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Turning the tide: national policy approaches to increasing physical activity in seven European countries
  1. Fiona Bull1,
  2. Karen Milton2,
  3. Sonja Kahlmeier3,
  4. Alberto Arlotti4,
  5. Andrea Backović Juričan5,
  6. Olov Belander6,
  7. Brian Martin3,
  8. Eva Martin-Diener3,
  9. Ana Marques7,
  10. Jorge Mota7,
  11. Tommi Vasankari8,
  12. Anita Vlasveld9
  1. 1Centre for the Built Environment and Health, School of Population Health, The University of Western Australia, Crawley
  2. 2School of Sport and Exercise Science, Loughborough University, London, UK
  3. 3Physical Activity and Health, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  4. 4Physical Activity Promotion Consultancy at Regione Emilia-Romagna, Bologna, Italy
  5. 5National Institute of Public Health, Ljubljana, Slovenia
  6. 6Norwegian Directorate of Health, Oslo, Norway
  7. 7Physical Activity Research Group, University of Porto, Porto, Portugal
  8. 8UKK Institute of Health Promotion Research, Tampere, Finland
  9. 9Netherlands Institute for Sport and Physical Activity, Wageningen, The Netherlands
  1. Correspondence to Professor Fiona Bull, Centre for the Built Environment and Health, School of Population Health, The University of Western Australia, MB 707, 35 Stirling Highway, Crawley, WA 6009, Australia; Fiona.bull{at}


Background Physical inactivity is one of the four leading behavioural risk factors for non-communicable disease (NCD). Like tobacco control, increasing levels of health-enhancing physical activity (HEPA) will require a national policy framework providing direction and a clear set of actions. Despite frequent calls, there has been insufficient progress on policy development in the majority of countries around the world. This study sought and summarised national HEPA policy in seven European countries (Finland, Italy, the Netherlands, Norway, Portugal, Slovenia and Switzerland).

Methods Data collection used a policy audit tool (PAT), a 27-item instrument structured into four sections.

Results All countries reported some legislation or policy across the sectors of education, sport and health. Only some countries reported supportive policy in the transport and environment sectors. Five countries reported a stand-alone HEPA policy and six countries reported national recommendations. HEPA prevalence targets varied in magnitude and specificity and the presence of other relevant goals from different sectors highlighted the opportunity for joint action. Evaluation and the use of scientific evidence were endorsed but described as weak in practice. Only two countries reported a national multisector coordinating committee and most countries reported challenges with partnerships on different levels of policy implementation.

Conclusions Bringing together the key components for success within a national HEPA policy framework is not simple. This in-depth policy audit and country comparison highlighted similarities and differences and revealed new opportunities for consideration by other countries. These examples can inform countries within and beyond Europe and guide the development of national HEPA policy within the NCD prevention agenda.

  • Children's health and exercise
  • Health promotion through physical activity
  • Physical activity promotion in primary care
  • Epidemiology

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