How Team Science can replace the pivot to active wellbeing’s echo chambers

GM Active’s Head of Business Operations and Company Secretary, Jon Keating, reflected on an ‘elephant in the room’ moment when he attended Elevate 2023, the leading UK trade show focused on fitness, sport, and physical activity.

Consensus among those present was that the ‘fitness sector’ needed to ‘pivot’ to work with and support the health service. 

The elephant in the room – quite literally writes Jon in his blog here – was that ‘leisure’ was there; but where was ‘health’?

Here, Dr Kristen Hollands, Senior Research Fellow at the School of Health and Society at the University of Salford, looks at why the two sectors largely operate in echo chambers and how the barriers can be broken down.

In our current ways of working, knowing better doesn’t support doing better. We need to change the way we create knowing, writes Dr Hollands.

A team of three people holding each others wrists.

Inspiring everyone to live better through movement 

Putting it simply, to achieve the pivot here in Greater Manchester, and anywhere else in the UK, it needs the ambition and aspiration not to be hamstrung by one peer group thinking it knows better than the other. Blunt but true. 

We need to mesh our collective experience and expertise to realise the enormous potential health benefits of using physical activity within the health and care systems more. 

Swathes of research evidence has led to physical activity being widely hailed as the panacea to manage and prevent many long-term health conditions. And yet, globally, very few people achieve the recommended levels of physical activity – Greater Manchester is no different. 

If we know what to do, why aren’t we doing it? 

We have a wealth of evidence that supports using physical activity to improve many aspects of quality of life and yet, so few people taking up this treatment suggests current evidence is in some way faulty. Research evidence and approaches thus far have failed to enable health and social care systems to take a holistic approach to increasing physical activity and realising the potential benefits on the management and prevention of long-term health conditions. 

Are some of the biggest health challenges simply insurmountable without redefining how the research is done and who it is done by to move the concept towards faster, more acceptable and effective implementation?

What supports people to take up physical activity?

The probability that someone will become physically active depends on several factors – just a few examples include: 

  • Who suggests they participate (a health care provider, a trusted friend or someone else?)
  • Previous experience of being active. For example, was it used as a punishment in school: being made to do laps or push-ups for poor behaviour, or as a reward: you’ve done well now you get to go out and play.
  • Whether social care benefits will be curtailed or even stopped if people are seen to be physically active, along with many other factors.

Unpacking the extent to which each factor plays into an individual’s decision to take part in physical activity and what kinds of support works best to overcome the barriers would take hundreds of experimental comparisons and thousands of research participants to achieve the highest levels of rigour and certainty to inform how health and care services fund and provide physical activity to help manage and prevent long-term health conditions. 

Furthermore, we need research to occur in the very places and involve the populations with the greatest need. This helps to make sure that knowledge generated through research is more likely to be implemented, its impact is more sustainable and occurs faster. 

We suggest what is needed is a broader movement towards grassroots, big-team science: endeavours in which an unusually large number of people in many roles – not only researchers or clinicians – across organisations, sectors and regions, organise themselves to pool intellectual and material resources in pursuit of a common goal* – to live better through moving more.

In health research fields, this is known as TEAM SCIENCE. The team science approach is about pooling resources to tackle a shared, large-scale challenge, meshing different sources of knowledge on the basis of equality (rather than hierarchy of education vs lived experience and/or practice). 

Alongside placing users at the centre of the conversation, it involves connecting research activity with delivery and implementation partners from the very outset. This helps ensure the complexity of the most important health and social care challenges is respected in the solutions that are generated. It helps speed up how knowledge from research is pulled through into practice on the ground..  

The fact that many people do not achieve the recommended levels of physical exercise despite the known benefits reflects our poor understanding of the diverse and complex mechanisms that influence health behaviours.

Realising the potential of physical exercise to help people live better is a long-term investment requiring effort and co-ordination across the whole system. It cannot be solved or demonstrated with a simple single intervention, clinical trial, or primary outcome/singular key performance indicator (KPI), for example, health care savings. 

It is a ‘perfect problem’ for a TEAM SCIENCE approach for several reasons:

  • It can provide better understanding of, and support for, the interacting factors affecting the use of physical activity within the whole system, from a wide range of perspectives.
  • It provides diversity of thought, resources, effort and long-term strategic thinking, which can translate into innovative ways of creating evidence, interventions and service configurations.
  • Solutions are stakeholder-led and include the people charged with implementing and sustaining initiatives, shifting thinking away from simple, linear, causal models towards considered processes and outcomes for all parts of the system (users, professionals, organisations).

In my experience, team science brings people together from all disciplines, backgrounds and experience, fostering a culture of mutual respect around shared goals. It could dispel some common myths.


Myth 1: 

Becoming physically active converts to health outcomes at population/health systems levels instantly – wrong! 

It’s a long-term investment which needs the whole system to come together to do their bit, consistently over time. 

For example, if someone attends a physical activity session in their local leisure centre but then goes home in the car, via the chippy while smoking, the physical activity alone won’t achieve the desired health outcome. We also need other parts of the system to support the opportunity to move more and to eat more healthily (quickly, cost effectively and enjoyably), and to restrict smoking.


Myth 2:

Physical activity is a medication to be given under supervision and must come with the notion of prescribed levels to be worthwhile. That’s wrong too, as is the notion that unless people are active at guideline levels, it’s not worth doing, and/or activity is unsafe for some people with long-term conditions and needs to be supervised and at the ‘right dose’.

Instead, we must recognise many people will need to build up to the recommended ‘dose’ in healthcare terms or in exercise terms; we need to build up the fitness. 

Supporting people to become more active and build towards guideline levels of what will help them realise health benefits can only be done by addressing the wider social factors determining health behaviours (ie: all those factors that affect people’s decision to be active or not). 

Physical activity is NOT a pill to be prescribed for and overseen only by health professionals. It’s a way of life that many health and allied healthy lifestyle professionals and social carers need to support – we need many parts of the system to work together. It’s more about ‘support’ than ‘treatment’.

Identifying the layers of behaviour change

If our shared aim is to support everyone to live better through movement then the only way we will see more people being active is to change the way we currently provide support. 

Often the issue of physical activity is seen as a behavioural change on the part of the person that needs to become more active. This way of thinking isn’t working – the vast majority of us do not achieve recommended physical activity guidelines. Everyone in the chain of physical activity provision and use needs to change their behaviour – this means you and me too!  

To change the way, we provide support for physical activity means there are many layers of behavioural change that need to happen.

Healthcare professionals need to change their clinical practice behaviours to include conversations about physical activity and to refer to available physical activity services more. 

People need support to overcome the social factors determining their health behaviours. For example, social prescribers and voluntary partners need to work alongside clinical referrals to help more patients take up the referrals they are offered. 

And we need to offer opportunities for physical activity that support people to maintain levels for long enough to realise health improvements. Only then will we reap a return on investment via savings for the NHS at a population level.

As part of the Pivot to Active Wellbeing, we are prioritising spending time working with ALL stakeholders (decision-makers, providers and recipients) to agree a core set of KPIs that are closer to the behaviours and outcomes physical activity services actually have influence over (not only the headline NHS business outcomes that are long term and system-wide achievements/investments).

All of these things point to the idea that supporting people to move more is not the job of the healthcare system nor of the leisure sector alone. 

We need many people in many different roles across the health and care systems and within the community to contribute to addressing the health challenge.

So, to address ’the elephant in the room’ and build our Move More Team Science, our Active Academic Partnership is bringing all the stakeholders together to make co-ordinated action and evidence necessary to help everyone live better through movement in three ways:

  1. A ‘Move More’ community of practice summits – this is an ongoing, quarterly series of summits that are open to anyone who has a role in supporting people to move more to prevent and manage long term conditions.
  2. A round table for core outcomes – we are involving policymakers, healthcare professionals, industry partners, leisure providers and many more stakeholders from across GM to be involved in determining how we collectively capture the determinants of physical activity behaviour. This is about looking at more than just savings for the healthcare system. We will look at attitudes towards physical activity, social connections, effects of activity on mental health and mood which may lead to increasing activity to guideline levels that reflect the health benefits we are seeking.
  3. Research through connecting with people who do not engage in physical activity to better understand their needs and wishes for a way in which they are supported to use physical activity to manage their health conditions. 

To achieve this, underlying conditions need to be in place:

  • Everyone is empowered to lead in their own right.
  • All knowledge source is equitable – this calls for careful management of hierarchy, of policy maker/consultant over front line provider or service user. 
  • Speaking the same language. 
  • Sharing the same goals – definition of success is ‘win is the service users’ not the service provider or the policy maker.

Then, and only then, will two disparate elephant tribes come together to make one.

Interested in working with us?

We are actively seeking new partners, opportunities for collaboration and innovative ways of working.  We can’t do this alone. If our plans, purpose and intent chime with you, please do connect with us and be part of our transformational movement.