15. PHYSICALLY ACTIVE ADULTS INDICATOR

TABLE 1 – INDICATOR DESCRIPTION

Information component	Pg 4 Health Summary – Indicator 15
Subject category / domain(s)	The way we live
Indicator name (* Indicator title in health profile)	Adults participating in recommended levels of physical activity (*Physically active adults)
PHO with lead responsibility	SEPHO
Date of PHO dataset creation	26/01/2007
Indicator definition	Participation in *moderate intensity sport and active recreation on 20 or more days in the previous 4 weeks, (averaging 5 or more times per week), percentage, persons, aged 16 and over, 2005/06, as percentage respondents of the Sport England Active People Survey, 2006
Geography	England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs.
Timeliness	Survey repeated 3 yearly, the next one will be due in 2008/2009
Rationale:What this indicator purports to measure	This indicator estimates the proportion of adults participating in physical activity beneficial to health.
Rationale:Public Health Importance	People who have a physically active lifestyle are at approximately half the risk of developing coronary heart disease compared to those who have a sedentary lifestyle.  Regular physical activity is also associated with a reduced risk of diabetes, obesity, osteoporosis and colon cancer and with improved mental health.  In older adults physical activity is associated with increased functional capacities.In terms of mortality, morbidity and quality of life, the Chief Medical Officer has estimated the cost of inactivity in England to be £8.2 billion annually.Evidence for the effectiveness of interventions to increase the population levels of physical activity is summarised by  Kahn E, Ramsey L, Brownson R, Heath G, Howze E, Powell K, et al. ‘The Effectiveness of Interventions to Increase Physical Activity: A Systematic Review’. Am J Prev Med 2002; 22 (4S).
Rationale: Purpose behind the inclusion of the indicator	To estimate prevalence of physical activity beneficial to health in the populationTo monitor the effectiveness of programmes aiming to increase participation of adults in sport and active recreationThe indicator is a measure of health need i.e. the ability to benefit from public health interventions aiming to improve levels of physical activity beneficial to health in the adult population.
Rationale:Policy relevance	Choosing Health:  making healthy choices easier, Department of Health, 2004http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_4094550Choosing Health: a physical activity action plan, Department of Health, 2005http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/ @dh/@en/documents/digitalasset/dh_4105710.pdfAt Least Five a Week: Evidence on the Impact of Physical Activity and its Relationship to Health, 2004 – report by the CMOhttp://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/ @dh/@en/documents/digitalasset/dh_4080981.pdfGame Plan: A Strategy for Delivering Government’s Sport and Physical Activity Objectives, 2002http://www.sportdevelopment.org.uk/html/gameplan.html Sport England has as an objective agreed with Government to increase participation in sport by an average of 1% a year over the next three years to 2008. The Framework for Sport in England has identified a longer-term target to continue this growth to at least 2020 to establish England as the most active nation in the world.
Interpretation: What a high / low level of indicator value means	A high indicator value (amber circle in health summary chart) represents a statistically significant higher estimated percentage of adults participating in physical activity and recreation beneficial to health for that local authority when compared to the England average value.A low indicator value (red circle in health summary chart) represents a statistically significant lower estimated percentage of adults participating in physical activity and recreation beneficial to health for that local authority when compared to the England average value.
Interpretation: Potential for error due to type of measurement method	Sport England numerator data are based on observed self-reported physical activity levels in the previous 4 weeks through a series of questions which focus on walking, cycling and other types of sport and recreational physical activity. Self-reported physical activity levels may be prone to respondent bias.  Respondents are required to remember how long each session of physical activity lasted and describe the intensity level of the activity they undertook.  As a result, levels of physical activity are likely to be over-reported.The Active People Survey measured sport and active recreation but excludes other forms of physical activity such as housework, DIY, activity in ones job etc. and this can lead to under-estimation of levels.
Interpretation: Potential for error due to bias and confounding	This measure of adults participating in recommended levels of physical activity is a crude proportion and no age-standardisation has been applied to the results to adjust for differences in age structure between areas.  It is likely that a greater proportion of younger people undertake levels of physical activity than older people.Details of the sampling frame used and which groups may have been under sampled (e.g. ethnic minorities, those without telephone access etc) were not available at the time of creation of this indicator.  Therefore, it is not known how representative of the general population the survey results are.
Confidence Intervals: Definition and purpose	A confidence interval is a range of values that is normally used to describe the uncertainty around a point estimate of a quantity, for example, a mortality rate. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In the case of indicators based on a sample of the population, uncertainty also arises from random differences between the sample and the population itself.The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and, generally speaking, describe how much different the point estimate could have been if the underlying conditions stayed the same, but chance had led to a different set of data. The wider is the confidence interval the greater is the uncertainty in the estimate.Confidence intervals are given with a stated probability level. In Health Profiles 2007 this is 95%, and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. The confidence intervals have also been used to make comparisons against the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and, under these conditions, the interval can be used to test whether the value is statistically significantly different to the national. If the interval includes the national value, the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. If the interval does not include the national value, the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively.

TABLE 2 – INDICATOR SPECIFICATION

Indicator definition: Variable	Participation in *moderate intensity sport and active recreation on 20 or more days (averaging 5 or more times per week) in the previous 4 weeks*Moderate intensity sport and active recreation is defined as a 30 minute session of activity such as cycling, walking, sport and recreational physical activity.  For walking, moderate activity was defined as walking at “a fairly brisk pace” or “a fast pace”.  For cycling and other sport and recreational activity, moderate activity was defined as where the effort required was enough to raise the individual’s breathing rate, make the respondent out of breath or sweat. For further details see http://www.sportengland.org/index/get_resources/ research/active_people.htm
Indicator definition: Statistic	Percentage of respondents of the Sport England Active People Survey 2006
Indicator definition: Gender	Persons
Indicator definition: age group	16 and over
Indicator definition: period	October 2005 – October 2006
Indicator definition: scale
Geography: geographies available for this indicator from other providers	At time of creation of indicator: County Sport Partnerships available from Sport England www.sportengland.org
Dimensions of inequality: subgroup analyses of this dataset available from other providers	Age, gender, ethnicity, education, housing tenure, disability, working status, household income, National Statistics Socio-economic Classification (NS-SEC) available from Sport England.
Data extraction: Source	Sport England.Ipsos MORI undertook the survey on behalf of Sport England.
Data extraction: source URL	Data received directly from Sport England.
Data extraction: date	10/01/2007
Numerator: definition	Respondents aged 16 and over, with valid responses to questions on physical activity in the Active People Survey 2006,  who participated in moderate intensity sport or recreational activities for 30 minutes or more on 20 or more days in the previous four weeks.
Numerator: source	Sport England Active People Survey, 2006.www.sportengland.org/
Denominator: definition	Respondents aged 16 and over, with valid responses to questions on physical activity in the Active People Survey, 2006.
Denominator: source	Sport England Active People Survey, 2006.www.sportengland.org/
Data quality: Accuracy and completeness	The Active People Survey was undertaken by Ipsos MORI and conducted across every local authority in England.  It is a telephone survey conducted using CATI (Computer Aided Telephone Interviewing) and 363,724 interviews were undertaken with at least 1,000 interviews per local authority.  The exceptions were Isles of Scilly, City of London (due to small populations) and Birmingham where 4,000 interviews were conducted. The Active People Survey data are weighted to make the data representative of populations at different geographical levels using the 2001 Census adjusted for mid year 2006 population estimates (ONS).  Local authority data are weighted by the following factors: age by gender, ethnicity, household size, working status, National Statistics Socio-economic classification (NS SEC). The variables age by gender, ethnicity, household size, work status and NS-SEC are also weighted by season to ensure that seasonal effects do not skew the results.  Other weights are created to make data representative of populations of other geographies (applies to County Council and Regional data).  Further information is available from Sport England.

TABLE 3 – INDICATOR TECHNICAL METHODS

Numerator: extraction	Extraction by Sport England.
Numerator: aggregation /allocation	Performed by Sport England.
Numerator data caveats	Numerator data are weighted totals and as such do not sum to overall totals.
Denominator data caveats	Denominator data are weighted totals and as such do not sum to overall totals.
Methods used to calculate indicator value	The number of respondents aged 16 and over, with valid responses to questions on physical activity in the Active People Survey 2006, who participated in moderate intensity sport or recreational activities for 30 minutes or more on 20 or more days in the previous four weeks for each local authority was divided by the number of respondents aged 16 and over, with valid responses to questions on physical activity in the Active People Survey, 2006 and multiplied by 100.  This generated the percentage participating in recommended levels of physical activity.
Small Populations: How Isles of Scilly and City of London populations have been dealt with	Isles of Scilly and City of London are excluded from the lower tier datasets but included in England, Regional and County figures.
Disclosure Control	None applied.
Confidence Intervals calculation method	95% confidence intervals have been calculated using a formula based on a normal approximation provided by Sport England as follows:Upper and lower 95% confidence interval = 100*(1.96*SQRT((Share*(1-Share))/Total)) where share is the question proportion and total is the sample size.  This produces results in line with the confidence intervals displayed on the Sport England website.

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