Are physical activity referral scheme components associated with increased physical activity, scheme uptake, and adherence rate? A meta-analysis and meta-regression.

BACKGROUND: Physical activity referral schemes (PARS) are composed of various components, such as a written prescription or a person-centered approach. The role of these components in their effectiveness is yet to be understood. Therefore, we aimed to explore the relationships between PARS components and physical activity, scheme uptake, and adherence rate; and to estimate the effect of PARS. METHODS: We searched Scopus, PubMed, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE. Eligible studies were published between 1990 and November 2023 in English or German, investigated PARS with participants aged ≥ 16 years, and reported physical activity, scheme uptake, or scheme adherence. Separate random-effects meta-analysis by comparison group were conducted for physical activity. Scheme uptake and adherence rates were pooled using proportional meta-analysis. The components were analyzed via univariate meta-regression. We rated the risk of bias using RoB2 and ROBINS-I, and the certainty of evidence using GRADE. RESULTS: Fifty-two studies were included. PARS were more effective in increasing physical activity than usual care (k = 11, n = 5046, Hedges' g = 0.18, 95%CI 0.12 to 0.25; high certainty of evidence). When PARS were compared with physical activity advice or enhanced scheme versions, the pooled Hedges' g values for physical activity were -0.06 (k = 5, n = 1082, 95%CI -0.21 to 0.10; low certainty of evidence), and 0.07 (k = 9, n = 2647, 95%CI -0.03 to 0.18; low certainty of evidence) respectively. Scheme uptake was 87% (95%CI 77% to 94%, k = 14, n = 5000) across experimental studies and 68% (95%CI 51% to 83%, k = 14, n = 25,048) across non-experimental studies. Pooled scheme adherence was 68% (95%CI 55% to 80%, k = 16, n = 3939) and 53% (95%CI 42% to 63%, k = 18, n = 14,605). The meta-regression did not detect any significant relationships between components and physical activity or scheme uptake. A person-centered approach, screening, and brief advice were positively associated with scheme adherence, while physical activity sessions were negatively associated. CONCLUSION: PARS are more effective in increasing physical activity than usual care only. We did not identify any components as significant predictors of physical activity and scheme uptake. Four components predicted scheme adherence, indicating that the component-effectiveness relationship warrants further research.

A systematic review and narrative synthesis of physical activity referral schemes' components.

BACKGROUND: Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. METHODS: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. RESULTS: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%). CONCLUSIONS: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.

Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice: insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries.

OBJECTIVE: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. DESIGN: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. SETTINGS: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). PARTICIPANTS: Nationally representative samples of 30 455 adults aged 25-65 years. RESULTS: HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. CONCLUSIONS: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.

Projecting cardiovascular deaths averted due to trans fat policies in the Eurasian Economic Union.

OBJECTIVE: To demonstrate the potential impact on population health if policies designed to reduce population trans fatty acid (TFA) intake are successfully implemented in the Eurasian Economic Union (EAEU) in line with the WHO's guidelines to lower intake of TFA as a percentage of total energy intake to less than 1 %. DESIGN: A projection exercise was conducted to estimate reductions in CVD-related deaths in countries of the EAEU if TFA policies are implemented in the EAEU. Plausibly causal, annual effects (in %) of Denmark's TFA policy on the evolution of CVD mortality rates were applied to project the potential effects of recently announced TFA policies in Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation under three TFA exposure scenarios. SETTINGS: Member States of the EAEU: Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation. PARTICIPANTS: Data used for the projection exercise were based on estimates from natural experimental evidence from Denmark. National CVD mortality rates used were from WHO and the Organisation for Economic Cooperation and Development datasets. RESULTS: In all countries and in all scenarios, deaths averted were ≤ 5 deaths/100,000 in year 1 and rose in years 2 and 3. The highest projected impacts in the high-exposure scenario were seen in Kyrgyzstan (39 deaths/100 000), with the lowest occurring in Armenia (24 deaths/100 000). CONCLUSION: This study demonstrates the potential population health gains that can be derived from effective policies to reduce TFA in line with WHO guidance. Monitoring and surveillance systems are needed to evaluate the effectiveness of the TFA reduction policies in a national context.

Population-level salt intake in the WHO European Region in 2022: a systematic review.

OBJECTIVE: The WHO recommends that adults consume less than 5 g of salt per day to reduce the risk of CVD. This study aims to examine the average population daily salt intake in the fifty-three Member States of the WHO European Region. DESIGN: A systematic review was conducted to examine the most up-to-date salt intake data for adults published between 2000 and 2022. Data were obtained from peer-reviewed and grey literature, WHO surveys and studies, as well as from national and global experts. SETTING: The fifty-three Member States of the WHO European Region. PARTICIPANTS: People aged 12 years or more. RESULTS: We identified fifty studies published between 2010 and 2021. Most countries in the WHO European Region (n 52, 98 %) reported salt intake above WHO recommended maximum levels. In almost all countries (n 52, 98 %), men consume more salt than women, ranging between 5·39 and 18·51 g for men and 4·27 and 16·14 g for women. Generally, Western and Northern European countries have the lowest average salt intake, whilst Eastern European and Central Asian countries have the highest average. Forty-two percentage of the fifty-three countries (n 22) measured salt intake using 24 h urinary collection, considered the gold standard method. CONCLUSIONS: This study found that salt intakes in the WHO European Region are significantly above WHO recommended levels. Most Member States of the Region have conducted some form of population salt intake. However, methodologies to estimate salt intake are highly disparate and underestimations are very likely.

Economic evaluation of physical activity interventions for type 2 diabetes management: a systematic review.

BACKGROUND: Economic evaluation of physical activity interventions has become an important area for policymaking considering the high costs attributable to physical inactivity. However, the evidence for such interventions targeting type 2 diabetes control is scarce. Therefore, the present study aimed to synthesize economic evaluation studies of physical activity interventions for type 2 diabetes management. METHODS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement (PROSPERO reference number CRD42021231021). An electronic search was performed in PubMed, Web of Science, Cochrane Library and NHS Economic Evaluation Database. Studies were eligible if they included: adults with type 2 diabetes; any physical activity intervention in the community settings; an experimental or quasi-experimental design; and a parameter of economic evaluation [cost analysis of interventions, cost-effectiveness analysis (including cost-utility analysis) and cost-benefit analysis] as an outcome. RESULTS: Ten studies were included in this review: seven were randomized controlled trials and three were quasi-experimental studies. All studies included direct costs, and four also included indirect costs. Four studies demonstrated that physical activity interventions were cost-saving, six studies showed cost-effectiveness, and two studies reported cost-utility. The estimates varied considerably across the studies with different analytical and methodological approaches. CONCLUSION: Overall, this systematic review found that physical activity interventions are a worth investment for type 2 diabetes management. However, comparability across interventions was limited due to heterogeneity in interventions type, design and delivery, which may explain the differences in the economic measures.

Cross-country collaboration for physical activity promotion: experiences from the European Union Physical Activity Focal Points Network.

BACKGROUND: An analysis of currently existing partnerships and cross-country collaboration for physical activity (PA) promotion is valuable for understanding how such partnerships operate, and how they impact national PA promotion efforts. This study aimed to outline the formation and development of the European Union's (EU) Physical Activity Focal Points Network, to evaluate its outputs and benefits and to describe its potential and challenges. METHODS: A mixed methods approach were employed, including document analysis, semi-structured interviews with key officials and an online evaluation survey with the focal points. RESULTS: The network was founded in 2014. Its main task is to coordinate the national collection of information for the EU's Health-Enhancing Physical Activity (HEPA) Monitoring Framework. Besides collecting data, focal points usually meet twice a year to share best practices and plan activities for the promotion of PA within the EU. The results of the evaluation survey show that participation in the network helped members specify goals for PA promotion, gain more knowledge regarding how to promote PA, identify more opportunities to promote PA in their country and to join a collaborative project with other countries. CONCLUSIONS: The study shows that the EU Physical Activity Focal Points Network may serve as an example of successful cross-country collaboration in PA promotion. The network has been able to make a contribution to monitoring the implementation of the EU Council Recommendation on HEPA across sectors in particular and of PA promotion in the EU in general.

Are we underestimating the impact of COVID-19 on children's physical activity in Europe?-a study of 24 302 children.

This repeat cross-sectional study investigated the impact of lockdown in Europe in Winter (January and February 2021) on children's and adolescent's physical activity (PA) and recreational screen time (RST), and compared PA to the lockdown in Spring 2020. An online survey was administered (n = 24 302; 6-18 years; 51.7% boys) in nine countries. PA and RST were assessed by 7-day recall. In total, 9.3% of children (95% confidence interval: 6.9-11.7) met WHO PA recommendation, which was half of the proportion observed in Spring 2020 [19.0% (18.2-19.9)]. Sixty percent exceeded the RST recommendations. This suggests that winter lockdown could have a more negative impact on PA than in spring.

A proposed checklist for climate-friendly sport and exercise programmes.

BACKGROUND: Fighting the climate crisis is the greatest challenge of our time and will touch all aspects of people's lives. In this context, the United Nations (UN) have called on the sport sector to reduce its negative impacts on the environment and show 'climate leadership'. While some efforts have already been made with regards to mega sport events, there is still a dearth of approaches on limiting the climate impact of recreational sport and exercise programmes. METHODS: Based on the UN-Framework 'Sports for Climate Action', literature reviews and additional desk research, a checklist to support local level stakeholders in providing climate-friendly sport and exercise programmes was developed. RESULTS: The proposed checklist consists of five dimensions that need to be considered when designing and offering a climate-friendly sport and exercise programme: (i) active transport to exercise programmes, (ii) the carbon footprint of different types of exercises, (iii) low carbon sport clothing and equipment, (iv) instructors as champions for climate action and (v) advertising and communication. These five dimensions result in a 16-item checklist that supports the planning, advertising, implementation and evaluation of climate-friendly sport and exercise programmes. CONCLUSIONS: The proposed checklist intends to facilitate the development of climate-friendly sport and exercise programmes. However, additional work is needed to test the implementation of the checklist at the local level. While the sport sector can make its own contributions to reduce its climate impact, intersectoral action is needed to improve infrastructure for active transport and to build sustainable sport facilities.

Monitoring of physical activity promotion in children and adolescents in the EU: current status and future perspectives.

BACKGROUND: Policy action is required to address physical inactivity in boys and girls. This action can be supported by international data collection, comparisons and sharing of good practices. Thus, this study aims to present and discuss the ongoing monitoring of physical activity (PA) indicators in children and adolescents in the 28 EU Member States. METHODS: Data on PA recommendations, PA prevalence, physical education (PE) and PA promotion programs for children and adolescents were provided by governments in a joint EU/WHO survey on the implementation status of the EU Council Recommendation on Health-Enhancing Physical Activity (HEPA) across Sectors. RESULTS: In 23 countries, national recommendations on PA are available. Detailed PA prevalence data among children and adolescents was available in 27 countries, in most cases separately for sex/gender and age groups. The total amount of PE lessons in schools differed greatly between countries and lessons were predominantly mandatory. After-school HEPA promotion programs were mostly implemented in EU Member States (78.6%), followed by active school breaks (57.1%), active travel to school (57.1%) and active breaks during school lessons (53.6%). CONCLUSIONS: This study summarizes the monitoring of PA indicators among children and adolescents in all EU Member States by providing a comprehensive overview of the status of PA promotion and monitoring across the region. Based on our findings, it could be concluded that the current EU monitoring system on PA promotion should be adapted to provide evidence that can inform future policy development.

Development of the health promoting sports club-national audit tool.

BACKGROUND: Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs. METHODS: A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus. RESULTS: Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders. CONCLUSION: To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Physical inactivity in nine European and Central Asian countries: an analysis of national population-based survey results.

BACKGROUND: Physical inactivity is a major risk factor for non-communicable diseases. However, recent and systematically obtained national-level data to guide policy responses are often lacking, especially in countries in Eastern Europe and Central Asia. This article describes physical inactivity patterns among adults in Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan. METHODS: Data were collected using the Global Physical Activity Questionnaire drawing nationally representative samples of adults in each country. The national prevalence of physical inactivity was calculated as well as the proportional contribution to total physical activity (PA) during work, transport and leisure-time. An adjusted logistic regression model was applied to analyze the association of age, gender, education, household status and income with physical inactivity. RESULTS: National prevalence of physical inactivity ranged from 10.1% to 43.6%. The highest proportion of PA was registered during work or in the household in most countries, whereas the lowest was during leisure-time in all countries. Physical inactivity was more likely with older age in eight countries, with female gender in three countries, and with living alone in three countries. There was no clear pattern of association with education and income. CONCLUSION: Prevalence of physical inactivity is heterogeneous across the region. PA during leisure-time contributes minimally to total PA in all countries. Policies and programs that increase opportunities for active travel and leisure-time PA, especially for older adults, women and people living alone will be an essential part of strategies to increase overall population PA.

Patterns and trajectories of inequality in physical activity from childhood to adolescence in Kazakhstan.

Objective: Sociodemographic differences in physical activity (PA) levels during the transition from childhood to adolescence, particularly in Central Asian countries, is lacking. In this study, we examine individual, family and environmental sociodemographic variables associated with PA among children and young adolescents in Kazakhstan. Study design: Secondary data analyses of two nationally representative cross-sectional studies administered by parents of children (aged 7-9 y) and by self-report surveys (adolescents aged, 11-15 y) . Methods: The 2020 Childhood Obesity Surveillance Initiative (COSI) and 2018 Health Behaviour in School-aged Children (HSBC) studies were used. Predictors of daily PA by individual (gender, grade, weight status), family (family composition, family employment, family wealth), and environment (school location) factors were analysed through binary logistic regressions after adjusting for screen time. Results: Among both children and adolescents, males were more physically active than females. Daily PA among children was positively associated with high family employment (OR = 1.23, CI = 1.03-1.48) or living in an urban location (OR = 0.58, CI = 0.49-0.70). Daily PA was associated with low family wealth, two-parent families (OR = 1.25 CI = 1.08-1.44) or living in a rural location (OR = 1.18 CI = 1.04-1.34) among adolescents. Conclusion: In Kazakhstan, the trajectory of children's and adolescent's PA levels, differed according to individual, family and environmental characteristics , suggesting a need for age-specific, targeted interventions to promote PA, appropriate policies that promote programs in schools, communities, and development of infrastructure for physically active lifestyles.

Recommendations for developing urban interventions to promote physical activity: interviews with key informants in Europe.

Although there is growing evidence on what interventions can promote physical activity in urban environments, guidance on how to get these interventions implemented is lacking in a European context. To understand the process of developing urban interventions to promote physical activity, we conducted 13 key informant interviews with professionals working in urban development in five European countries, though some worked in more than one country. Participants described their experiences, challenges and recommendations across six European countries. The main challenges faced were political environments, unsupportive contexts, communication issues, working with other sectors, resource limitations and evaluations. We presented recommendations made by participants which can overcome these challenges when developing urban interventions to promote physical activity. Recommendations included obtaining cross-party political support for a project; working with local communities right from the beginning; involving all stakeholders and encouraging their commitment through identification of common goals; asking the market for solutions when faced with resource constraints, and using existing data to facilitate evaluations.

Health promoting sports federations: theoretical foundations and guidelines.

Background: Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP). Methods: A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework. Results: Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club's intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP. Conclusion: The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP.

Capsaicinoids and capsinoids. A potential role for weight management? A systematic review of the evidence.

Capsaicinoids are a group of chemicals found in chilli peppers, with bioactive properties. The purpose of this study is to systematically review research investigating the potential benefits capsaicinoid compounds may have in relation to weight management. Medical databases were searched and 90 trials found, 20 of which were selected for inclusion, involving 563 participants. Three main areas of potential benefit for weight management were found: (1) increased energy expenditure; (2) increased lipid oxidation and (3) reduced appetite. Trial duration, dosage and sized varied, though trials were generally of high quality with a low risk of bias. It was observed that consumption of capsaicinoids increases energy expenditure by approximately 50 kcal/day, and that this would produce clinically significant levels of weight loss in 1-2 years. It was also observed that regular consumption significantly reduced abdominal adipose tissue levels and reduced appetite and energy intake. The mechanism of action is not presently fully understood, although it is well accepted much of the effects are caused by stimulation of the TRPV1 receptor. While capsaicinoids are not a magic bullet for weight loss, the evidence is that they could play a beneficial role, as part of a weight management program.

Policy Instruments for Health Promotion: A Comparison of WHO Policy Guidance for Tobacco, Alcohol, Nutrition and Physical Activity.

BACKGROUND: Policy is an important element of influencing individual health-related behaviours associated to major risk factors for non-communicable diseases (NCDs) such as smoking, alcohol consumption, unhealthy eating and physical inactivity. However, our understanding of the specific measures recommended in NCD prevention policy-making remains limited. This study analysed recent World Health Organization (WHO) documents to identify common policy instruments suggested for national NCD prevention policy and to assess similarities and differences between policies targeting different health-related behaviours. METHODS: Evert Vedung's typology of policy instruments, which differentiates between regulatory, economic/ fiscal and soft instruments, served as a basis for this analysis. A systematic search on WHO websites was conducted to identify documents relating to tobacco, alcohol, nutrition and physical activity. The staff of the respective units at the WHO Regional Office for Europe conducted an expert validation of these documents. The resulting documents were systematically searched for policy instruments. A word frequency analysis was conducted to estimate the use of individual instruments in the different policy fields, followed by an additional in-depth coding and content analysis by two independent reviewers. RESULTS: Across all health-related behaviours, the following policy instruments were suggested most frequently in WHO guidance documents: laws, regulations, standards, taxes, prices, campaigns, recommendations, partnerships and coordination. The analysis showed that regulatory and economic/fiscal policy instruments are mainly applied in tobacco and alcohol policy, while soft instruments dominate in the fields of nutrition and especially physical activity. CONCLUSION: The study confirms perceived differences regarding recommended policy instruments in the different policy fields and supports arguments that "harder" instruments still appear to be underutilized in nutrition and physical activity. However, more comprehensive research is needed, especially with respect to actual instrument use and effectiveness in national-level NCD prevention policy.

Promoting health-enhancing physical activity in Europe: Surveillance, policy development and implementation 2015-2018.

In the European Union (EU), the low levels of health-enhancing physical activity (HEPA) and high levels of sedentary behaviour are a concerning public health issue common to all Member States. In 2013, the Council of the EU recognized the need for more data related to HEPA to support policymaking across the region and proposed a monitoring framework that included 23 indicators covering different themes relevant to HEPA promotion in the EU context. In 2014, the EU Physical Activity Focal Points Network was established to support the implementation of the monitoring framework and in 2015 and 2018 surveys were conducted to collect epidemiological and policy information related to HEPA for each Member State. This paper aims to provide an update on the status of HEPA policies and surveillance in the EU and describe the changes that have occurred since 2015. In 2018, all countries had implemented more than 10 indicators, 8/28 had implemented 20 or more indicators, and only one country had completed all 23 indicators. From 2015 to 2018, 19 indicators improved, one remained unchanged, and three regressed. From the country perspective, 17 improved the number of accomplished indicators, five maintained the indicators, and five worsened the number of indicators. Overall, there has been a clear increase in the number of countries implementing HEPA policies and strategies across the different sectors, although some heterogeneity between Members Sates was still observed. Implementation of regional physical activity strategies and the establishment of the EU-wide monitoring framework appears to have had an overall positive impact on HEPA policy development and implementation.