Here I recount some interesting developments in the reporting of injury risk in rugby union. Enjoy (and be concerned!)
Here I recount some interesting developments in the reporting of injury risk in rugby union. Enjoy (and be concerned!)
Why is so much attention given to physical activity? Why do we care about it? Why is it in policy?
To answer this, in my book, I argue that we should think of physical activity as a specific political discourse. Discourses are forms of knowledge, so they govern the way a topic can be meaningfully talked about or reasoned about, and they influence how policy ideas are put into practice. So instead of thinking about physical activity simply as human movement, from a policy perspective it is much more than that. Here is a brief explanation of my thinking …
The physical activity discourse, I argue, has not emerged out of nothing. Other discourses, like ingredients, have facilitated the escalation in physical activity’s rise to prominence and legitimacy. For example, consider the obesity epidemic which has framed human bodies as susceptible to specific judgement and surveillance (see Gard and Wright, 2005). The rise of surveillance technologies which affect both leisure and work has allowed physical activity to be measured ad infinitum (and ad nauseum).
Of course, the discourse does not necessarily appear with all these ingredients. It needs a raft of committed “bakers” who will devote time and attention to escalate and seek legitimacy for the physical activity problem. Networks are needed, most obviously manifesting as scientific associations of physical activity. And along with these scholarly societies come links to industry and the state.
And after scientific elements establish legitimacy, the physical activity discourse is continually built upon and deployed in different spheres, with frontiers in all directions. Indeed, this framework for thinking about the physical activity discourse is not intended to be static. There will be specific contexts which frame physical activity in unique ways. That is part of what makes the discourse a potentially powerful policy driver. Its hybridity and its potential omnipresence as a matter of concern (affecting all domains of human life) means that it can be potentially infused into all sorts of policies.
The model below shows how a range of “forms of knowledge” work together (and / or separately) to produce what we know about physical activity (particularly in many Western, developed societies).
While I suggest biomechanics is an essential discourse, it does not carry a great amount of disciplinary weight when physical activity is researched, analysed or justified. Human movement without values added is not enough to produce and sustain the physical activity discourse. More influential is the biomedical discourse, which has made connections between physical activity, health, and death rates. (There’s more in the book on this!). Various sustaining discourses shown above allow for physical activity to be deployed at different times in texts, policies and programmes by a wide array of different organisations. You can see “health” is only one of many discourses that sustains current concern about it. Many other discourses contribute now too.
This discourse has real implications. Correlating insufficient physical inactivity with all manner of economic, health, environmental, and inter-personal outcomes leads to a number of flow on effects, including the production of new experts, new expectations, authoritative organisations and specific ideas about social order.
I argue that by seeing viewing physical activity in this way – as a discourse made up of the interplay of other discourses (and not simply as a means to promote public health) – we might better appreciate how the swirling and growing mass of concern about physical activity affects us all.
In my book, I offer a new definition of physical activity. Definitions are important because they set the scene for everything that follows. I propose that:
physical activity involves people moving, acting and performing within culturally specific spaces and contexts, and influenced by a unique array of interests, emotions, ideas, instructions and relationships.
A new definition is needed to move the concept of physical activity beyond it’s previous entrenchment in biomedical and epidemiological discourse. Previous definitions are too narrow and therefore insufficient to account for the complex nature of physical activity. There is an opportunity to open up the discourse of physical activity to be more inclusive of the wide variety of academic disciplines that study it, the increasing number of governmental departments that address it, and most importantly the enormous range and depth of human experiences which are attached to it.
Some historical context
Perhaps the most well-known and most cited definition of physical activity comes from Caspersen, Powell and Christenson (1985), who describe it as “any bodily movement produced by skeletal muscles that results in energy expenditure” (p. 126). It is important to note that this definition is authoritative within academia. Caspersen’s et al. 1985 article has been cited 8138 times according to Google Scholar (at the time of writing), an indication of its popularity. Other slight variations on this definition are also popular. This definition informs many health policies around the world (Australian Government, 2011; WHO, 2018). In 2018, the World Health Organisation’s (WHO) Global Strategy on Physical Activity deployed a slight variation of this definition – instead of activity resulting in energy expenditure, the WHO claimed that “any bodily movement produced by skeletal muscles that requires energy expenditure” (p. 14). In any case, I argue the sentiment remains the same.
The definition by Caspersen and colleagues is confined to, and thereby constrained by, epidemiology discourse. Indeed, the first sentence of their 1985 article declares that “The epidemiological study of any concept or event requires that the item under investigation be defined and measured” (p. 126). And so, in describing the “elements” of physical activity, the focus is on “bodily movement, skeletal muscles, energy expenditure, kilo-calories” and a positive correlation with “physical fitness” (p. 127). And so the definition is heavily laden with a particular type of science. The aim here is not to allege Caspersen’s definition and description of physical activity is insufficient for epidemiology. However, there are various reasons why the definition falls short of articulating what physical activity (really) is.
Towards a new definition …
First, I argue that physical activity is not the sole domain of epidemiology. The British Medical Journal describes epidemiology as “the study of how often diseases occur in different groups of people and why” (BMJ, 2019). By framing physical activity solely in relation to disease-potential and disease management, much is marginalised and ignored.
Caspersen’s et al definition is dis-integrated and exclusionary. It is dis-integrated because it prioritises some aspects – the anatomical (bodily movement, skeletal muscles), physiological (energy expenditure) – to the exclusion of others.
The cerebral, psychological and emotional aspects of physical activity are not accounted for. The elements of physical activity by Caspersen et al omit any reference to personal motives, emotions or thought. Struggle, pain, joy, achievement to name a few are inherent components of physical activity (either as motivations, outcomes or both), and so need to be accommodated. To illuminate this point, consider how Brian Pronger’s (2002) could not reconcile the embodied emotion and amazement of his active childhood with the technological knowledge of his university studies in physical education:
“I wrote about ‘the powerful source,’ the wonder and infinity that I discovered in swimming. And I said that when I started to study physical education, that dimension was completely absent from everything we were taught. The technological education I was receiving rendered the wonder second. And as I survey the array of scientific, government and commercial texts on physical fitness, I hear only silence in this regard. The technology of physical [fitness] seems deaf to this dimension of life. So the question of secondness here is: what kind of life is produced in such deafness? But another question also arises: what latent possibilities does that silence hold?” (p. 15)
While policy texts on physical activity do increasingly mention ideas about mental wellbeing, they still tend to stop well short of ‘wonder’. A more holistic definition of physical activity will move beyond “bodily movement” to appreciate lived experiences which inform physical activity.
Second, any definition of physical activity should not ignore the political and social aspects of activity that are shape the provision and structure of physical activity, from state resources for outdoor public space, to the culturally dominant expectations about what sorts of physical activity are encouraged. The political aspect of physical activity can be extended further to consider the efforts that are made to control, persuade and judge the physical activities that people partake in. There is space for depth, richness and inclusivity by redefining physical activity to account for its complexities, nuances and politics. As Silk, Andrew and Thorpe (2017) mention in their discussion of physical cultural studies, human movement can and should be considered from a variety of levels, including “the socio-cultural, discursive, processual, institutional, collective, communal, corporeal, affective and subjective” (p. 1). And so by including this depth in a new definition, there is room to expand both conversations about physical activity and policies which promote it.
So to repeat, this proposed new definition of physical activity involves people moving, acting and performing within culturally specific spaces and contexts, and influenced by a unique array of interests, emotions, ideas, instructions and relationships.
This definition involves three aspects not captured in earlier definitions:
I welcome improvements on this definition! I also hope this is not the end of discussion about what physical activity is.
Australian Government Department of Health (2011). Definitions. Retrieved from https://www.health.gov.au/internet/publications/publishing.nsf/Content/phd-physical-rec-older-disc~Definitions
British Medical Journal (2019). Chapter 1. What is epidemiology? https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/1-what-epidemiology
Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985; 100:126–131
Pronger B. (2002). Body Fascism. Salvation in the Technology of Physical Fitness. Toronto: University of Toronto Press.
Silk, M., Andrews, D. and Thorpe, H. (eds), (2017). Routledge handbook of physical cultural studies. London: Routledge.
World Health Organisation (2018). More Active People for a Healthier World, Global Action Plan on Physical Activity 2018-2030. WHO.
I have not been to an ISPAH conference since Rio, 2014. I have noticed quite a few changes since then. It seems more mature now. The talks I saw involved critical reflection, and there were entire sessions dedicated to health inequalities. And it was great to see far less Coca Cola, and much more “co-creation” (see what I did there).
Given the propensity for graphs at the conference, here is another one:
What the chart above shows with magnificent precision is that after initial calls for and hopes for change at the start of conferences, research presentations often are forced to acknowledge a lack of policy traction, barriers to implementation and modest intervention success, as well as many arguments about what best practice actually is. Along with this is often palpable frustration about the “slow progress” of policy change and the subsequent hoped-for population change. Maybe this is an essential part of all conferences, especially ones which are associated with major public health goals.
Set in the Brutalist QE2 Conference Centre in the heart of London, it is clear ISPAH is becoming physically and politically closer to decision makers around the world. While intersectoral partnerships take time to cultivate, it seems progress is being made. Professor Fiona Bull, working for the WHO on disease prevention, is a spokesperson for the movement and a connected and successful policy entrepreneur in the realm of PA promotion. And it appears there is an ever-growing legion of evangelical enthusiasts making connections with the various sectors, from state to transportation and town planning.
“Systems approaches” continued to get a lot of air time throughout the conference. Mapping systems is a logical and noble pursuit, though the limitations need to be, and were, acknowledged early in the conference.
While a small point, I would encourage no one to call the Morris et al London busmen study (1953) the “birthplace of physical activity”. Two presenters seemed to do so. Perhaps it was a slip of the tongue(s), or clunky explanation, as I’m certain “physical activity” was born earlier than 1953.
Overall, ISPAH 2018 was a slick affair, which ended with challenges and optimism. The WHO target of a 15% change in global activity levels by 2030 is a lofty goal – I suspect that aiming for less would not generate the political will to mobilize resources and change minds about the seriousness of the issue.
I have always intuitively favoured the social benefits that come from physical activity, as opposed to the changes in disease risk. Perhaps that is just my personal bias. Upon leaving the venue, one delegate, carrying a WHO football was accosted by one of the conference centre doormen, who enthusiastically exclaimed “Throw it here”. Two strangers briefly throwing a football to each-other might not lower the risk of anything, but it shows humans crave connection with one another. ISPAH are trying to make the world a better place, and it seems they are gaining traction. Maybe I should join?
A new study on “Worldwide trends in insufficient physical activity” has been published in a journal. It continues to confirm what many of us understand already, high income countries tend to have high rates of physical inactivity. Low income countries tend to have low rates of inactivity.
This BBC article pointed out that two of the most active countries are Uganda and Mozambique. Another BBC article explored the Uganda situation in a bit more detail. It asked “So what is Uganda getting right? … People in rural Uganda, where most of the population lives, are very active on their farms, says the BBC’s Patience Atuhaire. But, she says, in urban areas people are becoming more sedentary, especially as they get wealthier.” Evocative imagery accompanies the news item:
All of this leads me to ask three awkward, but necessary questions:
PS: The political nature of this issue (how people should be organised in society and what they should do), does remind me of something I wrote 11 years ago, available here. I critiqued the strange New Zealand policy of aiming to be “the most active country in the world”. Of course not only did New Zealand never have a chance at the title, but also the goal itself is morally problematic. The implicit rationale of trying to be more active than another country is that you want another country to be less active, and therefore, less “healthy” than your own. This, I argue in academic parlance, is crazy.
Warnings about risk are moral endeavors. Agendas which aim to minimize risk involve (usually implicit) ideas about human safety, welfare and security. But when people perceive the risk-minimization agenda is being taken too far, such as attempting to minimize risk in school settings, the reaction often contain claims of “nanny state” and “cotton wool”. But a recent Australian news report shows that everything we think about raising “tough”, “resilient” children might be a sham. I recommend reading the link above and then reading the rest of this critique … at your own risk.
The fascinating thing about this article is that despite the “pro-risk narrative” in the title, this narrative is subtly subverted through various disclaimers and imagery. The end result is that far from being a place where children “stare down risk”, the schools presented in the article are places where risk is continuously managed through numerous physical structures and rules. Here are some Socratic questions:
One of the most popular soft/sugar drinks in Brasil is GUARANÁ ANTARCTICA
Guaraná is as popular as Coca Cola is in many other countries. The brand sponsors the Brasilian football team, with national team players often wearing Guaraná branded clothing, and the products often feature player images and the logo of the national governing body, the CBF.
So, when a person consumes an entire 350mL can, and not just a 200mL cup, they would be consuming 35 grams of added sugar. Given what we know about ultra-processed drinks, teeth and overall health, it is astonishing that such an ultra-processed drink is so heavily endorsed by sport celebrities in a country with significant health problems for young children.
The Brasilian Ministry of Health argues that ultra-processed drink should be avoided. It is surely time for the CBF to end it’s sponsorship with Guaraná.
I hope England wins the World Cup, but whatever happens, children’s health is certainly losing. The entire football “pyramid” in England is riddled with junk food companies.
Through their love of football, children in England are bombarded with marketing for ultra-processed food and drink. It continues through their early years and into adulthood. And it’s not sneaky, ambush marketing. It comes from official football organisations, events, venues, teams, and role models. While sport marketers talk about the successful “reach” of sponsorship, public health promoters focus on the potentially disastrous effects these sponsors can have on children.
But it could all end very soon. The food charity Sustain has told the government what action is needed in sport settings: “Campaigns are currently calling on sports associations to disassociate themselves from junk food brands, but if sports associations will not act, the Government must step in.”
And now a Health Committee in the UK Parliament has formally recommended it is time to end these partnerships:
“The next round of the Government’s childhood obesity plan … should also include a commitment to end sponsorship by brands overwhelmingly associated with high fat, sugar and salt products of sports clubs, venues, youth leagues and tournaments.”
THIS IS MASSIVE NEWS. Sponsorship of children’s sport by junk food companies is pervasive and predatory. It includes organisations such as the FA and FIFA, competitions such as the Premier league and Carabao Cup, venues such as Wembley, and programmes such as McDonald’s national youth sponsorship.
To keep the momentum and pressure on the government to make these changes you can state your support with Sustain here: https://www.sustainweb.org/poll/sugar/
For the health of children, this English football food pyramid needs to come tumbling down.
PS: This problem is not confined to England either. It’s global. I plan to track other countries soon. See this recent research in the USA about the pervasiveness of junk food advertising in USA sport.
Academic work can be rough on egos. Particularly in the social sciences, where ideas matter. We cultivate our reputations over years, but confidence is a brittle thing – just one chastening book review or article rejection away from frustration, anger or anxiety. In a sense, absorbing criticism is inherent to an ideal university structure. As Stuart Hall said, “The university is a critical institution or it is nothing”. Still, it is often difficult to be either the giver or recipient of a scathing critique.
Being on the receiving end of criticism recently really brought this home to me. I co-signed a letter calling for tackling in rugby to be removed from schools (thereby protecting the bodies of school children from one of the most injurious sports), but there was widespread opposition to the idea. That was understandable, but what irked was that the opposition was often coupled with criticism of the letters signers, with claims that we in our ivory towers didn’t know what we were talking about. The idea to remove tackling was labelled ridiculous, as were the letter writers. It was no fun to have my expertise questioned, much less lambasted.
I am also conscious the egos of others might have been caught up in my own critiques of policy ideas. For example, in journals, presentations and on the blog, I have rejected the claims of scholars regarding the corporate influence of companies such as Coke and Nike on physical activity scholarship. More subtly, I have critiqued the ideas of physical activity scholars who have been trying to advance the discipline and promotion of physical activity. While I would not detract from honest academic labour, I do suspect that there have been times where other academics could have taken my analyses personally. So while the ideas are the target of critique, it is impossible to completely disentangle an idea from the person who espouses it. This potential for ego damage is an inherent condition of academic work. That is unfortunate. Where I have less sympathy is when corporate interests are directing the ideas that are generated. Happily and uncritically toeing the line of a company is simply academic dishonesty. You become a shill, not a critical voice in society.
Academics also put themselves up for ridicule in opinion pieces in the press. Consider this recent opinion article in The Times.
After an Oxford professor suggested people pay at the pump of petrol stations rather than entering a service station shop to be surrounded by sugar, the commentator in The Times wrote:
“Who the hell are you saying this to, Professor Jebb? I thought Oxford lectures unlocked the secrets of the physical universe or proposed new ways to unpick Sumerian orthography. But now it’s, “Don’t go into sweet shops, boys and girls, or you’re gonna get fat”? …
Seriously, though? Your answer to Britain’s greatest health calamity since the Black Death is to gently direct people away from places where sweeties are sold? …
That’s a pretty damning view of humanity, isn’t it? That’s what leads some cultures to veil their women from head to toe, because if men can see their lovely faces, like yummy sweeties on a checkout shelf, they cannot be trusted not to have sex with them right there on the street.”
I’m not quite British enough yet to understand the extent of playful sarcasm or liberal distain for the Professor here. Whatever the case, the writer severely misrepresents what Professor Jebb was saying. I wonder if public shaming like this chips away at the enthusiasm of academics to convey their voices in public. Or worse, if it means some health promotion ideas never see the light of day because of a fear of ridicule. But this opinion piece also raises some concerns for how physical activity and health academics portray their work. And it highlights the problem of trying to gain and maintain legitimacy in an area where many structures seem unbudge-able, so academic advice becomes directed at individuals who are more nudgeable. A health promoter’s job is to give practical advice about healthy living, and resisting unhealthy choice architecture (at petrol stations and elsewhere) is one aspect of the job. But there is a risk of academics in physical activity and health being limited to repeating common sense clichés about how to live healthy lives.
In 2014, Public Health England said there needs to be a revolution in physical activity. Revolutions are only possible by upsetting the status quo. And so academics need to be not only willing to do this, but also be prepared for the critiques of those with different agendas. We can rest assured that when giving controversial advice, or advice which negatively affects corporate interests, there is actually no need for our ego at all. We embody one of the seven principles of UK public life – selflessness.