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.

Putting the 'occupation' in Occupational Therapy and debating its role in Public Health

Guest post by Andrew Graham, Registered Occupational Therapist and PhD Candidate, Teesside University

Having recently made the move from NHS clinician into academia (I started my PhD at Teesside University in December 2017), I arrived in Belfast for the Royal College of Occupational Therapy Annual Conference with an appetite to hear new and interesting research in the profession.

In my welcome pack, I received a copy of the RCOT’s Strategic Intentions which represent the leadership response to the challenges of the changing landscape of health and social care. The principle that stood out for me was to ‘position the Profession, and our members, for the 21st century’.

With my background in amputee rehabilitation I have seen first-hand the impact of socio-economic inequalities and lifestyle trends on amputation rate in North East England. For example, the amount of amputations due to diabetes, and more shockingly intra-venous drug use, has spiked in the past 10 years or so. As an Occupational Therapist (OT), I view the person holistically and always try to take into account the social and psychological not just physical barriers they will need to overcome post amputation. My focus will always be on what the person needs and wants to do. The person’s meaningful activities (occupations).


The pledge tree

During the conference, we were asked to make a pledge about how we would do our part to ensure the new strategic intentions are met. The pledge tree seemed to have a recurring theme of ‘ensuring occupation is central to my work’.

My own pledge was to better explain ‘occupation’ and its meaning within occupational therapy to a range of audiences.

So, my attempt at articulating ‘occupation’? I’ll go with ‘doing things that we need to do and want to do (meaningful activities), which enable a sense of self-meaning and improved health and well-being.

I feel as a profession we are experts in using occupation as a goal (top down approach) and/or a means (bottom up approach) to ensure provision of high-quality, client centred services. Utilising the OT process from information gathering to evaluation we strive to enable growth, confidence and self-meaning.

Despite OTs generally being able to better define what they do and what the outcomes can be, it was a bit of a shock to see that the debate at the conference highlighted that the profession is still unsure about its stakeholders. The topic up for discussion was ‘This house believes that Occupational Therapy needs to be predominately based in public health, not in secondary or tertiary services’.

From my experience, this issue had been debated and answered years ago. My pre-registration training saw me working in the NHS, community mental health teams, a special needs school and a charity. The OTs all had a prominent and effective role in these sectors, so as intrigued as I was to hear the debate, I knew which way I would be voting!

For the purpose of this blog I’d like to highlight the case for OTs working in Public Health. A starting point would be the statement by the professional body, which points out that the Public Health Agenda has been of increasing importance and relevance for occupational therapists, who facilitate health promotion through working with people of all ages to enable their participation in meaningful occupations (RCOT 2004).

The evidence base is also pretty strong. A systematic review of Allied Health Professions and Health Promotion (Needle et al 2011) reviewed 28 studies related to occupational therapy and Public Health, and found related interventions in the areas of mental health, arthritis, pain and fatigue, pulmonary rehabilitation, stroke, drug and alcohol problems, and falls prevention.

Not only are OTs already working with people on aspects of Public Health and health promotion activity, but there is an expectation that this focus will form part of the delivery of all occupational therapy interventions in the future. For example, I remember reading about the ‘make every contact count’ campaign when working on an acute stroke ward and making sure I asked about smoking and drinking habits as part of my OT assessment.

So, it was with no surprise that the result swung against the motion at the conference. A particularly convincing rebuttal speech was given by Professor Diane Cox and Dr Jenny Preston, clearly showing the professions ability to address Public Health matters but also reach a wider audience through demonstrating outcomes in secondary and tertiary services.

Overall, I left the conference with a sense that the profession has strategically positioned itself to demonstrate that it is making a difference and will continue to make a difference to the health and well-being of people in the 21st century. It is time for OTs working in Public Health and other services to be proud. In my favourite quote of the conference….‘we are not the jack of all trades, rather we are the masters of human occupation’.


Andrew Graham is investigating ‘Sensory Discriminating Training for Phantom Limb Pain’, as a PhD candidate in the School of Health and Social Care at Teesside University.

Prevention by any other name would smell as sweet

Guest post by Tom Embury, Public Affairs Officer, British Dietetic Association

Next week, June 4th - 8th is Dietitians Week 2018, where the British Dietetic Association and its members and allies celebrate the work of dietitians. This year’s theme is “Dietitians Do Prevention”, which intends to highlight the important role that dietitians have to play in prevention and public health. We know nutrition and hydration underpin so much of our health and getting it right can reduce the impact of illness, aid recovery, or prevent some diseases and conditions altogether.

NHS England’s Five Year Forward View, in the most recent frameworks from NHS Scotland and the Northern Irish Health and Social Care Service and is embodied in the principles of the Wellbeing of Future Generations (Wales) Act.

It has been made clear by everyone from Marmot to the NHS Confederation that we need to strengthen prevention and that it should be everybody’s business. Despite this, many dietitians (and indeed healthcare staff in general) still don’t think of themselves as doing prevention or public health, especially as so many work in hospital settings, delivering acute care. Our recent 2018 member survey has shown that 40% of our members don’t feel that they do prevention or public health activity. This may be because they don’t have the time or resources, despite wishing to do so, but in some cases, it is because they don’t see public health as part of their remit.

Of course, we believe all our members “do prevention” and public health, but not everyone will call it by that name. Indeed, the term public health often seems to have quite a narrow definition, associated with the work of local government public health teams. This is important work, but by no means is that everything public health entails.

This is why, in preparation for Dietitians Week this year, we asked all our specialist groups for their view on how they do prevention. Our specialist groups cover pretty much all of the areas of dietetics - from paediatrics to older people, public health to critical care. What we found is that there are dozens of words and terms used to describe activity that is essentially a form of prevention.

Some were variations, like primary, secondary or tertiary prevention depending on where you work and what types of illnesses your patients have. Others, such as Making Every Contact Count or Healthy Conversations, relate to specific campaigns or initiatives. In areas like Mental Health or Paediatrics, a whole different language can exist. Even rehabilitation or recovery after acute illness is a form of prevention - preventing future episodes, further hospital visits or complications. One great example comes from Fuse itself – the research carried out into the impact of energy drink intake amongst young people has had an impact on national level policy making.

This is why we are trying to celebrate prevention in all its forms and with all its various names. Dietitians are and should to a greater extent be a core part of the public health workforce.

Our incoming Chairman, Caroline Bovey, highlighted this issue with terminology and understanding at our recent Annual General Meeting. She asked the crowd of over 100 dietitians to raise their hands if they were involved in public health. Some hands went up but they were definitely in the minority. She then asked who had a twitter account where they talked about diet and nutrition – far more hands shot up. “You are all”, she said, “doing public health dietetics”.

So, whether you’re having a healthy conversation or making every contact count, supporting rehabilitation or reducing hospital admissions, celebrate the way that you do prevention. We can’t let the terminology get in the way of sharing best practice or spreading good ideas. We’d love you to tell us about it as part of Dietitians Week! Get in touch via dietitiansweek@bda.uk.com