Analysis of Scottish health survey data to inform Scottish physical activity and sedentary behaviour policy and surveillance
Item statusRestricted Access
Embargo end date06/07/2019
Strain, Tessa Rosalind
In 2011, the United Kingdom (U.K.) physical activity (PA) guidelines were updated. The adult moderate-to-vigorous intensity PA (MVPA) recommendation changed to reflect that different frequency and intensity permutations lead to equivalent health benefits. New recommendations were added for muscle strengthening activities (MSA) and the reduction of sedentary time (ST). Those over 65 years were also recommended to undertake balance and co-ordination activities (BCA). Despite these new additions, Scottish PA policy still concentrated on MVPA, with considerable resources allocated to sport and some exercise activities. Since 2012, the Scottish Health Survey (SHeS) has collected data relating to these new recommendations annually, but few analyses have been undertaken. This thesis contains the most comprehensive analyses of the 2012-15 SHeS PA and ST data to date, and a review into whether the method produces valid and reliable estimates. The aim of this thesis was to inform Scottish PA and sedentary behaviour policy by producing research to support the incorporation of these new recommendations and the promotion of non-sport-related MVPA policies. It also aimed to inform any future developments to PA and ST surveillance in Scotland. The first three studies of this thesis are cross-sectional analyses of the updated recommendations for adults in Scotland. They present prevalence and participation data in specific domains, activities, and behaviours by age and sex. The main findings were that (1) sport was a minority contributor to the total MVPA of adults in Scotland, regardless of sex, age, or activity status (never more than 20%), (2) compliance with the MSA recommendation was approximately half that of the MVPA recommendation (31% of men and 24% of women), and compliance with the BCA recommendation amongst those over 65 years was very low (19% of older men and 12% of older women), and (3) middle-aged adults in work reported a comparable amount of weekday ST to adults over 75 years (7-8 hours per day). The fourth study was a review of the available evidence into whether the PA and ST estimates produced by the 2012-15 SHeS were valid and reliable. The SHeS was found to be fit for purpose, but recommendations were made regarding the analysis and interpretation of the data to minimise areas of concern. These were (1) analyse MVPA data with and without the domain of occupational MVPA, (2) make it clear that only sport and exercise activities can contribute to achieving the MSA and BCA recommendations under the SHeS method, and (3) focus on the comparisons between groups in relation to ST, rather than on the absolute values. The fifth study used the findings from the previous four to inform the design of a prospective cohort study that will investigate the joint effects of MVPA and total ST on all-cause mortality, cardiovascular disease, cancer, and diabetes. This thesis contains the results of the preliminary analyses. This study is designed to inform policy by providing novel information on how the combination of these behaviours affects health outcomes in a representative sample of Scottish adults. There is clear evidence that this work has already informed policy and surveillance. The work on the relative contribution of the domains of MVPA is regularly cited in evidence briefings for the Scottish Government and the Scottish Parliament. This has increased the awareness amongst key policy-makers that sport is not a major contributor to the total MVPA of adults in Scotland. The work on MSA, BCA, and ST was a catalyst for a proposal to include indicators relating to these recommendations on the national PA monitoring framework. The work on MSA and BCA has also been a key reference text in preparation for the next update to the U.K. PA guidelines, stressing the need to consider surveillance at an early stage. In summary, the novel analyses of SHeS data undertaken for this thesis have demonstrably informed PA and sedentary behaviour policy and surveillance in Scotland.