Moving a nation
•
1 gostou•126 visualizações
Presentation spring 2017 on the national actions and approaches to getting the population more physically active
Recomendados
Recomendados
Mais conteúdo relacionado
Mais procurados
Mais procurados (20)
Semelhante a Moving a nation
Semelhante a Moving a nation (20)
Mais de Dr Justin Varney
Mais de Dr Justin Varney (12)
Último
Último (20)
Moving a nation
- 1. Moving a nation Dr Justin Varney National Lead for Adult Health and Wellbeing Justin.varney@phe.gov.uk
- 2. The Non-Communicable Disease Challenge Why prevention matters 2
- 3. Risk factors for ill health 3 Newton et al. (2015) Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet
- 4. Inactivity is killing us Decreasing activity levels since 1960s: oAdults are over 20% less active oBy 2030 we will 35% less active Physical inactivity is responsible for: o1 in 6 UK deaths oUp to 40% of many long-term conditions Estimated £7.4 billion annual cost 4 Ng SW, Popkin B (2012); Lee I-M, et al. (2012); Wen CP, Wu X (2012); WHO (2010); Ossa D & Hutton J (2002); Murray et al. (2013)
- 5. What is physical activity? 5 Physical activity Active living Active travel Active recreation Active sport Informal sport Organised sport
- 6. Context HSE 2012 showed a third of men and almost half of women damaging their health through insufficient physical activity PHE was tasked with developing an evidence-based national framework and coproduced Everybody Active Every Day in 2014 Post-2014 there has been a range of cross-sector actions, including a matrix of Government policies and strategies The Sport Strategy has tasked PHE with undertaking a review of progress against EAED two years on 6
- 7. Key national policy / strategy Sporting Future NHS Five Year Forward View Sustainability and Transformation Plans NHS Workforce Health CQUIN Towards an active nation Childhood Obesity Plan Cycling and Walking Investment Strategy 7
- 8. 8 Everybody Active, Every Day: The national framework for action Active Society Moving Professionals Moving at scale Active environments Public Health England (2014) Everybody Active Every Day.
- 9. 9 Changing general attitudes to make physical activity the expectation or social norm Working across sectors in the places we live and work Developing a common vision for “Everybody Active, Every Day” 1. Active society – Creating a social movement Public Health England (2014) Everybody Active Every Day.
- 10. 2.7 million children, young people and families signed up Over 200 national partners and 700,000 local supporting organisations Participation added an average extra five minutes daily activity Primarily 40-60 years C2DE demographic Partnerships with Amazon, BBC, Halfords, etc. and local authorities 16.3 million engagements, 1.2 million positive interactions with One You products 10 1. Active society – Key PHE national progress
- 11. 2.8 million women have done some or more activity as a result of This Girl Can In 2015-16 alone, ~15,000 Workplace Challenge participants; 60% female 726,144 School Games participants; 52% female and 12% disabled In 2015 alone, 76,472 Parklives participants in 145 parks across the country 11 1. Active society – Other key national progress
- 12. 12 Utilising existing network of influencers on the public, the public & voluntary sector workforce ‘Making every contact count’ across sectors and disciplines Starting with expertise & leadership in key sectors: o Education o Sports & leisure o Health & social care o Planning, design, transport 2. Moving professionals – Activating networks Public Health England (2014) Everybody Active Every Day.
- 13. 13 Developing ‘healthy’ cities, villages, towns and communities Linking across disciplines through planning and policy o‘Active’ infrastructure planning o“Active by Design” campaigns oCapital funding investments Embedding activity for all oAge-friendly oDisability-friendly 3. Active environments – Creating the right spaces Public Health England (2014) Everybody Active Every Day.
- 14. Active Design guidance (with Sport England) Planning Health Weight Environments workshops (with Town & Country Planning Association) NHS Healthy Towns programme Active travel briefing for local authorities Guidance for planners (with the Town & Country Planning Association) Partnerships and briefings with the Horticulture and Health Forum, Natural England and National Parks 14 3. Active environments – Key national progress
- 15. 15 Positive change must happen at every level and must be measurable, permanent and consistent Implement ‘what works’ at scale Maximise existing assets o Human o Physical Make being active the easiest, efficient choice! 4. Moving at scale – Interventions that make us active Public Health England (2014) Everybody Active Every Day.
- 16. ‘What works’ national case study collation and review (with ukactive and NCSEM) Over 1,000 attendees at regional fora in 2015 and 2016 (with ukactive, CSPN, LGA, NCSEM and BHFNC) Whole System approach to Obesity programme Get Active, Get Healthy programme (Sport England) Active Lives survey (with Sport England) ROI tools – MOVES (Sport England), NICE 16 4. Moving at scale – Key national progress
- 17. Evidence for implementation Synthesis of existing evidence base (e.g. NICE) Evidence-based actions across public health system: oSettings oLife-course Includes five key steps for local action: 1. Every child to enjoy & have skills to be active 2. Safe, attractive & inclusive active living environments 3. Make every contact count in public & voluntary sectors 4. Lead by example in public sector workspace 5. Evaluate and share ‘what works’ 17
- 18. Moving Professionals – Overview of progress and development of a national programme for healthcare professionals
- 19. Context NICE guidance supports promotion of physical activity with inactive patients and across conditions Around 600,000 skilled health professionals as key influencers at times of change and life transitions 1 in 4 people would be more active if advised by a GP or nurse, but as many as 72% of GPs do not discuss the benefits of physical activity with patients Only 1 in 5 GPs are broadly or very familiar with the CMOs’ guidelines and medical students are 40% less likely physical activity compared alcohol guidelines 19
- 20. Embedding physical activity within the clinical care pathway 20 Macmillan Cancer Support (2012) The Importance of Physical Activity for People Living with and Beyond Cancer . Diagnosis Treatment Maintenance/ Remission Advanced disease End of Life Mental wellbeing, build resilience Maintain or improve functionality, reduce risk of recurrence, positive impact on mental wellbeing Menta l Health Mental wellbeing, independence, impact on symptoms like fatigue
- 21. International context 21 ISPAH (2016)
- 22. Role of activity in achieving population health goals - the UK PROMISE study 22 Scarborough P et al. (2016) Translating the World Health Organization 25x25 goals into a United Kingdom context: The PROMISE study. PROMISE modelled potential UK interventions to WHO target of 25% premature mortality reduction by 2025 Potential impact of primary care behaviour change over 2015-25: o Prevent 11,600 premature deaths o Save 98,000 Years Lived with Disability Also highlighted evidence for: o Redesign urban environments o Support community groups Possible deaths & YLD saved 2015-25
- 24. 24 Undergraduate education Post- graduate education Continuing professional development Professional accreditation process e.g. exams E learning Peer2Peer Conferences Targeted training Curriculum Professional Standards Moving Professionals – The model
- 25. Undergraduate o Movement for Movement resources (led by Exercise Works) o FSEM Medical Student Exercise Prescription Booklet Post-graduate o Clinical Champions Programme (PHE and Sport England ) o Bespoke training (Macmillan, Intelligent Health, ukactive, etc.) Continuing Professional Development o E-learning – BMJ modules, Motivate to Move o CMOs’ infographics o Evidence into practice conferences (NCSEM, BHF) o Specialism priorities and development (SEM, AoMRC report, RCGP clinical priority) 25 2. Moving health professionals Key national developments
- 26. 26 Movement for Movement undergraduate teaching resources Over 20 health free-to-use undergraduate teaching slide sets on physical activity and health Developed by international consortium led by Exercise Works, peer-reviewed and approved by Council of Deans of Health Supported by 150 MCQ in exam question bank Used by 17/34 medical schools in England, adopted by all medical schools in Scotland and Northern Ireland
- 27. BMJ e-learning modules Nine e-learning modules on physical activity and health, plus a motivational interviewing module Broad usage across specialisms and primary/secondary care Over 48,000 modules completed (14,000 and 34,000 in 15/16 and 16/17) High popularity modules: o 9,000 MI module completions o 6,500 Diabetes module completions 27
- 28. Clinical Champions programme Over 4,000 HCPs trained through peer-to-peer education integrated into existing training Delivered in conjunction with local physical activity system (through LA or CSP support) Stepped expansion with partners: o National footprint of 21 GPs and pilot AHP, midwife and nurse champions in 16/17 (with Sport England) o SEM HST trained as part of specialist training o Burdett Trust grant awarded for nurse cadre in 17/18 Internal evaluation with BHF demonstrates good engagement and leadership, but need to strengthen data collection and Quality Assurance 28
- 29. CMO Infographics Developed by CMOs’ Expert Group supported by PHE Wide dissemination o Insert in British Medical Journal o Electronically through British Journal of Sports Medicine o Cross-referenced across national programmes and initiative (e.g. NHS Health Checks, etc.) 29 Presentation title - edit in Header and Footer
- 31. Children need to be more active 31 Health Survey for England 2012 (HSE); Active People Survey 8, April 2013-April 2014 (APS); National Travel Survey July 2014 (NTS)
- 32. Sedentary Time Source: Health Survey for England 2015, NHS Digital: http://content.digital.nhs.uk/catalogue/PUB22610/HSE2015-Child-phy-act.pdf Children aged 2-15 years; Health Survey for England 2015 Proportion of children who spent six or more hours being sedentary per day by age group
- 33. Trends in travel to school Children aged 5-16years; National Travel Survey, Great Britain 1995/97-2013 Data includes trips of less than 50 miles only
- 34. The CMO Guidelines for Children 34
- 35. Why is promoting physical activity an important public health issue? 35 Lifecourse stage Benefits Under 5s • Contributes to a healthy weight* • Improves bone health • Improves cardiovascular health • Supports physical, social and emotional development • Develops movement and co-ordination Life course impact: is associated with higher physical activity levels later in life. *Diet makes a bigger contribution to a child’s energy intake and weight status. E.g. If a child consumes a full sugar beverage, a standard chocolate bar and a bag of crisps they would need to run for an average of 50 minutes to burn off the energy consumed. Start Active, Stay Active, 2011 Start Active, Stay Active, 2011
- 36. 36 Lifecourse stage Benefits 5-11s Physically • Enhanced cardio-metabolic health • Muscular-skeletal health • Bone density • Cardio respiratory fitness Mentally • Enhance mental wellbeing including positive self esteem and lower levels of anxiety and stress Socially • Improved confidence and peer acceptance Academically • Emerging association with academic achievement, improved concentration and attention Lifecourse impact: children and young people who are physically active are more likely to continue the habit into adult life* Why is promoting physical activity an important public health issue?
- 37. What works to support physical activity in Schools and Colleges 37
- 38. Contribution of schools and colleges 38 PHE (2015) What works in schools and colleges to increase physical activity
- 39. 2.7 million children, young people and families signed up Over 200 national partners and 700,000 local supporting organisations Participation added an average extra five minutes daily activity Change4life Sports clubs target the least active children. Evaluation has shown a significant, positive effect on the activity levels. Youth Health Champions - give young people the skills, knowledge and confidence to act as peer mentors. 726,144 School Games participants; 52% female and 12% disabled 39 1. Active society – CYP focus
- 40. Moving professionals: CYP focus Chief Medical Officers (CMO) infographics aimed at professionals working with Children and Young People Health Visitors and School Nurses • key role in educating parents and children on the importance of physical activity raising the issue during points of contact through the Healthy Child Programme. What works in schools and colleges to increase levels of activity (PHE 2015) • one key principle is upskilling staff to ensure they are confident and competent to deliver sport and physical activity. 40
- 41. Looking ahead
- 42. Three themes that are shaping the future 1.Technological acceleration 2.Cultural cohort evolution 3.Live span expansion 42
- 43. Looking ahead Investing in physical activity is key at an individual level to being able to enjoy life, remain economically active and independent into later life. For the public sector, ensuring individuals are active across the life course is essential to the economic viability of local communities and the sustainability of the public sector. 43
- 44. 44 Public Health Futurology
Notas do Editor
- As the statutory leader of the public health system at national and local level, PHE has worked with over 1,000 national and local stakeholders to coproduce the Everybody Active Every Day framework. It consolidates international evidence on ‘what works’ into a single cohesive framework across sectors and levels for increasing physical activity in England. It supports local leaders (e.g. Health and Wellbeing Boards, local authorities, NHS clinical commissioning groups, voluntary sector, private sector) to reframe, refocus and provide leadership on physical activity on: Cross-sector partnership Industrial scale action across the whole system Focus on addressing inactivity as well as increasing physical activity to health enhancing levels – as we now that the greatest gains are in getting people who are ‘inactive’ – doing less than 30 minutes per week of exercise – just to become active irrespective of whether they achieve 150 minutes per week. The overarching vision of ‘Everybody Active Every Day’ summarises the guidance of the UK Chief Medical Officer: The most effective way to achieve the recommended levels of physical activity for good health is by embedding physical activity in daily life; and Physical activity is needed by and should be the expectation for everyone. Irrespective of age, disability economic or any other factor we all need to be supported to be active and have a healthy, happy life. The vision is supported by four domains for national and local actions which are set out in the following slides with actions that NHS providers should take as part of this whole system approach.
- The physical environment is the focus of the third domain for action, ‘Active environments’, which focuses on creating environments that are conducive and supportive being physical activity in our daily lives. As we know environment shapes behaviour. In partnership with Sport England, we are today publishing updated “Active Design’ guidance. This work brings together health, design and planning agendas by providing material which supports the creation of the right conditions and environments for individuals and communities to lead active and healthy lifestyles through 10 overarching design criteria. It is primarily designed for planners; health professionals; and developers. Working with the Town and Country Planning Association, 15 Planning Health Weight environments’ workshops have been held across the country. The last of these occurring later this month in Greenwich. Based on feedback during the development of EAED we are working with Living Streets on two pieces of work regarding specific challenging issues: ‘What works’ to increase active travel in rural environments and barriers and opportunities to increase functional walking for people with disabilities. We have been working with the County Sports Partnership Network to evaluate the Workplace Physical Activity Challenge and its impact on sustained behaviour change through a pilot with our own workforce.
- The final domain, ‘Moving at scale’, focuses on identifying through evaluation and scaling up ‘what works’ to ensure that positive change to happen at every level in a way that is measurable, permanent and consistent. A second round of regional Moving More Living More fora were held across five cities in March 2015 attracted over 600 local decision makers. This partnership with UKactive, County Sports Partnership Network, Local Government Agency and others focused on embedding EAED at local level. We have just commissioned a consortium of the British Heart Foundation National Centre, National Centre for Sports and Exercise Medicine and County Sports Partnership Network to develop and run the next round of regional fora, focusing on specifically on understanding and skills on evaluation and scale-up of ‘what works’. These will be co-produced and rolled out with the local system in early-2016. So I would encourage your attendance. Alongside EAED we published an summary of the evidence of ‘what works’ to increase population physical activity across settings and the life course. Our Knowledge and Intelligence Team has continued to publish data and evidence briefings in this area, including updated local public health outcomes data.
- The Everybody Active Every Day framework is accompanied by a summary of the existing evidence base on what we know achieves change at population level. It is based on the national and international evidence base, in particular drawing on the nine existing NICE guidelines that specifically focus on physical activity. The evidence is presented across settings and the life course. It also highlights five key steps for local action: Ensuring ‘Every child to enjoy & have skills to be active’ so that they develop the physical literacy that will enable them to be active adults Creating ‘Safe, attractive & inclusive active living environments’ Embedding physical activity into a ‘“Making every contact count” approach in public & voluntary sectors’ ‘Lead by example in public sector workspace’ – as we know in some parts of the country up to a third of the workforce are employed in the public sector; and Embedding measurement and evaluation into all our work so that we can ‘Evaluate and share ‘what works’’
- Scarborough P, Cowburn G, Cobiac L, Foster C, Matthews A, Milton K, Thomas E, Wilkins E, Rayner M. Translating the World Health Organization 25x25 goals into a United Kingdom context: The PROMISE study. Richmond Group: London, 2016. www.richmondgroupofcharities.org.uk/sites/default/files/the_promise_study_final_report.pdf The Promise Study looked at translating the World Health Organization 25x25 goals into a United Kingdom context and what would be required to achieve those goals. considered current trajectory in England for the WHO target to reduce premature mortality by 25% by 2025 Based on extrapolating trends from the last five years for the next 10 years it showed we are on target for women, but off target for men. It modelled 12 interventions (with economic modelling on four of them) to consider potential impact on premature mortality and morbidity (the latter isn’t considered by WHO). Three of the twelve key interventions highlighted by the promise study PROMISE study are related to physical activity: Redesign urban environments to prioritise walking and cycling Support for community groups that encourage physical activity Behaviour change advice service, delivered through primary care
- 1 in 4 patients would be more active if advised by a GP or nurse. As many as 72% of GPs do not speak about the benefits of physical activity to patients.
- PA levels amongst children Aged 2-4 years only one in ten children meet the government recommendation for physical activity (boys 9%, girls 10%). High proportion of ‘low levels’ of activity in this age group Aged 5-15 years two in ten meet the government recommendations for physical activity (boys 21%, girls 16%). Levels of physical activity amongst CYP are declining over time between 2008 and 2012 from 28% to 19% among boys and from 19% to 16% amongst girls. For certain subgroups of children and young people there is marked inactivity Age Levels of activity decline with age in 4-10 year olds. Beyond primary age, levels of physical activity continue to fall with age and are worse for girls. Girls: from age 5 a lower percentage of girls compared to boys meet the recommended levels of physical activity. As girls get older their physical activity levels drop: Whilst 23% girls aged 5-7 meet the recommended levels of daily physical activity, by ages 13-15 only 8% do Socio-economic differences: people living in the least prosperous areas are twice as likely to be physically inactive as those living in more prosperous. Access to leisure time can be important for children’s physical activity, and family support (such as taking children to sport or activity sessions) is also positively associated with levels of physical activity in adolescents (Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW. Correlates of physical activity: why are some people physically active and others not? Lancet. [Review]. 2012 Jul 21;380(9838):258–71 ) Lower levels of physical activity amongst those with a limiting illness or disability Geographic: there are geographical differences in the % girls and boys meeting recommendations – for boys highest in SE lowest in SW, for girls highest in London lowest in W Mids The 2004 Health Survey for England showed there are considerable differences between the levels of participation in physical activity between ethnic minority groups. For example only 48% of Pakistani boys and 23% of Pakistani girls completed sport or organised sport compared to 59% of boys and 55% of girls overall. Boys and girls from minority ethnic groups were less likely to have been active through play, with levels of participation as low as 77% for Chinese boys, 75% for Indian girls and 74% for Bangladeshi girls. Most surveys use self-reported physical activity data. Although surveys which contrasted this with accelerometers showed that most of us overestimate the level of activity undertaken.
- Sedentary behaviour is a particular issue Around four in ten children aged 5-15 years are physically inactive (boys 39%, girls 45%) For all age groups and both sexes, levels of sedentary time are elevated at weekends compared to weekdays On weekdays, fewer than 10% of children under 10 are sedentary for six hours or more. The proportion of children aged 13-15 years is much higher at 24% for boys and 16% for girls. At weekends, there is a steady increase from the youngest age group (around 10%) to the oldest (43% of boys and 37% of girls). Sedentary behaviours appear to track from childhood to adolescence or adulthood at low to moderate levels, with the strongest tracking shown for TV viewing The PHE report, ‘Excessive screen time affects children's well-being’ published in 2013 showed: Excessive computer gaming becomes more common as children grow into young people, and is associated with lower levels of well-being. Those children who, on a school day, spent 4 hours or more on computer gaming tended to have lower well-being than peers who spent less time doing this. The highest well-being was reported by children who spent less than an hour a day playing computer game While other countries have implemented screen guidelines for children and young people the U,K has refrained from implementing guidelines due to an inconsistent evidence base.
- Travelling to and from school is recognised as an opportunity for children to achieve part of their recommended daily physical activity. The National Travel Survey: 2013 presents information on travel to and from school for children aged 5 to 16. Travel to school data Between 1995/7 and 2013 the % children aged 5-16 walking to school has decreased from 47% to 42% For 5-10 year olds % walking has decreased from 53% to 46% For 11-16 year olds walking has decreased from 41% to 38%
- The CMO guidelines were launched in 2011, in the Start Active, Stay Active report. A report on physical activity for health from the four home countries’ Chief Medical Officers. From birth physical activity should be encouraged, particularly through floor-based play and water-based activities in safe environments Pre-school age children who are capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day. All children and young people (aged 5-18 years ): should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day. vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week. All children an young people should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping)
- There are multiple benefits of encouraging regular physical activity amongst children and young people that extend into adulthood A wealth of evidence shows that an active life is essential for physical and mental health and wellbeing. Regular physical activity can guard us against a number of diseases are currently on the increase and affecting people at an earlier age. They include cancer and diabetes, and conditions like obesity, hypertension and depression. Being active plays a key role in brain development in early childhood good for longer-term educational attainment Contributes to a healthy weight. The link between physical inactivity and obesity is well established. With more than half of adults and almost a quarter of children overweight or obese everyone would benefit from being more active every day. It helps to maintain a healthy weight and improves health, regardless of weight. Improves bone health, develops movement and coordination Active play is a fundamental part of physical, social and emotional development from infancy. Good physical development in children is linked to other types of positive development, such as speech and coordination. Lifecourse impact: Being active in childhood builds the foundation for an active adult life. Once learnt, a skill like swimming or riding a bike is there for life
- There are multiple benefits of encouraging regular physical activity amongst children and young people that extend into adulthood A wealth of evidence shows that an active life is essential for physical and mental health and wellbeing. Regular physical activity can guard us against a number of diseases are currently on the increase and affecting people at an earlier age. They include cancer and diabetes, and conditions like obesity, hypertension and depression. Being active plays a key role in brain development in early childhood good for longer-term educational attainment Contributes to a healthy weight. The link between physical inactivity and obesity is well established. With more than half of adults and almost a quarter of children overweight or obese everyone would benefit from being more active every day. It helps to maintain a healthy weight and improves health, regardless of weight. Improves bone health, develops movement and coordination Active play is a fundamental part of physical, social and emotional development from infancy. Good physical development in children is linked to other types of positive development, such as speech and coordination. Lifecourse impact: Being active in childhood builds the foundation for an active adult life. Once learnt, a skill like swimming or riding a bike is there for life
- In 2014, PHE commissioned an evidence review to take a rigorous, objective look at local physical activity interventions in schools and colleges across England to identify ‘what works’. The review of evidence found few projects achieve the higher thresholds of NESTA, reflecting the gap in research investment into physical activity and the limitations of current methodologies. The project highlighted the significant gap in routine collection of baseline data and evaluation In 2015, PHE launched the briefing paper outlining the contribution schools can make to supporting physical activity for children and young people. The review of evidence found a gap in research investment into physical activity and the limitations of current methodologies. The project highlighted the significant gap in routine collection of baseline data and evaluation in physical activity interventions. The review summarised identified eight key promising principles for practice and provided case studies and resources to show schools and colleges how to translate the principles into practice.
- PHE (2015) What works in schools and colleges to increase physical activity
- Active society: Change4life Public Health England's flagship Change4Life campaign aims to help families and children in England to eat well, move more and live longer. Since its launch in 2009 more than 2.7 million people have signed up and it now has more than 200 national partners. Change4life Sports Clubs Change4life Sports clubs were set up by DH in 2011 to target the least active children and help them get more active through teaching physical activity literacy skills. Clubs run just over 12 weeks and take place mostly at lunchtime or after school. Four hundred and fifty School Games Organisers are supported by the Youth Sport Trust to deliver the clubs. SPEAR Evaluation has shown C4L Clubs have a significant, positive effect on the activity levels of participating children Start4life Youth Heath Champions - PHE is working with RSPH to support 800 young people to become health champions Designed to give young people the skills, knowledge and confidence to act as peer mentors, increasing awareness of healthy lifestyles and encouraging involvement in activities to promote good health. Young people from age 14 undertake an RSPH Level 2 Certificate for Youth Health Champions, which is equivalent to a GCSE Grade A-C. It consists of four modules; a basic understanding of the key determinants of health a research task about the health facilities in their own community practice at delivering health messages to their peers and one specialist module to deepen their understanding of a specific aspect of health. The young people then offer support to their peers by providing confidential signposting to specialist health professionals, by raising awareness of health issues through the delivery of health promotion campaigns and by acting as healthy role models in their communities. Campaign topics include: Physical activity taster sessions
- Chief Medical Officers (CMO) infographics aimed at professionals working with Children and Young People. These aim to increase awareness of the CMO guidelines & support advice given to CYP & families around physical activity and reducing sedentary behaviour. Establishing regional GP clinical champions to promote the CMO guidelines and support workforce development Health Visitors and School nurses play a key role in educating parents and children on the importance of physical activity and raising the issue during points of contact through the Healthy Child Programme. PHE works with the Nursing Directorate to support workforce development around the importance of physical activity and raise awareness of the CMO guidelines. Education: PHE published What works in schools and colleges to increase levels of physical activity? in October 2015 in collaboration with YST, AoC Sport and 4 Government Department (DH, DfE, DfT and DCMS).This sets out 8 promising principles for practice, drawing on a review of evidence of what works. The principles span: developing and delivering multi-component interventions; having a skilled workforce; promoting student voice, active environments; promoting choice and variety; embedding in the curriculum and promoting active travel. The document signposts to practice examples and sources of support. For example one of the key principles is upskilling staff to ensure they are confident and competent to deliver Sport and Physical activity.