Physical inactivity also generates a significant economic cost in both medical care and lost productivity. In 2013, the global cost of physical inactivity was estimated to be INT$54 billion per year in direct health care.

Crucially, the amount and type of exercise we do varies by stages of life and other factors. Physical activity guidelines act as a gold standard for assessing behaviour in clinical interventions and setting targets for chronic disease management, set effectiveness levels of programmes and research interventions, and offer the public a behavioural benchmark.

Professor Charlie Foster and the team in the School for Policy Studies reviewed the evidence, updated the existing UK Chief Medical Officer (CMO) physical activity guidelines, produced new guidelines and infographics for underrepresented population groups and improved UK and global policy dissemination and practice knowledge.

Reviewing physical activity guidelines

The 2019 update of the UK CMO physical activity guidelines, led by Professor Charlie Foster, generated a revised and extended national health policy guidance document. This included six infographics, developed using our research and methods, presenting recommended levels of physical activity across all groups.

The research of this team standardised and expanded the evidence available to inform physical activity guidelines and developed novel infographic dissemination methods to improve professional awareness and implementation. These guidelines are used by government to form policy on physical activity and are the official source of UK physical activity information.

Improved UK health policy dissemination and practitioner knowledge

Since their release these guidelines have been downloaded over 100,000 times, and have been disseminated via UK CMOs to Royal Colleges, NHS Trusts and Care Agencies (potentially reaching 1.4 million NHS workers and 1.6 million social care workers), offering a summary of the correct information about physical activity to use in their daily practice.

Infographic dissemination methods have changed health practitioner knowledge to support patients' changes in physical activity behaviour and are embedded in the UK's and WHO's Global Physical Activity Action Plan and new Global Physical Activity guidelines.

The update to the UK physical activity guidelines has also prompted the construction of a new (November 2020) CMO Expert Committee for Surveillance, co-chaired by Foster, that will review the current measures for monitoring physical activity across the UK.

New guidance for unrepresented population groups

The 2019 update to physical activity guidance identified the need for guidelines for:

• Women pre- and post-partum: In the UK this is relevant to over 650,000 women annually during and after their pregnancies, a time when women's physical activity levels decline. This development has led to changes in pregnancy services.
• Adults with disabilities: The UK disabled adult community is over 11 million people with a limiting long-term illness, impairment or disability. The assessment of physical activity using the new guidelines, is now an integrated part of the revised Care Needs Assessment protocol and supported by Sport England and Disability Rights UK's pilot programme "Get Yourself Active". An independent evaluation found that "(t)he proportion of respondents who undertook physical activity at least once a week or more increased from 28% at the start of the programme, to 68% six months into the programme".

The data and outputs have been used by national and international governments, policy makers and health organisations to update and create new guidance for previously underrepresented groups.

A novel approach to increase physical activity

The Bristol-led evidence briefing was used by Public Health England as the foundation for creating their Active10 national walking campaign. Our work produced evidence-based guidelines for the promotion of 10-minute bouts of brisk walking and connected to the 2019 UK CMO physical activity guidelines, where 10-minute walks were used as a key example of starting activity. The Active 10 campaign achieved around 500,000 downloads of the mobile phone app, with evaluation suggesting increases in those taking action.

Improving international public health policy dissemination

Professor Russ Jago was appointed to the WHO Global Physical Activity Guidelines Expert Group to update the WHO's physical activity guidelines, published in November 2020. The WHO has undertaken to disseminate physical activity recommendations for children, young people, adults, pregnant women and people living with disabilities, mirroring the UK. The new 2020 Guidelines include infographics for all these groups and advises countries to use infographics and tailor their guidance to specific population groups.

The team's development of infographics using new methods (co-creation) has also stimulated other nations to adopt similar methods. The role of infographics to communicate and disseminate physical activity guidelines to health professionals and beyond has been replicated by other international Public Health agencies including in Canada, the USA, and New Zealand for maternity care. Our disability infographic has been directly adopted by the national governments of South Korea, Finland and Spain.

This research has also contributed directly to the development of the national physical activity guidelines and plans of several countries, for example in the USA and Germany.