A systematic overview of institutions and bodies active in physical activity promotion in Europe

Sonja Kahlmeier¹, Christine Popp¹, Brian W. Martin¹, Andrea Backovic-Jurican², Winfried Banzer³, Finn Berggren⁴, Eddie L. Engelsman⁵, Charlie Foster⁶, Marteen Koornneef⁷, Jean-Michel Oppert⁸, Racioppi F.⁹, Harry Rutter¹⁰, Radim Šlachta¹¹, Tommi Vasankari¹², Willem van Mechelen¹³

 ¹ Physical Activity and Health Unit, Institute of Social and Preventive Medicine, University of Zurich, Switzerland
 ² National Institute of Public Health, Ljubljana, Slovenia
 ³ Olympics Sports Confederation, Frankfurt, Germany
 ⁴ Gerlev Physical Education and Sports Academy, Gerlev, Denmark
 ⁵ Netherlands Institute for Sport and Physical Activity (NISB), the Netherlands
 ⁶ British Heart Foundation (BHF) Health Promotion Research Group, Oxford, United Kingdom
 ⁷ Ministry of Health, Welfare and Sport, The Hague, the Netherlands
 ⁸ Pierre et Marie Curie-Paris 6 University, Pitié-Salpetriere Hospital (AP-HP), Paris, France
 ⁹ WHO Regional Office for Europe
¹⁰ National Obesity Observatory England, Oxford, United Kingdom
¹¹ Faculty of Physical Culture, Palacký University, Olomouc, Czech Republic
¹² UKK Institute for Health Promotion Research & National Institute of Health and Welfare, Tampere, Finland
¹³ EMGO + Institute, VU University Medical Centre, Amsterdam, the Netherlands

Abstract

Objectives: Growing interest in physical activity has led to the development of a number of organizations, networks and associations, including grass-root, professional and academic institutions. To maximize relevance and effectiveness of work undertaken in this field, we aimed at developing a systematic overview of institutions active in health-enhancing physical activity (HEPA).
Methods: Systematic, purposive weblink-search complemented by expert input; classification by institutional type, main activity and synergy with goals of HEPA Europe, the European network for the promotion of HEPA. Results: Of 127 identified institutions, 42 met the criteria of being European and active in physical activity promotion. 45.3% were NGO/associations, 33.3% were networks, 11.9% WHO units or platforms and 9.5% bodies of the European Commission. Sport was the main topic of 28.6% institutions. Health promotion was represented with 21.4%, physical activity promotion and transport/environment with 19.0% each, disease prevention with 7.2% and nutrition with 4.8%. Seven institutions had a high synergy to HEPA Europe’s goals.
Conclusions: The search identified many institutions, networks and initiatives, which 1. reflects the growing interest in and importance of physical activity for a number of stakeholders, 2. provides increased capacity to address this important topic on a European scale and 3. creates a “critical mass” to push the agenda forward into clearer and synergetic directions. Systematically mapping key players is a useful tool for institutions active in an environment with a multitude of
actors to ensure that activities provide added value, to avoid duplication and to promote partnership and efficient use of resources.

Zusammenfassung

Ziele: Die Anzahl der Institutionen, die sich auf verschiedenen Ebenen mit dem Thema Bewegung auseinandersetzen, hat deutlich zugenommen. Um die Wirksamkeit seiner eigenen Aktivitäten steigern zu können, hat HEPA Europe, das Europäische Netzwerk für Bewegungsförderung, einen systematischen Überblick über diese Institutionen erarbeitet.
Methoden: Systematische, zielgerichtete Weblink-Suche und Experteninput. Klassifizierung nach Art der Institution, Hauptaktivität und Synergien mit den Zielen von HEPA Europe. Resultate: Von 127 identifizierten Institutionen entsprachen 42 den Einschlusskriterien, in Europa aktiv zu sein und spezifische Bewegungsförderungsaktivitäten zu haben. 45.3% waren Nichtregierungsorganisationen oder Verbände, 33.3% Netzwerke, 11.9% Abteilungen oder Plattformen der Weltgesundheitsorganisation WHO und 9.5% Gremien der Europäischen Kommission. Sport war bei 28.6% die Hauptaktivität. Gesundheitsförderung war mit 21.4% vertreten, Bewegungsförderung und Transport oder Umwelt mit je 19.0%, Prävention mit 7.2% und Ernährung mit 4.8%. Sieben Institutionen wiesen starke Synergien mit den Zielen von HEPA Europe auf.
Schlussfolgerungen: Es wurden viele Institutionen identifiziert, was 1. zunehmendes Interesse und Bedeutung des Themas Bewegung aufzeigt, 2. eine Zunahme der vorhandenen Fachkompetenz darstellt, und 3. eine «kritische Masse» ergibt, um die Anliegen gemeinsam und gezielt voranzutreiben. Das systematische Abbilden von Organisationen ist ein nützliches Instrument für Institutionen, die in einem Umfeld mit vielen Akteuren tätig sind, um sicherzustellen, dass ihre Aktivitäten zusätzlichen Nutzen bringen, um Doppelspurigkeiten zu vermeiden und um Partnerschaften und optimale Nutzung der vorhandenen Mittel zu fördern.

Introduction

Over the past few years, growing interest of public health and policy makers in physical activity (WHO 2004; GAPA 2010; WHO 2011) has led to the development of a number of organizations, networks and associations, covering the range from grass-root to professional and academic institutions. This has resulted in a highly dynamic and thriving community, stronger advocacy and more capacities to promote physical activity, but at the same time has increased the challenge to avoid duplication of efforts and to direct advocacy efforts in synergic and coherent directions. Therefore, there is a strong interest in developing a methodology which allows collating a comprehensive map of relevant institutions as a means to “networking the networks”, promoting synergy and partnership with relevant players and ensuring that available resources are used efficiently.
An attempt in this direction has been made within the framework of HEPA Europe, the European Network for the promotion of Health-Enhancing Physical Activity (HEPA), founded in 2005, whose vision is to achieve better health through physical activity among all people in Europe (Martin-Diener et al. 2014; http://www.euro.who.int/hepa). The network is dedicated to strengthening and supporting efforts and actions that increase participation and improve the conditions favorable to a healthy lifestyle, in particular with respect to health-enhancing physical activity. HEPA Europe is also committed to maximizing its relevance and added value to its members and stakeholders, as well as to sharpen its communication and further developing its strategic partnerships.
This article presents a systematic overview of institutions active in the field of physical activity promotion in Europe. The analysis was undertaken to maximize relevance and effectiveness of work undertaken in this field by identifying the different scopes and areas covered as well as gaps and possibilities for synergies. The results were applied to HEPA Europe as a case study. The approach is of general interest to those active in fields with multiple players, such as networking or advocacy on different aspects of public health or sport science.

Methods

An initial list of institutions active in the field of health-enhancing physical activity compiled based on available knowledge served as a basis for developing a more detailed list. To identify further institutions, a systematic purposive weblink-search was carried out, using inclusion criteria. The websites of institutions on the initial list were searched for links to other institutions, adding further institutions to the list subsequently. The process was continued until no further relevant institutions were identified among the link web-sections of new institutions.
Private and public institutions with the following characteristics were included:

• European in scope
• clearly identifiable current activities related to promoting physical activity
  body, institution or policy platform
• Projects or processes (i.e. publications, time-limited projects and activities) were not included.

The preliminary list was discussed and amended in meetings of the Steering Committee of HEPA Europe in April and September 2010. The final draft was disseminated for input to all member institutions of HEPA Europe as well as to the participants of its 2nd conference and 6th annual meeting in November 2010. Institutions were considered for the overview until February 2011.

The institutions meeting the inclusion criteria were recorded in an overview table. Information was extracted on the following items:

• Type of institution
  According to the information on the website and expert input, the institutions were classified as “Network”, “EC body”, “WHO units & platforms”, or “NGO/Association” (also including councils, federations, committees).
• Topic
  The institution’s main domain was categorized as: physical activity promotion; sport (including promotion, science, education, management, platforms); health promotion; disease prevention (such as cardiovascular diseases, obesity, etc.); nutrition; transport or environment
• Mission
  Mission or goals stated on the website of the institution were summarized with a special focus on identifying physical activity-related aspects.
• Members
  Where stated, the number of members was noted.
• Affiliations
  If an institution was found to be closely related to or being part of another institution, the connection was recorded.
• Activities
  The main work focus of the institution was categorized into “research”, “promotion”, “intervention”, “policy”, “knowledge” (knowledge transfer/dissemination, including education). Additionally, projects initiated, guides developed or meetings organized by the institution were listed if identified as part of the web search.
• Synergy with goals of HEPA Europe
  The synergy of the institution’s work with the goals of HEPA Europe was rated on a scale ranging from 1=high to 2=intermediate and 3=limited. The following qualitative approach was used for this rating: the more activities on promoting health-enhancing physical activity (rather than e.g. elite sport), the higher the synergy with HEPA Europe; the more public health-related rather than disease focused, the closer the objectives. A preliminary rating was discussed and amended in the Steering Committee meetings.

Results

In total, 127 institutions and bodies were identified. Of those, 42 institutions and bodies (33.1%) met the inclusion criteria and were added to the overview list. Not included were 16 global institutions (12.6%), 7 medical associations (5.5%) and 62 bodies (48.8%) for other reasons (e.g. only mentioning physical activity in general but no specific activities).
Table 1 shows the 42 institutions in alphabetical order and classified according to type, topic, synergy with goals of HEPA Europe, and main activity.
Nineteen institutions (45.3%) were NGO/associations, while 14 (33.3%) were networks, 5 (11.9%) WHO units or platforms, and 4 (9.5%) bodies of the European Commission (EC). Sport was the main topic of 12 (28.6%) institutions, health promotion was represented with 9 bodies (21.4%), physical activity promotion and transport/environment with 8 each (19.0%), disease prevention with 3 (7.2%), and nutrition with 2 (4.8%).
The main activity of 14 institutions (33.3%) could be described as mostly promotion-related, of 12 (28.6%) as knowledge transfer, of 11 (26.2%) as policy making, of 3 (7.1%) as intervention-related and of 2 (4.8%) as research.
Where available, the number of member organizations and the number of countries represented by an institution were listed as well. They ranged from 9 to 1400 member organizations, and from 17 to 47 countries represented per institution, but information was incomplete on this item.
Figure 1 shows the 42 institutions in three circles according to their rated synergy with the goals of HEPA Europe, and separated into the 6 topical sectors and the 4 types of institutions.
The activities of 7 institutions (16.7%) were rated as very closely related to the scope and work of HEPA Europe. Four of them (9.6%) work on physical activity promotion, 2 (4.8%) on health promotion and 1 (2.4%) on transport/environment. Three (7.2%) are WHO units or platforms, 3 (7.2%) networks and 1 (2.3%) an NGO/association. Sixteen (38.1%) institutions were found to share intermediate synergy with the goals of HEPA Europe, 19 (45.2%) with limited synergy.
In addition to the European bodies, among the originally found 127 institutions 14 bodies with non-European or global scope were identified that are also relevant for the European context, including:

• Agita Mundo, the global physical activity network
• American College of Sports Medicine (ACSM)
• Centers for Disease Control and Prevention (CDC) / WHO collaborating Center on Physical Activity and Health
• International Council of Sport Science and Physical Education (ICSSPE)
• International Institute for Health Promotion (IIHP)
• International Olympic Committee (IOC)
• International Physical Activity and the Environment Network (IPEN)
• International Society for Behavioral Nutrition and Physical Activity (ISBNPA)
• International Society for Physical Activity and Health
  (ISPAH) & GAPA (Global Advocacy for Physical Activity), the Advocacy Council of ISPAH
• International Sport and Culture Association (ISCA)
• International Union for Health Promotion and Education (IUHPE)
• SportAccord (International Federations’ Union, both Olympic and non-Olympic sports)
• The Association For International Sport for All (TAFISA)
  HEPA Europe is also in close contact with three other regional HEPA promotion networks:
• AFPAN (African Physical Activity Network)
• APPAN (Asia Pacific Physical Activity Network)
• RAFA/PANA (Red de Actividad Fisica de las Americas).

Discussion

Investments into developing an evidence-based understanding of the environment in which an institution is operating can greatly support the development of a more strategic approach (Nutbeam 2006). Identification of partners can facilitate a more efficient use of resources by avoiding duplication of efforts while at the same time creating a “critical mass” of knowledge and advocacy power that can help pushing forward the agenda into clearer and synergetic directions. To our knowledge, no similar systematic overview of institutions active in the field of physical activity promotion has been developed so far. The search revealed the existence of many institutions, which displays an increasing capacity to address this important topic on a European scale and also emphasizes the importance of the points mentioned above.
For HEPA Europe, the approach confirmed its scope to be appropriate and unique in Europe, with no other institution positioned identically. Collaboration or exchange is taking place already with five of the seven very closely related bodies and with about two thirds of the intermediately close institutions, in accordance with one of HEPA Europe’s stated objectives to improve coordination in physical activity promotion across sectors and administrative structure, together with other relevant institutions and organizations (Martin-Diener et al., 2014).
Defining a European scope and specific physical activity related activities as inclusion criteria led to the exclusion of two-thirds of the 127 found institutions. About one third of the institutions active in Europe in the field of physical activity promotion focus mainly on promotion, while about 20% are more active in knowledge transfer or policy making, respectively. This seems to represent a good degree of diversity of key areas of activity. Research, listed only twice as main activity, is naturally done more by local institutions not accounted for in this overview, such as universities.
Of the 23 institutions with information on membership numbers, provenance of members was from at least 17 countries, thereby having the size to perform promotion, knowledge exchange and policy development with European reach.
By conducting a simplified overview, not all the properties of the institutions could be taken into account, which made it difficult in some cases to assign an institution clearly to one category or another. However, the topic most often addressed according to the information on the websites was sport. But the distinction between physical activity and sport still often seems to be more of a semantic nature rather than an actual topical one, as also found in a recent analysis of European sport policies (Christiansen, Kahlmeier and Racioppi 2012). About 20% of the identified institutions are active in transport and/ or environment which can be seen as encouraging in view of the need for intersectoral approaches to address the challenge to reduce inactivity in Europe and globally (WHO 2007; GAPA 2010; WHO 2010; GAPA 2011). Seven European medical associations were also identified as potentially relevant. However, no detailed information on current activities on physical activity promotion was available. As examples such as the development of physical activity recommendations show, in some countries (para-)medical associations have taken a leading role in this field (Haskell et al., 2007; Canadian Society for Exercise Physiology 2011). Another limitation may be that some organizations were not captured by the search methods; possible reviewer or selection bias was limited through the involvement and repeated discussion of results with a range of experts.
In summary, the overview placing institutions according to topic, type and synergy with HEPA Europe’s goals provides a useful picture of the current landscape of institutions, facilitating at the same time the positioning of an institution such as HEPA Europe among other bodies and institutions in Europe active in physical activity promotion. This will be a valuable basis for its communication strategy. The methodology in developing this overview may serve as an input for other institutions seeking to position themselves in a field with multiple players, for example in public health or sport science.

Acknowledgements

We wish to thank Ms. Claudia Frangella, University of Rome, Italy, for contributing to the initial web-search to identify institutions as part of an internship at WHO Regional Office for Europe, European Centre for Environment and Health, Rome, Italy. Funding: This study was co-financed by a grant of the WHO Regional Office for Europe. The views expressed are solely the authors’ and do not necessarily reflect those of the World Health Organization.

Corresponding author

Sonja Kahlmeier
Physical Activity and Health Unit
Institute of Social and Preventive Medicine
Seilergraben 49, 8001 Zurich, Switzerland
Phone +41 44 63 44 371, Fax +41 44 634 51 85
E-Mail: sonja.kahlmeier@uzh.ch

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