Temporal trends in physical activity in England: The Health Survey for England 1991 to 2004
Introduction
Physical inactivity is associated with increased risk for all-cause mortality (Lee and Skerrett, 2001) and many chronic conditions, including ischemic heart disease (Kohl, 2001), diabetes (Lynch et al., 1996), certain types of cancer (Thune and Furberg, 2001), and obesity (United States Department of Health and Human Services, 1996, Chakravarthy et al., 2002, Chief Medical Officer, 2004). Inactivity in England is estimated to cost the National Health Service over £8.2 billion a year (Department of Culture, Media and Sports, 2002).
Despite the wide recognition that physical inactivity is a major cause for chronic disease, no dedicated surveillance is in place in the UK. The insufficiency of the existing evidence has been highlighted in the first independent evidence-based assessment of the long-term resource requirements for the National Health Service (Wanless, 2004). Information on temporal physical activity trends can identify population subgroups at high risk for physical inactivity, evaluate public health interventions, enhance our understanding on dose–response issues, and help develop population specific physical activity interventions (Macera and Pratt, 2000).
The rapid upward obesity prevalence (Health and Social Care Information Centre, 2005) and the lack of a clear trend in dietary intake (Prentice and Jebb, 1995, Stamatakis, 2006) may imply that the overall physical activity energy expenditure levels of the population are declining. However, evidence supporting this hypothesis is based on ecological proxy measures, such as increases in car usage (Department of Transport, 2006) and TV watching (Rickards et al., 2004) rather than being based on direct measures or reports of physical activity. The only nationally representative, population-based resource that has been collecting multiple-domain physical activity data is the Health Survey for England (HSfE), running continuously since 1991. No published source has previously utilised all HSfE data to investigate population physical activity temporal trends.
The aim of this study was, therefore, to examine the temporal trends of participation in physical activity and to calculate the proportion of adults meeting the current public health recommendation for being active for at least 30 min per day on at least 5 days a week at a moderate intensity level (e.g. brisk walking, intense domestic, or sports).
Section snippets
Samples
The HSfE is a continuous survey that since 1991 has drawn an annual nationally representative sample of the general population living in households (up to 10 adults per household). The sample is drawn using multi-stage stratified probability sampling with postcode sectors as the primary sampling unit and the Postcode Address File as the sampling frame for households. The adults' physical activity module was included in the following surveys: 1991/2, 1993, 1994, 1997, 1998, 1999, 2003, and 2004.
Ethical approval
Demographics and response rates
In total 95,342 HSfE respondents (43,401 men) completed the physical activity interviews between 1991 and 2004 and were included in the analysis. As Table 2 shows, response rates for these years ranged between 79% (1991–92) and 66% (2003–04). There were significant increases in mean age (p < 0.001), ratio of non-manual over manual occupations (p < 0.001), and ratio of women over men (p < 0.001) between 1991/2 and 2004.
Occupational physical activity
Fig. 1 shows percentage of men and women aged 16 to 64 who were active at work
Discussion
This is, to our knowledge, the first study to examine temporal trends across multiple physical activity domains in English men and women over approximately the last 15 years, a period when the prevalence of obesity in adults living in England rose by over 65% (Health and Social Care Information Centre, 2005). We found a consistent upward trend for regular participation and time spent in sports but a decline in occupational physical activity between 1991/2 and 2004. The results also suggested a
Conclusions
Our results suggest that participation in sports has increased whereas occupational physical activity may have decreased in English adults over the last 15 years. However, these results provide a partial picture of physical activity temporal trends in England between the early 1990s and 2004 as highly prevalent activities such as walking have been inconsistently measured over time. There is an urgent need for a carefully designed UK physical activity surveillance system that includes objective
Acknowledgments
The Health Survey for England was funded by the English Department of Health. The data presented here are available from the UK Data Archive (http://www.data-archive.ac.uk/findingData/hseTitles.asp).
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