Intended for healthcare professionals

Letters Every step you take

Authors’ reply to Kenington

BMJ 2019; 366 doi: (Published 26 September 2019) Cite this as: BMJ 2019;366:l5693
  1. Jochen Klenk, professor1,
  2. Ngaire Kerse, professor2
  1. 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081 Ulm, Germany
  2. 2Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
  1. jochen.klenk{at}

We agree that environmental and structural changes in landscapes, life spaces, and public areas such as those cited by Kenington are efficacious in reducing sedentary time.12 Interventions such as the “green prescription” programme in primary care, which focuses on individuals, showed a similar effect to the mini-Holland projects.3 Public health interventions can and should be added to more individualised behavioural strategies. System based approaches are likely to be more effective at influencing sustainable activity behaviour than a single modality.4

We promote both individual approaches and public health and environmental interventions to enable increased activity. In this context, walking is a promising target for interventions with low barriers. It is simple, affordable (free), achievable even for older adults, and rarely contraindicated.


  • Competing interests: None declared.


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