Physical activity behaviour and promotion from a systems perspective

Regular symposium

Title: Physical activity behaviour and promotion from a systems perspective.

Purpose: To encourage reflection and discussion on the role and implications of adopting a systems perspective for physical activity (PA) behaviour and promotion.

Description: It is well-recognized that physical inactivity is a persistent, complex problem driven by factors and social actors operating and dynamically interacting across multiple levels over time. Acting upon the complex system that shapes and perpetuates PA behaviour requires that those working for more active societies are well equipped to understand and work with PA from a systems perspective. This symposium will go beyond a call to arms, provoking, supporting, and encouraging reflection to strengthen research and action informed and oriented by systems science. In this symposium, four presentations (totalling 40 minutes) will highlight multiple research and action implications of adopting a systems perspective in key areas in PA behaviour and promotion: (1) defining physical activity behaviour and promotion from a complex systems perspective; (2) inequalities in physical activity as an emergent feature of a complex system; (3) maximising policy impact to reduce physical inactivity in a complex system; and (4) systems approaches to scaling up PA promotion actions. In addition to the presentations, an open discussion with the audience will be facilitated by the discussant and chair around two main themes: (1) Q&A about presentations (10 minutes); (2) implications and next steps for the field (15 minutes). The remaining time will be used by the chair to introduce the symposium (5 minutes) and then by the discussant to share their views on the presentations (5 minutes).

Chair (Name and Affiliation): Dr Peter Gelius, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Presenter 1 (Name and Affiliation): Dr Leandro Garcia, Queen’s University Belfast.
Presenter 2 (Name and Affiliation): Ms Sophie Jones, Queen’s University Belfast.
Presenter 3 (Name and Affiliation): Dr Karen Milton, University of East Anglia.
Presenter 4 (Name and Affiliation): Dr Harriet Koorts, Deakin University.
Discussant/moderator (Name and Affiliation): Dr James Nobles, Leeds Beckett University.

Presentation #1: Defining physical activity behaviour and promotion from a complex systems perspective.
Background: there has been multiple attempts to approach physical activity behaviour and promotion using a systems lens. However, in general, these attempts do not provide a systems-based definition of physical activity, limiting the transformative potential of systems approaches for physical activity research and action.
Purpose: to offer a discussion about how physical activity patterns can be defined from a complex systems perspective, alongside implications for research and practice.
Methods: we describe the current attempts towards more holistic views of physical activity, and then build on them to provide the premises for a definition of physical activity grounded in complex systems theory.
Results: we argue that physical activity patterns are the observable result (or emergent feature) of a system (the components of which are conventionally called ‘drivers’), and that those patterns are generated by the system’s configurational state. The generative aspect is a key distinction from previous attempts to define physical activity, and implies, among other things, that (a) the same physical activity patterns can be reached by many different system’s configurations (equifinality), (b) physical activity as an emergent feature is scale dependent, e.g., collective patterns are not simply the sum of individual behaviours, and (c) physical activity patterns at higher levels are constrained by the configurational states of lower-level systems (modular hierarchical structures and second-order emergence).
Conclusions: we offer a definition of physical activity grounded in complex systems theory, which we believe is needed to unleash the full transformative potential of systems-based approaches for physical activity research and action.
Practical implications: full adoption of a systems perspective for physical activity implies a series of changes in the way we think about and do research and practice, going from what we measure (systems’ configurations?) to guidelines development and content (physical activity levels or configurational states?).
Funding: None.

Presentation #2: Inequalities in physical activity as an emergent feature of a complex system.
Background: inequalities in physical activity are well documented; however, progress on reducing these inequalities is proving difficult. We argue that a complex system perspective is needed, specifically to acknowledge inequalities in physical activity as an emergent feature of a complex system.
Purpose: to offer a discussion about inequalities as an emergent feature of a complex system due to dynamic interactions that produce patterns of behaviour, alongside an applied example to help visualise our argument and demonstrate how to operationalise the perspective argued.
Methods: following a discussion of why a different perspective is needed to reorientate our thinking of inequalities, we highlight a conceptual model that was developed to understand the various mechanisms and factors which interact to produce collective patterns and income inequalities in leisure-time physical activity.
Results: building on our proposition that inequalities in physical activity are an emergent feature of a complex system, a conceptual model will be presented to demonstrate how this perspective can be utilised. The conceptual model contains psychosocial, economic, environmental and social factors, which all dynamically interact to shape an individual’s decision to practice leisure time physical activity.
Conclusions: through our discussion and the conceptual model presentation, we argue the need to acknowledge inequalities in physical activity as an emergent feature of a complex system arising from multiple interactions between complex systems parts.
Practical implications: the approach we propose allows a nuanced and broader understanding of inequalities in physical activity as an emergent feature of a complex system and, consequently, improves our ability to develop systems-informed interventions and policies.
Funding: Northern Ireland Department for the Economy.

Presentation #3: Maximising policy impact to reduce physical inactivity in a complex system – the application of adaptive approaches.
Background: physical inactivity is a ‘wicked problem’, shaped and sustained by the dynamics, uncertainties, and unpredictability of a complex system. This has led to increased recognition of the need to adopt a ‘systems approach’ to physical activity promotion to achieve sustainable, systemic changes in interventions and behaviours at scale.
Purpose: to discuss why a systems perspective, and adaptive policy approach in particular, is relevant to reducing physical inactivity, and the implications of this for policymaking.
Methods: we will describe current systems approaches to policy formation in public health and illustrate how the concept of ‘adaptive policies’ could be beneficial. Using multiple examples, we will demonstrate how a systems perspective can inform the development of policies, and how the principles of adaptive policymaking might be applied to addressing physical inactivity.
Results: using a range of examples, we will illustrate how adaptive policies could be used to overcome common system archetypes in physical activity promotion. We argue that there are situations in which adaptive policymaking would help to achieve the long-term, systemic changes that are required globally to change population levels of physical activity.
Conclusions: it is important to support policymakers to move away from short-term ‘fixes’, to considering the steps needed to reconfigure the physical activity system to support populations to be more active. A key challenge is to develop policies that are designed to be adaptable across a range of different future scenarios, and embrace uncertainty and long-term adaptability.
Practical implications: there is a need to shift the approach to policymaking away from solely ‘static’ policies, to considering adaptive approaches that are more suited to uncertainty and changing conditions.
Funding: None.

Presentation #4: Systems approaches to scaling up: systematic review and narrative synthesis of evidence for four NCD risk factors.
Background: systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale-up in physical activity/nutrition promotion or NCD prevention more generally.
Purpose: to present a systematic review which sought to: (i) synthesise evidence on systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs, and (ii) explore how systems approaches have been conceptualised and used in intervention implementation / scale-up.
Methods: seven electronic databases were searched during 2016-2021. Eligible studies targeted either physical inactivity, tobacco use, alcohol consumption or diet, or described evaluation of an intervention planned for or scaled up. Studies were categorised as (i) high, (ii) moderate, or (iii) no use of a systems approach, using narrative synthesis following PRISMA guidelines.
Results: twenty-one intervention studies were included; 19% (n=4) explicitly used systems thinking to inform intervention design, implementation and scale-up. Five studies (‘high use’) planned and implemented scale-up, focussing on relations between system elements, using system changes to drive impact at scale. Seven studies (‘moderate use’) considered systems elements impacting scale-up but did not require achieving system-level changes from the outset. Nine studies (‘no use’) worked at multiple levels, but complexity of the system and relations between system elements was not articulated.
Conclusions: for researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice.
Practical implications: greater guidance is needed on what is required to adopt or support a systems approach to scaling up, and how to communicate and operationalise systems approaches in research and practice. We recommend using frameworks that incorporate systems thinking perspectives and adopt new ways of accounting for the complex systems in which interventions are implemented.
Funding: Deakin University Deans Fellowship, and NHMRC Leadership Level 2 Fellowship (APP 1176885).