...think again!Getting men more active

You thinkit’s all over?

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Key findings and policy recommendations

Men who are physically active have up to • a 30% reduced risk of premature death.i

It is estimated that 20% of Coronary • Heart Disease in men is due to physical inactivity.ii

Engaging men in physical activity may • reduce the risk of developing type II diabetes by around 40%.iii

Less than 40% of men do the recom-• mended amount of physical activity.iv

Levels of physical activity fall sharply in • men with age – 44% of men aged 16-34 meet the recommended level, but this falls to just 32% for men aged between 55-64.v

Did you know?

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As the famous quote goes, “you’ve reached middle age when all you exercise is caution.” For men in the UK today this is a fact of life, with less than half doing the weekly recommended amount of physical activity (5 x 30 minutes of moderate intensity). Some men feel that when they hit a certain age they are past it and that sport and exercise are a young man’s game. But once men reach their mid-thirties and approach middle age this is ex-actly the time when they should be increasing their activity levels.

The health benefit to middle aged men of getting sweaty and out of breath is as significant as giving up smoking. Men who are physically active have a reduced risk of developing certain cancers, including prostate cancer,vi and there is a decreased risk of developing heart disease – the number one threat to men’s health, accounting for 1 in 5 of all male deaths. An active lifestyle can help to prevent these and many other lifestyle diseas-es, often caused by an unhealthy weight, high blood pressure and high cholesterol levels.

Aside from extending years of life, an active lifestyle extends the life in years. Exercise is known to reduce stress, increase confi-dence and promote positive wellbeing, while participation in some form of activity often provides an opportunity for social interaction and a sense of belonging.

Despite these proven benefits, less than 4 in 10 men are doing enough exercise. Although male participation in sport and exercise at school is relatively high, the proportion of men meeting the weekly recommended level of exercise declines steeply with age from 16-24 through to 75 years and above.vii

There are a number of factors causing this drop off – the time demands of family life and work commitments are often cited as the main perceived barriers. Other barriers include not knowing other people to exercise with and poor body image/confidence.

Men and physical activity

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This year Men’s Health Week looked at the issue of sport and physical activity and what could be done to encourage men to be more active.

To support this, the YMCA, the country’s largest voluntary provider of physical activity, developed the Y Active Men programme involving 150 men over the age of 35 who were not meeting the recommended amount of physical activity.

Four YMCAs across England took part in the programme – Central YMCA in London led the project, together with YMCAs in North Tyneside, Manchester and across the Fylde Coast in the North West.

The Y Active Men programme

Each YMCA offered participants 12 weeks of free membership to their local YMCA fitness facility, together with a health and wellbeing assessment at the start and end of the programme and ongoing support.

We tracked the men over the 12 week period to find out whether the Y Active Men programme made a difference to their activity levels, physical health and wellbeing.

But we also wanted to better understand why they stopped participating in regular exercise and what would make it easier for them to continue being active in the future. And we hoped to persuade the men who participated that you’re never too old to get back into the habit of regular exercise.

To improve physical health

Weight loss, increased muscle mass and increased aerobic fitness were all mentioned as specific goals by participants.

Healthy ageing

Some of the men talked about it being increas-ingly important to look after their body as they got older, to maintain health and wellbeing. Becoming more active was seen as one way to achieve this.

Jolted by circumstances

Participants were motivated into being more active by life circumstances, for example one man got out of breath while playing with his family, another had recently turned 41 and this had made him think differently about his health.

For most men the programme came at the right time and gave them the kick start they needed to be more active. Prior to joining the programme 67% of the men self-reported that they were active less than 5 days a week, and most described themselves as inactive. Several participants commented that they had sedentary occupations and contrasted this with when they were younger and had more active jobs, such as manual work.

Free membership was a big incentive and made signing up to the programme easier. Almost one fifth of the people recruited onto the Y Active Men programme were currently out of work and reported that they couldn’t afford a gym membership. Being unemployed meant that in some cases they weren’t as active as they would have normally been and this affected their confidence and self- esteem.

Aside from it being a free programme, there were several other drivers which persuaded men to join:

Why did they join the programme?

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Where do you find inactive men?

At the heart of the Y Active Men programme was the provision of 12 weeks of free membership to YMCA fitness facilities. Each YMCA employed different methods to recruit participants.

Manchester YMCA joined forces with the local PCT and identified men with the help of the local Health Trainers.

Fylde Coast YMCA promoted the scheme to families through their MEND programme.

North Tyneside YMCA held a launch event attended by the ex-England footballer Malcolm “Supermac” MacDonald (pictured).

Central YMCA worked with the Royal Mail to identify suitable employees who worked at a major site nearby.

While the YMCA managed to recruit 150 men to take part, not all of those who signed up for the programme made it to their initial fitness assessment and consequently there was a drop out even before the programme began. Overall 121 of the 150 participants made it through the door and were given an initial fitness assessment, and a free 12 week membership to YMCA fitness facilities. These 121 individuals were the participants in the Y Active Men programme.

Above: The launch of Y Active Men, North Tyneside with Malcolm MacDonald, ex-England footballer

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Upon joining the programme participants were asked why they were not getting enoughexercise.

What took you so long?

The key barriers were work and family pressures. Many of the men said they would come home from work exhausted and just want to rest for the evening. Another obstacle was a perceived lack of time to be physically active.

What was the impact of Y Active Men?Of the 121 participants on the programme, 40% completed both an initial and final health and wellbeing assessment. Comparing the results from these assessments, together with findings from a series of focus groups demonstrated that there were a number of significant benefits for men taking part in the programme.

Cost

Lack of facilities/transport cost

Work/family commitments

Don’t know of anyone to do it with

Not fit enough

Too busy, not enough time

Wellbeing:

In addition to physical health improvements some of the men experienced many psycho-logical benefits. Participants reported feeling more energetic, having increased confidence and improved sleeping patterns. For the unemployed men on the scheme some stated that participation had given them back a lot of confidence, provided a routine and made them feel more positive about their lives.

Assessment of psychological wellbeing showed a statistically significant increase in the frequency of positive mood states and a trend towards fewer negative mood states.

Physical health:

Some of the participants achieved reductions in weight and waist circumference, whileothers set themselves the goal of increasingmuscle mass, which in many cases they achieved. The well established benefits of exercise to physical health were confirmed by participants on the programme: reduction in blood pressure, improvements in control of asthma, being able to fight off infections and increased aerobic fitness were all recorded.

Comparing the fitness assessment results for men on the programme before and after the 12 weeks reinforced this: there was astatistically significant reduction in waistcircumference for men who took part.

Above: Barriers to physical activity identified by participants

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Healthy eating

In addition to all of these positive effects,participants explained that as a result of becoming more physically active they had also begun to eat more healthily. Healthy eating was not promoted as part of the programme, but it was something that several individuals chose to do without any prompting. One man said he had stopped drinking alcohol for 2 months during the programme – previously he hadn’t gone a week without drinking for 25 years.

Remaining active

Upon completion of the 12 week programme 25 of the 121 participants took out mem-bership to their local YMCA fitness facility. Many of these individuals had never been a member of a gym before and were therefore new users.

Irrespective of whether they remained members of the YMCA some participants said that the programme had given them the motivation to be more active in other ways.

Evaluation of self-reported physical activity levels also supported this – it was significantly greater after the programme compared to the start.

Overcoming barriersParticipation did lessen some of the perceived physical activity barriers which the men faced prior to starting the programme. For example, work pressures had been perceived as abarrier to exercise before joining.

However, as a result of joining the programme and becoming more active, participants reported feeling having more energy after work and also during work.

Lack of child care

Don’t know what’s available

Not interested/motivated

Fear/embarassment

Poor health

Other

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Paul Gilroy, North Tyneside YMCA

A life changing project

Following completion of the programme, approximately 1 in 4 of the men on the programme took part in focus groups to identify what impact it had on their overall health and wellbeing. In many cases the programme had significantly changed attitudes and behaviour. Here are some examples:

“I was concerned that my fitness levels were hampering me and preventing me from doing the things I wanted to do with my young son and hobbies that I’d fancied doing for a long time. Taking part has shown me that there are actually very few excuses that I can use to stop me from exercising regularly. Previously I found excuses not to exercise, now I find excuses and ways to exercise.”

Nick Rothery, 45Fylde Coast YMCA

“This programme has made a huge difference – I feel a lot better both physically and mentally and it’s even boosted my confidence. If you’re long term unemployed which I have been in the past, then you get stuck in a rut – programmes like this really help motivate you. Aside from the exercise it’s also given me a kick up the backside, to have a healthier lifestyle overall.”

Colin Brooks, 45North Tyneside YMCA

“I’m extremely pleased at completing the programme. I’ve lost a stone in weight and 10cm from my waistline and I’ve become a member of the gym and a regular attendee. Those things alone make it a very worthwhile experience for me, but my 17 year old daughter has decided to join the gym as well and we try to go together and support each other.

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Challenges and learnings

Although there were notable success stories and benefits to some of the participants, there were also a number of challenges and aspects which could have been improved.

The most important aspect for me has been the discovery that I have high blood pressure – I made an appointment with my GP and have been monitored for a number of weeks. I’d like to thank the YMCA for running the programme and I’d like to record my thanks and gratitude – I’m now an advocate for the YMCA.”

Drop outs at the start

Not all of the 150 men who expressed an interest in the programme participated. While the incentive of a free 12 week membership attracted 150 men, 29 participants failed to show for their initial assessment and in some cases failed to show for a rescheduled appointment. One of the challenges in offering a free programme was that there was nothing to lose by not taking part.

Length of the programme

Once the free 12 week membership was over, some of those who could not afford to take out a membership felt they would probably go back to being inactive. This was a particular issue for those who were out of work, as they were disappointed at not being able to contin-ue and had benefited physically, mentally and emotionally from becoming more active.

Differing levels of engagement

During the programme there were differing levels of engagement. For some of the men this really was a life changing experience. But for others, life got in the way and a series of events, such as bereavements, injury/illness, job insecurity and family commitmentsaffected their participation.

Social support

A key theme which emerged from the evaluation which would have helped the participants is the formation of social sup-port networks. Many of the men didn’t know one another on the scheme and more group activities, competitions and social events could have improved peer support which in turn could have provided motivation.

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Where do we go from here?

Based on an evaluation of the programme we believe there are a number of lessons which could help to increase activity levels for men.

By increasing physical activity levels, programmes such as Y Active Men could reduce the risk of men developing preventable conditions such as type II diabetes, which are a drain on NHS resources. Treatment of type II diabetes currently costs the NHS £9bn. By refocusing on prevention GPs, Local Authori-ties and the NHS would make significant cost savings.

Prevention is better than cure

Health spending will come under increased pressure over the years ahead, in part due to the inexorable rise in lifestyle diseases, an ageing population and funding the cost of new medicines. We believe the NHS could realise significant cost savings by continuing to focus on interventions which can stop the develop-ment of preventable conditions.

The Y Active Men programme is one such intervention. Of the participants on the scheme 61% had a waist circumference measure-ment which suggested that they were at an increased risk of cardiovascular disease (36% were at a substantially increased risk).

Findings from the programme showed that for those who returned for a follow up assess-ment, after 12 weeks there was a significant reduction in waist circumference. Increased waist circumference is one of the determinants of developing metabolic syndrome (a disorder that increases the risk of developing cardio-vascular disease and diabetes).

We calculate that the average cost for each participant to be on the Y Active Men programme was around £100 (not includ-ing evaluation of the project). Participation in programmes such as this could help prevent men developing lifestyle conditions such as type II diabetes. Comparing the cost of participation with the likely bill to the NHS of treating just this one preventable condition illustrates why preventative healthcareprogrammes should be the preferred option:

£2,500Annual cost per patient of treating type II diabetes.viii

40%The extent to which physical activity can reduce the risk of developing type II diabetes.ix

Recommendations from the YMCA for better men’s health…

Health sector: NHS, GPs and Local Authorities

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Create similar programmes for the long-term unemployed to help them back into work

One of the key findings from the programme was the impact it had on those who were out of work. Around one fifth of the participants were unemployed and they reported that being on the programme gave them back a routine, enabled them to socialise with new people, and boosted their confidence and self esteem.

Individuals who are long term unem-ployed are less likely to be physically active compared with people in employment (26% participation compared to 36% participation rates respectively).x In turn, they may miss out on the benefits of an active lifestyle which can exacerbate health inequalities.

Providing support in the workplace

One of the recurrent findings from the programme was that work was perceived as a barrier to getting active, and the workplace a missed opportunity to provide motivation for individuals to be more physically active. It was disheartening to hear that some of the men felt embarrassed to reveal they were on the programme at work for fear that they would be ridiculed for taking part.

Employers should adopt programmes that promote a supportive culture, which encourage physical activity and related opportunities to their workforce. Aside from the benefits to individuals, employers can benefit through reducing the incidence of depression and stress, absenteeism and presenteeism. This has a positive impact on business outcomes.

As part of the Government’s welfare reforms, consideration should be given to provid-ing the long term unemployed with access to physical activity programmes. Participa-tion in structured activities and exercise can help build resilience, boost self esteem and confidence and offer a sense of purpose to individuals who are sometimes at their most vulnerable. Participation in any form of activity can also provide a sense of belonging and an opportunity to build valuable peersupport networks.

Feedback from some of the participants suggested that a peer support network of individuals working for the same company could have improved motivation and sustained interest.

The workplace should become less of a barrier and more supportive of measures to promote physical activity opportunities to employees. Programmes such as the YMCAs “Workplace Activator” in which activity champions are trained to motivate, support and encourage their work colleagues to be more physically active should be considered by employers.

Government

Employers

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More targeted programmes to support behaviour change

Each YMCA provided free membership to their fitness facilities for a 12 week period. Receiving a free membership for 3 months enables participants to build up their confidence levels within a facility, get to know other people and how to use the equipment. Of the 121 participants who received 3 free months membership, 25 (20%) signed up to become members of their local YMCA facility.

We believe similar programmes should be promoted by the leisure and fitness sector, particularly for those who are disengaged in activity. By removing cost as a barrier this puts other barriers in perspective and helps to sustain interest. The benefit to the individual is that it helps them become more active – even if they don’t necessarily sign up to the fitness facility in the end. However, it is likely that leisure and fitness facilities will be able to recruit new members as a result of such programmes.

Centers for Disease Control and Preventioni.

World Health Report (2002)ii.

K. Waller, Diabetologia (2010)iii.

Health Survey (2008)iv.

Health Survey (2008)v.

Orsini et al (2010)vi.

Heartstats (2006)vii.

Code 2 Studyviii.

K. Waller, Diabetologia (2010)ix.

Central Survey Unit (2002)x.

The leisure industry and fitness sector

References

© 2010 Central YMCACover photograph: Launch of Y Active Men programme at North Tyneside YMCACentral YMCA is a registered charity no. 213121

For full details of report please contact: Duncan StephensonCentral YMCA, 112 Great Russell Street, London, WC1B 3NQTel: 0207 343 1729

The Y Active Men programme is a collaborative project supported by the Men’s Health Forum and Department of Health. The project was led by Central YMCA in partnership with Fylde Coast YMCA, Manchester YMCA, and North Tyneside YMCA.