Physical activity surveillance across the life-course: from data to policy

As a major risk factor for non-communicable diseases (NCDs), physical inactivity is a prominent challenge for public health. The purpose of this symposium is to present an overview of physical inactivity prevalence in Europe using data collected through international surveillance initiatives, while highlighting successes and discussing future challenges for utilising data to promote physical activity across the life course. The World Health Organization (WHO) is involved in several physical activity surveillance systems on which discussions during this symposium will be based: 1. The WHO European Childhood Obesity Surveillance Initiative (COSI) is the largest survey of its kind in the world. An overview of results from the most recent round of COSI will be presented focusing on prevalence estimates for physical activity, screen time and sleep. Variations between countries of the socioeconomic determinants of physical inactivity, as well as the impact of the COVID-19 pandemic, will demonstrate the ongoing need for quality data to guide targeted policy actions in support of vulnerable groups throughout the life course. 2. The WHO’s STEPwise approach to surveillance (STEPS) survey provides important national level prevalence data on the behavioural and metabolic risk factors for NCDs. For many countries, the STEPS survey has provided the first estimates of physical inactivity and sedentary behaviour in the population and has been essential in raising awareness of the need for national policy actions to increase population levels of physical activity. 3. The European Commission, with the support of the WHO Regional Office for Europe, has established the European Union Physical Activity Focal Points Network to monitor implementation of the 23 indicators of the Health-Enhancing Physical Activity (HEPA) monitoring framework on physical activity policy development and implementation. 4. Within the European Union Physical Activity Focal Points Network, and during the COVID-19 pandemic, some countries established a survey on physical activity and screen time in children and adolescents.

Digital tools for physical activity assessment and brief counselling in Primary Health Care: The Portuguese model

Issue/problem Implementation of national systems for patients' physical activity (PA) assessment and counselling is a cost-effective strategy recommended in the WHO Global Action Plan for PA 2018-2030. Although Primary Health Care (PHC) professionals are recognized as key agents for PA promotion, challenges remain on how to develop feasible and scalable tools to support them in promoting patients' PA. The Portuguese model could help other countries improve PA assessment and brief counselling in PHC settings. This study aims to describe the tools' development and usage. Description of the problem The Portuguese Directorate-General of Health developed two evidence-based digital tools to support PA promotion by healthcare professionals: a) PA brief assessment tool;and b) brief counselling tool. The assessment tool was incorporated within the electronic medical health record software ?SClínico? in September 2017. It includes three questions: 1) how many days per week the patient performs any kind of PA (work, commuting or leisure-time);2) how much time per day;and 3) how many hours per day the patient spends in sedentary behaviours. The PA brief counselling tool is available through the electronic medical prescription software ?PEM? since December 2017 and consists of five inter-related self-explanatory guides that can be delivered to patients (printed or by email), according to their motivation and PA levels. They facilitate person-centered and autonomy-supportive PA counselling, targeting specific behaviour change mediators, and using validated techniques. Results From September 2017 to December 2021, 159,179 patients had their PA assessed (2235 per 100,000 users of the National Health Service) and, from these, 16133 received PA brief counselling guides (177 per 100000 residents in Portugal, ≥ 15 years old), with a six-fold and three-fold increases, respectively, between 2018 and 2019 (previous to the COVID-19 pandemic). Future actions will address cost-effectiveness of this policy. Lessons The brief assessment and brief counselling tools were well-accepted and are increasingly being used, with potential for generalized adoption within the Portuguese Health Care System. Main messages Portugal has taken a decisive action to promote PA using PHC as a priority setting. PA tools usage is increasing considerably, highlighting the importance of making available easy-to-use PA promotion tools.

Physical activity policies and good practices in Europe

Background The establishment of the EU physical activity (PA) guidelines and the HEPA monitoring framework has had an impact on policy development and implementation across the region from 2015. This works presents results from the third round of monitoring in 2021 and discusses trends since 2015. Methods A questionnaire was distributed in 2021 to all EU Member States of the WHO European Region through the network of PA Focal Points, who were requested to collect data from national colleagues and complete the questionnaire. All EU Member States (27 in 2021) responded to the survey on the implementation of the 23 indicators of the HEPA monitoring framework. Results The results of the 2021 round of data collection on HEPA indicators showed an overall stabilization of the implementation of PA promotion policies. Besides important increases in several indicators, such as indicators 15 (HEPA in the training of physical education teachers), 20 (Schemes to promote physical activity at the workplace) and 21 (Schemes for community interventions to promote physical activity in older adults), many others decreased and others showed no progress. Most national physical activity policies or action plans were multi-sectoral, with good coverage of the sectors recognized as important for HEPA promotion. While some methodological aspects may have affected the results, this round also reflected policy implementation during the COVID-19 pandemic (2019–2021). COVID-19 has had a significant impact on all sectors of society but especially on health, sports, education and mobility, which are major areas for PA promotion and policy implementation. Conclusions There seems to be an overall stabilization of the implementation of PA promotion policies since 2015. Public health experts and decision makers could utilise the increase in public awareness of the health benefits of physical activity kindled by the COVID-19 crisis to implement new health-promoting policies. Policy design, development and implementation of HEPA promotion must be strengthened for post-COVID-19 social and economic recovery.

Impact of COVID-19 Pandemic on Daily Life, Physical Exercise, and General Health among Older People with Type 2 Diabetes: A Qualitative Interview Study.

The COVID-19 pandemic has resulted in significant alterations to and implications for the lives of millions of people, and especially for those with pre-existing medical conditions. The aim of this study was to explore the lived experience of older people with type 2 diabetes mellitus (T2DM) throughout the first 9 months of the pandemic, with emphasis on the habits of physical exercise. We conducted a qualitative study using semi-structured interviews. The data consist of telephone interviews of seventeen older people with T2DM (10 women and 7 men, aged 62-76 years). Using thematic analysis, five themes were generated: (1) an altered social and relational life; (2) changes in routine and attitude regarding physical activity behaviour; (3) home-related activities gained relevance; (4) health and well-being impact and management; and (5) thoughts about the post-pandemic period. The increase in the number of cases and the fear of becoming infected with COVID-19 limited the social (i.e., contact with family and/or friends) and functional (i.e., daily routine, the habit of exercising) lives of these people, reverberating negatively on their health and well-being. Feelings of isolation, loneliness, anxiety were common. The findings of this study help to better understand the impact of the pandemic and determine areas of need for future interventions. A multidisciplinary approach is necessary to provide support for older people with T2DM and tackle the negative effect of the pandemic, including the reduction in physical activity.

Impact of COVID-19 Pandemic on Daily Life, Physical Exercise, and General Health among Older People with Type 2 Diabetes: A Qualitative Interview Study

The COVID-19 pandemic has resulted in significant alterations to and implications for the lives of millions of people, and especially for those with pre-existing medical conditions. The aim of this study was to explore the lived experience of older people with type 2 diabetes mellitus (T2DM) throughout the first 9 months of the pandemic, with emphasis on the habits of physical exercise. We conducted a qualitative study using semi-structured interviews. The data consist of telephone interviews of seventeen older people with T2DM (10 women and 7 men, aged 62–76 years). Using thematic analysis, five themes were generated: (1) an altered social and relational life;(2) changes in routine and attitude regarding physical activity behaviour;(3) home-related activities gained relevance;(4) health and well-being impact and management;and (5) thoughts about the post-pandemic period. The increase in the number of cases and the fear of becoming infected with COVID-19 limited the social (i.e., contact with family and/or friends) and functional (i.e., daily routine, the habit of exercising) lives of these people, reverberating negatively on their health and well-being. Feelings of isolation, loneliness, anxiety were common. The findings of this study help to better understand the impact of the pandemic and determine areas of need for future interventions. A multidisciplinary approach is necessary to provide support for older people with T2DM and tackle the negative effect of the pandemic, including the reduction in physical activity.

Impact of the First Wave of COVID-19 on Physical Activity Promotion in the European Union: Results From a Policymaker Survey.

BACKGROUND: The COVID-19 pandemic is a major challenge for societies and governments around the world that severely affects all aspects of health promotion. This study assesses the potential influence of the first wave of the pandemic on national physical activity promotion policy in the European Union (EU). METHODS: Data were collected using an online survey among members of the EU Physical Activity Focal Point Network, which consists of government officials from all EU member states. RESULTS: The COVID-19 pandemic has significantly affected physical activity promotion across the EU. In particular, experts indicated that it has negatively impacted opportunities for physical activity in their countries. There have, however, been positive effects of the crisis on public awareness of physical activity. While almost all countries were able to issue physical activity recommendations during quarantine, opinions varied regarding the overall impact of the pandemic on governmental capacities for physical activity promotion and policy. CONCLUSIONS: This study shows that the COVID-19 crisis has had both negative and positive effects on physical activity promotion in the EU. The positive experiences reported by some members of the Focal Point Network may assist other countries in identifying potential policy windows and strategies for the ongoing pandemic.

Towards an In-Depth Understanding of Physical Activity and Eating Behaviours during COVID-19 Social Confinement: A Combined Approach from a Portuguese National Survey.

Rapid worldwide decreases in physical activity (PA), an increase in sedentary behaviour (SB) and poorer dietary patterns have been reported during COVID-19 confinement periods. However, as national variability has been observed, this study sought to describe PA, SB and eating patterns, and to explore their gender as well as other socio-demographic correlates and how they interrelate in a representative sample of Portuguese adults during the COVID-19 first mandatory social confinement. The survey was applied online and by telephone to 5856 adults (mean age = 45.8 years; 42.6% women). The majority reported high (46.0%) or moderate (20.5%) PA levels. Men, younger participants, those with higher education levels and a favourable perception of their financial situation reported higher PA levels, with the opposite pattern for SB. Physical fitness activities and household chores were more reported by women, with more strength training and running activities reported by men. Regarding eating behaviours, 45.1% reported changes, positive (58%) and negative (42%), with 18.2% reporting increases in consumption of fruit, vegetables, and fish and other seafood consumption, while 10.8% (most with lower educational level and less comfortable with their income) reported an increase in consumption of ready-to-eat meals, soft drinks, savoury snacks, and take-away and delivered meals. Two clusters-a health-enhancing vs. risky pattern-emerged through multiple correspondence analysis characterized by co-occurrence of high vs. low PA levels, positive vs. negative eating changes, awareness or not of the COVID-19 PA and dietary recommendations, perceived financial situation, higher vs. lower educational level and time in social confinement. In conclusion, while in social confinement, both positive and negative PA and eating behaviours and trends were displayed, highlighting the role of key sociodemographic correlates contributing to healthy vs. risky patterns. Results may inform future health interventions and policies to be more targeted to those at risk, and also advocate the promotion of PA and healthy eating in an integrated fashion.

Can Tracking Data Help in Assessing Interpersonal Contact Exposure in Team Sports during the COVID-19 Pandemic?

During the COVID-19 pandemic, the temporary closure of physical activity and sports facilities, and the generalized cancellation or postponement of sports events have a massive impact on social and economic development. In this study, we explored the feasibility of using tracking data from a football match to assess interpersonal contact between individuals by calculating two measures of respiratory exposure. The dynamic tracking positioning of all players and referees during one international football match was analyzed. For each individual, two measures of respiratory exposure were calculated, based on the 2 m interpersonal distance recommendations for contact tracing for COVID-19 control. Overall, individuals spent a median of 0.12 mm:ss (IQR = 0.45 mm:ss) exposed to interpersonal contact of fewer than 2 m from others. The highest value of exposure was observed between two players of opposing teams (6.35 mm:ss). The results suggest that tracking data can be used to assess respiratory exposure to interpersonal contact in team sports, such as football. The measures of exposure calculated can be used to the prompt identification of high-risk contacts of COVID-19 cases during a match or a training session, but also the risk stratification of different sports and physical activities.