Let's Make Scotland More Active: A strategy for physical activity
5 Strategic priorities
'Play time.' Leith Walk Primary School, Edinburgh.
Children and young people
What are the benefits of activity for children and young people?
97 Regular physical activity is vital for healthy growth. Being active from an early age can do the following.
It reduces the risk factors for heart and circulatory diseases.
Why is this crucial for children in Scotland? A study by Freedman et al in 1999 found that in overweight children aged five to 10 years, 61% had one or more risk factors for heart and circulatory diseases and 27% had two or more.
It helps prevent weight gain.
Why is this crucial for children in Scotland? A study by Armstrong et al in 2001 found that in Scotland 8.6% of three-to four-year-olds and 15% of those in S3 were obese (very overweight). The UK reference standard is 5%.
It promotes positive mental health.
Why is this crucial for children in Scotland? The West of Scotland 'Twenty-07' study showed that at 18 years old, 33% of young women and 42% of young men had symptoms of potential mental ill health.
98 There is also evidence for the role of physical activity in improving social and moral development. The evidence linking physical activity to academic achievements is not solid but there are many positive links (ability to concentrate, lower levels of stress and anxiety, better classroom discipline). Also, studies show that giving more curriculum time to physical activities does not have a negative effect on other subjects.
How much activity do children and young people need?
99 The direct effects of physical activity on a child's health are important. However, ingraining the attitudes, skills and behaviours for lifelong physical activity and health are as important. Children should accumulate (build up) at least one hour of moderate activity on most days of the week. The World Health Organisation supports this guideline. One hour a day is the minimum needed to:
provide direct health benefits;
learn and practise a wide range of activities; and
live actively as a daily habit.
100 However, this hour will only result in a positive outcome if it is 'quality time'.
How active are Scottish children?
101 The 1998 Scottish Health Survey showed an alarming level of inactivity among children and young people. One in three primary school-aged girls and one in four primary school-aged boys does not achieve the minimum levels.
102 From the age of four, girls are less active than boys. This gap between the sexes is greatest during adolescence. By the age of 16, two in three girls and one in three boys do not reach the recommended minimum levels of physical activity. This accelerated decline in teenage years continues into adulthood and later life.
103 This situation is not unique to Scotland. Similar trends were reported for most European countries and the USA in a recent WHO Cross-National Study of the Health Behaviours of School Children.
104 A number of studies show that children and young people with a disability and those from ethnic-minority groups are, overall, less active than other young people. This puts them at higher risk of the diseases associated with inactivity earlier in their adult life. Also, they are less likely to have developed the necessary foundations for activity in later life.
So what needs to be done?
105 We have identified a number of areas that, based on the best available evidence, will have the greatest effect on the greatest number. Special efforts are needed to make sure that action responds to the children and young people in greatest need - in particular teenage girls.
We recommend that all parents should have support to gain the necessary skills and confidence to take an active role in helping their children enjoy an active life.
106 Families play an important role in a child's physical activity. Parents can influence the quality of a child's physical activity from birth by:
the way they hold and handle their child - gentle rolling, swaying, bouncing and turning can all help a baby develop muscle mass and motor skills;
toys and how they use them - these can stimulate and challenge babies to reach out, sit up and move around; and
the environment they provide for activity - children are more likely to challenge themselves physically in environments that are stimulating, safe and secure.
107 Developing skills that help a child to be active does not 'just happen'. Motor skills (the skills that allow them to move) develop when parents and carers expose babies and children to supportive opportunities and stimulating environments, such as those discussed above.
108 There is some evidence that parents need support in their efforts for their child. In particular, they need to be reassured that they are 'doing the right things'. There is also evidence that parents' and siblings' activity levels influence a child's activity levels. In this situation, it is important that families get support to be active.
109 There have been few research trials on the effectiveness of family-based interventions for physical activity. Those that have been carried out have included, keeping records of activity, family events in the community, setting goals and solving problems. There are no strong conclusions from these studies.
We can learn from Play@home
110 Parents in Fife get support to teach their child motor skills through an interactive movement and play programme. 'Play@home' started as 'Kiwi Babes' in New Zealand and was adapted and introduced in 1999 by Fife Council and Fife Primary Care NHS Trust. The programme has three books. They guide parents and carers through progressive activities that are appropriate to a child's stage of development from birth to five years old. Health visitors give the Baby Book to all new parents, the Toddler Book when their child is one year old and a pre-school book when the child is three years old. The programme supports the development of good parenting skills and introduces positive attitudes to physical activity from birth.
We recommend that all children and young people, including children with disabilities, should take part in at least one hour a day of physical activity.
This physical activity should include physical education, play, sports, exercise, dance, outdoor activities, active travel and support to be active in their daily tasks at home, at school and in the community.
111 Schools have a major influence on a child's physical activity - no institution other than the family has more effect on a child. Only schools can provide equal opportunities and a consistent, high-quality, safe and developmentally appropriate learning environment at no, or very limited, cost to a family. Given the pattern of health inequalities in Scotland this is an important consideration. However, strong links to opportunities in the home and community also need to be set up.
112 Through home, the school and the community, children and young people can access a wide range of activities, including the following.
The Scottish Health Survey shows that 'playing' accounts for the greatest proportion of children and young people's physical activity. Even in early teenage years, young people 'play' more than they take part in formal sports or exercise.
There is evidence that the more sports a young person has experience of in childhood, the greater the chance of them continuing to play sports as an adult.
55% of primary-aged pupils walk to school. Although this figure is high, this is less than in previous decades. The Scottish Executive Transport Division wants to increase the number of pupils who walk and cycle to school. Promoting physical activity could help achieve this.
It is important that children and young people learn the value of using up energy on everyday tasks such as walking, lifting and carrying, pushing and pulling. They should be encouraged to respond positively to every opportunity to be active. Taking two flights of stairs may seem irrelevant, but if they did this every day, it would add up to 14,560 calories in a year - the same as four pounds of fat.
113 The list of possible activities is even greater and includes dancing, exercise and fitness routines and outdoor activities.
114 In a review of successful school-based physical activity programmes, Pate et al (1999) found that the following are important factors to increase the range and quality of physical activity in schools.
To have a district-level co-ordinator.
To make sure that every year group takes part in PE lessons.
To employ physical education specialists.
To work with others who provide opportunities to be active outside school hours.
We can learn from the Active Primary School Programme
115 The Active Primary School Programme has been developing since it was set up by sportscotland in August 2000. An Active Primary School provides opportunities for young people to be more physically active within the school day and beyond. The programme employs primary school teachers as co-ordinators to work across a group of schools. The co-ordinator consults closely with teaching staff, parents and pupils to review and improve the school's physical activity programme. The main themes supported by Active Primary School co-ordinators are active play, physical education, after-school sports and active travel. Co-ordinators help to pull existing resources and initiatives together (such as the TOP Programme and The Class Moves). Schools show their commitment to this programme in their development plans. All Active Primary Schools are linked to a secondary school with a school sports co-ordinator. Thirteen groups of primary schools within five local authorities were involved in developing the first phase of this programme. Building on the success of this, the second phase has extended the network of Active Primary Schools across Scotland. At April 2002, there were 37 Active Primary School co-ordinators working across 22 local authorities in around 280 primary schools. sportscotland has secured funding for the Active Primary School Programme from the Scottish Executive until 2005.
We can learn from the School Sports Co-ordinator Programme
116 Developing sports programmes for outside school hours and combining them with opportunities in the wider community are the ideas behind the School Sports Co-ordinator Programme. An example of this is the work in Arbroath Academy. A physical education teacher within the school is released from formal teaching for one day a week to co-ordinate the programme. sportscotland provides 50% of the costs to employ the co-ordinator through the sports lottery fund. Angus Council's education department and the school then provide the other 50% between them. Now in its fourth year, the programme has increased the range of opportunities available for all pupils to take part in sport and dance before, during and after the formal school day. A range of team and individual sports is offered daily, and a promotional campaign aims to motivate and encourage all pupils to take part. The range of what's available reflects pupils' needs. A special feature of this programme is the commitment to reach those who are 'turned off' by sport. There is less emphasis on performance and competition, although pupils can still compete with each other if they choose this as an option. A measure of this programme's success lies in the recruitment of staff and local volunteers as coaches and helpers to promote and deliver the activities on offer. Strong links to local clubs and primary schools improve the programme's effect within the wider school community of Arbroath.
117 68% of young people between 16 and 21 are in full-time or part-time education. This is a critical environment in which to support them to be more physically active.
118 The arguments for providing physical activity in school apply to this group of young people. It is also important to make sure that opportunities to be active are financially and geographically accessible due to students' limited finances.
We can learn from Glenrothes College
119 Glenrothes College supports students to be active by providing a variety of opportunities throughout term time. Corporate membership of local leisure facilities is provided by the student association, with the main benefit to students being cheaper access. This makes it easier to take part in lunchtime games, activity classes and swimming. Students can also be active on campus with a daily programme of free lunchtime and evening classes, including yoga, belly dancing, lunchtime walks and table tennis. The activity programme is changed each term to suit students' choices and the teaching timetable. A health and fitness leadership course, provided through the academic programme, helps students become physical activity leaders within the college activity programme. These students also lead and promote physical activity in the community as part of professional development work placements. Glenrothes College is working towards achieving a Scotland's Health At Work Award at bronze level.
We recommend that all children and young people, including those with disabilities, should take part in at least two hours of physical education classes a week.
We also recommend that all children, including those with disabilities, should gain the movement and behavioural skills necessary for an active life.
To achieve this we recommend that the Scottish Executive's Review of Physical Education should tackle the status and content of the physical education curriculum and the resources for its delivery.
120 We recognise that putting these recommendations into practice needs high enough staffing levels and staff training. Teaching Profession for the 21st Century (McCrone) gives us the chance to deal with some of these issues.
121 There is a common belief that children 'naturally' develop the competence to enjoy being active. Research suggests this is not the case. Children run, jump, throw, catch, twist and turn at different levels of ability depending on the quality of the teaching and the opportunities to practise them. Research by Jess et al at the University of Edinburgh notes that children need to have opportunities to be adaptable with these moves by understanding space (where we move), effort (how we move) and relationships (who and what moves around us).
122 These basic movement skills support all our physical activity in later life. The extent to which we are competent, and see ourselves as competent, is important to developing self-efficacy (see paragraph 33 for what we mean by self-efficacy). Research shows that self-efficacy is a very important predictor of activity levels.
123 In a recent (2002) review of the evidence about the effectiveness of approaches to increase physical activity which reviewed evidence from all over the world, school-based PE was strongly recommended. This was the highest level of recommendation available, and compared with health education approaches was seen as more effective. In these studies, children were given more time in PE, spent more time being active during existing timetable allocations, or were taught different activities. In these research trials, pupils burned more calories, spent more time being active outside of PE and improved their aerobic capacity compared with children who took PE classes as usual. The results were strongest for primary-aged children and equally valid in urban and rural settings.
We can learn from the Basic Moves Programme
124 The Basic Moves Programme will help children develop their basic movement skills so they will be able to take part in physical activity throughout their lives. Researchers at the University of Edinburgh have created a three-year pilot programme to explore the effectiveness of a framework to develop children's basic motor skills. The Basic Moves Programme combines quality teaching, appropriate learning experiences and opportunities for children to practise physical movements.
125 Given the levels of inactivity in Scotland it is alarming that the amount of physical education in schools has gone down. There is clear evidence linking physical activity to people's health. This shows the importance of physical education.
126 In primary schools, physical education is provided within a broader 'Expressive Arts' curriculum. Although there are published curriculum guidelines for the physical education of three - to 14-year-olds in Scotland, these in themselves are not enough to make sure that children and young people experience a quality physical education.
127 The recent (2001) report by Her Majesty's Inspectorate (HMI) Improving Physical Education in Primary Schools found that "only about one-third of schools had very good programmes for physical education".
128 This report goes on to identify six main areas that need to be improved to raise achievement in physical education.
Raise expectations of what can be achieved.
Develop programmes for physical education which increase the opportunities in the school programme and promote sport, dance and outdoor education opportunities outside school hours.
Improve the effectiveness of learning and teaching.
Make better use of assessment to provide pupils with the kind of feedback that will improve their performance and keep them motivated in physical education.
Provide clearer advice and better support for teachers to develop their confidence and skills in teaching physical education.
Improve the management of physical education.
129 Guidelines on Curriculum Design for the Secondary Stages recommends that physical education should take up at least 5% of the curriculum (80 minutes a week). The school itself is able to choose how much time to set aside. In 1999, sportscotland in Sport 21, the national strategy for sport, called for a minimum time of 120 minutes a week in each school, and their draft strategy for the period 2003-2007 continues to support this. The European Heart Forum (2001) calls for at least three hours of activity a week in schools.
'Take a step in the right direction.'
Employee lunchtime walking group.
130 Rob Littlefield and colleagues from the University of Strathclyde (2002) found differences in the time that secondary schools set aside for physical education. Although most schools provide the minimum amount recommended in the Guidelines on Curriculum Design for the Secondary Stages, the average is less than it was 10 years ago.
131 Although certificated physical education courses have been very successful in Scottish schools, especially with boys, there is evidence that certificated physical education has led to a reduction in core physical education for all other pupils who have not chosen to take an exam in the subject. In 43% of the schools in their survey, no physical education or games were provided for pupils in S5 and S6. In a small number of schools, Littlefield found only 50 minutes of physical education to S1 and S2 and no core physical education in S3 and S4.
132 The Task Force believe that the nature and possible scale of work that needs to be resourced to improve core physical education for pre-school, primary and secondary pupils is such that it deserves a more thorough analysis. It is not clear that the current weaknesses can be dealt with and that the examples of good practice developed within the current resources are available.
133 National priorities for education have given the Task Force the opportunity to develop and consult on performance and quality indicators for physical activity. Our proposals are attached in Annex C. The Standards in Scotland's Schools etc Act 2000 creates a new statutory framework for school education. Under the Act, local authorities and schools must plan, monitor and report on improvement in education. National priorities and measures of performance for education in Scotland are published to help schools develop education.
What are the benefits of physical activity for adults?
134 Physically active adults live longer than inactive adults. Given that life expectancy at birth in Scotland is less than in England, Wales or Northern Ireland, it is an important area to deal with. However, active adults also have an improved quality of life and suffer less ill health. Being an active adult does the following.
It reduces the risk of heart disease by half.
Why is this crucial for adults in Scotland? The Report of the Coronary Heart Disease Task Force says that Scotland's death rate is still the second highest in Western Europe. Around 12,500 people in Scotland die each year from this condition.
It reduces the risk of a number of cancers, particularly colon and breast cancer.
Why is this crucial for adults in Scotland? Scotland's death rate from cancer is the highest in Western Europe, with colon and breast cancer having some of the fastest-growing rates.
It reduces the risk of Type II diabetes.
Why is this crucial for adults in Scotland? The number of cases of Type II diabetes has been increasing and is expected to continue to increase. Over 2.5% of the Scottish population are affected (over 125,000 people). The number of cases of diabetes is estimated to double in the next 10 to 15 years. Type II diabetes accounts for almost 90% of all cases of diabetes.
It helps promote positive mental health.
Why is this crucial for adults in Scotland? One in five Scots will experience a mental-health problem, such as anxiety and depression, in any one year. 30% of all GP consultations involve mental-health problems ( Our National Health 2000).
135 Keeping active is also important to maintain strength for everyday tasks. The Allied Dunbar Fitness Survey (1990) found that among women aged between 55 and 64, over half (55%) did not have the knee strength to get up from a chair without any help.
How much physical activity do adults need?
136 The direct effects of physical activity on our adult health are important. In fact, many of the benefits, such as reduced blood pressure and improved moods, only happen for a few hours immediately following the activity. This means that everybody needs to do some physical activity regularly every day to get the health benefits. Inactive adults are at risk of ill health no matter how active they have been in the past.
137 Recommended types and quantities of physical activity are based on good evidence and strong international research. Adults should accumulate (build up) at least 30 minutes of moderate activity on most days of the week. This is based on the minimum activity needed to:
provide direct health benefits;
maintain and develop a higher bone and muscle mass for later life; and
live actively as a daily habit.
How active are Scottish adults?
138 The 1998 Scottish Health Survey shows an alarming decline in activity among adults. Six in 10 men and seven in 10 women do not meet the minimum recommended levels.
139 The patterns of activity vary for men and women in their 20s and 30s. Although the activity levels of women in their 20s and 30s are stable, they start from a much lower base. During this time, men's activity levels steadily go down to a point in middle age where their inactivity levels are similar to that of women. By the time they are between 65 and 74, almost nine in 10 men and women fall short of the minimum recommended amount of physical activity.
140 The World Health Organisation, together with its partners and centres, particularly CDC (Centres of disease control and prevention, Atlanta), has recently developed an International Physical Activity Questionnaire (the IPAQ Study) and the Health Education Board for Scotland are currently piloting this alongside their Health Education Population Survey. This will provide international data that can be compared in the future.
141 A number of studies show that, overall, adults with a disability and those from ethnic-minority groups are less active than people from other groups. This puts them at higher risk of the diseases associated with inactivity.
So, what needs to be done?
142 We have identified a small number of areas that, based on the best available evidence, will have the greatest effect on the highest number of people. However, special efforts are needed to make sure that any action taken responds to adults in greatest need - in particular men and women aged between 35 and 55 from the most deprived households.
143 Published reviews of physical activity trials show that programmes that include frequent contact with trained professionals are more effective in getting people to take part and encouraging them to continue doing so.
144 The evidence also suggests that programmes are more effective if people are matched to the stages involved in individual behaviour change. Individuals at different stages need a different type of intervention to support the behaviour change process.
Stage of Behavioural Change
Is aware that inactivity and its consequences are a health problem.
Information about the problem
National and local media, leaflets, posters, advice from GP.
Personalises the problem (I need to get more exercise).
Opportunities to personalise
Taster sessions, promotional events and campaigns, fitness testing.
Balances the potential benefits of taking exercise against the costs (time, money, effect on others).
Opportunities for discussion
Discussions with an exercise or health professional, exercise counselling.
Prepares to take action and then takes action.
Knowledge of facilities or opportunities and prompts to take action
A variety of opportunities and events.
Continues to be active regularly or take part in exercise activities (or both).
Support to continue new actions
Clubs, support groups.
Adapted from: Health Education Authority, 1995: pages 48 and 49, Tables VIII and IX.
145 Programmes that are not tailored to individual characteristics and do not allow for personal contact with other people (for example, aerobics classes) are more appropriate for those who are already active.
146 A recent review of training for health-related physical activity promotion found that there are few training courses for physical activity generally and even fewer that relate to behaviour change counselling in particular.
We can learn from A Little Physical Activity Means A Lot
147 A 'Little Physical Activity Means A Lot' is a training resource targeted at people whose work could affect physical activity, and was created by the Glasgow Physical Activity Forum and NHS Argyll and Clyde. It will support a rolling programme of training and professional development for people working in areas such as health, leisure, education and planning. The delivery of 'A Little Physical Activity Means A Lot' within further and higher education institutions will let the future workforce in these areas know about the potential for promoting physical activity. Supporting behaviour change, considerations for special groups and the health effects of physical activity are the themes covered by the resource. People taking part will gain the information and skills needed to become involved in promoting physical activity to the public.
Activities for adults should include a range of things such as environmental changes, social support networks, education and using local media - these should be planned together as community-wide campaigns.
148 Community-based strategies to increase physical activity have been more successful where the need for a range of support has been acknowledged. Evidence shows that tackling only one area (such as providing information) is rarely effective. Campaigns that have tackled the need for better environments, social support and information are strongly recommended.
149 Such locally developed campaigns need to be based on a thorough assessment of local needs. However, the following are some of the more successful individual elements that have been used to affect entire adult populations (rather than individual and counselling approach).
Create or improve places for activity through:
planning transport and travel;
plans for using land; and
access to facilities: programming and costs.
Social support in community settings:
Build, strengthen and maintain social networks that can support physical activity; and
create new methods specifically to develop support for physical activity (for example, walking groups and activity buddies).
Providing information about reducing risks and simple actions that could reduce risks through:
signs on stairwells, at lifts, on escalators and so on;
local community events (family walks and health fairs); and
local media features.
We recommend that employers should be given incentives to promote physical activity and that this should be developed and supported through initiatives such as Scotland's Health at Work (SHAW). This is an award scheme to encourage and support employers to develop policies for promoting health in the workplace.
We recommend that employees should have opportunities to be active at work and through activities organised by their workplace.
150 Workplaces are an ideal setting to reach a large section of the adult population. Also, 'pressure of work' is one of the most common barriers to increasing levels of physical activity. With time being scarce for many working adults, the convenience of being active at and through work can be very attractive.
151 Evidence suggests that having a physically active workforce means:
fewer days off work - research shows that active employees take 27% fewer days sick leave than inactive employees;
lower staff turnover - studies show that following the introduction of an on-site fitness programme, turnover was reduced by between 8% and 13%; and
fewer industrial injuries - studies show that following the introduction of physical activity initiatives to workplaces, the number of injuries was reduced by 25%.
Exercise class for older adults.
Fife Sports Institute, Glenrothes.
152 Despite these benefits, jobs increasingly offer fewer opportunities for moderate physical activity. This trend looks set to continue with people carrying out meetings using video links, the use of e-mail, and more desk-based employment. Larger companies have made some progress towards dealing with physical activity (such as corporate fitness centres) but much still needs to be done to support the number of employees who take up the opportunities. Arguably, more needs to be done to extend the benefits of a physically active workforce to small and medium-sized businesses.
153 Policies and actions that have been proven to have a significant effect include:
discounts for employees who want to use recreation facilities;
flexible working hours;
longer lunch breaks;
installing equipment and facilities (showers, bicycle storage and so on); and
organising workplace active buddy systems (where colleagues can support and encourage each other by regularly taking part) and recreational events.
We can learn from Walk in to Work Out
154 'Walk in to Work Out' is a pack designed to support people who are thinking about walking or cycling to work. The pack can help them plan journeys and set goals and includes safety information. It shows how walking and cycling some or all of the way to work can help people reach their daily physical activity target. Glasgow employees took part in a pilot study carried out by Greater Glasgow NHS Board and the University of Glasgow. Those who received the pack were almost twice as likely to increase walking to work as those who did not. Many were still doing this one year later. HEBS distributed 'Walk in to Work Out' throughout Scotland. Travel plan co-ordinators and health promotion officers are using the packs to work with major organisations and businesses to help them support employees. The Department of Health distributed this resource in England in early 2002.
Adults in later life
What are the benefits of activity for adults in later life?
155 There is a wide range of evidence and a number of reviews dedicated to physical activity and people in later life. It is clear from these that physical activity is effective in dealing with many health problems in later life as well as giving people the chance to meet new people and remain mentally active. In particular, physical activity does the following.
It develops and maintains strength.
Why is this crucial for adults in later life in Scotland? Muscle strength is a critical part of our ability to walk. The Allied Dunbar Study (1990) found that 30% of all men and 60% of all women could not maintain walking speed of three miles an hour walking up a moderate slope (three to four miles an hour is a 'brisk' pace).
It develops and maintains postural stability ('balance').
Why is this crucial for adults in later life in Scotland? Having frequent falls is a sign of poor balance. Roughly one in three people over 65 reported having a fall in the past year. This rate rises to 40% for those over 80 years old. Among women 90% of hip fractures are the result of a fall.
It is effective in preventing and treating depression and mood disorders.
Why is this crucial for adults in later life in Scotland? Of all suicides, 25% happen in older people, although they account for only 15% of the population. 90% of such cases had serious depression and had visited their doctor in the three months before they died.
156 Even among frail and very old people, trials show positive results for people who become more active.
How much activity do adults in later life need?
157 Recommended types and quantities of physical activity are based on good evidence and strong international research. Adults should accumulate (build up) at least 30 minutes of moderate activity on most days of the week. This is also appropriate for healthy adults in later life.
158 However, for all adults from about the age of 55, including those who are frail, three sessions a week of strength and balance exercises is also recommended.
159 Activity programmes for frail and elderly people should focus on specific strength and balance training. This approach is more relevant than aerobic training for this group of people.
How active are adults in later life?
160 There are few active older people in Scotland.
Of those aged between 55 and 64, 74% of men and 81% of women fall short of the recommended level.
Inactivity among those aged between 65 and 74 is even greater. This is especially so among women, with 92% being inactive. Men are only slightly less inactive at 86%.
161 In Scotland, there is no information on levels of activity for adults aged 75 and over. There is no national screening or testing of strength and balance for adults in later life. This could be considered in the review of over 75s screening identified in the Report of the Expert Group on the Health Care of Older People.
So, what needs to be done?
162 We have identified a small number of areas that, based on the best available evidence, will have the greatest effect on the highest number of adults in later life. However, special efforts are needed to make sure that the action we take responds to adults in greatest need - older people in deprived households.
163 The physical activity goals of adults in later life are no different to those of young adults - to feel good, look good and keep well. As such, the recommendations for adults of working age also apply to many adults in later life - particularly those who continue to work. However, there is evidence that adults in later life may choose environments that they believe are supportive for inactive adults of their age.
164 Research shows that opportunities to meet people at similar life stages (possibly retired, widowed, and having a smaller circle of friends) are important. Physical activity programmes are proven successful strategies to meet the need to keep active as well as broader social needs. Successful community programmes usually:
involve the people taking part in designing and delivering the programme;
provide opportunities for individuals and small groups and large groups;
provide opportunities to learn new activities;
have sensitive, stimulating and challenging leaders; and
combine physical activity with broader lifestyle and community issues.
We can learn from Lothian Ageing Well
165 Lothian Ageing Well programme recruits volunteers to help their age group move into or step up their campaign for active healthy living. Since the programme began (in the late 1990s), volunteers have been trained to work with people over 50 through one-to-one contact or group situations across Lothian. Ageing Well recognises that older people are a valuable resource to their families, friends, and their communities.
166 There is a common myth that becoming inactive is a 'natural' part of our ageing process. There is no doubt that we age biologically in ways that we cannot control. However, much of this ageing takes place faster than necessary because we lead largely inactive lives.
167 However, even for frailer adults who want to become more active in their own homes, there is limited support to keep active. Many of these adults believe that it is too late to make a difference. It is not!
168 Home-visiting programmes have produced significant reductions in death rates and in admission into long-term institutional care. Trials of a tailored home-based exercise programme for over 75s in New Zealand showed falling was reduced by 46%. Serious injuries and hospital admissions due to falls were also reduced. Despite the evidence supporting home-based activity programmes for the frail elderly who live independently, these programmes do not yet exist in Scotland, even though there is an urgent need for them.
169 A care home can be the ideal place to provide physical activity that is relevant to the needs of the residents. However, there is a critical need to improve physical surroundings, the range of activities available and staff training. This would allow all residents (including younger disabled adults) to enjoy and benefit from appropriate physical activity.
170 We have already influenced the review of the Care Home Standards. From 2002, inspections of care homes will include an assessment of the opportunities for physical activity.
171 However, it is recognised that staff in care homes need support and training to encourage people to do physical activity. A review of existing programmes and evidence of effective practice should guide future delivery of physical activity programmes within care homes.
172 Older people who live in care homes in Fife are benefiting from more opportunities to be physically active. Since 1992, Fife Council, in partnership with St Andrews University and NHS Fife, has provided a training programme aimed at those who provide care for older people. 'Exercise and Older People' combines training and ongoing support to help care-home staff to promote physical activity. The course also attracts social services, health services and those working in the voluntary and private sector. Since it began, over 300 staff have taken part in the training course delivered by people involved in all areas of care for older people. There is now a growing network of older people's activity leaders across Fife.