When policy is necessary yet insufficient to address inactivity: Are ‘we’ up to the challenge?

Purpose: The aim of this symposium is to discuss physical activity (PA) policy and the role of the PA community in meeting the challenges policy interventions require to be successful.
Description: The promotion of PA requires an ecological and multi-level, as well as comprehensive whole system approach. The audience for this symposium is the PA community, i.e. the researchers, policymakers and practitioners responsible for advancing evidence-based actions for the promotion of PA across the whole of society.
Presentation one will challenge the PA communities’ lack of knowledge of the status of physical activity policy globally. It will chart the progress of PA policy over the last decade, sharing a systematic process for developing a PA policy database, the building blocks of a robust monitoring system. Presentation two presents an evidence synthesis showing how active transport used policy to enhance opportunities for walking and cycling during the COVID-19 pandemic. The lessons learned could prove fruitful in terms of leveraging windows of opportunity for the future. Presentation three challenges our ability as a PA community to react in a timely, evidence-informed manner to ‘windows of opportunity’, sharing learnings from qualitative research, it asks if the PA community understand how to garner commitment from national policymakers to prioritise and advance the PA policy agenda when the time is right. Presentation four is a reflection; it acknowledges that PA requires upstream policies across multiple sectors to address the challenge of physical inactivity. It uses evidence from other prevention related policy areas e.g. tobacco, alcohol etc. to inform the needed direction of PA policy, our shared understanding of the ‘policy issue’, our consensus on ‘policy framing’ and how collaboratively we prioritise action across multiple, sometimes competing, sectors. It asks are we –as a PA community –up to the challenge?
This symposium will share learnings from research teams across four continents with an emphasis on discussion, reflection and self-evaluation in relation to the future of physical activity policy in the post pandemic period and beyond.

Outline:
Chair: Catherine Woods, Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
Presenter 1: Andrea Ramírez Varela, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA.
Presenter 2: Michael Pratt, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA.
Presenter 3: Katja Siefken, Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany.
Presenter 4: Adrian Bauman, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia
Discussants:
Academic: Catherine Woods, Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
Policymaker: Wanda Wendel-Vos, Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands

Abstract 1: Development of the Global Observatory for Physical Activity Policy Directory: GoPA! – PD tool
Andrea Ramírez Varela (1), Adrian Bauman (2), Catherine Woods (3), Harold Kohl III (1,4), Katja Siefken (5), Wanda Wendel-Vos (6), J. Jaime Miranda (7), Juliana Mejía Grueso (8), Pedro C Hallal (9), Michael Pratt (10,11).
Affiliations:
1. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA.
2. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia.
3. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland.
4. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA.
5. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany.
6. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands,
7. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia.
8. Global Observatory for Physical Activity – GoPA!.
9. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA.
10. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA.
11. Institute of public Health, University of California San Diego. San Diego, USA.

Background: National-level policies are important ingredients for improving public health, but effectiveness of such policies for addressing population-wide physical inactivity is unknown.
Purpose: The purpose of this project was to create a comprehensive inventory of global national governmental physical activity policies, enabling cross-country comparison of policy indicators.
Methods: We developed a directory of worldwide national physical activity policy documents in 2023. Publicly available national data were consulted and compiled into an ongoing repository of the Global Observatory for Physical Activity (GoPA!). Using a variety of search strategies, data were gathered for physical activity policy indicators: 1) standalone (exclusive) policies for physical activity, 2) non-communicable disease (NCD) plans including physical activity, 3) physical activity guidelines, 4) quantitative targets, 5) comprehensive or multisectoral approaches, and 6) implementation plans with enablers (tasks and subtasks, budgets, timelines-timeframe, collaborators).
Results: The GoPA! policy directory comprised 1,005 documents from 217 countries. Overall, 15.2% [95% CI 13.1-17.6] were standalone physical activity policies, 43.5% [95% CI 40.4-46.6] were NCD plans including physical activity, 19.7% [95% CI 17.3-22.3] were physical activity guidelines, 9.2% [95% CI 7.4-11.1] had a comprehensive or multisectoral approach including more than three sectors to implement the policy, 23.6% [95%CI 21.0-26.3] had quantitative targets, 42.8% [95%CI 39.7-45.9] outlined an implementation plan with at least one enabler and 8.9% [95%CI 7.2-10.8] incorporated all enablers.
Conclusions: The policy directory offers important insights into the diverse approaches to promote and sustain physical activity, providing a comprehensive audit of physical activity policies around the world.
Practical implications: The policy directory repository of documents is a comprehensive and centralized resource that enhances accessibility, facilitates cross-country comparisons, and ultimately contributes to a deeper understanding of global physical activity policies for policymakers and researchers.
Funding: Global Observatory for Physical Activity (GoPA!).

Abstract 2: Policy window opportunities for active transportation during the COVID-19 pandemic: a systematic review
Michael Pratt (1,2), Juliana Mejía Grueso (3), Katja Siefken (4), Adrian Bauman (5), Catherine Woods (6), Harold Kohl III (7,8), Wanda Wendel-Vos (9), J. Jaime Miranda (10), Pedro C Hallal (11), Justin Richards (12), Andrea Ramírez Varela (7).
Affiliations:
1. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA.
2. Institute of Public Health, University of California San Diego. San Diego, USA.
3. Global Observatory for Physical Activity – GoPA!
4. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany.
5. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia.
6. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland.
7. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA.
8. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA.
9. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands.
10. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia.
11. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA.
12. Te Hau Kori, Te Herenga Waka – Victoria University of Wellington, Wellington, Aotearoa, New Zealand.

Background: The COVID-19 pandemic brought unprecedented challenges, yet it also created opportunities for active transportation and urban design policies’ implementation.
Purpose: The purpose of this study was to determine and evaluate the emergence of policy windows during the first three years of the COVID-19 pandemic that could directly and/or indirectly benefit physical activity.
Methods: Systematic review conducted in 2/2023 across multiple databases (PubMed, Scopus, ProQuest – Coronavirus Research Database, Web of Science, WHO COVID-19 Research Database, PsycInfo, and SPORTDiscus). Articles published between 1-12/2022 were included. Data extraction included general study characteristics, policy cycle stages and, characteristics of policy windows based on Kingdon’s Multiple Streams Framework.
Results: 3,746 articles were identified in the search and after applying the selection criteria twelve studies were selected for data extraction. These studies reported evidence on 74 case-study cities across 26 countries that implemented public policies that were directly or indirectly related to physical activity. Predominantly the case-study cities were located in the Americas (56.8%), Europe (27.0%) and high-income countries (77.0%). These studies focused on everyday mobility and transportation alternatives that could also mitigate SARS-CoV-2 transmission in the population. In 83.3% of studies, the five stages of the policy cycle (agenda-setting, formulation, adoption, implementation, evaluation) were identified and, the convergence of problem, policy and politics streams during this public health global crises led to legislative actions and emergency measures for the rapid implementation of active transportation infrastructure while supporting social distancing to avoid SARS-CoV-2 transmission.
Conclusions: The COVID-19 pandemic opened a policy window across multiple world regions, indirectly influencing physical activity promotion through the implementation of active transportation and urban design policies.
Practical implications: Political circumstances facilitated policy solutions that underscored potential synergies and collaborations between multiple sectors to implement effective public policies that may benefit physical activity.
Funding: Global Observatory for Physical Activity (GoPA!)

Abstract 3: Promoting Physical Activity amidst the COVID-19 Pandemic: Priorities for the Post-COVID-19 Era
Katja Siefken (1), Juliana Mejía Grueso (2), Adrian Bauman (3), Harold Kohl III (4,5), Catherine Woods (6), Wanda Wendel-Vos (7), J. Jaime Miranda (8), Pedro C Hallal (9), Michael Pratt (10,11), Justin Richards (12), Andrea Ramirez Varela (4)
Affiliations:
1. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany.
2. Global Observatory for Physical Activity – GoPA!
3. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia.
4. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA.
5. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA.
6. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland.
7. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands,
8. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia.
9. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA.
10. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA.
11. Institute of Public Health, University of California San Diego. San Diego, USA.
12. Te Hau Kori, Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand

Background: Evidence suggests that there is a significant knowledge gap regarding priorities, opportunities and barriers associated with fostering physical activity on a global scale for the post-pandemic future.
Purpose: The purpose of this study was to describe the perspective about the promotion of physical activity during the COVID-19 pandemic, along with post-COVID-19 priorities and recommendations for the global health future.
Methods: Cross-sectional survey conducted between April and November 2023. Target audiences were the Global Observatory for Physical Activity (GoPA!) Country Contacts and key informants/influential stakeholders from around the world on physical activity policy implementation.
Results: In total, 104 GoPA! contacts and key informants completed the survey (response rate of 40%), collectively representing 67 countries. Most participants represented countries from Europe and the Americas (60.6%) and high-income countries (58.7%). These respondents highlighted that pandemic response plans explicitly included physical activity promotion and predominantly emphasized creating more opportunities than restrictions for physical activity in contrast with other countries. Priorities for advancing post-COVID-19 physical activity promotion, included enhancing policy frameworks, developing comprehensive, equitable, up-to-date, and implementable national and subnational physical activity policies and plans. There was a perceived need for somewhat greater commitment from national decision-makers to prioritize physical activity policies and promotion. Promoting the synergy between mental health and social cohesion through physical activity promotion was emphasized by experts.
Conclusions: Elevating physical activity promotion to a top position on public health agendas is crucial for the post-pandemic era.
Practical implications: The diversity of contexts and high dependence on culture, the varying institutional, financial, and technical policy capacity, the shifting mid- and long-term political commitment; and the dynamic nature of intersectoral coordination and cooperation need to be taken into account for enhancing physical activity promotion in the post-pandemic era.
Funding: Global Observatory for Physical Activity (GoPA!)

Abstract 4: Considerations for advancing the physical activity policy agenda: A reflection.
Adrian Bauman (1), Catherine Woods (2), Wanda Wendel-Vos (3), Harold Kohl III (4,5), Andrea Ramírez Varela (5), Katja Siefken (6), J. Jaime Miranda (7), Juliana Mejía Grueso (8), Pedro C Hallal (9), Michael Pratt (10,11).
1. Charles Perkins Centre, Sydney School of Public Health, The University of Sydney. Sydney, Australia.
2. Physical Activity for Health Research Centre (PAfH), Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Ireland.
3. Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), The Netherlands.
4. Department of Kinesiology and Health Education, The University of Texas at Austin. Austin, USA.
5. Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), USA.
6. Institute of Interdisciplinary Exercise Science and Sports Medicine (IIES), MSH Medical School Hamburg. Hamburg, Germany.
7. School of Public Health, Faculty of Medicine and Health, University of Sydney. Sydney, Australia.
8. Global Observatory for Physical Activity – GoPA!
9. Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign. Illinois, USA.
10. Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. San Diego, USA.
11. Institute of Public Health, University of California San Diego. San Diego, USA.

Practice/Policy Abstracts
Background: Public health policies have an important role in prevention as they facilitate the implementation of evidence-based interventions and strategies targeting whole populations and communities. The progress in physical activity is policy is poor.
Policy Components: There are structural elements that are common to effective NCD prevention policies. These include problem definition, consensus that the issue is preventable, an understanding of the complexities of the issue and its hypothesized solutions. Finally, the realization of the need for action, and its prioritization by relevant political actors across whole of government and by civil society.
Evaluation: As an example, tobacco policy has been relatively successful. It has a long history, describes a small set of unhealthy behaviours, has universal and uncontested recognition of its hazardous effects, is underpinned by an agreed consensus based Framework Convention on Tobacco Control (FCTC) which is often legislated, and is regularly monitored and enforced. Physical activity policy has been less successful. It has a shorter history, requires action in a multiplicity of different contexts and settings to support a meaningful increase in physical activity for everybody. While consensus on physical activity guidelines exists, there is no robust, regular monitoring of policy outcomes. It therefore runs the risk of being everyone’s job, but nobody’s responsibility.
Conclusions: A clear standalone, single-issue physical activity policy, will define physical activity as a priority area for health and a co-benefit for other sectors. It will provide a framework for action, foster multi-sector coordination and collaboration, articulate national physical activity guidelines, and targets for action, clarify implementation goals, roles, resources, responsibilities and outputs. If robustly monitored with regulatory enforcement it has the potential to tackle population physical inactivity.
Practical implications: The global status of physical activity policy and its advancement as an intervention requires collective collaborative action from the physical activity community.
Funding: No funding