Simple, likeable, luck? How to get physical activity research into practice

Posted by Nicola McCullogh, Post-graduate Researcher, Northumbria University

Sometime last year – I can’t remember exactly when due to lockdown blur – I was asked by my mentor Caroline Dodd-Reynolds if I’d like to join the Fuse Physical Activity Network. I’d been to a number of workshops and I loved the focus on putting knowledge into practice, so I said yes and spent the rest of the year being in awe of the speakers we’ve had from across the world. And the discussion following the first workshop of 2021 (22nd January) was so rich that we wanted to do a bit of a follow-up to – as they say – ‘continue the conversation’.

                                     Watch a recording the 5th Fuse Physical Activity Workshop

This isn’t a report on the workshop itself, but it would be wrong to start on the discussion between the attendees without first acknowledging the speakers who inspired that discussion. First Professor Adrian Bauman (University of Sydney) spoke about how we can improve physical activity practices locally and nationally, and then Ben Rigby (Durham University) took us through 10 guiding principles for local physical activity practice which were developed by the Fuse Physical Activity Network. Some of the points that jumped out from the chat box during the presentations were around the topics of:

• Inclusivity: How can we make sure that physical activity messages get to specific groups of people? (e.g. can we do this via carers?)
• Scalability: Physical activity interventions tend to be less effective when scaled up; is this because they are often adapted in the scaling-up process?
• ‘Business as usual’: Should we move away from thinking about physical activity programmes and towards encouraging physical activity by integrating it into people’s daily lives?
• Making every contact count: How can we measure the effects of conversations between health professionals and patients about regular physical activity in a way that meets the definition of ‘evidence’ for all of the different groups interested in this sort of practice and research?

As you can see, there was so much going on that it’s no surprise there were a few things we didn’t get to explore on the day! So we pulled together the remaining key themes from the chat and these are considered below.

Are physical activity interventions long enough, as it can take years to become active/inactive? And when we’re researching interventions do we give enough thought to people staying active afterwards?

This seems to be one of those areas where there’s an unfortunate disconnect between research and practice. At the workshop we discussed the value of academic research in understanding the needs of communities but also acknowledged the potentially lengthy timeframes involved before research hits policy and practice. On the other hand, limitations on the practice side can include timescales over which practitioners need to deliver interventions due to funding requirements, meaning that interventions may be shorter than they would ideally be. When it comes to people staying active, although studies with follow-ups do exist, interventions tend to try to give their participants the skills to stay active on their own once the programme finishes, rather than being ‘maintenance interventions’. Maybe we need to try an approach a bit like weight loss groups for ongoing support?

Could we use financial incentives to increase people’s physical activity?

Anyone who knows me knows I love a bit of self-determination theory so I’m going to default to that for my answer, though of course other theories are available! Tying in with the above question, I think what we all want to see is interventions with long-term effects. Financial incentives might encourage physical activity while incentives are available, but we’re unfortunately not giving people the motivation to continue without these rewards and we know the rewards won’t last forever. On another level, those running the interventions have targets to reach to show the effects of their work, so they’re operating under short-term reward systems, too. Shifting our targets towards long-term effects may help.

How can we address the social factors that influence physical activity?

Social determinants of health (conditions in which people are born, grow, work, live, and age) are well recognised by physical activity researchers and practitioners. On a broad level, interventions try to reduce anything that would hinder participation for the groups they aim to help. But an interesting area of thought is how we can use people’s sense of belonging to a group, and their perception of what that group does, to encourage them to be active (e.g. encouraging new parents to be active together at parent and baby groups). We just need to explore the best ways to do this when people identify with groups to different degrees and their group identifications can change over time.


Our efforts can be supported by following the 10 guiding principles for local physical activity practice, which bring together some of the issues discussed above including social determinants of health, inclusivity, and harnessing things that are already happening to promote physical activity. Over the years there have been many different initiatives to encourage people to get active, and some of them have really stuck. The Daily Mile is a simple idea to get children moving in schools, and it seems to be something that works for pupils and staff because it’s been running for over five years now. And Park Run has been successful around the world for over a decade. So it might seem like it’s difficult to get something in place that has an effect, that is sustainable and that people actually like, but sometimes with a bit of luck we can put research into practice and it all comes together.

I think the overall conclusion – summarised very nicely by Professor Bauman – was "keep trying".

What do you think? Let us know in the comments below.



Thank you to everyone who attended the webinar and contributed to the discussion, and to everyone involved in the Fuse Physical Activity Network for their support.

Getting physical activity research moving

Posted by Louise Hayes, Research Methodologist, Newcastle University and the Fuse Physical Activity Group

So, we all know we should be more physically active – the evidence is out there. People who are more active are less likely to suffer from many chronic diseases, have more energy, better mental health, sleep better…… But how do we get people to be more active?

We knew researchers across North East England were working on physical activity related research and we knew that practitioners were delivering physical activity interventions, with the aim of getting more people active. What we didn’t know was who was doing what and whether or not the evidence from the researchers was getting to the practitioners or if the practitioners were delivering evidence-based intervention or evaluating their interventions. So, a little over five years ago, Martin White, the then Director of Fuse, Laura Basterfield and I (two physical activity researchers at Newcastle University), set about getting physical activity researchers from across the region together. We wanted to provide a forum for researchers to share information on current and future research and to identify opportunities for collaborations across individuals and teams conducting PA research in the Fuse partner universities. The inaugural Fuse Physical Activity Workshop (#FusePAW) was held at Newcastle University in May 2013.

It quickly became apparent that there was an appetite for a Fuse Physical Activity Group to be formed to build upon the enthusiasm for collaborative working and developing a shared physical activity research agenda that was in evidence at this first PAW. Several people also made it clear (and yes, we do mean you, @Scottylloyd1979!) that there was a need to widen the base of the group to include our practitioner partners involved in delivering physical activity interventions on the front line and to build relationships across sector boundaries. And so the Fuse physical activity group was born!

Liane Azevedo and I took on the role of leading the group, along with a team including Scott Lloyd, Caroline Dodd-Reynolds, Alison Innerd and Natalie Connor representing the North East Universities and public health partners. Since then we have had twice yearly Fuse PAWs, hosted by each of the five Fuse Universities and covering a range of topics from inequalities in physical activity to measurement of physical activity and physical activity during pregnancy. We’re proud to say that we’ve achieved an equal balance of academics and practitioners attending the events.

From the outside it might look like it’s been plain sailing – we’ve attracted an amazing cast of physical activity researcher royalty to present at our events, (see the list below - to name but a few!). On the inside there has been blood, sweat and occasional tears! Will the speakers agree to come? Will anyone sign up to attend? Will there be enough parking spaces/coffee? Will we be able to afford fruit during the breaks or just (unhealthy, but delicious) biscuits? (The latter has often been uppermost in the minds of some of our delegates if the feedback we receive in our, now infamous, shiny blue feedback box* is anything to go by!)

We were nervous that attendance might suffer when austerity measures cut into our budget meaning we were no longer able to provide lunch – but happily attendance has steadily increased and we have begun to attract individuals from outside the North East and sometimes even from outside the UK!

It was great to celebrate our tenth PAW on 20th April 2018, following #Fuse10 on 19th April, and to think about our previous events. All the hard work definitely felt worthwhile as we reflected on the many interesting presentations, workshops and discussions that have come out of the FusePAWs as well as collaborations, including a joint evaluation of the Redcar school pedometer intervention by Northumbria and Leeds Beckett Universities.

As #FusePAW, we have a responsibility to ‘do

’ physical activity research better and try to capture how FusePAWs inform physical activity within the region and further afield. To this end we discussed how we can work together more effectively as academics and public health practitioners to challenge traditional methods for delivering and evaluating physical activity interventions to nudge the field forwards at this event.  If you have any suggestions on how we can do this please contact me at louise.hayes@ncl.ac.uk

Watch this space for findings!


The Fuse Physical Activity Group is Louise Hayes, Liane Azevedo, Scott Lloyd, Caroline Dodd- Reynolds, Alison Innerd and Natalie Connor


Just a few of our amazing cast of presenters

Professor Ashley Cooper (University of Bristol), Dr Esther Van Sluijs (University of Cambridge), Dr Paul Kelly (University of Edinburgh), Dr Nick Cavill (Public Health England), Bob Laventure (Loughborough University), Prof Charles Foster (University of Oxford) Dr Mark Tully (Queens University), Prof Tess Kay (Brunel University), Prof Adrian Taylor (University of Plymouth) and Prof John Saxton (Northumbria University).

* Look out for our next event to see it for yourself!

A nation stood still for 25 years: Can we find solutions for action in policy and practice?

Guest post by Ben Rigby (pictured), a postgraduate student in Durham University’s School of Applied Social Sciences and Associate Member of the Wolfson Institute of Health and Wellbeing Research



Fourteen – the number of pieces of legislation published since 1991 which specifically state ‘physical activity’ (PA) in the context in which Public Health England presents as a problem needing a long-term solution. That is, an unsustainable burden on the UK economy, resulting from diminished health and well-being, which may be alleviated by increasing population-level PA.

 

I want to help do something about this problem. For the next few years, I will be undertaking a North East Doctoral Training Centre ESRC-funded PhD to research how PA-related practice, evidence, and policy interact to benefit or disadvantage different population subgroups. This project will be supervised by both Dr Emily Oliver and Dr Caroline Dodd-Reynolds, co-directors of Durham University’s Wolfson Institute Physical Activity Special Interest Group. 

Although advances in public health policy and evidence have emerged, not least through the work of the Fuse’s Physical Activity Group on improving evaluation and translation, for example, there remains a clear disconnect between use of evidence, proper evaluation and the influence (and interference) of policy and politics in decision making and the provision of activity opportunities. Having worked for Hampshire’s County Sport Partnership for the past year, these are issues I have experienced first-hand.

 

As a practitioner, it was often difficult to translate available evidence into viable practice. Reasons for this were numerous, though included funding issues, difficulty in physically accessing research, as well as in understanding complex ideas of theory and evaluation, within the particularly vague policy context by which one was guided. Emerging literature also highlights issues in policy, such as failing to consider local implementation barriers, persistent participation inequalities or the intricacies of behaviour change.

 

The aim of my research will be to identify systems and opportunities that facilitate a more integrated relationship between PA evidence, policy and practice. In order to garner a holistic appreciation of these factors, it is vital to understand how policy makers receive, adapt and adopt evidence; how organisational factors constrain or facilitate its adoption and importantly, recognise values and interests of those influencing responses to the evidence or policy problem. A particularly neglected policy research topic has been individual or organisational capacity to act upon evidence.

 

Previous research has perhaps been somewhat one dimensional in these areas. Alternatively by employing a mixed-methods approach and my applied social sciences background, I will be able to generate a much-needed complex understanding of the extent that local, regional and national stakeholders use evidence in PA policy design and implementation, and review factors associated with successful policy implementation. Whilst building upon existing literature, it is intended that this will offer a unique interpretive perspective on people, practices and policy processes (both locally and nationally), enabling and supporting policy development and implementation.

 

Does sitting and talking, and a lack of progressive
 policy action, promote our sedentary society?

Specifically by investigating the following two core propositions initially, I propose that it may be possible to find equitable solutions for progress in increasing physical activity and provide an important contribution to the field of public health research:

1. Weak evidence results in inherently conflicting and ambiguous PA policy, thus constraining implementation efforts
2. Political entrepreneurs may offer more effective solutions for policy development and implementation 

Being a fledgling researcher
One of my relatives (a PhD recipient herself), once told me that doing a PhD will be the hardest thing I ever do. I am under no illusions about the task before me, the complexity of which may be compounded by investigating one of society’s most entrenched problems. However I welcome the challenge and cannot wait to get stuck in, even if a little part of me wonders if I have what it takes to make a difference in the world, as I am sure many new Social Policy researchers before me have. I hope that my research will land well and have impact in the academic sense, but also in tangible real life outcomes for local communities in time.

 

I am not alone in this quest, and hope over the coming years to work closely with Fuse and its focus on Translational Research; specifically, the Fuse Physical Activity group offers an important platform for me to engage with physical activity policy makers, practitioners and academics who I hope will engage with me in developing this programme of work. I believe research evidence should be free and accessible wherever possible, an issue I have already raised. I wish to experiment with how better to present evidence to make it attractive to both policy makers and practitioners. At the same time, I am conscious of having to develop my academic reputation and profile and balancing this with experimentation is something I am wary of at this stage. 

 

I wish to build networks within local institutions with like-minded students and academics to share ideas and findings. My aim is to disseminate throughout my project and beyond. I hope to be able to present to Fuse research fora, access advice and support from the group’s members, as well as contribute to this blog. I welcome any feedback on this post. In particular I would be delighted to hear from individuals, practitioners or groups who:

• have shared research interests
• are responsible for PA-policy production locally
• research health inequalities
• had difficulties implementing policy guidance and evidence
• believe research in this area may benefit their line of work

Ben can be emailed at benjamin.p.rigby@durham.ac.uk. He is also on Twitter, LinkedIn and has a blog.

 

Notes and References:

1. Figure taken 27 June 2016 – using the search term ‘physical activity’ at http://www.legislation.gov.uk. Between 1991 and this date 72,088 pieces of legislation were published. Results were manually screened and filtered for ‘physical activity’ as recognised by the World Health Organisation as benefitting health, well-being and personal and social development.
2. Bowen and Zwi.2005. Pathways to evidence-informed policy and practice: a framework for action.
3. http://www.mirror.co.uk/news/uk-news/john-prescott-battle-jeremy-corbyn-8720209.

How active are pregnant women? Measuring the methods

Posted by Louise Hayes and Cath McParlin 

Louise and Cath are presenting on the subject of physical activity in pregnancy at the Fuse Phyical Activity Workshop tomorrow (15 May) at Sunderland University.

So we all know we should move a bit more to be more healthy and reduce our risk of getting diseases like diabetes. For a long time pregnancy was seen as a time when a woman could put her feet up, take it easy and ‘eat for two’. But not any longer! Guidance published over the last few years recommends no ‘pregnant pause’, but rather that pregnant women should aim to achieve at least 30 minutes of activity of at least moderate intensity activity on most days of the week - just like the rest of us.

Part of the justification for this is that physical activity might help to reduce the risk of gestational diabetes (GDM) – that’s a type of diabetes that is diagnosed in pregnancy and (usually) resolves after the pregnancy. However, to some extent, the jury’s still out on whether or not being active when you’re pregnant really does reduce GDM.

Partly this is because we don’t really know how to measure physical activity accurately in pregnant women. The more precisely we can measure physical activity, the more accurately we can establish the relationship between it and GDM and other health outcomes.

Physical activity measurement is fraught with difficulty in any circumstances – it’s a challenge to measure such a complex and multi-faceted behaviour. Pregnancy brings additional challenges. With the development (and increasing affordability) of numerous objective methods for measuring physical activity – pedometers, heart rate monitors, accelerometers - objective measurement of physical activity in epidemiology is increasingly common. For pregnant women, however, the validity and acceptability of these methods remains unclear.

We have agonised over how best to measure physical activity in a pregnant population. What effect does the increasing size of the ‘bump’ have on the validity of waist-worn monitors? How good are monitors at recording low-level activity, common in pregnant women? What are appropriate cut-offs for different activity intensities in pregnant women?

The choice of measurement method has a huge influence on conclusions we draw about how active women are during pregnancy. We have compared questionnaire methods and accelerometry using different criteria to define activity intensity and found that, depending on the method used, we identify anything from 12% to 65% of pregnant women to be meeting the current guideline (30 minutes of at least moderate activity per day) in the first half of pregnancy.

We’re looking forward to discussing the whys and wherefores of different methods of assessing physical activity with the experts attending the Fuse PA Group Workshop at Sunderland University tomorrow (Friday 15 May).