AF C Reis Et Al - 2016 - Scaling Up Physical Activity Interventions Worldwide-2

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Physical Activity 2016: Progress and Challenges

Scaling up physical activity interventions worldwide: stepping
up to larger and smarter approaches to get people moving
Rodrigo S Reis, Deborah Salvo, David Ogilvie, Estelle V Lambert, Shifalika Goenka, Ross C Brownson, for the Lancet Physical Activity Series 2
Executive Committee*
The global pandemic of physical inactivity requires a multisectoral, multidisciplinary public-health response. Scaling up Published Online
interventions that are capable of increasing levels of physical activity in populations across the varying cultural, July 27, 2016
http://dx.doi.org/10.1016/
geographic, social, and economic contexts worldwide is challenging, but feasible. In this paper, we review the factors that
S0140-6736(16)30728-0
could help to achieve this. We use a mixed-methods approach to comprehensively examine these factors, drawing on the
This paper forms part of the
best available evidence from both evidence-to-practice and practice-to-evidence methods. Policies to support active living Physical Activity 2016 Series
across society are needed, particularly outside the health-care sector, as demonstrated by some of the successful examples *Members listed at end of the
of scale up identified in this paper. Researchers, research funders, and practitioners and policymakers in culture, report
education, health, leisure, planning, and transport, and civil society as a whole, all have a role. We should embrace the See Online/Comment
challenge of taking action to a higher level, aligning physical activity and health objectives with broader social, http://dx.doi.org/10.1016/
environmental, and sustainable development goals. S0140-6736(16)31070-4,
S0140-6736(16)30960-6,
Background (scaling up) and achieve programme maintenance and http://dx.doi.org/10.1016/
Since the publication of the first Lancet Series on sustained health benefits requires extensive knowledge S0140-6736(16)30929-1, and
physical activity in 2012which recognised physical of strategies for implementation, adoption, and http://dx.doi.org/10.1016/
S0140-6736(16)30881-9
inactivity as a global pandemic and urged all sectors of sustainability.5,6
See Online/Articles
governments and societies to take immediate action Some well-known examples of fast-growing programmes http://dx.doi.org/10.1016/
the demand for eective strategies to increase have arisen from the real world, such as open streets, S0140-6736(16)30370-1, and
population physical activity levels has grown.1,2 A Academia da Sade, and bike sharing programs) often http://dx.doi.org/10.1016/
substantial body of evidence resulting from decades of reflecting common civic sense. These forms of S0140-6736(16)30383-X
research in the fields of exercise physiology, public practice-based evidence are often implemented at scale See Online/Series
health, epidemiology, and the behavioural sciences has and replicated in many settings around the world. Often
S0140-6736(16)30581-5
shown that physical activity has broad economic and there is no budget for assessment, but in the best of cases,
Prevention Research Center in
health benefits1 and that under scientifically controlled these programmes are later assessed by researchers to St Louis, Brown School,
circumstances, behaviour change is achievable for estimate their eectiveness in promoting physical Washington University in
increasing physical activity in diverse groups.3 Until activity.3,4,7 However, an exhaustive inventory of these cases St Louis, St Louis, MO, USA
(R S Reis PhD,
2010, most of this evidence came from high-income is not available to researchers, practitioners, and
R C Brownson PhD); Physical
countries (HICs),3 but during the past 5 years, the stakeholders, and the internal and external validity of the Education Graduate Program,
number of interventions developed, implemented, and evaluations have been questioned.3,4,7 Federal University of Paran,
assessed in low-income and middle-income countries In our view, scaling up is not simply achieved by Curitiba, Brazil (R S Reis);
Michael and Susan Dell Center
(LMICs) has grown substantially.4 researchers leading the implementation of a translated
for Healthy Living, The
Despite the many convincing arguments and global programme at a larger scale (eg, at city or state level), University of Texas Health
calls for action to reverse the physical inactivity although in some cases this type of scale-up could Science Center at Houston,
pandemic,1 practitioners and policy makers have represent the first step. When an intervention outgrows School of Public HealthAustin
Regional Campus, Austin, TX,
restricted access to knowledge about existing physical the research setting and becomes embedded in a system,
USA (D Salvo PhD); Center for
activity programmes that can be eectively implemented thereby ensuring maintenance and sustainability of its Nutrition and Health Research,
at scale. So-called eective physical activity interventions health benefits, only then can successful scale-up be National Institute of Public
have too often been done only in small, controlled considered to have been achieved. Likewise, in some Health of Mexico, Cuernavaca,
Mexico (D Salvo); MRC
settings.2 However, a few eorts to bring these findings cases, practice-based evidence can also outgrow its local Epidemiology Unit and UKCRC
into real-world programmes have been made. In fact, the context to improve external validity and be embedded in Centre for Diet and Activity
scientific literature contains abundant examples of its local system. Although other researchers have used Research (CEDAR), University
researcher-led translation and dissemination trials, varying definitions for scalability and scale-up, our of Cambridge School of Clinical
Medicine, Cambridge
implementing evidence-based physical activity inter- approach is pragmatic and responsive to the urgent call Biomedical Campus,
ventions in a variety of real-world settings.3 Unfortunately, to action to reverse the pandemic of inactivity. In essence, Cambridge, UK (D Ogilvie PhD);
these initial translation attempts have usually not thrived by seeking eective strategies for scaling up physical Division of Exercise Science and
in the real world (ie, in becoming embedded in a system) activity interventions around the world, we aim to find Sports Medicine, Department
of Human Biology, Faculty of
once the research funds for translation have expired. ways of reintegrating active living into the realms Health Sciences,
Further expansion to reach more people and places of government and society where it used to reside:
www.thelancet.com Published online July 27, 2016 http://dx.doi.org/10.1016/S0140-6736(16)30728-0 1

Series
University of Cape Town, Cape

Town, South Africa Key messages
(E V Lambert PhD); Indian
Institute of Public Health and

Public Health Foundation of factors required for the scaling up of physical activity physical activity and public health are desperately needed
India, Delhi, India interventions: proven ecacy in controlled settings, worldwide, especially in low-income and middle-income
(S Goenka PhD); and Division of partnerships beyond the health sector, and countries
Public Health Sciences and
Alvin J Siteman Cancer Center,
institutionalisation early in programme development
Washington University School (eg, schools, urban planning, transportation, sports and
of Medicine, St Louis, MO, USA the world, more than 50 unique physical activity recreation, the environmental sector); to reach these sectors
(R C Brownson) fully, medical and public health practitioners need to
Correspondence to: not reported in the peer-reviewed literature
Prof Rodrigo S Reis, Prevention

Research Center in St Louis,
Brown School, Washington increasing population physical activity levels, and not every
University in St Louis, focus on scaling up approaches with the highest face validity:
St Louis, MO 63130, USA

reis.rodrigo@wustl.edu
more useful scalability are needed: researchers, research approaches for promoting physical activity among
children and adolescents
studies for assessing the impact of real-world physical
activity interventions
sport participation
on the most important factors in the scale-up process, and
will aid policy makers and practitioners in understanding its of active living to maximise their opportunities for
staged nature adoption, implementation, and scale-up

should provide leadership for scaling up evidence-based prioritise actions that promote safe, equitable, and
physical activity interventions worldwide, by setting targets environmentally friendly active mobility and leisure
and indicators for countries options for all citizens

plan to increase population physical activity levels programmes, systems, and places to enable people to lead
more active lives
factor in clinical medical practice and in national and

regional surveillance systems, and health-care systems
should provide physical activity counselling and support for implemented at scale, regularly assessed, and fully
the prevention and treatment of chronic diseases embedded in a system
city planning, transport, education, culture, leisure, What can be learnt about scaling up physical
environmental sustainability, and, of course, health. activity interventions from the scientific
Scalable interventions in these wider areas of public literature?
policy will probably be needed to shift societies towards a We did a systematic review of the peer-reviewed, English-
more active way of life. language literature to summarise the available scientific
In this Series paper, we provide an overview of factors evidence on scaling up physical activity interventions. An
that could help to increase the ratio of success to failure intervention was defined as a set of actions with a coherent
in scaling up physical activity interventions around the objective to bring about change or produce identifiable
world. We have four aims: (1) to summarise the outcomes.8,9 Therefore, the review included not only
available peer-reviewed, scientific evidence on scaling traditional researcher-driven interventions proven to be
up physical activity interventions; (2) to integrate the ecacious in increasing physical activity in a controlled
knowledge and experience of senior researchers and research setting (evidence-based practice),10 but also
key stakeholders on the factors influencing the programmes, strategies, policies, or initiatives that
scalability of physical activity interventions in HICs and originated outside the scientific realm, but have been
LMICs; (3) to identify case studies of scaled-up physical assessed by researchers and shown to be eective (practice-
activity interventions from around the world; and (4) to based evidence).11,12 We searched PubMed and Scopus
develop a framework to guide researchers, practitioners, databases without any restriction on date of publication,
policy makers, and civil society in selecting, imple- given the anticipated dearth of suciently detailed
menting, and assessing scaled-up physical activity accounts of the scale-up process in the literature. We
interventions. reviewed publications with a scalability search termfrom
2 www.thelancet.com Published online July 27, 2016 http://dx.doi.org/10.1016/S0140-6736(16)30728-0

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an extended list based on that used by Milat and colleagues9

HIC literature review HIC Delphi survey U-MIC literature review
in a similar review for scaled-up public health LIC and L-MIC literature review LIC and L-MIC Delphi survey 3
interventionsin the title, and a physical activity term in U-MIC Delphi survey
the title or abstract. The search terms used to define
scalability were centred around the objective of identifying 1
truly scaled-up interventions, defined for this study as
Number of interventions
1
those that had outgrown research dependency and become 9
embedded into a system. Therefore, we purposely excluded 8
search terms reflecting researcher-driven and researcher- 9 7
funded translational studies (see appendix for a full list of 3
1
search terms and criteria). 2
Publications were eligible for further abstraction if they 1
reported an intervention implemented at scale and 3 5 3 5 2
embedded in a system, for which physical activity was an 2 3
1 1
intended outcome, and if they included sucient detail of Whole of Transport Urban Primary Public Community- Sport for all
the scaling-up process. We used an adapted version of the school policies and design and health-care education wide
systems infrastructure systems programmes
External Validity Assessment Tool (EVAT)7 developed by
Category of intervention
Project GUIA (Guide for Useful Interventions for Physical
Activity in Brazil and Latin America).13 Interventions were Figure 1: Number of scaled-up physical activity interventions identified in the literature review and in the
classified by theme, using the seven investments that work Delphi study
for physical activity outlined in the Toronto Charter for

Physical Activity,14,15 and by scalability category, using
WHOs ExpandNet framework for scaling up.16 When
available, information was abstracted on any process one on both adults and older adults.34 Two cases related to See Online for appenidx
assessment, key actors and partnerships, and cost- all age groups21,22 and two were not specific about age
eectiveness of scaling up. We also abstracted information groups.20,31
on the geographical setting (country, world region, and Scalability was most commonly defined exclusively as
World Bank income category17), the target population, and extending the reach of an intervention by replicating it in
whether the scaled-up intervention was an example of other localities, cities, or states (horizontal scale-up)16
evidence-based practice or practice-based evidence. Further (n=6),20,24,25,30,34,35 as institutionalising the intervention at
details of the review methods are available in the appendix. government level so it could reach all citizens within a
The search yielded 547 unique articles. Among these, given jurisdiction (vertical scale-up)16 (n=5),22,23,29,31,32 or as a
18 peer-reviewed articles were identified in which physical combination of horizontal and vertical scale-up
activity was either the main outcome or a co-benefit of a (n=4).18,19,21,2628 Most of the monitoring and assessment
scaled-up intervention, and for which sucient detail of activities pertaining to scalability assessed whether the
the scalability process was reported.1835 16 unique scaled-up programme was reaching the specified target population
physical activity interventions were identified (with more and whether the intervention was being properly
than one publication for some interventions), of which implemented, with several cases reporting deficiencies in
14 were from HICs,1830,32,34,35 one was from a middle-income these regards. Public or private health-sector entities were
country (MIC; Brazil)31 and one was from a low-income the most commonly reported key actors, whereas
country (LIC; Uganda).33 13 of the cases represented partnerships with other sectors (schools, urban planning,
evidence-based practice.1822,2430,32,34,35 Two of the three sports and recreation, or academia) were reported in over
practice-based evidence cases were from LMICs.31,33 14 of half of cases. Further details of the 18 scientific publications,
the cases described an intervention that fitted into one of representing 16 unique scaled-up physical activity
the seven categories of investment in physical activity interventions found in the peer-reviewed literature, are
(figure 1), with the most frequently represented categories available in the appendix.
being those of community-wide programmes The review provides important insights into the
(n=6),20,22,24,31,32,34 whole-of-school programmes (n=3),23,2628,30 processes, key actors, and partnerships involved in scaling
and physical activity promotion or NCD prevention up physical activity interventions. Demonstrated ecacy
integrated into primary health-care systems (n=3).18,25,29 No in controlled settings, partnerships beyond the health
cases relating to the categories of transport systems sector, and institutionalisation from an early stage of
prioritising active travel, or urban design policies and programme development emerged as key factors for
infrastructure, were identified. The remaining cases success. However, the exercise also highlighted some
involved public health education delivered by telephone or shortcomings of the evidence in this area. First, we found
text message.19,21 Six cases described interventions targeting little information in the scientific literatureonly
children or youth,18,23,2528,30,33 four focused on adults,19,24,29,35 18 publications, representing 16 unique interventions
one on older adults (aged 65 years or older),32 and another outlining the steps and processes involved in successful

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scale-up of physical activity interventions. Second, the LICs) responded to the first round of the survey, which
great majority of this literature relates to interventions included open-ended questions on key factors that should
being taken to scale in HICs. Third, we found few be considered when deciding to scale up a physical activity
examples of practice-based evidence. Fourth, we found no intervention, as well as examples of any such intervention
examples corresponding to transport systems or urban that had been scaled up in their country or region. Further
design policies and infrastructure, two of the seven best details on the questionnaire and sample characteristics are
investments for physical activity. available in the appendix. Following our definition of
scalability, we identified 56 unique interventions that were
Drawing from the knowledge and experience of cited as having been scaled up in the participants own
key researchers and stakeholders from around regions and were not found in our literature search
the world (figure 1; appendix). A search for information on content,
To complement the literature review in building a fuller reach, eectiveness, and scalability was done for each
picture of the factors influencing the scalability of physical regional intervention cited by the key informants, on the
activity interventions, we sought to integrate the knowledge basis of published references and web-links provided, and
and experience of senior researchers and key stakeholders through targeted internet searches based on the country,
from all continents. We used an adapted Delphi method36,37 setting, and programme name (appendix). Scaled-up
combining email and telephone contacts, as this hybrid interventions were more frequently cited by key informants
approach has been shown to outperform the traditional from HICs (38 interventions) than by their counterparts
paper-based Delphi design.37,38 We recruited participants (14 from U-MICs, four from L-MICs or LICs). The most
For the Global Observatory for from the Global Observatory for Physical Activity (GoPA), frequently reported categories of intervention were those
Physical Activity see comprised of key researchers and practitioners from of community-wide programmes (n=12) and public
http://globalphysical
activityobservatory.com
around the world. Among the country contacts of the education (n=11), whereas those of urban design policies
GoPA network with full contact information available, at and infrastructure (n=2) were the least frequent. Examples
least one person per country (its primary contact listed in of all seven categories of the best investments for physical
the network database) was invited to take part. This activity were cited by HIC informants, whereas examples
entailed completing a two-round online survey using the of urban design policies and infrastructure and of primary
For the Qualtrics platform see Qualtrics platform. health-care systems were not cited by any of our U-MIC,
http://www.qualtrics.com After testing all electronic contacts, 139 eligible L-MIC, or LIC informants.
participants (each from a dierent country) were identified. We identified a variety of factors regarded as important
Among them, 450% were from HICs (n=62), 286% were for scaling up physical activity interventions. 94 statements
from upper-middle-income countries (U-MICs; n=40), were provided and grouped by similarity into 16 unique
200% were from lower-middle-income countries (L-MICs; factors. To assess the relative importance and feasibility of
n=28), and 64% were from LICs (n=9). Of these, these factors, we invited all 74 initial respondents to
74 (36 from HICs, 17 from U-MICs, and 21 from L-MICs or complete the second round of the survey, of whom 67 did
so. They were asked to rate each factor for importance and
feasibility relative to the other factors on a 10-point scale
Importance Feasibility (from 1, relatively unimportant or infeasible, to 10,
rs=024 (p=0371)
873 756
extremely important or feasible). We also did pattern
matching, which creates a series of graphs representing
Sustainability Needs of community
clusters in the data in order of importance or feasibility, or
Political support Fit with the setting
both (according to the average rating of the statements in
Needs of community Eectiveness
Fit with the settings Content and delivery
each cluster). We used pattern matching to assess the
Reach Scalability correlation between importance and feasibility among our
Resources available Capacity building key informants (figure 2), between researchers and
Content and delivery Reach practitioners (appendix), and by country income level
Institutionalisation Multilevel collaboration (appendix). We also assessed the correlation between
Eectiveness Resources available groups using Spearmans rank correlation.
Multilevel collaboration Impact across co-benefits Overall, the scores attributed to importance were higher
Cost Institutionalisation (median 827, IQR 800835) than those attributed to
Capacity building Political support
feasibility (median 682, IQR 664712; figure 2),
Scalability Transferability
suggesting that it remains a notable challenge to put what
Systems thinking Cost
Impact across co-benefits Sustainability
is considered to be important into practice. This mismatch
Transferability Systems thinking was confirmed by the low and non-significant correlation
of the importance and feasibility scores (rs=024; p=037).
723 598
However, the needs of the community and the fit with the
Figure 2: Pattern matches for importance and feasibility of scalability factors setting showed relatively high scores for both importance
for physical activity interventions among key informants39 and feasibility, suggesting that these categories might be

Series
particularly important to consider when prioritising followed a clear linear progression from a controlled
actions for scale-up. The large number of responses citing ecacy trial,47 to researcher-led dissemination eorts,28 to
community-based interventions reinforces the importance showing eectiveness in researcher-led translation trials,26
of adapting and localising an intervention within a to achieving institutionalisation in more than half of Texas
community setting. Conversely, the most important factors schools plus several other areas of the USA.44,46 Despite its
(sustainability and political support) had relatively low success, the case of CATCH also serves to highlight how
scores for feasibility, indicating a gap that might impede long it takes for knowledge to become available to the
taking eective action. Previous research has found population at large through real-world programmesover
dierences between responses from key informants from 20 years have elapsed since the first ecacy trial of
research and practice backgrounds in rating priorities for CATCH.
action on physical activity,40,41 which our data support It seems that LMICs seldom rely on the evidence-based
(appendix). However, the pattern of mismatch did not practice approach for scaling up physical activity
change when comparing responses from key informants interventions. In addition to absence of (or only emerging)
with practice and research backgrounds, suggesting that research capacity,42 the dearth of examples of eective
our overall findings might be fairly consistent regardless of physical activity interventions appropriate to the context of
the background of the participants. Finally, in analysis these settings could help to explain why evidence-based
stratified by country income level, sustainability emerged practice is not implemented in LMICs. Interventions
as being equally important regardless of the country designed, implemented, and assessed in LMICs have only
income level, whereas content and delivery and multilevel fairly recently (ie, within the past 6 years) appeared in the
collaboration seemed to be more important in L-MICs and peer-reviewed literature.4 As for how the scale-up of
LICs than in their higher-income counterparts. However, physical activity interventions has occurred, scale-up
these factorsalong with capacity buildingwere given eorts in LMICs have primarily emerged from the real
lower feasibility scores by L-MIC and LIC informants world, with practice moving faster than research.43 In these
(appendix). settings, the low levels of knowledge or local applicability
of existing evidence, together with the urgent need for
Scale-up and eectiveness of strategies: lessons streamlined solutions to large-scale problems, seem to be
in finding balance important in moving practice agendas forward, as such
Our mixed-methods approach included a traditional factors are more highly valued than measures of
systematic literature search complemented by an adapted eectiveness. These large-scale problems are not exclusive
qualitative Delphi process to obtain comprehensive to health issues. Rather, the need to alleviate trac
information on scaled-up interventions worldwide. With congestion, air pollution, environmental injustice, social
this approach, we examined where, why, and how physical inequalities, and other societal challenges is resulting in
activity interventions are being scaled up around the world, the scaling up of interventions that might promote physical
and confirmed that the science of scalability in the realm activity as a co-benefit.43 Initial scaling up generally occurs
of physical activity interventions remains a nascent field of with little consideration of the potential eectiveness of
research. The fact that the adapted Delphi process yielded these programmes for increasing physical activity in
56 examples of scaled-up interventions, which were not populations.43 In some instances in U-MICs, researchers
found through the systematic review of the peer-reviewed are catching up to practice by producing well-designed
literature, highlights the importance of searching both evaluation studies of practice-based interventions such as
peer-reviewed and grey literature to achieve a better bus rapid transit (BRT) systems (panel 2).53,55,56,59 In L-MICs
understanding of the types of physical activity interventions and LICs, competing priorities and scarce resources, and
being scaled up around the globe. This mixed-methods in some cases research capacity, have resulted in few
approach also allowed us to identify case studies covering a rigorous assessments of scaled-up interventions,
variety of geographical and country-level income settings, exemplified by the case of Sports for Development (S4D;
and a range of strength of evidence of eectiveness. panel 3). There is insucient evidence to deem S4D as
In terms of where this evidence-based practice is taking either eective or ineective in increasing physical activity,
place, our findings suggest that it seems to be mainly a but the few available studies point out that the programmes
practice of HICs, and is also the predominant type of could be failing to reach those most in need (ie, the most
scaled-up intervention reported in the peer-reviewed inactive)33 despite their popularity and widespread adoption
literature. Apart from reflecting the obviousthat evidence in African nations and other regions worldwide.61,62,65
is more likely to be used for policy development in more Not every intervention implemented at scale is eective
highly developed nationsthese results could also reflect for increasing physical activity in populations, and not
the substantially larger research capacity available in HICs every eective, researcher-led intervention is scalable.
to undertake and publish studies documenting all steps of This highlights the need for more high quality research,
the knowledge-to-practice process.42,43 A good example of a and calls into question the role that the research
study that documents all these steps is the Coordinated community should play if we are serious about reversing
Approach To Child Health (CATCH; panel 1), which the global pandemic of inactivity. Is continuing to do

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Panel 1: Scaled-up interventions from around the globe: Coordinated Approach To Child Health (CATCH)
Overview organisational, and administrative support for CATCH,28,44 but
The Coordinated Approach To Child Health (CATCH) is a
multilevel programme, based on the US Centers for Disease
How has the scaled-up intervention been implemented?
Control and Preventions Whole School, Whole Community,

Whole Child model.44,45 The programme is designed to promote a
CATCH has become institutionalised, with strong multisectoral

involvement (including principals, teachers, physical educators,
education, nutrition and cafeterias, the classroom, families and

communities, and sun protection.
community) in schools.46 Elsewhere, discontinuous funding, or
Where did the intervention originate? the lack of institutionalisation or a local champion, have
California, Louisiana, Minnesota, and Texas, USA (high income) impeded optimal implementation.27,28
How has the intervention been scaled up? Does the scaled-up intervention reach the target
Through horizontal (replication) and vertical (institutionalisation) population?
scale-up. Over 10 000 sites worldwide have adopted CATCH, CATCH is currently used in centres run by the Young Mens
mostly in the USA.46 Christian Association in 32 USA states and more than half of
Texas schools, but access varies by region.46
subsidising initial distribution of materials for schools.28
Is the scaled-up intervention eective?
Did the intervention originate from the research world or Yes. A substantial body of evidence shows that CATCH is
from the real world?
both in controlled trials and in real-world studies.26,47
early 1990s: the Child and Adolescent Trial for Cardiovascular
Have the eects of the scaled-up intervention been
Health.47 The intervention was later renamed for translation,
maintained over time?
implementation, and scale-up in the real world,28 which has been

facilitated by the CATCH Global Foundation, a charitable
3 years,48 and investigations in some real-world settings (eg,
organisation founded in 2014.46
4951 Evidence
Which of the seven investments for physical activity does
it fit best? childhood obesity.52
Whole-of-school programmes.
To what extent is CATCH an example of successful
Is physical activity promotion the main purpose of the scaling up?
intervention, or is it a co-benefit? CATCH is one of few good examples of the successful
Physical activity is one of its main intended outcomes, along with translation, dissemination, and scaling up of an evidence-
healthy eating and preventing obesity. based (research tested) physical activity programme that is
institutionalised and given full school, health, and other
Has the scaled-up intervention been adopted by target sta,

settings, or institutions?
0 years ago, to
Education and health authorities at various levels from school
be widely translated into practice.
to state across the USA have provided legislative, economic,
randomised controlled trials in HICs necessary to show process of physical activity interventions, and in some
that positive changes in health behaviour are achievable cases of their impacts on population health, lies in
in small, selected samples under controlled conditions? government databases, reports, or websites, and not in
More evidence of eective, contextually appropriate the scientific peer-reviewed literature. This shortage of
strategies is needed in LMICs, so should research funds evidence in the peer-reviewed literature raises important
be allocated if no clear potential for rapid, cost-eective questions about the methodological rigour and internal
scale-up is shown? Should we not be learning more and external validity of such evidence. Why does the
about scaling up successful ventures, and how research community not focus more on systematic
opportunities for dissemination can be strategically documentation and investigation of already scaled up
brokered to reduce the lag in scaling up evidence-based innovations from around the world, using the best
practice? How could we improve understanding of the available methods to assess their reach and eectiveness,
policy processes involved across varying settings, and why are there still so few opportunities for funding
contexts, and political systems to facilitate streamlining and publishing natural experimental studies of
of adoption and implementation of evidence-based innovations that are being scaled up without clear
practice? Much of the evidence describing the scale-up evidence of eectiveness?

Series
Panel 2: Scaled-up interventions from around the world: bus rapid transit (BRT) systems
Overview with other transit systems (eg, feeder bus systems).56
BRT systems provide high-speed, mass public transport, using
buses running on segregated lanes and stopping at stations integration with other urban transit systems, or scarce supporting
spaced further apart than traditional bus stops.53,54 infrastructure around some stations, might have restricted the
57
Where did the intervention originate?
Curitiba, Brazil (upper-middle income). Does the scaled-up intervention reach the target population?
Studies assessing BRTs reach are scarce, and indicators vary
How has the intervention been scaled up?

Through horizontal scale-up (replication in other settings).
accessible to residents of middle-income neighbourhoods than
Over 150 cities worldwide have BRT systems,53 most in
to those in high-income or low-income neighbourhoods.58
middle-income countries.

Did the intervention originate from the research world or that were previously dicult to reach without a car.59
from the real world? Cambridge, UK, there is no evidence of a socioeconomic
BRT originated from the real world of transport planning. gradient in use of a new BRT.60 Further analysis is needed to
establish the extent to which BRT reaches those at highest risk
Which of the seven investments for physical activity does it
for inactivity.
fit best?
Transportation systems that promote walking, bicycling, or Is the scaled-up intervention eective?
public transit use. Emerging evidence suggests that BRT can promote physical
activity through transport: living closer to BRT is associated
Is physical activity promotion the main purpose of the
with higher levels of physical activity in adults in Bogot,
intervention, or is it a co-benefit?
Colombia, and Curitiba, Brazil,55,56 and with shifting from car use
55 which were
towards active transit in Cambridge, UK.60
primarily designed to improve mobility and reduce carbon
emissions in cities, more economically than by building Have the eects of the scaled-up intervention been
metrorail or light-rail systems.53,54 maintained over time?
Stable or increasing prevalence of BRT use indicate potential for


City mayors in several middle-income countries have provided
maintained over time.
strong political, economic, and structural support for BRT,
To what extent is this an example of successful scaling up?
sustainable public transport.55 Nonetheless, not all cities that
innovative urban public transport systems, it has been
successfully scaled up in some settings (eg, Bogot, Colombia).
Key factors for success have included having a committed

champion (often the mayor), providing supportive
been accompanied by new supportive infrastructure including
infrastructure as outlined above, and implementing
improved routes for pedestrians and cyclists, and full integration
complementary measures to restrict car use.55
Tying it all together: developing a framework for scaling up and on which inferences about eectiveness
scaling up physical activity interventions could be made. A framework can help ensure that
Taken together, the analytical steps described above suggest researchers focus on the most important factors in the
that successfully scaled-up physical activity interventions scaling-up process, and that policy makers and
should not just be those that are implemented at a large practitioners understand its staged natureeg, that
scale, but also those that are eective in increasing physical eectiveness is a prerequisite for sustainment.
activity levels of a population, and that become fully We used a two-step process to develop the framework.
embedded into a system. To further advance this field and We searched for existing frameworks. We then reviewed
improve eorts to develop, implement, and assess such these together with the results of the literature review and
interventions, we have developed a framework for action. Delphi survey, with the aim of either identifying one or
The scaling up of physical activity interventions can be more existing frameworks that could be adapted to create a
better understood and enhanced by the use of systematic scalability framework, or building one from scratch if
planning frameworks, logic models, and theory.66 The necessary.
main purpose of a planning framework is to map the key We identified more than 60 possible frameworks for
linkages, stages, and conditions that are likely to aect translational research,9,6769 many of which could

Series
Panel 3: Scaled-up interventions from around the globe: Sport for Development (S4D)
Overview The UNs adoption of S4D in 2001 has enhanced the credibility,
S4D is an umbrella term for a variety of programmes that and probably the scaling up, of these initiatives.61,64
promote sport participation as a vehicle for development
understood broadly to include outcomes such as gender equity,
Mainly through international partnerships between an
economic development, access to education, health

61
local NGO for delivery.65,63 So-called top-down approaches with
Where did the intervention originate? funder-led programme design and implementation are
common, but have been criticised for being paternalistic and
S4D programme is unclear.62 Several S4D programmes emerged not accounting for local nuances.63 Other programmes have
in (mostly low-income) African nations in the 1990s, facilitated used a more horizontal approach with substantial local
involvement and autonomy.63 For the most part, comparative
62 evidence from process assessment is absent.33
How has the intervention been scaled up? Does the scaled-up intervention reach the target population?
Mostly through replication (horizontal scale-up), and sometimes Rigorous analysis is scarce, and reach probably varies by setting.
also through institutionalisation (vertical scale-up).63 The UN has For example S4D in Gulu, Uganda, was found to reach mostly
contributed to recent accelerated expansion through the those who were already suciently active, owing to its
establishment of its own S4D oce in 2001.64 voluntary enrolment policy.33
Did the intervention originate from the research world or Is the scaled-up intervention eective?
from the real world?

disadvantaged settings. activity levels.33 More rigorous investigation is needed.
Which of the seven investments for physical activity does it Have the eects of the scaled-up intervention been
fit best? maintained over time?
Sports systems and programmes that promote sport for all. This is not known.
Is physical activity promotion the main purpose of the To what extent is S4D an example of successful scaling up?
intervention, or is it a co-benefit?
other than evidence-based practice. Despite weak evidence of
prioritised other outcomes as outlined above.
worldwide and therefore extremely successful in terms of being
scaled up to multiple settings, and becoming embedded in
systems. Rigorous outcome and process assessment could
Worldwide, S4D programmes have been adopted by governments
assess S4Ds impacts on physical activity and other outcomes,
and non-governmental organisations (NGOs): mostly by those in
and contribute important learning on how other interventions

might be scaled up.
countries, but sometimes fully based in higher-income countries.65
potentially apply to scaling up physical activity of organisations that will adopt a given programme or
interventions.9 A small number of published frameworks policyeg, for a school-based intervention, how many
exist for scaling up public health programmes and states within a country, municipalities within a state,
policies.6,7074 After our three-step process, the RE-AIM school districts within a municipality, and schools within
framework emerged as the one that best framed the core a school district, adopted the intervention as an ocial
elements. RE-AIM takes a staged approach to measure school programme to be implemented within their
reach, ecacy and eectiveness, adoption, imple- jurisdiction? Implementation refers to intervention
mentation, and maintenance.75 In RE-AIM, reach refers integrity, or the quality and consistency of delivery when
to the participation rate within the target population and the intervention is replicated in real-world settingsie,
the characteristics of participants versus non- is the real-world, scaled-up version of the intervention
participantsie, does the scaled-up intervention reach being delivered properly? Finally, maintenance describes
people at highest risk for inactivity? Eectiveness refers the long-term change at both individual and system or
to the impact of an intervention on specified outcomes organisational levels, which are fundamental concepts
ie, does the scaled-up intervention increase population for scaling upie, have all of the implementation
physical activity levels? Adoption applies at the system activities of the intervention been maintained fully
level and refers to the percentage and representativeness throughout the years, thus ensuring that the health

Series
Push factors Pull factors
Development Implementation
Maintenance
Is the intervention
sustained and
Implementation scaled up?
Is the intervention
delivered properly?
Adoption
Is organisational
support available?
Reach
Is the target
population being
Eectiveness reached?
What is known
about the impact
of the intervention?
Evidence-based Internal validity External validity Practice-based

practice evidence
Integrative variables: multisector collaboration, co-benefits, systems thinking
Contextual variables: political climate, economic conditions, public interest
Figure 3: Framework for scaling up physical activity interventions
benefits of the intervention continue to occur through Conclusions

time? RE-AIM has been applied across numerous risk Despite facing a global pandemic of similar proportions to
factors, diseases, and settings.76 Its usefulness in that of smoking,1,2 our response to the public health
assessing the impact of public health policies and challenge of inactivity has not been as strong as is needed.1,2
physical activity scale-up eorts has also been The successful scaling up of interventions that result in
documented.7779 In figure 3, concepts from RE-AIM are increased levels of physical activity is challenging but
supplemented by two additional frameworks: the feasible, across varying cultural, geographical, social, and
ExpandNet framework for scaling up,74 and the economic settings. We should draw on the best available
framework for disseminating evidence-based health evidence from both the traditional evidence-to-practice
promotion practices.80 pathway and the practice-to-evidence route. Using a mixed-
In addition, our framework accounts for the importance methods approach, we have comprehensively examined
and relevance of both evidence-based practice (the push, both researcher-led and practice-based insights into the
interventions developed and tested through research that factors aecting scalability around the world. Active
might be scaled up81) and practice-based evidence (the pull, policies across societyparticularly outside the health-care
real-world practitioner experience to inform intervention sectorare urgently needed, as shown by some of the
approaches12) in informing the scaling up of physical successful examples of scale-up identified in this Series
activity interventions. Therefore, this framework can be paper. Researchers, research funding agencies,
used both by people in the research world and in the real practitioners in public health, transport, leisure, recreation,
world (including public-health practitioners, stakeholders, and other sectors, policymakers, and civil society should
and policy makers) to optimise the scaling-up process in embrace the challenge of taking action to a larger and
many stages across the research-to-practice or practice-to- more sustainable level.
research spectra. For instance, it can be used by The research community should shift the balance of
stakeholders and policy makers to select a contextually its eorts from designing and testing small-scale
appropriate intervention for scaling up, which has been interventions to change individual behaviour towards
proven to work at scale in similar settings in reaching the expanding the evidence on strategies for translating,
target population and in promoting physical activity. In disseminating, implementing, and scaling up eective
such cases, the framework stresses that for successful policy and practice for physical activity promotion
scale-up, assessment of adoption, implementation, and worldwide. In LMICs, new evidence is needed on eective
maintenance is needed. Similarly, our framework can be interventions that are contextually appropriate. The science
used by researchers to study innovative strategies of scalability will be greatly advanced by research that
implemented at scale, without sucient existing evidence systematically identifies the key steps and processes
to show one or more of the stages of RE-AIM. needed for successful scale-up of interventions. Although

Series
this might require more robust and standardised measures inactivity should become an actively monitored risk factor
and indicators for tracking, assessing, and reporting all in clinical medical practice and in national and regional
stages of scale-upmany of which might be developed at surveillance systems, and health-care systems should
comparatively low cost using geographical information provide physical activity counselling and support for the
systemsit will also entail examining how political, prevention and treatment of chronic diseases. Ministries
cultural, and economic contexts influence the potential to of education should adopt whole-of-school approaches for
adopt and scale up evidence-based practices. Researchers promoting physical activity among children and
from all regions of the world should do more programme adolescents. More graduate-level programmes to train
analysis studies to strengthen the global practice-based researchers in physical activity and public health are
evidence base, which can be achieved by using rigorous urgently needed worldwide, and especially in LMICs.
research methods to establish the impact of real-world Sports authorities should prioritise sports-for-all
scaled-up interventions of which the reach and approaches and harness the potential co-benefits of sport
eectiveness remain unknown. participation. Similarly, environmental policies should be
However, the success of these proposed actions for the linked to the promotion of active living to maximise their
research community is highly dependent on existent and opportunities for adoption, implementation, and scale-
future mechanisms for research funding, particularly for up. Urban planning and transportation policies should
the rapid investigation of natural experiments. Research prioritise actions that promote safe, equitable, and
funding agencies should provide fast and flexible environmentally friendly active mobility options for all
mechanisms to allow researchers to develop practice-based citizens, including improved infrastructure for walking
evidence through natural experimental studies or studies and cycling for transport and recreation, and accessible
of programmes that have already been scaled up. The and convenient public transport. Civil society should
complexity of these research projects is likely to require demand improved policies, programmes, systems, and
transdisciplinary teams, sometimes with expertise in fields places that enable people to lead more active lives. We
such as systems science, network analysis, or policy encourage practitioners, policy makers, and researchers
analysis. For LMICs in which more evidence on eective to consider our framework and the catalogue of examples
interventions is needed, funding agencies should prioritise of scaled-up interventions from around the globe
the assessment of projects with clear potential for fast and presented here (appendix) for selecting contextually
cost-eective scale-up. Likewise, scientific journals should appropriate, evidence-based strategies for scaling up,
facilitate and prioritise the dissemination of this type of prioritising evaluation across all RE-AIM stages. Likewise,
research. we encourage them to use our framework to guide the
Although increasing the amount and strength of analysis of scaled-up interventions that are already in
research is important, public health action in the face of a place, using the findings to modify programme delivery
global pandemic responsible for over 5 million deaths as needed to optimise the health benefits.
each year should not wait for the outcomes of future Unilateral eorts will not be enough to shift populations
studies. We urge all sectors of government and society to to a more active way of life even if taken to scale. A shift in
take immediate, bold actions to help make active living a the focus of researchers will not help if funding agencies
more desired, aordable, and accessible choice for all do not facilitate this type of research, and an increase in
population groups. Getting people moving should the quality of evidence to support scaling up will achieve
become a priority of all sectorsnot just healthin all nothing if it is not translated into practice and eectively
entities and countries. In light of the scarce scientific scaled up by policy makers and practitioners in multiple
evidence of what works at scale and how to scale up most sectors. Large-scale problems require large-scale solutions,
strategies, we encourage governments and society to and we need the committed and joint eorts of all sectors
adopt and adapt strategies already used to address other of government and society to tackle the global public
public health issues such as smoking and sugar- health challenge of inactivity.
sweetened beverage consumption.82,83 International Contributors
organisations such as the UN, WHO, and the World Bank All authors contributed equally to the paper.
should provide strong leadership for accelerating the Declaration of interests
scale-up of evidence-based physical activity interventions RSR is supported by The Brazilian National Council for Scientific and
worldwide by setting targets and indicators for tracking Technological DevelopmentCNPA (grant number 308979/2014-1). DS is
supported by the Michael and Susan Dell Foundation through a
countries progress. Governments should integrate active postdoctoral research fellowship at the Michael and Susan Dell Center for
living into policies across sectors. National policies and Healthy Living, which is part of the School of Public Health (Austin
action plans are particularly important to overcome Regional Campus) of the University of Texas Health Science Center at
scalability challenges in countries in which Houston, and by the National Institute of Diabetes and Digestive and
Kidney Diseases (grant number 3R01DK101593-03S1). DO is supported by
decentralisation of power has led to devolved authority. the Medical Research Council (Unit Programme number
Ministries of health should have a multilevel and MC_UU_12015/6). SG is supported by the Bernard Lown Scholars in
multisectoral physical activity plan, with specific strategies Cardiovascular Health Program, Harvard School of Public Health
to scale up physical activity interventions. Physical (201517). RCB is supported by the National Cancer Institute at the

Series
National Institutes of Health (grant numbers 1R01CA124404-01 and 17 World Bank Group. World development indicators 2012. Washington
P30 CA09184), the National Institute of Diabetes and Digestive and Kidney DC: World Bank Publications, 2012. data.worldbank.org/sites/default/
Diseases (grant number 1P30DK092950), and Washington University files/wdi-2012-ebook.pdf (accessed Dec 20, 2015).
Institute of Clinical and Translational Sciences (grant numbers UL1 18 Anderson YC, Taylor GM, Grant CC, Fulton RB, Hofman PL.
TR000448 and KL2 TR000450) from the National Center for Advancing The Green Prescription Active Families programme in Taranaki,
Translational Sciences. We declare no other competing interests. New Zealand 20072009: did it reach children in need?
J Prim Health Care 2015; 7: 19297.
Lancet Physical Activity Series 2 Executive Committee 19 Arbour-Nicitopoulos KP, Tomasone JR, Latimer-Cheung AE,
Adrian E Bauman, Ding Ding, Ulf Ekelund, Pedro C Hallal, Martin Ginis KA. Get in motion: an evaluation of the reach and
Gregory W Heath, Harold W Kohl 3rd, I-Min Lee, Kenneth E Powell, eectiveness of a physical activity telephone counseling service for
Michael Pratt, Rodrigo S Reis, James F Sallis. Canadians living with spinal cord injury. PM R 2014; 6: 108896.
20 Brady TJ, Sniezek J, Ramsey LA. News from the CDC: scaling up
Acknowledgments sustainable intervention deliverylessons learned from the CDC
We thank Jessica Mason, Anna Porter, and Sarah Bentley for their arthritis program. Transl Behav Med 2012; 2: 35.
assistance in data abstraction for the literature review, under the 21 Buis LR, Hirzel L, Turske SA, Des Jardins TR, Yarandi H,
supervision of DS; Adalberto Lopes and Claudia Alberico for the assistance Bondurant P. Use of a text message program to raise type 2
with the online survey, under the supervision of RSR; and Andrea Ramirez diabetes risk awareness and promote health behavior change
for the assistance with the compilation of the Global Physical Observatory (part I): assessment of participant reach and adoption.
contacts. J Med Internet Res 2013; 15: e281.
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Supplementary appendix
This appendix formed part of the original submission and has been peer reviewed.
We post it as supplied by the authors.
Supplement to: Reis RS, Salvo D, Ogilvie D, et al. Scaling up physical activity
interventions worldwide: stepping up to larger and smarter approaches to get people
moving. Lancet 2016; published online July 27. http://dx.doi.org/10.1016/http://dx.doi.
org/10.1016/S0140-6736(16)30728-0.
Online Appendix
This is an online appendix with supplemental material for the article Scaling up physical activity interventions worldwide:
stepping up to larger and smarter approaches to get people moving by Rodrigo S. Reis, Deborah Salvo, David Ogilvie, Estelle V
Lambert, Shifalika Goenka, Ross C Brownson, for the Lancet Physical Activity Series 2 Working Group.
Index
Appendix Section Pages
A. Systematic review of the peer-reviewed literature to identify manuscripts on scaling-up physical activity 2-3
interventions: process and search terms
B. Instruments used in the adapted Delphi survey 4
C. Web Figure 1: Pattern matches for importance and feasibility of scalability factors for physical activity 5
interventions among key informants according to practice and research positions
D. Web Figure 2: Pattern matches for importance of scalability factors for physical activity interventions 6
among key informants according to country income level
E. Web Figure 2: Pattern matches for feasibility of scalability factors for physical activity interventions 7
among key informants according to country income level
F. Web Table 1: Characteristics of the interventions from the identified peer-reviewed studies on physical 8
activity scalability (part 1 of 3)
G. Web Table 2: Characteristics of the interventions from the identified peer-reviewed studies on physical 9
H. Web Table 3: Characteristics of the interventions from the identified peer-reviewed studies on physical 10
I. Web Table 4: Characteristics of physical activity interventions identified by key informants or in-country 11-24
physical activity contacts through the adapted Delphi process (part 1 of 2)
J. Web Table 5: Evaluation of physical activity interventions identified by key informants or in-country 25-51
physical activity contacts through the adapted Delphi process (part 2 of 2)
1
A. Systematic review of the peer-reviewed literature to identify manuscripts on scaling-up physical activity interventions:
process and search terms
Aim of the systematic review

Keeping in mind our definition for successful scaling-up of physical activity interventions (i.e., those implemented at scale, and
that have been embedded into a system), we conducted a systematic review of the peer-reviewed literature to summarize the
scientific evidence available on scaling-up physical activity interventions in the English-language literature.
Definition of Interventions
For the search, we defined an intervention as a set of actions with a coherent objective to bring about change or produce
identifiable outcomes.1,2 Therefore, the review did not only include traditional researcher-driven interventions proven to be
efficacious in increasing physical activity in a controlled research setting (evidence-based practice),3,4 but also programs,
strategies, policies or initiatives that originated outside of the scientific realm, but have been evaluated by researchers showing
their effectiveness for increasing physical activity levels (practice-based evidence).5,6
Databases used
The search was conducted using PubMed and Scopus databases, and did not include publication date restrictions given the
anticipated dearth of published peer-reviewed literature including sufficient details outlining the processes involved in the scale-
up of physical activity interventions.
Search terms
Scalability: Scalability search terms were based on those used by Milat et al. 2 for a similar search to define the scalability of
interventions for the broad context of public health. In addition to the terms used by Milat et al,2 our search included key terms to
identify vertically e.g., (institutionalization) and horizontally (e.g., dissemination, roll-out) scaled-up interventions. The decision
on which search terms to include was centred around the objective of identifying truly scaled-up interventions, defined for this
study as those which had outgrown research-dependency and had become embedded into a system. Therefore, we purposefully
excluded search terms dealing with researcher driven and funded translation studies. The decision on which search terms to
include was made after several rounds of discussion by all study co-authors, and with further input from the Lancet Physical
Activity 2nd Series Working Group. The final scalability search terms used were as follows: scaled-up OR scale-up OR scaling-up
OR scalability OR scalable OR reach OR expanding OR expandable OR expandability OR institutionalization OR
institutionalisation OR roll-out OR rolling-out OR dissemination OR disseminating.
Physical activity: Physical activity terms included both those referring to physical movement, as well as those encompassing the
concept of sedentary behaviours. The physical activity search terms used were as follows: physical activity OR physically active
OR physical inactivity OR physically inactive OR fitness OR exercis* OR sport* OR walk OR walking OR sedentary OR sitting
OR television OR TV OR screen time OR screen-time OR active transport* OR active transit OR active travel OR commut* OR
active commuting OR bicycle OR bicycling OR bike OR biking OR active living OR active-living. The search was conducted in
December, 2015.
Search criteria
Because our definition for interventions involved a broad set of potential search terms (intervention, program, strategy, policy,
initiative, etc.), only scalability and physical activity terms were forced in the search, and publications reporting on a scaled-
up intervention were further abstracted. Publications with a scalability search term in the title and a physical activity term in
the title or abstract were reviewed. First, publications were classified as a) including physical activity as the main outcome of the
intervention, b) including physical activity as a secondary outcome or co-benefit of the intervention, or c) not being focused at all
on physical activity. Second, publications were classified as meeting the search criteria for scalability, meaning that the
manuscript a) described a truly scaled-up intervention which is not fully dependent of research funds and has been embedded into
a system, and b) included sufficient detail describing the steps and processes through which scale-up was achieved.
This initial phase of the review and manuscript classification was performed by Deborah Salvo, and reviewed by Rodrigo Reis.
No discrepancies were found among both authors.
Abstraction
The data from the search was abstracted using an adapted version of the External Validity Assessment Tool (EVAT) 7 developed
by project GUIA (Guide for Useful Interventions for Physical Activity in Brazil and Latin America). 8 Data was abstracted from
manuscripts that were classified in the previous step as both focusing on physical activity as a central or secondary outcome, and
that met the established search criteria for scalability.
First, manuscripts were classified by theme using the seven investments that work for physical activity outlined by the Toronto
Charter for Physical Activity.9,10 The seven investments are: 1) Whole-of-school programs; 2) Transport policies and systems
that prioritize walking, cycling and public transport; 3) Urban design regulations and infrastructure that provides for equitable and
safe access for recreational physical activity, and recreation and transport-related walking and cycling across the life course; 4)
Physical activity and NCD prevention integrated into primary health care systems; 5) Public education, including mass media to
raise awareness and change social norms on physical activity; 6) Community-wide programs involving multiple settings and
2
sectors and that mobilize and integrate community engagement and resources; and 7) Sports systems and programs that promote
sports for all and encourage participation across the life span. Next, publications were classified based on the definition of
scalability, using the World Health Organizations (WHO) ExpandNet11 categories for scalability as a starting point
(spontaneous diffusion, expansion or replication --horizontal scale-up--, policy/legal/institutional scale-up vertical scale-up--,
diversification functional scale-up--). Finally, information, if any, on process evaluation activities to assess or document the
scale-up process, key actors and partnerships for scale-up, and cost-effectiveness considerations, was abstracted. Additional
abstracted information included the geographic setting of the scaled-up intervention (country, World region, and World Bank
income category12), the target population, and whether the scaled-up intervention was an example of evidence-based practice or
of practice-based evidence.
Data abstraction was led by Deborah Salvo, and assisted by three graduate student research assistants of the School of Public
Health (Austin Regional Campus) of The University of Texas Health Science Center at Houston: Jessica Mason, Anna Porter and
Sarah Bentley. Deborah Salvo trained the three research assistants for standardisation in data abstraction. Each article was
abstracted by one research assistant and by Deborah Salvo (weighted kappa >0.80 with all research assistants for categorical
abstraction fields). Discrepancies were resolved by a re-review by Deborah Salvo, followed by a final review of the abstraction
table by Rodrigo Reis.
References (Section A)
1. Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. Journal of
epidemiology and community health 2002; 56(2): 119-27.
2. Milat AJ, Bauman A, Redman S. Narrative review of models and success factors for scaling up public health
interventions. Implementation science : IS 2015; 10: 113.
3. Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. American journal of
public health 2009; 99(9): 1576-83.
4. Brownson RC, Fielding JE, Maylahn CM. Evidence-based public health: a fundamental concept for public health
practice. Annual review of public health 2009; 30: 175-201.
5. Green LW. Public health asks of systems science: to advance our evidence-based practice, can you help us get more
practice-based evidence? American journal of public health 2006; 96(3): 406-9.
6. Green LW. Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? Family
practice 2008; 25 Suppl 1: i20-4.
7. Hoehner CM, Ribeiro IC, Parra DC, et al. Physical activity interventions in Latin America: expanding and classifying the
evidence. American journal of preventive medicine 2013; 44(3): e31-40.
8. Pratt M, Brownson RC, Ramos LR, et al. Project GUIA: A model for understanding and promoting physical activity in
Brazil and Latin America. Journal of physical activity & health 2010; 7 Suppl 2: S131-4.
9. Global Advocacy for Physical Activity the Advocacy Council of the International Society for Physical A, Health. NCD
prevention: investments [corrected] that work for physical activity. British journal of sports medicine 2012; 46(10): 709-12.
10. Trost SG, Blair SN, Khan KM. Physical inactivity remains the greatest public health problem of the 21st century:
evidence, improved methods and solutions using the '7 investments that work' as a framework. British journal of sports medicine
2014; 48(3): 169-70.
11. World Health Organization. Practical guidance for scaling up health service innovations. Geneva, Switzerland, 2009.
12. World Bank Group. World development indicators 2012. Washington D.C.: World Bank Publications; 2012.
3
B. Instruments used in the adapted Delphi survey
Survey 1
Survey was conducted over three weeks and included an online questionnaire with 10 questions, all in English language. The
average time for completing the questionnaire was 17.3 minutes. Participants of Survey 1 were predominantly Men (52.7%), less
the 50 years old (55.5%), holding a PhD level degree (76.0%), and from high-income countries (52,0%).
Survey 1 Questionnaire
a) By intervention we are not only referring to a classic scientific trial, but to anything fitting the following definition: a set of
actions with a coherent objective to bring about change or produce identifiable outcomes. As such, an intervention can be the
result of evidence-based practice, but could also be a set of actions promoting physical activity originating from outside the
scientific realm.
b) Scaling-up does not simply refer to the first attempt of translation of an efficacious intervention into a real-world program,
which may or may not be effective. Rather, scaling-up refers to the actions necessary to extend the reach and ensure the
sustainability of an already translated intervention (i.e., a program in the real world) so that it benefits more people. This could be
achieved by replicating the same intervention elsewhere, or by growing and/or further institutionalizing the existing one.
1. In what country do you work primarily (please consider where you are predominantly developing your work)
2. Which one of the following best describes your main activity within your current position?
Research Public Health Practice Administration Policy Other
3. How long have you worked in this position?
4. How long have you have you conducted this line of work?
5. 6. Are you male or female?
6. 7. What is your age?
7. What is your highest academic degree?
Bachelors degree (4-year college) Masters degree Doctoral degree
8. What are the top three factors that should be considered when deciding to scale-up a physical activity intervention?
9. Could you cite up to three examples in your region, and any available references
10. Could you cite examples of success and failures of physical activity interventions that have been scaled-up anywhere in
the world?
Survey 2
Survey was initiated two weeks after Survey 1 and was conducted during three weeks. The online questionnaire included nine
questions; all in English language, with an average time for completing of 22.5 minutes. Participants of Survey 2 were
predominantly Men (52.3%), less the 50 years old (60.0%), holding a PhD level degree (78.5.0%), and from high-income
countries (53.8%).
Survey 2 Questionnaire
Please, when answering the survey, keep in mind that:
a) By intervention we are not only referring to a classic scientific trial, but to anything fitting the following definition: a set of
actions with a coherent objective to bring about change or produce identifiable outcomes. As such, an intervention can be the
result of evidence-based practice, but could also be a set of actions promoting physical activity originating from outside the
scientific realm.
b) Scaling-up does not simply refer to the first attempt of translation of an efficacious intervention into a real-world program,
which may or may not be effective. Rather, scaling-up refers to the actions necessary to extend the reach and ensure the
sustainability of an already translated intervention (i.e., a program in the real world) so that it benefits more people. This could be
achieved by replicating the same intervention elsewhere, or by growing and/or further institutionalizing the existing one.
1. In what country do you work (please consider where you are predominantly developing your work)
2. Which of the following best describe the main activity in your current position? (select all that apply)
Researcher Director Politician Practitioner Policy maker
3. How long have you worked in this position?
4. How long have you conducted this line of work?
5. Are you male or female?
6. What is your age?
7. What is your highest academic degree?
8 Please, rate each factor according to its IMPORTANCE relative to other factors, when deciding to scale-up a physical activity
'intervention' (16 factors identified in Survey 1 are listed)
9. Please, rate each factor according to its FEASIBILITY relative to other factors, when deciding to scale-up a physical activity
intervention (16 factors identified in Survey 1 are listed)
4
C.
5
D.
6
E.
7
F. Web Table 1: Characteristics of the interventions from the identified peer-reviewed studies on physical activity scalability (part 1 of 3)
Physical True Paper Country Income
Citation Country
Activitya Scalabilityb Typec Categoryd
Anderson YC, Taylor GM, Grant CC, Fulton RB, Hofman PL. The Green Prescription Active Families programme in Taranaki, 1
New Zealand 2007-2009: Did it reach children in need? Journal of primary health care. 2015; 7(3): 192-7. 1 1 New Zealand HIC
Arbour-Nicitopoulos KP, Tomasone JR, Latimer-Cheung AE, Martin Ginis KA. Get in motion: an evaluation of the reach and 1
effectiveness of a physical activity telephone counseling service for Canadians living with spinal cord injury. PM & R: the 1 2 Canada HIC
journal of injury, function, and rehabilitation. 2014; 6(12): 1088-96.
Brady TJ, Sniezek J, Ramsey LA. News from the CDC: Scaling up sustainable intervention delivery-lessons learned from the 2
CDC arthritis program. Transl Behav Med. 2012; 2(1): 3-5. 1 1 United States HIC
Buis LR, Hirzel L, Turske SA, Des Jardins TR, Yarandi H, Bondurant P. Use of a text message program to raise type 2 diabetes 1
risk awareness and promote health behavior change (part I): assessment of participant reach and adoption. Journal of medical 1 1 USA HIC
Internet research. 2013; 15(12): e281.
de Silva-Sanigorski AM, Bolton K, Haby M, Kremer P, Gibbs L, Waters E, et al. Scaling up community-based obesity 1
prevention in Australia: background and evaluation design of the Health Promoting Communities: Being Active Eating Well 1 1 Australia HIC
initiative. BMC public health. 2010; 10: 65.
Farrell L, Lloyd B, Matthews R, Bravo A, Wiggers J, Rissel C. Applying a performance monitoring framework to increase reach 1
and adoption of children's healthy eating and physical activity programs. Public health research & practice. 2014; 25(1). 2 2 Australia HIC
Gyurcsik NC, Brittain DR. Partial examination of the public health impact of the People with Arthritis Can Exercise (PACE) 1
1 1 United States HIC
program: reach, adoption, and maintenance. Public health nursing. 2006; 23(6): 516-22.
Hardy LL, Mihrshahi S, Gale J, Nguyen B, Baur LA, O'Hara BJ. Translational research: are community-based child obesity 1
treatment programs scalable? BMC public health. 2015; 15: 652. 1 1 Australia HIC
Heath EM, Coleman KJ. Evaluation of the institutionalization of the coordinated approach to child health (CATCH) in a 1
U.S./Mexico border community. Health education & behavior: the official publication of the Society for Public Health 1 1 United States HIC
Education. 2002; 29(4): 444-60.
Hoelscher DM, Feldman HA, Johnson CC, Lytle LA, Osganian SK, Parcel GS, et al. School-based health education programs 1
1 2 United States HIC
can be maintained over time: results from the CATCH Institutionalization study. Prev Med. 2004; 38(5): 594-606.
Hoelscher DM, Kelder SH, Murray N, Cribb PW, Conroy J, Parcel GS. Dissemination and adoption of the Child and Adolescent 1
Trial for Cardiovascular Health (CATCH): a case study in Texas. Journal of public health management and practice: JPHMP. 1 1 USA HIC
2001; 7(2): 90-100.
Janus ED, Best JD, Davis-Lameloise N, Philpot B, Hernan A, Bennett CM, et al. Scaling-up from an implementation trial to 1
state-wide coverage: results from the preliminary Melbourne Diabetes Prevention Study. Trials. 2012; 13: 152. 2 2 Australia HIC
McKay HA, Macdonald HM, Nettlefold L, Masse LC, Day M, Naylor PJ. Action Schools! BC implementation: from efficacy to 1
1 1 Canada HIC
effectiveness to scale-up. British journal of sports medicine. 2015; 49(4): 210-8.
Parra DC, Hoehner CM, Hallal PC, Reis RS, Simoes EJ, Malta DC, et al. Scaling up of physical activity interventions in Brazil: 3
how partnerships and research evidence contributed to policy action. Global health promotion. 2013; 20(4): 5-12. 1 1 Brazil UMIC
Phelan EA, Williams B, Leveille S, Snyder S, Wagner EH, LoGerfo JP. Outcomes of a Community-Based Dissemination of the 1
1 1 USA HIC
Health Enhancement Program. Journal of the American Geriatrics Society. 2002; 50(9): 1519-24.
Richards J, Foster C. Sport-for-development interventions: whom do they reach and what is their potential for impact on physical 1
1 2 Uganda LMIC&LIC
and mental health in low-income countries? J Phys Act Health. 2013; 10(7): 929-31.
Seguin RA, Economos CD, Nelson ME, Hyatt R, Palombo R, Reed PNT. Design and National Dissemination of the 1
StrongWomen Community Strength Training Program. Preventing chronic disease. 2008; 5(1): A25. 1 1 USA HIC
van Dongen JM, van Poppel MN, Milder IE, van Oers HA, Brug J. Exploring the reach and program use of Hello World, an 1
2 2 The Netherlands HIC
email-based health promotion program for pregnant women in the Netherlands. BMC research notes. 2012; 5: 514.
a b
Physical Activity Outcome (1=Main Outcome; 2=Co-benefit); True Scalability [(Is the manuscript focused on true scalability? (i.e., describes, discusses, etc. the scaling-up of a program,
intervention, initiative, etc.); (1=Yes, and it describes in detail the scaling-up process; 2=Does not focus on describing the scaling-up process, but reports on an already scaled-up intervention)];
c
Paper_Type (1=Original Research; 2=Brief Report; 3=Commentary); dCountry Income Level, per World Bank classification (LIC&LMIC=Low-income and Lower Middle-income countries,
UMIC=Upper Middle-income country or countries, HIC=High-income country or countries).
8
G. Web Table 2: Characteristics of the interventions from the identified peer-reviewed studies on physical activity scalability (part 2 of 3)
Other Target
Citation Intervention Name 7 Investmentsa Settingb
Settingc Populationd
Anderson YC, Taylor GM, Grant CC, Fulton RB, Hofman PL. The Green Prescription Active Families programme in Taranaki, The Green Prescription Active Families
New Zealand 2007-2009: Did it reach children in need? Journal of primary health care. 2015; 7(3): 192-7. Programme 4 6 - 3
Arbour-Nicitopoulos KP, Tomasone JR, Latimer-Cheung AE, Martin Ginis KA. Get in motion: an evaluation of the reach and Get in Motion
Telephone
effectiveness of a physical activity telephone counseling service for Canadians living with spinal cord injury. PM & R: the - 12 4
counsel
Brady TJ, Sniezek J, Ramsey LA. News from the CDC: Scaling up sustainable intervention delivery-lessons learned from the Arthritis Program strategic approach
6 5 - NS
CDC arthritis program. Transl Behav Med. 2012; 2(1): 3-5.
Buis LR, Hirzel L, Turske SA, Des Jardins TR, Yarandi H, Bondurant P. Use of a text message program to raise type 2 diabetes Txt4Health
Text
risk awareness and promote health behavior change (part I): assessment of participant reach and adoption. Journal of medical - 12 1
messaging
de Silva-Sanigorski AM, Bolton K, Haby M, Kremer P, Gibbs L, Waters E, et al. Scaling up community-based obesity 'Go for your life' Health Promoting
prevention in Australia: background and evaluation design of the Health Promoting Communities: Being Active Eating Well Communities: Being Active Eating 6 5 - 1
initiative. BMC public health. 2010; 10: 65. Well (HPC:BAEW)
Farrell L, Lloyd B, Matthews R, Bravo A, Wiggers J, Rissel C. Applying a performance monitoring framework to increase reach Childrens Healthy Eating and Physical
1 2,3 - 2,3
and adoption of children's healthy eating and physical activity programs. Public health research & practice. 2014; 25(1). Activity Program
Gyurcsik NC, Brittain DR. Partial examination of the public health impact of the People with Arthritis Can Exercise (PACE) People with Arthritis
6 5,6,7,9,10 - 4
program: reach, adoption, and maintenance. Public health nursing. 2006; 23(6): 516-22. Can Exercise (PACEs) Program
Hardy LL, Mihrshahi S, Gale J, Nguyen B, Baur LA, O'Hara BJ. Translational research: are community-based child obesity Go4Fun (Australia) is a replication of the
treatment programs scalable? BMC public health. 2015; 15: 652. MEND program (UK) 4 6 - 3
Heath EM, Coleman KJ. Evaluation of the institutionalization of the coordinated approach to child health (CATCH) in a El Paso CATCH = Coordinated Approach
U.S./Mexico border community. Health education & behavior: the official publication of the Society for Public Health to Child Health 1 3 - 3
Education. 2002; 29(4): 444-60.
Hoelscher DM, Feldman HA, Johnson CC, Lytle LA, Osganian SK, Parcel GS, et al. School-based health education programs CATCH: Child Approach to Cardiovascular
can be maintained over time: results from the CATCH Institutionalization study. Prev Med. 2004; 38(5): 594-606. Health = Coordinated Approach to Child 1 3 - 3
Health
Hoelscher DM, Kelder SH, Murray N, Cribb PW, Conroy J, Parcel GS. Dissemination and adoption of the Child and Adolescent CATCH renamed as "A Coordinated
Trial for Cardiovascular Health (CATCH): a case study in Texas. Journal of public health management and practice: JPHMP. Approach to Child Health (CATCH)" to 1 3 - 3
2001; 7(2): 90-100. reflect focus on dissemination and scale-up
Janus ED, Best JD, Davis-Lameloise N, Philpot B, Hernan A, Bennett CM, et al. Scaling-up from an implementation trial to Greater Green Triangle Diabetes Prevention
state-wide coverage: results from the preliminary Melbourne Diabetes Prevention Study. Trials. 2012; 13: 152. Program (GGT DPP), scaled-up to the 4 6 - 4
Victorian state-wide Life! programme
McKay HA, Macdonald HM, Nettlefold L, Masse LC, Day M, Naylor PJ. Action Schools! BC implementation: from efficacy to Action Schools! BC
1 3 - 3
Parra DC, Hoehner CM, Hallal PC, Reis RS, Simoes EJ, Malta DC, et al. Scaling up of physical activity interventions in Brazil: Academia da Cidade
6 5 - NS
how partnerships and research evidence contributed to policy action. Global health promotion. 2013; 20(4): 5-12.
Phelan EA, Williams B, Leveille S, Snyder S, Wagner EH, LoGerfo JP. Outcomes of a Community-Based Dissemination of the The Health Enhancement Program (HEP)
Health Enhancement Program. Journal of the American Geriatrics Society. 2002; 50(9): 1519-24. 6 9 - 5
Richards J, Foster C. Sport-for-development interventions: whom do they reach and what is their potential for impact on Sport-for-development: Gum Marom Kids
7 5 - 3
physical and mental health in low-income countries? J Phys Act Health. 2013; 10(7): 929-31. League
Seguin RA, Economos CD, Nelson ME, Hyatt R, Palombo R, Reed PNT. Design and National Dissemination of the Strong Women Program 5,6,8,9,10,
StrongWomen Community Strength Training Program. Preventing chronic disease. 2008; 5(1): A25. 6 - 4,5
11
van Dongen JM, van Poppel MN, Milder IE, van Oers HA, Brug J. Exploring the reach and program use of Hello World, an Hello World
5 12 Online 4
c
7 Investments (1='Whole of School' programs; if school-based but not 'whole of school', it doesn't fit this category, 2=Transport policies and systems prioritizing walking, cycling and public
transport, 3=Urban design regulations and infrastructure that provides for equitable and safe access for recreational PA, and recreation and transport walking and cycling across the life-span,
4=Physical activity and non-communicable disease prevention integrated to primary health care systems, 5=Public education, including mass media to raise awareness and change social norms on
physical activity, 6=Community-wide programs involving multiple settings and sectors and that mobilize and integrate community engagement and resources, 7=Sports systems and programs that
promote 'sports for all' and encourage participation across the life-span); b Intervention setting (1=Home, 2=Preschool, 3=School, 4=College/University, 5=Community, 6=Health-care settings,
7=Church, 8=Park or public recreation space, 9=Public recreation center, 10=Private fitness/recreation centers, 11=Workplace, 12=Other); d Target population (NS=Not specified, 1=All ages,
2=Preschool children, 3=Children or Adolescents, 4=Adults, 5=Older Adults).
9
H. Web Table 3: Characteristics of the interventions from the identified peer-reviewed studies on physical activity scalability (part 3 of 3)
WHO Scalability
Citation Practice or Evidence Baseda Scalec
Categoryb
Anderson YC, Taylor GM, Grant CC, Fulton RB, Hofman PL. The Green Prescription Active Families programme in Taranaki,
1 2,3 National
New Zealand 2007-2009: Did it reach children in need? Journal of primary health care. 2015; 7(3): 192-7.
Arbour-Nicitopoulos KP, Tomasone JR, Latimer-Cheung AE, Martin Ginis KA. Get in motion: an evaluation of the reach and
effectiveness of a physical activity telephone counseling service for Canadians living with spinal cord injury. PM & R: the 1 2,3 National
Brady TJ, Sniezek J, Ramsey LA. News from the CDC: Scaling up sustainable intervention delivery-lessons learned from the
1 2 National
CDC arthritis program. Transl Behav Med. 2012; 2(1): 3-5.
Buis LR, Hirzel L, Turske SA, Des Jardins TR, Yarandi H, Bondurant P. Use of a text message program to raise type 2 diabetes
risk awareness and promote health behavior change (part I): assessment of participant reach and adoption. Journal of medical 1 2,3,4 Community
de Silva-Sanigorski AM, Bolton K, Haby M, Kremer P, Gibbs L, Waters E, et al. Scaling up community-based obesity
prevention in Australia: background and evaluation design of the Health Promoting Communities: Being Active Eating Well 1 3 City
initiative. BMC public health. 2010; 10: 65.
Farrell L, Lloyd B, Matthews R, Bravo A, Wiggers J, Rissel C. Applying a performance monitoring framework to increase reach
2 3 State
and adoption of children's healthy eating and physical activity programs. Public health research & practice. 2014; 25(1).
Gyurcsik NC, Brittain DR. Partial examination of the public health impact of the People with Arthritis Can Exercise (PACE)
1 2 State
program: reach, adoption, and maintenance. Public health nursing. 2006; 23(6): 516-22.
Hardy LL, Mihrshahi S, Gale J, Nguyen B, Baur LA, O'Hara BJ. Translational research: are community-based child obesity
treatment programs scalable? BMC public health. 2015; 15: 652. 1 2 State
Heath EM, Coleman KJ. Evaluation of the institutionalization of the coordinated approach to child health (CATCH) in a
U.S./Mexico border community. Health education & behavior: the official publication of the Society for Public Health 1 2,3 Region
Education. 2002; 29(4): 444-60.
Hoelscher DM, Feldman HA, Johnson CC, Lytle LA, Osganian SK, Parcel GS, et al. School-based health education programs
1 2,3 National
can be maintained over time: results from the CATCH Institutionalization study. Prev Med. 2004; 38(5): 594-606.
Hoelscher DM, Kelder SH, Murray N, Cribb PW, Conroy J, Parcel GS. Dissemination and adoption of the Child and Adolescent
Trial for Cardiovascular Health (CATCH): a case study in Texas. Journal of public health management and practice: JPHMP. 1 2,3 State
2001; 7(2): 90-100.
Janus ED, Best JD, Davis-Lameloise N, Philpot B, Hernan A, Bennett CM, et al. Scaling-up from an implementation trial to
1 3 State
state-wide coverage: results from the preliminary Melbourne Diabetes Prevention Study. Trials. 2012; 13: 152.
McKay HA, Macdonald HM, Nettlefold L, Masse LC, Day M, Naylor PJ. Action Schools! BC implementation: from efficacy to
1 2 State
Parra DC, Hoehner CM, Hallal PC, Reis RS, Simoes EJ, Malta DC, et al. Scaling up of physical activity interventions in Brazil:
2 3 National
how partnerships and research evidence contributed to policy action. Global health promotion. 2013; 20(4): 5-12.
Phelan EA, Williams B, Leveille S, Snyder S, Wagner EH, LoGerfo JP. Outcomes of a Community-Based Dissemination of the
1 3 Region
Health Enhancement Program. Journal of the American Geriatrics Society. 2002; 50(9): 1519-24.
Richards J, Foster C. Sport-for-development interventions: whom do they reach and what is their potential for impact on physical
2 1 City
and mental health in low-income countries? J Phys Act Health. 2013; 10(7): 929-31.
Seguin RA, Economos CD, Nelson ME, Hyatt R, Palombo R, Reed PNT. Design and National Dissemination of the
StrongWomen Community Strength Training Program. Preventing chronic disease. 2008; 5(1): A25. 1 2 National
van Dongen JM, van Poppel MN, Milder IE, van Oers HA, Brug J. Exploring the reach and program use of Hello World, an
1 2 National
a
Practice or Evidence Based [(Is the intervention, program or policy evidence-based evidence (designed by scientists and proved efficacious before scale-up), or is it practice-based evidence
(real-life program, not initiated by scientists, but evaluated for effectiveness)?; 1=Evidence-based practice, 2=Practice-based evidence]; b WHO Scalability Category based on the WHO
Expand Net Practical Guide for Scale [1= Spontaneous Diffusion, 2=Expansion or Replication (horizontal scale-up), 3=Policy/institutional/legal scale-up (vertical scale-up), 4=Diversification
(functional scale-up)]; c Scale indicates the scale to which the program was implemented (e.g., National, Region, State, City, Community).
10
I. Web Table 4: Characteristics of physical activity interventions identified by key informants or in-country physical activity contacts through the adapted Delphi process (part 1 of 2)
Country True Physical Seven
Country Intervention Name Intervention summary
Incomea Scalabilityb Activityc Investmentsd
Aruba HIC Exercise is Medicine Courses In October 2014, the Aruba Prime Minister and Minister of Public Health, Care of the Elderly and Sports met with the Global 3 1 N/A
Exercise is Medicine leadership in Washington DC. The EIM activities for Aruba were reviewed, and a robust series of next
steps were identified. Aruba, through these officials, has made "commitment to increase walking and walkability throughout the
entire island". To date, there is no available evidence of the success of this initiative.
http://www.multibriefs.com/briefs/acsm/100714.html
Australia HIC 10,000 Steps Rockhampton The 10000 Steps Rockhampton program was funded by Health Promotion Queensland as an innovative community-based, 1 1 5, 6
multi-strategy health promotion program focusing on increasing health-related physical activity at a population level.
The project was implemented by Central Queensland University (CQU), the University of Queensland (UQ) and Queensland
University of Technology (QUT) in collaboration with members of the Rockhampton community, with implementation directed
by a Local Physical Activity Task Force (LPATF).
The LPATF was formed to balance the top-down approach from the researchers with bottom-up input from the
community, and to assist with translating the evidence from previously successful intervention strategies into approaches that
would be relevant in the Rockhampton context.
Five strategies were developed to increase population prevalence of physical activity, including:
Local Media Campaigns
Promotion of physical activity through general practice and other health services
Improving Social Support among Disadvantaged Groups
Policy and Environmental Change (signage, worksite engagement, walking paths, etc.)
Community Micro-Grant Scheme
The project incorporated social marketing tools, and was well branded under 10,000 Steps as a means to unify this multiple
strategy approach. In addition, the use of the pedometer as a tool, and making it accessible by loan through the convention of
public libraries was also an innovation of the program.
Belgium HIC "Play Streets" Play Streets is an initiative that has been going since 1998, to create street that is reserved for children's safe play for a 1 1 N/A
specific period during school vacations. The street is allocated by the city council, and vehicular traffic is limited or prohibited.
These streets also encourage social interaction. Neighborhoods have to request a Play Street event, at least one-third of the
residents must agree, and there must be at least 3 volunteers from the neighborhood, who will inform, close-off the street and
monitor the event. A "Plat Street" runs between 14h00 and19h00 and boxes of play equipment are available at no cost, for
hiring on the day by volunteers.
11
Belgium HIC 10,000 Steps Ghent The 10,000 Steps Ghent was modeled on the 10,000 Steps Rockhampton model, as a 'multi-strategy community-based 1 1 2, 3, 5, 6
(Dissemination Flanders) intervention' involving a local media campaign, signage and walking routes, and the sale or loan of pedometers. This was
followed by an attempt at wide-scale dissemination of 10,000 Steps to the entire region of Flanders, Belgium.
Dissemination was defined in this context, as an active approach of spreading an evidence-based intervention to the target
audience via determined channels using planned strategies.
Due to limited funding support, dissemination efforts for 10,000 Steps for Flanders focused
on the use of media and in-person meetings with representatives from various stakeholder groups. The website was updated
from 10,000 Steps Ghent,
A permanent media strategy was based on an update of the website used for 10,000 Steps Ghent, but with content for potential
adopters and the general public of Flanders. Implementation manuals and intervention materials were made available for
downloading from the website, community contacts and announcements were given web-space, and web-content for
individuals focused on tips to increase daily physical activity and provided an online diary for logging personal steps.
Emails concerning the effectiveness of 10,000 Steps Ghent were sent to various stakeholder groups, such as municipal sports
services, local health promotion services and health insurance organisations. In addition, group meetings were
opportunistically used as a platform on which to share the results of the 10,000 Steps Ghent program. Those organizations
attending were encouraged to were advised to take advantage of this project support materials, available for download from the
website.
Brazil UMIC Academia da Sade (Physical Academia da Cidade is a community-based physical activity promotion strategy, which since 2002, has been responsible for 1 1 6
Activity Classes in implementing physical activity classes at the community level. It was started by the Health Secretary of the City if Recife, and
Community Settings) under has grown to more approximately 30,000 participants in its 19 polos (settings where the intervention occurs, commonly
the National Physical Activity public parks). Classes generally take place early in the morning or from 5-8pm in the evenings, and include aerobics and dance
Network of Brazil classes, jogging groups, and general physical activity and diet counseling aimed at healthy adults, as well as those with
conditions such as hypertension, diabetes, overweight and heart disease. The classes are run by qualified exercise professionals
and are free to the general public. A similar program exists in Bogota, Colombia known as Recreovia.
The Ministry of Health of Brazil has begun to implement the Academia da Saude, which is a national program, replicating the
Academia da Cidade and with a view to expanding the physical activity intervention to 4,000 new municipalities around the
country over the next 5 years.
The Academia program depends on coordination from the Ministry of Health, as well as as state and municipal Health
Departments, and falls within the Universal Health Care System of Brazil. Through these programs, structural and financial
barriers to guided physical activity are eliminated.
12
Brazil UMIC Agita Sao Paulo Agita Sao Paulo is a social movement, aimed at increasing population participation in physical activity levels, with a message 1 1 5, 6
to participate in at least 30 minutes of moderate activity every day and an iconic mascot, which is a cartoon alarm clock with
the hands set at 12 and 6, representing 30 minutes.
Agita Sao Paulo began in the late 1990s as a collaboration between the Secretary of Health at the time, Dr. Jose Guedes, and a
research center with a track record of success, the Studies Center of the Physical Fitness Research Laboratory of Sao Caetano
do Sul (CELAFISCS). One of the most notable attributes of this program was that it established an extensive network of
partnerships with governmental and nongovernmental organizations, working with an excess of 300 partner institutions.
One example of an Agita Sao Paulo mega event is the Agita Galera, held annually with the Department of Education in August
in 6000 public schools. On this day, regular classes are replaced with physical activity and awareness events.
Another mega event is the World Day for Physical Activity, celebrated every year on the 6th April. Partner institutions register
their activities on the Agita website. This social movement gave rise to the global Agita Mundo, movement promoting physical
activity.
Brazil UMIC Bike sharing programs There are bike-sharing programs being implemented in Brazil as private-public sector partnerships. In So Paulo, the largest, 2 1 N/A
Bike Sampa, is sponsored by Ita Bank, with around 1,000 bicycles and 100 stations throughout the city. Cyclists can also find
rentals available from the Our Bike system operated by the Parada Vital Institute since 2009. Our Bike offers 240 bikes for rent
at 17 subway stations and four bus terminals throughout Rio. Bike share in Rio de Janeiro is sponsored by the municipal
government in partnership with Banco Ita, and operated by Serttel, a private concessionaire. The bike sharing system has 600
bicycles available at 60 rental stations located in 14 neighborhoods throughout the city.
Cameroon LIC & Parcours Vita Parcours vita: a publicly funded leisure area/park for walking and group fitness activities. 3 1 N/A
LMIC
Caribbean LIC & Wellness week and Workplace Wellness Week is celebrated in the PAHO region, building on Caribbean Wellness Day, established by the CARICOM Heads 3 2 5
LMIC; wellness of Government, to commemorate the landmark summit held on September 15, 2007 in Port of Spain, Trinidad. This was
UMIC established to discuss the social and economic burden of CNCDs on the people of the region. Generally, this week, and
National Wellness Day are celebrated by mass media campaigns and mass participation events, supported by a theme. Typically
there are road closures for Ciclovias and street celebrations, public talks and health walks, and worksite health promotion
activities, no car days, and walk-to-work initiatives.
Denmark HIC Cycling City Copenhagen Copenhagen is known as the Cycling City or City of Cyclists and the infrastructure, logistical, legislative and cultural support 2 1 2
that has been implemented to increase access, ensure safety, and reduce costs and time have been well-documented, as well as
secular trends in terms of use, accidents and injuries, opportunity and time costs. For example, the modal share in journeys to
work and education in the city by bicycle has increased from 36% in 2012 to 43% in 2014. As a result of better infrastructure
and dedicated lanes and bridges (Bicycle Serpent), travel times have reduced by 7% over the same period.
13
Denmark HIC Get Moving National Since 2005, the Danish Health and Medicines Authority has conducted a nationwide campaign for physical activity targeting 2 1 5, 6
Campaign: children and youth, entitled Get Moving. The campaign is centered on the principal message, that all children and young
https://sundhedsstyrelsen.dk/e people should be physically active for at least 60 minutes per day. The program focuses on parents of children ages 10-15, as
n/health/physical-activity well as working through after-school clubs, staffed by leisure-time teachers.
Each year, the campaign comprises nationwide mass media elements, as well as local efforts. In 2015 the target group was the
parents of children aged 1015 years, as well as leisure-time teachers in after-school clubs.
The program relies on brand ambassadors who are well-known public figures, such as comedians or actors. There is
downloadable information and ideas for parents and educators on the website and FaceBook page, inspirational videos on
YouTube, and events conducted, for example, through a street sports non-governmental organization. The campaign also
works through and with municipalities.
Dominican UMIC Short-term campaign through The National Physical Education Institute (INEFI) created a program of physical activity with instructors in different urban 3 1 6
Republic the INEFI, National Physical parks, which were free to the public. It only lasted a few months because there was insufficient budget.
Education Institute
Ethiopia LIC & Great Ethiopian Run (GER) The Great Ethiopian Runs main objective is to introduce mass-participation running events throughout Ethiopia, working 2 1 7
LMIC specifically towards fulfilling the Millennium Development Goals. These events take place in different cities each year. The
main event, the Great Ethiopian run is hailed as Africas largest running event, with over 37000 participants in 2013, and with a
focus on AIDS awareness.
The GER also has other health awareness campaigns linked to events, including the Every One campaign, conducted through
the Hawassa Half Marathon, aiming to reduce infant and maternal mortality. This initiative has been running for four years,
inspired by the death of Great Ethiopian Run Patron Haile Gebrselassies mother due to birth-related complications. Another
initiative of the GER is a series of races aimed at highlighting the importance of education for girls.
Finland HIC Finnish Schools on the Move "Finnish Schools on the Move" is a national campaign which aims to establish a" physically active culture in Finnish 2 1 1
comprehensive schools". Schools and affiliated municipalities developed tailored action plans (adapted for schools and
regions), to increase physical activity opportunities for learners during the school day.
Materials that focus on specific components of the school day are provided to serve as examples. Some of the ideas include:
Add a long activity-based school break to the school schedule

Utilise activity-based methods during classes in all learning subjects
Inserting short activity breaks or standing during class
Standing workstations or substituting gym balls instead for desk chairs
Upgrading playgrounds and school yards to be more activity permissive
Active travel to and from school
The program is funded by the Ministry of Education and Culture and is organized by the Board of Education, regional state
administrative agencies, and various other organizations.
Ghana LIC & Physical education and sports Physical education and sports policy for schools / Research efforts to increase physical activity levels of children and youth 3 1 1, 7
LMIC policy for schools / Research
efforts to increase physical
activity levels of children and
youth
14
Iceland HIC School-based intervention This two-year, randomized, controlled, school-based intervention, focusing on increasing physical activity and promoting 2 1 1
healthy eating, was implemented in 6 primary schools in Reykjavik Iceland. The teachers received training through bi-monthly
workshops, and on-site meetings. Teachers documented childrens time spent in physical activity, progressing from 30
minutes/day to 60 minutes, aiming to integrate physical activity into the school day.
India LIC & Worksite health promotion A multi-component, multilevel, and multi-method intervention was implemented by trained, locally stationed, project health 3 2 N/A
LMIC program care personnel in 6 purposively selected worksites (N=4885), that agreed to participate, over a 4 year period. These sites were
compared to a control worksite (N=943). This intervention was based on the socio-ecological model, with interventions for
behavior change at an individual level, interpersonal level (family and workplace) and at an environmental level (social norms
at work and home).
The intervention included one-on-one and small group behavioral counseling, as well as, an education and awareness campaign,
involving posters and banners, booklets and videos shown on internal networks within worksites. There were also health
displays and motivational talks were scheduled. Finally, environmental and policy changes were initiated in the workplace
included canteen menus, the banning of tobacco, and the provision of fruit at the worksite. The intervention and evaluation
were both funded by the World Health Organization Country Office, along with the Ministries of Health and Family Welfare.
The intervention showed positive changes in cardiovascular disease risk factors, including physical activity behavior.
Ireland HIC GAA Healthy Club GAA Healthy Club project is a public-private sector partnership, run within communities, across the nation. The partnership is 2 2 N/A
between the Gaelic Athletic Association, the Health Service Executive, the Department of Health, the Irish Sports Council, Irish
Life and various academic institutions. There is not a clear description of the program activities, but during phase one, there
were '72 initiatives were delivered across seven target areas (physical activity, diet/nutrition, health awareness, emotional well-
being, social inclusion, anti-bullying, smoking/alcohol) and mostly delivered to the club and community'.
http://gaa.ie/community/healthy-club-project/phase-1-evaluation-report/
Ireland HIC Men on the Move program The Men on the Move Activity Programme is a 16 week physical activity program with a variety of activities for men aged 35 2 1 6
to 74 years, with the aim of increasing physical activity levels through community-based exercise intervention. Recruitment
was done using the "hook" of health risk screening, information evenings have been held in the 3 communities in which the
program has been run, and exercise classes with an emphasis on fun and social interaction were led by physical activity
specialists for 2 x 8 week sessions, twice weekly. At this stage, it has only been run in the pilot communities but the intention
is to roll it out at the county level. In the evaluation, recommendations were made as to how to increase uptake, engagement and
impact.
http://www.mayosports.ie/media/Media,20875,en.pdf
Ireland HIC Park Run Parkrun is a global movement that organises 5km timed runs every Saturday in countries all over the world. In Ireland, the 2 1 7
parkrun movement began in 2012, and now has 39 sites, more than 690 clubs, nearly 48000 runners, and has held more than
2400 events thus far. Participation is entirely free and parkrun relies on strategic partnerships and volunteers.
http://www.parkrun.ie
Italy HIC SAMBA (School-based The SAMBA school-based intervention was conducted in 26 primary schools in the Emilia Romagna province of Italy. The 3 1 N/A
primary school physical study compared standard-of-care physical education (2 x 50 minutes per week) with an enhanced physical activity and physical
education intervention) education program delivered in classroom, at break and in physical education classes, by specialist trained teachers in
conjunction with classroom teachers (averaging 45 minutes of moderate-to-vigorous activity per day).
15
Japan HIC COMMUNICATE This community-wide intervention for physical activity was conducted as a pilot effectiveness trial in 12 communities, 3 of 1 1 6
(COMMUNIty-wide which were randomly allocated as control communities. The other 9 were divided into either aerobic activity promotion (Group
CAmpaign To promote A), flexibility and muscle-strengthening activities promotion (Group FM), or aerobic, flexibility, and muscle-strengthening
Exercise) activities promotion (Group AFM).
Using social marketing techniques, the program consisted of 3 components:
(1) Information delivery. Flyers, leaflets, community newsletters, posters, banners, and local audio broadcasts
(2) Education delivery. Outreach health education program and mass-encouragement through motivation talks and
demonstrations or and individual encouragement by professionals including face-to-face promotion of PA while waiting for
community health check-ups.
(3) Support delivery. Social support, i.e., promoting encouragement by community leaders and lay health workers; Material
support, i.e., arranging for residents to obtain light-reflective material for walking safety, pedometers, and videotapes and
DVDs on flexibility and muscle-strengthening activities at each relevant community center; and Professional support, i.e.,
establishing a call center for questions about PA and requests for outreach programs.
Kenya LIC & Healthy Active Kids Kenya Healthy Active Kids Kenya is a not-for-profit organisation, based largely at Kenyatta University, who have been responsible for 3 1 N/A
LMIC Physical activity report cards producing the Healthy Active Kids Kenya Report Cards in 2011 and 2014. At this stage, the objectives of this organisation are
for children and youth largely to develop the evidence-based for advocacy and to develop and implement programs for physical activity in children. At
present, they are collaborating in a regional initiative concerning active travel to school.
Macedonia UMIC HEPA Move for Health HEPA Macedonia National Organization for the Promotion of Health - Enhancing Physical Activity was established in October 3 1 N/A
2005. The aim was to develop steps to implement national policy on physical activity in accordance to the new EU Health
Strategy (2007-2016). The website Macedonia on the Move was developed http://www.cindi.makedonija.com . The
organization appears to continue to be actively involved in tertiary academic training and supporting the global Move for
Health initiative. It is difficult to find details on any recent activities, although the Facebook Page does appear to be regularly
updated with information.
Mexico UMIC Ecobici - Mexico City Public Ecobici - Mexico City Public Bike Sharing Program. The ECOBICI system has been managed by the Mexico City 2 1 2
Bike Sharing Program Environmental Ministry, since their opening on February 2010. https://www.ecobici.df.gob.mx/en.
Mexico UMIC Muevete y Metete en Cintura Since November 2008, Muvete y Mtete en Cintura in Mxico City, is a program based on 5 strategies, aimed at reducing the 1 1 1, 2, 4, 5, 6
(Move and get in shape) prevalence of obesity (in response to the local Law on Obesity in Mexico City).
The program includes a mass campaign for PA and healthy eating, referrals to the public health care system for overweight and
obese patients, and several physical activity programs by site: a) Move in the office - Physical educators or "activators" deliver
short PA routines in office spaces; b) Move with social support groups in your social environment; c) Move in the city
(Recreovia type program, both independent and incorporated to Ciclovia); d) Move in school (Several "activation" programs in
schools); e) Move in the park (special events held in Mexico City parks to promote PA).
In the Health sector, Muvete con los Grupos de Ayuda Mutua engage communities in promoting healthy eating and physical
activity in 188 groups formed in the 16 Health Jurisdictions. More than 600 volunteer activities from 36 units of the Local
Government (Muvete en la Oficina) conduct workouts or activity breaks in the office lasting 10 minutes, and disseminate
messages regarding healthy eating and stress management, to people working in the office.
Community-led exercise classes take place under Muvete en la Ciudad Muvete y en el Parque, which has three venues for
workout activities in Paseo de la Reforma, in the Bike program. School-based intervention takes place under Muvete en la
Escuela, where talks and guidance are provided concerning healthy eating and exercise, with dynamic teaching.
16
Mexico UMIC Paseo Dominical (Sunday Paseo Dominical is a Sunday Ciclovia program, modeled after Bogota. Approximately 40 km of Ciclovias are made available 2 1 2, 3, 6
Cicolvia program) each Sunday.
Netherlands HIC BeweegKuur (combined This program targets persons who are obese or overweight with associated risk factors, and receive a lifestyle prescription from 3 2 4
lifestyle intervention for obese their doctor and a referral to a lifestyle consultant, dietitian and/or exercise or physical therapist for up to a year of guidance
and overweight people in concerning healthy eating, and physical activity. From the available literature, it is not clear the extent to which this program
combination with other risk has been implemented, and whether or not it has been embedded in the health care system. http://www.beweegkuur.nl
factors, such as diabetes type
2)
Netherlands HIC Dutch Obesity Intervention in The DOiT program was developed using Intervention Mapping with input from the target group (adolescents), implementers 1 2 1
Teenagers (DOiT) (teachers) and parents. DOiT is a school-based obesity prevention program for 12 to 14-year olds, focusing on 5 energy-balance
related behaviors (EBRB): (1) reducing intake of sugar-containing beverages; (2) reducing intake of high-energy snacks; (3)
reducing screen time; (4) increasing levels of physical activity (i.e. active transport and sports participation) and (5) daily and
healthy breakfast consumption.
There is a curriculum component including theory and physical education, a school environment component, and a parental
component focusing on social support and awareness. Materials include booklets for parents, and worksheets for students, and
a student toolkit (pedometer, food/ exercise diary and an online computer-tailored advice), along with an extensive teachers
manual and website. Due to the real life condition of the study, there was no formal teacher training, interference or guidance
by the research team.
Netherlands HIC JUMP-In In 2002 the Municipal Health Service and the Municipal Sports Service of the city of Amsterdam started the development and 1 1 1
implementation of JUMP-in, a Dutch intervention that aims to prevent overweight by stimulating PA in school- aged children
in socially and economically deprived areas in Amsterdam. The intervention incorporates policy, environmental, and individual
components and involves municipal authorities and agencies, primary schools, local sport services, sports clubs and youth
health care.
The JUMP-In school-based intervention designed to increase physical activity in children between the ages of 6-12 years old
was extensively evaluated using the RE-AIM framework (Reach, effectiveness, adoption, implementation, and maintenance)
and was revised for dissemination at a municipal level in the city of Amsterdam. The revised program consists of the
following components:
i) The Pupil Follow-up System (PFS) which is an annual assessment and register of childrens physical activity (PA) levels,
BMI and motor skills, as well as attendance at after school activities. This allows tailored solutions and additional support
where needed.
ii) Daily exercise with The Class Moves which provide for regular PA breaks throughout the school day focusing also on
posture and motor skills. There is now training for classroom teachers by certified content experts from a school advisory
service.
iii) Personal workbook: This is how you move! provides a personal workbook for learners and parents with assignments to be
completed together and embedded messages for the parents.
iv) School sports activities have been made more accessible, by introducing learners to a wide variety during the school day and
then offering club sports outside of school hours. There are adapted sports programs for overweight children, children with low
perceived competence, or low self-esteem, providing a safe social environment for children to enjoy physical activity while still
acquiring skills.
v) A Parental Information Service is offered providing information, personal consultations, meetings, courses, and even sports
programs for parents. Parents are contacted if there child has difficulties with motor skills or participation in physical activity,
financial support can be provided provided for sports activities if there is demonstrated need. These services are carried out by
trained professionals, known as information officers.
vi) Club Extra is a program to provide screening and extra care (motor development training) for children who are delayed.
17
New HIC Active Families GRx Active Families is a free community-based health program that targets children referred from pediatricians and public 1 1 4
Zealand health or school nurses. Children may be targeted because of overweight or other health issues, or low levels of activity. The
program aims to help children and families become more active and learn about healthy eating. In most regions, there are
physical activity programs at community centres provided by service providers. Baseline assessments are done, nutritional
counseling is offered and physical activity sessions including: fitness circuits, modified games, sports and aquatic activities.
http://www.health.govt.nz/your-health/healthy-living/food-and-physical-activity/green-prescriptions/active-families
New HIC Green Prescription The Green Prescription (GRx) began as a randomised clinical trial over 17 years ago, and has subsequently been scaled-up at a 1 1 4, 6
Zealand national level in New Zealand, through partnerships with general practitioner groups and funding from the Ministry of Health.
The GRx is issued by a general practitioner or practice nurse, in written form or electronically. The GRx can be forwarded to
the nearest GRx Support Person (physical activity specialist). The support person helps the patient to become more physically
active through monthly phone calls or face-to-face meetings for 3-4 months, or group support in a community setting for 306
months. Patient's progress is reported back to the referring health professional and if the patient requires additional support,
the GRx can be repeated.
http://www.health.govt.nz/our-work/preventative-health-wellness/physical-activity/green-prescriptions/how-green-prescription-
works
New HIC Project Energize Project Energize, delivered by Sport Waikato since 2004, through a contract with the Waikato District Health Board employs 1 2 1, 6
Zealand Energizers, former teachers or graduates in the fields of physical activity or nutrition, to develop and deliver the program in
each school. Generally, between 6-8 schools are allocated to each Energizer. Energizers underwent combined training
throughout the two-year intervention to gain experiences, resources and skills. Energizers acted to support classroom teachers,
introducing fundamental motors skills, fun, fitness-related activities and sports-related and modified games. In addition,
Energizers advocated for active travel to and from school, bike days, and leadership training for students for physical activity
promotion before and after school. Energizers also supported healthy eating activities including: canteen makeovers,
healthy food fund raising, and curriculum-based educational materials, and parents evenings.
The program goals, promoting physical activity and healthy eating are aligned with the curriculum. In addition, schools must
sign a contract with Sport Waikato, clearly outlining accountabilities and roles, so expectations are met. Furthermore, there is a
lead teacher or liaison that works with the Energizer, in particular, to help focus on the specific needs of and developing an
action plan for each school. One of the key areas of emphasis is on low-resource, under-served, indigenous communities.
Sport Waikato makes a specific effort to address the needs of indigenous Maori and Pacific Island children, by subcontracting
with four local health providers (as appropriate, three Maori and one Pacific) to deliver the program.
The Energizers move beyond the schools to facilitate activities to promote healthy eating and physical activity within
surrounding communities, including community sports events and vegetable gardens.
Nicaragua LIC & World Day for Physical The first national celebration of World Day for Physical Activity, reported by the key informant, had 100 persons in attendance. 3 1 5
LMIC Activity celebration
Northern HIC Exercise referral and 10000 Northern Ireland is currently in the process of developing a new exercise referral pathway and a national 10,000 steps program, 3 1 3, 4, 6
Ireland Steps as well as introducing a cycling infrastructure.
Norway HIC Active Smarter Kids The Active Smarter Kids (ASK) School-based intervention incorporates 3 components for physical activity. These include: 1) 3 1 1
ASK physically active educational lessons (3 x 30 min each week) in Norwegian, mathematics and English, carried out on the
school playground, 2) ASK physical activity breaks during classroom lessons (5 min x 5 days each week), and 3) ASK
physical activity homework prepared by the teachers (10 min daily; 5 x 10 min each week). In addition, children receive the
prescribed 90 min/wk of mandatory physical education, and 45 minutes of free play physical activity daily. The program is
being offered in 28 schools, with 29 control schools.
Teachers were trained during three comprehensive instructional seminars, and were offered two regional refresher sessions
during the intervention period. In addition, they were given email and telephonic support and a website with lesson material and
videos. Evaluation has not yet been released.
18
Peru UMIC Cyclovias and Recreativas There are increasing efforts in Lima, Peru to increase Active Travel and recreational cycling by increasing the connectedness of 1 1 2, 3
(Open Streets) Municipality of the more than 126km of cycle paths (52 routes) in Lima, half of which are in the city. The Cicloda consists of a circuit of
Lima streets closed to motorized transport, which runs until noon Sunday (from 7:00 to 1:00 hr), which allows thousands of people to
take part sport and recreation activities freely.
San Borja district since March 2011 began offering a system of public bicycle rental. The bikes are situated at stations, bicycle
paths and near Metro stations.
Ciclovias within various districts of the city of Lima (5th largest in South American and 27th largest globally) will differ
depending on the income status of the community, and some are more orientated around the open streets concept while others
more toward cycling and skateboarding (more affluent neighborhoods).
There does not appear to be formal evaluation of this program available in the peer-reviewed literature.
Portugal HIC Mexa-se Mais (Better This project implemented by the City of Oeiras appears to have several components, including mass media to increase 2 1 5, 6
Activity, More Health) awareness and the promotion of physical activity for health, well-being and quality of life. Another component involves
activity in the open air which is offering group-based physical activity in places of cultural and historical significance in the
city for the entire family. In addition, the city offers group-based physical activity programs for senior adults including fitness
and swimming classes.
Qatar HIC National Physical Activity The State of Qatar National Physical Activity Guidelines, First Edition, has been described as a "practical guideline 3 1 N/A
Guidelines reference ...distilled from the latest scientific evidence and driven by local realities. The intention of this book is to be an
immediate and easy source of information for practitioners, physicians, educators, and individuals who wish to prescribe or
engage in regular physical activity."
Russia HIC Exercise is Medicine and The key informant mentioned the development of the guidelines for general practitioners on counseling for physical activity. In 3 1 3, 4
improved pedestrian activity addition, the respondent mentioned programs for improved pedestrian safety.
Scotland HIC Active Scotland Outcomes The Active Scotland Outcomes Framework provides an aspirational and measureable "blue print" for government-led, physical 2 1 1, 2, 3, 6, 7
Framework activity and sport-related programs and infrastructure. The outcomes include:
A More Active Scotland

Inactive to More Active
Active to Stay Active
Physical Confidence and Competence
Infrastructure - People and Places
Wellbeing and Resilience in Communities
Participate, Progress and Achieve in Sport
Equality
For example, under well-being and resilience in communities, the goal is to develop communities through sport and physical
activity, rather than developing sport in communities. Sport and physical activity can be a means to develop social cohesion in
communities, for example education, employment and crime related outcomes. "Harnessing the power of sport and physical
activity to improve resilience in communities is widely referred to as sport for development."
http://www.gov.scot/Topics/ArtsCultureSport/Sport/Outcomes-Framework
Seychelles HIC Seychelles national policy on Seychelles national policy on sports and physical activity has been made available and a website has been launched by the 2 1 1, 7
sports and physical activity Seychelles National Sports Council (NSC), a government body that is accountable to organize events to promote PA in all
population subgroups. The NSC organises an all- school competition on Independence Day, where teams from all schools
participate, and which is then broadcast live in national TV. Prizes are given to best schools in different sports are awarded by
president of country.
19
Slovenia HIC Golden Sun and KrPan The Golden Sun and KrPan programs are managed by the Ministry of Education and Sports from 1997 and 1999 onwards, 2 1 N/A
programs respectively. The Golden Sun program targets children from 5 to 8 years of age (for four years), and provides them with
additional basic skills in physical activity (skating, skiing, hiking, cycling etc). . Each year it includes about 84% of all targeted
children (58,800). Children completing the program receive a medal each year. The Krpan program is offered to children from
9-11 years of age, enriching physical education with additional motivational approaches. It reaches about 65% of all targeted
children (36,100) and children also receive a medal on successful completion of the annual program (bronze, silver or gold).
Slovenia HIC Move for Health Slovenia Move for Health (related to HEPA Slovene Programme, NPS and Transport Policy) is a national and population oriented HEPA 1 1 5, 6, 7
promotion project/program, financially supported by Health Insurance Institute of Slovenia. It receives institutional support
from the Ministries of Health, Education and Sport. The purpose of the program is to encourage inactive or inadequately active
adults, elderly citizens of Slovenia and families to engage in regular and at least moderate physical activity. Between 1999 and
2006, it was managed jointly by CINDI Slovenia and Sports Union of Slovenia.
From 2006 onwards, it was renamed Move for Health (MFH), with a new logo and partly, re-conceptualised and is now
managed by CINDI Slovenia. It engages a network of health and sports professionals/organizations in collaboration with mass
media to promote health enhancing physical activity (HEPA). Dissemination of free promotional and educational material
helps to raise awareness, however, one of the primary ways in which the program reaches out to the public is by offering free-
of-charge, 2 km walk tests (UKK walk tests) annually. These tests are usually coupled with major local events or international
health days, and often paired up with blood pressure measurements, physical activity counseling or demonstrations, for
example, for Nordic walking.
Other activities and partnerships within the Move for Health initiative include the training of more than 300 INWA
(International Nordic Walking Association) guides who are able to teach Nordic walking to people at risk for cardiovascular
disease and other NCDs. Most of these are health workers. The project is also supported by the Ministry of Transport, the
Regional Environmental Centre and Olympic Committee.
To expand Move for Health, the Sport Union of Slovenia developed a quality label Healthy Club for members/sport societies
of this union in 2006. The label Healthy Club gave the general public an indication that these societies offered high quality,
healthy exercise programs. The criteria of Healthy Club included: comprehensively set goals; uniform organisation
structure; competent trainers; preventive medical checkups; constant quality control; and the societys role as a partner in health
strengthening.
In addition, the Olympic Committee of Slovenia partners with Move for Health, distributing 100,000 leaflets for healthy
exercise prescription, through the sports organisations and partners. In addition, Slovenia Runs (for Health)
(www.slovenijatece.si) and Slovenia Cycle (www.slovenijakolesari.si/) promote running and cycling as part of daily lifestyle.
Under Action Slovenia, there are more than 120 events all over the country between March and December and 50-60 cycling
events between April and October, altogether involving more than 45,000 persons.
South MIC Discovery Vitality Physical The Discovery Vitality Physical Activity benefit allocates points for fitness center or gym visits; fitness assessment and meeting 2 1 N/A
Africa activity incentives/benefits in age- and gender-standardized fitness targets (annual subsidized fitness assessment through a network of service providers
health insured persons similar to clinical exercise physiologists or exercise specialists in the United States); use of downloadable heart rate monitors or
step counters to document physical activity participation; and completion of accredited fitness-related events, such as fun runs,
bicycle races, or triathalons. Fitness center membership is discounted up to 80 percent, after a nominal registration fee of
approximately US$80$120, in any one of three national fitness center chains, including more than 110 centers nationwide.
20
South UMIC Grassroots Soccer Grassroots Soccer (GRS) in South Africa is part of a global movement in sport for development, in particular, focusing on 2 1 7
Africa HIV/AIDS prevention and awareness. The program has demonstrated sustainability, dissemination and translation (Fuller CW,
et al. 'Football for Health'--a football-based health-promotion program for children in South Africa: a parallel cohort study. Br J
Sports Med. 2010 Jun;44(8):546-54) across a number of African countries, and within South Africa. Grassroots Soccer is run in
5 different sites in South Africa, with 3 different targeted programs, including skills, along with HIV awareness. In addition,
GRS administers the South African sites for Football for Hope, funded by FIFA.
South UMIC Siyadladla Mass Participation The Ministry of Sport and Recreation South Africas program, Siyadlala, a Zulu term meaning lets play, was launched in 2 1 7
Africa Program 1994. This program aimed at facilitating mass participation in sport and recreation activities, particularly during leisure time.
Siyadlalas activities included handball, soccer, basketball, aerobics, gymnastics, fun walks, netball, rugby, cricket, volleyball
and learn to swim and indigenous games. The Siyadlala campaign included the 30 minutes of physical activity on at least 5
days if the week message at these community-based interventions, thereby promoting the physical activity guidelines to the
broader South African community.
This program is responsible for the organisation and delivery of the Golden games a sports event for older adults (>60 years);
Indigenous Games and other Siyadlala programs across SA with a focus on marginalised groups including women, children,
youth, elderly, persons with a disability and people living in rural areas. In addition, conditional grants have been awarded to
each of South Africas provinces (or states), to promote activities within communities and schools related to the FIFA World
Cup legacy, mass participation hubs under Siyadlala and school sport.
Spain HIC MOVI2 program for An after-school, but school-based recreational and non-competitive physical activity program based on sports or music games, 3 1 N/A
Extracurricular physical or games using alterative materials (parachutes, etc.) designed to increase physical activity and health-related fitness. The
activity program consists of 2 x 90 minute sessions during the week, and one 150 minute session on the weekend, using school sports
facilities from October to May. http://www3.uclm.es/proyectosCESS/movi2/public/intervention
Sri Lanka LIC & Nirogi Lanka project; - Nirogi Lanka project is described in part on the following website: http://nirogilanka.org/projects-phase1.html. The intention is 3 3 N/A
LMIC Diabetes awareness and to develop capacity in Sri Lanka to prevent and manage diabetes in clinics, in worksites, schools and communities. The
prevention program is outlined over 2 phases, the second phase of which is planned for the various settings. Nurses have been trained as
diabetes educators. It is not clear, however, from the materials presented, the role that is planned for physical activity
counseling and the promotion of physical activity.
Swaziland LIC & "Shukuma" (be active) policy The Shukuma (be active) policy under the Ministry of Arts and Culture and Sports which is reported in a single press release on 3 1 7
LMIC under the Ministry of Arts and the internet, appears to be a policy aimed at building sports centers and promoting physical activity through sport. However,
Culture and Sports there is limited information regarding participation, reach or impact.
http://www.gov.sz/index.php?option=com_content&view=article&id=372&Itemid=359
Sweden HIC Physical Activity on The FaR@ is similar in many respects to the Green Prescription from New Zealand, in which qualified medical personnel can 1 1 4
Prescription (FaR) in write a prescription for physical activity for persons who are inactive, or at risk. The Physical Activity on Prescription (FaR@)
combination with Physical participants can then undertake exercise on their own, or join community-based groups led by physical activity leaders and
Activity in Disease Prevention resources to assist. One of the key differences between the programs is the resource manual that has been created for health
and Treatment (FYSS) care practitioners which is freely available for downloading (Physical activity in disease prevention and treatment (FYSS)), and
which highlights the importance of physical activity for health, and guides practitioners for screening and in exercise
prescription.
https://www.folkhalsomyndigheten.se/pagefiles/12386/Physical-acitivty-and-public-health-in-Sweden.pdf
21
Switzerland HIC Youth and Sports: Youth+Sports (Y+S) is the Swiss Federal Office of Sports (FOSPO) largest sports promotion program and focuses on youth 2 1 1, 7
www.jugendundsport.ch. (10 to 20 yrs) and children (5-10 yrs). The program provides training for heads of sports clubs and each year, trained Y+S
leaders, working mostly on a volunteer basis, run 50,000 Y+S courses and camps with over 550,000 children and youth. The
Swiss adult sports program, or ESA, of the Federal Office of Sport (FOSPO) encourages adults to play sports and exercise
more, and functions as a resource for job-related sports and physical activity opportunities and training for non-profit and
commercial sports activities.
Tajikistan LIC & Scaling Up Nutrition: Development and approval of Nutrition and Physical Exercise Strategy in Tajikistan- In August 2015, The Ministry of Health 3 Not clear N/A
LMIC Nutrition and Physical and Social Protection of Population hosted an intersectoral meeting together with WHO/Europe to review the ongoing
Exercise Strategy implementation of the nutrition and physical activity action plan for 20152016, in connection with the national strategy for
Tajikistan 20152024.
This was coupled with a 3-day training workshop, the objectives which were to: create awareness concerning healthy eating,
physical activity, obesity and health outcomes, to introduce and discuss existing guidance from WHO in relation to these health
risk behaviors, so that participants would be able to use the key recommendations in their daily practice, and to collectively
consider how WHO guidance can be implemented according to the local context in Tajikistan.
Turkey UMIC Fighting Obesity Campaign A national Fighting Obesity and Control Program was implemented by the Ministry of Health of Turkey, in which a mass 2 2 5
media campaign, the Fighting Obesity Campaign (FOC) was conducted. By this vehicle, obesity awareness programs were
adopted by healthcare organisations and introduced by the national media.
UAE HIC Dubai Pulse and Upgrade of Dubai Pulse is a multi-component initiative to promote physical activity to all segments of society, with the aim of reducing 1 1 3, 6
all public parks, running tracks diseases and promoting physical and psychological health.
and public beaches
The program began in February 2009 and is still part of the Dubai Sports Councils strategic plan and long-term vision for
health promotion. Along with the Dubai Sports Council, implementation partners include: Dubai Municipality, Dubai Road
and Transport Authority, schools, government departments, and private companies.
Key components for physical activity include:
Community events
The Dubai Pulse programme organizes regular events such as Dubai swims, Dubai walks, Dubai cycle rides, Dubai Golf,
Marathons, and employees sport competitions.
Resource development
Dubai Pulse physical activity booklet
Leaflets and flyers
Older adult physical activity guide
Dubai Sport Destinations Map
World Day for Physical Activity yearly book.
World Day for Physical Activity

Each year the Dubai Sports Council organizes a comprehensive promotional campaign and a range of mass participation events
to celebrate Word Day for Physical Activity on 6 April. Government has upgraded all public parks, running tracks and public
beaches
22
UK HIC National Cycle Network Sustrans is a leading UK charity, the goal of which is to enable sustainable transport, and to facilitate people to be able to travel 1 1 2, 3
by foot, bike or public transport for more of their daily journeys. They partner with communities, policy-makers, urban planners
and transport authorities and other non-profit organisations, to achieve this goal. Under Sustrans, there are programs such as
London Quietways planned, the aim of which is to improve cycling routes and infrastructure.
One of the programs highlighted by the key informant is the National Cycling Network, which was established over 20 years
ago. The Network is a series of safe, traffic-free paths and quiet on-road cycling and walking routes that connect to every
major town and city, and in fact, today, the Network passes within a mile of half of all UK homes and now stretches over
14,000 miles across the length and breadth of the UK, with nearly 5 million users. The Network is also accessed by walkers
and joggers, wheelchair users, and even equestrians.
UK HIC StreetGames The StreetGames charity was set up in 2005, by a number of organizers of neighborhood sports projects. The goal is to make 2 1 7
sport more widely available for disadvantaged young people and to harness the power of sport to change young lives and to
change disadvantaged communities. The initial pilot program was run through the Football Foundation and the New Deal for
Communities regeneration program, and subsequently funding was secured from the Sport England Lottery and officially
launched in January 2007.
StreetGames promotes Doorstep Sport, conducted in disadvantaged communities that takes place at the right place, the right
time and for the right price . StreetGames runs a Young Volunteer program, also established in 2007, and after training, these
volunteers run local sport activities and tournaments, coaching sport and youth-led activities. The volunteers also benefit, by
enhancing leadership skills, self-esteem, and by providing them with an opportunity to gain awards and qualifications.
Generally, the ratio of volunteers to participants is seven-to-one.
Coaches are trained, and firstly need to consult with communities to determine the best venue, considering issues of territory,
utility, and facilities. The sessions are exciting, and over and above sports training, coaches need to be empathic to the practical
and emotional issues that may be faced by the participants.
StreetGames is a national partner of Sport England and a centre of expertise for developing doorstep sport in disadvantaged
communities. The charity supports community based sports projects that deliver sport and volunteering opportunities to young
people living in the 20% most deprived wards in the UK. StreetGames works with National Governing Bodies of Sport to
establish and develop links between community and mainstream sport, and was recognised by the London 2012 Olympic &
Paralympic Games Inspire Mark.
UK HIC Well at Work The aims of the Well@Work project were to assess the effectiveness of worksite wellness programs, in diverse settings, with a 1 1 N/A
view to better understanding what works for health promotion. The emphasis of the programs was on increasing physical
activity, healthy eating and maintaining a healthy weight, and tobacco control.
The program ran for 3 years, with funding support from the British Heart Foundation, in 11 worksite settings (including
primary care providers, food manufacturers, city council, health insurer, etc). The overall sample included 32 organisations, and
more than 10,300 participants. The intervention took place over a 22-month period. Each Well@Work project had an
implementation team with a full- or part-time coordinator and regional partnerships with various groups such as sports trusts
and primary care groups. After the 3 years, 8 of the 11 interventions continued. Many of the worksites also involved
workplace champions.
The interventions were not prescriptive, and each worksite developed their own strategies. The only requirements were that
there was at least some focus on physical activity. Four approaches were recommended, including: awareness and education,
programs and services, supportive environment, healthy workplace policies.
23
Uruguay HIC Exercise is Medicine and Exercise is Medicine courses and a Facebook page for Uruguay, are both active and ongoing. However, there is no information 3 1 4, 6
Active Pauses at Work regarding scaled-up, population-based strategies or implementation.
It appears that Uruguay has at least a partially implemented National Plan for Physical Activity, and that there has been a
replication of Active Pauses at Work, a physical activity program involving 10 minute activity breaks in the workplace,
called Lift Offs. However, there does not appear to be any published or grey literature on these initiatives at present.
USA HIC Complete Streets and Safe The National Complete Streets Coalition was launched in 2004, and promotes the development and implementation of policies 2 1 2, 3
Routes to School and professional practices that ensure streets are safe for people of all ages and abilities, balance the needs of different modes,
and support local land uses, economies, cultures, and natural environments.
A Complete Street is one that is easy and safe to cross, accommodates multiply modes of travel (on foot, by bicycle, public
transport, and private vehicles), allows access to shops and facilities on route, and is safe for all users. There is not one specific
design, and each Complete Street will involve multiple stakeholders in its design or re-design. Typically they include:
sidewalks, bicycle facilities (such as protected bike lanes in urban areas), special bus lanes, comfortable and accessible public
transportation stops, frequent and safe crossing opportunities, median islands, accessible pedestrian signals and ramps, curb
extensions, narrower travel lanes, roundabouts, and multimodal bridges. In the USA, over 700 agencies at the local, regional,
and state levels have adopted Complete Streets policies. Safe Routes to School (SRTS) programs operate in all 50 states and in
Washington, D.C. This is a federally-funded program, from 2012, SRTS initiatives were eligible to apply for funding. Since
September 2012, nearly $1.15 billion will have benefited close to 15,000 schools.
USA HIC Grow Healthy Together Grow Healthy Together Chattanooga (GHTC) was initiated by the Chattanooga-Hamilton County Health Department and 2 2 2, 3, 6
Chattanooga numerous partners in 2009 through a fouryear grant from the Robert Wood Johnson Foundation called Healthy Kids, Healthy
Communities. The goal of GHTC is to reverse and prevent childhood obesity in some of Chattanoogas neediest communities
by reducing the barriers to physical activity and healthy eating.
The lead agency was the Chattanooga-Hamilton County Health Departments Step ONE (Optimize with Nutrition and
Exercise) program. The Partnership for Healthy Living, formed in 2007 under Step ONE, was made up of over 40 different
organizations, programs, businesses, and community groups. After receiving HKHC funds, the Partnership for Healthy Living
restructured to include more community members and leaders under the name of Grow Healthy Together Chattanooga (GTHC).
The partnership focused on increasing healthy eating and active living in Eastside and Southside Chattanooga. The partnership
and capacity building strategies of the partnership included: forming Leadership Advisory Councils within each community,
and conducting training and workshops to develop community action plans, along with community engagement. Specifically,
the active living strategies of Grow Healthy Together Chattanooga included: substantial financial support to improve active
transportation infrastructure (sidewalks, pedestrian crossings, signal lights and bus shelters). Additionally, funding was
allocated for the upgrade and revitalization of a large, community park, and the after-hours sharing of play space between local
schools and the communities in which they are situated.
http://www.transtria.com/pdfs/HKHC%20Case%20Reports%2012_29_14/Chattanooga,%20TN.pdfy
Venezuela HIC Exercise is medicine Exercise is Medicine, Venezuela, is hosted by the Central University of Venezuela. The goals of EIM in Venezuela are to 3 1 N/A
continue offering the training course for healthcare professionals, and to conduct research concerning the lifestyle of medical
students to better implement EIM on campuses across Universities in Venezuela.
a
Country Income Level, per World Bank classification (LIC&LMIC=Low-income and Lower Middle-income countries, UMIC=Upper Middle-income country or countries, HIC=High-income
country or countries); b True Scalability [(Is the information source focused on true scalability? (i.e., describes, discusses, etc. the scaling-up of a program, intervention, initiative, etc.); 1=Yes, and
it describes in detail the scaling-up process; 2=Does not focus on describing the scaling-up process, but reports on an already scaled-up intervention, 3=Does not report on a truly scaled up
intervention]; c Physical Activity Outcome (1=Main Outcome; 2=Co-benefit); d 7 Investments Category (1='Whole of School' programs; note, if school-based but not 'whole of school', then it
doesn't fit this category, 2=Transport policies and systems prioritizing walking, cycling and public transport, 3=Urban design regulations and infrastructure that provides for equitable and safe
access for recreational PA, and recreation and transport walking and cycling across the life-span, 4=Physical activity and non-communicable diseases prevention integrated into primary health care
systems, 5=Public education, including mass media to raise awareness and change social norms on physical activity, 6=Community-wide programs involving multiple settings and sectors and that
mobilize and integrate community engagement and resources, 7=Sports systems and programs that promote 'sports for all' and encourage participation across the life-span)
NOTE: The information contained in this Web Table was abstracted by co-authors Estelle V. Lambert and Shifalika Goenka.
24
J. Web Table 5: Evaluation of physical activity interventions identified by key informants or in-country physical activity contacts through the adapted Delphi process (part 2 of 2)
Intervention Name Evidence Scaling: Key Actors Scaling: Monitoring & Evaluation Impact: Evaluation Scaling: Partnerships References for entry
or Practice
Baseda
Exercise is No Government of Aruba No information available No information available No information available None provided
Medicine Courses evidence (Aruba Prime Minister and
Minister of Public Health,
Care of the Elderly and
Sports) and Exercise is
Medicine Global
Leadership
10,000 Steps 2 The Physical Activity Based on the 10000 Steps website there The 2001-2003 program Health Promotion Queensland, Brown, Wendy J., et al. "10,000 Steps Rockhampton:
Rockhampton Task Force was comprised are 316,838 members who have logged a evaluation showed that local tertiary academic evaluation of a whole community approach to improving
of researchers and ..." key grand total of 163,073,047,367 steps. In members of the institutions, the Local Physical population levels of physical activity." J Phys Activity and
members of community terms of program evaluation, in Rockhampton community Activity Task Force, regional Health 3.1 (2006): 1.
organizations, some of Rockhampton, 95% of persons were had a 1% increase in those health services, local libraries,
whom had high-level aware of the program, compared to only meeting guidelines for worksites, and the wider web- Mummery WK, Schofield G, Hinchliffe A, Joyner K,
expertise in PA promotion. one-third of the control community physical activity compared based community and service Brown W. Dissemination of a community-based physical
They included local MacKay. Moreover, 18% of persons to a 7% decline in the providers. activity project: the case of 10,000 steps. J Sci Med Sport.
representatives from the from Rockhampton had used a pedometer control community. Those 2006 Oct;9(5):424-30.
National Heart within the previous 18 months to count meeting guidelines with
Foundation, Rockhampton steps, vs only 5.6% of MacKay sufficient and vigorous Mummery WK, Brown WJ. Whole of community physical
City Council, Division of respondents. Finally, roughly half of the activity inreased by 3% vs a activity interventions: easier said than done. Br J Sports
General Practice, health Rockhampton respondents were aware of 3% decline in the control Med. 2009 Jan;43(1):39-43.
services, and the regional the library pedometer loan scheme. community. Moreover, the
public health unit, state program is still in existence,
government, sport and some 12 years later.
recreation, and business
and media organizations."
"Play Streets" 2 Government, Media, Civil No information available regarding "Play Streets" have been In the manuscript cited, there DHaese, Sara, et al. "Organizing Play Streets during
society, parent volunteers scaling up; however, a toolkit was shown to impact is a detailed explanation of the school vacations can increase physical activity and
prepared by the Bambini initiative (social significantly on moderate- process involved in running a decrease sedentary time in children." International Journal
mobilisation to reduce car use) on behalf to-vigorous physical activity "Play Street" and the of Behavioral Nutrition and Physical Activity 12.1 (2015):
of the European Union, explaining how to in children (measured using relationship between the 14.
develop and scale up a "Playing or Living accelerometry) and to volunteers and municipal
Street". reduce sedentary time, on authorities and mutual https://ec.europa.eu/energy/intelligent/projects/sites/iee-
an intervention day, accountability. In addition, projects/files/projects/documents/bambini_toolkit_for_livin
compared to control there is some information g_and_playing_streets.pdf
conditions. provided on how to manage
and minimise nuisance and
inconvenience to the rest of
the street homeowners. The
program has been running
since 1998, but there does not
appear to be public
information available in
English on the actual scope of
the program (reach and
engagement of partners).
25
or Practice
Baseda
10,000 Steps Ghent 1 Government, Media, Civil Using the RE-AIM framework (Reach, See Monitoring evaluation See monitoring evalution Van Acker R, De Bourdeaudhuij I, De Cocker K, Klesges
(Dissemination society Effectiveness, Adoption, Implementation LM, Cardon G. The impact of disseminating the whole-
Flanders) and Maintenance); the program was community project '10,000 Steps': a RE-AIM analysis.
evaluated. For the REACH components, BMC Public Health. 2011 Jan 4;11:3.
80% of organisations contacted,
responded, and of those, 90% had heard
of the 10,000 Steps program. Of the
503,000 potential persons, 2600 were
randomly contacted. Of these, 29%
agreed to be interviewed. As part of
measuring effectiveness, 35% were
aware of the program.
Of the organisations that were aware of

the program, 36% adopted all or some of
the program for its members, while 65%
did not. Of the organisations that
responded, 52 out of 100 potential
program components were implemented.
There was a significant differences in

moderate-to-vigorous physical activity
and accumulated steps in persons who
were aware of the program vs those who
were unaware.
Finally, 33% of organisations intended on

implementing as a whole-of-community
approach in the future, 19% did not and
the remainder were undecided. Reasons
for not implementing included lack of
time, lack of perceived value, and the
need for more information regarding the
program.
Academia da Sade 2 The key actors for the An evaluation of the National Physical Using systematic Project GUIA is a Paez DC, Reis RS, Parra DC, Hoehner CM, Sarmiento OL,
(Physical Activity program include the Activity Network program in Brazil was observation, persons using collaboration between national Barros M, Brownson RC. Bridging the gap between
Classes in Ministry of Health at a undertaken, and of contact was made with the ACP parks were more and international government research and practice: an assessment of external validity of
Community national level, and the the coordinators of the more than 1300 likely to be participating in and academic institutions from community-based physical activity programs in Bogot,
Settings) under the municipalities (health, registered projects, via email from the moderate-vigorous physical the United States (U.S.) and Colombia, and Recife, Brazil. Transl Behav Med. 2015
National Physical recreation and sport) for Department of Health. These individuals activity than users of non- Brazil, including the U.S. Mar;5(1):1-11.
Activity Network of logistical support, were invited to complete a telephone ACP parks. Similarly, Centers for Disease Control
Brazil facilities and trained survey concerning information on the persons using the ACP and Prevention (CDC), the Reis RS, Yan Y, Parra DC, Brownson RC. Assessing
personnel. types of activities offered, number of parks were more likely to be Prevention Research Center in participation in community-based physical activity
weekly sessions, duration of each session, meeting physical activity St. Louis, and the Ministry of programs in Brazil. Med Sci Sports Exerc. 2014
period of the day available for activities, recommendations. Health of Brazil. The Jan;46(1):92-8.
geographical distribution in the city, evaluation of the Academia da
academic qualifications of professionals Cidade Program was Hoehner CM, Ribeiro IC, Parra DC, Reis RS, Azevedo
and trainees applying the activities, area undertaken as part of this MR, Hino AA, Soares J, Hallal PC, Simes EJ, Brownson
covered by activities (urban or rural), collaboration, and results led, RC. Physical activity interventions in Latin America:
facilities used and perception of its in part, to the government expanding and classifying the evidence. Am J Prev Med.
quality, in addition to aspects that intentions to scale-up the 2013 Mar;44(3):e31-40.
positively or negatively influence the Academia de Saude.
execution of actions. Daz Del Castillo A, Sarmiento OL, Reis RS, Brownson
RC. Translating evidence to policy: urban interventions
26
or Practice
Baseda
This evaluation showed that most of the and physical activity promotion in Bogot, Colombia and
programs targeted older adults and higher Curitiba, Brazil. Transl Behav Med. 2011 Jun;1(2):350-60.
risk persons; over 70% of the programs
involved walking, stretching or gym
classes; one third met more 3-4 times per Brownson RC, Parra DC, Dauti M, Harris JK, Hallal PC,
week, nearly 40% met 5 or more times Hoehner C, Malta DC, Reis RS, Ramos LR, Ribeiro IC,
per week; and ore than 50% convened in Soares J, Pratt M. Assembling the puzzle for promoting
parks, squares or gym clubs, with more physical activity in Brazil: a social network analysis. J Phys
than 30% in churches and community Act Health. 2010 Jul;7 Suppl 2:S242-52.
centers.
Mendona BC, Oliveira AC, Toscano J J O, Knuth AG,
Borges TT, Malta DC, Cruz DK, Hallal PC. Exposure to a
community-wide physical activity promotion program and
leisure-time physical activity in Aracaju, Brazil. J Phys Act
Health. 2010 Jul;7 Suppl 2:S223-8.
Pratt M, Brownson RC, Ramos LR, Malta DC, Hallal PC,

Reis RS, Parra DC, Simes EJ. Project GUIA: A model for
understanding and promoting physical activity in Brazil
and Latin America. J Phys Act Health. 2010 Jul;7 Suppl
2:S131-4.
Reis RS, Hallal PC, Parra DC, Ribeiro IC, Brownson RC,
Pratt M, Hoehner CM, Ramos L. Promoting physical
activity through community-wide policies and planning:
findings from Curitiba, Brazil. J Phys Act Health. 2010
Jul;7 Suppl 2:S137-45.
Ribeiro IC, Torres A, Parra DC, Reis R, Hoehner C,

Schmid TL, Pratt M, Ramos LR, Simes EJ, Brownson
RC. Using logic models as iterative tools for planning and
evaluating physical activity promotion programs in
Curitiba, Brazil. J Phys Act Health. 2010 Jul;7 Suppl
2:S155-62
Simoes EJ, Hallal P, Pratt M, Ramos L, Munk M,

Damascena W, Perez DP, Hoehner CM, Gilbertz D, Malta
DC, Brownson RC. Effects of a community-based,
professionally supervised intervention on physical activity
levels among residents of Recife, Brazil. Am J Public
Health. 2009 Jan;99(1):68-75.
27
or Practice
Baseda
Agita Sao Paulo 2 Agita Sao Paulo has an The attributes of scaling up Agita Sao Several impact evaluations A number of manuscripts and Matsudo V. The role of partnerships in promoting physical
executive and scientific Paulo (which took two years of planning) have been conducted on the reports describe the activity: the experience of Agita So Paulo. Health Place.
board. The executive have been captured in a recent manuscript program from 2002-2008, partnerships required for 2012 Jan;18(1):121-22.
board meets monthly and and include: and have shown that scaling up Agita Sao Paulo.
represents the partner sedentary behavior has These include intellectual Innovative Action Against Non-Communicable Diseases:
institutions. The scientific (a) national and international intellectual significantly decreased by partnerships (scientific A case Study on Agita Sao Paulo: Defeating NCDs through
board represents partnership; as much as 70% in the advisory), institutional Physical Activity http://www.arogyaworld.org/wp-
international and national population surveyed. In partnerships and partnerships content/uploads/2011/09/BrazilCaseStudy1_w.pdf 1:
experts on physical (b) strong institutional partnerships, addition, Agita Sao Paulo is to promote activity-permissive Matsudo V, Matsudo
activity and health. including government in one hand, and widely recognized by the environments.
non-governmental and private sector in public, as well as the 30 Matsudo, Victor K. R. , Sandra M. Matsudo, and Timoteo
the other hand, in a so called: two-hats minute clock mascot. An L. Araujo. ""Time Trends in Physical Activity in the State
approach; economic analysis has of Sao Paulo, Brazil: 2002-2008."." Medicine and Science
estimated that Agita in Sports and Exercise 42.12 (2010): 2231-6.
(c) minimal formalization/maximal represents a saving of 310 Matsudo SM, Matsudo VR. Coalitions and networks:
flexibility; million US dollars per year facilitating global physical activity promotion. Promot
in the health sector of Sao Educ. 2006;13(2):133-8, 158-63.
(d) a signed letter of agreement: an active Paulo.
symbol of institutional commitment; S, Andrade D, Araujo T, Andrade E, de Oliveira LC,
Braggion G. Promotion of physical activity in a developing
(e) use the mobile management country: the Agita So Paulo experience. Public Health
adaptation of the ecological model, in Nutr. 2002 Feb;5(1A):253-61.
which attention was given to
intrapersonal, social, and physical Matsudo, Sandra Mahecha, et al. "The Agita Sao Paulo
environmental factors, in a dynamic way; Program as a Model for Using Physical Activity to Promote
Health." Pan American Journal of Public Heatlh 14.4
(f) attention to inter-sectoral as well as to (2003): 265-72.
intra- sectoral partners, in which creates
incentives for participation of more than Amorim TC, Knuth AG, Cruz DKA, Malta DC, Reis RS,
one representative from each sector; Halla PC. lDescription of the physical activity promotion
programs funded by the Brazilian Ministry of Health; Rev
(g) the inclusion principle, that was not Bras Ativ Fis e Saude Pelotas/RS 18(1):63-74
restricted to the institution, but affected Jan/2013
the program actions, materials, and
particularly the messages;
(h) a high level of legitimacy of the

coordination institution in the leadership;
(i) special attention to improve

environment supports for physical
activity, such as: strategic partnerships
established with the Metro System, that
serves over 1 million persons/day.
Agita Sao Paulo also has a strong social

marketing component,with branding and
a visible, and consistent logo.
Bike sharing 2 Private - Public sector Not mentioned Not mentioned The bike share programs in https://en.wikipedia.org/wiki/Bike_Rio
programs partnerships, municipal Brazil partner with private http://thecityfix.com/blog/sao-paulo-brazil-bike-sharing-
government sector sponsors and are integrated-transport-pass-maria-fernanda-cavalcanti/
rentals-based.
28
or Practice
Baseda
Parcours Vita No Government, Ministry of Not mentioned Not mentioned Not mentioned None provided other than internet annoucenments
evidence Sport regarding the launch of the parcours
Wellness week and 2 Government Not mentioned Not mentioned Not mentioned http://www.paho.org/hq/index.php?option=com_content&v
Workplace wellness iew=category&id=3828&layout=blog&Itemid=39571&lan
g=en
http://health.gov.bz/www/past-a-upcoming-events/864-
ministry-of-health-commemorates-caribbean-wellness-
week
Active Smarter 1 Government, School Not yet published Not yet published Not mentioned as not yet Resaland GK, Moe VF, Aadland E, Steene-Johannessen J,
Kids authorities, communities scaled. Glosvik O, Andersen JR, Kvalheim OM, McKay HA,
Anderssen SA. Active Smarter Kids (ASK): Rationale and
design of a cluster-randomized controlled trial investigating
the effects of daily physical activity on childrens academic
performance and risk factors for non-communicable
diseases. BMC Public Health (2015) 15:709
http://www.forskningsradet.no/servlet/Satellite?blobcol=url
data&blobheader=application%2Fpdf&blobheadername1=
ContentDisposition%3A&blobheadervalue1=+attachment
%3B+filename%3DSigmundAnderssen.pdf&blobkey=id&
blobtable=MungoBlobs&blobwhere=1274502628790&ssbi
nary=true
Cycling City 2 City of Copenhagens In the City of Copenhagens Bicycle There is no specific Not mentioned City of Copenhagens Bicycle Strategy, 2011-2025
Copenhagen Bicycle Strategy, 2011- Strategy, 2011-2025, published by the evaluation of the impact of
2025, published by the City of Copenhagens Technical and the Bicycle Strategy on http://kk.sites.itera.dk/apps/kk_pub2/pdf/823_Bg65v7UH2t
City of Copenhagens Environmental Administration, and overall physical activity .pdf
Technical and Traffic Department prevalence or health
Environmental (www.kk.dk/cityofcyclists ), there is a outcomes, at present.
Administration, and current situational analysis of access,
Traffic Department travel times, parking, safety, use,
satisfaction, articulation with other
transport infrastructure, school routes,
cargo cycles and modal share. In terms of
scaling up, there is a detailed plan for
how the City of Copenhagen can become
even more cycling friendly in terms of
each of these factors, and to increase the
contribution of cycling to social capital
and quality of life, by widening certain
cycle lanes (PLUSnet for family or
friends to cycle side by side).
Furthermore, there is planned innovation
including the use of LED lights in cycle
lanes to change the width or use,
depending on the time of day, and various
traffic calming strategies and shortcuts, to
reduce travel times further. Because
there are planned indicators and ongoing
monitoring and surveillance, the
effectiveness of these strategies will be
measured.
29
or Practice
Baseda
Get Moving 2 Health Protection Agency, An evaluation of the 2013 Get Moving Not clear There is no specific
National Campaign: Municipalities, Get- campaign has been published as a report information on scaling up http://ec.europa.eu/sport/library/factsheets/denmark-
https://sundhedsstyr moving ambassadors (high and is available in the public domain. partnerships, however, the factsheet_en.pdf
elsen.dk/en/health/p profile public figures), However, it is in Danish, and a translation campaign relies on iconic,
hysical-activity Educational authorities, is not available. brand ambassadors, social The Danish campaign Get Moving [website]. Copenhagen:
leisure-time teachers, media, downloadable content, Danish Health and Medicines Authority; 2012 (https://
parents, and local, after-school sundhedsstyrelsen.dk/en/campaigns/get-moving, accessed
activities conducted by leisure- 16 July 2015).
time teachers in recreational
clubs.
Short-term No Government educational Not mentioned Not mentioned Not mentioned None provided.
campaign through evidence agency
the INEFI, National
Physical Education
Institute
Great Ethiopian 2 The Great Ethiopian Run The GER records and posts results and Not mentioned Not mentioned http://www.ethiopianrun.org/index.php/about-us/aims-
Run (GER) is an NGO working in participation on its website, as well as the membership
conjunction with various funds raised for various charities. Other
NPO's to promote various than these activities, there is no
health and social goals, information available with regard to
along with mass monitoring and evaluation.
participation in physical
activity. One of the key
partners is the Association
of International Marathons
and Distance Races
(AIMS). The other key
actor is iconinc Ethiopian
marathon runner Haile
Gebrselassie, the patron of
the GER.
Finnish Schools on 2 The program is funded by This program provides an excellent Impact evaluation on Schools educational authorities Haapala, H. L., Hirvensalo, M. H., Laine, K., Laakso, L.,
the Move the Ministry of Education example of true scaling up. The pilot student physical activity and municipalities (See Hakonen, H., Lintunen, T., & Tammelin, T.
and Culture and is phase from 2010-2012 began with 45 levels was conducted during Scaling Key actors)
organized by the Board of schools and 10000 students from grades the pilot phase of the Haapala, H. L., Hirvensalo, M. H., Laine, K., Laakso, L.,
Education, regional state 1-9. During the period from 2013-2014, program and showed that Hakonen, H., Lintunen, T., & Tammelin, T.
administrative agencies, more than 500 schools, representing the proportion of students H. (2014). Adolescents physical activity at recess and
and various other approximately 20% of all public schools participating in active play actions to promote a physically active school
organizations. It appears in Finland participated in the program. during break time increased day in four Finnish schools. Health Education Research,
that the municipalities are The initial emphasis was on increasing from 30-49%. This 29, 840852. doi:10.1093/her/cyu030
also involved and that physical activity levels in learners occurred mostly in boys,
requests for funding throughout the school day (at least 60 although girls activity Kmppi, K., Asanti, R., Hirvensalo, M., Laine, K., Pnkk,
support from the national mint), however this has now changed to increased in two of the pilot A., Romar, J. E., & Tammelin, T. (2013). A more pleasant
government for the rather create a better school environment schools. Attributes and peaceful learning environmentschool staffs
program occur at the level through the inclusion of physical activity. associated with increased experiences and views on promoting a physical activity
of the city. There are also physical activity during based operating culture in school (LIKES Research Reports
national mentors for Because schools implement the program break included recess on Sport and Health 269). Jyvskyl, Finland: LIKES
training support. In in a bottoms up manner and adapt it to activators who were peer- Foundation for Sport and Health Sciences.
addition, school principals each school setting, there is an application leaders, and facilities
and teachers are key to the process and municipalities apply for development (playgrounds Tammelin, T., Laine, K., &Turpeinen, S. (2012). Final
success of the program. funding and then become part of the and sports halls). report on the Finnish Schools on the Move programmes
Finnish Schools on the Move Network. pilot phase 20102012. (LIKES Research Reports on Sport
By the end of the pilot and Health 261). Jyvskyl, Finland: LIKESFoundation
30
or Practice
Baseda
Factors that have contributed to the phase, subsequent surveys for Sport and Health Sciences.
success of this program include: national revealed that approximately
training and mentoring, funding one-third to half of all Tammelin, T., Laine, K., & Turpeinen, S. (2013). Physical
opportunities, and adaptation to each students, depending on the activity of school-aged children (LIKES Research Reports
schools needs and environment. grade, reported increased on Sport and Health 272). Jyvskyl, Finland: LIKES
participation in physical Foundation for Sport and Health Sciences.
activity.
Turpeinen, S., Lakanen, L., Hakonen, H., Havas, E., &
Tammelin, T. (2013). On the way to school. School
commutes and the promotion of active commuting amongst
school-aged children (LIKES Research Reports on Sport
and Health 271). Jyvskyl, Finland: LIKESFoundation
for Sport and Health Sciences.
http://www.liikkuvakoulu.fi/in-english
School-based 1 Icelandic Centre for Not mentioned Although the program was Not mentioned Hrafnkelsson H, Magnusson KT, Thorsdottir I, Johannsson
intervention Research, the City of evaluated, there was no E, Sigurdsson EL. Result of school-based intervention on
Reykjavk, the Ministry of significant reduction of age- cardiovascular risk factors. Scand J Prim Health Care. 2014
Education, Science and related increase in blood Dec;32(4):149-55. doi: 10.3109/02813432.2014.982363.
Culture, Brim Seafood, pressure, on fat percentage Epub 2014 Nov 26. PubMed PMID: 25424464; PubMed
and the Primary Health or other cardiovascular risk Central PMCID: PMC4278391
Care Research Fund. factors. It is nor clear
whether the program had an
impact on physical activity
levels,
31
or Practice
Baseda
Worksite health 1 Tertiary and government There is no specific evidence in the peer- Impact evaluation showed Not mentioned Jeemon P, Prabhakaran D, Goenka S, Ramakrishnan L,
promotion program institutions were involved reviewed literature evaluating the roll-out significant changes in Padmanabhan S, Huffman M, Joshi P, Sivasankaran S,
in developing, delivering of the intervention within the worksites; weight, waist, blood Mohan BV, Ahmed F, Ramanathan M, Ahuja R, Sinha N,
and evaluating the other than response rate of over 80% for pressures, total and HDL Thankappan KR, Reddy KS; Sentinel Surveillance in
intervention including: repeat assessments over the 4 year period. cholesterol, and plasma Industrial Populations Study Group. Impact of
Initiative for glucose in the intervention comprehensive cardiovascular risk reduction programme
Cardiovascular Health sites, compared to the on risk factor clustering associated with elevated blood
Research in the control site. In addition, pressure in an Indian industrial population. Indian J Med
Developing Countries, tobacco use and salt intake Res. 2012 Apr;135(4):485-93. PubMed PMID: 22664495;
New Delhi; All India decreased in the PubMed Central PMCID: PMC3385231.
Institute of Medical intervention sites, and
Sciences, New Delhi; Sree physical activity and fruit Prabhakaran D, Jeemon P, Goenka S, Lakshmy R,
Chitra Tirunal Institute of consumption increased. Thankappan KR, Ahmed F, Joshi PP, Mohan BV, Meera R,
Medical Sciences and Das MS, Ahuja RC, Saran RK, Chaturvedi V, Reddy KS.
Technology, Trivandrum, This large pilot study Impact of a worksite intervention program on
Kerala; Khajabandanawaz showed that worksite cardiovascular risk factors: a demonstration project in an
Institute of Medical interventions, using a Indian industrial population. J Am Coll Cardiol. 2009 May
Sciences, Gulberga, complex, ecological model, 5;53(18):1718-28. doi: 10.1016/j.jacc.2008.12.062.
Karnataka; Government with multiple interventions PubMed PMID: 19406349.
Medical College, Nagpur; at multiple levels, in a
Ambedkar Medical lower- and middle-income
College, Bangalore; PSG country setting can be
Medical College, effective and sustainable
Coimbatore; Nizams over a 4 year period.
Institute of Medical
Sciences, Hyderabad;
King George Medical
College, Lucknow; and the
Public Health Foundation
of India, New Delhi, India.
Funding was received by

the World Health
Organization, Country
Office, Nirman Bhavan,
New Delhi, and the
Ministry of Health and
Family Welfare,
Government of India.
32
or Practice
Baseda
GAA Healthy Club 2 This project was Key factors shown to be important for Impact measurements The evaluation report http://gaa.ie/community/healthy-club-project/phase-1-
developed as a public- scaling up were the commitment of the showed that project identified the original partners, evaluation-report/
private sector partnership clubs to their communities; and membership increased over including the GAA, Irish Life,
between the Health service community links and partnerships; the the duration of the project, Irish Sports Council, Health
Executive (HSE) of biggest challenges were funding and lack and the orientation of the Service Executive, and the
Ireland, and the Gaelic of capacity. club activities towards Department of Health, but on
Athletic Association, Irish health promotion also recommendation was to
Life, the Irish Sports increased. Qualitative identify community and other
Council, the Department evaluation showed an stakeholders or partnerships.
of Health and various overall perception that the
academic institutions. club activities impacted on
attitudes toward health and
health promotion.
In general, there were

recommendations for better
infrastructure, greater
stakeholder engagement,
and better governance with
respect to funding. It was
felt that there should be a
suite of club activities, a
tool kit, and training for
coaches delivering the
health messages, as well as
overall effectiveness
evaluation.
Men on the Move 2 Men on the Move The key learning outcomes from the The 6-month impact Not mentioned Canavan, L. (2013) Men on the Move Activity Programme
program represents a partnership qualitative evaluation which provide evaluation showed that t Evaluation Report, Health Service Executive,
project between Mayo insights for scaling up (particularly 19% of all men achieved at http://www.mayosports.ie/media/Media,20875,en.pdf
Sports Partnership, Mayo horizontally and also diversifying) least a 30% improvement in http://www.hse.ie/eng/services/news/media/pressrel/newsar
Primary Care Services, included the following: objectively measured chive/2013archive/feb2013/mayomen.html
Health Promotion Services fitness. At the start of the
Health and Safety Continue to employ a targeted approach program, nearly one-third of
Executive West, Cro for recruiting, but consider lower the age men were in the low
(West of Ireland Cardiac criteria to include younger men, not physical activity category,
Foundation), and Media involved in competitive sport, and also which was reduced to 4% at
partner Mid West Radio. reach out to marginalized communities 6-month follow-up.
Funding for the through networks and non-government Furthermore, at the start of
Programme was provided organisations; the program, only 30% of
by the National Taskforce men reported their health
on Obesity, based on a Continue to use the hook of a free status as very good which
proposal submitted by health check to engage men; increased to 44% by the end
Thelma Birrane, Health of the 6-month follow-up.
Promotion Officer, HSE. Include a more comprehensive approach
to lifestyle education, not only The program had limited or
This program was funded emphasizing physical activity; no overall effect on other
by the HSE and groups in particularly mental health (to also lower health risk behaviors such
existing areas have the stigma) as: alcohol consumption and
continued the program in a only some healthy eating
self-sustaining format with Develop a Men on the Move habits (although salt intake
the aid of local community Maintenance Programme and the intake of fried foods
groups such as athletic were improved).
clubs and Family
33
or Practice
Baseda
Resource Centres. The Emphasise and acknowledge the However, the qualitative
initiative has recently important social aspects of the program evaluation found that the
expanded to include both men found the program
the Erris and Castlebar regarded the program very
areas with more planned in positively, and in particular,
the near future. enjoyed the social aspects of
the program, the importance
of the group and male
only focus.
Park Run 2 Healthy Ireland, Athletics Currently run in 11 countries, including Other than attendance, Global partners and local Stevinson C, Wiltshire G, Hickson M. Facilitating
Ireland and Gala retail Ireland, and first conceived in 2004. The growth of the movement, partners include retail participation in health-enhancing physical activity: a
stores are sponsors, and global parkrun movement has a culture of and individual timed (primarily sporting equipment qualitative study of parkrun. Int J Behav Med. 2015
the Irish Sports Council, evaluation concerning participation and records, there does not and sports technological Apr;22(2):170-7. doi: 10.1007/s12529-014-9431-5.
Phillip Lee law firm and global statistics can be accessed via each appear to be any published solutions and apps) such as PubMed PMID: 25096794.
Leave No Trace (an country's website. There is also an impact evaluation of the Tribesports, Jabra, Wiggle,
outdoor education invitation to conduct research on parkrun parkrun movement at and Strava , and sports http://www.parkrun.com/results/attendancerecords/
initiative) are supporters. and requests can be made through their present, either in Ireland or organizations such as the http://www.parkrun.com/global-partners/
Sponsors secure the global website. A recent study by globally. However, there is IAAF. http://www.parkrun.ie/sponsors/
operational costs and Stevison et al.,( International Journal of an invitation from the
supporters help to grow Behavioral Medicine April 2015), found organisers for research and
the footprint of parkrun or that the key features of parkrun that evaluation partners.
improve the experience for encouraged participation included: "the
participants. accessible, inclusive ethos, achievement
opportunities, and inherent social support,
along with the outdoor natural settings,
and integrated volunteer system". These
authors suggested that community-based
physical activity interventions should
consider these elements as a means of
growing participation and ensuring
sustainability.
SAMBA (School- 1 School educational Not mentioned The program resulted in a Not mentioned Sacchetti R, Ceciliani A, Garulli A, Dallolio L, Beltrami P,
based primary authorities and significant increase in Leoni E. Effects of a 2-year school-based intervention of
school physical specifically-trained fitness, reduced sedentary enhanced physical education in the primary school. J Sch
education physical educators behavior and a smaller Health. 2013;83(9):639-46.
intervention) increase in BMI over the 3
yr intervention (2006-2009).
34
or Practice
Baseda
COMMUNICATE 1 Not mentioned Implementation evaluation was The intervention program Not mentioned Kamada M, Kitayuguchi J, Abe T, Taguri M, Inoue S,
(COMMUNIty- undertaken for all 3 arms of the was not more effective than Ishikawa Y, Harada K, Lee IM, Bauman A, Miyachi M.
wide CAmpaign To intervention, for both Phase 1 and Phase the standard-of-care in Community-wide promotion of physical activity in middle-
promote Exercise) 2. The type of outcome measures for changing physical activity aged and older Japanese: a 3-year evaluation of a cluster
information delivery included: the behavior, flexibility randomized trial. Int J Behav Nutr Phys Act. 2015 Jun
numbers of flyers, leaflets, posters, exercise and 3;12:82.
community newsletters, and banners musculoskeletal pain, over
distributed and the number of times and the 3 year follow-up period.
duration of local audio broadcasts. For
education delivery, the number of
participants and an estimate of population
coverage rate for such educational
activities was calculated as gross numbers
of participants divided by the population
within the age group 4079 years, in each
community. Support delivery was
documented by recording information on
times and hours of home visits, and
community engagement by documenting
the number and characteristics of
community partners.
According to the evaluation, information,

education and support delivery were
implemented in all communities; with
estimated quasi-population educational
activities coverage rate of 62% in Phase 1
and 24% in Phase 2. Conversely, home
visits and community engagement were
more intensive in Phase 2. The standard-
of-care in the control communities
included: medical check-ups, general
lifestyle education classes and ad-hoc
counseling.
Healthy Active 1 Government and tertiary Not mentioned Not mentioned Not mentioned http://www.hakkenya.org/index.php?option=com_content&
Kids Kenya academic institution and view=article&id=30&Itemid=53
Physical activity NGOs
report cards for
children and youth
HEPA Move for No Government, WHO and No evidence is available on the scope of Not mentioned Not mentioned http://docslide.us/documents/1-1-main-activities-on-the-
Health evidence tertiary academic activities. promotion-of-health-enhancing-physical-activity-in-
institutions macedonia-hepa-macedonia-2001-2007-hepa-macedonia-
2001-2007-simovska.html
Ecobici - Mexico 2 State/Government ECOBICI started with 85 bikestations, A Spanish language usage Government, Civil society Eco-bici is a Spanish-language website
City Public Bike nowadays has reached 444 in a 32 km2 evaluation is available at: https://www.ecobici.df.gob.mx/en.
Sharing Program area and 42 neighborhoods. https://www.ecobici.df.gob.
mx/sites/default/files/pdf/ec
obici_2014_encuesta.pdf
35
or Practice
Baseda
Muevete y Metete 2 This program is The REACH of the program has been The lack of evaluation and Not mentioned http://epode-international-
en Cintura (Move maintained by the local reported, for example, "In three years of assessment has been network.com/members/programmes/2014/11/14/muevete-
and get in shape) government and some its launch, 1 million 500 thousand people highlighted as a limitation y-metete-en-cintura
sponsorship from have been moving over the weekend in and a recommendation
companies. which the physical activators of the going forward. http://www.noalaobesidad.df.gob.mx/index.php?option=co
Ministry of Health of Mexico City visit m_content&view=article&id=70&Itemid=55.
public parks and esplanades in the Health
Fairs and the dozens of mass events that https://blumcenter.ucla.edu/files/view/pdfs-of-student-
have taken place in the 16 delegations of research-2013/E._Standen.pdf
Mexico City." Since 2012, more than
34,000 physical activity events have been
held in the city.
Paseo Dominical 2 State/government The uptake and engagement is not Not mentioned Not mentioned None provided.
(Sunday Cicolvia mentioned, although there are 42km of
program) available Ciclovias on Sundays.
BeweegKuur 2 Key actors for the Process evaluation results indicate that One-year results from 47 The website identifies the Helmink JH, Kremers SP, van Boekel LC, van Brussel-
(combined lifestyle Beweegkuur include: the GPs who participated were positive sites show significant following partnership with the Visser FN, de Vries NK. Factors determining the
intervention for towards the intervention; self-efficacy weight loss, reduction in "Dutch Institute for Sport & motivation of primary health care professionals to
obese and -family doctor and / or and peer support were factors that waist circumference and Exercise (NISB) to build implement and continue the 'Beweegkuur' lifestyle
overweight people nurse practitioner contributed to commitment for fasting glucose and a cooperation (networks) at intervention programme. J Eval Clin Pract. 2012
in combination with -lifestyle consultant implementation. Interviewees significant increase in national, regional and local Jun;18(3):682-8.
other risk factors, -physiotherapist or highlighted the advantage of competency physical activity levels. levels."
such as diabetes exercise therapist training (e.g. motivational interviewing Schutte BA, Haveman-Nies A, Preller L. One-Year Results
type 2) -dietician skills, general lifestyle counseling skills) of the BeweegKuur Lifestyle Intervention Implemented in
-local sport and exercise which would add to the sustainability of Dutch Primary Healthcare Settings. Biomed Res Int.
coaches the intervention. 2015;2015:484823.
Patients are referred via

family practitioners who
prepare the lifestyle
prescription or recipe.
The lifestyle consultant
then becomes the primary
care provider with as a
lifestyle coach and for
basic exercise prescription
and support. The
physiotherapist or exercise
therapist and dietitian
work closely with the
lifestyle consultant. In
addition, a local sport and
exercise supervisor called
in to support and motivate
participants in conducting
accessible, appropriate
physical activity and
works in conjunction with
the other professionals in
the Beweegkuur.
36
or Practice
Baseda
Dutch Obesity 1 The intervention is a Planned evaluation includes the following Following a promising Not mentioned Singh AS, Chin A Paw MJ, Kremers SP, Visscher TL,
Intervention in systematically developed, indicators: recruitment, context, reach, effectiveness trial, a Brug J, van Mechelen W. Design of the Dutch Obesity
Teenagers (DOiT) joint project involving dosage, fidelity, satisfaction, dissemination trial was Intervention in Teenagers (NRG-DOiT): systematic
municipal authorities, effectiveness and continuation. conducted in 20 development, implementation and evaluation of a school-
local sport services, implementation schools and based intervention aimed at the prevention of excessive
primary schools and local 9 control schools (national weight gain in adolescents. BMC Public Health. 2006 Dec
sport clubs; the pilot study level). There was no effect 16;6:304.
was thoroughly evaluated after 20 months on adiposity
(process, barriers, measures or physical Singh AS, Chinapaw MJ, Brug J, van Mechelen W. Process
mediators) and the scaling activity behaviors, however, evaluation of a school-based weight gain prevention
up process for national there were some effects on program: the Dutch Obesity Intervention in Teenagers
dissemination was well- the intake of breakfast and (DOiT). Health Educ Res. 2009 Oct;24(5):772-7.
described. However, for sugar-sweetened beverages.
BMI and physical activity van Nassau F, Singh AS, van Mechelen W, Paulussen TG,
outcomes, the scaled-up Brug J, Chinapaw MJ. Exploring facilitating factors and
program showed little or barriers to the nationwide dissemination of a Dutch school-
no effect. based obesity prevention program "DOiT": a study
protocol. BMC Public Health. 2013 Dec 19;13:1201. Ned
van Nassau F, Singh AS, Cerin E, Salmon J, van Mechelen

W, Brug J, Chinapaw MJ. The Dutch Obesity Intervention
in Teenagers (DOiT) cluster controlled implementation
trial: intervention effects and mediators and moderators of
adiposity and energy balance-related behaviours. Int J
Behav Nutr Phys Act. 2014 Dec 24;11:158.
van Nassau F, Singh AS, van Mechelen W, Brug J, Chin A

Paw MJ. In preparation of the nationwide dissemination of
the school-based obesity prevention program DOiT:
stepwise development applying the intervention mapping
protocol. J Sch Health. 2014 Aug;84(8):481-92.
37
or Practice
Baseda
JUMP-In 1 Municipal government and The improvements in JUMP-In from the The program was shown to Not mentioned except with De Meij JS, Chinapaw MJ, Kremers SP, Van der Wal MF,
educational authorities effectiveness trial to dissemination trial, increase participation in respect formulation of Jurg ME, Van Mechelen W. Promoting physical activity in
(embedded in policy), based on structured evaluation using the organised sporting activity, coalitions children: The stepwise development of the primary school-
school authorities, RE-AIM framework include the which was also associated based JUMP-in intervention applying the RE-AIM
neighborhoods, parents- following changes: with improved fitness. evaluation framework. Br J Sports Med. 2010
and personal components Sep;44(12):879-87.
i) increased reach through involving the
parents and by implementing the Pupil de Meij JS, Chinapaw MJ, van Stralen MM, van der Wal
Follow-up System (PFS); MF, van Dieren L, van Mechelen W. Effectiveness of
JUMP-in, a Dutch primary school-based community
ii) improved efficacy through targeting intervention aimed at the promotion of physical activity. Br
children with special challenges, and J Sports Med. 2011 Oct;45(13):1052-7.
improving the measure of physical
activity; de Meij JS, van der Wal MF, van Mechelen W, Chinapaw
MJ. A mixed methods process evaluation of the
iii) improved adoption by communicating implementation of JUMP-in, a multilevel school-based
more effectively with educators, and by intervention aimed at physical activity promotion. Health
providing adequate preparation time and Promot Pract. 2013 Sep;14(5):777-90.
recognition of these activities as part of
their job description;
iv) getting additional buy-in from

schools by developing MOUs or contracts
with the municipality for implementation
of the program;
v) improved implementation through

training and instructional presentations
provided for physical education teachers,
sports trainers and school staff carried out
by professionals; develop well-defined
and protocolised program components
and adequate information services;
vi) improved maintenance through

structural embedding, including formal
employment of physical education
teachers and coordinators to fulfill the
tasks;
vii) participation in public dialogue to

ensure adequate finances for structural
implementation; and
viii) developing structural professional

centralised service center for the
provision of technical assistance,
information, instruments, tools, cues,
reinforcement and training'.
38
or Practice
Baseda
Active Families 2 Practice nurses and GPs, During 2014/15,A survey was conducted The program was shown to The New Zealand Ministry of Anderson YC, Taylor GM, Grant CC, Fulton RB, Hofman
physical activity on behalf of the New Zealand Ministry of be effective in increasing Health and regional PL. The Green Prescription Active Families programme in
specialists within Health, and found that there were over physical activity levels in community partners, as well as Taranaki, New Zealand 2007-2009: Did it reach children in
communities, families, 1000 children from 936 families referred nearly 80% of participants health care professionals (GPs need? J Prim Health Care. 2015 Sep 1;7(3):192-7. PubMed
dietitians, and Community to the program, mainly by GPs and and 70% of families. and practice nurses) PMID: 26437042.
Sports Trusts pediatricians. The program reached those Almost all families
who were most in need, with the majority surveyed recognised the http://www.health.govt.nz/your-health/healthy-living/food-
from Maori or Pacific families, and from importance of physical and-physical-activity/green-prescriptions/active-families
low income homes. activity for health and well-
being.
39
or Practice
Baseda
Green Prescription 1 General practitioners The Ministry of Health carries out annual There is an extensive body An evaluation of the Green Rx Elley R, Kerse N, Arroll B, Swinburn B, Ashton T,
Practice nurses patient surveys, to determine the reasons of peer-reviewed literature in Donegal explored the role Robinson E. Cost-effectiveness of physical activity
Patients for referral, the degree of change in on the Green Prescription, of communities and health counselling in general practice. N Z Med J. 2004 Dec
Physical activity providers physical activity and other lifestyle showing it to be effective in professionals in sustainable 17;117(1207):U1216. PubMed PMID: 15608809.
Regional sports trusts behaviors, the degree of satisfaction with changing self-reported and implementation of the Green
(such as Sport Northland the program and the extent to which the pedometer-measured Rx. With respect to the Pfeiffer BA, Clay SW, Conatser RR Jr. A green
and Sport Otago) program was implemented successfully. physical activity levels . communities, the limitation prescription study: does written exercise prescribed by a
Primary health In 2015, over half of the 3000 adults The process is well-received appears to be readiness and physician result in increased physical activity among older
organisations surveyed were more active 6 months after by physicians and their capacity of the host adults? J Aging Health. 2001 Nov;13(4):527-38. PubMed
District health boards their GRx, and nearly 3/4 felt healthier. patients, the primary community group, which PMID: 11813739.
Maori health providers The vast majority of respondents were limitation being time, and a depends to some extent on
community groups. satisfied with the support from the recommendation that patient funding. In terms of the health Kerse N, Elley CR, Robinson E, Arroll B. Is physical
regional sports trusts and primary health support counselors play a professionals, when this activity counseling effective for older people? A cluster
care organisations administering the larger role. The program evaluation took place in 2013, randomized, controlled trial in primary care. J Am Geriatr
program. Most important was the has been shown to be cost- the Green Rx was still not Soc. 2005 Nov;53(11):1951-6. PubMed PMID: 16274377.
perception regarding the GRx support effective. The most likely embedded in the health
personnel follow-up and motivation. persons to be referred to the system, and while the doctors Croteau K, Schofield G, McLean G. Physical activity
http://www.health.govt.nz/our- program are those with were supportive and advice in the primary care setting: results of a population
work/preventative-health- some existing chronic understood the importance of study in New Zealand. Aust N Z J Public Health. 2006
wellness/physical-activity/green- condition, older adults or physical activity to reduce Jun;30(3):262-7. PubMed PMID: 16800204.
prescriptions/green-prescription- overweight persons. Finally, lifestyle disease, they still
research/green-prescription-patient- the program has been shown highlighted time constraints as Sinclair KM, Hamlin MJ. Self-reported health benefits in
survey to be acceptable across a a barrier. It is clear that an patients recruited into New Zealand's 'Green Prescription'
variety of cultural groups in almost seamless referral primary health care program. Southeast Asian J Trop Med
New Zealand. system is needed to maximise Public Health. 2007 Nov;38(6):1158-67. PubMed PMID:
implementation. 18613560.
http://www.hse.ie/eng/services
/Publications/corporate/evaluat Kolt GS, Schofield GM, Kerse N, Garrett N, Schluter PJ,
iongreenprescription.pdf Ashton T, Patel A. The healthy steps study: a randomized
controlled trial of a pedometer-based green prescription for
older adults. Trial protocol. BMC Public Health. 2009 Nov
1;9:404. doi: 10.1186/1471-2458-9-404. PubMed PMID:
19878605; PubMed Central PMCID: PMC2780414.
Elley CR, Garrett S, Rose SB, O'Dea D, Lawton BA,

Moyes SA, Dowell AC. Cost-effectiveness of exercise on
prescription with telephone support among women in
general practice over 2 years. Br J Sports Med. 2011
Dec;45(15):1223-9. doi: 10.1136/bjsm.2010.072439. Epub
2010 Nov 16. PubMed PMID: 21081641.
Patel A, Schofield GM, Kolt GS, Keogh JW. General

practitioners' views and experiences of counselling for
physical activity through the New Zealand Green
Prescription program. BMC Fam Pract. 2011 Nov
2;12:119. doi: 10.1186/1471-2296-12-119. PubMed PMID:
22044577; PubMed Central PMCID: PMC3233500.
Leung W, Ashton T, Kolt GS, Schofield GM, Garrett N,

Kerse N, Patel A. Cost-effectiveness of pedometer-based
versus time-based Green Prescriptions: the Healthy Steps
Study. Aust J Prim Health. 2012;18(3):204-11. doi:
10.1071/PY11028. PubMed PMID: 23069363.
40
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Tava'e N, Nosa V. The Green Prescription programme and
the experiences of Pacific women in Auckland. J Prim
Health Care. 2012 Dec 1;4(4):313-9. PubMed PMID:
23205381.
Patel A, Kolt G, Keogh J, Schofield G. The Green

Prescription and older adults: what do general practitioners
see as barriers? J Prim Health Care. 2012 Dec 1;4(4):320-7.
PubMed PMID: 23205382.
41
or Practice
Baseda
Project Energize 1 Sport Waikato and AUT The process evaluation for the school- The overall effect of the Sport Waikato and AUT Rush E, Reed P, McLennan S, Coppinger T, Simmons D,
University, University of based component of this project formed program on health outcomes University, University of Graham D. A school-based obesity control programme:
Waikato, Waikato Institute part of a PhD dissertation from the was generally modest but Waikato, Waikato Institute of Project Energize. Two-year outcomes. Br J Nutr. 2012
of Technology, Sport and Aukland University of Technology. favorable over a 2 year Technology, Sport and Feb;107(4):581-7. doi: 10.1017/S0007114511003151.
Recreation NZ, National Project Energize has been operating in period. The intervention Recreation NZ, National Epub 2011 Jul 7. PubMed PMID: 21733268.
Health Foundation Waikato, New Zealand primary schools was associated with a Health Foundation Program
Program delivery partners since 2005. In 2011 the Project Energize slower age-related increase delivery partners include: Graham D, Appleton S, Rush E, McLennan S, Reed P,
include: Maori and program delivered by Sport Waikato in systolic blood pressure in Maori and Pacific health Simmons D. Increasing activity and improving nutrition
Pacific health providers Te included 40,000 children, 244 schools, 10-12 year olds, and less providers Te Kohao Health, Te through a schools-based programme: Project Energize. 1.
Kohao Health, Te and 27 Energizers including one accumulation of body fat in Korowai Hauora O Hauraki, Design, programme, randomisation and evaluation
Korowai Hauora O dietitian. the 5-7 yr old intervention Nga Miro Health and South methodology. Public Health Nutr. 2008 Oct;11(10):1076-
Hauraki, Nga Miro Health group, when compared to Waikato Pacific Islands Health 84. doi: 10.1017/S136898000700153X. Epub 2008
and South Waikato Pacific controls. Unfortunately, Committee.
Islands Health Committee. physical activity was not Anna Mrkusic, School engagement in the Project Energize
measured, either health intervention programme. What works, what does
subjectively or objectively, not work, what next?
but physical activity http://www.waikatodhb.health.nz/assets/public-health-
knowledge was reported to advice/project-energize/School-engagement-in-the-Project-
have increased in the Energize-health-intervention-programme.pdf
majority of intervention
schools.
World Day for No Not clear Not mentioned Not mentioned Not mentioned None provided.
Physical Activity evidence
celebration
Exercise referral 2 Government Not mentioned Not mentioned Not mentioned None provided
and 10000 Steps
Introducing No Government policy Not mentioned Not mentioned Not mentioned None provided
physical activity evidence
classes in primary
schools / Integrating
physical activity
course as a college
requirement
42
or Practice
Baseda
Cyclovias and 2 Not mentioned Not mentioned Not mentioned Not mentioned http://rpp.pe/lima/seguridad/55-ciclovias-para-montar-
Recreativas (Open bicicleta-en-lima-feliz-de-la-vida-noticia-901774
Streets) https://es.wikipedia.org/wiki/Ciclovas_en_Lima
Municipality of http://gettingto2100.org/a-tale-of-three-cities-sunday-
Lima cycling-in-lima-peru/
Mexa-se Mais 2 City Council of Oeiras and City Council of Oeiras and College of Not mentioned Not mentioned http://www.gulbenkian.pt/mediaRep/gulbenkian/files/instit
(Better Activity, College of Motricity and a Motricity are indicated to be responsible, ucional/FTP_files/pdfs/FuturodaSaude2014/ReportFuturefo
More Health) scientific -pedagogical however, the extent and nature of the rHealth_FCG2014/files/assets/basic-html/page86.html
commission monitoring and evaluation is not detailed
in any document
http://www.ensp.unl.pt/saboga/prosaude/misc/hp_source/in
/HP_Joana_Rita_i.pdf
National Physical No Government educational Not mentioned Not mentioned Not mentioned http://www.namat.qa/NamatImages/Publications/75/QATA
Activity Guidelines evidence agency R%20PA%20GUIDLINE%20ENGLISH.PDF
Exercise is No Government Not mentioned Not mentioned Not mentioned None provided
Medicine and More evidence
pedestrian activity
Active Scotland 2 Government and the For each outcome, there is established Not mentioned As described under key actors http://www.gov.scot/Topics/ArtsCultureSport/Sport/Outco
Outcomes National Strategic Group surveillance of key indicators, and mes-Framework
Framework for Sport and Physical strategies to address shortfall and achieve
Activity (NSG), chaired targets.
by the Cabinet Secretary
for Health, Wellbeing and
Sport. The framework
describes the key
outcomes desired for sport
and physical activity in
Scotland over the next ten
years. Success will rely on
the collective efforts of
communities, individuals
and a wide range of
partners.
Seychelles national 2 Government Not mentioned Not mentioned Government, sport bodies None provided
policy on sports and
physical activity
(recent, not clear
yet how much it
contributes to PA
promotion),
43
or Practice
Baseda
Golden Sun and 2 Ministry of Education and None mentioned or able to be sourced in None mentioned or able to Not mentioned None provided
KrPan programs Sports English, other than the reach (% of be sourced in English
targeted group that participate)
Move for Health 2 Ministries of Health, Approximately 78 health, sport and other Not mentioned The HEPA Policy Audit Jurican AB, Health-enhancing physical activity (HEPA)
Slovenia Transport, Sport, Tourism, organisations participate in events indicated that partnerships Policy Audit Tool (PAT), Slovenia. June 2012,
Education, along with associated with the annual 2km walking within government included www.euro.who.int/hepapat
sporting clubs and the tests. Between 1999 and 2009, 1375 walk Ministries of Health,
Olympic Committee of test events were conducted, and 17 000 Transport, Sport, Tourism and
Slovenia people were tested in the first five years Education. In addition,
of the project. The overall fitness levels partnerships with civil society
of persons being tested over this time and NGO's included the
actually declined, because the program International Nordic Walking
began to attract higher risk persons. As a Association, Slovenia Runs,
result, CINDI Slovenia and partners and Slovenia Cycle, as well as
responded by training around 1750 the Olympic Committee of
medical staff and sports experts in the Slovenia and various sporting
field of health promotion and counseling codes.
for health enhancing physical activity.
Further evaluation is underway.
Discovery Vitality 2 Private health insurer Not mentioned In 2012, a retrospective Not mentioned Patel D, Lambert EV, da Silva R, Greyling M, Kolbe-
Physical activity (medical scheme), fitness longitudinal analysis Alexander T, Noach A, Conradie J, Nossel C, Borresen J,
incentives/benefits center chains interrogated changes in Gaziano T. Participation in fitness-related activities of an
in health insured participation in the fitness- incentive-based health promotion program and hospital
persons related activities over three costs: a retrospective longitudinal study. Am J Health
years and in-patient health Promot. 2011 May-Jun;25(5):341-8. doi:
claims among more than 10.4278/ajhp.100603-QUAN-172. PubMed PMID:
300,000 members. 21534837.
Participation in fitness-
related activities increased https://www.discovery.co.za/portal/individual/vitality
over time in the Vitality
program, with gym
membership growing from
24-33%, and fewer inactive
members (76% to 69%).
Those members who
increased their fitness-
related activities, over the
three years was associated
with a significantly lower
probability of hospital
admissions and in-patient
claims.
44
or Practice
Baseda
Grassroots Soccer 2 NGOs and FIFA Grassroots Soccer currently works from Grassroots soccer, typically Not mentioned Fenton SA, Duda JL, Barrett T. The Contribution of Youth
five core sites across South Africa as practiced in low-income Sport Football to Weekend Physical Activity for Males
shown in the map above: Alexandra, settings, is associated with Aged 9 to 16 Years: Variability Related to Age and Playing
Cape Town, Kimberley, Port Elizabeth, greater HIV/AIDS Position. Pediatr Exerc Sci. 2015 May;27(2):208-18.
and Soweto. awareness and lower doi:10.1123/pes.2014-0053. Epub 2014 Nov 10. PubMed
stigma, and contributes PMID: 25387122.
significantly to achieving
the recommended Balfour L, Farrar T, McGilvray M, Wilson D, Tasca GA,
guidelines for moderate-to- Spaans JN, Mathews C, Maziya L, Khanyile S, Dalgleish
vigorous activity for youth. TL, Cameron WD. HIV prevention in action on the football
field: the WhizzKids United program in South Africa.
AIDS Behav. 2013 Jul;17(6):2045-52. doi:
10.1007/s10461-013-0448-6. PubMed PMID: 23504231.
http://www.grassrootsoccer.org/research-
development/proven-results/
Siyadladla Mass 2 National Department of Monitoring and evaluation reports for Not mentioned Burnett C, and W. J. Hollander. "Post-impact report of the
Participation Sports and Recreation, Siyadlala that suggests that this mass Mass Participation Projects of Sport and Recreation South
Program Community Leaders, participation program is now reaping Africa." Report prepared for SRSA, Department of Sport
NGOs, Sporting Codes, rewards, with increase in capacity and and Movement Studies, University of Johannesburg (2006).
and Schools participation (38 community hubs, 9537
participants per week, 122 activity Burnett, Cora. "Siyadlala delivering community sport in
coordinators and more than 740 practice Gauteng: delivery and uptake." African Journal for
sessions per week, typically involving an Physical Health Education, Recreation and Dance 20.1
average of 25 participants per session). (2014): 76-88.
Results from formal evaluation in http://www.srsa.gov.za/pebble.asp?relid=90

Gauteng province show many benefits to
learners. When surveyed, more than 75%
secondary school respondents cited the
following benefits of Siyadlala: improved
health, more discipline and kept them
busy and gave them a feeling of safety.
More than two-thirds also cited lifeskills
as a benefit, and over a third indicated
that it reduced the likelihood of drinking
alcohol and also risk of HIV/AIDS.
MOVI2 program 1 Not mentioned Not mentioned In progress, but only of the Not mentioned http://www3.uclm.es/proyectosCESS/movi2/public/interve
for Extracurricular intervention, not scaling up ntion
physical activity
Nirogi Lanka No Government, worksites, Not mentioned Not mentioned Not mentioned http://nirogilanka.org/projects-phase1.html
project; - Diabetes evidence health care providers and
awareness and schools
prevention
45
or Practice
Baseda
"Shukuma" (be No Government Not mentioned Not mentioned Not mentioned http://www.gov.sz/index.php?option=com_content&view=
active) policy under evidence article&id=372&Itemid=359
the Ministry of Arts
and Culture and
Sports
Physical Activity on 1 The scaling up of the Monitoring evaluation by government Research has shown that the The partnerships with activity Kallings et al. 2008. Physical activity on prescription in
Prescription (FaR) FaR@ program depends indicates that less than a third of patients program is effective in leaders and community primary health care:a follow-up of physical activity level
in combination with on cooperation between discuss lifestyle with their doctors, that increasing levels of physical resources, along with and quality of life. Scand J Med Sci Sports, 18(2): 15461.
Physical Activity in the Health Care System women are more likely to participate in activity in patients. government funding appear to Raustorp and Sunberg, Schweizerische Zeitschrift fur
Disease Prevention and various physical FaR@ than men, that funding for FaR@ be important in terms of Sportmedizin und Sporttraumatologie 62 (2), 2325, 2014.
and Treatment activity organizers within needs to be expanded, that reimbursement scaling up. https://www.folkhalsomyndigheten.se/pagefiles/12386/Phy
(FYSS) the local community, for for FaR@ to patients needs to be sical-activity-and-public-health-in-Sweden.pdf
example, NGOs such as increased, that a more formal relationship
sport associations, patient with activity leaders and community
organizations or municipal resources needs to be established, that
facilities and private there is a need to integrate the physical
business. activity information into a more
formalised health care records, and
finally, there is more regular evaluation
and monitoring.
Youth and Sports: 2 Government There does appear to be information Not mentioned Not mentioned Federal Office of Sport
www.jugendundspo concerning the number of persons
rt.ch. undergoing training, and the reach of the http://www.baspo.admin.ch
program in various internet sites.
www.jugendundsport.ch.
Scaling Up No Not mentioned Not mentioned Not mentioned Not mentioned http://scalingupnutrition.org/news/tajikistan-brings-people-
Nutrition: Nutrition evidence together-to-scale-up-plans-for-improved-nutrition-and-
and Physical physical-activity
Exercise Strategy
Fighting Obesity 1 National government, The evaluation of the national media Not mentioned Not mentioned Arikan I, Karakaya K, Erata M, Tzn H, Baran E, Levent
Campaign national media and health campaign showed that overall awareness G, Yeil HK. Fighting obesity campaign in Turkey:
care providers was high with more than 85% of persons evaluation of media campaign efficacy. Cent Eur J Public
surveyed nationally who were familiar Health. 2014 Sep;22(3):170-4.
with the campaign. The overall adoption
of self-reported behavioral change was
nearly 30% However, there were no
specific details concerning changes in
physical activity behavior.
Dubai Pulse and 2 Government The program has been associated with The program has been Not mentioned http://www.emro.who.int/health-education/physical-
Upgrade of all over 15000 persons taking part in events. associated with an increase activity-case-studies/dubai-pulse-uae.html
public parks, in the overall population
running tracks and prevalence of physical
public beaches activity.
46
or Practice
Baseda
National Cycle 2 The Network is owned by Regular evaluation takes place The Network spin-offs for Not specifically mentioned. National Cycle Network Impact.
Network local authorities and concerning the users of the network. health suggest that the UK http://www.sustrans.org.uk/policy-evidence/the-impact-of-
landowners, such as: The Recent monitoring shows that over half economy saves the our-work/national-cycle-network-impact
National Trust, Network the users are in fact, walkers; that 27 equivalent of nearly
Rail, the Highways million schoolchildren use the Network 900,000 per day in health Brand C, Goodman A, Ogilvie D. Evaluating the impacts of
Agency, the Forestry for the daily trips to and from school; that related benefits; that the new walking and cycling infrastructure on carbon dioxide
Commission and Canal more than half the people using the Network was responsible emissions from motorized travel: a controlled longitudinal
and River Trust. Sustrans Network feel fitter and that it saves them for a 22 million savings for study. Appl Energy. 2014 Sep 1;128:284-295. PubMed
is responsible for 560km money. the National Health Service PMID: 26435570; PubMed Central PMCID: PMC4591464.
of the National Cycle by reducing the prevalence
Network where the charity of obesity, and through Cope A, Cairns S, Fox K, Lawlor DA, Lockie M, Lumsdon
has purchased or been using the Network, more L, Riddoch C, Rosen P. The UK National Cycle Network:
gifted the land. Sustrans than 1 million UK citizens an assessment of the benefits of a sustainable transport
also has a network of were able to meet the infrastructure. World Transport Policy & Practice, Volume
volunteers who help to recommended levels of 9, Number 1, 2003.
maintain the land and physical activity.
upkeep on the Network.
The co-benefits of a modal
shift of almost 30 million
car trips replaced by persons
traveling on the Network,
means less congestion,
noise pollution and CO2
emissions. People traveling
by foot or on bicycles tend
to spend more in local
shops, and there is a direct
benefit to the economy of
33 million as a result of
fewer sick days.
47
or Practice
Baseda
StreetGames 2 NGO's, Government In terms of scaling up, StreetGames Not mentioned StreetGames is a national http://www.streetgames.org/sites/default/files/StreetGames-
poverty alleviation manages the network of Doorstep Sport partner of Sport England and a Strategic-Plan-2013-2017.pdf
program, sporting codes, providers, representing over 600 centre of expertise for
community organisations, independent organisations, including developing doorstep sport in http://www.streetgames.org/our-work
sports clubs community groups, local authorities, and disadvantaged communities.
sports clubs, as well as NGOs interested The charity supports
in disadvantaged youth. community based sports
projects that deliver sport and
From its beginnings in 2007, StreetGames volunteering opportunities to
started a program in in Wales 2009, and young people living in the
in the program was supported by Sport 20% most deprived wards in
Wales and the Welsh Governments the UK. StreetGames works
Communities First Program for poverty with National Governing
alleviation, to increase sporting Bodies of Sport to establish
opportunities. At present, they work with and develop links between
44 out of the 52 Community First community and mainstream
clusters, and it has been estimated that sport, and was recognised by
over 18,323 Young people have benefited the London 2012 Olympic &
directly from StreetGames activity. Paralympic Games Inspire
Mark
The network is continuing to grow with
over 150 national and regional
organisations involved across the nation.
StreetGames also works with the national

governing bodies of sport to help them to
grow their sport amongst disadvantaged
young people.
In 2012, over 6000 coaches had been

trained, nearly 4000 volunteers and over 2
million cumulative attendances at events.
48
or Practice
Baseda
Well at Work 2 Government, British Heart Not scaled up yet. Key findings were that it External service providers Bull F, Adams E, Hooper P. Well@Work, Promoting
Foundation, Worksites, was possible in some were found to be an important Active and Healthy Workplaces, Final Evaluation Report,
Tertiary academic worksite settings to increase component of successful http://www.bhfactive.org.uk/userfiles/Documents/WWEV
institutions participation in active travel implementation. ALUATIONREPORT1.pdf
(facilitated by bike storage,
changing facilities and
incentives), and that
walking groups could be
formed with some success.
However, exercise classes
enjoyed lower uptake, due
to the limitations of time
and appropriate showering
and changing facilities.
Competitions and team
challenges, for example,
based on pedometer steps
were popular. For example,
in one pedometer challenge
the average increase in step
counts across 4 teams over
405 weeks was 48%.
Another challenge
attempted to increase stair
use (Stairway to Health),
resulting in a 28% overall
increase in stair-use. This
campaign incorporated
posters and email
messaging. Additionally, a
supportive environment
with respect to facilities,
company policy, and the
presence of a wellness
champion, all were found to
be extremely important for
successful implementation.
Exercise is No Not mentioned Not mentioned Not mentioned Not mentioned Lara A et al. Pausa para tu salud: reduction of weight and
Medicine and evidence waistlines by integrating exercise breaks into workplace
Active Pauses at organizational routine. Prev Chronic Dis 2008;5(1).
Work http://www.cdc.gov/pcd/issues/2008/jan/06_0122.htm.
49
or Practice
Baseda
Complete Streets 2 Local government, urban To date, over 700 agencies at the local, Complete Streets have been On a broader level, Moreland-Russell S, Eyler A, Barbero C, Hipp JA, Walsh
and Safe Routes to planners, transport regional, and state levels have adopted associated with improved particularly with respect to H. Diffusion of Complete Streets policies Across US
School planners, civil society for Complete Streets policies. Recent studies traffic safety for partnerships for SRTS, a communities. J Public Health Manag Pract. 2013 May-
Complete Streets; USA have identified factors that help to ensure pedestrians, reducing risk in recent best practice publication Jun;19(3 Suppl 1):S89-96. doi:
Federal government, adoption of Complete Streets policies one study by 28%. highlighted the following key 10.1097/PHH.0b013e3182849ec2. PubMed PMID:
communities, schools and within communities and these include: the Complete Steets are lessons: to communicate and 23529062.
partners for Safe Routes to state obesity rate , the percentage of associated with a greater consider differing viewpoints,
School including: Partners people who bike or walk to work in the prevalence of meeting to partner with schools early, Geraghty AB, Seifert W, Preston T, Holm CV, Duarte TH,
include: the American state and the presence of a border physical activity guidelines try multiple strategies to Farrar SM. Partnership moves community toward
Association of State community with a Complete Streets and active travel. They have increase participation, do not complete streets. Am J Prev Med. 2009 Dec;37(6 Suppl
Highway and policy. been associated with less expect rapid change, target 2):S420-7. doi: 10.1016/j.amepre.2009.09.009. PubMed
Transportation Officials, traffic congestion, and children, have a strong PMID: 19944943.
America Walks, Since 2005, the SRTS program has reduced carbon emissions. evaluation plan to monitor
Governors Highway reached more than 6.8 million students progress, and collaborate with Macridis S, Garca Bengoechea E. Adoption of Safe Routes
Safety Association, nationwide, with underserved schools Safe Routes to school have pre-existing groups. to School in Canadian and the United States Contexts: Best
Institute of Transport well represented. In a study of the SRTS been shown to significantly Practices and Recommendations. J Sch Health. 2015
Engineers, and the Toole program, 4 key factors were identified to increase the prevalence of Aug;85(8):558-66. doi: 10.1111/josh.12283. PubMed
Design Group ensure successful program children walking and PMID: 26149312.
implementation. These included: (1) cycling to school (24-28%
Identifying an in-school leader, often the increase). In a modeling Muennig PA, Epstein M, Li G, DiMaggio C. The cost-
principal, to champion SRTS, (2) exercise, SRTS changes in effectiveness of New York City's Safe Routes to School
Conducting activities that reinforce road infrastructure were Program. Am J Public Health. 2014 Jul;104(7):1294-9. doi:
walking and bicycling, such as frequent modeled against societal 10.2105/AJPH.2014.301868. Epub 2014 May 15. PubMed
walker/biker programs and Walk to costs and injury rates, PMID: 24832430.
School Day events, (3) Generating parent showing it to be a cost-
support for SRTS, and (4) Establishing effective intervention. Stewart O, Moudon AV, Claybrooke C. Multistate
policies that support SRTS, such as early evaluation of safe routes to school programs. Am J Health
dismissal for students who walk or Promot. 2014 Jan-Feb;28(3 Suppl):S89-96. doi:
bicycle home from school. 10.4278/ajhp.130430-QUAN-210. PubMed PMID:
24380471.
http://www.smartgrowthamerica.org/complete-
streets/complete-streets-fundamentals/complete-streets-faq
http://saferoutesinfo.org/program-tools/national-
progress/national-reports
50
or Practice
Baseda
Grow Healthy 2 Government, NGO, Implementation, uptake and sustainability Not mentioned Partners involved in Grow http://www.transtria.com/pdfs/HKHC%20Case%20Reports
Together Community, are reported on the website; highlighting Healthy Together Chattanooga %2012_29_14/Chattanooga,%20TN.pdfy
Chattanooga certain challenges, such as funding for included the City of Parks and
infrastructure, political changes for Recreation, Ochs Center for
example in the mayor's office, failure of Metropolitan Studies,
community members to meet their Chattanooga-Hamilton County
responsibilities. However, there appears Regional Planning Agency,
to be planning in place for a more Chattanooga Area Chamber of
community-centred approach and some Commerce, University of
innovation in terms of delivery (mobile Tennessee at Chattanoogas
apps, etc.). Department of Health and
Human Performance,
http://www.transtria.com/pdfs/HKHC%2 University of Tennessee
0Case%20Reports%2012_29_14/Chattan Agriculture Extension Office,
ooga,%20TN.pdf Crabtree Farms, the
Chattanooga Medical Society
and Foundation, Benwood
Foundation, and other local
organizations and groups.
Exercise is 2 Government and Not mentioned Not mentioned Not mentioned http://www.exerciseismedicine.org/assets/documents/pdf_fi
medicine American College of les/2015%20International%20Prospectus_EIM%20Venezu
Sports Medicine ela.pdf
a
Type of Evidence, [1=Evidence-based Practice (i.e., research-driven scaled-up intervention), 2=Practice-based Evidence (i.e., real world program evaluated for effectiveness by researchers)];
NOTE: The information contained in this Web Table was abstracted by co-authors Estelle V. Lambert and Shifalika Goenka.
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16tl0990

Physical Activity 2016: Progress and Challenges

www.thelancet.com Published online July 27, 2016 http://dx.doi.org/10.1016/S0140-6736(16)30728-0 1

University of Cape Town, Cape

2 www.thelancet.com Published online July 27, 2016 http://dx.doi.org/10.1016/S0140-6736(16)30728-0

an extended list based on that used by Milat and colleagues9

truly scaled-up interventions, defined for this study as

www.thelancet.com Published online July 27, 2016 http://dx.doi.org/10.1016/S0140-6736(16)30728-0 3

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Push factors Pull factors

Evidence-based Internal validity External validity Practice-based

Integrative variables: multisector collaboration, co-benefits, systems thinking

Contextual variables: political climate, economic conditions, public interest

Figure 3: Framework for scaling up physical activity interventions

benefits of the intervention continue to occur through Conclusions

www.thelancet.com Published online July 27, 2016 http://dx.doi.org/10.1016/S0140-6736(16)30728-0 9

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Appendix Section Pages

B. Instruments used in the adapted Delphi survey 4

Aim of the systematic review

Add a long activity-based school break to the school schedule

Using social marketing techniques, the program consisted of 3 components:

A More Active Scotland

Key components for physical activity include:

World Day for Physical Activity

Of the organisations that were aware of

There was a significant differences in

Finally, 33% of organisations intended on

Pratt M, Brownson RC, Ramos LR, Malta DC, Hallal PC,

Ribeiro IC, Torres A, Parra DC, Reis R, Hoehner C,

Simoes EJ, Hallal P, Pratt M, Ramos L, Munk M,

(h) a high level of legitimacy of the

(i) special attention to improve

Agita Sao Paulo also has a strong social

Funding was received by

In general, there were

According to the evaluation, information,

Patients are referred via

van Nassau F, Singh AS, Cerin E, Salmon J, van Mechelen

van Nassau F, Singh AS, van Mechelen W, Brug J, Chin A

iv) getting additional buy-in from

v) improved implementation through

vi) improved maintenance through

vii) participation in public dialogue to

viii) developing structural professional

Elley CR, Garrett S, Rose SB, O'Dea D, Lawton BA,

Patel A, Schofield GM, Kolt GS, Keogh JW. General

Leung W, Ashton T, Kolt GS, Schofield GM, Garrett N,

Patel A, Kolt G, Keogh J, Schofield G. The Green

Results from formal evaluation in http://www.srsa.gov.za/pebble.asp?relid=90

StreetGames also works with the national

In 2012, over 6000 coaches had been

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