What we did

Over a period of two weeks at the end of September 2018 we held our second national consultation asking for feedback on the updated physical activity (PA) and sedentary behaviour guidelines across all age groups. To help structure the feedback, we asked comments to be linked to specific recommendations within each Expert Working Group (EWG), general feedback and information on:

1. Whether respondents agreed or disagreed with the proposed recommendations
2. What would respondents change and why?
3. Potential impacts that the proposed changes may have on professional and public communities.

The consultation was promoted on Twitter by the EWG Chairs and the University of Bristol’s School for Policy Studies. It was also sent to delegates who attended the London and Edinburgh Scientific Consensus Meetings and these individuals were asked to inform their colleagues about the consultation.

We would like to thank all 18 respondents for their valued input to the national consultation. UK universities, local authorities, public health departments, charity groups, college sport organisations, NHS trusts and governing bodies were all represented by individuals and groups who responded. 

What were the results

The feedback received was mostly specific for each EWG. Three key themes could be generated from the responses (see below), but it is important to note that common across all EWGs was that the majority of respondents agreed with the proposed update of the guidelines.

1. Overarching considerations

Respondents felt that the shift between 24 hour, daily and weekly guidelines could cause confusion among those using them, and this should be carefully considered when messaging to the public. The language used in the guidelines should be consistent across groups (e.g. the use of the word ‘activities’ vs ‘training’) as well taking in to consideration the use of controlling language; a more autonomous approach was favoured. Respondents also questioned why weight loss and weight maintenance was only mentioned for adults and older adults, not children and young people. Some felt it was also important to explore effective recommendations across the different characteristics that stratify health opportunities and outcomes. 

2. Key concerns and proposed changes

Under 5s

Key concerns	Proposed changes
The guidelines do not consider the impact of different types of screen time activities  Division in to age groups bears no meaning to developmental stage The 24-hour approach could be seen as prescriptive  Sleep recommendations may increase feelings of distress/frustration in parents with children with sleep problems	Suggest that pre-schoolers should progress to 60 mins of MVPA by age 5 Explicitly reference Fundamental Movement Skills and cognitive development Need a threshold amount of time for sedentary behaviour

Children and young people (5-18 years)

Key concerns	Proposed changes
Recommendation 2: No frequency is too vague for those using these guidelines	Be more inclusive of the older end of this age group (more activities relevant to young people) Need to clarify the inconsistencies with HIIT

Adults (19-64 years)

Key concerns	Proposed changes
No mention of daily PA Including HIIT – is it appropriate for the public outside a controlled environment? Removing 10 minute bouts will mean individuals will have no baseline to work towards	Stress the importance of ‘little and often’ and ‘some is better than none’ Mention the need for flexibility and the benefits to cognitive health more explicitly in the recommendations

Older adults (65+ years)

Key concerns	Proposed changes
The stages of mobility are not incorporated There is a need for more supporting evidence in some areas (i.e. light PA, removal of bouts etc)	There was support for the strength recommendation to come before the aerobic one Explicitly reference the benefits of PA on cognitive health and mental illness Emphasis the importance of maintaining PA

Sedentary behaviour

Key concerns	Proposed changes
There are no screen time recommendations for children (5-18 years) and adults Being too specific could over complicate the message for the least active and make behaviour change seem unachievable	Be more specific about the key definitions of sedentary, sitting etc. Add additional evidence by pooling epidemiological datasets and exploring publications released after the USA review

3. Considerations for messaging of the guidelines 

Much of the feedback received related to the messaging of the recommendations for individual age groups. Responses concerned factors such as the nature of PA in particular age groups, i.e. how to consider the nature of play when following recommendations; how messages should be sensitive to those to which the recommendations apply; considering the transition between age groups and highlighting the importance of different PA in different age groups. Key areas for consideration were highlighted:

• A collaborative approach to messaging between the four home nations
• Tailoring messages to different populations
• Who to message to? – conduct formative research to ensure we know who our target audience is and we are delivering a message relevant to them
• What should the mode of delivery be? – use health behaviour change and communication experts to our advantage 

What next?

The comments received were summarised and passed on to each EWG. The groups are currently reviewing all feedback and will consider using it to inform any changes to their final technical reports and recommendations. The six technical reports will then be used to write the final report for the UK CMOs, who will sign-off on the recommendations proposed by the EWGs.