This piece was written by one of our contributors; personal trainer – Jake Gifford.
‘Move more’ is a common phrase in physical activity messaging but it is helpful or might it be diluting our understanding of the barriers associated with getting active?
The belief in the capacity of physical activity to improve the health of the nation is largely accepted and has a long history. Early examples of its promotion include an Aberdonian doctor in the late seventeenth and early eighteenth centuries called George Cheyne, who was particularly influential in promoting the benefits of regular exercise for healthy living and mental stability (1).
It is of course important to promote exercise, because the noticeable benefits to being active are certainly well documented. Physically active adults have a reduced risk of cardiovascular disease, coronary heart disease, type 2 diabetes, cancer, osteoporosis and stroke (2). The ever-growing body of scientific evidence, which highlights the benefits, has consequently led to position statements since the late 1980s for recommendations on the quantity and quality of physical activity for both health and fitness.
So what are the guidelines?
Whilst changes to the recommendations on physical activity for health have been minor over time, the current guidelines for healthy adults aged 19-64 are 150 minutes of moderate intensity physical activity, 75 minutes of vigorous intensity physical activity or a combination of both each week, and are currently published in the ‘Start Active, Stay Active’ report, which was released by Sport England in 2011 (3).
Despite reports such as ‘Start Active, Stay Active’ positioning physical activity in policy and practice as a method of improving health outcomes as well as the continued growth of the fitness industry which is now worth an eye-watering £5 billion in the UK alone, the promotion of physical activity has been met with limited success with only 23-32% of women and 33-43% of men in the UK meeting the physical activity guidelines (3). These figures have consequently justified the call for practitioners and policy makers to seek further solutions to increase the nation’s physical activity levels through interventions, policies and public health messaging.
Based on these figures, it is evident that collectively as a nation we do need to ‘move more’ and this is perhaps partly why simple phrases like the aforementioned are drummed out without context or consideration to the constraints, which prevent people from getting active. However stating the seemingly obvious has so far neither proven to be helpful or effective in supporting people take action and in some cases it can create more problems than it solves.
Public attitudes towards health behaviours such as physical activity are particularly strong, with those who fail to meet guidelines viewed as possessing an individual deficiency, assumed simply to be non-compliant, lazy or a reflection of someone’s virtuosity. This perception isn’t reserved to the public but seeps into professional domains too and is often overlooked or uncontested. Opinions like this do not just naturally form on their own; rather they are shaped by a combination of media coverage, contemporary public policy and health messages. One reason for this is that current public policy and health messages draw much of their evidence from biomedical research and allows for a direction, which is concise, clear and expedient often omitting the nuance to complex topics.
Whilst biomedical research is undeniably important through it’s contribution to saving lives, improving patient care and integrality in the pursuit of further knowledge, the issue of framing the problem of physical inactivity from solely this perspective limits our understanding of why a large percentage of the population are struggling to meet the physical activity guidelines. The emphasis on the use of biomedical research has also led to the development of policies and interventions which places the focus on the individual through simple messaging and lifestyle interventions that emphasise individual behaviour change without reference or understanding to how deprivation, hardship, social and environmental structures might impact how people may get active (4).
How do external + lifestyle factors create barriers?
It is unsurprising that the deeply held belief that physical activity is simply a matter of individual responsibility where people need to simply prioritise or exercise more willpower, particularly when this narrative is built into the fabric of our society and health inequalities are rarely covered in the media (5). However our uncritical acceptance of this discourse ignores important data, which highlights the fallacy of personal responsibility framing. When we look at the national data on physical activity levels, the proportion of the population at the lower end of the socio-economic gradient meeting physical activity guidelines is half of that at the higher end of the social gradient (6) . In other words, the worse off you are socioeconomically, the less likely you are to meet physical activity guidelines.
These statistics aren’t a reflection of virtuous differences across social classes; rather they highlight how health behaviours such as physical activity are influenced by multiple, multilevel factors beyond the individual, as well as our failures to address these health inequalities in current physical activity discourse. In conversations of behaviour change and health, we’ll often hear phrases such as ‘we all have the same 24 hours in the day’, ‘what’s your excuse’ or the seemingly more sensible “lifestyle choices” as if people are choosing inactivity, ill-health and disease. This dominant dialogue often from able-bodied, middle class people omits the complexity and variations that shape our lives and how behaviours are not only influenced by our cognition but the forever changing social, economic and environmental structures around us which can affect our health (7). Poverty, deprivation and material hardship are all factors which can affect both our health and ability to engage in health behaviours such as physical activity, yet despite the ever-growing evidence around health inequalities, we fail to even acknowledge these disparities within policy, practice and conversation pertaining moving our bodies (8).
It is undeniable that some people may find incorporating physical activity into their daily & weekly routines relatively easy, but I reject the idea that if one person can do it then anyone can, because not everyone has the opportunity or conditions to do so. For example, a single mother at a higher weight on a low income, working multiple jobs to support herself and her two children, both financially and emotionally, is less likely to have the opportunity to get active than a single adult with no dependents and plenty of disposable income. This could be due to a number of factors which affect physical activity levels not limited to cost of gym membership, travel (cost, time and availability), cost of childcare, lack of appropriate transport, lack of hours beyond work and caring for own children, exhaustion, choosing between time spent with loved ones or time spent getting active, lack of safe green spaces, an unsafe neighbourhood, lack of nearby facilities, lack of appropriate support, weight stigma (both internal and external), lack of motivation, psychological distress, sexism or lack of choice of activities which they may find enjoyable or are likely to sustain (9–13).
Telling this single mother in the aforementioned example to ‘move more’ might be considered ‘the truth’, but it fails to address the structural and psychological barriers, which make getting active so much harder compared to those who aren’t constrained by these barriers and have the capacity to make individual behaviours changes. Of course there are outliers who meet the guidelines despite hardship and deprivation, but they are the exception not the rule. When we treat people as a collective through simple messaging, advice and interventions which ignore the individual needs and experiences, we fail to provide people with circumstance appropriate guidance and perpetuates the notion that physical inactivity is a choice or reflection of personal characteristics rather than constrained by factors outside of individual control.
I know as a society we are always searching for simple answers to explain complex problems and I often think that our collective attempt at over-simplification is part of the problem. Whilst this isn’t a dispute on the relevancy of biomedical research in the context of physical activity neither am I suggesting that lifestyle interventions are useless, I am highlighting that current discourse around physical activity only paints part of the picture and addressing inactivity solely from a medical-model is not only counter-productive but potentially harmful by implying that we all have the same opportunities and exacerbating inequalities by failing to support those who need it most through policies and interventions which cater to those who have the capacity to make changes.
I’d like to stress that this isn’t negating the importance or relevance of individual behaviours, nor is it meant to be disempowering or leaving people feeling helpless. Rather this is highlighting the issues of framing physical activity as a personal responsibility or moral imperative and stating they are no longer viable narratives. Instead, it’s important we do more to support others by taking the time to understand personal experiences, empathy and addressing the interrelated barriers is something more of us need to acknowledge in ensuring physical activity is more equitable and not just reserved to those who can either afford it or already beneficiaries to the current system.
Everyone should be able to have the opportunity to get active and no one should be judged for struggling to within this economic climate.
References
(1) Cheyne G. An essay of health and long life. George Strahan; 1724.
(2) Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical
activity: the evidence. Can Med Assoc J [Internet]. 2006 Mar 14;174(6):801 LP-809. Available from: http://www.cmaj.ca/content/174/6/801.abstract
(3) Department of Health. Start Active, Stay Active: A report on physical activity from the four home countries’ Chief Medical Officer. 2011;62. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf
(4) Kay T. Bodies of knowledge: connecting the evidence bases on
physical activity and health inequalities. Int J Sport Policy [Internet]. Routledge; 2016;8(4):539–57. Available from: http://dx.doi.org/10.1080/19406940.2016.1228690
(5) Levay K, Gibbons C, Down L, O’Neil M, Volmert A. Only Part of the
Story: Media and Organisational Discourse about Health in the United
Kingdom. Fram Inst. 2018;
(6) Public Health England. Everybody active , every day. An evidence-
based approach to physical activity. 2014;1–23.
(7) Marmot M, Alpbach EF. Fair Society Health Lives Michael Marmot
European Forum Alpbach August 2013 Why we need to tackle health
inequalities • Moral responsibility • Much can done in countries at all
levels • Financial difficulties are not a barrier. 2010;(August):1–27.
(8) Bambra C, Smith KE, Garthwaite K, Joyce KE, Hunter DJ. A labour of
Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. J Epidemiol Community Health [Internet]. 2011 May 1;65(5):399 LP-406. Available from: http://jech.bmj.com/content/65/5/399.abstract
(9) R. VL, A. NS. Internalized Societal Attitudes Moderate the Impact of
Weight Stigma on Avoidance of Exercise. Obesity [Internet]. Wiley-Blackwell; 2012 Sep 6;19(4):757–62. Available from: https://doi.org/10.1038/oby.2010.234
(10) Bodde AE, Seo D, Ph D. A review of social and environmental barriers to physical activity for adults with intellectual disabilities. Disabil Health J [Internet]. Elsevier Inc; 2009;2(2):57–66. Available from: http://dx.doi.org/10.1016/j.dhjo.2008.11.004
(11) Humpel N, Owen N, Leslie E. Environmental factors associated with adults ’ participation in physical activity : a review. 2002;22:188–99.
(12) Esteban-Cornejo I, Carlson JA, Conway TL, Cain KL, Saelens BE, Frank LD, et al. Parental and Adolescent Perceptions of Neighborhood Safety Related to Adolescents’ Physical Activity in Their Neighborhood. Res Q Exerc Sport [Internet]. 2016/03/30. 2016 Jun;87(2):191–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27030158
(13) Ball K, Carver A, Downing K, Jackson M, Rourke KO. Addressing the
social determinants of inequities in physical activity and sedentary
behaviours. 2015;30:8–19.
