Professor Gareth StrattonChair, NICE Physical activity and Children PDG

Research Institute for Sports and Exercise SciencesLiverpool John Moores University

Producing Public Health Guidance the “NICE” Way

Process to Productand

Product to Process

How can NICE help?• NICE is an independent organisation

responsible for standards to promote good health and prevent or treat ill health, based on best value for money

• NICE recommendations can help organisationsmeet public health targets (NIs, PSAs etc)

• NICE offers advice to organisations who have a role in promoting health and wellbeing

How can NICE help?Public Health ProblemLow Physical Activity

Where is the problem?Young People

Can PA be changed?Evidence

Effectiveness:Cost

Use EvidenceRecommendations

Use RecommendationsPolicy, Strategy, Practice

Monitor Evaluate

Product

The issues• Physical inactivity in England is estimated to

cost £8.2 billion a year and is predicted to rise

• Physical activity is important for children’s healthy growth and development

• Physical activity contributes to general health and wellbeing and can reduce the risk of several chronic conditions

Assessing Cost Effectiveness

Probability of rejection

Cost per QALY (£K)

x XX XX

10 20 30 40 50

0

1

Promoting physical activity for children and young

people

Schools and colleges

Implementing NICE guidance2009

NICE public health guidance 17

Health Survey for England (2003) www.heartstats.org

Percentage of children participating in at least 60 minutes of physical activity daily, 2002, England

40

45

50

55

60

65

70

75

80

2 3 4 5 6 7 8 9 10 11 12 13 14 15

Age

%Boys

Girls

Decrease in Physical Activity in School Age Children

Physical activityOverestimated

EYHS Physical Activity and Metabolic Risk

Odds ratios for Clustered Risk in Children and Adolescents

01234

1 2 3 4 5

Quintile

Od

ds

ra

tio

Increased riskSD>1

Andersen LB, Lancet. 2006 Jul 22;368(9532):299-304

>2000 cpm116 min 9y olds88 min 15y olds

Mapping the obesity epidemic in Liverpool 9-10 year olds

Taylor, Stratton, and Hackett, Health Educ Res (2004).Dummer, Hackett, Stratton, Taylor PHN (2004).

Stratton, Hackett, Boddy, Taylor, Buchan and Canoy IJO (2007)

30000 children 1998-2004Fitness, fatness, parents activity, diet, sports preference.

- 0.5

- 0.4

- 0.3

- 0.2

- 0.1

0

0.1

0.2

0.3

0.4

98/99 99/00 00/01 01/02 02/03 03/04

Year

z s

core Fitness

BMI

Data from G Stratton, Liverpool Sportlinx

Rise in BMI and fall in cardio-respiratory endurance of Liverpool 10 year olds from 1998 to 2004

Scope•The recommendations are for: •all children and young people up to 18

•specifically:- children aged 11 and under - girls aged 11 to 18

What is evidence?

• How much evidence do you need to make recommendations?

• How good does the evidence need to be?

• What type of evidence should you use?

Searching for Evidence for Programme EffectivenessReview 1: Descriptive epidemiologyReview 2: Correlates of physical activity in children: a review of quantitative

systematic reviewsReview 3: The views of children on the barriers and facilitators to

participation in physical activity: a review of qualitative studiesReview 4: Intervention review: under eightsReview 5: Intervention review: children and active travelReview 6: Intervention review: adolescent girlsReview 7: Intervention review: family and communityReview 8: Review of learning from practice: children and active playReview of economic evaluations:Cost effectiveness analysis: Fieldwork

What does evidence tell you?• Quantity• Quality

– Different question– Different

population group– Different

comparator– Different outcome– Different context– Different

intervention…• Diversity

Lay Members

ProfessionalsPractitioners

Academics

ChairNICEPACC

Reading

Understanding

SHOKK®

ProductChildren’s Physical Activity Guidelines (draft)

Study Type

Authors Study Quality

Physical activity change?

RCT Prochaska & Sallis (2004)Patrick et al. (2006)

++++

No changeNo change

CRCT Simon et al. (2004)Schofield et al. (2005)Haerens et al. (2006)Murphy et al. (2006)Robbins et al. (2006)

+++++

PositivePositive

No changePositive

No change

CNRT Baxter et al. (1997)Metzker (1999)Moon et al. (1999)Winett et al. (1999)

----

No changePositive

No changePositive

RNCT Marks et al. (2006) + Positive

Adolescent Girls Review

.

• There is evidence from one controlled non-randomised trial in the USA [-], that a counselling intervention can lead to an increase in physical activity in adolescent girls. A characteristic of this intervention is that it is was short (8 weeks) and included older girls (>14 y) only.

• Who is the target population?

Focus, related to the scope

• Who should take action?

Be as specific as possible

• What action should they take?

Be precise and realistic

Targeted and Specific

Recommendation 14

• Who is the target population?• Girls and young women aged 11–18.• Who should take action?• Practitioners who lead physical activities, including youth

leaders, teachers, coaches and volunteers.• What action should they take?• Ensure all physical activity opportunities emphasise

participation, enjoyment and personal development. Support participants of all abilities in a non-judgemental way which is sensitive to cultural and religious issues. Encourage those who initially choose not to participate in physical activity to observe. Help them move gradually from observation to full participation.

Key Principles• Young people at the centre• Involving staff and parents• Effective community links• Space, facilities and equipment• Developing a physical activity policy• Providing structured and unstructured

opportunities• Monitoring and evaluation• Cost:Benefit

Recommendations : Audience• NHS – hospital,community• Local authority• Education• Third Sector• Individual• Public• Government• Private/Commercial

ProductChildren’s Physical Activity Guidelines (draft)

Sections

• Key priorities • Public health need and practice• Children and young people’s activity levels• National policy• Non-government initiatives • Considerations• Value of physical activity • Children and young people’s needs• Factors that encourage or hinder physical activity

• Limitations

• Recommendations

How the Recommendations Fit Together

Local Practitioners Delivery

Local OrganisationsPlanning, Delivery, Training

Local Strategic Planning

High Level PolicyAnd Strategy

National Policy

Ordering of Recommendations

“Between the thought and the action lies the shadow”

(Mark Twain)

www.nice.org.uk/PH17

Using NICE Public Health Guidance