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NICE urges planners to consider people’s need for exercise

BMJ 2008; 336 doi: (Published 24 January 2008) Cite this as: BMJ 2008;336:179
  1. Geoff Watts
  1. 1London

    In an unusually wide ranging set of recommendations, the National Institute for Health and Clinical Excellence (NICE) in England and Wales is aiming to deal with obesity and other health problems by tackling one of their causes: lack of exercise. Its immediate targets are not obese people themselves, however, but the planners who could be doing more to prevent the onset of the condition.

    The guide, which is the second of NICE’s public health interventions, sets out what are claimed to be the first national, evidence based recommendations to encourage physical activity by changing the environment.

    “The guidance reaches out to sectors well beyond the NHS,” said Mike Kelly, director of NICE’s centre for public health excellence. But he added that it was prompted in part by doctors who had responded to previous calls for more physical activity by pointing out how changes to the environment would help.

    The guidance states that everyone concerned with creating artificial environments and planning the use of natural ones should be trying to maximise their potential for physical activity. All planning applications for new developments should give priority to ways of allowing people to use their own muscles.

    Transport planners should aim to give priority to pedestrians and cyclists by widening pavements and introducing more cycle lanes and routes. Use of motor vehicles should be discouraged by narrowing or closing roads, using measures to slow traffic, and introducing charges for motorists.

    Philip Insall, a transport specialist and a member of the panel that developed the guidance, points out that cities elsewhere in Europe—he cited Basel—rely much less on car journeys than cities in the United Kingdom. “I think these NICE recommendations are perfectly doable,” he insisted. “This is about choice. In the past we’ve progressively reshaped the environment in a way that makes healthy choice more difficult.”

    Public open spaces, including parks, riverside paths, and canal towpaths, should be well maintained and accessible by public transport, say the guidelines. School playgrounds should be designed to encourage more varied and physically active play. Buildings distributed over campuses, including those of hospitals and universities, should be linked by walking or cycle routes.

    When buildings are being designed or refurbished, staircases should be placed where they are most likely to be used. They should be clearly signposted (notices encouraged journalists attending NICE’s third floor press conference to use the stairs), well lit, and properly maintained.

    “The big difference that this guidance should make is to put physical activity on the radar of planners and architects,” said Tim Stonor, another member of the panel. “Buildings shouldn’t only look good; they should give people the option of becoming healthy.”

    Whether planners will respond to the guidance is an open question. Unlike health authorities they are under no obligation to act on NICE’s suggestions. The best hope is that the guidance will be written into the policies of other public bodies whose views do carry statutory force.


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