A Framework for Health Sector Action for Physical Activity 2005–2010

The Strategic Inter-Governmental forum on Physical Activity and Health (SIGPAH) of the National Public Health Partnership.

National Public Health Partnership, 2005.

This work is copyright. It may be reproduced in whole or in part for research or training purposes, subject to the inclusion of an acknowledgment of the source and provided no commercial usage or sale is to be made.  Reproduction for purposes other than those indicated above requires prior written permission of the National Public Health Partnership, GPO Box 4057, Melbourne 3001, Victoria, Australia.

There have been many people who have generously contributed ideas and suggestions, and provided criticisms in the development of this document. The National Public Health Partnership (NPHP) expresses its sincere thanks to all contributors and those who have taken part in consultations that informed this document. In particular, the NPHP would like to thank Ms Michele Herriot, Chief Project Officer, for her commitment in bringing this piece of work to fruition.

Contact the NPHP Secretariat:

3/456 Lonsdale St Melbourne, 3000 Victoria Australia

Tel: (61 3) 9603 8338  Fax: (61 3) 9603 8310

Email: nphp@dhs.vic.gov.au   Website: www.nphp.gov.au  Endorsed by the Australian Health Ministers’ Conference, July 2005

There is overwhelming evidence on the health benefits of physical activity, yet less than half of

all adult Australians are sufficiently active for a health benefit. There is also evidence to suggest

children are participating less in sport and incidental activity and spending a considerable

proportion of their time in sedentary leisure activities. The significant and inequitable impact

of physical inactivity on health outcomes requires urgent action.

The National Public Health Partnership agreed, in March 2003, to the development of a

national action plan to raise the profile of physical inactivity as a major health issue, facilitate

coordination and guide investment. There are many benefits to be gained by increasing levels of

physical activity. First, the improved health and well being for individuals and reduced health

care costs, and second, the potential for improvements in a range of social, environmental,

economic and community indicators.

a national framework for coordinated and comprehensive health sector action over the next five

years. It aims to add value to the work at jurisdictional levels, as well as identifying clear links

and opportunities for united approaches through other national strategies, including work on

healthy weight, nutrition, chronic disease prevention, falls prevention, healthy ageing, child

health and Aboriginal and Torres Strait Islander peoples’ health.

Reversing the trend towards inactivity is a long-term challenge. Causes of physical inactivity

determinants of physical inactivity are outside the control of the health sector and that action

is required by a variety of sectors, as well as public, private, non-government and community

and other sectors to collectively redress this common problem.

Mike Daube Dr David Filby

Chair Co-Chair

National Public Health Partnership Strategic Inter-Governmental Forum

on Physical Activity for Health

1. Children and youth should participate in at least 60 minutes of moderate to

vigorous-intensity physical activity every day.

2. Children and youth should not spend more than two hours per day using

electronic media for entertainment (eg computer games, Internet, TV),

particularly during daylight hours.

1. Think of movement as an opportunity, not an inconvenience.

2. be active every day in as many ways as you can.

3. Put together at least 30 minutes of moderate-intensity physical activity

on most, preferably all, days.

4 If you can, also enjoy some regular, vigorous exercise for extra health and fitness.

Evidence 3

Links With Other National Health Strategies 3

The Determinants of Physical Activity 4

The Costs of Physical Inactivity 5

The Vision 6

The Goal 6

Guiding Principles 6

Strategic Intent 6

1.1 Community Environments and Organisations 11

1.2 Health Services 15

1.3 Child Care and Out of School Hours Care 17

1.4 Schools 19

1.5 Workplaces 22

2.1 Communication and Community Education 24

2.2 Workforce Capacity 25

2.3 Evidence, Research, Monitoring and Evaluation 28

2.4 Strategic Management and Coordination 30

3.1 Aboriginal and Torres Strait Islander Australians 32

3.2 Populations With Special Needs 35

Children and Young People 44

Adults 45

Older People 47

Local 49

States and Territories 49

National Level 49

International 50

Public Policy 51

Environmental Determinants 51

Individual Biological Determinants 53

Health Services Determinants 53

Figure 1: Overview of determinants and outcomes from increased physical activity 8

Figure 2: A summary of the BAA Framework in terms of Strategic Focus

and identified Action Areas 10

Table 1: People who were not sufficiently active, by education level 36

Table 2: People who were not sufficiently active, by age group 46

Table 3: Milestones in the Promotion of Physical Activity in Australia 49

developed by the Strategic Inter-Governmental forum on Physical Activity and Health, a subcommittee

of the National Public Health Partnership. The Framework responds to evidence of

growing levels of physical inactivity and the contribution this is making to a diminished level

of health and wellbeing for Australians of all ages.

The Framework aims to increase awareness and understanding of the health and related benefits

of participation in physical activity, and provide the structure that will assist individuals to

develop the necessary skills that are central to a physically active and healthy lifestyle.

The determinants of physical activity are addressed, along with ways to improve public policy

for physical activity, by promoting, developing and supporting policy that facilitates and

encourages physical activity for health.

The Framework provides a strategic focus to increase access to physical and social environments

which support people to be active and to strengthen the capacity for communities to take part in

physical activity. To achieve this, implementation of the Framework will encourage individuals,

communities and organisations to influence social and cultural norms to develop and improve

the range of community-based physical activity programs and initiatives, and assist individuals

and communities to overcome barriers to physical activity.

The importance of building the health sector’s capacity for sustained and coordinated public

health action on physical activity is emphasised through strengthening skills, competencies,

systems and infrastructure, including funding, workforce numbers, leadership and

organisational support.

Specific indicators and timelines will be developed as part of the Implementation Plan for the

Framework.

The Framework seeks to consolidate the current investment of government, non-government

and private organisations and ensure that it is spent strategically. The significance of inactivity

in Australia, however, warrants additional funding to that currently being invested. The

Framework clearly identifies the priorities for action that require commitment if the community

is to be effectively supported to achieve appropriate levels of physical activity.

has been developed by the Strategic Inter-Governmental forum on Physical Activity and Health

(SIGPAH), a sub-committee of the National Public Health Partnership (NPHP). SIGPAH is a

collaborative body established to provide national leadership for government action in physical

activity and health issues, and coordination of a national approach across Australia. SIGPAH’s

work assists the NPHP in its aim to protect and promote the health of all Australians. SIGPAH

comprises representation from all state, territory and the Australian Government health

departments as well as invited experts.

The NPHP through SIGPAH has a major role in leading and coordinating the implementation

The document describes the BAA Framework; Strategic Focus; and Partnerships for Action.

Strategic Intent; and Priority Populations.

• Community Environments and Organisations;

• Health Services;

• Child Care and Out of School Hours Care;

• Schools; and

• Workplaces

• Communication and Community Education

• Workforce Capacity

• Evidence, Research, Monitoring and Evaluation; and

• Strategic Management and Coordination

• Aboriginal and Torres Strait Islander Australians; and

• Populations With Special Needs

Each of the sub-sections under the Strategic Focus includes: a Rationale for their inclusion;

Evidence for Interventions; Key Outcomes sought; Strategic Links; and a list of Actions.

Partnerships for Action and Monitoring and Evaluation are also discussed.

Increased physical activity is beneficial to improvements in various aspects of health including

cardiovascular disease, musculoskeletal health and diabetes. Physical activity may also assist in

the reduction on symptoms of depression and reduced risks of developing some cancers (AIHW

2002).

evidence regarding the impact of physical activity on health and confirmed there is clear

evidence that physical activity confers health benefits and reduces the risk of ill health.

Further the review confirmed that maximal risk reduction is observed amongst those who are

inactive and move to becoming at least moderately active. There are however additional benefits

from vigorous activity and generally there is a dose response effect, though this is stronger for

men than women.

Evidence of impact varies for different conditions with stronger evidence for the prevention

of cardiovascular disease, diabetes, colon and breast cancer. It remains difficult to interpret

the evidence regarding stroke, and the evidence in relation to mental health benefits is mixed,

however, a number of studies have concluded that the use of exercise for depression and anxiety

The major recent development in the literature is the good evidence about the effectiveness of

preventing diabetes onset in people at risk through lifestyle change. This is convincing and has

been replicated in several large studies.

In adults and older people there is good evidence to show that sufficient physical activity can:

• decrease the risk of premature death from cardiovascular disease, diabetes, colon and breast

cancer;

• lower the risk of diabetes and prevent diabetes onset in people at risk;

• increase muscle and bone strength;

• prevent osteoporosis and reduce the risks and consequences of arthritis;

• prevent functional decline in middle aged and older people, especially through resistance

training;

• improve health outcomes for people who are overweight or obese;

• assist people with established disease to manage their disease (eg lower high blood pressure

and elevated lipid levels) and prevent further decline;

• prevent falls though the relative contributions of strength training, balance and gait training;

and

• increase the ability of people with certain chronic, disabling conditions to perform activities

of daily living.

There is mixed evidence in relation to the prevention of stroke and some cancers (eg lung,

prostate) as well as the role of physical activity in benefiting mental health.

Although we know comparatively little about children’s levels of physical activity there is

sufficient evidence to show that it is insufficient compared with the national physical activity

In children and young people there is good evidence to show that physical activity can:

• have beneficial effects on adiposity and skeletal health;

• benefit psychological indicators including depression, self esteem, anxiety, stress and self

• have a positive correlation with behaviours such as not smoking.

For a more detailed summary of the evidence around physical activity and health, see

Appendix 1: Physical Activity and Specific Population Groups.

The importance of physical activity in relation to different health-related conditions and issues,

population groups, settings and communities makes it important for BAA to link with, and add

synergy to, other national strategies and frameworks including:

• Plans related to National Health Priority Areas including diabetes, cardiovascular disease,

A summary of current structures and programs for physical activity is provided in Appendix 2.

BAA recognises the vast number of variables that impact both positively and negatively on

health, as well as on levels of physical activity.

BAA identifies ‘upstream actions’ that focus on population wide influences, such as public

policy and the creation of physical activity friendly social and physical environments. There

are also ‘downstream interventions’ that assist individuals and specific groups to develop the

personal skills to build physical activity into their lives.

These actions and interventions include:

• Broad public policy

• Social, economic and environmental determinants

• Socio-cultural factors (or interpersonal)

• Psychosocial factors (or intrapersonal)

• Individual biological determinants, and/or

• Health service use

A more detailed list of the determinants of physical activity is provided at Appendix 3.

There is work in progress updating the costs of physical inactivity to the health care system.

However, current evidence suggests:

• The direct health care costs due to physical inactivity, based on mid-1990s costings, are

around $400m per year.

• Physical inactivity causes more than 8000 deaths annually, including 77,000 premature

• The annual total direct cost of heart, stroke and vascular disease was estimated in 1993/94 as

$3,719 million, representing 12% of the total health care costs for all diseases. Inactivity is one

• The true costs of obesity have been estimated as $1.3 billion and rising fast; physical

• Physical inactivity is responsible for about 6% of the total burden of disease in males and 8%

in females and is a major contributor to high blood pressure (5% of burden) and obesity (4%

All Australians enjoying the benefits of physical activity as a part of everyday life.

To improve the health and well being of all Australians and reduce inactivity and related disease

and disability by increasing levels of physical activity across the population.

More specifically the intention is to ensure all Australians meet relevant National Physical

BAA actions are based on the following principles:

• Helping those most in need and closing the health gap between different population groups as

a result of geography, ethnicity, and socio-economic status;

• Initiating and supporting partnerships between health sector agencies at all levels of

government and between the health and other sectors, public, private and non-government

organisations, families and the community;

• Concentrating on solutions and strengths, not problems;

• Focusing on long-term and sustainable solutions that recognise behaviour change is complex,

difficult and takes time;

• Recognising and addressing the multiple determinants of physical activity as well as the interrelationships

between physical activity and other health issues;

• Building and using the evidence base to inform effective actions;

• Ensuring a population focus that embraces a public health approach and systematic planning

of physical activity actions;

• Supporting a comprehensive range of strategies including policies, programs and services for

individuals and communities;

• Focusing on capacity building, including research, monitoring and evaluation, leadership,

resourcing and workforce development.

There are three main areas of Strategic Focus which underpin this Strategy. They are

(1) Settings; (2) Overarching Strategies; and (3) Priority Populations.

BAA will address the determinants of physical activity and contribute towards the long-term

goal through health sector action to:

* At present there are only national physical activity measurement instruments for adults. Guidelines for children and

young people have recently been developed (see page iv). The development of measurement tools for children and

young people is a priority action. Guidelines and tools need to be developed for older people as a priority.

Promote, develop and support public policy that facilitates and encourages physical activity,

including high-level commitments, legislation, finance and taxation options, regulation and

guidelines, supportive strategic plans, broad advocacy and resource allocation.

Promote, develop, support and initiate actions for increased and equitable access to physical and

social environments which support people to be active, including walking and cycling networks,

public awareness, promoting positive role models and settings which make it easy to be active in

safe and pleasant environments, and the provision of services that are accessible.

Promote and support individuals, communities and organisations to encourage and influence

social and cultural norms that support physical activity, develop and improve the range of

community-based physical activity programs and initiatives, and which assist individuals and

communities to overcome barriers to physical activity.

Increase awareness and understanding of the health and related benefits of participation in

physical activity, develop skills to be active as part of daily life and support individuals, families

and communities to overcome barriers to physical activity.

Building the health sector’s capacity for sustained and coordinated public health action on

physical activity by strengthening skills, competencies, systems and infrastructure, including

funding, workforce numbers, leadership and organisational support.

Specific indicators and timelines will be developed as part of the Implementation Plan.

Settings

Overarching Strategies

Population Groups

Health and Well Being

Health and Care Costs

Inequity

Disease

Disability

Individual

Psychosocial

Cultural

Environmental

Economic

Health System

BAA contains three areas of Strategic Focus: Settings, Priority Populations, and Overarching

Strategies. Each of these areas of focus contain Action Areas. Each of the Action Areas provides

detailed information on what evidence based actions need to be undertaken to achieve BAA’s

goal of increased physical activity for improved health outcomes.

There is clear evidence that settings, typically geographical areas or institutions with a large

captive audience, can either support or fail to support people to be physically active.

Working through a range of settings provides the opportunity to work with communities and

organisations, influence policies, practices and programs and to create environments that

encourage people to be active.

Action Areas under Settings include:

• Community environments and organisations

• Health services

• Child care and out of school hours care

• Schools

• Workplaces

To effectively implement BAA and address physical activity in a long-term and sustainable way

there is a need for increased health sector capacity for action, and to convey information and

influence community attitudes and knowledge regarding physical activity for health.

The availability of regular, reliable, relevant data about a variety of factors related to physical

activity including levels of physical activity and its various determinants (knowledge, attitudes,

health outcomes) is necessary to inform practice and enhance accountability.

Building partnerships with other sectors is also integral to the success of BAA.

Action Areas under Overarching Strategies include:

• Communication

• Workforce capacity

• Research, evaluation, monitoring and surveillance

• Strategic management

Public health strategies require a focus on the whole population, as well as paying attention to

the needs of population groups that have additional needs.

BAA includes Action Areas which focus specifically on Aboriginal and Torres Strait Islander

Australians and Populations with Special Needs. Actions related to other priority populations,

including Children, Adults and Older People, and people who are insufficiently active for health

benefit, are included throughout the BAA Framework.

The greatest public health gains will be achieved by getting those people who are inactive or

insufficiently active to be more active and to move towards the recommended minimum of 30

relevant for this population group.

BAA recognises that the needs of children and young people, adults and older people can best

be met through the different environments in which people live, work, study and play, as well as

through the influence of overarching strategies.

With the worst health status, high levels of disadvantage and a range of barriers to physical

activity, BAA has a particular focus on Aboriginal and Torres Strait Islander peoples and

includes specific actions throughout.

Evidence shows that those people who have the worst health outcomes are those of lowest socioeconomic

including culturally and linguistically diverse communities, people with a disability or chronic

condition such as mental illness or arthritis or those who are socially or geographically isolated.

These Australians require specific attention, as well as priority in all areas of action.

Health Services

Community Environments

and Organisations

Child Care and Out

of School Hours Care

Schools

Workplaces

Workforce Capacity

Communication and

Community Education

Evidence, Research,

Monitoring and Evaluation

Strategic Management

and Coordination

Populations With

Special Needs

Aboriginal and Torres

Strait Islander Australians

* Each Action Area is populated by a set of Actions.

Priority Settings in BAA are:

1.1 Community environments and organisations

1.2 Health services

1.3 Child care and out of school hours care

1.4 Schools

1.5 Workplaces

Ideally the places in which people live, work, study and play should support physical activity

and help make the healthy choice the easy choice.

This includes:

connected street networks, well maintained footpaths, adequate lighting, playgrounds,

accessible national, state and local parks and other open spaces;

transport systems, bicycle parking and change facilities. Additionally, reduced car use

through increased walking and cycling has been shown to decrease greenhouse gas emissions

and other types of pollution;

physical activity, services and programs provided through sport, recreation and leisure clubs,

fitness and community centres, playgroups, group programs – especially for those who are

inactive or disabled or require culturally appropriate leisure activities. In addition to the

benefits for individuals, participation in sport and physical recreation provides benefits such

Achieving these outcomes requires long-term sustainable approaches that predominantly are

outside of the direct control of the health sector. However, the health sector can play a role by

ensuring it has a coordinated approach and through initiating, responding to, and working in

partnership with other sectors, including transport, local government, sport, recreation and

fitness and urban and transportation planning to achieve common outcomes.

Of particular concern are changes in legal liability rules and its limitation on community

physical activity opportunities, for example public events, signage suggesting people use stairs,

and out-of-hours use of school facilities. This has an impact on all areas of BAA and is a priority

area for action.

Community organisations that support those people who need, or want, assistance are a vital part

of the solution to inactivity.

An integrated multi-strategy approach to supporting healthy lifestyles, including physical

activity in identified communities, offers promise in achieving good outcomes. Key

characteristics include: community involvement; implementation of good practice strategies;

involvement of different sectors; the development of locally appropriate policies; programs for

individuals and groups; supportive environments; and infrastructure in terms of information;

settings

and, workforce. Strong partnerships are essential, and if done effectively and in a sustainable

way there is great potential for positive improvement for Aboriginal and Torres Strait Islander

peoples as well as with other groups with special needs.

Research and interventions related to the impact of environments on levels of physical activity

are only now being studied extensively and there is a need for more long-term rigorous research.

Findings are promising, though they come mostly from correlational studies. McCormack et al

(2004) found that:

• both perceived and objectively measured physical environmental attributes appear to be

associated with walking and moderate and vigorous intensity activity;

• the functionality, for example street or urban design, traffic and the presence of paths,

aesthetics (trees, views) and destinations (shops, facilities and transport) in neighbourhoods

appear to be correlated with physical activity – though evidence related to safety is mixed;

• although physical activity is correlated with physical environments, causality cannot be

implied. People may choose environments that support their physical activity patterns, or

• There are a range of evidence-based interventions which can encourage active transport

• There is good evidence on the health benefits of active commuting, with a Danish study

showing those who cycled to work for three hours per week had a 30% lower all cause

• There is good evidence for point of decision prompts for example signage to encourage the

• Individually adapted health behaviour change programs which are tailored to the person’s

readiness for change, or their specific interests or circumstances, and which focus on

behavioural skills (goal setting and monitoring, social support and problem solving) are

• Building social networks (buddy systems, walking groups, contracts) that support behaviour

• Enhancing access to community facilities for physical activity, including fitness centres and/

Community wide interventions reach large numbers of people and can achieve increases in

participation, but must be well resourced and have trained staff to ensure they are adequately

1. Policies, programs and built environments, relevant to local communities, support individuals

and groups to overcome barriers to physical activity.

2. Local community organisations provide accessible, relevant and appropriate physical activity

options.

3. The health sector has a more coordinated approach to its actions related to supportive

environments, community organisations and physical activity, including community

demonstration programs.

4. Sustainable partnerships with other sectors support a more coordinated intersectoral

approach to the development, delivery and evaluation of physical activity initiatives and

infrastructure.

5. Improved good practice interventions to support inactive people to be active through

innovative action involving all sectors, organisations, population groups and methodologies

in a community location.

• The Sport and Recreation Ministers’ Council agreed to work closely with the National

Obesity Taskforce to develop a nationally coordinated, collaborative approach to help increase

• There are many tools and programs to assist local government to plan supportive

environments (NHF’s SEPA and SEAL, NSW Creating Active communities, Physical

Activity Guidelines for Local Councils, the WA Government’s Liveable Neighbourhood

Guidelines for Developers) and many more. Strategically and systematically encouraging

uptake of these guidelines is important.

• The 1999 WHO Charter on Transport, Environment and Health provides impetus for action

• There is considerable action to support active transport initiatives designed to encourage

people to regularly walk or cycle, or to catch public transport to destinations.

• The Adelaide Workshop recognised the way in which recreation, fitness, sports, active living,

parks, arts and culture all contribute to social and emotional well being, enhance quality

of life and contribute to the development of skills and health and weight control. It also

identified the need for the provision of accessible and acceptable services for both urban and

rural Indigenous Australians and also the need for trained and supported community workers

• Australian Health Ministers have supported the recommendation of the National Obesity

Taskforce to establish whole of community demonstration areas in all states and territories,

including at least two Aboriginal and Torres Strait Islander communities. Evaluation is a

crucial component to build the evidence about what works well and why.

1. Seek joint calls to action with key Ministers and associations (Local Government, Sport

and Recreation, Transport, Planning, Environment and Health Ministers) and key nongovernment

organisations (Australian Local Government Association, Planning Institute

of Australia) to encourage environments which support people to be active.

2. Review options and opportunities to support physical activity through healthy public

policy, beginning with the issue of legal liability, but that also consider supportive codes

and standards, legislation, financial (dis)incentives, and health impact assessment tools.

Ensure particular consideration of the needs of Aboriginal and Torres Strait Islander

communities.

3. In collaboration with other sectors develop a nationally coordinated, sustainable approach

to promoting and supporting active transport initiatives. Ensure the health sector

provides timely and relevant information about the health impact of physical inactivity

settings

4. Seek commitment from relevant agencies, including Indigenous sports organisations to

a national approach to support Aboriginal and Torres Strait Islander communities to be

active, including:

• innovative strategies to support the provision of community facilities (pools, courts,

equipment);

• funding and structures to support the coordinated and sustainable provision and

evaluation of affordable community-based programs and support resources targeting

different groups (older people, young women, diabetics) and differing abilities and

interests and which are relevant to social and community needs (dance, traditional

games, camps, walking);

• a broad range of sports programs which build individual physical and leadership skills

(coaching, team building, umpiring, organisation);

• building workforce capacity, including adequate funding to recruit and train sport and

recreation officers, on-going support and training and access to specialist expertise;

• guidelines for mainstream services to ensure they are culturally acceptable and

welcoming.

5. Support collaborative national partnerships with relevant sectors (local government,

sport, recreation, fitness, transport, parks) and public, private and non-government

organisations to identify, implement and evaluate innovative and best practice policies,

programs, facilities and environments that support inactive people to be active and which

meet the needs of populations with special needs.

6. Seek opportunities for collaborative national approaches to support the identification,

implementation and evaluation of promising behaviour-support programs and initiatives

for active, disadvantaged adults (individuals and groups) including those with chronic

conditions.

7. Advocate for, and support the adoption of, planning guidelines by state/territory and

local governments that support physical activity (walking and cycling networks, street

connectivity, integrated planning for ‘mixed-use localities’ and the availability of

swimming pools in rural areas).

8. Seek opportunities to research and address issues related to safety (real and perceived) and

physical activity.

9. Support the establishment and evaluation of comprehensive, community-wide

demonstration programs in each state and territory (including at least two Aboriginal and

Torres Strait Islander communities) which include, but are not limited to, a strong focus

on multiple evidence-based physical activity related strategies and ensure high quality

physical activity input in all phases of the demonstration programs. Ensure the results are

widely and effectively disseminated and that they inform policy and interventions, both

within health and other sectors.

There are many health professionals based in primary health care services, community

controlled Aboriginal and Torres Strait Islander health services as well as hospitals and

specialised services in government, private and non-government organisations who have regular

contact with large numbers of inactive people of all ages including those:

• with special health needs (newly diagnosed diabetics, those living with cancer or a particular

physical condition, including a disability, injury or weight problem and inactive older

people);

• at crucial life points (ante and post-natal, or post cardiac event).

BAA aims to encourage moderate physical activity – something that is achievable by most

Australians. Clearly, health professionals of all types are potentially well placed to provide

assessment, practical information, support and referral for individuals and communities who

may need assistance to get started, or to maintain regular physical activity.

Providers need assistance to make appropriate and informed referrals to both communitybased

and commercial services. This assistance comes in the form of services such as: health

and fitness assessment; walking or cycling groups; gyms; sport clubs; Aboriginal and Torres

Strait Islander specific sports programs; fitness programs; and, help lines. Assistance is also

available through health workers with specialised skills such as physiotherapists and exercise

physiologists. Recognition of financial and other social impediments to using such services

is also critical, and to be useful, information must be appropriate to the individual’s stage of

change.

It is recognised however that health professionals face limitations on what can be done given

the pressures (time, money, legal liability and others) and the need to be adequately funded

and supported with clear guidelines for action. Primary health care practitioners also play an

important role in building partnerships for action within school and community settings. In

addition, clarification of the roles of different parts of the health system will assist in further

strengthening action.

In reviewing the evidence related to the promotion of physical activity through primary health

care settings Smith (2004) found few interventions have been tested within the time and

• There is good evidence that brief and intensive interventions delivered to patients in primary

health care can achieve short term (at least six month) increases in physical activity;

• Advice should include verbal instruction about physical activity (often written down for

patients) as well as written materials, and be based on behaviour change theory;

• Priority should be given to advising patients with health problems (hypertension, elevated

blood pressure/cholesterol, overweight or obesity, glucose intolerance or depression) about the

health benefits of increased physical activity;

• Longer term success may be increased by the involvement of other practitioners such as exercise scientists and health educators;

(at least in motivated volunteers) with multi-element programs tailored to the needs and

circumstances of participants and involving long term intensive contact with trained

practitioners;

settings

• There is now evidence that the onset of Type 2 diabetes can be prevented or delayed with

improvements in lifestyle following intensive advice and support – though the tested

• There is potential to achieve behaviour change using two or more forms of mediated

interventions (print materials plus phone or internet advice) but more information is needed

• Programs in primary care settings can be a way to assist adolescents to be active especially if

1. The health sector, at all levels, has a strong commitment to addressing physical inactivity

through all relevant policies, plans, programs and environments and provides leadership as

well as sufficient funding and resources to address this issue.

2. All Australians, but particularly those who are inactive, have access to appropriate physical

activity assessment, advice, information, referral and/or support programs through the health

system.

3. Health care professionals have the knowledge, confidence, skills and resources to routinely

promote physical activity to their inactive clients and refer appropriately.

4. Sustainable partnerships within the health sector and with other sectors, support a more

coordinated approach to the development, delivery and evaluation of physical activity

initiatives.

• There is considerable work in this area and the challenge is to build good partnerships to

support the expansion of effort and to minimise duplication.

Australian College of General Practitioners (RACGP) has developed a Practice Guide to

SNAP outlining the organisational strategies and appropriate clinical interventions that may

be used within general practice to support patients to reduce risk factors.

• A number of jurisdictions have general practice based initiatives that include physical activity

oriented components.

• The 2003–2004 Focus on Prevention Package Australian Government Budget initiative is

aimed at raising awareness for the role of health professionals in prevention, and building a

• Queensland Health has commenced work on defining the role of all health services in relation

to physical activity.

Medicare now provides a rebate for GPs undertaking the health assessment of Aboriginal and

Torres Strait Islander clients.

Note: Actions broadly related to building the capacity of health sector workers are covered

under Capacity Building. Workforce Actions specifically related to encouraging individuals

to be active are addressed above.

1. Promote the (proposed) Statement on the Importance of Physical Activity throughout

the health sector and urge all health organisations to commit to, and adequately fund,

the promotion of physical activity.

2. Building on the work of Queensland Health, define and disseminate appropriate roles

and indicators for health care services, including Aboriginal and Torres Strait Islander

health services in promoting and supporting physical activity.

3. Explore options to remove or reduce funding and financial barriers to health services

and providers supporting physical activity.

4. Building on current initiatives, support the coordinated development and expansion

of physical activity related lifestyle prescription initiatives within General Practice

especially for high need groups and customise prescriptions to meet and respect physical

and cultural differences.

5. Explore options and alternative models to expand the prescription of physical activity to

other health professionals including Aboriginal Health Workers.

6. Support General Practitioners to undertake the adult health assessment of Aboriginal

and Torres Strait Islander people (15–54 years) including the physical activity

component.

7. Ensure lifestyle interventions for Aboriginal and Torres Strait Islander peoples

(prevention of diabetes, maintenance of healthy weight) and mainstream programs that

include accurate information on physical activity.

8. Support the development and dissemination of good practice guidelines to support

health workers to appropriately assess, inform and refer patients to community-based

physical activity support services.

9. Trial an Australian version of the diabetes prevention programs based on the successful

intensive lifestyle advice programs.

10. Trial innovative interventions to provide physical activity advice to individuals using

new and emerging technologies such as Internet and automated phone systems.

11. Advocate for the inclusion of best practice standards into aged care accreditation, and

funding of frameworks and the writing of guidelines.

Child care (centre based care and family day care) preschools or kindergartens and out of school

hours care services play an important role in supporting and encouraging children to be healthy

and active. They should complement the role of families.

It is important that physical environments maximise opportunities for activity, that staff

are supported to assist and encourage children to be active and that child care policies and

guidelines support the importance of physical activity.

settings

The health sector can assist the child care sector and staff to develop and run physical activityrelated

programs and contribute to training and the development of high quality, accessible

resources. A focus on reducing sedentary behaviour through structured and unstructured

opportunities is important and needs to be provided. Programs should cater for a range of skills,

abilities and interests and be age appropriate. They should also maximise integration with local

community and sporting organisations and facilities. There is some opportunity to reach parents

through this setting.

In June 2002, 83% of four year olds were in formal child care, including preschool, with 9%

often a source of advice and information to parents. In relation to out of school hours care

programs (Norton, 2003) found that one of the best predictors of fitness and fatness in children

is their physical activity pattern in the two hours immediately after the formal school day.

Action through this setting also has the advantage of addressing parents’ concerns about fear

Attendance at child care services by Aboriginal and Torres Strait Islander children, those living

in rural and remote regions and others with special needs may be lower than average, making

action in other settings important for these population groups. However opportunities need to

be explored for innovative partnerships with key organisations to develop culturally appropriate

programs and resources for those children who are in child care.

interventions with young children, probably reflecting the focus in the past on school age

children and the difficulty in collecting reliable data. The evidence related to school age

children is included under the section on Schools.

1. The health sector provides coordinated support to the child care sector in relation to physical

activity.

2. Sustainable partnerships between the health and child care sector.

3. Child care sector staff have increased knowledge and skills about promoting physical activity.

4. Children (and their parents/carers) are supported to be active through the child care sector.

• Arrangements related to licensing, administrative and regulatory standards vary across

Australia, however there are opportunities for joint action. Integration with nutrition and

healthy weight initiatives will be essential.

initiatives. The National Child Care Accreditation Council provides high level benchmarks

and supports for the child care sector and there are opportunities to support their work.

• Several jurisdictions are developing resources or piloting preschool and out of school hours

care programs.

1. Map and review physical activity related child care sector interventions being undertaken

through the health sector; disseminate information and share resources (training

packages, resources, policy guidelines).

2. Seek to: establish partnerships with key national child care organisations to address gaps,

develop and promote good practice and culturally appropriate physical activity programs

and policies; progress collaborative action consistent with accreditation and funding

requirements and which is integrated with related nutrition programs; and, consider

options for children not attending child care services.

initiative and encourage integration with current initiatives.

5. Advocate for the provision of physical environments and the removal of barriers to

Refer to Schools Section for Actions relevant to children.

Schools, including primary and secondary, public, independent and catholic schools and

preschools, play a vital role in providing physical and social environments that support children,

their parents and the whole school community to enjoy an active life and reduce sedentary

behaviour.

By working collaboratively with the education sector, there is an opportunity to provide physical

activity options for all children, but particularly those who are inactive for reasons such as

weight, disabilities, ethnicity, gender, income or because they have working parents.

The health sector can also help facilitate effective partnerships with education, sport and

recreation, transport and local government. The Health Promoting Schools approach underpins

(Timperio, Salmon and Ball, 2004) reviewed the limited number of recent high quality school

• The most successful interventions were comprehensive in nature and included contact with

families, as well as having a school component;

• Interventions that seek to decrease time watching television show some promise;

• School programs that had whole-of-school approaches including curriculum, policy and

environmental strategies were more effective than single strand interventions;

• Many school interventions were complemented by supports including social marketing,

family information and teacher training.

settings

The United States Review of Physical Activity Interventions also supports the modification of

curricula and policies to increase the amount of time spent in moderate or vigorous physical

activity as part of physical education classes. This includes longer and new or additional classes,

• Supportive physical environments for example space, more equipment and prompts for

physical activity;

• Policy support for physical activity supervision and school-based physical education time

requirements;

• Curriculum strategies, for example classroom based health and physical education focused on

information provision and skills related to decision-making as well as programs focused on

reducing TV watching and video playing;

• Active transport to and from school;

• Combined in and out of school approaches for children and adolescents based on schoolcommunity

links.

1. Improved and more coordinated health sector support for children, young people and families

in relation to physical activity.

2. Sustainable partnerships between the health and the education sector that results in policies,

programs and environments that support children to be active and to participate in planning

for physical activity.

3. Increased knowledge and skills of children, young people and parents/carers about physical

activity.

1. BAA is committed to facilitating opportunities to add value to, and work with, other

initiatives will be essential.

• Many government and non-government health sector agencies in jurisdictions are working in

partnership with the education sector and developing a number of exciting initiatives.

two hours of physical activity per week for primary and junior secondary students as well as

• In July 2003 the Ministerial Council on Education, Employment, Training and Youth

Affairs (MCEETYA) endorsed the need for a national, collaborative, cross-agency strategy

on physical activity in the school and early childhood sectors to link with the work of the

National Obesity Taskforce. Where possible, it will be important for the health sector to

collaborate with this work.

importance of schools developing healthy and culturally appropriate school environments

1. Seek a joint National Call to Action with relevant Ministers including: Education;

Youth; Sport and Recreation; Children and Family Services; and Health Ministers on the

importance of physical activity.

3. Map and review physical activity related interventions for children and young people

being undertaken through the health sector and disseminate and progress collaborative

national approaches for the identification, implementation and evaluation of promising

programs and initiatives, as well as the sharing of training packages and resources.

4. Work with the education sector, and other sectors as appropriate, to develop a national

collaborative, cross agency approach to support physical activity in the school and early

childhood sectors, which should:

a. be based on, and supportive of, the needs of the education sector regarding the

promotion of physical activity;

b. take account of the specific needs of disadvantaged, Aboriginal and Torres Strait

Islander and special needs children and their families;

c. include the coordinated development, testing and implementation of innovative and

best practice strategies covering:

• model school physical activity related policies;

• programs for Aboriginal and Torres Strait Islander and other special needs students,

including the further development and promotion of Indigenous games resources,

use of role models (elite athletes, disabled people and ‘local heroes’) and appropriate

curricula guidelines and resources;

• programs/ideas to build skills (physical, sports, life skills, self efficacy) and

knowledge for being active and participating in planning and implementing

physical activity initiatives;

• programs to reduce excessive sedentary recreation (television watching and

computer games);

• guidelines for supportive school environments for physical activity;

• effective and innovative curricula and resources including appropriate links with

nutrition and other issues;

• comprehensive school and family programs;

schools network and local government programs for young people;

• support for education sector leaders and staff.

5. Support the development of school oriented active transport initiatives.

settings

Worksites offer a way to reach large numbers of adults and young people in a single setting,

including those on low incomes. A number of workplaces have determined that a physically

active workforce can result in significant savings and benefits including a reduction in common

week at work, and lack of time is a common reason for being insufficiently active, it makes sense

to support physical activity to, from, and at work.

Workplaces can encourage and support individuals to take responsibility for physical activity

and develop initiatives such as:

• Policies including Green Travel Plans that encourage walking, cycling and public transport

use, financial incentives (gym membership, flexible working hours, providing alternative

forms of transport to cars, information about public transport, support for a holistic work-life

balance).

• Programs, for example, TravelSmart programs, pedometers, individual or group programs

tailored to stage of change and buddy programs.

• Infrastructure such as showers, changing facilities, bike racks, lockers, fitness facilities, and

signs encouraging the use of stairs.

• Integrating physical activity with other health issues (sun protection and healthy eating) may

also be appropriate.

effectiveness of workplace physical activity programs there is some promise from:

• Strategic comprehensive approaches including ‘multi-strategy interventions that incorporate

individually-tailored behaviour-change techniques, mass reach approaches (electronic and

• Gaining management support and integration into organisational structure and culture.

• Programs that incorporate behaviour change theory with organisational change issues.

• Promotion of incidental workplace activity (including prompts for stair use), social support

Changing behaviour in workplace settings is difficult given concerns over the ‘bottom line’ and

entrenched organisational cultures. For this reason BAA has a focus on health sector workplaces

over the next five years. Partnerships with the transport sector, infrastructure, environment and

unions will support this move.

1. Health service workplace policies, programs and environments that support inactive people to

be active.

2. Inactive people have access to appropriate physical activity advice, information and programs

in the workplace.

3. Physical activity is built into existing workplace health promotion programs.

• The Transport sector has an interest in active transport initiatives related to workplaces (travel

to and from work as well as during work).

• Many health departments and other organisations provide training or conduct their

own programs including pedometer programs, lunchtime activities, information on

musculoskeletal health, support for community activities (fun runs, gym memberships).

The challenge is to learn from, build on, and support these programs.

1. Health departments and agencies provide leadership in developing and evaluating

workplace policies, programs and infrastructure that support physical activity, and assist

workers to be active in their work, travel and home lives.

This should include active transport initiatives integrating physical activity into other

workplace health promotion programs and encouraging other employers to support

physical activity in their workplace.

2. Review options to provide incentives (financial and non-financial, regulatory, rewards,

occupational health and safety) and reduce barriers (public liability) for workplaces to

encourage and support physical activity and recommend future actions.

3. Commission the development of guidelines and practical suggestions for physical activity

friendly workplaces and trial and evaluate them in health units.

settings

Overarching Strategies in BAA are:

2.1 Communication and community education

2.2 Workforce capacity

2.3 Evidence, research, monitoring and evaluation

2.4 Strategic management and coordination

The general public needs access to consistent physical activity information that is evidence

based, easily understood, reviewed regularly and widely available. There is support for the view

that sustained campaigns, including mass media, are an important supplementary strategy in

broad population based approaches to increasing physical activity as described in BAA. They

A Western Australian study revealed only 54% of adults were aware that 30 minutes of daily

physical activity was required for a health benefit suggesting there is potential to further

increase understanding about the physical activity guidelines of how much and how often to

be more focused on skills, fun, motivation and practical information on how to be active. It also

reinforces the need to: complement communication strategies with more targeted interventions;

support individuals and communities; and, create supportive environments.

Information, through a range of media support services can be used (social marketing, web

sites, public relations, community education) and should be appropriate for, and reflect,

different cultures and population groups including those who are: inactive or have particular

health related needs; have low levels of literacy; and which include reference to a variety of

low-cost physical activity options, and the value of short bouts of exercise. It should also cover

information on where to get help.

Clarity and consistency of message and image between all partners in physical activity is

important to avoid public confusion and to maximise awareness of a national ‘brand’.

• Mass media programs can result in significant recall of slogans and messages, but have limited

impact on behaviour unless supplemented by strategies such as walking groups, community

events, print materials and promotion by health professionals.

• The WHO recommends campaigns be conducted over many years to continuously reinforce

messages to the public.

• Well planned combinations of two or more media (print materials, web sites, phone based

counselling) plus community-based initiatives may have the potential to produce sustained

effects by delivering effective advice, motivational prompts and practical guidance to large

In addition, large scale, high intensity, community-wide campaigns with sustained high

visibility complemented by support groups, counselling, risk factor screening and community

events are recommended by the United States Guide to Preventive Services as effective in

1. All Australians, but particularly those who are inactive and those with special needs have

sufficient skills, knowledge and understanding of the importance of, and options to be active

resulting in increased levels of physical activity.

2. A committed, sustained, consistent and coordinated health sector approach to community

education about physical activity.

• The National Obesity Taskforce has included support for families and community-wide

education as a key action area. This includes a focus on physical activity along with nutrition

and healthy weight.

• Opportunities for collaboration with groups addressing complementary messages such as

nutrition, healthy weight and active transport have been supported through consultation.

• Various community and private sector organisations are keen to work in partnership to

implement communication strategies.

• A number of states and territories have developed their own media strategies and coordinated

approaches to achieve efficiencies. Recognising jurisdictional preferences is important.

1. Develop and commence implementation of a comprehensive, national, five-year social

marketing plan for physical activity, including a common identity and image for all

physical activity community education initiatives building on current initiatives around

Australia. Ensure comprehensive evaluation is included.

• specific population groups (older people, children, young people and parents

(in progress), inactive people, those with special needs and multicultural groups).

• those with specific needs (for those who are overweight and obese, suffer dementia,

mobility or sensory problems).

• specific issues (diabetes, prevention of falls, living with cancer etc).

4. Investigate options to increase the positive profile of physical activity in media,

advertising and promotions.

5. Review options for high profile public recognition of innovation in promoting active

living across the full range of settings (awards programs).

There is potentially a large workforce in the health sector as well as in other sectors and within

the community who can help support and encourage inactive Australians to be active.

However, a 2003 national survey of (primarily) government capacity to address overweight

overarching strategies

there exists only a very limited strategic readiness to take on the difficult challenge of halting

strategic capacity in relation to physical activity is clearly limited across Australia compared to

the significance of the issue of inactivity and the complexity of responses required.

Building workforce capacity in the health sector includes a number of components:

• those with specialist skills (for providing assistance to individuals with specific requirements

such as Exercise Physiologists, Physiotherapists);

• generalists (including those able to provide general advice about physical activity and health);

• those in other sectors who may be in a position to encourage people to be active; and,

• Planning, coordination and leadership for physical activity population health programs

should fall to those with appropriate skills.

Ensuring supply and distribution of workers and clarity of role is important to ensure there are

sufficient people in the right locations to undertake the necessary and defined roles (see also

Health Services).

Both formal (University, TAFE, VET) and informal training (short courses, mentoring)

programs are necessary, but it is important that they are accessible to diverse workers in varied

settings, for example able to be accessed by rural and remote health professionals.

Professional support and resources: websites, journals, conferences, networks, resource packages

etc. should support staff to share good practice, research information and current actions.

Organisational commitment and leadership: commitment to such things as the importance of

physical activity; partnerships; the needs of workers and funding is an essential prerequisite.

Workers in sectors other than health are also likely to benefit from many of these initiatives, so

partnerships will be essential in progressing this area.

Building workforce capacity falls largely to states, territories and regions. BAA identifies actions

which will assist all jurisdictions and which are best done collaboratively.

The workforce includes all those who are in a position to assist or support individuals and

groups to be active, as well as those providing policy, planning and infrastructure support.

Health workers can also assist to build the capacity of workers in other sectors (the fitness

industry, community workers, sport and recreation officers, teachers, child care workers) and

the community (volunteers, walking group leaders, carers) to provide effective advice, programs

and support for physical activity and healthy lifestyles. Equally they can learn about effective

physical activity practice from other sectors. Clarity regarding legal indemnity is also an

important issue.

1. Strengthened capacity of health workers to promote and support Australians to be active.

2. Improved knowledge, confidence, skills and resources to enable health care professionals

to routinely promote physical activity with their clients and the community and refer

appropriately.

3. Sustainable partnerships within the health sector and with other sectors to support a more

coordinated approach to workforce development.

4. Sustainable structures to support health and other workers in their physical activity role.

• Workforce capacity is a critical issue for Aboriginal and Torres Strait Islander Communities.

• Increase the availability of appropriately accredited on site/local training and professional

development;

• Increase participation of Aboriginal and Torres Strait Islander health professionals in

accredited training and professional development; and

• Ensure alignment with the objectives in the Aboriginal and Torres Strait Islander Health

• The recommendations from the Workshop have been incorporated throughout BAA.

• Some states have funding for specialist physical activity coordinators while some

organisations in other sectors (Fitness Australia) have developed programs to support their

workforce. There are excellent opportunities for partnerships to progress actions in this area.

1. In partnership with key groups undertake a review of the physical activity related

workforce in the health sector (numbers, location, role, organisations, qualifications

and training needs) and develop a workforce plan which includes key competencies and

expectations.

2. Increase the number of physical activity related positions (specialists and generalists) in

the health sector.

3. Increase the number of Aboriginal and Torres Strait Islander health professionals in

specialist positions in physical activity and contribute to strategies designed to address

issues related to Aboriginal and Torres Strait Islander health worker positions (across

government and non-government agencies).

4. Monitor legal indemnity issues and contribute appropriately.

5. Explore options for the development of a suite of training programs and options (stand

alone, units within existing courses) to meet current and predicted needs. Ensure

relevance for, and delivery to, Aboriginal and Torres Strait Islander health workers

and people working with Aboriginal and Torres Strait Islander communities and other

special needs groups. Develop, disseminate and maintain a catalogue of relevant training

opportunities.

6. Work in partnership with other sectors to ensure the non-health workforce (teachers,

fitness leaders, aged care and community development workers) and interested

community members can access appropriate health-related training to support their role

in physical activity. This includes training relevant to different population groups (older

people, people with disabilities, of culturally and linguistically diverse communities) and

in different settings (schools, aged care);

7. Scope options for the establishment (or addition to an existing structure) of a physical

activity clearinghouse function to disseminate up-to-date information on physical activity

issues and initiatives (research, current initiatives, media information) to support health

workers and those in other sectors.

overarching strategies

8. Explore options and seek funding to provide ongoing support, networking, information

sharing and professional development including training and education on physical

activity for Aboriginal and Torres Strait Islander professionals.

9. Develop best practice guides for community workers to assist in implementation of good

practice for individuals and communities, including a focus on low income and inactive

people.

The availability of regular, reliable, relevant data about a variety of factors related to physical

activity including levels of physical activity and its various determinants (knowledge, attitudes,

health outcomes) is necessary to inform practice and enhance accountability. Ongoing

commitment to, and resources for, research, evaluation and dissemination are also important

in informing directions.

Like nutrition, policy development, program planning, evaluation and reporting are hampered

to this issue to ensure the health system, alone and in partnership with other sectors, builds the

physical activity evidence base. Measurement of the impact of BAA relies in part on monitoring

levels of physical activity.

for adults 18–75 years and there is baseline and trend data for all states. There is however a

significant lack of data on children and older people, as well as other important components

of physical activity, for example household physical activity, active transport and occupational

physical activity.

intervention research is characterised by small sample sizes, including self report measures only,

no long-term follow up, not having physical activity as the main focus and being unpublished. It

rarely includes high need groups and it is under-resourced in relation to the size of the problem.

Research needs included:

• The needs and issues of at-risk populations, including Aboriginal and Torres Strait Islander

Australians and low socio-economic groups and inclusion of these groups in all physical

activity related monitoring and evaluation systems;

• Developing the evidence base on the relationship between physical activity and mental

health;

• Development of reliable measures of occupational, incidental and transport related physical

activity;

• A culturally appropriate tool to monitor physical activity levels in remote Aboriginal and

Torres Strait Islander communities;

• The relationships between social and environmental factors and physical activity;

• The benefits of different types of physical activity for older (including very old and frail)

people, for example gardening, the acceptability, adherence and maintenance of participation

among older people and the efficacy of home and community-based strength training on a

range of health outcomes.

1. Comprehensive, regular and consistent information about physical activity levels, knowledge,

attitudes, intentions and behaviours across all age groups as well as social and physical

environments to inform physical activity related policy, programs and environments.

2. High level understanding by the health sector and other sectors of the determinants and

consequences of physical (in)activity and the effectiveness of potential interventions.

3. Health sector workers have reliable, relevant and timely information to influence decision

making.

4. Sustainable partnerships within the health sector and with other sectors to support a more

coordinated and strategic approach to research, evaluation and monitoring.

• Measurement and information was a major component of the recommendations from the

capacity of the community to conduct and utilise research for themselves and to use culturally

appropriate models. Recommended actions included the importance of supporting local data

collection as well as research, evaluation, surveillance and information management and

strategies incorporated above.

• Please note data on physical activity levels is one important component of judging the

effectiveness of BAA, but a comprehensive evaluation plan will be developed.

1. Work with key stakeholders to develop a longer-term plan for the development

and implementation of a comprehensive, regular, coordinated national, state and

regional physical activity monitoring and surveillance system and support of practical

implementation with a view to increasing collaboration across Australia in standardising

2. Scope and develop specifications for a comprehensive and standard set of validated

indicators (core indicators and additional periodic indicators) including key behaviours,

environments and social factors related to physical activity which are culturally

appropriate and can be used for monitoring at national, state, regional, local levels and

across settings.

3. Develop and validate a set of indicators on occupational physical activity, active transport

and household chores.

4. Develop a reliable and valid tool for monitoring the national prevalence of physical

activity by: children; young people; older people; Aboriginal and Torres Strait Islander

Australians; which potentially includes strength and balance, and review its applicability

for different cultural groups.

5. Collaborate with other sectors on the routine collection and use of non-health physical

activity related data, for example active transport and environmental data.

6. Conduct strategic and policy research to inform decision-making and fast track the

dissemination and application of new research evidence Australia-wide.

overarching strategies

7. Establish mechanisms to assist health workers (expertise, human resource and financial)

to effectively research physical activity programs including process and outcome

measures, and to give special consideration to the needs of those involved in research

related to Aboriginal and Torres Strait Islander Australians.

8. Support the development of well designed and evaluated studies related to all settings and

population groups included in BAA.

9. Support and/or develop partnerships to encourage research relevant to the health sector

and to other sectors and promote more investment in high quality, collaborative physical

activity research

The implementation of BAA by the health sector requires strategic leadership and commitment

at the national level, as well as a coordinated approach at national, state and local levels with

good communication between all key stakeholders. There must also be an integrated approach

with the many relevant national health strategies that provide opportunities for joint action, and

leverage on physical activity-related issues and options for funding and resources.

Partnerships with other sectors underpin BAA. This might involve mechanisms such as annual

planning and review workshops, working groups on different issues or components of BAA

comprising members from different organisations and/or project based partnerships. SIGPAH

and the NPHP are well placed to lead this process and ensure implementation of BAA.

1. A strategic, planned, collaborative integrated approach to promoting physical activity across

Australia.

2. Public policy supports all Australians to be physically active.

3. Structures and management ensure leadership and coordination for physical activity at

national levels, within health and with other sectors.

4. Clear and strong health sector commitment to, and leadership for, physical activity.

5. Sustainable partnerships within the health sector and with other sectors to support a more

coordinated and strategic approach to physical activity planning, implementation and

evaluation.

• All states and territories have established or are considering intersectoral leadership groups

and have, or are developing, state strategies.

• SIGPAH commissioned a report on the feasibility of establishing a national intersectoral

and partnerships related to the issue of physical activity and developing a nationally

coordinated, collaborative, cross-sector approach to increasing levels of physical activity.

implementation is coordinated

1. Ensure the widespread dissemination and promotion of BAA within the health sector

and to other interested groups.

2. Develop a sustainable mechanism to support, monitor, inform and influence the

development of national policy directions to ensure they promote and support people to

be active.

3. Support SIGPAH to oversee the implementation of BAA.

4. Establish effective mechanisms to ensure the involvement of, and commitment to,

implementation of BAA by key Aboriginal and Torres Strait Islander stakeholders and

other priority groups.

5. Establish effective structures and seek resources to ensure sustainable, integrated

approaches with other national health-related initiatives with relevance to physical

activity (in adults as well as children, young people and older people).

6. Establish effective partnerships with other sectors to assist with implementation of BAA

and work towards the establishment of a National Physical Activity Intersectoral Task

Force.

7. Establish effective mechanisms to ensure integrated planning, implementation and

evaluation of BAA, as well as role clarity, between SIGPAH, state and territory physical

activity taskforce representatives (or equivalent), key non-government and private sector

organisations, Aboriginal and Torres Strait Islander organisations and other significant

intersectoral partners. Undertake a process of prioritisation of actions using public

health tools.

8. Investigate opportunities to engage with the private sector for the promotion of physical

activity.

9. Seek high level endorsement of a National whole-of-government Physical Activity

Statement on the importance of physical activity and commitment to action to address

the needs of priority population groups.

10. Support strategies to build leadership for, and commitment to, physical activity by

key decision makers in government, non-government and the private sector, as well as

political leaders and Aboriginal and Torres Strait Islander organisations and leaders,

with a view to increasing their support for physical activity.

11. Seek opportunities to gain and harness funding for BAA implementation including

collaboration with other partners.

12. Prepare a detailed Implementation Plan for BAA including timelines, priorities,

indicators and responsibilities and monitor all indicators outlined in BAA in

implementation on the SIGPAH website and to NPHP, AHMAC and SCATSIH.

13. Commission an external and culturally appropriate evaluation of the achievements of the

Framework and implementation progress in 2008 and make recommendations for future

action.

overarching strategies

Priority Populations in BAA are:

3.1 Aboriginal and Torres Strait Islander Australians

3.2 Populations with special needs

The appalling health status of Aboriginal and Torres Strait Islander Australians is well

documented, as is the significant level of disadvantage including poverty, unemployment, poor

community facilities, lower education rates and reduced access to culturally appropriate health

services. Much of the health burden is due to preventable diseases including diabetes, renal and

cardiovascular disease, that can be reduced in part by increased level of physical activity.

commitment to improving the health of Aboriginal and Torres Strait Islander Australians

but notes the solutions are complex requiring a ‘coordinated, collaborative and multisectoral

approach’ supported by Aboriginal and Torres Strait Islander health stakeholder organisations at

provides additional detail to this Framework.

There is considerable scope to form collaborative and empowering partnerships between

key Aboriginal and Torres Strait Islander health groups and other sectors of society in the

coordination, delivery and funding of physical activity and health programs.

Examples of barriers to physical activity faced by Aboriginal and Torres Strait Islanders include:

development within health and across sectors; and, disparate approaches to strategic planning

and research.

unsafe communities; lack of facilities and infrastructure; services and programs; dominance

of cars; and, limited income.

issues which don’t support physical activity; limited role models; racism; and

competing influences (television, gambling).

motivation; lack of knowledge; and, confidence.

physical conditions.

activity programs; and, limited funding for health related physical activity programs.

Most of the actions in BAA are relevant to, and should assist in, increasing levels of physical

activity by Aboriginal and Torres Strait Islander Australians. In addition, there are a number

of specific recommendations throughout BAA that have been developed in response to

consultations with Aboriginal and Torres Strait Islander peoples. This section identifies

overarching actions.

The Actions are based on consultations with Aboriginal and Torres Strait Islander stakeholders

Recommended levels of physical activity for Aboriginal and Torres Strait Islander adults and

children are the same as for all Australians.

There is a lack of reliable data on physical activity levels of Aboriginal and Torres Strait Islander

living in non-remote areas reported ‘no leisure-time physical activity’, compared with about

The high levels of preventable chronic disease, of which physical inactivity is a major risk factor,

suggest there are considerable benefits in increasing levels of physical activity by Aboriginal and

Torres Strait Islander Australians.

In addition, it is now clear that a range of psychosocial factors (depression, social isolation and

and Torres Strait Islander Australians are also likely to suffer many co-morbidities (obesity,

peripheral vascular disease and depression) which can also be influenced by physical activity,

the potential health gain by increasing activity levels is considerable.

There are few published studies specifically related to physical activity of Aboriginal and Torres

operating throughout Australia which address physical inactivity directly (programs related to

sport or traditional activities) or indirectly (such as healthy weight programs). There is evidence

to suggest programs should be consistent with the following Key Principles:

and values of Aboriginal and Torres Strait Islander peoples.

physical health issues such as nutrition as well as spiritual, cultural, emotional and social well

being.

Islander people to be active as a routine part of their services.

play a major role in supporting people to be active and developing strong partnerships with

other services (sport and recreation).

health and in a range of other sectors including environment, transport, sport and recreation

must form collaborative and empowering partnerships with each other and with communities

to develop sustainable solutions to inactivity.

activity programs are appropriate to community issues and needs, culture and values and that

capacity for long-term action is sustained.

prevent illness and to also assist people to better manage existing health conditions.

priority populations

the capacity (expertise, funding, infrastructure, leadership) of services, communities and

individuals to support physical activity and build a culture of success.

provide effective physical activity programs, infrastructure and policies in partnership with

individuals and communities.

1. A detailed plan to support physical activity for Aboriginal and Torres Strait Islander

Australians including integration with other relevant strategies.

2. Increased support for implementation of BAA including on the ground programs.

1. Develop, in further consultation with a broad range of Aboriginal and Torres Strait

Islanders, a detailed implementation plan for BAA.

2. Ensure the inclusion of physical activity into Framework Agreements being developed in

all jurisdictions.

3. Develop practical strategies to assist community controlled health services and

mainstream health services to encourage Aboriginal and Torres Strait Islanders to be

active.

4. Consider options for providing national strategic leadership, partnerships and

coordination on physical activity across government for Aboriginal and Torres Strait

Islander Australians.

5. Consider options to increase funding, support and recognition for the development,

implementation and evaluation of local physical activity best practice programs that are:

• Designed, implemented and owned locally, using community development processes,

and which are supported nationally;

• Aimed at building the leadership and capacity for sustained action by individuals and

the community in the area of physical activity and other issues;

• Relevant to local issues, needs, cultures and conditions;

• Based on, and supportive of, the knowledge, skills, experience and resources of the

community;

• Consistent with best practice principles including a holistic approach to health;

• Focussed on overcoming barriers to physical activity for individuals and communities.

6. Actively seek opportunities to integrate physical activity into relevant national, state

and local policies, programs and initiatives (in the health sector and other relevant

sectors including sport and recreation, planning) particularly in relation to nutrition

(NATSINSAP), healthy weight, chronic disease prevention and community development.

7. Explore the potential for partnerships with other sectors and private industry (mining,

employment, sport and recreation) with a view to supporting physical activity programs

and initiatives and creating broad support for physical activity as well as win/win

outcomes such as income earning opportunities.

8. Support appropriate research into the barriers and facilitators of physical activity for

Aboriginal and Torres Strait Islander communities.

There are many Australians who face additional barriers to being active.

This includes, but is not limited to:

• People on low incomes;

• Those who have a chronic condition (mental illness, arthritis, cancer, diabetes, obesity,

dementia or other condition);

• Culturally and linguistically diverse Australians. In 2001 approximately 25% of Australians

• People with a disability (defined as any limitation, restriction or impairment, which has

lasted, or is likely to last, for at least six months and restricts everyday activities), who

• People who face social or geographic barriers such as isolation or are living in rural or remote

locations where distances, lack of services and infrastructure pose additional barriers.

A range of policy and legislative frameworks related to disability discrimination and equal

opportunity underpin the need to ensure groups with special needs have equitable access to

services and programs that encourage physical activity.

Barriers to physical activity and the use of services include: religious and cultural sensitivities;

language; racial and religious discrimination; economic barriers; lack of service providers with

specific skills; and, limited appropriate and accessible services.

Physical activity can provide opportunities for social interaction that helps to build community

Clear information about which barriers are significant for particular groups and ways of

overcoming these would inform the development of more appropriate actions.

There are significant opportunities to develop partnerships with organisations representing a

variety of special needs groups including culturally and linguistically diverse Australians, the

disability sector and the mental illness field. A number of activities are already in place and

consultations showed enthusiasm for progressing such partnerships.

for physical activity. However it is true that any increase in physical activity for those who are

inactive or insufficiently active is to be encouraged and supported; some people, for various

reasons, may not meet the guidelines.

People with a physical disability can also benefit from physical activity though specific

recommendations, but the amount and type will vary with individual circumstances.

priority populations

Australia has only limited information on the physical activity levels of those with particular

needs:

• In 2000, people who usually spoke a language other than English at home were more likely

than people who spoke only English at home (64% compared with 54%) to report lower than

• Persons born in non-English speaking countries had a participation rate of 10.3% compared

to 22.0% for those born overseas in the main English-speaking countries and 26.8% for those

• People with a disability have extremely low levels of participation in physical activity and

poor levels of health, and die of preventable diseases 20 years younger than the general

Table 1 shows that those with lower levels of education are less active.

Did not complete secondary school 63.1 59.3 60.6

Completed secondary school 49.5 54.3 51.6

TAFE/tertiary 49.2 52.7 50.8

No. CVD 27. Canberra: AIHW and National Heart Foundation of Australia (Cardiovascular Disease Series No. 22)59

There is little evidence in this field, however the benefits of physical activity seem likely to be

the same in terms of reduced risk of illness and premature mortality for those with special needs,

but may also include social and community benefits.

For those with a disability there is evidence to suggest lower rates of hospital admission, fewer

secondary health problems and some decrease in psychological problems. Independence and

There is little in the way of research to inform specific program recommendations for groups.

Good processes however will be essential, including recognising diversity, partnerships with

community and key groups, ensuring equitable access (which may require innovative solutions

in country areas) and good communication. The provision of trained professionals who can

provide appropriate, affordable and readily accessible advice to, and support for, those with

special needs is also vital.

1. Policies, programs and environments support populations with special needs and those at risk

of disadvantage to be active.

1. Ensure all BAA actions include a focus on populations with special needs.

2. In conjunction with key organisations, research needs, issues and options for innovative

and best practice action to increase levels of physical activity for different population

groups with special needs, including a thorough consultation process.

3. Advocate for national leadership and coordination, strong policy support, and increased

resources for the development of policies, programs, environments and infrastructure,

which supports and encourages populations with special needs to be active.

4. Share information about effective programs and strategies for special needs groups

through the proposed physical activity clearinghouse.

5. Develop or disseminate service provision guidelines to improve access to physical activity

programs and services for groups with special needs.

6. Explore options to use equity impact assessment tools in physical activity policy, planning

BAA acknowledges that most of the factors that impact on levels of physical activity are outside

the direct influence of the health sector and addressing the significant levels of inactivity by

Australians requires a long-term, well coordinated, intersectoral approach.

The health sector cannot address physical inactivity alone. This requires the health sector,

along with other interested and concerned sectors, to build partnerships to influence the many

determinants of physical activity.

Nonetheless, if the health sector is to improve the health of the population and reduce inequities

in health, it is crucial that it ensure it comprehensively and consistently addresses inactivity

in every way possible through all its policies, programs and structures while at the same time

initiating, developing and supporting intersectoral partnerships.

BAA identifies a number of actions that are the responsibility of the health sector as well as

actions where the health sector can add value to, support and complement the work of other

sectors. Partnerships will involve the public, private and non-government sectors as well as the

community working together to find solutions to complex problems, including inequalities, in a

The health sector includes those individuals and organisations with a role in the promotion and

protection of good health, prevention, treatment and management of illness and rehabilitation.

This includes government, non-government and private sector organisations; hospital and

community based services; generalist services; those with a focus on specific health issues or

population groups; the full range of multi-disciplinary professionals and their organisations;

those dealing with individuals as well as addressing the needs of groups and communities; and,

community groups working with health organisations to address health issues. Academic and

Research Institutes also play a vital role.

Education, Academia, Transport, Local Government, Environment, Urban Planning, Tourism,

Arts, Media, Advertising, Sport and Recreation, Fitness Industry, Employers, Workplaces,

Occupational Health and Safety, Parks, Child Care, Aged Care, Retail, Architecture and Building

Development, Motor Industry, and more can all contribute to influencing physical activity.

The health system can support increased levels of physical activity by:

• Developing or influencing health-related public policy.

• Developing health enhancing environments within the health sector.

• Ensuring the health system routinely and systematically promotes physical activity to

individuals and the community.

• Building the knowledge, skills and motivation of individuals to be active.

• Supporting communities to take action for physical activity.

• Identifying and promoting the extensive range of factors which influence levels of physical

activity.

• Collecting and analysing the evidence about the epidemiology of physical activity and the

effectiveness of approaches to support people to be active.

• Ensuring a strategic and coordinated approach to physical activity at national, state and local

levels.

The health sector can work with, and support the work of, other sectors by actions such as:

• Providing up-to-date information about the health impact of physical (in)activity or the

effectiveness of interventions.

• Referral or joint case management of individuals with community based services.

• Collaboratively developing projects.

• Providing technical support, information or training for other professionals.

• Providing sponsorship or funding for programs.

• Forming coalitions.

• Developing formal agreements, joint policy or high level statements.

• Advocating for legislative or policy change.

BAA consultations revealed considerable enthusiasm to work collaboratively, as well as strong

support for an intersectoral national physical activity plan and coordinating structure. The

health sector is committed to working with other key agencies to progress this aim.

BAA presents a framework for national action by the health sector over the coming five years.

A more detailed implementation plan will be developed by SIGPAH outlining timelines, lead

organisations, indicators and key milestones to inform an evaluation plan and other details.

A Monitoring and Reporting Framework will also be prepared, published on the NPHP website

(www.nphp.gov.au) and regularly updated to maximise accountability for implementation

progress. BAA will be evaluated after three years to inform progress, future directions and the

next stage. In addition, BAA will be distributed and promoted widely.

National and state governments, non-government and private sector organisations already fund

a range of physical activity programs and initiatives. BAA seeks to consolidate this investment

and ensure that it is spent strategically. The significance of inactivity in Australia however,

warrants significant additional funding to that currently being invested. BAA clearly identifies

the priorities for action that require investment and commitment, if physical activity is to be

addressed in Australia.

1. Bull F, Bauman A, Bellew B, Brown W. Getting Australia active II – An update of Evidence on Physical

Activity. Melbourne: NPHP 2004.

2. Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of complementary and self-help

treatments for depression. Medical Journal of Australia. 2002(176):84–96.

3. Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of complementary and self-help

treatments for anxiety disorders. Medical Journal of Australia. 2004(181):29–46.

4. Trost S. Discussion Paper for the development of recommendations for Children’s and Youths’

Participation in Health Promoting Physical Activity (unpublished): Australian Department of Health

and Ageing; 2003.

5. Department of Health and Ageing. Physical activity recommendations for children and youth.

Canberra: DoHA; 2004.

6. National Public Health Partnership. Eat well Australia. Melbourne (Vic): NPHP; 2001.

7. Department of Health and Ageing. Healthy weight 2008 – Australia’s future: the national action

agenda for children and young people and their families. 2004 [cited Accessed April 8 2003]; Available

from: www.nphp.gov.au

8. National Public Health Partnership. Preventing Chronic Disease: A Strategic Framework Background

Paper. Melbourne: National Public Health Partnership; 2001.

9. National Public Health Partnership. National Injury Prevention Plan: Priorities for 2001–2003

Implementation Plan. Canberra: National Public Health Partnership; 2001.

10. Department of Health and Ageing. National Health Priority Action Council. 2004 30 September 2002

[cited 2004 16 July 2004]; Available from: http://www.health.gov.au/pq/nhpa/index.htm

11. enHealth Council. The National Environmental Health Strategy Implementation Plan. Canberra:

Department of Health and Aged Care; 2000.

12. National Public Health Partnership and Positive Ageing Task Force. National Public Health Action

Plan for an Ageing Australia (unpublished). Melbourne: NPHP; 2003.

13. National Aboriginal and Torres Strait Islander Health Council. National strategic framework for

Aboriginal and Torres Strait Islander health: framework for action by governments. Canberra (ACT):

AGPS; 2003.

14. Mathers C, Penm R. Health system costs of cardiovascular diseases and diabetes in Australia 1993–94.

AIHW cat. No.-HWE 11 Canberra (ACT): AIHW; 1999.

15. Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. Canberra (ACT):

AIHW; 1999. Report No.: AIHW Cat No PHE 17.

16. Department of Health and Aged Care. Developing an active Australia: a framework for action for

physical activity and health. Canberra (ACT): AGPS; 1998.

17. Australia Post. Australia Post Annual Report 2002–03. 2003 [cited 2004 22 July 2004]; Human

Resources: Available from: http://www.auspost.com.au/annualreport2003/human_health.asp

18. Glover J, Harris K, Tennant S. A social health atlas of Australia, Volume 1. Australia; 2nd edition,

PHIDU 1999.

19. Australian Sports Commission. Personal communication. In; 2004.

20. McCormack G, Giles-Corti B, Lange A, Smith T, Martin K, Pikora T. An update of recent evidence of

the relationship between objective and self-report measures of the physical environment and physical

activity behaviours. Journal of Science and Medicine in Sport 2004;7(1) Supplement):81–92.

21. National Public Health Partnership and Strategic Intergovernmental forum on Physical Activity and

Health. Promoting Active Transport: An intervention portfolio to increase physical activity as a means

of transport. Melbourne: NPHP; 2001.

22. Bauman A. Updating the evidence that physical activity is good for health: an epidemiological review

2000–2003. Journal of Science and Medicine in Sport 2004;7(1) Supplement):6–19.

23. Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, et al. The effectiveness

of interventions to increase physical activity: A systematic review. American Journal of Preventive

Medicine 2002;22(no S4):73–107.

24. Garrard J, Lewis B, Keleher H. Planning for healthy communities: reducing the risk of cardiovascular

disease and type 2 diabetes through healthier environments and lifestyles. Melbourne: Department of

Human Services; 2004.

25. Sport and Recreation Ministers’ Council. Minutes. In: Meeting Communique 12 September; 2003.

26. World Health Organization Regional Office for Europe. Charter on transport, environment and health.

In: Third Ministerial Conference on Environment and Health. Copenhagen: WHO Regional Office

for Europe; 1999.

27. Department of Health and Ageing. Healthy and Active National Obesity Taskforce Aboriginal

and Torres Strait Islander Workshop – 10 and 11 September 2003. [Available at http://www.

healthyandactive.health.gov.au/] 2003 [cited Accessed on 8 April 2004]

28. Mason C. Transport and health: en route to a healthier Australia. Medical Journal of Australia

2000(172):230–232.

29. Smith B. Promotion of physical activity in primary health care: update of the evidence on

interventions. Journal of Science and Medicine in Sport 2004;7((1) Supplement):67–73.

30. Cyarto E, Moorhead G, Brown W. Updating the evidence relating to physical acitivity intervention

studies in older people. Journal of Science and Medicine in Sport 2004;7(1) Supplement):30–38.

31. Miller Y, Dunstan D. The effectiveness of physical activity interventions for the treatment of

overweight and obesity and type 2 diabetes. Journal of Science and Medicine in Sport 2004;7(1)

Supplement):52–59.

32. Marshall A, Owen N, Bauman A. Mediated approaches for influencing physical activity: update of the

evidence on mass media, print, telephone and website delivery of interventions. Journal of Science and

Medicine in Sport 2004;7(1) Supplement):74–80.

33. Timperio A, Salmon J, Ball K. Evidence-based strategies to promote physical acitivity among children,

adolescents and young adults: review and update. Journal of Science and Medicine in Sport 2004;7(1)

Supplement):20–29.

34. Department of Health and Ageing. Improving population health outcomes through partnership with

General Practice. [Available from http://www.health.gov.au/pubhlth/about/gp/index.htm] 2004 [cited

Accessed April 13 2004]

35. Minister for Health and Ageing. A focus on prevention. Budget 2003–2004 May. [http://www.health.

gov.au/budget2003/fact/hfact3.htm] 2003 May 2003 [cited Accessed 13 April 2004]

36. National Aboriginal Community Controlled Health Organisation. National guide to a preventive

health assessment in Aboriginal and Torres Strait Islander Peoples. in press; 2003.

37. Australian Bureau of Statistics. Child care, Australia. Canberra (ACT): ABS; 2003. Report No.: Cat No

4402.0.

38. Norton K, Dollman J. Decreasing physical activity levels? Beyond reasonable doubt! ACHPER

Matters 2003;ed 2.

39. Booth M, Okely A, Chey T, Bauman AE. Epidemiology of physical activity participation among New

South Wales school students. Aust NZ J Pub Health 2002(26):371–374.

40. Australian Government. Building a healthy, active Australia. 2004 29/6/04 [cited 2004 20 July 2004];

Available from: http://www.healthyactive.gov.au/index.htm

41. NSW Commission for Children and Young People and Commission for Children and Young People

QLD. A head start for Australia: An early years framework. [Available at http://www.kids.nsw.gov.au/

files/headstart_full.pdf] 2004 [cited Accessed on 8 April 2004]; Available from:

42. World Health Organization. School and youth health. 2004 [cited 20 July 2004]; Available from: http://

www.who.int/school_youth_health/en/

43. Bauman A, Bellew B, Vita P, et al. Getting Australia active: towards better practice for the promotion of

physical activity. Melbourne (Vic): National Public Health Partnership; 2002.

44. Health Canada. Active living at work trends and impact the basis for investment decisions. 2004

8 January 2004 [cited Accessed July 20 2004]; Available from: http://www.hc-sc.gc.ca/hppb/fitness/

work/trends_e.html

45. Marshall A. Challenges and opportunities for promoting physical activity in the workplace. Journal of

Science and Medicine in Sport 2004;7(1) Supplement):60–66.

46. McCormack G, Milligan R, Giles-Corti B, Clarkson J. Physical activity levels of Western Australian

adults 2002: Results from the adult physical activity survey and pedometer study. Perth (WA): Western

Australian Government; 2003.

47. Armstrong T, Bauman A, Davies J. Physical activity patterns of Australian adults. Canberra (ACT):

AIHW; 2000.

48. DarlisonRowe Consultants. The feasibility of establishing a National Intersectoral Physical Activity

Taskforce (unpublished). Melbourne: National Public Health Partnership and Department of Health

and Ageing; 2002.

49 Australian Bureau of Statistics. National Health Survey 2001: Aboriginal and Torres Strait Islander

results, Australia. ABS cat. No. 4715.0. Canberra: ABS 2002.

50. Bunker S, Colquhoun D, al. MEe. “Stress” and coronary heart disease: psychosocial risk factors

National Heart Foundation of Australia position statement update. Medical Journal of Australia

2003;6(178):272–276.

51. Shilton T, Brown W. Physical activity among Aboriginal and Torres Strait Islander people and

communities. Journal of Science and Medicine in Sport 2004;7(1) Supplement):39–42.

52. National Public Health Partnership. National Aboriginal and Torres Strait Islander Nutrition Strategy

and Action Plan 2000–2010; 2001.

53. Australian Institute of Health and Welfare. Australia’s health 2004. Canberra: Australian Institute of

Health and Welfare; 2004.

54. Australian Bureau of Statistics. Disability, ageing and carers, Australia: Summary of findings, ABS,

Canberra, 2004. Report No:4430.0.

55. Coggins A, Swanston D, Crombie H. Physical activity and inequalities: A Briefing Paper. London

(UK): Health Education Authority; 1999.

56. Australian Institute of Health and Welfare: Holdenson Z, Catanzariti L, Phillips G & Waters A-M.

A picture of diabetes in overseas-born Australians. Bulletin No. 9. AIHW Cat. No. AUS 38. Canberra:

2003.

57. Australian Bureau of Statistics, 2001. Involvement in organised sport and physical activity, ABS,

Canberra (ACT) 2001. Report No:6285.0.

58. Dr Paul Collier National Disability Advisory Council. In; 2004.

59. Australian Institute of Health and Welfare. Heart, stroke and vascular diseases – Australian facts 2004.

Canberra: AIHW and National Heart Foundation of Australia; 2004. Report No.: Cat. No. CVD 27.

60. E Harris, Wise M, Hawe P, al. e. Working together: intersectoral action for health. Canberra: AGPS;

1995.

61. Australian Bureau of Statistics. Children’s participation in cultural and leisure activities. Canberra

(ACT): ABS; 2004.

62. Seaton J, Wall S. A summary of walker’s and walking in the Perth metropolitan region in Australia. In:

Walking the 21st century conference; 2001; Perth; 2001.

63. Sport and Recreation New Zealand. An Introduction to Active Movement, Koringa Hihinko.

Wellington; 2004.

64. Zubrick S, Silburn S, Gurrin L, al e. Western Australian child health survey education health and

competence. Perth (WA): Australian Bureau of Statistics and the TVW Telethon Institute of Child

Health Research; 1997.

65. Australian Bureau of Statistics. 2001 health risk factors Australia. Canberra: ABS; 2003. Report No.:

4812.0.

66. Hill J. Physical activity and obesity. The Lancet 2004;Vol. 363,(Iss. 9404):182.

67. Reilly J, Jackson D, Montgomery C, Kelly L, al e. Total energy expenditure and physical activity in

young Scottish children: mixed longitudinal study. The Lancet 2004;363(9404):211.

68. Magarey A, Daniels L, Boulton J. Prevalence of overweight and obesity in Australian children and

adolescents: reassessment of 1985 and 1995 data against new standard international definitions.

Medical Journal of Australia 2001;174:561–564.

69. Australian Government Department of Health and Ageing. National Physical Activity Guidelines for

Australians. Canberra (ACT): AGPS; 1999.

70. National Health and Medical Research Council. Clinical practice guidelines for the management of

overweight and obesity in adults. Canberra (ACT): NHMRC; 2003.

71. Australian Institute of Health and Welfare: Bennett SA, Magnus P & Gibson D 2004. Obesity trends in

older Australians. Bulletin No. 12. AIHW Cat. No. AUS 42. Canberra: AIHW.

72. Sherrington C, Lord S, Finch C. Physical activity interventions to prevent falls among older people:

update of the evidence. Journal of Science and Medicine in Sport 2004;7(1) Supplement):43–51.

73. Australian Sports Commission. Active Australia a national participation framework. Canberra (ACT):

ASC; 1997.

74. Stephenson J, Bauman A, Armstrong T, et al. The cost of illness attributable to physical inactivity in

Australia. Canberra (ACT): Commonwealth Department of Health and Aged Care and the Australian

Sports Commission; 2000.

75. Ministerial Council on Education E, Training and Youth Affairs. Minutes 10–11 July 2003. In. Perth

(WA); 2003.

76. World Health Organization. Integrated prevention of non-communicable disease. Draft global strategy

on diet, physical activity and health. Geneva (Switz): WHO; 2003. Report No.: EB111/44 Add 1.

77. Centre for Disease Control. Energize your Life. 2003 [cited 2004 22 July]; Available from: http://www.

cdc.gov/nccdphp/dnpa/physical/terms/index.htm

78. Centers for Disease Control and Prevention. Physical activity and health: a report of the Surgeon

General. Atlanta: U.S. Department of Health and Human Services; 1996.

79. Department of Health WA. Find 30 It’s not a big exercise. 2003 [cited 2004 Accessed on 8 April 2004];

Available from: http://www.find30.com.au/

There are many reasons to provide children and young people of all ages access to a wide range

of physical activity options including play, sport, dance, walking and cycling, games and the

development of fundamental movement skills.

From a health perspective it is ‘intuitively sensible and biologically plausible that preventive

health measures such as fostering a physically active lifestyle should begin early rather than later

part of childhood.

However, things such as increased car ownership and use, concerns about neighbourhood and

street safety, competing sedentary alternatives for leisure time, increased parental working hours

and the resultant reduction in free play time and increasing demands on school curriculum help

to create obesogenic environments that encourage sedentary behaviour. It therefore makes sense

to encourage and support children to be less sedentary and more active in daily life.

Clearly children and young people have different requirements at different ages, and programs

and policies should reflect these changing needs. The early years (0–8 years) is a key time for

within this period children have a vast range of needs. As children grow older the emphasis

moves from a focus on the role of parents and caregivers, to building the skills and motivation of

the children and young people themselves to make healthy decisions. Programs and initiatives

need to be age, and stage, appropriate and evidence based.

1. Children and youth should participate in at least 60 minutes of moderate- to vigorousintensity

physical activity every day.

2. Children and youth should not spend more than two hours per day using electronic media for

entertainment (eg computer games, Internet, TV), particularly during daylight hours.

Australia lacks accurate population level physical activity monitoring and surveillance data for

children and young people. This is a priority for action for BAA.

There have been a number of surveys but there is little comparability. However:

• In the 12 months to April 2003, an estimated 38% of Australian children aged five to 14 years

did not participate in any organised school, club or planned sport or physical activity outside

• 42% of those who lived within a 10 minute walk from primary school in Western Australia

• 20% of New South Wales students in grades eight and 10 engaged in only low levels of

physical activity and 60% have moderate to poor fundamental motor skills. Students of low

* There was insufficient evidence to develop Guidelines for children under five. For more information on physical

activity and young children see New Zealand’s An Introduction to Active Movement, Koringa Hihinko. Wellington;

2004.63

• 64% of 12 to 16 year old Western Australian young people will not have engaged in any aerobic

• Almost one quarter or 22% of 15–24 year olds reported no physical activity at all in the two

• Overseas evidence suggests even children under five years of age appear to be increasingly

• In 1995 approximately 1.5 million young people aged 2–17 years or 21% of boys and 23% of

While children of all ages are almost certainly more active than adults, the increasing rates of

obesity in children is clearly linked to levels of physical activity as well as eating patterns. The

consequent increasing rates of onset of Type 2 diabetes in young people is reason enough to

support action to encourage children and young people to be active.

activity can assist children and young people in:

• Building and maintaining healthy bones, muscles and joints;

• Helping achieve and maintain healthy body weight;

• Reducing adiposity or body fat;

• Protecting against cigarette smoking, alcohol use and illegal drug use; and

• Improving psychological indicators including depression, self esteem, anxiety, stress and self

concept in children.

There are some risks of injury and inappropriate weight loss in participation, especially with

intensive levels of physical activity, however these risks are outweighed by the benefits.

There are a number of reported, though not always agreed upon, related benefits for active

children and young people, including improved skills development, movement competence

and confidence, interaction with peers, academic performance and teamwork, a greater sense of

community belonging, and a reduction in antisocial behaviours.

The greatest population gains in relation to physical activity will be achieved by increasing

levels of activity among adults who are sedentary and in moving them to the point where they

reach the recommended levels of physical activity.

Cyarto et al (2004) comment that demographic change will mean an increase in the proportion of

the Australian population aged 65 years and older from approximately 13% in 2002 to about 20%

conditions and that almost 60% of ‘current’ 45–60 year olds are insufficiently active for health

benefit, it is likely that this group will place a large burden on the health system in the next two

decades.

If current levels of inactivity persist within this age group the combined effect of increasing

prevalence of chronic disease attributable to inactivity and a rise in the number of overweight

and obese people in this age group, will have a major and costly impact on health services

over the next 20 to 30 years. Intervention through health services, workplaces and community

settings is therefore critical.

The Guidelines outline recommendations for the minimum level of physical activity required

for good health for adults. They are:

• Think of movement as an opportunity, not an inconvenience;

• Be active everyday in as many ways as you can;

• Put together at least 30 minutes of moderate intensity physical activity on most, preferably all,

days of the week;

• If you can, also enjoy some regular, vigorous exercise for extra health and fitness.

Examples of moderate intensity activity are brisk walking, swimming, doubles tennis and

medium paced cycling. More vigorous activity includes jogging and aerobics. Activity can be

accumulated in blocks of 10 to 15 minutes.

There is not widespread agreement on how much physical activity is necessary for weight

reduction, but it seems likely to be around 60 minutes of moderate intensity (or lesser amounts

changes.

• Leisure time physical activity participation data (Refer to Table 2) shows that more than half

of adults did not achieve sufficient levels of physical activity in 2000. This increased from

49.1% in 1997.

• Sedentary behaviour – that is, undertaking no leisure-time physical activity – increased from

14% in 1997 to 16% in 2000. This rise was due to an increase in the proportion of men who

18–29 39.6 44.8 42.2

30–44 58.5 57.6 58.0

45–59 58.1 59.4 58.7

60–75 56.8 56.0 56.4

No. CVD 27. Canberra: AIHW and National Heart Foundation of Australia (Cardiovascular Disease Series No. 22).59

Based on self-reports; data for ages 18–75 years; all rates other than the age-specific rates are age-standardised (ASR) to the

2001 Australian population; ‘Sufficient’ physical activity is at least 150 minutes of activity accrued over at least five separate

sessions in the previous week.

A review of recent literature again demonstrated convincing evidence that regular moderate

physical activity improves health and reduces the risk of illness, disability and premature

Bauman (2003) concluded that benefits of physical activity include, but are not limited to:

• Reduction in all cause mortality by around 30% for those achieving at least moderate intensity

physical activity on most days of the week;

• Reduction in risk of cardiovascular disease incidence and mortality of around 30%;

• Reduction of cardiovascular risk factors including hypertension and lipid levels;

• Protection against ischaemic stroke, particularly amongst males;

• Reduction in Type 2 diabetes incidence and better diabetes management through improved

insulin sensitivity, increased glucose metabolism and weight management. This includes

high-risk groups with impaired glucose tolerance;

• Reduction of cancer risk for colon cancer (30 to 40% risk reduction) and breast cancer (20 to

30% risk reduction);

• Protection against osteoporosis and a reduction in the risk and consequences of arthritis with

moderate physical activity;

• Reduction in the risk of hip fractures through falls;

• Helping people with chronic, disabling conditions to perform activities of daily living,

therefore improving functional status; and,

• Assisting people to achieve and maintain healthy body weight if coupled with good nutrition

and physical activity.

Evidence is mixed regarding the mental health benefits of physical activity. However, a number

of studies have concluded that the use of exercise for depression and anxiety is supported

example anxiety and depression, and the limitations in the quality and quantity of published

research impacts on the conclusions that can be made regarding the relationship between

physical activity and mental health benefit.

The ageing of the Australian population as well as increasing rates of obesity and its

consequences suggest there will be significant health and economic benefits from inactive older

people becoming more active. Benefits will accrue no matter what age and older people are likely

Aside from individual physical and psychological factors such as poorer health and fear of injury,

older people can face additional barriers to physical activity such as transport, cost and access to

age appropriate programs.*

* It is not considered necessary to specifically define the age of ‘older people’ as people who are in their fifties may

have similar requirements to those in their eighties and the actions are relevant to people as they age. There are

a number of national initiatives and plans relevant to older people, for example, National Health Priority Action

Council plans related to diabetes, arthritis and musculoskeletal conditions, Veterans Affairs programs, Council on

the Ageing initiatives, strategies on mental health promotion and falls prevention, social issues and those related to

settings such as residential care. These provide an opportunity to work in partnership to further develop innovative

and best practice programs and initiatives but the focus must be on inactive older people, particularly those who are

disadvantaged through reduced access or have special needs because they are, for example, socially isolated, have

dementia or live with a limiting condition.

The National Physical Activity Guidelines for adults recommends at least 30 minutes of

regular moderate intensity physical activity on most days of the week but does not differentiate

requirements for older people.

The development of specific guidelines for older people is a BAA priority and is likely to also

cover strength and balance components.

In addition to the benefits listed for adults, physical activity confers benefits for older people

including:

• Ameliorating the age related decline in physical function (balance, mobility, and ability to

• A positive influence on chronic disease (improved glycaemic control and reduced dosage of

medication for those with Type 2 diabetes) through progressive resistance training although

At the local level many individuals and organisations are supporting people to be physically

active and to develop health-promoting environments in their region.

complement local action, and by providing a framework that may also be useful at the local level.

Most states and territories are considering, or have established, intersectoral structures and the

development of associated strategies, to improve coordination and leadership of physical activity.

Usually this involves government, non-government and community members and has in recent

years significantly increased progress on physical activity at the state and territory level.

BAA will support and strengthen this approach by providing a framework for national health

sector coordination and by ensuring national recognition of the importance of physical activity

and progressing actions that work collaboratively at the national level to support the efforts of

state and territory organisations.

All state and territory health departments have physical activity as a priority issue. It is expected

BAA will inform and complement health sector physical activity plans and programs.

Nationally BAA aims to build on work undertaken in the past as well as influencing current

activities at the national level through development of a strategic approach to supporting

Australians to be active.

Government’s response to Active Australia16

1999 • Strategic Inter-Governmental forum on Physical Activity and Health (SIGPAH) formed and key reports supported

over coming years 15,43,74

activity13

• Education75 and sport and recreation25 sectors commit to importance of a national approach to physical

activity

activity among Australian children, including school curriculum guidelines for physical activity, Active afterschool

communities program and information for families40

In 2003 the World Health Organization (WHO) released the Draft Global Strategy on Diet,

Physical Activity and Health clearly identifying physical inactivity and unhealthy diets as key

contributors to the growing burden of non-communicable disease throughout the world. The

report confirms the importance of individuals engaging in adequate levels of physical activity

throughout life and identifies the responsibility of member states to develop and support the

implementation of national strategies on both physical activity and nutrition. It states that while

further research is needed regarding successful interventions, ‘current knowledge warrants

A number of factors can help or hinder levels of physical activity in the community. These are:

This includes:

• Laws, for example legal liability barriers, cycling or road related legislation;

• Policies such as public transport, urban planning and development, housing, education,

economic, welfare, health, justice, organisational and relating to use of community facilities.

• Government and public attitudes to physical activity in general. The role of government and

the role and responsibility of individuals.

This includes:

• Practices, rules and policies regarding physical activity in organisations such as schools, child

care and the workplace;

• Community perceptions compared with the reality of safety;

• Sports, fitness and recreation opportunities and services;

• Level of competitiveness of sport;

• Access to healthy food to support activity; and

• Advertising messages.

• Income available for expenditure on physical related activities and the cost/fees to the user;

• Employment; and

• Education.

• Functionality, including level of sprawl or density, land use mix, street accessibility;

• Urban and neighbourhood design of suburbs, cul-de-sacs and connectivity of streets;

• Walking surface characteristics;

• Street width, presence of footpaths and width (wider means further from traffic);

• Age and ‘walkability’ of neighbourhoods;

• Public open space, access to parks and playgrounds;

• Walking and cycling networks;

• Aesthetics of the environment – cleanliness, wide variety of sights;

• Climate, for example hot, dry, dusty, humid or wet weather;

• Access to public transport and transport networks both for active transport and for

participation in formal activities that require travel;

• Destinations and proximity to things such as shops and the post office;

• Traffic volume, speed;

• Design and access to buildings;

• Provision of lighting; and

• Proximity to the beach.

• Family, community, cultural and social values, norms, attitudes, beliefs, values and

perceptions;

• Rules about sedentary behaviour that affect, for example, TV watching, computer, games, or

whether children ride to school;

• Social and family support including someone to be active with (friends, children, partner

support, family), or the level of isolation; Family arrangements (one parent families);

• Child care or domestic responsibilities;

• Social networks and social connectedness;

• Physical activity levels by siblings, parents, role models;

• Occupation (sedentary or active);

• Social, geographical or location relevant isolation or mobility;

• Social capital in the community;

• Racism, discrimination/alienation;

• Language and cultural barriers;

• Low socio-economic status and levels of education;

• Dislocation of communities and families from home and land;

• Access to, and support from, health services;

• Encouragement and advice from a GP or other important person;

• Culturally inappropriate services or poor cross-cultural communication;

• Information about where and how to participate;

• Role models.

• Motivation;

• Self efficacy and fear of personal failure, for example, in a competitive situation;

• Self esteem and perceptions of body image;

• Resilience, coping skills and sense of control;

• Stress levels;

• Depression;

• Decision making skills and knowledge;

• Beliefs, perceptions (already active enough) and expectations;

• Enjoyment of physical activity and previous experiences;

• Time (real and perceived) and working hours;

• Skills to participate;

• Lack of interest and other preferences for time;

• Desire to improve health or to lose weight;

• Lack of energy and/or tiredness;

• Age;

• Gender;

• Health status for example experiencing obesity, high/low blood pressure, injury or physical

impairment. All, or any of these may deter physical activity; and

• Genetics.

• Accessible, available, affordable physical activity advice, support and referral to appropriate

services;

• Use of preventive health services;

• Public health programs; and

• Availability of trained and supportive workforce.

Michael Pratt, MD, MPH

Relates to physical activity undertaken as a means of transport. It includes travel by foot, bicycle

and other non-motorised vehicles. Use of public transport is also included in the definition as

it often involves some walking or cycling to pick-up and from drop-off points. Active transport

Travel Access Plans or workplace travel plans are other names used to describe green transport

plans. They are workplace travel plans and provide a framework for initiatives the workplace

can take to encourage active/sustainable transport. Issues that a plan could address include

car parking constraints facing staff, lack of awareness of public transport services near the

workplace, staff concern about bicycle facilities and opportunity for active transport to benefit

staff health.

Is physical activity that is planned or structured. It involves repetitive bodily movement done

to improve or maintain one or more of the components of physical fitness – cardiorespiratory

fitness, muscular strength, muscular endurance, flexibility, and body composition. Sometimes

the word exercise is used to communicate with the public because it is better understood than

It comes with being more active and through it people usually develop cardiorespiratory fitness

(heart, lungs and circulatory systems) as well as muscular strength, stamina, flexibility and body

composition (a reduction in the percentage of body fat). It is determined by a combination of

regular activity and genetically inherited ability. It takes a different type of physical activity to

improve things like power, speed, reaction time and coordination, but these are not necessary for

good health.

Includes activities such as sweeping floors, scrubbing, washing windows and raking the lawn.

Describes not engaging in any regular pattern of physical activity beyond daily functioning.

The amount of heat required to raise the temperature of 1 kg of water 1°C. Kilocalorie is the

ordinary calorie discussed in food or exercise energy-expenditure tables and food labels.

Is physical activity that is performed during exercise, recreation or any additional time other

than that associated with one’s regular job duties, occupation, or transportation.

Generally requires sustained rhythmic movements and individuals should feel some exertion

but should be able to carry on a conversation comfortably during the activity. It refers to a level

of effort equivalent to:

• a ‘perceived exertion’ of 11 to 14 on the Borg scale;

• three to six metabolic equivalents (METs);

• any activity that burns 3.5 to seven calories per minute (kcal/min); or

• the effort a healthy individual might expend, for example, walking briskly, mowing the lawn,

dancing, swimming, or bicycling on level terrain.

Is activity completed regularly as part of one’s job. It includes activities such as hauling, lifting,

pushing, carpentry, shovelling, and packing boxes.

Is any bodily movement produced by skeletal muscles that results in an expenditure of energy.

The World Health Organization states physical activity includes ‘all movements in everyday life,

including work, recreation, exercise and sporting activities’. It can include:

• Active recreation, for example bush walking, skateboarding and surfing.

• Sport, for example netball, soccer and volleyball.

• Dance, such as line dancing, ballet, ballroom dancing.

• Exercise, for example strength training, balance exercises, Tai Chi and flexibility activities.

• Active play, using playground equipment and skipping.

• Active living, where physical activity is integrated into everyday life such as using the stairs,

energetic housework and gardening. Some occupations also involve physical activity.

• Active transport, for example walking to public transport, walking or cycling to locations.

Is a pattern of physical activity that is regular and if activities are performed:

• most days of the week, preferably daily;

• five or more days of the week if moderate-intensity activities are chosen; or

• three or more days of the week if vigorous-intensity activities are chosen.

In scientific literature, sedentary is often defined in terms of little or no leisure time physical

activity. A sedentary lifestyle is a lifestyle characterised by little or no physical activity.

These are one type of exercise, but unlike physical activity it is usually planned, competitive and

includes particular rules or guidelines.

There are two ways of calculating ‘sufficient’ activity for health based on the Australian

Guidelines. These are: ‘sufficient time’ (at least 150 minutes per week of moderate intensity

physical activity) and ‘sufficient time and sessions’ (at least 150 minutes of moderate-intensity

physical activity accrued over at least five sessions per week). For population-monitoring

purposes, sufficient time (down to 10 minutes) and number of sessions can be beneficial as well,

Generally requires sustained, rhythmic movements and refers to a level of effort equivalent to:

a ‘perceived exertion’ of 15 or greater on the Borg scale;

• greater than six metabolic equivalents (METs);

• any activity that burns more than seven kcal/ min; or

• the effort a healthy individual might expend while doing activities such as jogging, mowing

the lawn with a non-motorised push mower, chopping wood, participating in high-impact

aerobic dancing, swimming continuous laps, or bicycling uphill.

• Vigorous-intensity physical activity that is intense enough to represent a substantial challenge

to an individual and results in a significant increase in heart and breathing rate.

ABS Australian Bureau of Statistics

AHMAC Australian Health Ministers’ Advisory Council

AIHW Australian Institute of Health and Welfare

ASC Australian Sports Commission

DOHA Commonwealth Department of Health and Ageing

GPs General Practitioners

SCATSIH Standing Committee on Aboriginal and Torres Strait Islander Health

MCEETYA Ministerial Council on Education, Employment, Training and Youth Affairs

NATSINSAP National Aboriginal and Torres Strait Islander Nutrition Strategy and Action

Plan

NSW New South Wales

NHF National Heart Foundation of Australia

NPHP National Public Health Partnership

PA Physical activity

SCORS Standing Committee on Recreation and Sport

SEAL Supportive Environments for Active Living

SEPA Supportive Environments for Physical Activity

SIGNAL Strategic Inter-Governmental Nutrition Alliance

SIGPAH Strategic Inter-Governmental forum on Physical Activity and Health

SIPP Strategic Injury Prevention Partnership

WHO World Health Organization