Edinburgh Explorer The contribution of leisure center usage to physical activity in the United Kingdom

4 Background : Physical activity (PA) levels vary across specific population groups, 5 contributing to health inequalities. Little is known about how local authority leisure centres 6 contribute to population PA, and whether this differs by age, sex or socioeconomic group. 7 Methods: We calculated weekly leisure centre-based moderate/vigorous PA for 20,904 8 registered adult users of local authority leisure facilities in Northumberland, U.K., between 9 July 2018-June 2019, using administrative data. We categorised activity levels (<30 10 minutes/week, 30-149 minutes/week and 150+ minutes/week) and used ordinal regression to 11 examine predictors for activity category achieved. Results: Registered users were mainly female (58.7%), younger (23.9% aged 18-29 years 13 versus 10.1% aged 70+ years) and from the two most affluent socio-economic quintiles 14 (53.7%). Median weekly moderate/vigorous leisure centre-based activity was 55 (IQR 30-15 99) minutes/week. Being female (OR: 2.09, 95% CI: 1.95-2.35), older (OR: 1.14, 95% CI: 16 1.11-1.16), and using a large facility (OR: 1.21, 95% CI: 1.03-1.42) were positive predictors 17 of leisure centre-based PA. Conclusion: Older adults and females were more likely to be active and achieve recommended PA levels through centre usage. Widespread use of this novel measure of leisure centre-based activity would improve understanding of how local authority leisure centres physical inactivity and associated inequalities.


1 Background
24 Physical inactivity causes 9% of premature death globally. 1 Achieving recommended levels 25 of physical activity (PA) is associated with risk reductions of 35% in cardiovascular mortality 26 and 33% in all-cause mortality, 2 30% in diabetes, 3 20-40% in breast cancer 4 and 20-30% in 27 colon cancer. 5 Additionally, regular PA promotes social interactions and social equity, 6 7 and 28 is positively associated with mental health. 8 Therefore, the World Health Organisation 29 identifies increasing population levels of PA as a public health priority. 9 30 Progress to improve PA has been slow; globally 1 in 4 adults do not currently meet the 31 recommended ≥150 minutes of weekly moderate or 75 minutes of vigorous PA, or a 32 combination of both. 10 United Kingdom (UK) PA levels for adults are broadly similar to 33 other European countries such as Sweden and Spain, 11 however, in 2019 36.7% of adults 34 aged over 18 years in England failed to meet World Health Organisation recommendations 35 for PA, 12 putting them at a significantly greater risk of cardiovascular disease, and premature 36 mortality. 13 By 2030, it is estimated that the UK population will be 35% less active if current 37 trends continue. 14 PA levels are strongly influenced by demographics such as age and sex.13 38 In England, 63.3% of the population were estimated to be sufficiently active in 2018-19, with 39 men more likely to report being active than women (65% and 61% respectively). Activity 40 levels decrease with age (70% of 16-34 year olds report being physically active compared to 41 40% of those aged 75 and over).15 Additionally, those people who are in managerial, 42 administrative and professionals occupations are more likely to be active compared to those 43 who are long-term unemployed or have never worked (72% and 54% respectively).15 44 Occupation is a common indicator of socioeconomic status; therefore it is likely that these 46 In more economically developed countries, like the UK, leisure time PA (LTPA) is an 47 important sub-domain of PA, which is associated with significant protection against heart 48 disease, 16 and a reduction in all-cause mortality. 17,18 For these countries, a greater 49 understanding of LTPA at a local/regional level is important to help plan potential solutions 50 to increase population levels of PA and address inequalities in PA. One potential source of 51 LTPA data is that collected routinely by fitness facilities about service usage, but there are a 52 lack of studies examining these data to investigate whether demographic factors affect 53 attendance, and the contribution of fitness facility usage to population PA levels. indicating that even if independent operators have expanded to fill some of the market 298 occupied elsewhere by large gym chains, there is likely to be latent demand for fitness usage local authority leisure provision in the county, accounting for 24.2% of use. This is one of the 301 benefits of public sector provision, but better understanding of these users is required.

302
Registered pay-as-you-go members had a much shorter median usage period (4 weeks [IQR 303 1.0-25.0]), making them a group to target for maintained engagement. There was also a large 304 group of users where data are lacking (non-registered pay-as-you-go users). This group 305 accounts for 16.9% of usage, but we were only able to estimate number of users and had no 306 information about demographics. Due to a lack of comparable studies, we are unable to 307 comment on whether this issue is specific to Northumberland. We encourage other providers 308 to examine these data. Encouraging or incentivising this group to register details would 309 increase understanding.

310
Our analysis indicated that, compared with the Northumberland population those who were 311 older were less likely to use the local authority leisure centres, but where they did engage 312 they were more likely to achieve the recommended PA levels 12 through leisure centre use 313 than younger people. This highlights the potential for local authority leisure centres to 314 increase PA for older populations if they can be encouraged to engage. Since

315
Northumberland population projections indicate that 31% of residents will be over 65 by 316 2031, 35 provision must be made appealing and accessible to those who are older. It is unclear 317 why a large proportion of the older population in Northumberland do not currently access the 318 local authority leisure centres, but it is possible that older people do not consider the facilities 319 to be easily accessible, activities to be appropriate, or attended by others of a similar age, all 320 factors rated as important among older adults. 36 Furthermore, a primary factor in encouraging 321 older people to take part in PA is identified as being motivated by the social environment, 37 322 indicating that the social aspect of activities is likely to be an important element in future 324 Northumberland reported that this intervention was more successful in those aged over 55 325 years, 38 suggesting that building on this type of programme may lead to increased access for 326 those who are older.

327
We also reported that those from more deprived areas were less likely to access the local 328 authority leisure centres. As those living in more deprived areas have potentially less 329 disposable income, it is possible that price is a contributing barrier to access but we were