The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC): International consensus statement and user guide

Effective physical activity messaging plays an important role in the pathway towards changing physical activity behaviour at a population level. The Physical Activity Messaging Framework (PAMF) and Checklist (PAMC) are outputs from a recent modified Delphi study.

This sought consensus from an international expert panel on how to aid the creation and evaluation of physical activity messages. In this paper, we (1) present an overview of the various concepts within the PAMF and PAMC, (2) discuss in detail how the PAMF and PAMC can be used to create physical activity messages, plan evaluation of messages, and aid understanding and categorisation of existing messages, and (3) highlight areas for future development and research. If adopted, we propose that the PAMF and PAMC could improve physical activity messaging practice by encouraging evidence-based and target population focused messages with clearly stated aims and consideration of potential working pathways.

They could also enhance the physical activity messaging research base by harmonising key messaging terminologies, improving quality of reporting, and aiding collation and synthesis of the evidence.

Lee, I.M., et al., Effect of physical inactivity on major non- communicable diseases worldwide:
an analysis of burden of disease and life expectancy. Lancet, 2012. 380(9838): p. 219-229.
2. Strain, T., et al., Use of the prevented fraction for the population to determine deaths averted
by existing prevalence of physical activity: a descriptive study. The Lancet global health,
2020. 8(7): p. e920-e930.
3. Strain, T., et al., Wearable-device-measured physical activity and future health risk. Nature
medicine, 2020. 26(9): p. 1385-1391.
4. Rutter, H., et al., Systems approaches to global and national physical activity plans. Bulletin
of the World Health Organization, 2019. 97(2): p. 162-165.
5. Organization, W.H., Global action plan on physical activity 2018-2013: more active people for
a healthier world. 2018: Geneva.
6. International Society for Physical Activity and Health (ISPAH). ISPAH’s Eight Investments That
Work for Physical Activity. 2020.
7. Williamson, C., et al., Get the message? A scoping review of physical activity messaging.
International Journal of Behavioral Nutrition and Physical Activity, 2020. 17(51).
8. Milton, K., et al., Maximising the impact of global and national physical activity guidelines:
the critical role of communication strategies. British journal of sports medicine, 2020. 54(24):
p. 1463-1467.
9. Williamson, C., et al., A modified Delphi study to enhance and gain international consensus
on the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC). International
Journal of Behavioral Nutrition and Physical Activity, 2021. 18(108): p. 1-13.
10. Connell, L.E., et al., Links Between Behavior Change Techniques and Mechanisms of Action:
An Expert Consensus Study. Annals of behavioral medicine : a publication of the Society of
Behavioral Medicine, 2019. 53(8): p. 708.
11. Michie, S., v.M.M. Stralen, and R. West, The behaviour change wheel: a new method for
characterising and designing behaviour change interventions. Implementation Science, 2011.
6.
12. Williamson, C., et al., A modified Delphi study to enhance and gain international consensus
on the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC). In preparation.
13. Jünger, S., et al., Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative
care: Recommendations based on a methodological systematic review. 2017: London,
England. p. 684-706.
14. Pfadenhauer, L.M., et al., Making sense of complexity in context and implementation: The
Context and Implementation of Complex Interventions (CICI) framework. Implementation
science : IS, 2017. 12(1): p. 21-21.
15. Lewis, C.C., et al., From Classification to Causality: Advancing Understanding of Mechanisms
of Change in Implementation Science. Frontiers in public health, 2018. 6: p. 136-136.
16. Nutbeam, D. and A. Bauman, Evaluation in a nutshell : a practical guide to the evaluation of
health promotion programs. 2nd edition / Adrian Bauman, Don Nutbeam.. ed, ed. A.E.
Bauman. 2014, North Ryde, NSW: North Ryde, NSW : McGraw Hill Education, Medical.
17. Smith, B., O. Williams, and L. Bone, Co-producing research in the sport, physical activity, and
exercise sciences: A resource to guide co-production. Qualitative Research in Sport, Exercise
and Health, forthcoming.
18. Latimer, A.E., L. Brawley, and R. Bassett, A systematic review of three approaches for
constructing physical activity messages: What messages work and what improvements are
needed?, in Int. J. Behav. Nutr. Phys. Act. 2010.
19. Conroy, D.E., et al., Personalized models of physical activity responses to text message microinterventions: A proof-of-concept application of control systems engineering methods.
Psychology of Sport & Exercise, 2019. 41: p. 172-180.
25
20. French, J., Social Marketing and Public Health: Theory and Practice. 2017, Oxford: Oxford:
Oxford University Press USA - OSO.
21. Cross, R., S. Davis, and I. O'Neil, Health Communication: Theoretical and Critical Perspectives.
2017, Cambridge: Polity Press.
22. Lee, Y.O., et al., Peer crowd segmentation for targeting public education campaigns: Hip hop
youth and tobacco use. Preventive medicine reports, 2019. 14: p. 100843-100843.
23. Oliver, K., A. Kothari, and N. Mays, The dark side of coproduction: do the costs outweigh the
benefits for health research? Health research policy and systems, 2019. 17(1): p. 33-33.
24. Prochaska, J.O. and W.F. Velicer, The transtheoretical model of health behavior change. Am.
J. Health Promot., 1997. 12(1): p. 38-48.
25. Bandura, A., Social Cognitive Theory of Mass Communication. Media psychology, 2001. 3(3):
p. 265-299.
26. Ajzen, I., The theory of planned behavior. Organizational behavior and human decision
processes, 1991. 50(2): p. 179-211.
27. Janz, N. and M. Becker, The health belief model: A decade later. Health Education Quarterly,
1984. 11(1): p. 1-47.
28. Arnardottir, N.Y., et al., Comparison of Summer and Winter Objectively Measured Physical
Activity and Sedentary Behavior in Older Adults: Age, Gene/Environment Susceptibility
Reykjavik Study. International journal of environmental research and public health, 2017.
14(10): p. 1268.
29. Glowacki, K., et al., Barriers and facilitators to physical activity and exercise among adults
with depression: A scoping review. Mental health and physical activity, 2017. 13: p. 108-119.
30. Government, S. Scotland in lockdown: urgent action to bring virus under control. 2021 [cited
2021 31st May]; Available from: https://www.gov.scot/news/scotland-in-lockdown/.
31. World Health Organization (WHO), WHO guidelines on physical activity and
sedentary behaviour. Licence: CC BY-NC-SA 3.0 IGO. 2020: Geneva.
32. Scottish Government., UK Chief Medical Officers' Physical Activity Guidelines. 2019. Available
from:https://assets.publishing.service.gov.uk/government/uploads/system/u...
ment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf
33. Public Health Agency of Canada, Canadian 24-hour Movement Guidelines for Adults ages 18-
64 years: An Integration of Physical Activity, Sedentary Behaviour and Sleep. 2020.
34. U.S. Department of Health and Human Services, Physical Activity Guidelines for Americans,
2nd Edition, U.S. Department of Health and Human Services, Editor. 2018: Washington, DC.
USA.
35. Pate, R.R., et al., Physical activity and public health: a recommendation from the Centers for
Disease Control and Prevention and the American College of Sports Medicine. JAMA: Journal
of the American Medical Association, 1995. 273(5): p. 402-407.
36. Choi, B.C.K., et al., Daily step goal of 10,000 steps: A literature review. Clinical and
investigative medicine, 2007. 30(3): p. E146-E151.
37. Kelly, P., et al., Walking on sunshine: scoping review of the evidence for walking and mental
health, in Br. J. Sports Med. 2018. p. 800-+.
38. Teychenne, M., et al., Do we need physical activity guidelines for mental health: What does
the evidence tell us? Mental health and physical activity, 2020. 18: p. 100315.
39. Rhodes, R. and K. Courneya, Effects of a Health-Based versus Appearance-Based Persuasive
Message on Attitudes Towards Exercise: Testing the Moderating Role of Self-Monitoring.
Journal of Social Behavior and Personality, 2000. 15(3): p. 321.
40. Gaston, A. and K. Gammage, The effectiveness of a health‐based message on pregnant
women’s intentions to exercise postpartum. Journal of Reproductive and Infant Psychology,
2011. 29(2): p. 162-169.
26
41. Brand, C., et al., The climate change mitigation impacts of active travel: Evidence from a
longitudinal panel study in seven European cities. Global environmental change, 2021. 67: p.
102224.
42. Gilbert, G., et al., Do Framed Mental Health Messages on Social Media Influence University
Students’ Motivation for Physical Activity? International Journal of Environmental Research
and Public Health, 2021. 18(16, 8671): p. 1-11.
43. Bassett-Gunter, R.L., K.A. Martin Ginis, and A.E. Latimer-Cheung, Do You Want the Good
News or the Bad News? Gain- Versus Loss-Framed Messages Following Health Risk
Information: The Effects on Leisure Time Physical Activity Beliefs and Cognitions. Health
Psychology, 2013. 32(12): p. 1188-1198.
44. Bassett, R.L.M.S. and K.A.P.D. Martin Ginis, Risky business: The effects of an individualized
health information intervention on health risk perceptions and leisure time physical activity
among people with spinal cord injury. Disability and health journal, 2011. 4(3): p. 165-176.
45. Dacey, M., A. Baltzell, and L. Zaichkowsky, Older adults' intrinsic and extrinsic motivation
toward physical activity. American journal of health behavior, 2008. 32(6): p. 570-582.
46. Nobles, J., et al., “Let’s Talk about Physical Activity”: Understanding the Preferences of
Under-Served Communities When Messaging Physical Activity Guidelines to the Public.
International Journal of Environmental Research and Public Health, 2020. 17(2782): p. 2782.
47. Quick, B.L. and J.R. Considine, Examining the Use of Forceful Language When Designing
Exercise Persuasive Messages for Adults: A Test of Conceptualizing Reactance Arousal as a
Two-Step Process. Health Communication, 2008. 23(5): p. 483-491.
48. Hatchell, A.C., et al., Messages for Men: The Efficacy of EPPM-Based Messages Targeting
Men's Physical Activity. Health Psychology, 2013. 32(1): p. 24-32.
49. Brengman, M., et al., Functional Effectiveness of Threat Appeals in Exercise Promotion
Messages. Psicologica: International Journal of Methodology and Experimental Psychology,
2010. 31(3): p. 577-604.
50. Green, J., Health promotion : planning and strategies. Third edition.. ed, ed. K. Tones, R.
Cross, and J. Woodall. 2015, Los Angeles: Los Angeles : SAGE.
51. Hubley, J., Communicating health : an action guide to health education and health
promotion. 1993, London: London : Macmillan.
52. Hunter, R.F., et al., Addressing inequalities in physical activity participation: Implications for
public health policy and practice. Preventive medicine, 2015. 72: p. 64-69.
53. Lehne, G. and G. Bolte, Impact of universal interventions on social inequalities in physical
activity among older adults: An equity-focused systematic review. The international journal
of behavioral nutrition and physical activity, 2017. 14(1): p. 20-20.
54. Demarest, S., et al., Educational inequalities in leisure-time physical activity in 15 European
countries. European journal of public health, 2014. 24(2): p. 199-204.
55. Beenackers, M., et al., Socioeconomic inequalities in occupational, leisure-time, and
transport related physical activity among European adults: A systematic review. The
international journal of behavioral nutrition and physical activity, 2012. 9(1): p. 116-116.
56. Acheson, D., Independent inquiry into inequalities in health : report. 1998, London: London :
Stationery Office.
57. Kwak, N., Revisiting the Knowledge Gap Hypothesis: Education, Motivation, and Media Use.
Communication research, 1999. 26(4): p. 385-413.
58. Gaziano, C., The Knowledge Gap: An Analytical Review of Media Effects. 1982.
59. Spence, J.C., et al., Awareness of ParticipACTION among Canadian adults: a seven-year crosssectional follow-up. Health promotion and chronic disease prevention in Canada, 2018.
38(4): p. 179-186.
60. Kreuter, M.W., et al., Achieving Cultural Appropriateness in Health Promotion Programs:
Targeted and Tailored Approaches. Health education & behavior, 2003. 30(2): p. 133-146.
27
61. Emma M, D., et al., Behavior Change Interventions to Improve the Health of Racial and Ethnic
Minority Populations: A Tool Kit of Adaptation Approaches. The Milbank quarterly, 2013.
91(4): p. 811-851.
62. Smith, B. and L. Wightman, Promoting physical activity to disabled people: messengers,
messages, guidelines and communication formats. Disability and rehabilitation, 2019: p. 1.
63. Sport England. This Girl Can. Our Work 2019 4th July 2019]; This girl can is our nationwide
campaign to get women and girls moving, regardless of shape, size and ability]. Available
from: https://www.sportengland.org/our-work/women/this-girl-can/.
64. Sport England, This Girl Can: Campaign Summary. Available from: https://sportenglandproduction-files.s3.eu-west-2.amazonaws.com/s3fs-public/2020-01/CampaignSummary.pdf?VersionId=Yu_jmNiqPxjL8IlJC0EqvKXjJ_GOFpfx
65. Sport England, Go where women are: Insight on engaging women and girls in sport and
exercise. Available from: https://sportengland-production-files.s3.eu-west2.amazonaws.com/s3fs-public/insight_go-where-women-are.pdf
66. Bevington, F., et al., The Move Your Way Campaign: Encouraging Contemplators and
Families to Meet the Recommendations From the Physical Activity Guidelines for Americans.
Journal of physical activity & health, 2020. 17(4): p. 397-403.
67. Smith, B., et al., Disability, the communication of physical activity and sedentary behaviour,
and ableism: a call for inclusive messages. British journal of sports medicine, 2021: p.
bjsports-2020-103780.
68. Barnish, M.S. and S. Turner, The value of pragmatic and observational studies in health care
and public health. Pragmatic and observational research, 2017. 8: p. 49-55.
69. Moher, D., et al., Preferred reporting items for systematic reviews and meta-analyses: the
PRISMA statement. BMJ, 2009. 339(jul21 1): p. b2535-b2535.
70. Schulz, K.F., D.G. Altman, and D. Moher, CONSORT 2010 statement: Updated guidelines for
reporting parallel group randomised trials. PLoS medicine, 2010. 7(3): p. 1-7.
71. Faught, E., et al., Optimal messaging of the Canadian 24-Hour Movement Guidelines for
Adults aged 18–64 years and Adults aged 65 years and older. Applied Physiology, Nutrition,
and Metabolism, 2020. 45: p. S125-S150