title: Turning the tide: national policy approaches to increasing physical activity in seven European countries.
abstract: BACKGROUND
  Physical inactivity is one of the four leading behavioural risk factors for non-communicable disease (NCD). Like tobacco control, increasing levels of health-enhancing physical activity (HEPA) will require a national policy framework providing direction and a clear set of actions. Despite frequent calls, there has been insufficient progress on policy development in the majority of countries around the world. This study sought and summarised national HEPA policy in seven European countries (Finland, Italy, the Netherlands, Norway, Portugal, Slovenia and Switzerland).
  
  
  METHODS
  Data collection used a policy audit tool (PAT), a 27-item instrument structured into four sections.
  
  
  RESULTS
  All countries reported some legislation or policy across the sectors of education, sport and health. Only some countries reported supportive policy in the transport and environment sectors. Five countries reported a stand-alone HEPA policy and six countries reported national recommendations. HEPA prevalence targets varied in magnitude and specificity and the presence of other relevant goals from different sectors highlighted the opportunity for joint action. Evaluation and the use of scientific evidence were endorsed but described as weak in practice. Only two countries reported a national multisector coordinating committee and most countries reported challenges with partnerships on different levels of policy implementation.
  
  
  CONCLUSIONS
  Bringing together the key components for success within a national HEPA policy framework is not simple. This in-depth policy audit and country comparison highlighted similarities and differences and revealed new opportunities for consideration by other countries. These examples can inform countries within and beyond Europe and guide the development of national HEPA policy within the NCD prevention agenda.
authors.affiliation: Centre for the Built Environment and Health, School of Population Health, The University of Western Australia, Crawley.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bull
authors.affiliation: School of Sport and Exercise Science, Loughborough University, London, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Milton
authors.affiliation: Physical Activity and Health, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Kahlmeier
authors.affiliation: Physical Activity Promotion Consultancy at Regione Emilia-Romagna, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arlotti
authors.affiliation: National Institute of Public Health, Ljubljana, Slovenia.
authors.forename: Andrea Backović
authors.initials: AB
authors.lastname: Juričan
authors.affiliation: Norwegian Directorate of Health, Oslo, Norway.
authors.forename: Olov
authors.initials: O
authors.lastname: Belander
authors.affiliation: Physical Activity and Health, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Brian
authors.initials: B
authors.lastname: Martin
authors.affiliation: Physical Activity and Health, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Martin-Diener
authors.affiliation: Physical Activity Research Group, University of Porto, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Marques
authors.affiliation: Physical Activity Research Group, University of Porto, Porto, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mota
authors.affiliation: UKK Institute of Health Promotion Research, Tampere, Finland.
authors.forename: Tommi
authors.initials: T
authors.lastname: Vasankari
authors.affiliation: Netherlands Institute for Sport and Physical Activity, Wageningen, The Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Vlasveld
mesh_terms: D019058:Community Networks; D003299:Cooperative Behavior; D005060:Europe; D019317:Evidence-Based Medicine; D015444:Exercise / Q000502:physiology*; D006040:Goals; D006266:Health Education; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006293:Health Promotion / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D040242:Risk Reduction Behavior
keywords: Children's health and exercise; Epidemiology; Health promotion through physical activity; Physical activity promotion in primary care