Physical inactivity is a major public health issue, and there is an urgency to find sustainable and affordable ways of getting the world moving. Large numbers of people are inactive to the extent that they risk their health, and while it is often assumed that this is a problem of the West, it has now spread into every corner of the globe. Some describe the current situation an 'inactivity pandemic'.
The inactivity pandemic rivals smoking as a public health concern. It is one of the principal causes of the escalation of Type 2 diabetes, heart disease, high blood pressure and obesity, which are the leading causes of death for both men and women. No one has been able to calculate the total health care costs associated with inactive lifestyles, but it is likely to be hundreds of billions of pounds/dollars/euros every year.
Almost every country now has a physical activity strategy and recommended daily targets (generally 60 minutes per day for children and 150 minutes per week for adults). However, in almost all cases, top-level national and international guidance either omits or marginalises one of the most popular, palatable forms of physical activity - sport.
Sport is the elephant in the room for physical activity policy. Its absence of sport in discussions of health promotion seems surprising as for centuries it has been heralded as a fun way of getting fitter and healthier. In recent decades, though, policy statements about physical activity have pushed sport to the margins, or even out of the discussion entirely. Enrico Michelini calls the virtual invisibility of sport among top-level documents 'the disqualification of sport'. He argues that the source of the problem lies in a perceived incompatibility between the illness-orientated focus of health policies and the win/lose orientation of sport.
There is truth in this analysis, but it does not exhaust the challenge. Sports organisations have increasingly focused their interests on elite performers, usually at the expense of other players. This was seen clearly in the build-up to the 2012 Olympic / Paralympic Games. Despite an appeal by Sebastian Coe to the power of the Olympics to mobilise youth participation, the selection of London to host the Games was almost immediately followed by the transfer of funds for mass participation to the tiny proportion of players who would be competing in the Games. And ad hoc statements by the UK Government that medals would inspire the rest of us to get off our couches and start playing were undermined by the fact that there was no evidence that this has ever happened in the past.
The tension between elite and mass participation sport is not limited to Olympic Games. Almost every country around the world assumes a 'pyramid' model of participation, which is structured around the demands of competitions at higher and higher levels. As players progress in their sport, they move further up the pyramid. But despite its intuitive appeal, the pyramid model is fatally flawed. One problem is that, despite advances in the sport sciences, the identification of talented players is subjective and error-prone, so talented players are often discarded. And any system premised on the need to eject participants seems fundamentally wrong-headed.
But disqualifying sport as a potential source of physical activity because of the ways it has sometimes been organised risks throwing out the baby with the bathwater. Numerous studies have shown that people, especially children, who play sport have higher overall levels of moderate-to-vigorous physical activity than non-sporty peers. And engagement with sport during childhood tends to predict physical activity later life. A recent study from Ireland reported the frequency of participation in club sport predicted physical activity 5 years later. Similarly, Canadian researchers found a positive relationship between the duration of teenagers' engagement in sport and activity levels at 24 years. And a group of scientists from the UK found 10-year-olds who often participated in sport were more likely to participate in sport and other forms of physical activity when they were 42.
Of course, sport is not a panacea. While it can be an attractive form of physical activity, especially for young people, it does not appeal to everyone. And even among those who are drawn to sport, some eventually leave because of negative and exclusionary experiences. While such experiences are rare, their existence undermines ambitions for sport to be located as a core element of the healthy physical activity agenda. So, it is odd that organisations seeking to promote physically active lifestyles would exclude on the most attractive forms of activity from their consideration, but it is importantly not to deny that sport comes with baggage that can interferes with this role. Elite competitions can be exciting and politically sexy, but it is a long way from the day-to-day sport of the vast majority of players. Performance and competitive success are parts of sport, but sport's centre of gravity lies closer to participation, friendship and fun. And it is precisely these qualities that make sport a potentially appealing setting for physical activity.
Many agencies recognise this. The International Council of Sport Science and Physical Education has supported numerous developments consistent with positive sport experiences. The best-known of these is the Designed to Move initiative, with its focus on positive early experiences and activity-friendly environments for everyone. National agencies, too, have engaged with this agenda. In Germany, the Deutsche Gesellschaft für Internationale Zusammenarbeit has introduced a range of projects that bridge the apparent sport-health divide. And Sport England has successfully aligned itself with the healthy physical activity agenda with, among others, the 'This Girl Can' programme.
These developments give clues to ways in which the appeal of sport can connect with the urgent need for healthy physical activity. And they show how both can benefit from the relationship. Health without sport risks losing passion and commitment. Sport without health risks running out of players.