Health-enhancing Physical Activity Policies Research Articles

A systematic evaluation of physical activity and diet policies in Scotland: results from the 2021 Active Healthy Kids Report Card.

Policymaking regarding physical activity (PA) and diet plays an important role in childhood health promotion. This study provides a detailed examination of Scottish government and policy for child and adolescent PA and diet and discusses strengths and areas for improvement. Scottish policy documents (n=18 [PA]; n=10 [diet])-published in 2011-20-were reviewed for grading using an adapted version of the Health-Enhancing Physical Activity Policy Audit Tool Version 2. There is clear evidence of leadership and commitment to improving PA and diet and tackling obesity in children and adolescents. The allocation of funds and resources for policy implementation has increased substantially over the past decade. Progress through early key stages of public policymaking-policy agenda and formation-has improved. However, there is limited information on later key stages, including policy monitoring and evaluation. Childhood PA and diet are a clear priority in Scotland, and PA and diet policies clearly support the desire to achieve other goals, including reducing inequalities and increasing active travel in Scotland. Nonetheless, future policies should be further strengthened through clear(er) plans of implementation, and monitoring and evaluation to support their societal impact.

7.F. Workshop: Local physical activity policy evaluation: state of the art, tools and methods and future directions

Abstract Insufficient physical activity (PA) is one of the most significant risk factors for chronic diseases and premature mortality worldwide. Public policies are recognized as upstream factors providing system change beyond individual changes. Policies have been recognised as an effective way to increase population PA levels, as they support the development of evidence-based interventions and programs in different domains, that help create a ‘healthy’ PA environment and enhanced PA opportunities. Previous studies have shown an important impact of PA promotion policies at local level (municipalities), but insufficient research and tool development has been realised on PA policies beyond national level. First, the workshop will briefly describe the scientific state of the art on local PA promotion policies evaluation, based on results from a literature review. Second, the panel will present the CAPLA-Santé, a policy evaluation tool designed by a stakeholders’ group in France, based on the Health Enhancing Physical Activity Policy Audit Tool of the World Health Organisation, to comprehensively review local PA policies. The final version of CAPLA-Santé contains 21 items divided into six sections: 1. Overview of HEPA stakeholders in the local government area, 2. Policy documents, 3. Policy contents, 4. Funding and political engagement, 5. Studies and measures relating to physical activity in the local government area, and 6. Progress achieved and future challenges. CAPLA-Santé allows the collection and in-depth analysis of local level policies to assess the progress in promoting PA and intersectoral collaboration as well as identifying successful policy levers and remaining challenges. Third, the panel will illustrate its use in 5 countries worldwide (Finland, France, Germany, Japan and Romania), summarising findings and explaining how such tools allow cross-cultural comparison. Fourth, panellists will discuss the challenges and success in using such tools and provide insights on how these tools can serve as capacity building for policy makers and to draw recommendations, as well as cross-cultural comparisons. Key messages • The workshop will provide key advise on how to monitor local physical activity policies. • The workshop will equip participants with tools to face the challenge of local physical activity policy evaluation. Speakers/Panelists Petru Sandu Cluj School of Public Health, Babes-Bolyai University in Cluj-Napoca, Cluj-Napoca, Romania Anne Vuillemin Université Côte d’Azur, Nice, France François Berdougo Société Française de Santé Publique, Laxou, France Peter Gelius FAU Erlangen-Nürnberg, Erlangen, Germany

Healthy fitness zone prevalence and age-specific fitness profile of young people in seven European countries in 2022: The EUFITMOS project.

Physical fitness is a health marker in youth and is associated with current and future health. Present the healthy fitness zone (HFZ) prevalence and age-specific fitness profile of young people from seven European countries. This study used data from the European Fitness Monitoring System project. The sample comprised 4965 (51.4% boys) youths aged 9 to 18 years. Fitness data were collected by physical education teachers using field-based tests. Raw data from the fitness tests were used to calculate the prevalence and 95% confidence intervals (CI) of participants in the HFZ. The overall prevalence of boys and girls in the HFZ for all tests was 16.6% (95% CI = 14.7, 18.1) and 14.9% (95% CI = 13.2, 16.6), respectively. Boys have a mainly positive HFZ profiles, except for the 9-year-olds in the sit and reach (z-score difference = -1.20) and the 20 m run for boys 13-18-year-olds (z-score difference range: -0.09 to -0.01). Girls have worse HFZ profiles than boys, being out of the HFZ in several tests. Furthermore, a decreasing trend in z-score difference from the HFZ with age was observed in VO2 peak for boys and girls and sit and reach for girls. Notwithstanding, several country-related, sex and age differences were observed. Boys presented mostly healthy age-specific fitness profiles in several fitness tests and ages. These differences should be considered when promoting youth's health through physical activity and fitness, as different fitness levels may require different approaches to implementing health-enhancing physical activity policies.

S10-3 Research on policy audits for promoting physical activity at the local level in Japan

Abstract Purpose Increasing levels of health-enhancing physical activity (HEPA) requires a comprehensive policy framework across all political levels. At the local level, Japan has a two-tier system of government: prefectures and municipalities. We developed specific tools to identify the strengths and weaknesses of the implementation of national HEPA policies by the different local governments. Methods We started by developing and testing the Local Policy Audit Tool (L-PAT) in all 47 Japanese prefectures (Takeda et al. 2019). It comprises 11 items based on WHO’s HEPA Policy Audit Tool (PAT), covering key policy actions such as: the presence of a local action plan; its implementation; and cross-sectoral cooperation. The L-PAT was sent to key government departments (e.g. health, sports, urban planning and transport) in all prefectures. As a second step, we assessed the development and implementation of local action plans for HEPA promotion in municipalities using the City PAT (C-PAT), which employs six questions based on the HEPA PAT. We surveyed a random selection of 272 out of Japan’s 1,700+ municipalities, stratified by administrative division and population. Results The results of the L-PAT indicate that health and sports are the most active departments in promoting HEPA policy at prefecture level. Some prefectures also reported HEPA actions by the urban planning and transport sectors, although these sectors are not covered by the national policy. A major result of the C-PAT survey was that the scale and contents of projects implemented differed depending on the size of the municipality. Both tools revealed that local governments have a low awareness of the “Japanese physical activity guidelines for health promotion 2013” in their policy planning and implementation. Conclusions In 2023, both the Japanese physical activity guidelines and the government's most comprehensive health policy, “Healthy Japan 21”, will undergo major revisions. The next step after the L-PAT and C-PAT would be to revise the content of the C-PAT questionnaire to increase its usefulness; that is, a policy audit tool for continuously monitoring local HEPA policies will be created on this occasion, aimed at supporting future national planning processes for HEPA promotion.

O.6.2-8 Enforcing physical education in the official examinations in Anglophone Cameroon

Abstract Purpose Cameroon has two main educational systems: English and French, which have a colonial heritage. The controversy is that each educational sub-system has its own curriculum. In the French-speaking part of the country, sports and physical education are mandatory for obtaining the CEPE, Baccalaureate, and any other public examination. In the English-speaking part, sports and physical education are yet to be included in the curriculum. The goal of this policy paper is to change the narrative of the curriculum of public examinations in Cameroon's anglophone educational sub-system by following the example of the country's French part. This policy paper targets curriculum developers, the General Certificate of Education Board, and the Ministries of Education. What will be innovative is that students from English-speaking Cameroon will also be included in sports activities at an early age. Project or policy description Development: We used the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) to collect data at the ministries of education, the Ministry of Sports and Physical Education, 197 public schools, and 204 health care facilities. Content analysis, ethnographic studies, and Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis are used to assess why average French-speaking Cameroonians have a longer life span, are physically active, and participate in more high-level sports than their English-speaking counterparts. The Cameroon Government Certificate (GCE) of Education Board is in charge of putting this project into action. Sports and physical education should be required courses for both the ordinary and advanced levels of the GCE. We will implement the process and conduct an impact assessment. With the process evaluation, we will monitor if the program is meeting the intended goals. The impact evaluation will give a broader view of the outcome of the program. Conclusions When this policy is put into place, the English-speaking part of Cameroon will have HEPA and be pushed to be as healthy and fit as the French-speaking part.

O.4.4-3 Developing a bespoke undergraduate physical activity course for a Portuguese Medical School - the VANGUARD European Union Erasmus+ project

Abstract Purpose Embedding physical activity in the undergraduate curricula of frontline health professionals is one of the policies recommended by the World Health Organization and the European Commission to promote health-enhancing physical activity (HEPA). The VANGUARD project is supported by the European Union Erasmus+ Programme, and aims to embed physical activity in the undergraduate curricula of healthcare professionals in European countries. Within this project, this work aimed to describe the bespoke development of a physical activity and health course integrated into the undergraduate medical curriculum of a Portuguese Medical School. Project or policy description The School of Medicine and Biomedical Sciences of the University of Porto (ICBAS) was the invited Medical School to implement the VANGUARD project in Portugal - led by the Institute of Public Health of the University of Porto (ISPUP). An auscultation process with the undergraduate medical students was held to evaluate the importance of HEPA in their curriculum and assess the preferred operational characteristics of including a physical activity and health course in the Integrated Master’s degree in Medicine. A course proposal structure was then developed by the VANGUARD project Portuguese team from ISPUP, the Director of the Integrated Master’s degree in Medicine, and the Coordinator of the Medical Education Office of ICBAS, based on the students’ acceptability, the Medical School constraints, and VANGUARD project goals and resources. The course integrates 26 lessons, from physical activity technical terminology, epidemiology and guidelines, going through its relation with noncommunicable diseases (using #MovementForMovement resources), to Portuguese National Health Service brief intervention tools and community-based exercise programs - in a total of 20 hours of contact, including continuous evaluation and final case studies analysis. The course will be offered on an optional basis to 2nd-year medical students, on an online training platform, using a self-paced learning method. After embedding this course in ICBAS, it will be presented to the Council of Portuguese Medical Schools to be scaled up nationally. Conclusions Medical doctors and Medical Schools are key stakeholders in HEPA promotion, especially in the health sector. Successful implementation of HEPA policies requires tailored solutions to organizations and direct involvement of target groups in policy development.

Analysis of national physical activity and sedentary behaviour policies in China

PurposeThe aims of this study were to advance knowledge on physical activity (PA) and sedentary behaviour (SB) policies in China and to highlight related gaps and opportunities in the Chinese policy landscape.MethodsLiterature and web-based searches were performed to identify national PA and SB policies in China. We assessed which of the 17 elements of the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT, version 2) are included in each of the policy documents and whether and how they address the ‘cornerstones’ of PA and SB policy: PA and SB guidelines, targets, surveillance and monitoring, and public education programmes.ResultsWe found 60 national PA and SB policies, of which 54 focused on PA only and 6 focused on both PA and SB. There was a rapid increase in the number of policies issued between 2002 and 2021. In totality, the policies include all 17 key elements for a successful national policy approach to PA promotion according to the HEPA PAT. The policies reflect engagement from a range of sectors and encompass PA targets, recommendations for PA and SB, mandates and recommendations for school-related PA, plans for public education on PA, and plans for surveillance and monitoring of PA and SB.ConclusionOur findings demonstrate that there has been increasing focus on PA and SB policies in China, which reflects efforts by policymakers to address the health burden of insufficient PA and excessive SB. More emphasis may be placed on SB in Chinese policy, particularly in terms of setting specific targets for population SB. Policymakers and other relevant public health stakeholders in China could also consider developing or adopting the 24-hour movement guidelines, in accordance with recent trends in several other countries. Collaboration and involvement of different sectors in the development and implementation of Chinese PA and SB policies should continue to be facilitated as part of a whole-of-system approach to health promotion.

O6-3 Analysis of the local health-enhancing physical activity policies in the French Riviera

BackgroundAccording to the socio-ecological model, policy is one of the levers to initiate structural and environmental changes to foster health-enhancing physical activity (HEPA) promotion (Golden et al., 2015). However, little is known about local evidence to support governments in their policies to promote HEPA (Bull, 2018). Research on HEPA policies at local level seems particularly remains scant (Noël Racine et al., 2020). This study aims to carry out the collection of comprehensive information on municipal HEPA policies of the French Riviera to provide an overview of the development of these policies on this territory.MethodsMid-size cities from 2 counties of the French South Region were targeted (n = 17). In each city, a local HEPA policy analysis tool, CAPLA-Santé, was administered to key informants heading the departments of sport, health and social. CAPLA-Santé is a local policy analysis tool adapted from the national HEPA policy analysis tool (HEPA PAT version 2) developed by the World Health Organization. Data were collected through semi-structured interviews and documents analysis. These empirical data were used to make an inductive analysis.ResultsA total of 10 mid-size cities were volunteered to participate. Key informants from sport (n = 10), health (n = 5) and social (n = 6) departments were interviewed. Several written HEPA policies were formalized in 6 cities, 4 of them based their policies on scientific evidences or a national policy. These policies (n = 14), were mainly from the sport (n = 8) and the health sectors (n = 4). Some cities had a department head to ensure cross-sectoral collaboration (n = 3). Key informants reported that the support of national policies, the commitment of elected officials and an important local stakeholders' network could facilitate the HEPA promotion; whereas lack of intersectoral collaboration and resources could be a limitation.ConclusionsThe results help to better understand the local HEPA policies, highlighting some barriers, facilitators and perspectives. Using a local HEPA policy analysis tool can provide evidence to support policymakers. These findings could be valuable to scale up the HEPA promotion at the local level.

O4-2 Evaluate the health-enhancing physical activity policy of Rio de Janeiro: ‘Programa Academia Carioca'

Issue and problemIn Brazil, 47% of people are insufficiently physically active (Guthold et al, 2018). According to the Global Physical Activity Observatory, 13.2% of deaths in Brazil are caused by inactivity. Besides, Ding et al (2016) estimated the direct health cost attributable to physical inactivity in this country at 1.6 billion US dollars. Rio de Janeiro (RJ) is one of the largest cities in Brazil, with a high mortality rate (54.1%) from non-communicable diseases (NCDs) and substantial health inequalities (SIM/MRJ, 2019). As a large city, it reproduces a worldwide trend, which associates economic growth and urbanization with an unhealthy lifestyle and epidemic levels of obesity and remarkable physical inactivity (WHO, 2014).Problem descriptionThe multifactorial context above described enables NCDs and challenges health protection systems. For this reason, the Municipal Health Department of RJ implemented since 2009 a Health-Enhancing Physical Activity (HEPA) policy: ‘Programa Academia Carioca' (PAC). This policy supports regular physical activity free of charge, in Primary Care Health Units (UAP). The Program combines the practice of physical activity associated with various educational and community activities. It includes Physical Education professionals who work in a multidisciplinary way. Therefore, this study aims to evaluate the implementation of this policy.Results (effects/changes)After 11 years, the PAC has 142,969 participants, 80% of whom have NCDs. Among its participants, blood pressure control was demonstrated in 90% of hypertensive patients; weight loss, and a 60% reduction in cardiovascular risk classification, and suspension of medication in 20% of users. Being part of the PAC resulted in greater use and understanding of the general services of UAP in 86% and 98% of participants, respectively. Detailed results are not available at that time but will be presented at the conference.LessonsThe PAC showed to be a successful tool to enhance health through physical activity at UAP. The use of trained and specialized professionals plays a fundamental key to develop educational and community actions in vulnerable groups.Main messagesThe implementation of an ambitious and integrated HEPA policy, considering environmental and health factors, can produce more effective institutional responses to change this epidemiological scenario.

Analysis of the Texts Framing the practice of Health-Promoting Physical Activities in Burkina Faso

Physical inactivity and sedentary lifestyle are recognized as risk factors for non-communicable diseases and avoidable mortality. It is in this context that the promotion of physical activity and sport has become a real public health issue and is included in most medical recommendations of learned societies. Multiple determinants affect the adoption of a physically active lifestyle. This situation has led to the development, implementation and coordination of public policy documents that promote the practice of health-promoting physical activities. In this context, the World Health Organization (WHO) has developed the Health Enhancing Physical Activity Policy Analisis Tool (HEPA PAT) to support countries in developing and evaluating strategies and policies that address all the determinants of health-enhancing physical activity. Burkina Faso, like other countries in the world, is confronted with the problem of physical inactivity with its corollaries on health. In order to find palliative solutions to this scourge, the government, through the ministry in charge of sports and leisure, has developed texts to stimulate the practice of physical activities and sports. The objective of this study is to evaluate the policies governing the practice of physical activities and sports in Burkina Faso. To this end, the HEPA PAT tool was used as an analysis model. It was found that the policies governing the practice of physical activity and sport contain only eight of the 17 criteria required to create an appropriate context for the development of health-promoting physical activity and sport. Therefore, it is necessary for the government of Burkina Faso to integrate the nine other criteria without which the expected results cannot be achieved.

Health Enhancing Physical Activity Policies in Poland: Findings from the HEPA PAT Survey.

Insufficient physical activity (PA) is one of major risk factors for serious diseases and premature mortality worldwide. Public policies to enhance PA across society are recognized as an effective tool against the problem. This paper presents the results of a comprehensive assessment of national-level PA policy approach in Poland. A standardized survey of Word Health Organization named the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) was used for data collection. Content analysis and strengths, weaknesses, opportunities, and threats analysis (SWOT) were used to characterize various PA policy aspects, to appraise the current situation, and accommodate organizational and environmental factors that it is influenced by. The results show that the national PA policy approach has been constantly developing in Poland, but there is room for improvement in a number of areas. The most important weaknesses are the lack of clear leadership, no mechanisms in place to coordinate efforts undertaken at different levels, and lack of collaboration across different levels of government and across different sectors of economy. Providing an umbrella covering all PA promotion policies and activities is, therefore, a key issue to be addressed. The country should seize the opportunity coming from an increasing awareness of a healthy lifestyle among Polish society.

Modeling the Development of Local Health-Enhancing Physical Activity Policies from Empirical Data and Policy Science Theories.

Physical inactivity is considered a pandemic, requiring strong policy responses to address this major health issue. However, research on the development of Health-Enhancing Physical Activity policies (HEPA) remains scarce, particularly at the local level. There is a need to produce evidence to better understand the process to develop local HEPA policies. This study aims to model the development of HEPA policy promotion in French municipalities from empirical data and policy science theories. This research was undertaken in three steps: (1) assess the level of development of HEPA policies from 10 French municipalities using a local HEPA analysis tool, (2) provide a brief overview of core political science theories applied in health promotion, and (3) from these empirical and theoretical perspectives, model a conceptual framework to better understand the development of HEPA policy promotion in French municipalities. Based on empirical data and the Multiple Streams, policy cycles and Institutional Rational Choice theories, a conceptual framework of the development of municipal HEPA policy promotion was modeled. This conceptual framework is comprised of five stages describing the development of municipal HEPA policies. This paper contributes to a better understanding of the development of municipal HEPA policies.

A Critique of National Physical Activity Policy in Oman Using 3 Established Policy Frameworks.

This paper aimed to assess the development process, content, and early implementation of Oman's national physical activity plan of action to identify strengths and areas for improvement. Data were extracted from 4 documents: national noncommunicable diseases policy, physical activity plan of action, and 2 World Health Organization Mission Reports. Three policy frameworks and approaches (physical activity content analysis grid, health-enhancing physical activity policy audit tool, and policy cube approach for diet-related noncommunicable diseases) were used. The findings demonstrated that policymakers engaged a broad range of sectors in developing a national plan. It aligned with many of the elements from the 3 policy frameworks (ie,multisectoral approach, political commitment/leadership, identification of national goals and targets, time frame for implementation). The main gaps included the lack of a specified sustainable funding mechanism, systems for monitoring progress, and an emphasis on general interventions, with limited focus on specific target groups. A range of sectors were engaged in the development of Oman's national physical activity plan of action, with strong political commitment and using global guidance and local evidence. Establishing a strong accountability framework, including a clear financing mechanism, is critical for Oman to meet its target for a 10% relative reduction in physical inactivity by 2025.

Promoting health-enhancing physical activity in Europe: Surveillance, policy development and implementation 2015–2018

In the European Union (EU), the low levels of health-enhancing physical activity (HEPA) and high levels of sedentary behaviour are a concerning public health issue common to all Member States. In 2013, the Council of the EU recognized the need for more data related to HEPA to support policymaking across the region and proposed a monitoring framework that included 23 indicators covering different themes relevant to HEPA promotion in the EU context. In 2014, the EU Physical Activity Focal Points Network was established to support the implementation of the monitoring framework and in 2015 and 2018 surveys were conducted to collect epidemiological and policy information related to HEPA for each Member State. This paper aims to provide an update on the status of HEPA policies and surveillance in the EU and describe the changes that have occurred since 2015. In 2018, all countries had implemented more than 10 indicators, 8/28 had implemented 20 or more indicators, and only one country had completed all 23 indicators. From 2015 to 2018, 19 indicators improved, one remained unchanged, and three regressed. From the country perspective, 17 improved the number of accomplished indicators, five maintained the indicators, and five worsened the number of indicators. Overall, there has been a clear increase in the number of countries implementing HEPA policies and strategies across the different sectors, although some heterogeneity between Members Sates was still observed. Implementation of regional physical activity strategies and the establishment of the EU-wide monitoring framework appears to have had an overall positive impact on HEPA policy development and implementation.

The added value of using the HEPA PAT for physical activity policy monitoring: a four-country comparison

BackgroundPublic policy is increasingly recognized as an important component of physical activity promotion. This paper reports on the current status of physical activity policy development and implementation in four European countries based on the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) developed by WHO. It compares the findings to previous studies and discusses the general utility of this tool and its unique features in relation to other instruments.MethodsThe study was conducted as part of the Policy Evaluation Network (www.jpi-pen.eu) in Germany, Ireland, the Netherlands and Poland. Data collection built upon information obtained via the EU Physical Activity Monitoring Framework survey, additional desk research and expert opinion. Data analysis employed Howlett’s policy cycle framework to map and compare national physical activity policies in the four countries.ResultsIn all countries under study, policy agenda-setting is influenced by prevalence data from national health monitoring systems, and the sport and/or health sector takes the lead in policy formulation. Key policy documents were located mainly in the health sector but also in sport, urban design and transport. Physical activity programmes implemented to meet policy objectives usually cover a broad range of target groups, but currently only a small selection of major policies are evaluated for effectiveness. National experts made several suggestions to other countries wishing to establish physical activity policies, e.g. regarding cross-sectoral support and coordination, comprehensive national action plans, and monitoring/surveillance.ConclusionsThis study provides a detailed overview of physical activity policies in the four countries. Results show that national governments are already very active in the field but that there is room for improvement in a number of areas, e.g. regarding the contribution of sectors beyond sport and health. Using the HEPA PAT simultaneously in four countries also showed that procedures and timelines have to be adapted to national contexts. Overall, the instrument can make an important contribution to understanding and informing physical activity policy, especially when used as an add-on to regular monitoring tools like the EU HEPA Monitoring Framework.

Analysis of the Local Health-Enhancing Physical Activity Policies on the French Riviera.

Policy is a lever for initiating the structural and environmental changes that foster health-enhancing physical activity (HEPA) promotion. However, little is known about the evidence in support of local governments regarding their HEPA-promoting policies. The aim of this study was to collect comprehensive information on municipal HEPA policies on the French Riviera (Alpes-Maritimes and Var counties) to provide an overview of the development of these policies in this territory. Mid-sized cities from the two counties constituting the French Riviera were targeted (n = 17). In each city, a local tool for HEPA policy analysis, CAPLA-Santé, was used to gain information from key informants heading the departments of sports, health services, and social services. Data were collected through semi-structured interviews and document analysis. Ten mid-sized cities volunteered to participate. Key informants from the sports (n = 10), health services (n = 5), and social services (n = 6) departments were interviewed. Written HEPA policy documents were formalized in six cities. These documents (n = 14) were mainly from the sports (n = 8) and health services (n = 4) sectors. The key informants reported that support from national policy, the commitment of elected officials, and large local stakeholder networks facilitated HEPA promotion, whereas the lack of intersectoral collaboration and limited resources were limitations. The results provide insight into the development of municipal HEPA policies, highlighting some of the barriers, facilitators, and perspectives. These findings could be valuable to scale up HEPA promotion at the local level.

A Rapid Review of Communication Strategies for Physical Activity Guidelines and Physical Activity Promotion: A Review of Worldwide Strategies.

To support the strategy development for communication of the updated physical activity (PA) guidelines, the UK Chief Medical Officers' Expert Panel for Communication was created. To help inform this process, a rapid review was performed to identify and describe how other nations are communicating their PA guidelines and PA generally. Elements of the health-enhancing physical activity policy audit tool created by the World Health Organization were used to investigate all 195 countries. Seventy-seven countries had their own guidelines; 53 used the World Health Organization guidelines, and for 65 countries, no guidelines could be found. For the communication, 27 countries used infographics; 56 had government policies/documents, and 11 used a mass media campaign. Only 6 of these had been evaluated. Although many countries used infographics, there were no associated evaluations. As such, any future communication strategies should incorporate an evaluation. Mass media campaigns had the strongest evidence base, proving to be an effective strategy, particularly when incorporating aspects of social marketing. This review provides an insight into strategies countries worldwide have taken to communicate PA guidelines and PA promotion. These should be carefully considered when deciding how best to communicate and promote PA guidelines.

Analysis of the local health-enhancing physical activity policies in the French Riviera

Abstract Background Policy is one of the levers to initiate structural and environmental changes to foster health-enhancing physical activity (HEPA) promotion. However, little is known about local evidence to support governments in their policies to promote HEPA. This study aims to analyze the local HEPA policies development in French mid-size cities. Methods Mid-size cities from 2 counties of the French South Region were targeted (n = 17). In each city, a local HEPA policy analysis tool, CAPLA-Santé, was administered to key informants heading the departments of sport, health and social. CAPLA-Santé is a local policy analysis tool adapted from the national HEPA policy analysis tool (HEPA PAT version 2) developed by the World Health Organization. Data were collected through semi-structured interviews and documents analysis. Results A total of 10 mid-size cities were volunteered to participate. Key informants from sport (n = 10), health (n = 5) and social (n = 6) departments were interviewed. Several written HEPA policies were formalized in 6 cities, 4 of them based their policies on scientific evidences or a national policy. These policies (n = 14), were mainly from the sport (n = 8) and the health sectors (n = 4). Some cities had a department head to ensure cross-sectoral collaboration (n = 3). Key informants reported that the support of national policies, the commitment of elected officials and an important local stakeholders' network could facilitate the HEPA promotion; whereas lack of intersectoral collaboration and resources could be a limitation. Conclusions The results help to better understand the local HEPA policies, highlighting some barriers, facilitators and perspectives. These findings could be valuable to scale up the HEPA promotion at the local level. Key messages Local policymakers had difficulties to adopt an intersectoral and global approaches in HEPA promotion. Using local HEPA policy analysis tool can provide evidence to support policymakers.

Perceptions of barriers and levers of health-enhancing physical activity policies in mid-size French municipalities

BackgroundPolicy is one of the levers for initiating structural change to foster the promotion of health-enhancing physical activity (HEPA). To this end, policy-makers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been conducted on this topic at the local level. The purpose of this study was to identify the perceived barriers and levers of HEPA policies according to department heads and elected officials across various sectors in mid-size French municipalities.MethodsThis study used a mixed method primarily based on an adaptation of the concept mapping approach. A list of statements completing the sentence: ‘In a mid-size municipal context, to develop HEPA policies, it is necessary to …’ was submitted to key informants of 17 mid-sized French cities. Key informants in each municipality first rated the importance of each statement without considering their local context; they then rated the feasibility of each statement given their local context. In both cases, they used a Likert scale ranging from 1 to 6.ResultsA total of 23 municipal department heads and 10 elected officials from the sport (n = 14), health (n = 10) and social (n = 9) sectors in 11 mid-size French cities participated in this study. A list of 84 statements, sorted into 16 categories, was rated by participants according to their importance (M = 4.52, SD = 0.86) and their feasibility (M = 3.77, SD = 0.74). Potential barriers to (n = 10) and levers of (n = 38) HEPA policy development were identified. These results varied according to the position and sector of the participants.ConclusionsThe results suggest that local contextual factors can affect the development of HEPA policies in mid-size French municipalities. The different perceptions of the potential levers and barriers according to sector might affect intersectoral collaboration. This study contributes by enhancing understanding of how local HEPA policies are developed in the French context.

Development of a Local Health-Enhancing Physical Activity Policy Analysis Tool in France: CAPLA-Santé

The promotion of health-enhancing physical activity (HEPA) has become a key objective in public health policy. Therefore, based on the national HEPA Policy Audit Tool Version 2 (HEPA PAT v2) of the World Health Organization, a tool was designed to support local governments in assessing HEPA policies. This study aims to describe the adaptation and testing of the HEPA policy analysis tool (CAPLA-Santé) at the local level in France. The work was conducted in three stages: (1) an intersectoral group of experts was constituted, and the group adapted each item of the HEPA PAT v2 tool to the local level; (2) a testing phase with seven local governments helped to collect data and feedback on the tool; and (3) a final workshop was organized to adjust and finalize the tool. The final version of CAPLA-Santé contains 21 items divided into six major sections: overview of HEPA stakeholders in the local government area, policy documents, policy contents, funding and political engagement, studies and measures relating to physical activity in the local government area, and progress achieved and future challenges. CAPLA-Santé allows the collection and in-depth analysis of local level policies to assess the progress in promoting HEPA and intersectoral collaboration as well as identifying successful policy levers and remaining challenges.