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Health Education Population Survey (HEPS) 1996-2003

Contents:

Summary 1. Introduction 2. Scotland's health 3. Attitudes towards own health 4. Perceptions of mortality, morbidity and risk 5. Physical activity 6. Diet 7. Smoking 8. Alcohol 9. Mental health 10. Oral health 11. Drugs 12. Sexual health 13. Conclusions References Appendix 1: Questions analysed in overview Appendix B: Topics covered 1996-2003 Appendix C: Base sizes Appendix D: Physical activity levels

5. Physical activity

Physical activity is an important protective factor against coronary heart disease and a number of other diseases. It is also associated with mental and social well-being. The current two-stage approach in Scotland is based on guidelines highlighting the health benefits of moderate intensity physical activity, or 'active living' (Scottish Executive 2002a; HEBS, 1997b) and is described in Section 2.2. The 'active living' message aims to maximise public health gain by targeting those who are sedentary, and thus at most risk from coronary heart disease. This group is likely to be less responsive to the traditional exercise guidelines involving three 20-minute sessions of vigorous exercise per week, and would therefore benefit from more achievable targets in relation to moderate physical activity. Health education campaigns to introduce the health benefits of moderate intensity physical activity have focused on brisk walking and were first introduced in Scotland in 1996.

Three indicators were used to assess behaviour in relation to physical activity: the first was a measure of physical inactivity, while the two other indicators assessed opportunity for and levels of physical activity. Being sedentary, or physically inactive, is considered to be a risk factor for coronary heart disease, and thus is defined as a risk behaviour for the purposes of this report.

5.1 Risk behaviour

Sedentary behaviour is calculated on the basis of reported levels of physical activity in an average week, as described in Section 5.3. The data indicates that there is a sizeable target group for the first stage of the current approach to promoting physical activity (Table 5.1), since around a third of the Scottish adult population can be classified as sedentary (no 20-minute sessions of vigorous activity and no 30-minute sessions of moderate activity per week).

It should be noted, however, that this classification is likely to result in an overestimation of the number of sedentary people, as it includes those who are active at both moderate and vigorous levels, but do not fulfil the current recommendations for either of these intensities. For instance, those who take two sessions of vigorous physical activity plus three sessions of moderate physical activity would be classed as sedentary because they do not reach three sessions of vigorous physical activity or five sessions of moderate physical activity. These questions used to derive levels of sedentary behaviour were only asked of half of respondents in 2002 as a new WHO measure of physical activity was being trialled with the other half of respondents. The apparent fall in the number of sedentary adults in 2002/2003 is of borderline significance; longer-term data are needed to determine whether these apparently lower levels in 2002 and 2003 will be sustained. Otherwise, there is no consistent pattern of change over time except that the proportion of sedentary respondents aged 25-34 has declined significantly.

There is no consistent marked sex difference in the percentage of respondents who are sedentary, although women were more likely to be sedentary than men. There is, however, a clear age gradient, with older people being more likely to be sedentary. Those in the lower social grades were more likely to be sedentary, particularly in the E group. There is generally a similar pattern by DEPCAT with those in the more deprived areas most likely to be sedentary, although this was not the case in 2002 - a finding which may be related to the smaller sample size.

Table 5.1: Percentage who are sedentary, by sex/age/social grade/DEPCAT

%	1996	1997	1998	1999	2000	2001	2002	2003
All	35	34	35	34	-	35	29	30
Sex
Men	34	28	33	27	-	35	26	26
Women	35	39	37	40	-	36	31	34
Age
16-24	21	23	28	17	-	20	16	17
25-34	36	31	26	26	-	25	20	22
35-44	28	28	23	27	-	31	26	29
45-54	40	29	36	39	-	41	21	30
55-64	38	46	53	48	-	48	46	38
65-74	51	56	58	59	-	56	54	55
Social grade
AB	28	30	24	20	-	27	21	19
C1	29	31	27	29	-	27	24	23
C2	33	33	34	35	-	31	30	32
D	39	35	36	32	-	44	31	37
E	47	49	68	56	-	63	51	51
DEPCAT
1-2	30	29	25	25	-	27	23	20
3-5	35	32	33	33	-	31	31	30
6-7	38	43	54	47	-	49	25	42
Base: all respondents, half sample in 2002	1810	1795	1794	880	-	1757	877	1720

Significant changes (p<0.05)

The key gradients by age, social grade and DEPCAT are illustrated in Figure 5.1 using the 2003 data.

Fig 5.1: Percentage who are sedentary, by age/social grade/DEPCAT, 2003

Base: all respondents 2003 (1720)

 

5.2 Active living

The amount of time respondents spend walking as part of their daily routine was used as one indicator of physical activity. This measure does not include leisure time walking or any indication of intensity of exercise, and is used to assess opportunity and inclination for 'active living' type exercise.

Around six in ten respondents reported walking at least 30 minutes on an average day (Table 5.2). Unlike sedentary behaviour, there was little consistent difference by age, although those aged 16-24 were slightly more likely to walk at least 30 minutes a day than older respondents - possibly due to younger respondents walking to school or college. The percentage walking at least 30 minutes a day was consistently slightly lower for women than for men.

Table 5.2: Percentage walking at least 30 minutes per day, by sex/social grade/DEPCAT

%	1996	1997	1998	1999	2000	2001	2002	2003
All	63	64	63	56	-	64	61	59
Sex
Men	65	67	68	56	-	69	64	62
Women	61	60	59	55	-	60	59	57
Social grade
AB	50	60	56	48	-	54	46	56
C1	63	58	60	52	-	61	64	57
C2	69	65	68	69	-	72	66	60
D	72	74	72	55	-	65	65	67
E	57	69	65	57	-	68	63	57
DEPCAT
1-2	64	58	57	52	-	60	57	56
3-5	61	66	64	57	-	62	61	60
6-7	68	62	68	58	-	71	68	61
Base: all respondents, half sample in 2002	1810	1795	1794	880	-	1757	877	1720

There was also an inverse correlation with social grade. Those in the highest social grades were least likely to have walked 30 minutes a day, rising for those in the C2D social grades, but generally falling again slightly for those in the E grade. The relatively high level of walking for the lower social grades may in part be explained by lack of access to amenities and transport, notably 'inverse care' patterns of provision where areas with relatively poor public transport systems are also those with low levels of car ownership. In addition, findings from the Scottish Household Survey show that those in the lower socio-economic groups tend to walk more as part of travelling to work (Scottish Executive, 2002c). Relatedly, proximity to the home may be an important factor in seeking employment when access to transport is problematic, thus restricting employment prospects (Bailey et al, 1999). These issues raise a question regarding the extent to which walking patterns can be considered to be an indicator of a healthier lifestyle rather than an outcome of relative deprivation for some sectors of the population. The gradient by DEPCAT supports this finding. Since lack of car ownership is one of the factors making up the DEPCAT measure, it is perhaps not surprising that those in the least affluent postcode sectors tend to be more likely to walk at least 30 minutes per day than those in the most affluent areas.

5.3 Protective behaviour

The current recommended levels of activity in terms of health benefits and protection against coronary heart disease are five or more moderate sessions, or three or more vigorous sessions, per week. These measures of physical activity are therefore based on the intensity, frequency and duration of sessions taken. Respondents are asked a series of questions on the types of physical activity they do in an average week. The number of 30-minute sessions of moderate activity or 20-minute sessions of vigorous activity is used to derive a summary activity level, and those achieving the recommended levels for moderate or vigorous activity are classified as regular exercisers (the questions on physical activity can be found in Appendix A and the method used to derive the summary activity level is described in Appendix D). As explained in Section 5.1, in 2002 only half of respondents were asked these questions.

Table 5.3 Percentage achieving recommended levels of physical activity, by sex/age/social grade/DEPCAT

%	1996	1997	1998	1999	2000	2001	2002	2003
All	36	39	36	39	-	36	42	43
Sex
Men	41	50	41	46	-	43	50	49
Women	31	29	31	32	-	30	36	37
Age
16-24	52	44	41	39	-	46	59	57
25-34	39	47	44	58	-	49	57	53
35-44	40	44	49	40	-	44	38	40
45-54	28	42	31	34	-	32	40	46
55-64	30	27	23	31	-	22	32	31
65-74	24	19	17	20	-	11	21	23
Social grade
AB	35	36	42	44	-	36	41	45
C1	38	41	37	47	-	38	45	45
C2	39	43	39	42	-	46	47	50
D	38	46	39	51	-	33	42	40
E	30	25	18	32	-	19	28	29
DEPCAT
1-2	38	39	40	49	-	45	45	47
3-5	37	41	37	35	-	37	42	44
6-7	34	32	26	38	-	30	43	37
Base: all respondents, half sample in 2002	1810	1795	1794	880	-	1757	877	1720

Significant changes (p<0.05)

In 1996 just over a third of respondents attained the recommended levels of moderate or vigorous activity, and there was a slight increase over the eight-year period of the survey (Table 5.3). The observed results are very similar to those from the 1998 Scottish Health Survey (Shaw et al, 2000). Men were more active than women on the whole. Those in social grade E are least likely to be regular exercisers. There appear to be generally increasing trends for those in the ABC1C2 social grades. Except in 2002, those in the least affluent DEPCAT areas were less likely to achieve the recommended levels of activity than those in more affluent areas.

In most years of the study, levels of physical activity were fairly similar for those aged 44 and under, but start to decline for older respondents. This is in contrast to levels of daily walking where older respondents were generally as likely to walk for at least 30 minutes a day as younger respondents. It is difficult to find any patterns of change over time by age, as the results fluctuate somewhat year on year.

Figure 5.2 illustrates the overall trends in the three measures of physical activity discussed in this section.

Fig 5.2: Trends in physical activity, 1996-2003

Base: all respondents

 

5.4 Knowledge

The knowledge indicator for physical activity used in HEPS to date is geared towards the old health education messages that emphasised the health benefits of accumulating at least 30 minutes of moderate intensity physical activity per day. Since 2003, however, the message has been revised to a frequency of at least five days a week and this is the measure that should be tracked in future survey waves. This report is, however, concerned with knowledge of the message that would have been current at the time of fieldwork. Respondents were asked how many minutes per day of moderate activity, such as brisk walking or heavy gardening, were required in order to keep healthy. Knowledge of the recommended levels was not particularly widespread as approximately a third of respondents gave the correct answer of around 30 minutes per day (Table 5.4). Around half thought that they needed to do more than 30 minutes (most saying at least an hour), and it is possible that such beliefs might represent a disincentive to take up moderate activity. In addition, there appears to be a shift over time, from respondents underestimating the recommended levels to overestimating them.

Table 5.4: Knowledge of recommended levels for moderate activity

%	1996	1997	1998	1999	2000	2001	2002	2003
All
25 minutes or less	16	21	12	18	-	12	11	11
26-30 minutes	30	35	34	36	-	30	35	32
Over 30 minutes	47	40	49	43	-	53	51	56
Sedentary
25 minutes or less	14	34	12	17	-	16	11	15
26-30 minutes	30	30	33	39	-	29	42	31
Over 30 minutes	45	29	47	39	-	49	44	51
Base: all respondents	1810	1795	1794	880	-	1757	1742	1720
Base: all sedentary	632	606	700	329	-	586	544	509

Significant changes (p<0.05)

Respondents classified as sedentary were no less likely to be aware of the recommended levels. There was, however, a difference in knowledge by social grade (Table 5.5). Just as those in the lower social grades were more likely to be sedentary and less likely to achieve the recommended levels of physical activity, they were also least likely to be aware of the recommended levels of moderate activity. The pattern for DEPCAT is less clear, but in general terms, those living in the more deprived areas were least likely to be aware of the recommended levels of moderate activity.

Table 5.5: Percentage who know that 26-30 minutes of moderate activity weekly, recommended by social grade/DEPCAT

%	1996	1997	1998	1999	2000	2001	2002	2003
All	30	35	34	36	-	30	35	32
Social grade
AB	40	37	45	48	-	37	43	34
C1	31	42	35	34	-	34	34	35
C2	33	30	31	39	-	29	36	30
DE	24	28	30	31	-	22	31	29
DEPCAT
1-2	27	42	43	35	-	34	39	38
3-5	30	35	35	39	-	29	35	31
6-7	33	29	22	28	-	28	32	28
Base: all respondents, half sample in 2002	1810	1795	1794	880	-	1757	877	1720

5.5 Motivation

In general, over half of respondents had tried or wanted to increase their levels of physical activity, although motivation is lower for those who are sedentary (Table 5.6). Over the eight years there does not appear to have been any consistent change in motivation. More recently there appears to have been a shift from those not contemplating change towards those who have tried to increase their activity levels, although this change is only of borderline significance, and this was not the case for sedentary respondents.

Table 5.6: Motivation to increase activity levels

%	1996	1997	1998	1999	2000	2001	2002	2003
All
Not contemplating	44	44	51	48	-	42	39	38
Would like to	18	16	16	17	-	20	19	18
Have tried	37	40	33	35	-	38	42	44
Sedentary
Not contemplating	56	52	66	53	-	50	49	53
Would like to	21	18	16	22	-	25	23	19
Have tried	23	30	19	25	-	25	28	28
Base: all respondents	1810	1795	1794	880	-	1757	1742	1720
Base: all sedentary	632	606	700	329	-	586	544	509

Significant changes (p<0.05)

The changes over time in motivation to increase physical activity are illustrated in Figure 5.3. This shows clearly the move away from those who are not contemplating change, towards those who have tried to change, or would like to change, since 1999.

Fig 5.3: Trends in motivation to increase physical activity (tried to or would like to change), 1996-2003

Base: all respondents

Main points

• Younger respondents were least likely to have a sedentary lifestyle, as were those from higher socio-economic groups.
• There is some indication of a slight decrease over time in sedentary behaviour, and a corresponding increase in protective behaviour. This increase is restricted to those in the higher social grades.
• Around one third are aware of the minimum recommended levels of moderate intensity physical activity; there has been no change in these knowledge levels.
• Those in the lower social grades were more likely to be sedentary and less likely to be aware of the recommended levels of moderate activity. However, they were most likely to walk more than 30 minutes on an average day, possibly out of necessity rather than as a health-related choice.
• Men were more likely than women to achieve the recommended levels of physical activity, as were the under 45s compared with older respondents.
• Levels of motivation to take more exercise remained largely unchanged from 1996 to 2003, but there appears to be a small shift more recently away from those not contemplating change towards those who have tried to change.