Summary Introduction Definition and measurement of physical activity Key points Physical activity levels in the UK Key points Physiological effects of physical activity Key points Physical activity in health and disease Key points Physical activity and public health Key points Conclusions Summary  Physical activity levels in the UK are low. Only 35% of men and 24% of women reach the recommended 30 minutes of moderate‐intensity physical activity at least five times a week. Men tend to be more active than women at all ages, and there is a marked decline in physical activity with age in both sexes. Children are more active than adults. Seventy per cent of boys and 61% of girls reach the recommended 60 minutes of moderate‐intensity physical activity a day. Boys tend to be more active than girls and there is a decline in physical activity as children reach adolescence, which is more marked in girls. For adults and children, lower‐income groups have particularly low physical activity levels. Although physical activity levels in adults and children have been relatively stable in recent years, there is some evidence to suggest a decline in occupational activity from the 1990s onwards, and a decrease in active transport to school and time spent in school physical education lessons. This has coincided with an upward trend in sports participation (e.g. joining fitness clubs) in adults. The physiological effects of physical activity are wide ranging, and affect various body systems. As a modifiable component of energy expenditure, physical activity can affect energy balance. However, the total effects of physical activity on total energy expenditure go beyond the physical activity‐induced energy expenditure. Increases in resting metabolic rate and non‐exercise activity thermogenesis are also seen. Furthermore, physical activity can modify body composition favourably by decreasing fat mass and increasing lean mass. Physical activity can reduce resting blood pressure and increase capacity to carry blood in the coronary arteries. Beneficial changes also occur in the lining of blood vessels which help direct the appropriate distribution of blood in the body. Regular physical activity can also exert beneficial effects on the body's capacity for forming and breaking down blood clots, and produces favourable changes in plasma lipid profile. Physical activity is known to improve blood glucose handling and is also associated with beneficial immunological (with the exception of intense activities of long duration) and neurological changes. In terms of its interaction with food intake, physical activity tends not to lead to an increase in energy intake in the short‐term. But long‐term studies indicate that negative energy balance cannot continue indefinitely; eventually energy intake increases until energy balance is resumed. In those who are physically active, the greater energy intake needed to match energy expenditure means that it is easier to achieve adequate micronutrient intakes. In addition, those who are more act...

The Rank Forum on Vitamin D was held on 2nd and 3rd July 2009 at the University of Surrey, Guildford, UK. The workshop consisted of a series of scene-setting presentations to address the current issues and challenges concerning vitamin D and health, and included an open discussion focusing on the identification of the concentrations of serum 25-hydroxyvitamin D (25(OH)D) (a marker of vitamin D status) that may be regarded as optimal, and the implications this process may have in the setting of future dietary reference values for vitamin D in the UK. The Forum was in agreement with the fact that it is desirable for all of the population to have a serum 25(OH)D concentration above 25 nmol/l, but it discussed some uncertainty about the strength of evidence for the need to aim for substantially higher concentrations (25(OH)D concentrations > 75 nmol/l). Any discussion of 'optimal' concentration of serum 25(OH)D needs to define 'optimal' with care since it is important to consider the normal distribution of requirements and the vitamin D needs for a wide range of outcomes. Current UK reference values concentrate on the requirements of particular subgroups of the population; this differs from the approaches used in other European countries where a wider range of age groups tend to be covered. With the re-emergence of rickets and the public health burden of low vitamin D status being already apparent, there is a need for urgent action from policy makers and risk managers. The Forum highlighted concerns regarding the failure of implementation of existing strategies in the UK for achieving current vitamin D recommendations. Keywords

Background It is considered best practice to provide clear theoretical descriptions of how behaviour change interventions should produce changes in behaviour. Commissioners of the National Health Service Diabetes Prevention Programme (NHS-DPP) specified that the four independent provider organisations must explicitly describe the behaviour change theory underpinning their interventions. The nationally implemented programme, launched in 2016, aims to prevent progression to Type 2 diabetes in high-risk adults through changing diet and physical activity behaviours. This study aimed to: (a) develop a logic model describing how the NHS-DPP is expected to work, and (b) document the behaviour change theories underpinning providers’ NHS-DPP interventions. Methods A logic model detailing how the programme should work in changing diet and activity behaviours was extracted from information in three specification documents underpinning the NHS-DPP. To establish how each of the four providers expected their interventions to produce behavioural changes, information was extracted from their programme plans, staff training materials, and audio-recorded observations of mandatory staff training courses attended in 2018. All materials were coded using Michie and Prestwich’s Theory Coding Scheme. Results The NHS-DPP logic model included information provision to lead to behaviour change intentions, followed by a self-regulatory cycle including action planning and monitoring behaviour. None of the providers described an explicit logic model of how their programme will produce behavioural changes. Two providers stated their programmes were informed by the COM-B (Capability Opportunity Motivation – Behaviour) framework, the other two described targeting factors from multiple theories such as Self-Regulation Theory and Self-Determination Theory. All providers cited examples of proposed links between some theoretical constructs and behaviour change techniques (BCTs), but none linked all BCTs to specified constructs. Some discrepancies were noted between the theory described in providers’ programme plans and theory described in staff training. Conclusions A variety of behaviour change theories were used by each provider. This may explain the variation between providers in BCTs selected in intervention design, and the mismatch between theory described in providers’ programme plans and staff training. Without a logic model describing how they expect their interventions to work, justification for intervention contents in providers’ programmes is not clear.

A number of lifestyle characteristics have already been well established as risk factors for cancer; these include tobacco smoking, diet, alcohol consumption and obesity. More recently, attention has been drawn to the potential relationship between physical activity and cancer risk. In 2002, the International Agency for Research on Cancer (IARC) published volume 6 of Handbooks of Cancer Prevention: Weight Control and Physical Activity. The IARC report concluded that regular physical activity reduces the risk of breast and colon cancers, and suggested that physical activity also possibly reduces the risk of endometrial and prostate cancers. Since 2002, seven additional reviews and 38 original reports from cohort studies have been identified. These papers cover cancers of the colon/colorectum, breast, endometrium, pancreas, prostate, lung and ovary. This review updates the evidence on physical activity and cancer risk based on these new findings.It now appears that the decreased risk of colon cancer associated with physical activity is stronger in men than women, and also that the link between breast cancer and physical activity is stronger in post-menopausal than pre-menopausal women. The recent evidence also suggests that risk of cancers of the lung and endometrium, and to a lesser extent prostate, is likely to be decreased by physical activity. Yet, there is little or no suggestion that pancreatic or ovarian cancer risk is modified by physical activity. The biological plausibility of the observed associations between physical activity and cancer are supported by a variety of site-specific and generic mechanisms which are discussed in this review.

ABSTRACT. The purpose of this study was to assess the success of neurolinguistic programming in reducing the need for general anaesthesia in claustrophobic patients who require MRI and to consider the financial implications for health providers. This was a prospective study performed in 2006 and 2007 at a teaching hospital in England and comprised 50 adults who had unsuccessful MR examinations because of claustrophobia. The main outcome measures were the ability to tolerate a successful MR examination after neurolinguistic programming, the reduction of median anxiety scores produced by neurolinguistic programming, and models of costs for various imaging pathways. Neurolinguistic programming allowed 38/50 people (76%) to complete the MR examination successfully. Overall, the median anxiety score was significantly reduced following the session of neurolinguistic programming. In conclusion, neurolinguistic programming reduced anxiety and subsequently allowed MRI to be performed without resorting to general anaesthesia in a high proportion of claustrophobic adults. If these results are reproducible, there will be major advantages in terms of patient safety and costs.