Interview with Dr. Alexis Lion, director of the Association Luxembourgeoise des Groupes Sportifs Pour Cardiaques and the Fédération Luxembourgeoise des Associations de Sport de Santé, and chair-elect of the European HEPA (Health-Enhancing Physical Activity) network.
According to OECD data, almost half (45%) of Europeans report that they never exercise or play sports. Could you please explain the primary reasons behind this lack of physical activity among Europeans, and how these reasons vary by demographics (e.g. age, gender, and socioeconomic status)?
Alexis Lion: Physical inactivity is a significant issue in Europe and worldwide. There are numerous reasons for physical inactivity, with lack of time being the most commonly cited according to the latest Eurobarometer on this topic.
However, it is important to consider why people do not have time. Perhaps finding time for physical activity can be made a priority by managing our daily lives in a way that allows us to find time for physical activity. We can make simple changes like taking the stairs instead of the elevator. It is unclear whether time is the only reason for inactivity, but lack of motivation is also a significant factor. I believe we can increase motivation by incorporating physical activity into daily routines without it feeling like exercise. Changing the environment can also be helpful.
Additionally, we know that people with chronic diseases tend to be less active. Illness or disability was mentioned by 14% of the respondents in the Eurobarometer as a barrier to engaging in regular physical activity. However, they should be enabled to be as active as possible, because their health and their overall quality of life would truly benefit from this. Accessibility may play a role here, as physical activity should be tailored in order to be accessible and suitable for every individual, including those with disabilities or illnesses.
The last factor to consider is cost, as physical activities may come at a cost. Families with higher incomes tend to have more physically active children than those from lower socioeconomic backgrounds. This may be due to greater differences in terms of access and cost. In other words, it may be that the socioeconomic environment is not very favourable, I would say, for people with a lower level of income to engage in physical activity. That said, it is also possible to engage in some forms of physical activities without spending money.
What role does the living environment play in influencing physical activity levels within the EU? Is there a significant difference in terms of physical inactivity rates between people living in cities and those living in more rural areas?
Alexis Lion: I was surprised to learn that people living in urban areas tend to be more physically active than those in rural areas, which is contrary to my initial assumption. This could be due to the availability of more leisure facilities and opportunities for sports and exercise in cities. Although people in rural areas may have physically demanding jobs such as farming, and this can influence their approach to physical activity.
It is important to distinguish between ‘leisure time physical activity’ and ‘occupational physical activity’, as farmers and other rural workers may engage in physical activity as part of their work. So this is not the same outcome in terms of health benefits. Of course, cultural or personal preferences play a role as well as influence the amount of extra physical activity that people engage in.
When it comes to why people are physically inactive, do you see differences between countries?
Alexis Lion: It is difficult to determine whether barriers for physical activity vary significantly from country to country, as the situation can be very different even within the same country. In addition, comparing data between countries may not always be fair or accurate due to differences in data collection or analysis. Culture can influence how physical activity is perceived and practised in different countries.
When discussing physical activity and sport, it is interesting to note that in English and French there is a clear distinction between the two concepts, whereas in other languages, such as Luxembourgish or German, the same word may be used for both. This may have an impact on individuals’ perceptions of, and participation in, physical activity and sport.
With regard to barriers, the HEPA Europe network has 11 working groups that focus on different areas, including age groups, where we see that both children and older people face similar challenges, and specific settings, such as urban versus rural areas, may also have different challenges that need to be addressed.
We also have another working group on ‘Promoting Physical Activity and Health in Sports Clubs’. In sports clubs, there is often a strong emphasis on achieving high levels of performance, which can discourage those who cannot reach the top from remaining active. We need to look at how we can get everyone involved, regardless of how they perform.
Considering the current EU policies on the promotion of sports & physical activity, what additional strategies or policies would you recommend to effectively address the issue of physical inactivity across member states?
Alexis Lion: When I read EU recommendations on sports and physical activity like these ones, I see that the terminology used might be a bit confusing. They talk about physical activity, but most of the time they actually mean just sports. At a certain point, the document mixes everything up – sports competitions, physical activity and sports events. So, firstly, the text should be more structured.
Secondly, it should be easier to read, I found it hard to continue reading until the end. The final part of this document is a resolution, which is essentially a wish list. However, it may be helpful to better consider the feasibility of the implementation of physical activity initiatives in different EU countries.
Finally, the question is how widely is this document disseminated? Who is aware of this? It should be widely disseminated nationally, regionally and locally.
Within the EU, we also have the National Physical Activity Focal Points. Each country from the EU should appoint one or two people to attend this meeting. The meetings are held twice a year, and every three years, they collect data in each country about physical activity regarding 11 indicators, which is a good practice. However, we should consider if the collected data is relevant and what’s next. If there is no actual willingness to implement something new at the national or EU levels, it may not be the best approach.
In what ways can technology and digital platforms be utilised to combat physical inactivity (such as mobile steps counter apps etc), particularly among younger populations?
Alexis Lion: Technology is becoming increasingly pervasive. Smartphones, smartwatches and even cars now have sensors that can track our behaviour and physical activity. While these tools are beneficial, their effectiveness in increasing physical activity varies between individuals, but they can be a good starting point.
It is important to remember that they are not a magic solution. We can use these kinds of applications to promote physical activity, but the evidence supporting their effectiveness is limited. It may work in the short term, but its long-term efficacy is uncertain. One potential solution is gamification, using games to encourage physical activity, as seen with the popular game Pokemon Go a few years ago. However, it is important to ensure that such tools work well and are widely accessible.
It can also be difficult to balance the benefits of gaming with the risks of addiction, which the WHO has recognised as a serious problem. While gaming can be fun, excessive gaming can be dangerous. So, there are negative side effects to consider.
Finally, influencers on social networks can also have a role in making people more active. That said, it is important to monitor and educate them to ensure they do not promote dangerous practices. If the promotion of physical activity is done incorrectly, such as through excessive exercise or misleading advertising, it can cause serious health problems.
How has smart working during the COVID-19 pandemic affected physical activity, and how can we promote daily exercise for Europeans working from home?
Alexis Lion: When it comes to working from home, not all people can do that. Professions such as bus drivers, cleaners, nurses and doctors working in hospitals cannot work from home, so only a limited number of workers can work from home. Research shows that people who work from home are less physically active. This may seem paradoxical as they save time by not commuting. However, they tend to be more active in domestic activities such as gardening or housework.
Perhaps technology can be used to encourage physical activity among those who work in front of computers for extended periods. This should be done in all workplaces, including those working in the office and elsewhere, to improve overall health and well-being levels. One idea could be to collect data on employees’ activity levels and encourage them to stand up or move around periodically. Our network, HEPA, has also a working group dedicated to promoting physical activity in the workplace.
Based on your expertise, what advice would you offer to individuals seeking to lead more active lifestyles and to European policymakers aiming to reduce physical inactivity rates?
Alexis Lion: Making people aware of the health benefits of physical activity is the first vital step. People should understand the impact that this has on their lives, from reducing chronic diseases to improving mental health and helping manage fatigue, especially in people undergoing treatments such as chemotherapy.
There is also a need to educate stakeholders, including health practitioners, teachers, human resource managers and urban planners, on how to incorporate more opportunities for physical activity into daily life and the surroundings. Designing spaces where stairs are more prominent than elevators, and incorporating accessible infrastructures for those with disabilities, can be an example of how to encourage physical activity.
It is also important to adapt strategies to different life stages to ensure that people maintain good habits throughout their lives.
However, developing effective action plans and policies remains a challenge. It is necessary to consider from early stages how to implement them effectively. The magic ingredient? Working together: scientists, policymakers, and community groups need to join forces to make a real difference in public health. And, of course, we’ve got to make sure everything we do is backed by solid evidence. That means testing our ideas with pilot studies before scaling up.