Klepac, Bojana ORCID: 0000-0002-9141-1862 (2020) A Critical Assessment of Physical Activity and Sedentary Behaviour Policies. PhD thesis, Victoria University.

Abstract

It is well established that physical inactivity is one of the main behavioural risk factors for noncommunicable diseases (NCDs). Research on sedentary behaviour (SB; i.e., sitting or reclining with low energy expenditure during waking hours) has grown rapidly in the past two decades, after epidemiological evidence indicated that high levels of sitting may pose a health risk. Research on physical activity (PA) and SB policies is considered underdeveloped, compared with other areas of PA and SB research. This thesis, therefore, aimed to: (1) map the evidence on indicators, development, and content of national PA and SB policies globally (Study 1); (2) develop a new conceptual framework for PA policy analysis – the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework (Study 2); (3) identify and critically assess available instruments for the analysis of national-level PA and SB policies (Study 3); and (4) analyse the availability, comprehensiveness, implementation, and effectiveness of current national-level PA and SB policies globally (Study 4). To achieve the aim of Study 1, a systematic scoping review of indicators, development, and content of national PA and SB policies was conducted. The achieve the aim of Study 2, an extensive review of literature, an open discussion between the authors, three rounds of a Delphi process, and two-rounds of consultations with PA policy stakeholders were employed in the development of the CAPPA framework. To achieve the aim of Study 3, a systematic review of instruments for national-level PA and SB policies was conducted, and the identified instruments were assessed against the CAPPA framework. To achieve the aim of Study 4, a survey was developed based on Study 3 findings and according to the CAPPA framework. PA policy experts from 173 countries (n = 76; response rate = 44%) were then asked to provide data on their national PA and SB policies by completing the survey. Study 1 found that PA policy research is much more developed than it was considered several years ago and that research on SB policies is still in its infancy. The following research gaps were identified: (i) there is a lack of PA and SB policy research in low- and middle-income countries; (ii) the definitions of PA and SB policies varied significantly across studies; (iii) most studies did not rely on any conceptual or theoretical framework; and (iv) studies have used a variety of methods to analyse PA and SB policies which may cause problems with comparability. The CAPPA framework, developed in Study 2, provides a novel definition of PA policy, which, if widely adopted, will help to standardise the scope and language used in future research. The CAPPA framework developed in Study 2 specifies 38 elements of a comprehensive analysis of PA policies in the following six categories: purpose of analysis; policy sector; type of policy; stage of policy cycle; and scope of analysis. It can be used to guide future studies related to PA and SB policy and provide a context for the analysis of its specific components. Study 3 found 16 instruments for PA policy analysis. Only two instruments include questions about SB policy and none of the instruments allows for the analysis of all the relevant components of national PA and SB policy. Therefore, developing new instruments or adapting existing ones is needed to enable a more thorough analysis of national PA and SB policies. Study 4 found that most countries have formal written PA policies, guidelines for PA, quantifiable national targets for PA, and PA surveillance or monitoring. However, the levels of comprehensiveness, implementation, and effectiveness of national PA policies are largely low-to-moderate. Compared with P A policies, SB policies are less available, comprehensive, implemented, and effective. Both PA and SB policies are more developed in high- income countries, compared with low- and lower-middle-income countries, and in countries of the European and Western-Pacific regions, compared with other world regions. Future studies should aim to focus more on low- and middle-income countries and countries from the African and Eastern Mediterranean regions. Comprehensive analyses of PA and SB policy, considering all elements specified in the CAPPA framework, are needed to facilitate PA and SB policy research, and the development and implementation of comprehensive and effective PA and SB policies.

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