Active 10 – A new approach to increase physical activity in inactive people in England

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Abstract

Public health physical activity (PA) guidelines are failing to increase levels of population PA, requiring a new approach. A national integrated marketing campaign was developed based on published literature and ethnographic research to get inactive lower socioeconomic 40–60 year olds to walk briskly for bouts of 10 or more minutes per day and move towards recommended levels of PA. National and local communications campaigns and partnerships promoted key messages and directed people to a free mobile phone app that provided the user with time, intensity and periodicity of walking, and included goal setting and encouragement to support behaviour change. Campaigns in the summers of 2017 and 2018 achieved around 500,000 downloads of the mobile phone app, with evaluation suggesting increases in brand and app awareness, and those taking action. Active 10 is a promising example of a physical activity promotion campaign based on evidence-based messages tailored for a target audience to change social norms rather than guidelines, an approach recognised as an effective population intervention for increasing walking.

Section snippets

PA guidelines and PA levels in England

In common with most high income countries, England has seen declining levels of PA since the 1960s as a consequence of economic, social and cultural changes.10 Lack of physical activity is estimated to cost the UK at least £7.6 billion each year (including £0.9 billion to the National Health System in England) and contributes to 1 in 6 deaths.11 National PA for health guidelines were published by the UK Chief Medical Officers in 2011, including a recommendation for 150 min of moderate intensity

Understanding the inactive population with the greatest potential of getting active

National guidelines in England prioritise “targeting those adults who are significantly inactive (i.e. engaging in less than 30 min of PA per week) [to] produce the greatest reduction in chronic disease12. The Health Survey for England reports that 62% of the adult population achieve the national guidelines on moderate intensity physical activity,13 but almost one in four (23%) of the population are within the category of doing less than 30 min moderate intensity PA per week;19 Fig. 1

Walking as a health-enhancing PA intervention

Brisk walking at 3 mph is estimated to be 3.3 metabolic equivalents (METS)22 and therefore a ‘moderate intensity’ PA. Walking is recommended in the UK guidelines as one of “the easiest and most acceptable forms of physical activity…that can be incorporated into everyday life”.12 For adults not achieving recommended levels of activity, the relative contribution of walking is similar across genders and has limited age-related decline compared to exercise, cycling or swimming.23

In addition to

Health benefits of 10 min of brisk walking per day

Although the evidence for 10 min bouts of walking is limited, it is clear that 70–90 min per week of brisk walking can improve fitness with a significant weighted mean treatment effect of 3.04 ml·kg−1·min−1 of oxygen uptake.26 The benefits of such an improvement in aerobic capacity include greater ease of performance of everyday PA and improved quality of life.27 From a population perspective, an improvement of this magnitude (approximately 10%) is likely to result in a 15% reduction in

Developing a marketing message

The role of marketing is to make change easier, more desirable and more achievable. Insight research was undertaken with the target audience to understand: i) how they engage with PA, particularly walking, in their day to day lives; and ii) how they respond to messages/propositions aimed to engage them and trigger behaviour change to undertake PA. Focus groups were undertaken in five geographic areas with 48 individuals between the ages of 40 and 60 years of age of a lower socioeconomic group

Creating an integrated behaviour change approach

Behaviour change models help understand the factors behind behavioural decisions and can shape interventions to influence those decisions and behaviours. The Behaviour Change Wheel is a popular approach that was developed from 19 frameworks of behaviour change and is based on the COM-B (Capability, Opportunity, Motivation and Behaviour) model whereby effective interventions impact on one of the three factors to change behaviour.37 In 2016, Public Health England launched a national social

Mobile phone app

Brisk walking, like other PAs of moderate intensity, causes an individual to breathe faster, experience an increase in heart rate and feel warmer12; which is not the normal or sustained walking pace for most people, especially those who are inactive. Work was undertaken with the University of Sheffield and Sheffield Hallam University to develop a mobile phone app to measure time and intensity (i.e. the two dimensions that determine health-enhancing activity) and present the information in an

Communications campaign

A communications strategy was developed for the inaugural 2017 campaign, consisting of media activities (advertising and public relations) and partnerships with national and local organisations to raise awareness, change perceptions and encourage people to take up brisk walking. All activities directed people to download the mobile phone app.

The media campaign focussed on media known to be popular with the target lower socioeconomic, 40–60 year old demographic. Advertising included TV and

Campaign outcomes

The campaign was launched in the summer of 2017, with over 300 pieces of positive coverage in the popular media and #Active10 trending in the top five on Twitter. There were over 379,000 downloads of the app over five weeks in August–September 2017, which was rated four stars on the app store and was the number one health and fitness download, and number seven overall download. Online pre and post tracking research were undertaken with 1800 adults aged 18+ with a boost of the key target

Conclusions

Walking is prevalent, has no skill, facility or equipment requirement and is more accessible and acceptable to an inactive audience than other forms of PA. An integrated marketing campaign was developed based on behaviour change principles to encourage inactive people to become more active. Ethnographic insight research was undertaken with the target lower socioeconomic, 40 to 60 year old demographic to develop the underpinning evidence-based messages. The programme consisted of a media

Acknowledgements

Thanks to Fabio Ciravegna (University of Sheffield) and Rob Copeland (National Centre for Sport and Exercise Medicine and Sheffield Hallam University) who developed the Active 10 app and the original Move More app upon which it was based.

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