Scottish Health Survey 2018: main report - revised 2020

Chapter 6 Physical Activity

Summary

In 2018, two thirds of adults (66%) met the guidelines for Moderate or Vigorous Physical Activity (MVPA)*. This was the highest level in the time series, though it has not changed significantly since 2013 (64%).

*At least 150 minutes of moderate physical activity, 75 minutes vigorous physical activity, or an equivalent combination of the two, per week.

Men continued to be more likely than women to meet the MVPA guidelines.

Adherence to the MVPA guidelines was more common among adults in less deprived areas, declining from 74% in the least deprived areas to 54% in the most deprived areas.

• Adherence to MVPA guidelines declined with age, from over three-quarters of those aged 16–44 (77%) to 31% of those aged 75 and above.
• Adults in the most deprived areas were more likely to have very low activity levels than those in the least deprived areas (32% compared to 12% respectively).

Average time spent sedentary by adults and children excluding time at work/school

• Men spent more hours sedentary on weekend days, on average, than women (6.1 and 5.8 respectively).

The five most common reasons cited among adults for participating in activity were:

Of those who had not participated in any physical activity in the last month, the main barriers were:

6 Physical Activity

Kasmita Mirani

6.1 Introduction

Physical activity and sport are a powerful force in transforming lives. There is clear and growing evidence of the health, economic and social benefits physical activity and sport can bring. Physical activity and sport improve the health of the heart, skeletal muscles, bones and blood, the immune system and nervous system; and enable people to live longer, healthier lives. Being active improves psychological wellbeing, boosts self-esteem, plays an important role in maintaining a healthy weight and improves mood and sleep quality. The early years is a vitally important period to intervene to improve outcomes for children. There is strong evidence that intervention in this period, including through play, improves health and cognitive development^[1].

Physical activity and sport can also play a major role in improving outcomes and tackling inequalities across many different aspects of our lives and society. Positive changes being achieved through physical activity and sport initiatives in Scotland include improving mental health, supporting weight management initiatives, overcoming loneliness and isolation; reducing reoffending; promoting sustainable forms of transport; and enabling people to connect with the natural environment^[2].

In 2011, the four Chief Medical Officers (CMOs) of England, Scotland, Wales and Northern Ireland issued guidelines on duration, frequency and type of physical activity required to achieve general health benefits for different age ranges. These drew on global evidence for the health benefits people can achieve by taking regular physical activity throughout their lives.

The Chief Medical Officer's guidelines were under review during preparation of this report and updated guidelines were published on the 7th September 2019. The updated guidelines will be included in next year's report. ^[3].

Table 6A UK CMO physical activity guidelines (2011)

Age group	Guidelines
Early years – children under 5 years	Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments. Children capable of walking unaided should be physically active daily for at least 180 minutes (3 hours), spread throughout the day. Minimise amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).
Children and young people aged 5 to 18	Should engage in moderate to vigorous activity for at least 60 minutes and up to several hours every day. Vigorous activities, including those that strengthen muscles and bones, should be carried out on at least 3 days a week. Extended periods of sedentary activities should be limited. Should be active daily.
Adults aged 19-64	Should engage in at least moderate activity for a minimum of 150 minutes a week (accumulated in bouts of at least 10 minutes) - for example by being active for 30 minutes on five days a week. Alternatively, 75 minutes of vigorous activity spread across the week will confer similar benefits to 150 minutes of moderate activity (or a combination of moderate and vigorous activity). Activities that strengthen muscles should be carried out on at least two days a week. Extended periods of sedentary activities should be limited.
Adults aged 65 and over	In addition to the guidance for adults aged 19-64, older adults are advised that any amount of physical activity is better than none, and more activity provides greater health benefits. Older adults at risk of falls should incorporate activities to improve balance and coordination on at least two days a week.

6.2 Policy Background

Physical activity, in conjunction with eating well and maintaining a healthy weight, is one of the six Public Health Priorities for Scotland published jointly by the Scottish Government and COSLA in 2018^[4]. The Active Scotland Delivery Plan, also published in 2018, is one of five linked public health strategies and delivery plans which support the Public Health priorities. Taken together these aim to create a healthy environment whilst encouraging people to make good choices about their health, their life and their communities.

The Active Scotland Delivery Plan aims to cut physical inactivity in adults and teenagers by 15% by 2030 using wide-ranging approaches including active travel funding, support for both formal sports and informal physical activity, and partnership working across the transport, education, health and planning sectors^[5].

The Plan contains 90 actions including development of community sports hubs in the most deprived areas; more opportunities for pupils to participate in sport before, during and after school; support and development for helping people move from school sport to clubs; increased funding for cycle and walking paths; promoting good practice to ensure children have safe places to play; and addressing barriers to women and girls participating.

Scotland was one of the first countries to publish a national action plan following the World Health Organisation's global plan on physical activity.

6.2.1 Reporting on physical activity in the Scottish Health Survey (SHeS)

Physical activity is recognised as a key aspect of the new National Performance Framework outcome that 'we are healthy and active'. SHeS is the source for monitoring the percentage of adults meeting the physical activity recommendations which is one of the indicators used to gauge progress on the overall outcome^[6].

Adult adherence to the guidelines on moderate / vigorous physical activity (MVPA) and muscle strengthening guidelines are presented in this chapter along with reasons for participating in activity and barriers to doing so. Levels of adult and child sedentary time are also reported.

The area deprivation data for physical activity are presented in Scottish index of Multiple Deprivation (SIMD) quintiles. To ensure that the comparisons presented are not confounded by the different age profiles of the quintiles, the data have been age-standardised. Readers should refer to the Glossary at the end of this Volume for a detailed description of SIMD and age-standardisation.

Supplementary tables on physical activity are available on the survey website^[7].

6.3 Methods And Definitions

6.3.1 Adult physical activity questionnaire

The SHeS questionnaire^[8] asks about four main types of physical activity:

• Home-based activities (housework, gardening, building work and DIY)
• Walking
• Sports and exercise
• Activity at work.

Information is collected on the:

• time spent being active
• intensity of the activities undertaken
• frequency with which activities are performed.

6.3.2 Adherence to adult physical activity guidelines

The current activity guidelines advise adults to accumulate 150 minutes of moderate activity or 75 minutes of vigorous activity per week or an equivalent combination of both, in bouts of 10 minutes or more. These guidelines are referred to throughout this chapter as the MVPA guidelines (Moderate or Vigorous Physical Activity). To help assess adherence to this guideline, the intensity level of activities mentioned by participants was estimated. Activities of low intensity, and activities of less than 10 minutes duration, were not included in the assessment. This allowed the calculation of a measure of whether each SHeS participant adhered to the guideline, referred to in the text and tables as "adult summary activity levels". A more detailed discussion of this calculation is provided in the 2012 report^[9].

Table 6B Adult summary activity levels^a

Meets MVPA guidelines	Reported 150 mins/week of moderate physical activity, 75 mins vigorous physical activity, or an equivalent combination of these.
Some activity	Reported 60-149 mins/week of moderate physical activity, 30-74 mins/week vigorous physical activity, or an equivalent combination of these.
Low activity	Reported 30-59 mins/week of moderate physical activity, 15-29 mins/week vigorous physical activity or an equivalent combination of these.
Very low activity	Reported less than 30 mins/week of moderate physical activity, less than 15 mins/week vigorous physical activity, or an equivalent combination of these.

^a Only bouts of 10 minutes or more were included towards the 150 minutes per week guideline

To avoid overcomplicating the text, where descriptions are provided of the summary activity levels, they tend to refer only to moderate physical activity, although the calculations were based on moderate or vigorous activity as described above.

A second summary measure was calculated for adults, in respect of meeting the guidelines to carry out activities that strengthen muscles on at least 2 days a week to increase bone strength and muscular fitness. Nine different sports were classed as always muscle strengthening, and other sports or exercises were classed as muscle strengthening if the participant reported that the effort was enough to make the muscles feel some tension, shake or feel warm. If the participant carried out such activities for at least 10 minutes on 2 or more days a week, on average, they were deemed to meet the muscle strengthening guideline. As this only includes muscle strengthening through sporting activity, reported levels may be an underestimate.

6.3.3 Child physical activity questionnaire

The questions on child physical activity are slightly less detailed than those for adults^[10]. No information on intensity is collected (with the exception of asking those aged 13-15 about their walking pace). The questions cover:

• Sports and exercise
• Active play including housework and gardening
• Walking

We are not reporting on children's physical activity in the main report this year as the Chief Medical Officer's physical activity guidelines were under review during the period of the survey with implications for the measurement method for children's physical activity used in the survey. The updated UK Chief Medical Officer's Physical Activity Guidelines were published on 7th September 2019, and figures on the proportion of children meeting the guidelines will appear in the Scottish Health Survey results for 2019 published next year.

6.3.4 Sedentary activity

Since 2003, all participants aged 2 and over have been asked about time spent in front of a screen (e.g. a TV or tablet) during leisure time on both weekdays and weekend days. For everyone aged 2 and over, questions about time spent sitting during leisure time (apart from in front of a screen) were added in 2012. The examples of time spent sitting that participants were given included eating, reading, studying and (for children) doing homework. For adults in paid work, new questions on time spent sitting during the working day were also added in 2012.

6.4 Adult Physical Activity Levels

6.4.1 Summary activity levels since 2012

In 2018, around two-thirds (66%) of all adults met the guidelines for moderate or vigorous physical activity (MPVA) of at least 150 minutes of moderate physical activity, 75 minutes of vigorous physical activity, or an equivalent combination of the two, per week. This was the highest level in the time series though it has not changed significantly since 2013 (64%). Fewer adults reported engaging in some activity (10%) or low activity (4%), and around a fifth (21%) reported very low activity.

As in previous years, in 2018 a significantly higher proportion of men met the recommendations for physical activity than women (70% and 62%).
Figure 6A, Table 6.1

Figure 6A
Adult adherence to the MVPA guideline^a, 2012-2018, by sex

^a Meets moderate/vigorous physical activity guideline of 150 minutes of moderate physical activity, 75 minutes of vigorous physical activity, or a combination of both each week.

6.4.2 Summary adult physical activity levels, 2018, by age and sex

Physical activity levels varied significantly by age with younger age groups more likely to meet the MVPA guidelines than older age groups. A higher proportion of those aged 16-24 met the physical activity guidelines (77%), declining to 67% among those aged 45-54, and to 31% among those aged 75 and over.

Slightly different patterns of adherence to the MVPA guidelines by age were found for men and women. For men adherence declined from 83% among those aged 16-34 to 39% among those aged 75 and over. For women adherence was highest among those aged 25-34 (77%) and then declined with age to 26% among those aged 75 and over.

Men were significantly more likely than women to meet the guidelines on physical activity across all age groups, with the greatest differences in the oldest and youngest age groups. Among men in the youngest age group (16-24) 83% met the guidelines, compared with 70% of women in the same age group and among men aged 75 and over 39% met the guidelines compared with 26% of women in the same age group.

Figure 6B
Adult adherence to the MVPA guideline^a, 2018, by age and sex

^a Meets moderate/vigorous physical activity guideline of 150 minutes of moderate physical activity, 75 minutes of vigorous physical activity, or a combination of both each week.

The decline in activity levels by age corresponded to increasing levels of very low activity (less than half an hour a week of moderate activity or the equivalent level of vigorous activity) as age increased. This pattern was the same for men and women. The proportion of adults with very low activity levels increased from 12% among the youngest adults (16-24) to 49% among adults aged 75 and over.
Figure 6B, Table 6.2

6.4.3 Summary adult physical activity levels (age-standardised) since 2012, by area deprivation and sex

As in previous years, adult physical activity levels were significantly associated with area deprivation. The prevalence of age-standardised adherence to the MVPA guidelines was highest among adults living in the least deprived areas at 74% and declined alongside area deprivation to 54% among adults living in the most deprived areas. As shown in Figure 6C, this association has been similar since 2012.

The pattern by deprivation was similar for both men and women. Among men, the age-standardised prevalence of adherence to the MVPA guidelines declined from 83% in the least deprived areas to 57% in the most deprived areas. Among women, the prevalence declined from 67% to 52%.
Figure 6C, Table 6.3

Figure 6C
Adult adherence to the MVPA guideline^a (age-standardised), by area deprivation, 2012 to 2018

^a Meets moderate/vigorous physical activity guideline of 150 minutes of moderate physical activity, 75 minutes of vigorous physical activity, or a combination of both each week.

Similar to the pattern observed for age, the decline in adherence to the MVPA guidelines as deprivation increased largely corresponded to the increasing levels of very low activity. In 2018 the proportion of those with very low activity levels were 12% in the least deprived areas compared with 32% in the most deprived areas. This pattern was evident for both sexes and has been observed every year since 2012

6.4.4 Adult adherence to muscle strengthening and MVPA guidelines, 2018, by age and sex

In 2018, 29% of adults aged 16 and over met both the muscle strengthening and MVPA guidelines, with 1% having met the muscle strengthening guideline only. Over a third (37%) met the MVPA guideline but not the recommended level of muscle strengthening activity. The remaining third (33%) of adults did not meet either guideline.

Men were more likely than women to meet both the muscle strengthening and MPVA guidelines (31% of men compared to 27% of women). This pattern was driven by differences among those aged 16-44 (36-53% of men aged 16-44 met both guidelines compared with 31-47% of women) and those aged 75 and over (12% of men aged 75 and over met both guidelines compared to 5% of women).

Adherence to muscle strengthening and MVPA guidelines declined significantly with age, with adherence to both guidelines falling from half (50%) of those aged 16-24 to under a tenth (8%) of those aged 75 and over. Patterns by age were slightly different between men and women. Among men there was a larger drop in adherence to muscle strengthening and MVPA guidelines between the 35-44 and 45-54 age groups (from 36% to 26%) than for women (31% to 28%) and among women there was a larger percentage point drop in adherence between the 65-74 and 75 and over age groups (from 15% to 5%) than for men (from 14% to 12

Overall, adults were significantly less likely to have met the muscle strengthening guideline than the MVPA guideline, with 66% meeting the MPVA guideline and 30% meeting the muscle guideline. A similar pattern was observed across all age groups for both men and women.
Figure 6D, Table 6.4

Figure 6D
Adult adherence to muscle strengthening guidelines, 2018, by age and sex

6.4.5 Reasons for participating in activity, 2018, by age and sex

In 2018 the five most common reasons cited among adults for participating in activity were to keep fit (not to just lose weight) (68%), for enjoyment (63%), to de-stress, to relax and unwind (44%), for health reasons (36%) and to socialize (32%).

A number of significant differences were apparent between men and women's motivations to participate in activity in 2018. Men were more likely than women to be motivated by each of the following reasons: for enjoyment (66% of men and 59% of women), to improve their performance (27% of men and 16% of women), to train / take part in competition (14% of men and 7% of women) and for other reasons (3% of men and 1% of women). A significantly higher proportion of women stated losing weight (33%) or taking the children (14%) as reasons for engaging in activity compared with men (27% and 10% respectively).

Many of the reasons for participating in activity varied significantly by age, with different patterns evident depending on the reason. For example, keeping fit was mentioned by 65-75% of those aged 16-64, but was a less common reason for those aged 65 and over (55-60%). The highest proportion citing this reason were among those aged 35-44 (75%). Similarly, losing weight was most likely to be mentioned by those aged 35-44 (43%) falling to 10% among those aged 75 and over.

The proportion that stated health reasons as a motivation to be active was highest among those aged 45-64 (44-45%) and lowest at age 16-24 (19%), compared with a range from 33-38% among other age groups. Similarly, being active to de-stress and relax was mentioned by around half of those aged 25-54 (47-50%), dropping to 24% among those aged 75 and over.

There was an age-related decline in the proportion that were active to train / take part in competition (23% among those aged 16-24 dropping to 5% among those 75 and over) or to improve their performance (29% among those aged 16-24 falling with age to 12% among those 75 and over).

A higher proportion of those aged 35-44 said they were active to take children (23%) compared with 1% among those aged 16-24 and between 7 and 16% among other age groups. Those aged 65 and over were most likely to be active in order to socialize (43-44%) compared with between 28 and 35% among other age groups. Those aged 35-44 were most likely to be active to walk the dog (17%) compared with between 6 and 12% among other age groups.

For all the above reasons for participating in activity, similar patterns by age were found for men and women.
Table 6.5

6.4.6 Barriers to being more active, 2018, by age and sex

Table 6.6 presents the barriers to being more active mentioned by people who had not participated in any physical activity in the previous month.

In 2018, difficulty finding time (30%), health isn't good enough (30%) and lack of interest (17%) were the three most commonly mentioned barriers to being more active among people who had not participated in any activity in the previous month. The remaining barriers were mentioned by less than one in ten people, including 8% who said that they already do enough and 8% gave no reason.

The most commonly cited barriers to engaging in physical activity were similar for men and women with significant differences only found between the sexes for two barriers; 3% of women were deterred from physical activity because there was no one to do it with compared to 1% of men and 3% of men were deterred by the weather compared to 1% of women.

A number of the barriers to being more active varied significantly by age. The proportion of adults who stated their health not being good enough as a barrier increased with age from 8% among those aged 16-24 to 54% among those aged 75 and over. Younger adults were more likely than older adults to state 'it costs too much' as a barrier with 17% of those aged 16-24 stating this with the proportion declining across the age groups to less than 1% among those aged 75 and over. Lack of time was the most common response among adults in the four youngest age groups from age 16-54 (cited by 37-51%) and thereafter declined with age to 4% among those aged 75 and over.

Among the less commonly stated barriers for being active, the proportion that stated they might feel uncomfortable / out of place fell with age from 11% among those aged 16-24 to 0% among those aged 75 and over.
Table 6.6

6.4.7 Trends in adults' sedentary time since 2015, by sex

In 2018, adults spent an average of 5.3 hours of sedentary time (outside of work, school or college) per day on weekdays and 6 hours sedentary time on weekend days. This figure has not changed significantly since 2015, ranging from 5.2-5.3 hours on weekdays and 5.9-6 hours on weekends. This pattern is the same for both men and women, with neither group having seen an increase or decrease in average sedentary time since 2015.

As in previous years, men spent more hours sedentary on weekend days, on average, than women (6.1 and 5.8 respectively). In 2018 there was no significant difference between men and women in the average number of hours spent sedentary during weekdays (5.3 for both).
Figure 6E and 6F, Table 6.7

Figure 6E
Mean hours of sedentary time per weekday, 2015 to 2018, by sex

Figure 6F
Mean hours of sedentary time per weekend day, 2015 to 2018, by sex

6.4.8 Adults' sedentary time in 2018, by age and sex

Sedentary activity patterns by age in 2018 were the same on weekdays and weekend days. Sedentary levels (outside of work, school or college) declined from those aged 16-24 (6.1 hours on weekday, 7.0 on weekends) to those aged 35-44 (3.9 hours and 5.0 hours respectively) before then increasing with age; those aged 75 and over were sedentary for the greatest amount of time, on average, 7.1 hours on both weekdays and weekend days. Sedentary activity patterns by age were similar for men and women.
Figures 6G and 6H, Table 6.8

Figure 6G
Adults' sedentary time on weekdays, 2018, by age and sex

Figure 6H
Adults' sedentary time on weekends, 2018, by age and sex

6.5 Children's Sedentary Time

6.5.1 Trends in children's sedentary time since 2015, by sex

In 2018, children spent an average of 3.3 hours sedentary (outside of nursery or school) on weekdays and 4.6 hours sedentary on the weekends. This has not changed significantly since 2015, with average figures having fluctuated between 3.3-3.4 hours for weekdays and 4.5-4.7 hours for weekends. A similar pattern was found for both boys and girls, with both spending more time sedentary on weekends, and with neither group having seen an increase or decrease in the average time spent sedentary since 2015.

As in previous years since 2015, there was no significant difference in the amount of time boys spent sedentary compared with girls. In 2018, boys and girls both spent 3.3 hours sedentary on the weekdays and boys spent 4.6 hours sedentary on weekend days, compared with girls, who spent 3.3. hours sedentary on weekdays and 4.5 hours sedentary on weekend days.
Table 6.9

6.5.2 Children's sedentary time in 2018, by age and sex

In 2018, the amount of sedentary time (outside of nursery or school) reported for children was significantly associated with age. As age increased there was a rise in the number of hours children spent sedentary on both weekdays and weekends. On weekdays there was an increase from 2.9 hours spend sedentary, on average, among those aged 2-4 to 3.2 hours among those aged 8-10 and to 4.3 hours on weekdays among those aged 13-15. During weekend days there was an increase from 3.6 hours spend sedentary for those aged 2-4 to 4.7 hours for those aged 8-10 and then to 5.7 hours for those aged 13-15.

Different patterns of sedentary time by age were found between boys and girls only on weekdays. For boys, sedentary time on weekdays was higher for boys aged 2-4 than for boys aged 5-7 (3.0 compared to 2.8 respectively) and then increased with age, whereas for girls, weekday sedentary time generally rose with age.
Figures 6I and 6J, Table 6.10

Figure 6I
Children's sedentary time on weekdays, 2018, by age and sex

Figure 6J
Children's sedentary time on weekends, 2018, by age and sex

References and notes

1. See: https://www.who.int/ncds/prevention/physical-activity/gappa/

2. See: https://www.gov.scot/publications/active-scotland-delivery-plan/

3. See: https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report

4. See: https://www.gov.scot/publications/scotlands-public-health-priorities/

5. See: https://www.gov.scot/publications/active-scotland-delivery-plan/

6. See: http://nationalperformance.gov.scot/

7. See: www.gov.scot/Topics/Statistics/Browse/Health/scottish-health-survey

8. The questions used in the survey since 1998 are based on the Allied Dunbar National Fitness Survey, a major study of physical activity among the adult population in England carried out in 1990. For further details see: Health Education Authority. Allied Dunbar National Fitness Survey. Health Education Authority and Sports Council, London. 1992

9. Bromley C. (2013) Chapter 6: Physical Activity. In Rutherford L, Hinchliffe S and Sharp C (eds.) Scottish Health Survey 2012 – Volume 1: Main Report. Edinburgh: Scottish Government. Available from: www.gov.scot/Publications/2013/09/3684/10

10. The questions on child physical activity included in SHeS since 1998 are based on the 1997 Health Survey for England (HSE) children's physical activity module.

Table list

Table 6.1 Adult summary activity levels, 2012 to 2018
Table 6.2 Adult summary activity levels, 2018, by age and sex
Table 6.3 Adult summary activity levels, (age-standardised), 2012 to 2018, by area deprivation and sex
Table 6.4 Adult adherence to muscle strengthening and MVPA guidelines, 2018, by age and sex
Table 6.5 Reasons for participating in activity, 2018, by age and sex
Table 6.6 Barriers to being more active, 2018, by age and sex
Table 6.7 Adults' sedentary time, 2015 to 2018, by sex
Table 6.8 Adults' sedentary time, 2018, by age and sex
Table 6.9 Children's sedentary time, 2015 to 2018, by sex
Table 6.10 Children's sedentary time, 2018, by age and sex