Scottish Health Survey: content review outcomes report

Physical activity

The physical activity module currently takes up a disproportionate amount of space in the health survey and during the review process we asked respondents to consider shorter alternatives, such as the International Physical Activity Questionnaire – short form.

During the review process there was strong support to retain the existing physical activity module including from Obesity Action Scotland, the SG SHS team and sportscotland.

There was support for moving to a shorter question set from ScotPho. An individual was also supportive of moving to a measure such as IPAQ if it was no longer possible to include the existing physical activity question set, however, they suggested we run the existing and new module concurrently in SHeS so that the data can be compared. PHS suggested that the existing questions are retained in SHeS for a further 2 years to determine the impact of the COVID-19 on physical activity and to maintain a trend from pre-pandemic and also suggested we include the old and new physical activity questions concurrently.

However, the estimated survey length for 2025 was overrunning and it was therefore necessary to reduce the length of this module and it would not be possible to include both question sets and compare respondents’ answers.

Due to the need to have comparable pre- and post-pandemic data, we agreed to retain the existing question set in SHeS until 2024 and liaised with internal and external colleagues, including SG policy and research colleagues, PHS and academic experts, to identify key policy needs and to agree on a new physical activity question set to be included in SHeS from 2025 onwards.

Following this research we identified the ability to measure the Chief Medical Officer’s (CMO’s) Moderate or Vigorous Physical Activity (MVPA) guidelines, ability to measure CMO muscle strengthening guidelines and the ability to measure sedentary time as the key policy needs alongside the ability to provide national and local level data as physical activity initiatives are undertaken at a local level.

We have, therefore, agreed to replace the existing set of questions with a shorter question set, based on a modified version of the Global Physical Activity Questionnaire (GPAQ). The GPAQ asks about activity in a typical week, including sedentary behaviour, and consists of 6-16 questions, depending on filtering. Respondents are asked separately about MVPA across 3 domains: at work, travel and recreational activities. We are making a minor change of wording to the preamble to better align with activities respondents are more likely to have undertaken in Scotland. As walking is a key measure for policy we are also going to split the walking and cycling travel domain into two question sets to provide separate data on walking  - an approach used in the National Health Survey of Panama.

We will also add a new question to assess muscle-strengthening guidelines. The current muscle strengthening questions in SHeS are asked in relation to specific sporting activities respondents report participating in only (a respondent will be asked this question in relation to each qualifying activity e. g. tennis, football and pilates)  – the stakeholders agreed that going forward the focus should be on muscle strengthening from all physical activity (e. g. housework, DIY etc) not just sporting activity to more accurately capture all muscle strengthening activities. We are, therefore, including a single question (included in annex 10) that was developed by academics at Edinburgh University for Public Heath Scotland’s screening tool for physical activity levels (The Scottish Physical Activity Screening Questionnaire (Scot-PASQ)) and was favoured by stakeholders at the time. Our contractors tested this question, including the preamble, to provide reassurance regarding the validity of the question.

The change to this module will impact the time series and won’t allow for local authority level analysis for up to 4 years for smaller areas, although it may be possible to provide data on request after fewer years for larger local areas.

We are also making some minor changes to the location of physical activity questions for both adults and children. Currently, respondents are asked about the location (and frequency) of physical activity in the last 4 weeks. If a respondent reports undertaking activities in all of the locations listed (11 options) they will have to answer the next question about frequency of use for every location so this can be quite lengthy. We are, therefore, removing the question about frequency and, in future years if there’s space, including a new question asking which place they typically undertake most of their physical activity.

These proposals apply to the adult module only with the exception of changes to the location of physical activity section. The child module (ages 2 – 15) will otherwise remain unchanged for 2025.

For the new physical activity module being introduced in SHeS from 2025 see annex 10.