Assessing golf and health, and investigating how the evidence base can impact policy and practice
Murray, Andrew Duncan
Golf is a sport played by over 60 million people in over two-thirds of countries worldwide. This thesis contributes knowledge regarding what is known about golf and health, and what can be advised to maximise health benefits, and minimise the health dis-benefits of golf, and assesses the impact of this knowledge for the golf industry and policy makers. The first chapter describes the scientifically well-established longevity, physical and mental health benefits of regular physical activity, and provides background information on golf. Following this introductory chapter, this thesis first identifies, and then addresses some critical gaps in the literature on the associations between golf and health. The second chapter of the thesis presents a scoping review assessing the relationships between golf and health. Three hundred and one studies met inclusion criteria for the scoping review. The studies showed that golf can provide moderate intensity physical activity and is associated with health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence relating to mental health, while regarding longevity there was some evidence for benefits of golf, but more robust studies are required. No measures of physical activity obtained by golf spectators had been reported. The third chapter of the thesis addresses one of the evidence gaps identified by the scoping review, this is the area with least existing evidence, and relates to physical activity (PA) obtained by spectators. An initial cross-sectional study of n=339 spectators at a 4-day 2016 UK golf tournament used pedometers and surveys to investigate PA behaviours and attitudes. Findings highlighted that obtaining exercise/PA can be a motivator to attend, and that spectators can engage in health-enhancing physical activity (HEPA) while at the event with 82.9% obtaining the recommended daily step count while spectating. A follow up study of n=135 spectators who responded to an online questionnaire three months post intervention showed that a 40.4% of spectators do self-report an increase in PA during the 3 months post intervention at a golf tournament. These are important findings as golf spectating has high global participation and potential for impact is therefore high. However, it is not yet clear if the results from these two novel studies are generalisable. Having conducted the scoping review, I identified the absence of coherent scientific advice to/for players, the golf industry, and policy makers. I aimed to address this in the fourth chapter of the thesis and describe the modified Delphi methods used to engage leaders at the intersection of health, sport, policy and golf to build a cross-sectoral consensus statement relating to golf and health. Consensus findings, and their implications for players, the golf industry and facilities and policy makers are described. Measuring the uptake, use and impact of research is imperative to demonstrate value to funders and employers, and to highlight and support further knowledge translation and decision-making efforts. The fifth chapter provides a novel Research Impact tool and utilises the established Research Contribution Framework to explore and explain the uptake, use and impact of the studies in this thesis. There is clear evidence that the work contained in this thesis has had wide uptake and use. Chapter 6 provides discussion of the thesis overall, analysing key findings, reflecting on strengths and weaknesses of the work, and making recommendations for policy, practice and future research. This thesis has assessed current knowledge regarding golf and health, conducted original research to address knowledge gaps, provided guidance to key stakeholders, and evaluated the uptake, use and impact of our work. The best available evidence highlights physical health, well-being and probable longevity benefits for golf participants. Health enhancing physical activity can also be achieved by spectators at professional golf tournaments. There is evidence of strong uptake and use of the research in this thesis. If practical recommendations contained in this thesis to i) golfers and potential golfers ii) the golf industry and facilities iii) policy makers iv) the scientific community, are adopted, this will contribute to increased inclusivity, and improved health through golf.