strategy aligns with Uniting the Movement and includes the development of agile systems across sectors. It is led by Active Lincolnshire and delivered as a countywide movement of stakeholder and resident collaboration across sectors and systems. It sits within the Lincolnshire Health and Wellbeing Board strategy. 

Activity levels of Lincolnshire residents are collated in the adults, children and young people Active Lives surveys. In Lincolnshire, 42% of adult residents fail to meet CMO physical activity guidelines, with many being completely inactive (doing less than 30 minutes a week). This has remained relatively consistent and is worse than the national and regional averages. 

In Lincolnshire there is a 10% difference in adult inactivity rates across the 7 districts, with greatest inactivity recorded in Boston and South Holland. The greatest levels of activity are recorded in Lincoln, North Kesteven and West Lindsey. The percentage of residents achieving 150 minutes of moderate intensity physical activity, as recommended by the Chief Medical Officer, varies by 16% between Boston (lowest) and Lincoln (highest). This is, in part, due to residents of Boston living in an area that exhibits higher prevalence of deprivation, larger populations of lower-socio economic groups and higher numbers of people with long-term health conditions and disabilities compared to Lincoln, all of which are determinants of inactivity. Environmental factors, policies, infrastructure, and access also play a part. 

Evidence suggests that social isolation is greater in rural areas and that those who are less socially connected tend to engage less with preventative services (Source: Lancet Public Health). If individuals feel lonely or isolated, they may be less engaged in physical activities, despite the physical, mental and social benefits that this could bring. Loneliness can affect people of all ages and is more likely following major life events, such as leaving school or becoming a parent. These are also transitions that are sometimes associated with a reduction in physical activity levels so perhaps a key opportunity for targeted interventions.  

As seen across the country, inactivity in adults in Lincolnshire increases with age, is more prevalent in lower socio-economic groups, unemployed, retired and people with long-term health conditions, and for people with disabilities, (increasing with each additional impairment). Nationally and across Lincolnshire more males than females meet the CMO recommended levels of physical activity. However East Lindsey, Lincoln and South Holland show gender equality whilst West Lindsey currently shows a higher percentage of females than males meeting the recommendations. These trends were beginning to emerge before the pandemic and likely increased because conditions created during this time, conditions conducive to creating environments and opportunities where women and girls felt comfortable being active. 

Children and young people display a similar pattern across the districts, with Boston and East Lindsey having the highest levels of inactivity compared to Lincoln and West Lindsey. However, the pandemic has affected the gender breakdown with inactivity of boys being higher than girls in 2021 for the first time since the survey began in 2017-18. Across the county (data unavailable at district level) inactivity is lower between Year 3-4 and Years 7-8 but increases again for Years 9-11 to levels similar to the adult survey. Inactivity decreases as family affluence increases. There are higher levels of inactivity amongst pupils whose families qualify for free school meals. Children and young people with disabilities and long-term health conditions follow the same trend as adults, being less active the more impairments they have. 

• One You Lincolnshire provides free health and wellbeing programmes across Lincolnshire supporting individuals to make small, sustainable changes including increasing physical activity to improve health and wellbeing, enabling people to live longer, happier lives. 
• Let’s Move Lincolnshire is a countywide movement co-ordinated by Active Lincolnshire, providing the following system wide support: 
  • • Co-ordination and communication across the physical activity sector in Lincolnshire. 
    • The Let’s Move Lincolnshire website is a one-stop-shop for residents and stakeholders to find safe, condition-specific activities and access resident stories. 
    • Cross agency co-ordination of communications for Let’s Move Lincolnshire, national campaigns such as We Are Undefeatable, This Girl Can, and major events e.g. Commonwealth Games. 
    • Facilitating and enabling the development, management, and promotion of condition specific programmes including This Mum Moves for pregnant women and new mums, and Fighting Fit for people living with, or recovering from cancer. 
    • Members of the national Live Longer Better programme which aims to help people increase their healthy life expectancy and reduce the need for health and social care. 
    • Management and distribution of the Together Fund which seeks to tackle inequalities exacerbated by the pandemic, impacting on a person’s ability to be physically active. Priority audiences include lower socio-economic groups, culturally diverse communities, and those with a disability or long-term health condition. 
    • Ensuring continued professional development opportunities to better understand and provide for patient needs, bringing the physical activity and health sectors closer together. 
    • Embedding Moving Medicine across health sector partners countywide. 
    • Creating an evidence base of case studies, reports and data analysis to strengthen the local narrative between sectors. This includes using Moving Communities data to evidence the value of leisure provision on physical and mental health indicators. 
• Lincolnshire and district health and wellbeing strategies. Developed collaboratively to ensure alignment and futureproofing, they include a section on physical activity aligned to the Let’s Move Lincolnshire strategy. 
• Leisure operators provide sessions and spaces suitable for different conditions, e.g. dementia friendly leisure centres. Facilities also offer discretionary pricing and subsidised access e.g. free membership for Children in Care. 

The Let’s Move Lincolnshire strategy was refreshed in 2022 using recommendations made following research and consultation undertaken by University of Lincoln in 2021-22. More than 80 stakeholder agencies contributed via focus groups or surveys and 331 residents via online surveys. The report from this research can be found on the Let’s Move Lincolnshire webpage. 

• Physical activity is not consistently embedded in non-sport sector strategies or corporate plans despite its ability to achieve a wide range of health, social, and economic outcomes. 
• There is an inconsistent countywide picture of activities aligned to the health needs of residents. Consistent, detailed data collection would allow for better promotion of existing offers aligned to conditions as well as distribution of resources, training and the establishment of new activities. 
• There is a lack of knowledge of the workforce required to meet future population growth and associated health needs of the county, and the skills gap between the current and future workforce. Currently, there are barriers to (gaps) some training offers, e.g. Social prescribing link workers are not eligible to attend Clinical Champion training. 
• Resident voice is not consistently involved in decision making. Co-production is required to be a guiding principle, a new paradigm in the suite of tools for gaining representative involvement. 
• No GP practices in Lincolnshire have signed up to the active practice charter (Royal College of GPs) or Active Hospitals (Moving Medicine) and there is limited use of the physical activity clinical champion training. 
• Low use of physical activity specific digital tools for prevention, management and rehabilitation. 
• There has not yet been detailed consideration given to opportunities to address physical activity or agreed standards that span care pathways in primary, secondary or community care. 
• Resident engagement in the survey was not wholly representative of the county. In particular there was a lack of representation from males, Boston and South Holland residents, and inactive residents across all demographics. 
• There is a data gap for district level activity trends. This leads to a lack of understanding where they differ to county, regional and national patterns. 
• There is a need to develop a greater understanding of the communities facing greatest barriers to participation, enabling improved action plans and to remove all barriers to accessing sport and physical activity. 
• There is an opportunity to increase the messaging and communications targeted at residents, providing them with relevant information, inspiration and ways to be active  

The ‘Connecting with Health and Wellbeing’ strand of Let’s Move Lincolnshire is led by a strategic steering group representing primary, secondary and community health and social care. The strategy will create systemic level change to ensure all residents at risk of, or already diagnosed with, a long-term health condition are able to easily access quality physical activity and sport provision to enjoy the physical and mental health benefits of being physical active. Actions of the steering group include: 

• To advocate for, and facilitate the inclusion of, physical activity in strategies and processes across multiple sectors and agencies including local authority, integrated care systems and local enterprise partnerships. Embedding cross-sector developed guidance e.g. Active Design into planning policies and practices. 
• Improved collation and dissemination of key messages, resources, tools, case studies for shared learning, growth of opportunities and scalability of successful programmes. 
• Collation and utilisation of data to inform decisions and secure increased investment for physical activity. This includes mapping the current physical activity offer overlaid to health conditions across the county and identifying skills gaps within different workforces. 
• Create equality of access to opportunities through scaling-up condition-specific work to inform other care pathways of the development of their work, focusing resources on areas with limited opportunities available. 
• Train all staff (paid and voluntary) in the Integrated Care System workforce (managerial, front-line, and administrative) to build physical activity into policy, working practices and delivery. 
• Train the physical activity workforce (paid and voluntary) and community voluntary organisations offering physical activity, to better understand and provide positive experiences for residents with health conditions and those facing greatest barriers to participation. 
• Advocate for and amplify resident voice in decision making and delivery planning. Building mechanisms that ensure all use of physical activity to achieve outcomes includes better, more representative, resident voice in design, delivery and promotion. 

• Active Lincolnshire Knowledge Hub