A report on the Department of Health ‘Walking Cities’ initiative in Birmingham, Cambridge, Leeds and Bradford, Norwich and Manchester

Overview This report on the five ‘Walking Cities’ was commissioned by Beelin Baxter, Senior Physical Activity Policy Officer at the Department of Health (DH). The aim was to synthesise the findings from the reports submitted to DH, highlight innovative practice and to enable learning for the future. This report was written by Sarah Hanson, Research Associate and Professor Andy Jones, both from the Norwich Medical School at the University of East Anglia. Executive summary and recommendations The Department of Health funded five ‘Walking Cities’ in 2013 – 2015 to develop walking initiatives. There was great variety in the projects and evidence of much activity. The aim was also to target the particularly inactive and those who were less well socially situated. Whilst there are useful transferable lessons to be learned from this project, the poor reporting did not allow the assessment of how well aims were achieved. Where baseline measurements were recorded it appeared that participants were already physically active. Where interventions were particularly successful, they built on ‘grass-roots’ community assets already in existence which took them to the heart of a community. The use of community based assets was particularly important in accessing those who are harder to reach and hence the learnings from this programme support assessing and utilising the assets in a community. There were attempts to work with health professionals with direct referrals into the walking interventions. This met with very limited success and continues to represent a major missed opportunity in reaching those who are the most inactive and in poorest health. Due to the poor project reporting the mandated and full use of the Standard Evaluation Framework for Physical Activity is recommended for the future. There was limited outcomes reporting and this limited our evaluation of how successful the programme was at increasing physical activity. We would make the following two recommendations. Firstly, that the Standard Evaluation Framework for Physical Activity is mandated for future work and that practitioners are trained in how to use it. Secondly, we would recommend that we need to understand the missed opportunity of direct referrals from health professionals; why this is the case and why health professionals do not refer to walking interventions, such as group walks

Why might adults belong to outdoor walking groups? A qualitative study using photo-elicitation methods in a population with poor health and physical activity indicators

Walking groups have multiple health benefits but walking interventions tend to be socially patterned and have the potential to increase health inequity. This poster presented preliminary findings of a qualitative study with a new walking groups in an area of social deprivatio

Designing Costumes for The King Stag

My research comes from three places: Commedia dell’ Arte style theatre, medieval period clothing, and current children’s movies. The costumes for the University of Minnesota, Morris spring children\u27s show The King Stag are unique and imaginative in order to ensure that the show is as magical as possible for the children who attend. This show is a fairy tale about King Seren searching for a Queen who really loves him. When King Seren finds his love, the jealous Prime Minister casts a spell turning King Seren into a stag and himself into the king. Chaos breaks out in the kingdom but eventually everything is sorted out. The original intent of this script was to be performed in the Commedia dell’ Arte style, which originated in Italy in the 16th century and was characterized by masked “types,” but our pre-production discussions at UMM led us to a less traditional approach. The director of The King Stag liked the look of movies with three-dimensional animations made by companies such as Pixar or DreamWorks, so much of my inspiration designing these costumes comes from Brave and Shrek, as well as other classic Disney movies such as Snow White. The style of these costumes loosely reflects the setting in medieval England, but the costumes also include unexpected elements to add to the spectacle. My designs reflect elements from a combination of all these areas.https://digitalcommons.morris.umn.edu/urs_2013/1002/thumbnail.jp

Towards an understanding of walking groups as a health promoting intervention

Low levels of physical activity are a major cause of disease burden. This presents a serious health challenge. Despite the benefits of physical activity being widely promoted, inactivity remains pernicious. This is compounded by physical activity interventions tending to be placed in more affluent areas and taken up by those who are more educated and in better health. Outdoor group walks have the potential to be a useful health intervention as they increase physical activity and are cost effective. However, a more extensive understanding is needed before they can be more widely promoted. This thesis sought to address this. Using mixed methods, it assessed any health benefits from group walking. It then evaluated their potential to influence health inequity. Finally, it sought to make recommendations to more effectively promote, and recruit to, walking groups for those people in poorest health. This thesis demonstrates the wide ranging psychological and physiological benefits from walking groups. With good adherence and virtually no adverse effects they can be safely and confidently recommended by clinicians. Their potential to increase inequity has also been demonstrated. Firstly, they may not be set up in those areas in greatest need. Secondly, the lack of a ‘bottom-up’ community partnership approach precludes reach into deprived communities and long term sustainability. Thirdly, without effective partnerships and promotion of walking groups by health professionals, targeted recruitment of the most inactive and those in poorest health remains problematic. Finally, promoting the social element of group-based interventions creates a barrier to those who find such expectations inhibiting; rather better to give clear tangible advice about their health promoting benefits. Outdoor walking groups are a safe and effective health promoting intervention but they should be developed and promoted judiciously to target those who would benefit the most and avoid potentially increasing intervention based inequity

A spatial equity analysis of a public health intervention: a case study of an outdoor walking group provider within local authorities in England.

INTRODUCTION: If an intervention is not well spatially targeted, appropriate levels of uptake, efficacy, long-term compliance and improved health outcomes are unlikely to be attained. Effective health interventions should seek to achieve not only absolute improvements in health but also to reduce inequity. There is often a disparity whereby preventative interventions are more likely to be successful amongst the more affluent, a process which has been coined the 'inverse prevention law'. Physical inactivity is known to be socially patterned and disproportionately prevalent in disadvantaged communities yet there is a lack of clear evidence on which interventions have the potential to influence inequity. Walking groups have been found to have multiple health benefits and increase physical activity. In England the major facilitator is a not for profit organisation which has 70,000 regular walkers and is lay led with 10,000 volunteers. The aim of this study was to evaluate the extent to which walking groups operated in those places with the greatest health need and whether consequently the scheme has the potential to influence health inequity. METHOD: The work used a spatial approach whereby geographical variations in walking group provision within the 326 local authorities in England (mean population 163,410) were linked to health and socio-economic measures of population need. RESULTS: Generally, greater need was not associated with higher provision of the walking group intervention. Although the magnitude of differences was small, provision of the intervention tended to be poorest in those local authorities with the greatest health need, as measured by our indicators. CONCLUSIONS: Without targeting those areas with greater health and socio-economic need, there is a concern that walking groups may not be set up in areas that need them most. There is therefore a potential that this intervention could, albeit in a small way, widen inequity between local authorities. However small-scale and well-intentioned, interventions need to be evaluated for their potential impact on inequity.This work was partially supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.This is the final version of the article. It was first available from BioMed Central via http://dx.doi.org/10.1186/s12939-015-0256-

Is there evidence that walking groups have health benefits? A systematic review and meta-analysis.

OBJECTIVE: To assess the health benefits of outdoor walking groups. DESIGN: Systematic review and meta-analysis of walking group interventions examining differences in commonly used physiological, psychological and well-being outcomes between baseline and intervention end. DATA SOURCES: Seven electronic databases, clinical trial registers, grey literature and reference lists in English language up to November 2013. ELIGIBILITY CRITERIA: Adults, group walking outdoors with outcomes directly attributable to the walking intervention. RESULTS: Forty-two studies were identified involving 1843 participants. There is evidence that walking groups have wide-ranging health benefits. Meta-analysis showed statistically significant reductions in mean difference for systolic blood pressure -3.72 mm Hg (-5.28 to -2.17) and diastolic blood pressure -3.14 mm Hg (-4.15 to -2.13); resting heart rate -2.88 bpm (-4.13 to -1.64); body fat -1.31% (-2.10 to -0.52), body mass index -0.71 kg/m(2) (-1.19 to -0.23), total cholesterol -0.11 mmol/L (-0.22 to -0.01) and statistically significant mean increases in VO(2max) of 2.66 mL/kg/min (1.67-3.65), the SF-36 (physical functioning) score 6.02 (0.51 to 11.53) and a 6 min walk time of 79.6 m (53.37-105.84). A standardised mean difference showed a reduction in depression scores with an effect size of -0.67 (-0.97 to -0.38). The evidence was less clear for other outcomes such as waist circumference fasting glucose, SF-36 (mental health) and serum lipids such as high-density lipids. There were no notable adverse side effects reported in any of the studies. CONCLUSIONS: Walking groups are effective and safe with good adherence and wide-ranging health benefits. They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity.This work was partially supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The authors thank William Jones, faculty librarian for his help in the search strategy and Dr Toby Smith for helpful advice and comments.This is the final published version. It first appeared at http://bjsm.bmj.com/content/early/2014/12/19/bjsports-2014-094157

TRA-914: TDM TO PROMOTE SUSTAINABLE COMMUTING – AN EMPLOYER’S PERSPECTIVE

There is a comprehensive transportation consulting industry across Canada that provides engineering services for highway and roadway design, environmental assessments, traffic engineering, etc. that all contribute to the development of our transportation infrastructure. However, as leaders in transportation planning and engineering, these transportation consultants must also strive to ‘practice what we preach’ in terms of promoting sustainable transportation solutions in our communities and in our daily lives. The purpose of this presentation is to examine the Travel Demand Management (TDM) initiatives that our AECOM Richmond Hill office has implemented to promote more sustainable work related commuting, and to present a discussion on successes and lessons learned through the application of these programs