Tackling how to get Australians moving each and every day

Gretchen Miller: Hello. This is the Prevention Works podcast from The Australian Prevention Partnership Centre and we’re bringing you members of the Centre’s multidisciplinary team to talk about Australia’s problem with chronic illness and look at the research that will help us all become healthier. Today, we’re outside Sydney’s Charles Perkins Centre looking at the rich green at the classic Australian’s sports oval on a fine sunny day and there’s a lot going on, walkers and joggers and football players all around. But despite our great weather and the beaches, bush, footpaths, ovals and parks all around us, as a nation, generally, we’re just not doing enough physical activity. But why?

I’m Gretchen Miller and this episode brings you one of Australia’s foremost researchers into physical activity. Adrian Bauman is Professor of Public Health at the University of Sydney and he’s just started a new project with the Prevention Centre to address a serious issue, how to get us all off our backsides and moving every day. And I’m remembering Norm now, a classic figure from the 1980s which was well before social media and YouTube. And I was a kid then but I think the idea was to nag us to get off the couch. Norm sticks in my head so he must have been pretty powerful and I wonder is something like that appropriate now?

Adrian Bauman: Norm in the late 1970s resonated with lots of people. Some people identified with Norm as a figure that they wanted to be like and some realized that that was not what you needed to do to be healthy.

Gretchen Miller: And Norm of course was this big overweight guy who sat on the couch and drank beer and watched telly. So yes, he wasn’t really an aspirational figure.

Adrian Bauman: But that’s only an information campaign and basically we know we can inform people about things. We informed people that smoking was a health risk until all smokers knew it was hazardous but until we changed the smoking environment by regulation, by building smoke-free environments, we couldn’t actually make the population change and we need to do the same for physical activity. Most people know that being inactive is not good for them, not so many know that you can be active in many ways. It’s not just exercise but then we need to provide the infrastructure and cross-agency facilities to support that.

Gretchen Miller: Adrian, you have a long work history in this field. I wonder what is the most unexpected thing you’ve discovered in your work into Australian physical activity. What surprised you in your history of research?

Adrian Bauman: It surprises me that we don’t take it seriously yet. It’s as important an issue as smoking or being overweight or obese. People know those things are risk factors. They think physical activity means you have to be sporty or you have to go to a gym and yet it doesn’t mean those things. It means the totality of all that we do in physical activity and we need to take it more seriously because it’s a problem more prevalent than smoking and nearly as prevalent as overweight and obesity in Australia.

Gretchen Miller: So that’s quite mind-boggling. As we sit here, people are walking past, pushing prams, looking sporty. Here’s an older woman in her sandals, obviously going for a walk. Why are we having problems with that in Australia?

Adrian Bauman: It depends where you look. If you look at our beaches on a summer weekend, there are little nippers running up and down, and people cycling and walking their dogs. But if you move inland from those areas to our vast suburban sprawl of many of our larger cities, you see very little activity in parks other than organised sport. You see few people walking themselves or their dogs and people are very, very inactive. They’re watching television, kids and adolescent are spending time on screen time and this hasn’t changed in 25 years.

Gretchen Miller: There’s no drugs for physical activity. We’re very focused on things we can take a pill for. We can find alternatives to tobacco. We can take a pill for cholesterol. But PE, physical activity is kind of, in a strange way, outside the health sector.

Adrian Bauman: This is one of the critical challenges because even tobacco or overweight and obesity have become medicalized and there are therapies for them, and they’re part of the way you interact with your GP, and part of the way the health system will interact with you. Physical inactivity is actually created by our physical environment, our urban planners, our transport engineers, our schools, our sporting facilities, our sporting ovals and our culture. So, the actual drivers are outside the health system but it’s a health problem amongst other things so that it’s very difficult to find solutions to a health problem outside the health sector and that’s why taking a systems approach is part of this work with The Australian Prevention Partnership Centre and is essential to do so.

Gretchen Miller: What do you mean by systems approach? Tell me about this latest project.

Adrian Bauman: So this is a long-term and challenging project to get Australians to think about being more active and create the places, environments and resources where they can be. A systems approach means physical activity or physical inactivity is caused by the intersection of multiple pieces in society, including all the sectors I described before. Different pieces interact and you can’t just do one thing.

Gretchen Miller: So, the project itself, you’re starting out. What are you doing to begin with?

Adrian Bauman: The project will actually work with stakeholders, with governments, with non-government organizations, with professional groups to actually work out how they can understand each other’s dynamic and contribution better, work out where the intersects are. And where you can find intersects, you can save costs in doing things together between agencies and hopefully, build a more physical active Australia.

Gretchen Miller: So, you’re talking about getting the states and territories talking to one another. What’s going on there? Is there no communication?

Adrian Bauman: One of the things is we have no national policy on physical activity. We’ve got national policies on tobacco control. We’ve got national policies on alcohol, on illicit drugs, national obesity strategies but nothing specific to physical activity, and we’ve got a fragmented patchwork of policies across the states and territories. The first thing is going to be to map the physical activity context in Australia, work out why we’ve got policy levers that we might influence better and get communicating together and in that way, build the communications to increase physical activity.

Gretchen Miller: Can you give me an example of the different strategies between, say, New South Wales and the Northern Territory?

Adrian Bauman: Some states and territories have a particular focus in which physical activity is embedded. For example, a childhood obesity strategy is one of the premier’s priorities in New South Wales. Other states and territories have a focus on physical activity as part of the sport sector so will approach it through the department of sport and recreation. Different approaches to physical activity don’t create good communications or standardized policies and it’s that that we’re going to try and work with to build, for the first time, a cross-sectoral framework that encompasses all the agendas and we can at least map where we are.

Gretchen Miller: We are bombarded daily in all directions with instructions on diet and exercise from high-intensity interval training to joining gyms, from yoga to Pilates, to the Fitbit, the ever-prevalent Fitbit, doing your 10,000 steps. It really does seem to me to be in the daily public conversation, so why are we still sitting around?

Adrian Bauman: Exercise is in the daily public conversation as are diets but these are transient media stories which generate transient interest, “I could do that. I might think about doing that.” But it’s not describing the way in which we live our lives. Whether we use the stairs, whether we walk to the shops, whether we catch public transport, physical activity is in fact ideally embedded into everything we do, not just exercise or sport. Even Fitbits and wearable devices are a transient phenomenon applied to a large number of people for a short period of time. They’re not going to make Australians more active by themselves until we change the way we think about moving more.

Gretchen Miller: Is there anyone in the world who does think about moving more?

Adrian Bauman: There’s several cultures and countries where moving is part of the way they think about themselves. Scandinavia is the obvious example and I don’t just mean bicycles in Copenhagen. I mean the entire ethos in Norway, Sweden and Denmark favors physical activity. Canadians also have physical activity as part of their DNA and to a certain extent, across the ditch, our New Zealand cousins also do. We don’t. British people don’t. Southern Europeans don’t. And many countries in the developing world, rapidly industrializing are losing physical activity, countries like China, India, Brazil, as they move from active transport to moving in cars and not doing any physical activity during their day.

Gretchen Miller: So this research though will be one of the first in the world to develop a common framework for improving the systems, to monitor and encourage physical activity, a world first.

Adrian Bauman: Most countries in the world have got physical activity nested somewhere and we mentioned earlier either in sport or in an obesity strategy, sometimes in school education as a PE strategy and few countries have attempted to put this together into a national framework. In Australia, we have a great need to do that to bring a harmonised approach to what we’re doing. We can’t make states and territories do the same thing but we can get them to think about it and open the conversation so they can all think about physical activity in the same way, know what they’re doing and what they’re not doing. And because we haven’t made much of a difference to physical activity in three decades, we’ve got a lot of work to do. And if we work off the same hymn sheet, the same song sheet, we can do better across the country.

Gretchen Miller: This is Prevention Works, a podcast all about improving our health from The Australian Prevention Partnership Centre. I’m with Adrian Bauman who’s Professor of Public Health at the University of Sydney and we’re in a very noisy environment conducting a fascinating interview. So, you’ve mentioned that one of the problems that we have now is our obsession with elite sport and I wonder how that’s not working for the general public. Isn’t that kind of part of that idea of the trickle-down effect where if we see elite sports people, we might be inspired to be just like them?

Adrian Bauman: I’ve done a lot of research in that area. I’ve looked particularly at mass events and the Olympic Games and their effect on physical activity participation immediately afterwards, and there is no evidence whatsoever for the trickle-down effect. Trickle-down effect is one of those myths that have achieved currency by the Chinese whisper across government departments and sporting agencies. At the moment, in 2018, we’re in a good place in Australia because sport focuses on elite sport but there’s also been one of the cyclical moves to encourage community sport participation. And at the federal level, sport lives within the health ministry, Commonwealth Department of Health. And as such, community sport participation is part of their agenda and that’s a good thing.

Adrian Bauman: We really need to create grassroots examples of programs for people to play at all ages, not just for young people but for old people as well, in all kinds of sports and cultural activities and recreations. We need to encourage them as well as trying to win gold medals but not putting all our sporting investment into the gold medal basket. It’s having a mix of investments in sport sectors where we do foster community sports and not just elite sports or professional sports because sport watching never conferred any benefit to the watchers. Olympic Games increase our national pride and our national sense of well-being when we have the games in Sydney, infrastructure gains were real but physical activity gains were not and we need to think about how we can get a balance. And sport focusing on elite training but also focusing on development at the grassroots of sport for everyone, not in a competitive way but in a participatory way. The sport clubs in Europe do this very well and have a grassroots framework that is excellent and we should aspire to be like that. In other words, they don’t just target kids who are going to go on and become elite sports, they target participating for all kids at all levels. So, they’re not funneling kids into, “You can only be a cricket or footballer, netballer or swimmer if you’re a very good one”, but everyone can be part of that activity.

Gretchen Miller: You’ve mentioned that measurement is actually really important and that if you invest in PE lessons in schools but if you don’t measure implementation, then you could be up for a fall.

Adrian Bauman: One of the problems in public health is we often have policies that are actually written and exist. Governments make a policy. You have to have mandatory PE in schools for example. Every child should do physical education twice a week. But if you don’t measure how many schools actually do that, then you’re not measuring whether it’s reaching all the kids in a society. You’re only measuring that we’ve got a policy. And measuring policy implementation is an important part of this project to work out what are the indicators, how can we tell if a policy is being implemented and sharing that with state and territory governments in the Commonwealth will be one of the key outcomes we’ll do for physical activity.

Gretchen Miller: So, once you’ve done this measurement, what happens then? Where do you go from there?

Adrian Bauman: What it may show you is that the policy’s not being implemented well. You feed that back to government who then considers, “Can we do anything better, differently or more? Will it take more resources? What will it take to make every school implement a physical activity strategy?” Then, they realize it’s got pockets. In some areas, it’s implemented well and in disadvantaged areas, maybe less so, or remote rural areas. And how can we get those programs implemented so that it provides a feedback loop in the communication with government and agencies saying, “This is how it’s going.” Or if it’s going well, just monitor the maintenance of it to make sure it doesn’t slip over time.

Gretchen Miller: You already really know what each state and territory is doing differently. Once you get those territories talking to one another, then what do you do?

Adrian Bauman: Help them work out ways of cooperating and sharing a framework that we would build so that they can do things better and in synergy with each other. I’m an academic in the university, I can tell governments what to do as much as I like but it doesn’t mean that they will do those things. But if you actually get them communicating and sharing ideas, working towards a common purpose, because governments want to make us healthier too, you can often get that kind of cooperative effort, creating the synergies and the changes to practice over time.

Gretchen Miller: And practically speaking, for those on the ground, me, policymakers, that lass over there who’s currently doing sprints, what might come out of this in practical terms?

Adrian Bauman: At the national level, I’d like to see our rate of physical activity going up rather than staying flat for the last 30 years.

Gretchen Miller: How do we make that happen thought?

Adrian Bauman: I’d like to see more support across agencies for building more facilities, for building an infrastructure that supports physical activity, for getting every general practitioner to ask about physical activity when they ask about tobacco, for getting every school to implement PE for all, not only for the kids who are fast runners. And getting that happening across the system is possible and will create and healthier Australia at relatively modest costs compared to the amount we spend on pharmaceutical medications for blood pressure or high cholesterol which are the results of poor diet and inactivity.

Gretchen Miller: All right. So, I’m interested in, as we are a very multicultural community, the cultural issues that we’re looking at here.

Adrian Bauman: We’re so multicultural. We have so many diverse groups but we have got some major migrant populations and you need to think carefully about what those major migrant populations would conceptualize physical activity to be. One of the things might be that many parents might take their kids out of sport and give them extra lessons after school. What you need to do there is encourage them to think about physical activity and kids, improve kid’s academic performance. Other kids may have other cultural groups, may have specific activities, cultural dance or a passion for football or something that’s particular to their culture and it may be possible to run programs locally and in regional areas that reflect that. One of the good examples of that in some of the suburban pools in parts of Western Sydney is they open those pools only to women to encourage Muslim women to come to aquarobics and swimming programs in the mornings, 10:00 AM to noon because those were low-use periods. All of a sudden, they were flooded with people wanting to come and do something because they changed the way swimming pools operated for a brief period of time. And that kind of thing is doable, it can make economic sense and it can provide opportunities for large cultural groupings to engage in activity that they enjoy and would want to do.

Gretchen Miller: I was reading that I have to do between 150 to, say, 300 minutes of physical activity a week and I am actually a bit of a jogger but not a serious one and it actually made me go, “Oh, no. Seriously? Maybe I’m not even making the grade with my jogging. “Does it have to be that hard?

Adrian Bauman: First of all, what that means is roughly 30 to 60 minutes a day of moderate activity. So if you walk to the bus and you walk home from the bus, you’re getting your weekly recommended levels. If you walk the dog, you’re actually getting your recommended levels. Secondly, that applies to moderate intensity activity and you’ve only got to do half that much if it’s vigorous like jogging, or vigorous cycling, or lap swimming, or playing football or netball. So that for your jogging three times a week for 20, 25 minutes would actually get you well into the threshold easily. So that we really need to get people to understand that it’s not that hard to achieve in your daily life to move around that much, not only if you get a chance to jog or play sport or go to the gym.

Gretchen Miller: So, it can be as simple as taking the stairs.

Adrian Bauman: Simple as taking the stairs but you need to take the stairs every day. You need to walk up three or four flight of stairs twice a day, that will get you close to your recommended levels.

Gretchen Miller: Okay. So simple as that. It really isn’t that much. What about window shopping or walking around the supermarket?

Adrian Bauman: Now, that’s interrupted walking where you’re walking and then stopping, and one of the key things is we mean continuous activity. So whatever it is, a continuous walk. Even walking the dog and stopping at every tree is fairly continuous, so continuous activity is health enhancing. Window shopping is really stopping for a minute or two and then walking for a minute, and that’s not what we mean.

Gretchen Miller: Is social media your friend in this case? Instagram, Facebook, Snapchat even.

Adrian Bauman: This is a very complex question because we’ve used social media interventions to get people to talk to their friends and get them to go out and be active together. So, it can be useful in getting people to bond and say, “Let’s go for a walk.” And other people in your social media group will respond and you’ll go and do something, whether it’s going to kick a ball in the park or whatever it is, go down to the beach and have a swim. However, innately, social media is an inactive pastime and lots of hours spent on social media means lots of hours spent being inactive. So the act itself of most forms of social media is sedentary, whereas it can be used as an intervention to encourage activity.

Gretchen Miller: All right. Well, I do want to go back and ask you another question. What were you up to at the time of the life being at the Norm campaign? Where were you in your research then? And I wonder how its changed but also what drives you.

Adrian Bauman: In the mid-1970s to late 1970, I was an undergraduate student at university. I was a medical student and I was not physically active because I spent most of my life studying, but I’d often go and play squash two or three times a week at about midnight with my colleagues when we finished studying. But the whole concept of making population change and the Norm mass media campaign were foreign to me at that point because as a medical student, I was focusing on individual patients and it took me a decade after graduating until I came back to public health and realised you can make more of a difference by taking a whole population approach and that not all of the answers lived in the health sector, especially in the area of prevention. It took me to a public health degree and a PhD, and it took me to start to work in preventive health. And gradually, it took me outside of the health system to work with a whole range of other agencies because making people more physically active or helping people give up smoking or lose weight are all things that require systems approaches or multiple agencies, not just one health piece of advice from your general practitioner or one health intervention.

Adrian Bauman: Of course, at the extreme end, when you develop diabetes, when you develop heart disease which are all related to smoking and overweight and obesity and physical inactivity, then you need the best medical care that you can have. But at the population level and especially internationally where I do a lot of this prevention work, we can’t afford to have that epidemic of disease down the track, so we have to try and help people lead healthier lifestyles now and help those countries make better environments to support those lifestyles.

Gretchen Miller: So, given the messages that do already exist out there to some degree, even if it’s in a haphazard and non-systemic way, why does getting Australians to move such a complex notion? Are we too laid-back?

Adrian Bauman: We make lots of excuses for not being active. The commonest excuse is we report that we don’t have enough time, we’re too busy to be active. However, most adults, most teenagers, most children find time for two to three hours of screen time, television or small screen device time, every day. And we live in a fairly safe environment that time could be spent playing with the kids in the backyard, out walking in their communities. There’s all kinds of time which we could use. Even when we drive to the local shops which might only be a few hundred meters, we could walk that trip and do things slightly differently.

Adrian Bauman: So that we need to reframe the way we think about moving and we also need to reframe that it isn’t exercise. Because a lot of people say, “I’m not sporty. My body shape wouldn’t look any good in lycra. I’d be embarrassed going to a gym.” Or, “All those young people at the gym, what would I do there?” So we need programs that have people in street clothes doing physical activity, age appropriate and matched so you’re doing activities with people in your 60s if you’re in your 60s. And you’re doing things that are not necessarily sporty, not necessarily perceived as exercise but are moving more and doing you good, or you’re building those things into everyday life. We have a habit of driving round, and round, and round the block looking for a parking space. I’ve even seen this in country towns in Australia, whereas if we park 15-minute walk away and walk that distance, it would be time equivalent but we’d get half our daily physical activity through the process.

Gretchen Miller: So easy. It is interesting that we do have really great infrastructure. We’re sitting here at a gorgeous park which is being used at the moment by a jogger. We’ve got great beaches. We’ve got footpaths. We’ve got pretty good infrastructure.

Adrian Bauman: For most Australians, our climate is actually very favourable. And we might complain that it’s too hot or it’s too cold or it’s too wet but compared to Northern Europe, compared to Central Africa, compared to tropical Brazil, we actually have very favourable environmental conditions. Think about this as a challenge for Australians. Finnish people are actually more active in the middle of their dark, cold winter than we are, which means we must be spending an awful lot of time just sitting around.

Gretchen Miller: You’re getting the data and having studied this for decades, you already have a good idea I think of the answers. What are you going to do next?

Adrian Bauman: The next steps will be to test the feasibility of some of these changes to the built environment, to people’s perceptions. Test some innovative programs around maybe getting people to travel in more active ways. Identify what’s the return on investment from physical activity intervention so that governments can know this is as cost-effective as losing weight. Start to build capacity for doing physical activity actions at the state level but also amongst professional groups, also moving and taking this knowledge outside of Australia through WHO, World Health Organization Collaborating Centre and sharing this with other countries. All of whom, many of whom also have physical inactivity as a major under-recognised problem.

Gretchen Miller: Yes. Because this is going to be a world first, isn’t it? So you are hoping to take it around the world.

Adrian Bauman: Hoping to share this in the hope that other countries will adopt the systems approach to thinking systematically rather than just thinking about the individual, “You need to do more. Why don’t you go and do it?” But thinking about all the cues, the social and environmental cues that can make us an active Australia. We’ve got the environment, we’ve just lost the message and the capacity to do it in the last five or six decades.

Gretchen Miller: Thanks to Professor Adrian Bauman. Here on the Prevention Works podcast from The Australian Prevention Partnership Centre.

Adrian Bauman: Thank you.

Gretchen Miller: On their website, you’ll find more information into the research we’ve been discussing and more podcasts with nutritionists, lawyers, epidemiologists and urban planners. They’re all at preventioncentre.org.au. I’m Gretchen Miller. See you next time.