Promotion Of Health-enhancing Physical Activity Research Articles

S12-3 School-based physical activity promotion in a cross-cultural context: interventions from France and Spain

Abstract Purpose School-based interventions seems to be effective to promote active lifestyles among youth but recent literature shows that these interventions have a lack of effectiveness and very few report data on its sustainability. In the same way, few of these interventions are being replicated in different contexts than their beginning. Therefore, the balance between the adaptability and fidelity of a programme in a new context is nowadays an implementation gap. Project For this reason, the 2PASS-4Health (Promoting PA in Secondary Schools for Health) project has created a collaborative network between different European universities with the purpose of promoting Health-Enhancing Physical Activity (HEPA) in adolescents in a school-based environment. This project was made to identify the good practices and the main problems linked to the design, implementation, evaluation, and sustainability of interventions aimed at HEPA promotion. In this line, two school-based (effective) interventions in a cross-cultural context have been disseminated and developed, at the same time, both in France and Spain respectively to examine the key parts in the process of fidelity, adaptability and sustainability of them. The intervention developed in France, took place in Tarbes, a little city in the south of the country. In the other side of the Pyrenees, the other intervention took place in Jaca (Spain), in the north of Aragon’s region. Both interventions adopted a multi-level approach involving all parts of the educational community: students, families, teachers and policymakers. The research team (all together) with the school’s staff developed the interventions by a co-creational process helped by local policymakers. As a result of these interventions, an intervention guide was developed. This tool can be used by stakeholders to disseminate and adapt these school-based interventions to make their effects sustainable over time (sustainability). Conclusion The collaborative line of this project renders visible the possibility of connecting cross-cultural educational contexts, through common elements in similar school-based interventions, with the aim of creating environments that promote HEPA.

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.

O.1.1-3 Measuring the mental health benefits of community-based physical activity programmes-what are the most important indicators for pragmatic evaluation?

Abstract Purpose While health enhancing physical activity (HEPA) initiatives can improve mental health, there is a lack of standardised measures to evaluate mental health outcomes. The need for the current work emerged from discussions amongst researcher and practitioner members of the HEPA promotion in socially disadvantaged groups Working Group of the HEPA Europe network. This study aimed to identify the most relevant indicators of mental health and well-being in community-based HEPA initiatives in Europe, and determine optimal assessment methods. Methods An adapted, two round, Delphi method (guided by an indicator framework to categorise mental health indicators based on the dual-continua and socio-ecological models) was conducted with 20 experts in the field of mental health and physical activity from Denmark, the Netherlands, the UK, and Ireland. Experts selected the most important indicators and agreed consensus on definitions and their application, where consensus ≥50% signified important indicators. Results Experts compiled 66 (n = 21 outcome, n = 45 determinant) indicators. Top rated indicators for the evaluation of HEPA initiatives were self-rated mental health (69.2%), physical activity (69.2%) life satisfaction (53.8%), stress (53.8%), loneliness (53.8%), social participation, network, connection and support (53.8%). Consensus on definition and application of the nine indicators varied (44.4% - 100%), with no consensus on a standardised measurement tool reached. Conclusions While this study highlights a lack of conformity for evaluating mental health and wellbeing outcomes, it suggests utility in an agreed definition and application of nine indicators for the evaluation of HEPA initiatives, with social determinants of particularly high importance across all countries. Suggested measures are provided to aid community based practitioners measure mental health outcomes of physical activity programmes. Further research is recommended to develop a standardised measurement tool that can be utilised across other European countries and its implementation tested.

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.

Promotion of health-enhancing physical activity in the sport sector: a study among representatives of 536 sports organisations from 36 European countries

BackgroundIt is a common belief that most sports clubs and organisations are primarily focused on elite sports while placing less emphasis on the promotion of health-enhancing physical activity (HEPA). However, there is a lack of evidence on this topic in the scientific literature. Therefore, the aim of this study was to determine the level and correlates of the commitment of sports organisations in Europe to HEPA promotion.MethodsRepresentatives of 536 sports organisations from 36 European countries responded to our survey. A multiple regression analysis was conducted with the commitment of sports organisation to HEPA promotion (0 [“not at all”] – 10 [“most highly”]) as the outcome variable and organisation type (“national sport association” reference group [ref], “European sports federation”, “national umbrella sports organisation”, “national Olympic committee”, “national sport-for-all organisation”), headquarters in a European Union member state (“no” [ref], “yes”), region of Europe (“Western” [ref], “Central and Eastern”, “Northern”, “Southern”), commitment to elite sports (“low” [ref], “medium”, “high”), and awareness of Sports Club for Health (SCforH) guidelines (“no” [ref], “yes”) as explanatory variables.ResultsApproximately 75.2% (95% confidence interval [CI]: 71.5, 78.8) of sports organisations were highly committed to elite sports. Only 28.2% (95% CI: 24.4, 32.0) of sports organisations reported a high commitment to HEPA promotion. A higher commitment to HEPA promotion was associated with the national Olympic committees (β = 1.48 [95% CI: 0.41, 2.55], p = 0.007), national sport-for-all organisations (β = 1.68 [95% CI: 0.74, 2.62], p < 0.001), location in Central and Eastern Europe (β = 0.56 [95% CI: 0.01, 1.12], p = 0.047), and awareness of SCforH guidelines (β = 0.86 [95% CI: 0.35, 1.37], p < 0.001).ConclusionFrom our findings, it seems that most sports organisations are primarily focused on elite sports. Coordinated actions at the European Union and national levels are needed to improve the promotion of HEPA through sports organisations. In this endeavour, it may be useful to consider national Olympic committees, national sport-for-all organisations, and relevant sports organisations in Central and Eastern Europe as role models and to raise the awareness of SCforH guidelines.

P01-11 Economic impact of health-enhancing-physical activity from different settings in France

BackgroundThere is strong evidence of the multiple benefits of physical activity on health in primary, secondary and tertiary prevention (WHO, 2020). However, economic evaluations are still needed to estimate direct and indirect costs that could be saved from various Health-Enhancing Physical Activity (HEPA) promotion strategies (Ding et al., 2020). Moreover, these savings might be influenced by specificities of the national health system. The aim of this study is to explore the economic impact of HEPA from different settings in France.MethodsA systematic scoping review of grey and scientific literature was conducted. Relevant articles were identified through searching from PubMed, ScienceDirect, SportDiscus databases and from google. Searches were conducted in English and French between January 2000 and December 2020. A data extraction template was used to collect, organize and summarize data regarding the following variables: aim of the study, study population, study settings, methods, and main results.ResultsA total of 17 studies were included from the grey literature (n = 10) and the scientific peer-reviewed literature (n = 7). Data from each variables of interest were heterogeneous, making comparisons difficult. Studies were categorized in 5 types: studies aiming to estimate the cost of physical inactivity or the cost that could be saved from HEPA promotion in general population (n = 8); studies aiming to evaluate the medico-economic impact of a physical activity adapted program (n = 5); studies aiming to assess the economic benefit of active travel in a city (n = 3); study aiming to estimate the economic impact of physical activity from a company and its employee's perspectives (n = 1). Whatever the methods, the study population or the study setting, several tens of millions of euros to several billions of euros could be saved each year by investing in HEPA promotion.ConclusionsHEPA promotion can lead to substantial saving. Methods should be standardized to more precisely estimate its extent in different settings in France. This could help policy-makers in their decision to invest in HEPA promotion, especially in phases of epidemics, where sedentarity and physical inactivity account for major health risks.

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.

P01-17 Promotion of health-enhancing physical activity in Europe: a cross-sectional study among 536 sports associations

BackgroundSports associations may play an important role in the promotion of health-enhancing physical activity (HEPA) in Europe. However, no recent findings on their commitment to HEPA promotion are available. Therefore, we aimed to determine the level and correlates of the commitment of European sports associations to HEPA promotion.MethodsRepresentatives of 1717 sports associations from 36 countries were invited to take part in a survey conducted within the Sports Club for Health (SCforH) 2015-17 project, and 536 (31%) agreed to participate. The participants were asked about their organisation's awareness of SCforH guidelines and its commitment (0-10) to the promotion of: elite sports; health-enhancing sports; health-enhancing exercise, and other types of HEPA. An overall HEPA promotion score was calculated as the arithmetic mean of the latter three. A multiple regression analysis was conducted with the overall HEPA promotion score as the outcome variable and organisation type (“national association of a specific sport” as the reference group [ref], “European sports federation”, “national umbrella sports organisation”, “national Olympic committee”, “national sport-for-all organisation”), headquarters in an EU member state (“no” [ref], “yes”), region of Europe (“Western” [ref], “Central-Eastern”, “Northern”, “Southern”), commitment to elite sports (“low” [ref], “medium”, “high”), and awareness of SCforH guidelines (“no” [ref], “yes”) as explanatory variables.ResultsThe commitment to HEPA promotion was low (score: 0-3) in 32.1% (95% confidence interval [CI]: 28.1, 36.0), medium (4-6) in 39.7% (95% CI: 35.6, 43.9), and high (7-10) in 28.2% (95% CI: 24.4, 32.0) of sports associations. Being a national sport-for-all organisation (β = 1.68; 95% CI: 0.74, 2.62; p > 0.001), national Olympic committee (β = 1.48; 95% CI: 0.41, 2.55; p = 0.007), located in Central-Eastern Europe (β = 0.56; 95% CI: 0.01, 1.12; p = 0.047), and aware of the SCforH guidelines (β = 0.86; 95% CI: 0.35, 1.37; p > 0.001) was associated with greater commitment to HEPA promotion.ConclusionRelatively low commitment of European sports associations to HEPA promotion may be increased by raising awareness of the SCforH guidelines and by considering national sport-for-all organisations, national Olympic committees, and organisations in Central-Eastern Europe as role-models in this endeavour.

S08-2 Reproducibility and validity of four physical activity questionnaires in 18 European union member states: the European Union Physical Activity and Sport Monitoring System (EUPASMOS) project

BackgroundThe successful promotion of health-enhancing physical activity (HEPA) requires reliable and valid prevalence data of physical activity (PA) to enable the design, implementation and evaluation of effective and cost-effective policies. As part of the development of a new integrated monitoring framework in Europe, the reliability and validity of the Eurobarometer, European Health Interview Survey (EHIS), International Physical Activity Questionnaire (IPAQ) and Global Physical Activity Questionnaire (GPAQ) were studied in the ongoing European Union Physical Activity and Sport Monitoring System project (EUPASMOS) among 18 European Union member states.MethodsPhysical activity (PA) and sedentary behavior (SB) were assessed among 80-100 adults per member state using the four questionnaires and the UKK RM42 accelerometer. Participants completed the questionnaires in random order and wore the accelerometer seven consecutive days on their right hip (during the day) and on their non-dominant wrist (overnight). Time spent in moderate-to-vigorous intensity physical activity (MVPA), sedentary behavior and adherence to the WHO PA guidelines were calculated based on the 5 methods. The reproducibility and validity of the four questionnaires were tested by using the Spearman's correlation coefficient (ρ) or Cohen's kappa coefficient (κ), dependent of the outcome measure.ResultsPreliminary results from the Netherlands (N = 91) showed that the correlations for reproducibility of all four questionnaires varied between 0.51 and 0.63 for MVPA, between 0.30 and 0.60 for the WHO PA guidelines and between 0.65 and 0.82 for SB. All correlations were statically significant (p > 0.05). Significant correlations for validity of the questionnaires were found for MVPA (ρ = 0.22-0.43) and the WHO PA guidelines (ρ = 0.19-0.25). The only exception was the association between the EHIS questionnaire and the WHO PA guidelines. For SB, only GPAQ and the EHIS questionnaire showed significant associations (ρ = 0.31-0.32).ConclusionsFirst analyses of the Dutch data within the EUPASMOS project showed that the four commonly used questionnaires in Europe are fairly to strongly reliable methods depending on the outcome measure. The four questionnaires are fairly valid methods, except the Eurobarometer and IPAQ when examining SB. It is of interest to examine the quality of these questionnaires in all 18 member states for national and European policy makers.

S04 Sports Club for Health (SCforH) approach: evidence on importance and examples of implementation activities

There are more than 60 million sports club members in the EU, which makes sports clubs an organizational settings with a huge potential for health promotion. The Sports Club for Health (SCforH) initiative started in 2008, to assist sports clubs in promoting health-enhancing physical activity. In support of this endeavour, SCforH guidelines were issued in 2011 and updated in 2017. The SCforH initiative has been supported by three large European Union grants and included partner organisations from 18 countries. In 2013, the Council of the European Union proposed the national implementation of SCforH guidelines as one of the 23 indicators for evaluation of HEPA levels and policies in the European Union member states. Recently, the European Commission recognised the SCforH initiative as a ‘success story' and an example of good practice. The aim of this symposium is to summarize recent evidence relevant to the promotion of health-enhancing physical activity through sports clubs in the EU and to discuss about future directions and challenges for EU public health efforts in this area. The symposium will include five 10-minute presentations on: [i] the findings of an updated systematic review on health benefits of different sport disciplines; [ii] Hungarian implementation of a SCforH intervention; [iii] the effectiveness of a coordinated action between the healthcare sector and local sports clubs to promote physical activity; [iv]; tracking participants in Jackpot.fit program?an Austrian sport promotion initiative; and [v] the development of a SCforH online learning tool. The symposium program will also include: Introduction by Chair (5 minutes), 25 minutes of Q&A, and conclusion by Discussant (10 minutes).Discussant: Prof Nanette Mutrie, Moray House School of Education and Sport, ISPEHS research cluster, University of Edinburgh, United Kingdom - nanette.mutrie@ed.ac.uk

S08-1 Comparing physical activity measurement instruments across member states by means of a conversion factor: European Union Physical Activity and Sport Monitoring System (EUPASMOS) project

BackgroundThe successful promotion of health-enhancing physical activity (HEPA) requires authoritative information to enable the design, implementation and evaluation of effective and cost-effective policies. This includes reliable and valid prevalence data of physical activity (PA) that can be compared across European Union Member States populations regardless of the type of measurement instrument used. In order to enable comparison of PA prevalence data between different measurement instruments, an attempt was made to develop a conversion factor between commonly used questionnaires in Europe and accelerometry in the ongoing European Union Physical Activity and Sport Monitoring System project (EUPASMOS) among 18 member states.MethodsData of physical activity (PA) and sedentary behavior (SB) were collected in 18 member states using four questionnaires (Eurobarometer, European Health Interview Survey, International Physical Activity Questionnaire and Global Physical Activity Questionnaire) and the UKK RM42 accelerometer. The number of measured participants varied between 100 and 1000 among the 18 member states. Participants completed the questionnaires in random order and wore the accelerometer seven consecutive days on their right hip (during the day) and on their non-dominant wrist (overnight). Time spent in moderate-to-vigorous intensity physical activity and sedentary behavior were calculated based on these 5 measurement instruments. The comparison between methods will be examined by using sophisticated regression analyses.ResultsThe EUPASMOS project is in progress and the final data is collected in the last two member states. In the meantime, a model is being developed to examine whether a conversion factor can be calculated to compare prevalence data based on questionnaires and accelerometry. By developing a conversion factor, prevalence data can be compared between member states although the measurement instruments used differ between member states. In June 2020 the results from these analyses are expected.ConclusionsThese results will provide insight into the possibility to compare prevalence data of physical activity among member states, when using different measurement instruments within their monitoring systems.

Monitoring of physical activity promotion in children and adolescents in the EU: current status and future perspectives.

BackgroundPolicy action is required to address physical inactivity in boys and girls. This action can be supported by international data collection, comparisons and sharing of good practices. Thus, this study aims to present and discuss the ongoing monitoring of physical activity (PA) indicators in children and adolescents in the 28 EU Member States.MethodsData on PA recommendations, PA prevalence, physical education (PE) and PA promotion programs for children and adolescents were provided by governments in a joint EU/WHO survey on the implementation status of the EU Council Recommendation on Health-Enhancing Physical Activity (HEPA) across Sectors.ResultsIn 23 countries, national recommendations on PA are available. Detailed PA prevalence data among children and adolescents was available in 27 countries, in most cases separately for sex/gender and age groups. The total amount of PE lessons in schools differed greatly between countries and lessons were predominantly mandatory. After-school HEPA promotion programs were mostly implemented in EU Member States (78.6%), followed by active school breaks (57.1%), active travel to school (57.1%) and active breaks during school lessons (53.6%).ConclusionsThis study summarizes the monitoring of PA indicators among children and adolescents in all EU Member States by providing a comprehensive overview of the status of PA promotion and monitoring across the region. Based on our findings, it could be concluded that the current EU monitoring system on PA promotion should be adapted to provide evidence that can inform future policy development.

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.

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.

The AHK-Wales Report Card 2018: Policy Measures - is it possible to 'score' qualitative data?

Comprehensive and meaningful policy analysis in the field of physical activity is difficult, not least because of the variable influence of other policy domains. However, in 2011 a Policy Assessment Tool (PAT) was developed by members of the WHO European Network for the Promotion of Health-Enhancing Physical Activity (HEPA Europe) and tested in several different countries. In 2014, Wales joined a global initiative, active healthy kids (AHK) Global Alliance, that supported the development of country level 'Report Cards' scoring a range of indicators that influence physical activity amongst children and young people, one of which was labelled 'Government Strategies and Investments'. For the first two Report Cards this indicator and its associated 'score' was informed subjectively by expert consensus. In 2018, it was decided to utilize the Policy Audit Tool Version 2 (PAT v2) developed by HEPA Europe to aid analysis and to develop and test a scoring rubric aligned to the tool. The subsequent process indicated that the tool could be applied and translated into a 'grade' that could be used in conjunction with the other indicators of the AHK Report Card to generate overall Report Card grades. The use of both the HEPA PAT v2 and the scoring rubric offers an opportunity to provide greater consistency and potential for developing both comparative and trend data when assessing policy impact on physical activity in children and young people. These tools should be utilized by the AHK Global Alliance in future Report Cards.

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.

Perceptions of barriers and levers to health-enhancing physical activity policies in French cities

Abstract Background Policy is one of the levers to initiate structural change to foster the promotion of Health-Enhancing Physical Activity (HEPA). To this end, policymakers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been published on this topic at the local level. The purpose of this study was to identify the barriers and levers to develop HEPA policies from the point of view of municipals managers and elected officials in mid-size French cities. Methods This study was conducted following the concept mapping approach: a list of statements was submitted to 17 French mid-size cities. These statements completed the beginning of this sentence: “In a mid-size municipality context, to develop HEPA policies, it is necessary to...”. First, key informants in each city rated the importance of each statement without considering their local context according to a Likert scale, ranging from 1 (not at all important) to 6 (extremely important). Then, they had to rate the feasibility of each statement considering their local context according to a Likert scale ranging from 1 (not at all feasible) to 6 (extremely feasible). Results A total of 23 municipal managers and 10 elected officials from sport (n = 14), health (n = 10), and social (n = 9) sectors from 11 French mid-size cities participated in this study. Statements related to political commitment, shared governance and partnership appeared as potential levers to develop HEPA policies. Statements related to the economic model of the local HEPA promotion, mandate of the mayor, and land use planning appeared as potential barriers to develop HEPA policies. The results varied according to the position and the sector of the respondent. Conclusions The results suggest that some local contextual factors could affect the development of HEPA policies in mid-size French cities. This study contributes to a better understanding of the development of local HEPA policies in the French context. Key messages Local contextual factors should be considered when developing health-enhancing physical activity policies. The perceptions of these local contextual factors varied according to the position and the sector of the respondent.

From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

Background: Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). Methods: Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002–2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested. Results: The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels. Conclusions: The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies.