Sport England Research Articles

Do people with long-term pain swim? Understanding participation using the active lives survey

Purpose: Physical activity and exercise are recommended for the management of long-term pain. Swimming is often encouraged despite little supporting evidence. To date, there is a lack of information on the profiles of people with long-term pain who choose to swim. The Sport England Active Lives survey measures rates and modes of physical activity, exercise, and sport across England. The objective of this project was to review the Active Lives dataset to understand the profile of people with long-term pain who swim.

The Active Hospital pilot: A qualitative study exploring the implementation of a Trust-wide Sport and Exercise Medicine-led physical activity intervention.

BackgroundIn 2017 Public Health England and Sport England commissioned a Consultant-led Sport and Exercise Medicine (SEM) pilot to test the feasibility and acceptability of embedding physical activity interventions in secondary care clinical pathways. The aim of this paper is to report qualitative findings exploring the experience of healthcare professionals (HCPs) and patients involved in the Active Hospital pilot.MethodsQualitative data was collected by semi-structured interviews with Active Hospital pilot SEM Consultants, and staff and patients involved in three clinical pathways. Interviews with SEM Consultants explored the experience of developing and implementing the pilot. Interviews with staff and patients explored the experience of delivering and receiving Active Hospital interventions. Data were analysed thematically.ResultsInterviews identified the importance of the Active Hospital pilot being Consultant-led for the following reasons; i) having trusting relationships with decision makers, ii) having sufficient influence to effect change, iii) identifying champions within the system, and iv) being adaptable to change and ensuring the programme fits within the wider strategic frameworks. HCPs emphasised the importance of the Active Hospital interventions fitting easily within existing work practices, the need for staff training and to tailor interventions for individual patient needs. The Active Hospital pilot was well received by patients, however a lack of dedicated resource and capacity to deliver the intervention was highlighted as a challenge by both patients and HCPs.ConclusionThe SEM Consultants’ ability to navigate the political climate of a large National Health Service (NHS) Trust with competing agendas and limited resource was valuable. The interventions were well received and a valued addition to usual clinical care. However, implementation and ongoing delivery of the pilot encountered challenges including lack of capacity within the system and delays with recruiting to the delivery teams in each pathway.

The roles of motivational interviewing and self-efficacy on outcomes and cost-effectiveness of a community-based exercise intervention for inactive middle-older aged adults.

Increasing physical activity (PA) among inactive middle-older aged adults in rural communities is challenging. This study investigates the efficacy of a PA intervention supporting inactive adults in rural/semirural communities. Inactive participants enrolled on either a single signposting session (n=427) or a multisession pathway combining signposting with motivational interviewing (MI; n=478). Pre-post outcomes data assessed activity levels (International Physical Activity Questionnaire-Short Form; Single Item Sport England Measure), self-efficacy (New General Self-Efficacy scale [NGSE]) and well-being (five-item World Health Organization Well-Being Index [WHO-5]). Measures were repeated at longitudinal time points (26, 52weeks) for the MI pathway. Outcomes were contrasted with results from an unmatched comparison group receiving treatment as usual (TAU). Cost-utility (quality-adjusted life years [QALY]-incremental cost-effectiveness ratio) and return on investment (NHS-ROI; QALY-ROI) were estimated for short (5years), medium (10years) and long (25years) time horizons. Both pathways significantly increased participants' PA. The MI pathway resulted in significantly greater increases in PA than signposting-only and TAU. Improvements in psychological outcomes (NGSE; WHO-5) were significantly greater in the MI pathway than TAU. Longitudinal results indicated MI pathway participants sustained increases in light-intensity PA at 52weeks (p<0.001; =0.16). Regression analyses found baseline self-efficacy predicted increased PA at 52weeks, while baseline well-being did not. The relationship between self-efficacy and PA increased successively across time points. However, magnitude of participants' increased self-efficacy did not predict PA at any time point. Both pathways were cost-effective and cost -saving for participants aged ≥61years from the short time horizon, with the MI pathway having greater ROI estimates. Overall, MI increased efficacy of a signposting PA intervention and was cost-saving for older adults.

Bourdieu’s practice theory as a multilevel framework for exploring change in disability sport: a case study of disability cricket

ABSTRACT Research question This paper takes a multilevel perspective by combining meso and micro levels of analysis to examine change within a field of disability sport. What is the impact of policy shifts on the power relations between organizations in a field of disability sport? How does change prompt action at the micro-level of disability sport management? Research methods A longitudinal, ethnography of organizations involved in managing disability cricket is conducted during the inaugural implementation of Sport England’s Whole Sport Plans. Semi-structured interviews with 17 managers and participant observations in the form of field notes were the main tools of data collection. Results and findings While the appearance of structural management relations within the field did not appear to change, the underlying power dynamics did. Shifting power relations at the meso-level and the availability of new economic capital to reinforce this power shift, created a series of implications for agents operating at the micro-level, and on the lived experience of disability sport managers. Implications Much of the resistance to change that occurred could have been avoided by better communication between agents. Greater effort should be made policymakers to understand the experiences of those who work to develop sport.

Exploring influences on evaluation practice: a case study of a national physical activity programme

BackgroundInterventions to improve physical activity behaviour are a core part of public health policy and practice. It is essential that we evaluate these interventions and use the evidence to inform decisions to improve population health. Evaluation of ‘real-world’ interventions provide an opportunity to generate practice-relevant evidence, however these interventions are difficult to evaluate. Various guidelines have been developed to facilitate evaluation, but evidence about their effectiveness in practice is limited. To explore influences on evaluation practice in an applied context, we conducted a case study of Sport England’s ‘Get Healthy Get Active’ (GHGA) programme. This was a national programme that funded 33 projects that were delivered and evaluated across England. The programme was chosen as it was designed to generate evidence on the role of sport in increasing physical activity and improving health. The study aimed to explore and appraise whether strategies intended to facilitate project evaluation, including funder requirements to use a standardised evaluation framework and specific data collection methods, were effective in generating evidence that enabled the programme to meet its aims.MethodsWe applied a collective case study design involving 35 semi-structured interviews, and documentary analysis of multiple sources of evidence from 23 physical activity projects funded by GHGA. We applied thematic and framework analysis. We developed a logic model and mapped actual outcomes against intended outcomes. A narrative synthesis is provided. We discuss implications for the effective commissioning and evaluation of public health interventions.ResultsWe identified five main themes of influences on evaluation practices that can act as barriers and facilitators to good practice: programme and project design; evaluation design; partnerships; resources; and organisational structures and systems. These influences are context-specific and operate through a complex set of interactions.ConclusionDeveloping a better understanding of how influences on evaluation practice can act as facilitators or barriers is vital to help close current gaps in the evidence-based practice cycle. Critically, organisational structures and systems are needed to facilitate collaborative decision making; integration of projects and evaluation across partners organisations; transfer of knowldege and insights between stakeholders; and more rapid feedback and dissemination.

A \u2018Life-Style Choice\u2019 or a Philosophical Belief?: The Argument for Veganism and Vegetarianism to be a Protected Philosophical Belief and the Position in England and Wales

The recent judgment in Casamitjana Costa v The League Against Cruel Sports in England and Wales held that ethical veganism was a protected philosophical belief under employment law. In contrast, vegetarianism was found not to be a protected philosophical belief in Conisbee v Crossley Farms Limited and others. The authors argue that the Employment Tribunal misunderstood the notion of vegetarianism when deciding that it was a ‘life-style choice’. There are different kinds of vegans and vegetarians, each with their own way of practising the philosophy which influences how they live their life. Not all people who follow a meat-free diet should be afforded this protection, and it depends on whether their belief is one which is determined by certain factors, such as animal welfare and environmentalism, rather than for health purposes. The authors explore the arguments and analysis in the above employment cases, coming to the conclusion that the tribunals oversimplified what it means to hold values such as veganism and vegetarianism, failing to understand the differences between different classifications and sub-groups when coming to a decision. The different kinds of vegans and vegetarians and their characteristics are outlined, before determining whether this should constitute protection under employment law, protecting individuals from discrimination. The situation in the USA and Canada regarding this issue is very different, and there are parallels drawn with attempting to establish veganism or vegetarianism as a religion, and where they could benefit from the recent decision in England and Wales. Finally, this paper concludes that ethical and environmental veganism and vegetarianism should both qualify as protected philosophical beliefs, but other kinds may fall short of what is required to satisfy the requirements under law.

Национальный культ спорта в Англии: история формирования

The paper aims to reveal essence of the cult of sport in England. The research problem is as follows: historical development of sport and its assertion as a national symbol. The author tries to prove that the English national sport represents the basic features of the national character. It is shown that the national sport influences directly the process of the national spirit formation. Scientific originality of the study lies in the fact that sports games are analysed from the viewpoint of their cultural value at different stages of the nation formation. The research findings are as follows: the author reveals specificity of the “sport” concept in the English language, identifies certain features of the English national character, justifies key importance of sport as an element of the national culture.

“It is always going to change” – examining the experiences of managing top-down changes by sport development officers working in national governing bodies of sport in England

ABSTRACT Research question: This article examines how sport development officers (SDOs) employed within national governing bodies of sport (NGB) managed Sport England’s top-down policy changes from 2008 to 2015. The main research question examines the experiences of SDOs as they responded to, and managed these changes at the community level. Research methods: In-depth, semi-structured interviews gathered qualitative data from 18 employees from four NGBs, including 6 SDOs, Chief Executive Officers (CEOs), senior managers and a representative from Sport England, with responsibility for policy formulation. Results and Findings: SDOs felt increasingly constrained in how they worked due to the intensification of a top-down and cyclical process of change, a result-orientated approach and the sporting habitus of SDOs. These factors combined to create resistance among some SDOs as the power differentials within the interdependencies formed, which contributed to the unintentional outcome of elongating the time taken to implement policy on the ground. Implications: This article has developed more object-adequate insights into how SDOs have responded to, and managed top-down policy implementation. The article suggests recommendations for policy-makers, Sport England and NGBs, to consider the dynamic interdependencies in which employees are bound and a more rounded and processual view to policy formulation and implementation

Sustaining and changing sport and physical activity behaviours in the forest: An evaluated pilot intervention on five public forest sites in England

Encouraging physical activity and reducing sedentary behaviours are key issues in contemporary society. The Active Forest Programme was set up through a partnership between Sport England and Forestry England. A pilot programme ran for three years on five public forest sites in England. A mixed methodology explored what types of sport and physical activities were undertaken, what if any were the benefits of undertaking physical activity in a forest environment and was there any evidence of changes in sporting activity. We provide insights into key elements of how the forest-based programme aimed to sustain and change physical activity.

A community-based, sport-led programme to increase physical activity in an area of deprivation: a qualitative case study

BackgroundEngaging in physical activity is essential for maintaining mental and physical health but a high proportion of adults are inactive, especially in areas of socioeconomic deprivation. We evaluated a novel exercise referral scheme funded by Sport England and run by a social enterprise in an area of socioeconomic deprivation in inner London. This study aimed to examine the experiences of participants and staff and to identify barriers and facilitators of implementation and participation in this and potentially similar projects.MethodsThirty-five semi-structured interviews with project participants (N = 25) and staff members involved with the project (N = 10) were conducted based at one centre in London in 2017/2018. The interview schedule was informed by the Theoretical Domains Framework. Data was analysed using the Framework method and NVivo software.ResultsThree themes emerged from the data: ‘Not like your regular gym’, Individual journeys and Practical aspects of the scheme. Study participants regarded the environment of the project centre as friendly and sociable. The project differed from a commercial gym by offering free or subsidised membership and the participation of people of all sizes and abilities. Classes were provided free of charge and this, together with mentor support, facilitated participation and continuation in the project. Participants reported changes not only in their physical activity level, but also in their physical and mental health. Additionally, their families’ lifestyle changes were reported. Difficulties of accessing the project included lack of awareness of the project and lack of engagement from key referring groups.ConclusionsProviding free or subsidised classes incorporating individualised assessment, follow-up and support appeared to facilitate engagement in physical activity among socioeconomically deprived populations. The supportive social context of the centre was a major facilitator. Differing levels of abilities and health status among participants call for special attention. Increasing community and referrer awareness of available exercise referral schemes and enhancing communication between sources of referrals and project staff may help to address access issues.

The intersubjective accomplishment of power by medical professionals within unregulated combat sports

The lack of power experienced by medical professionals working in various sport settings has been consistently evidenced by sociologists researching the provision of medical care to athletes. In this paper, which focuses on the work of medical professionals within unregulated combat sports in England, we extend this discussion by focusing on the means by which such professionals attempt to (re)construct power within contexts where it cannot be taken for granted. To explore this issue, we conducted 200 hours of observational fieldwork at competitive combat sports events, along with interviews with 25 medical professionals with experience in this field, 7 combat sports referees and 9 event promoters and their staff. Employing the concept of power as ‘intersubjective accomplishment’, we argue that the influence necessary for medical professionals to undertake their work must be actively won within specific situations, principally relying on their ability to tactically interact with various other people. In so doing, we evidence both successes and failures of medical staff in this respect, arguing that such informal means of securing power make caring for the health of combat athletes a challenging proposition.

Serious sports-related injury in England and Wales from 2012-2017: a study protocol

BackgroundPhysical activity is an important component of healthy lifestyles, with a central role in morbidity prevention. However, sporting and physical activity also involve an inherent injury risk. Some sports and activities have a higher injury risk, and may involve more severe injuries. Furthermore, injuries of a severe nature have substantial individual and societal consequences, including the burden of assessment, treatment, and potential on-going care costs. There are limited data on severe sports injury risk in England and Wales, and no national data describing risk across sports. The aims of this study are to identify the cases and incidence of: i) paediatric and ii) adult severe sports injury from 2012 to 2017; and to describe injury incidence in individual sports.MethodsThis study is an analysis of prospectively collected sport-related injuries, treated from January 2012 to December 2017. Incidents involving a severe injury (in-patient trauma care) in England and Wales, will be identified from the Trauma Audit Research Network registry. Data for patients who were: transfers or direct hospital admissions, with inpatient stays of ≥3 days, admissions to High Dependency areas, or in-hospital mortality after admission; and whose injury mechanism was sport, or incident description included one of 62 sporting activities, will be extracted. Data will be categorised by sport, and sports participation data will be derived from Sport England participation surveys. Descriptive statistics will be estimated for all demographic, incident, treatment and sport fields, and crude serious annual injury incidence proportions estimated. Poisson confidence intervals will be estimated for each sport and used to describe injury risk (incidence) across sporting activities.DiscussionThis study will be the first to describe the number of, and trends in severe sport-related injuries in England and Wales. These data are useful to monitor the number and burden of severe sports injury, and inform injury prevention efforts. The monitoring and mitigation of sports injury risk is essential for individuals, health services and policy, and to encourage physically active lifestyles and safer participation for adults and children.

The Sport of Kingmakers: Horse Racing in Late Stuart England

This essay sketches the general outlines of an argument that locates the rise of horse racing as a national sport in England in the context of national political change. In brief, the argument might be summarized as saying that horse racing was as much the sport of kingmakers as of kings, a recreation of martyrs as well as monarchs; and that some of its early participants were associated with breeding rebellion, as well as racehorses. The earliest public mention of a ‘Jockey Club’ appears to be a newspaper notice in the summer of 1729, and I have argued elsewhere that this club can be seen acting as a quasi-official body as early as 1717, though not necessarily under that name. Here, I want to extend that argument further in suggesting that the Club whose meeting was publicly announced in 1729 coalesced over the course of the preceding half-century. The argument I sketch here identifies how a very specific emergence of a particular organization of the sport served a very specific ideological purpose during a time of considerable tension over the relationship of church and state. The conflict between Protestants and Catholics, and the anxieties about succession and rebellion that these conflicts engendered, were more than just the backdrop to the rise of the sport; and the particular sport that emerged helped celebrate and popularize a Protestant succession settlement that ultimately excluded dozens of Stuart claimants to the throne in favor of the house of Hanover.

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

BackgroundUK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies all components of a whole-school PA approach. The study’s aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA).MethodologyFifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one ‘initial’ framework. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.ResultsFollowing voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers’ capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA.SummaryTo the authors’ knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

Carrying out Physical Activity as Part of the Active Forests Programme in England: What Encourages, Supports and Sustains Activity?-A Qualitative Study.

The Active Forests programme was developed through a partnership between Forestry England and Sport England. A three-year pilot programme focused on five forest sites ran from 2014. It was mainstreamed in April 2017 and is now running on eighteen forest sites in England in 2019. The aim of the programme is to encourage a physical activity habit, and participants can get involved in a wide range of activities from Nordic walking to mountain biking, Pilates, running, and Bootcamp in different scenic forests. The aim of the research was to identify the motivations, benefits and the overall experience participants had from their forest physical activity. As part of the programme, qualitative data was gathered through in-situ participant observation, and interviews or focus groups. One hundred and twenty people were involved in the research. The findings identify some of the key elements of the programme that encourage, support and in some instances help to sustain or change physical activity. These include participants gaining a wide range of wellbeing benefits; appropriate targeted activities; opportunities for progression; social connections; providing challenge; and a supportive atmosphere. There is evidence of participants sustaining and changing physical activity practices, however attribution of this to the Active Forests programme is not straightforward. The programme is also explored through the lens of social practice theory and its concepts of materials, competence, and meanings. The research highlights how a targeted physical activity programme can reach and involve a broad range of people from the already physically active to those who are less active.

From finding sports partners to medical case sharing: transforming ideas into reality

Dr Asif Qasim is a consultant cardiologist in London and a technology entrepreneur. Here he shares his story of how he founded a medical knowledge platform (figure 1), which now...

Medical care in unlicensed combat sports: A need for standardised regulatory frameworks

ObjectivesTo explore the provision of medical care at ‘unlicensed’, full-contact amateur and lower-level professional combat sports competitions in England. DesignQualitative, mixed methods. MethodsObservations totalling 200h of fieldwork shadowing medical professionals at 27 individual combat sports events, alongside formal, semi-structured interviews with 25 medical professionals, 7 referees and 9 promoters/event staff. ResultsPractices and standards vary widely. Event organisers and promoters often have very little understanding of how different types of medical practitioners operate. They rarely, if ever, check that the staff they are hiring are qualified, sometimes resulting in unqualified staff being used to provide medical cover at events. Venues are often poorly equipped to accommodate basic medical procedures. Patient confidentiality is very often compromised. Medical professionals often have limited autonomy within the combat sports milieu and may find themselves marginalised, with their judgements overruled by non-medical staff during competitive events. Some practitioners are cognisant of the dangers such working environments pose to their professional reputations and livelihoods, but remain working within combat sports regardless. ConclusionsDespite pockets of good practice, the lack of standardised rules for medical care provision creates substantial risks to athletes, to practitioners and the standing of the profession. The development and implementation of standardised, enforceable regulatory frameworks for full-contact combat sports in England is urgently needed.

Social return on investment (SROI) in sport: a model for measuring the value of participation in England

ABSTRACTRecent and historical evidence suggests that sport creates societal benefits in terms of improved health, reduced crime, improved education and enhanced subjective well-being. However, there is limited empirical research on the monetary value of these non-market outcomes for society. The original research presented in this paper aims to calculate the social impact of sport in England, using a Social Return on Investment (SROI) framework. It is the first time an SROI framework has been used to value the sports sector at the national level. According to our study, in 2013/14 the social value of sports participation in England was £44.8 billion and the total financial and non-financial inputs to sport were £23.5 billion, giving an SROI ratio of 1.91. This means that for every £1 invested in sport, £1.91 worth of social benefit was generated. The research has several implications for policymakers. First, it shows it is possible to use an SROI framework to measure and value the wider benefits of sport to society, which provides a useful benchmarking tool for gathering evidence on the social impact of sport. Second, the research demonstrates that the return on investment in sport in England is positive and substantial, providing policymakers with evidence-based research upon which to better articulate the case for investment in sport. Third, it provides evidence that sport creates value to society across multiple social outcomes, potentially making it a cost-effective investment for addressing social issues across multiple public policy areas.

This Girl Can(’t): A Risk of Subjectification and Self-Surveillance in Sport England’s Behavioral Change Campaign

We examine the potential unforeseen consequences from Sport England’s This Girl Can (2015) promotion program, specifically arguing that the campaign videos released in 2015 and 2017 take the previously narrow heteronormative gaze of desire, and inclusively apply it to all women, suggesting empowerment where there is only sexual subjectification. Overall, what prevails is a campaign that presents the female body – historically a locus of social control – as a body-as-object, despite being ‘in process’, and suggesting the attributes of female sexualisation – hips, lips, butts and breasts – are essential to attention and visibility, rather than action, movement, fitness or strength. Thus, it is the sexualisation of women posited as essential to agency and action that muddies a campaign of intended empowerment into being one of subjectification and self-surveillance.

Moving healthcare professionals \u2013 a whole system approach to embed physical activity in clinical practice

BackgroundHealthcare professionals are key informants to support individual behaviour change, and although there has been some progress in empowering clinicians to promote physical activity and health at work, an effective strategy overarching the whole medical educational journey is still lacking. This report provides an overview from the Moving Healthcare Professionals programme (MHPP), a whole-system educational approach to embed prevention and physical activity promotion into clinical practice.MethodsThe MHPP model integrates educational resources into three core domains of medical education: undergraduate education, postgraduate education and continuing professional development. The interventions are designed to spiral through existing educational approaches rather than as additional special study modules or bolt-on courses, thus reducing self-selection bias in exposure. Interventions include spiral undergraduate education materials, e-learning, embedded post-graduate resources and face-to-face peer-to-peer education.ResultsTo date the MHPP model has been applied in two key areas, physical activity and health and work. The physical activity programme in a partnership between Public Health England and Sport England has delivered face-to-face training to 17,105 healthcare professionals, embedded materials in almost three quarters of English medical schools and overseen > 95,000 e-learning modules completed over two and half years. Evaluation of the individual elements of the model is ongoing and aims to show improvements in knowledge, skills and practice. Further evaluation is planned to assess patient impact.ConclusionsThe MHPP model offers a coherent whole-system approach to embed public health action into existing healthcare education models, and as such provides a framework for rapid change as well as upstream implementation to support the clinicians of today and tomorrow.