ADOPTION

WHO undertakes a rigorous and extensive process to develop globally relevant guidelines (21) for use by all countries. These Guidelines on physical activity and sedentary behaviour provide evidence-based recommendations on the health impacts of physical activity and sedentary behaviour that national governments can adopt and use as part of their national policy frameworks. The development of global guidelines, with extensive consultation, should largely remove the need for individual countries to use resources to undertake the lengthy scientific process. Reviewing and adopting these global physical activity and sedentary behaviour guidelines provides a rapid and cost-effective method to develop guidelines tailored to local context.

Adopting the WHO guidelines at regional or national level will ensure countries provide consistent recommendations on physical activity and sedentary behaviour, which are informed by the latest and best available scientific evidence. In addition, consistency of the recommendations across countries will facilitate national surveillance, global estimates of physical activity and sedentary behaviour, and cross-country comparisons. Throughout the adoption process, consideration should be given to the need to contextualize and tailor the guidelines. Translation into the local language is one element of adoption and contextualization. Examples of physical activities may need to be changed to be locally relevant and the use of images tailored to reflect local cultures, norms and values.

A step-by-step framework to support country adoption of the Global guidelines is under development, following a series of regional workshops with relevant stakeholders. This framework can be populated with relevant national data (for example physical activity prevalence estimates), and will provide a fast-track approach to the development of a national guidelines document. These supporting resources will be available in 2021 through the WHO website.

When considering adopting the guidelines it is recommended that the following ten-step process is applied:

1. Advocate for a review of current national guidelines on physical activity and the adoption of the WHO guidelines to secure government authorization.
2. Engage key stakeholders both within the health sector and other relevant sectors, such as sport, education, transport; engage relevant professional associations and scientists, with topic expertise.
3. Assess the applicability, acceptability and feasibility of the recommendations.
4. Adapt guidelines to the local context, including language, examples, and other cultural considerations.
5. Conduct an external review with target users, including policy-makers, practitioners, and the general public.
6. Establish a budget and clear plan for dissemination and communication.
7. Publish and promote the national guidelines, ideally alongside a launch event to generate publicity and interest.
8. Engage relevant professional bodies or organizations and support policy alignment and/or endorsement.
9. Implement national policies and practices to support implementation of national guidelines and behaviour change.
10. Agree a timeline for evaluation, review, and update of the guidelines.

DISSEMINATION

National physical activity guidelines are a core component of the governance structures for a comprehensive approach to increasing population levels of physical activity. National guidelines inform the development and priorities of national and subnational strategy planning and require dissemination of the correct information, to the relevant groups of people, in an appropriate way. Unfortunately, too often, national guidelines are not disseminated, and so awareness of recommendations among both professional audiences and the wider community can remain very low. Securing dedicated resources to support wide-scale dissemination is an important first step to changing awareness and knowledge about the importance of increasing physical activity and reducing sedentary behaviours.

Key audiences for dissemination of national guidelines on physical activity and sedentary behaviour include:

• Policy-makers within and outside the health sector (including transport, planning, education, workplaces, sport, parks and recreation), to increase:

  1. knowledge of the contribution that increasing physical activity and reducing sedentary behaviour can have in improving not only health, but also a range of diverse yet related agendas, including gender equity, human rights obligations, and sustainable development;
  2. integration of policy and programmes on physical activity and sedentary behaviour into all relevant policies; and
  3. investment in scaled-up and coordinated national and local actions.
• Non-state actors (including nongovernmental organizations, academic and research organizations, the private sector as well as the media and research funding agencies), to:

  1. raise awareness of the importance of increasing physical activity and reducing sedentary behaviours across all ages;
  2. encourage and ensure policy alignment; and
  3. increase collaboration and investment in policy implementation and local action.
• Practitioners in health and non-health sectors (including sport, education, transport, and planning) to increase:

  1. awareness and knowledge of national guidelines on physical activity and sedentary behaviours;
  2. knowledge, skills and confidence in promoting increased physical activity and reduction in sedentary behaviours; and
  3. integration of physical activity promotion into routine practice where applicable.
• The general public and specific population subgroups, to increase:

  1. awareness and knowledge of the guidelines on physical activity and sedentary behaviour;
  2. knowledge of how to achieve the physical activity and sedentary behaviour guidelines; and
  3. intentions and motivation to be more physically active and to reduce sedentary behaviour.

COMMUNICATION CAMPAIGNS

Different stakeholders will benefit from different materials; therefore to communicate guidelines to multiple audiences effectively, consideration must be given to the content, format, and delivery channels for guideline communication. When developing a guideline communication strategy, formative research can help determine the key audiences and understand the values, needs and preferences that influence levels of physical activity and sedentary behaviour. This should include exploration of the barriers to physical activity or to the integration of physical activity into policy and practice, as well as testing of draft messages and materials with different groups. This will help inform the key messages that are used, as well as the appropriate format(s) and channel(s) for communication. A comprehensive communication strategy will include a range of communications aimed at different audiences. Countries may need to prioritize specific groups depending on available resources (human and financial).

Communication campaigns on physical activity targeting the general public or specific subpopulations are a cost-effective intervention (133) and recommended in the WHO Global action plan on physical activity 2018–2030 (14). National and subnational campaigns on physical activity typically establish an overarching campaign slogan (for example “Be Active” or “Move More”), and develop design elements or characters, which may include tailored messages for different audiences (such as for young children, adolescents, adults or older adults, the less active, people living with disability or chronic conditions). Campaign messages and resources that are tailored to specific population groups are likely to be more effective than generic materials. Communication campaigns should consider the reach and effectiveness of both traditional media channels (such as television, radio, billboards, printed resources) as well as digital media channels (websites, mobile phones, Apps). Providing information on the national guidelines in a variety of formats is also useful. For example, a relatively new but increasingly common approach to communicating physical activity guidelines is through the use of infographics or short animated videos. WHO has supporting materials for developing and implementing such communication campaigns (135).

The academic and research community are likely to be interested in the scientific report which details the epidemiological evidence on which the guidelines are based. However the specific details of the underlying research is unlikely to be of interest to other more general audiences. Policy-makers may prefer a summary of the science, or even a short briefing document. Other audiences, such as health and non-health professionals, are more likely to favour different types of resources, for example a brochure or factsheet about the guidelines, or about how to integrate physical activity promotion into routine practice (for example in patient consultations in a health-care setting, or when developing building or transport plans for urban environments). Different professionals will require resources that are tailored to their role. Health professions, in particular, may benefit from a suite of resources to reflect the diverse population groups that they work with.

IMPLEMENTATION OF POLICY AND PROGRAMMES

National guidelines on physical activity and sedentary behaviour, in isolation, are unlikely to lead to increases in population levels of physical activity and should therefore be seen as one element of a policy and planning framework. It is critical that national guidelines are disseminated to key audiences and supported by a sustained national communication strategy that will lead to increased awareness and knowledge about the multiple benefits of regular physical activity and reducing sedentary behaviours. However, in order to achieve sustained behaviour change, these actions must be supported by policies that create supportive environments that enable and encourage people to be active, along with increased local, appropriate opportunities for people to participate in physical activity. Policies and programmes must consider and be adapted to the local context, in terms of both the health system and the complex multisector institutions that have an interest in, or opportunity to support, physical activity promotion. Action should be taken using a “whole of government” approach and consider the “system” of policies and multiple actions that can, through engagement of a wide range of stakeholders, support more people to be physical active across multiple sectors and settings. Using a “systems” approach that is aligned with a sustained communication strategy ensures that increased demand for physical activity, generated through effective communication, is matched by the provision of environments and opportunities for people to be physically active.

The WHO Global action plan on physical activity 2018–2030 set a target to reduce physical inactivity by 15% by 2030, and outlined 20 recommended policy actions and interventions (14). These included recommending that all countries implement sustained national public education and awareness campaigns and the integration of physical activity counselling programmes into primary and secondary health care. Other recommendations included the creation of appropriate environments for physical activity, including walking, cycling and wheeling, for all population groups and the provision of more opportunities and programmes for physical activity in schools, workplaces and sports clubs and venues. Implementation across all 20 recommendations may not be feasible in the short term in all countries, but should be viewed as a long-term goal. To identify an appropriate and feasible set of immediate actions, WHO Member States should conduct a situational analysis of current policy and practice. This will enable multisector collaboration and help identify areas of strength as well as gaps and opportunities, and can be used as the basis for developing or updating national and subnational plans.

These new WHO guidelines support expanding the scope of actions to include additional groups, such as people living with disability or chronic conditions, and women who are pregnant or postpartum. Policy will need to support appropriate programme delivery and practice that recognizes community needs and the diversity of groups and contexts. A number of sector-specific toolkits are under development to support implementation of the ACTIVE technical package (135); these will provide each sector with guidance on how to promote physical activity, for example through schools, through primary health care, or by improving provision for walking and cycling. The ACTIVE toolkit, as well as other WHO regional and national resources will support implementation of these physical activity and sedentary behaviour guidelines.

SURVEILLANCE AND EVALUATION

The WHO Global recommendations for physical activity for health have been used as benchmarks for population health monitoring and surveillance since 2010. The changes introduced to the recommendations in these updated guidelines will have some implications for surveillance systems and assessment instruments currently used to monitor national levels of physical activity. The publication of these new guidelines will call for a review of current instruments and reporting protocols to inform any adjustments and recommendations on future reporting against the new guidelines. Instruments, such as the Global Physical Activity Questionnaire and Global Student Health Survey, will be reviewed and protocols updated to align with these new guidelines; supporting guidance to all countries will be provided in 2021.

The WHO NCD Country Capacity Survey (CCS) is the main instrument used to monitor global progress on NCD policy implementation, and is conducted every two years. The CCS includes specific questions on population surveillance systems on physical activity for each age group covered by these WHO guidelines on physical activity and sedentary behaviour, and since 2019, on the existence of national physical activity guidelines. WHO Member States are requested to upload documentation to support their response. In 2019, of the 194 WHO Member States, 78 (40%) reported having physical activity guidelines (136). A detailed document analysis of responses to the CCS in 2019 was carried out, and identified that only two thirds of the 78 Member States (52/78) with national guidelines include statements on how much physical activity their populations should do; and of these, only 42 countries aligned fully with the 2010 WHO Global recommendations on physical activity for health (1). Data from the 2021 and subsequent surveys will provide information on uptake of these updated guidelines.

UPDATING

These guidelines will be updated after ten years, unless advances in the science of how physical activity is assessed using device-based measurement, and the rapidly evolving science on sedentary behaviour, prompt an earlier update.