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Health Education Population Survey (HEPS): Update from 2004 Survey - Final Report

Contents:	Summary 1. Introduction 2. Attitudes to own health 3. Physical activity 4. Diet 5. Smoking 6. Alcohol 7. Mental Health 8. Oral health 9. Sexual health 10. Cannabis legislation Appendix

3. 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’. 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.

Respondents were 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 was used to derive a summary activity level, and those achieving the 5 or more sessions of moderate activity or 3 or more sessions of vigorous activity were classified as regular exercisers and meeting the recommended levels. Those with no such sessions of moderate or vigorous activity were defined as sedentary. The 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 amount of time respondents spend walking as part of their daily routine was used as a third 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.

The questions on physical activity can be found in Appendix A and the method used to derive the summary activity level in described in Appendix D.

3.1 Reported behaviour

Figure 3.1 shows change over time in the proportion of respondents with evidence of risk behaviour (sedentary), active living (walking 30 minutes per day) and protective behaviour (meeting the recommended levels of weekly activity).

Figure 3.1 Time trends in physical activity (1996-2004)

Base: all respondents (2004:1784)

There is a sizeable target group for the first stage of the current approach to promoting physical activity since around three in ten of the Scottish adult population can be classified as sedentary. The apparent fall in the number of sedentary adults in 2002/2003 was only of borderline significance, but the results in 2004 confirm that this apparent fall has been sustained.

Around six in ten respondents reported walking at least 30 minutes on an average day. Whilst this figure has fluctuated over time, there has been no sustained change from 1996 to 2004. Similarly, whilst there appeared to have been an increase in the proportion achieving the recommended levels of physical activity in 2002/2003, this increase has not been sustained in 2004.

Figure 3.2 Percentage who are sedentary by age/social grade/DEPCAT

Base: all respondents 2004 (1784)

As in previous years, there are patterns of different in physical activity by age, social grade and deprivation. In general, older people and those in the lower social grades and more deprived areas are less likely to be physically active, as illustrated in Figure 3.2. The patterns for sedentary behaviour are mirrored by those for achieving the recommended levels of activity in terms of age, social grade and DEPCAT. In terms of sex, however, whilst men were more likely than women to achieve the recommended levels of physical activity (46% compared with 32%) they were no less likely than women to be sedentary.

The pattern is different for the measure of active living (walking at least 30 minutes per day). As in previous years, higher levels of walking were seen in the C1C2D social grades with lower levels for both the AB and E social grades. This is likely to be related to car ownership and access to public transport as discussed in the 1996-2003 report.

3.2 Knowledge and motivation

The knowledge indicator for physical activity used in HEPS 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. More recently, 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 research.

3.2.1 New Message

When asked how many times per week people needed moderate exercise to keep healthy, only one in ten (12%) gave the correct answer of five. Three in ten (30%) believed they needed to exercise seven times a week (i.e. every day), whilst 53% gave a figure below five. There was no clear difference in understanding by sex, age or social grade.

3.2.2 Old Message

Respondents were asked how many minutes of moderate activity, such as brisk walking or heavy gardening, they needed to do to keep healthy.

There has been no change in knowledge in 2004 with 30% able to give a figure of around 30 minutes. This was higher for those in the AB social grade (36%). Over half of respondents (55%) believed they needed more than 30 minutes per day to keep healthy; this belief could act as a disincentive to exercise.

There has been no change in motivation to increase physical activity since the increase in 2002 (Figure 3.3). Four in ten were not contemplating any change in their behaviour whilst 42% had tried to make a change and a further 18% would like to. As in previous years those who were sedentary we less likely to be contemplating change (50% not contemplating).

Figure 3.3 Time trends in motivation to increase physical activity (1996-2004)

Base: all respondents (2004:1784)

Main points

• Three in ten adults were sedentary. Younger respondents were least likely to have a sedentary lifestyle, as were those from higher socio-economic groups.
• The slight decrease over time in sedentary behaviour has been consolidated in 2004 (30%), although the apparent increase in protective behaviour in 2002/2003 has not (39%).
• Men were more likely than women to achieve the recommended levels of physical activity, but no less likely to be sedentary.
• Around one third were aware of the minimum daily recommended levels of moderate intensity physical activity; there has been no change in these knowledge levels. Only one in ten knew that moderate activity was recommended five times a week to stay healthy, with three in ten believing daily exercise was needed.
• 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.
• Levels of motivation to take more exercise remain largely unchanged from 2002 to 2004.