Active Canada 20/20: a physical activity plan for Canada.

Spence, John C. ; Faulkner, Guy ; Bradstreet, Christa Costas 等

Population levels of physical activity (PA) have decreased, and sedentary behaviours have increased in most developed countries over the past 50 to 70 years. (1-3) Physical inactivity is now identified by the World Health Organization as the fourth leading risk factor for global mortality, (4) and the vast majority of Canadian adults (5) and children (6,7) do not meet minimum guidelines for PA. The solution to such widespread unhealthy lifestyle behaviours does not rest solely on individual-level interventions or programs promoting leisure-time PA; (8) policy and environmental approaches are also essential. (9-11) For instance, the Toronto Charter for Physical Activity (12) calls for the implementation of robust national policies and action plans that support PA.

Such national policies, plans or strategies can provide direction, support and coordination of the many sectors and stakeholders involved through the establishment of common objectives and strategies, and the negotiation of roles and responsibilities (i.e., an action plan). These describe the procedures of institutions in the government, non-government and private sectors to promote PA in the population. (13) The development of a policy should also allow greater allocation of resources and greater accountability, and it would be a significant indicator of political commitment. To be effective, such policies and plans should recommend a combination of strategies to affect multiple levels of influence (e.g., individual, organizational), incorporate evidence-based guidelines on PA and health, provide an implementation plan and obtain support from a broad range of relevant stakeholders. (12) National policies, plans or strategies have been developed and implemented in countries across the world (e.g., Australia, the US). (14,15) Though Canada has a long history of policy initiatives addressing physical fitness, active living and sport, (16) a recent assessment of the current policy context determined these were "inadequate to increase population PA". (17) In spite of efforts such as the Integrated Pan-Canadian Healthy Living Strategy, (18) which was driven by concerns about rising obesity rates in the mid-1990s, Canada's approach to increasing PA has been under-resourced (17) and has lacked the coordination and strategic approach required for population-wide interventions that link evidence to action. (19-21) For instance, the most recent version of Canadian physical guidelines was funded and produced with minimal support, involvement or leadership from the federal government. (22)

A call to action and plan for Canada: Active Canada 20/20

In the absence of demonstrable leadership, the PA sector responded with a collective call to action and identified the need for a coordinated approach to address physical inactivity and sedentary behaviour in Canada. The result of their efforts was a document entitled Active Canada 20/20, A Physical Activity Strategy and Change Agenda for Canada. (23) As its development has not been led by or endorsed by government at the federal level to date, Active Canada 20/20 (AC 20/20) is not a formal or national policy but, rather, an action plan or strategy. It is designed to engage decision-makers and rally the collaborative, coordinated and consistent efforts of all stakeholders at every level to reverse the decline in population PA levels and the rise in sedentary behaviours that have taken place over recent generations, and to create a "culture of an active nation". It provides a vision for an active Canada, focuses on high-priority actions and needed investments, builds on current strengths, identifies strategies to address gaps, and provides focus and opportunity for coordinated action. AC 20/20 is intended to support and guide the work of stakeholders at the local, regional, provincial/territorial and federal levels. Provinces and territories may also choose to use AC 20/20 as a basis for developing their own plan appropriate to their own context and priorities.

Development of Active Canada 20/20

Grounded in the 2010 Toronto Charter for Physical Activity, (12) the Pan-Canadian Physical Activity Strategy (24) developed by the Coalition for Active Living in 2003 and a number of Canadian and international evidence-based PA strategies, an AC 20/20 consultation document was prepared in 2011 that incorporated recommendations for bridging the research, policy and practice components to collectively achieve the vision of an active Canada (see Table 1 for a timeline of the development of AC 20/20). This process was initiated by the advisory groups of ParticipACTION (www.participaction.com), which serve as a voice of PA and sport participation in Canada. (25) The plan was developed around a framework consisting of four Areas of Focus (Policy Development, Change and Implementation; Targeted Information and Public Education; High Quality, Accessible Programs and Services; Community Design); three Foundations for Change (Evidence and Knowledge Exchange; Strategic Investments; Mobilization); and a series of strategic and priority actions that are mutually reinforcing and work together to achieve the AC 20/20 objectives (see Figure 1). The Foundations provide essential support to the Areas of Focus, which in turn provide the major thrusts of a change agenda to make Canada a more physically active country. No one Area of Focus can be addressed in isolation, and each is essential to building an active Canada.

The consultation document was used to support a national consultation through an online survey and a series of in-person consultations held from September 2011 to January 2012. Over 850 respondents completed the online survey along with another 450 respondents specifically from the Aboriginal community. Participants originated from every province and territory in Canada and represented multiple sectors (e.g., recreation, sport, government, health care professionals). In total, approximately 1,700 stakeholders provided input and feedback that informed the final version of AC 20/20. (23) The resulting document was supported by members of the Interprovincial Sport and Recreation Council and was presented to federal/provincial/ territorial (F/P/T) ministers responsible for sport, physical activity and recreation in Inuvik, Northwest Territories, in June 2012. Ministers accepted the document and encouraged the sector to continue its efforts to fine-tune AC 20/20 in relation to initiatives in the sport and recreation sectors. At their most recent meeting in Prince George, British Columbia (BC), in February 2015 the ministers called for a review of AC 20/20 "with a view to developing a pan-Canadian framework to be brought to Ministers for endorsement at a future meeting". (26)

Implementing Active Canada 20/20

The first step toward implementing the plan was to convene a two-day National Gathering in Fredericton, New Brunswick, in May 2013 with 100 delegates from across Canada in attendance. The invited delegates comprised representatives from every province and territory and from a variety of sectors (e.g., PA, sport, recreation, public health, government), as well as 20 national non-government organizations (NGOs). The primary objectives of the Gathering were to create momentum in the country for the aligned and collaborative implementation of AC 20/20 by key stakeholders and to identify national priorities for collective action. Provincial and territorial delegations agreed to develop and/ or align their PA strategies with AC 20/20. Further, they identified national priorities for collective action, which resulted in the development of four actions groups to address active play, active transportation, school PA, and accessibility and diversity. The AC 20/20 Steering Committee identified an additional priority: to advocate for a national PA policy.

[FIGURE 1 OMITTED]

As a result of, or in alignment with, the outcomes of the National Gathering, several provinces are developing plans consistent with AC 20/20 (e.g., BC, Saskatchewan) or re-examining existing ones (e.g., Alberta). Further, the Steering Committee is working towards the development of a "business case" in partnership with the Conference Board of Canada, (27,28) an implementation plan that includes a communications strategy, and an advocacy plan for the creation of a national PA policy. A synthesis that aligns AC 20/20 with the national recreation framework (29) and the Canadian Sport Policy 201230 was conducted in January 2015 in preparation for the meeting later that month of F/P/T ministers responsible for sport, physical activity and recreation in Prince George. Finally, an evaluation framework to establish the baseline criteria for evaluating the impact of Active Canada 20/20 has been developed through funding from the Canadian Institutes of Health Research.

SUMMARY

Canada's approach to increasing PA has been fragmented and has lacked coordination, funding and a strategic approach. AC 20/20 provides both a national plan and a commitment to action from NGO and public sectors with a view to engaging corporate Canada and the general public. It outlines a road map for implementing proactive initiatives to address this prominent health risk factor in the Canadian population. The identified actions are based on the best available evidence and have been endorsed by the majority of representatives in the relevant sectors. The next crucial steps are to engage all those involved in public health promotion, service provision and advocacy at the municipal, provincial and national levels to incorporate AC 20/20 principles into practice and planning, and thus increase the PA level of every person in Canada. Further, governments, as well as the private, not-for-profit and philanthropic sectors, should demonstrate leadership and continue their efforts toward providing the substantial and sustained resources needed to recalibrate Canadians' habitual PA patterns; this will ultimately improve the overall health of our citizens. In the absence of a coordinated effort and plan, it will be difficult for a haphazard assortment of programs and initiatives to have any meaningful impact on the national secular trend in physical inactivity.

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Received: March 5, 2015

Accepted: September 20, 2015

John C. Spence, PhD, [1] Guy Faulkner, PhD, [2] Christa Costas Bradstreet, MA, [3] Mary Duggan, CAE, [4] Mark S. Tremblay, PhD [5]

[1.] Sedentary Living Lab, Faculty of Physical Education & Recreation, University of Alberta, Edmonton, AB

[2.] School of Kinesiology, University of British Columbia, Vancouver, BC

[3.] ParticipACTION, Toronto, ON

[4.] Canadian Society for Exercise Physiology, Ottawa, ON

[5.] Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON

Correspondence: John C. Spence, PhD, Sedentary Living Lab, Faculty of Physical Education and Recreation, University of Alberta, 3-113 Van Vliet Complex, AB T6G 2H9, Tel: 780-492-1379, E-mail: jc.spence@ualberta.ca

Acknowledgements: G. Faulkner holds a CIHR-PHAC Chair in Applied Public Health. Stephen Grundy of LifeUnplugged, Inc. was a project consultant on the development of Active Canada 20/20. Also, ParticipACTION is recognized for important leadership throughout the process, and the members of the ParticipACTION advisory groups are acknowledged for significant input into the Plan. Finally, the insight shared by those many Canadians who participated in consultations on the Plan is much appreciated.

Conflict of Interest: None to declare.

Table 1. Active Canada 20/20 timeline

2010, February             ParticipACTION's Policy and Capacity
                           Building Advisory Group identifies gaps
                           and decides to develop a sector-wide
                           national physical activity
                           framework/strategy.

2011, February             Active Canada 20/20 Steering Committee
                           established.

2011, June                 Draft Active Canada 20/20 Strategy
                           presented to members of ParticipACTION's
                           advisory groups.

2011                       Steering Committee fine-tunes Active
                           Canada 20/20 Strategy and develops
                           Consultation Strategy.

2011, July                 Domain name purchased and website
                           developed.

2011, July                 Stakeholders engaged in national online
                           survey (683 responses).

2011-2012                  Stakeholders engaged in face-to-face
                           consultation sessions in 12 out of 13
                           provinces and territories (Sept
                           2011-Jan 2012).

2011, October              National online survey: Aboriginal
                           stakeholders (approx. 450 responses).

2012, January              Finalized Active Canada 20/20 Strategy
                           document.

2012, February             Presented to
                           federal/provincial/territorial (F/P/T)
                           deputy ministers responsible for sport,
                           physical activity and recreation.

2012, January & February   Presented Active Canada 20/20 Strategy
                           and consultation results: Canadian Sport
                           for Life (CS4L) Summit; 4th Chronic
                           Disease Prevention Alliance of Canada
                           (CDPAC) Conference.

2012, June                 Presented Active Canada 20/20 Strategy
                           document to F/P/T ministers responsible
                           for sport, physical activity and
                           recreation, Inuvik, Northwest
                           Territories.

2013, February             Development of an evaluation framework
                           through the leadership of the
                           ParticipACTION Research Advisory
                           Committee.

2013, May                  A two-day National Gathering was held in
                           Fredericton, New Brunswick, to create
                           momentum in the country for
                           collaborative implementation of Active
                           Canada 20/20.

2013, May; ongoing         Action groups established to coordinate
                           efforts in four priority areas
                           identified at the National Gathering:
                           Active Transportation; Inclusion/
                           Accessibility; Schools; Active Play.

2013, August               F/P/T ministers responsible for sport,
                           physical activity and recreation called
                           for collaboration and alignment between
                           the Canadian Sport Policy, Active Canada
                           20/20 and the National Recreation
                           Agenda, Sherbrooke, Quebec.

2014, November             Pathways to Wellbeing. Framework for
                           Recreation in Canada; National Summit.

2015, February             F/P/T ministers responsible for sport,
                           physical activity and recreation called
                           for review of Active Canada 20/20 with a
                           "view to developing a pan-Canadian
                           framework to be brought to Ministers for
                           endorsement at a future meeting," (27)
                           Prince George, British Columbia.