Tom Lake

6 Week Sport-Based Healthy Eating Intervention for Year 6 Students in Barnstaple Primary

Schools

3000 Words

Executive Summary

A role-model based childhood obesity intervention programme can make a positive

contribution to young people’s lives.

My proposal involves implementing a dual-curriculum, offered to Year 6 classes in Primary

Schools of the Barnstaple catchment area. The curriculum consists of six weeks of two back-

to-back 45 minute lessons; one educational classroom or kitchen-based lesson and one

practical multi-sports lesson with a healthy eating theme. The programme will be free for

the schools, funded entirely by Exeter City Football Club, through applied funding from

Active Devon, the County Sports Partnership for Devon.

Sessions will run by the Community Coaches from Exeter City in the Community; a

registered charity from whom a team of seven coaches work in the North Devon area. All

coaches are to be paid to achieve the Level 2 Award in Food Safety (Chartered Institute of

Environmental Health, 2015) allowing them to safely demonstrate food handling and

preparation. Later lessons include student participation in creating uncooked snacks such as

fresh fruit salads, vegetable batons and sandwiches, demonstrating a healthier way of

eating.

The educational lessons will consist firstly of classroom-based educational activities, with

lessons four and five practical-based food preparation. A first-team footballer from Exeter

City will visit the school in lesson six, assisting with the lesson and providing autograph and

photo opportunities.

Physical activity sessions will take the form of structured physical education lessons,

allowing teachers to use their planning, preparation and assessment time (PPA) in this

session. The lessons will be inclusive for all and focus on key themes of healthy eating,

delivered through a multi-skills programme using various types of sporting equipment.

Page | 1

Tom Lake

Once the programme is successfully completed, students will be accredited through an

internal certification system and given opportunities to participate further in discounted

extra-curricular activities, such as after-school and holiday clubs.

Assessing Policy Implications and Relevance to Local and National Priorities

The topic of childhood obesity and fitness is often presented as one of the greatest threats

to global, let alone national health (Karnik and Kanekar, 2012, pp1-7). Jones (2012a, pp27-

28) further demonstrates this, explaining that decreasing food quality and physical activity

levels have contributed to rising rates of obesity in the United Kingdom.

Intervening on childhood obesity and physical activity can be viewed as a largely proactive

idea, as improving health in young people can hopefully alleviate issues in later life.

Referring to the Ottawa Charter for Health Promotion (World Health Organisation (WHO),

1986, in The Open University, 2014a) the development of personal skills and knowledge of

public health are both applicable to the lifestyles of young people and also reflect the

movement away from clinical interventions to a health promotional approach.

There are also economic justifications for combatting childhood obesity; in 2012 alone

obesity cost the United Kingdom economy an estimated £47.9 billion and the National

Health Service (NHS) £6 billion (Dobbs et al, 2014, pp19-23). In comparison, this is greater

than the national defence budget, yet under 1% of the health budget is spent on childhood

obesity (Dutta, 2014), demonstrating the need for cost-effective anti-obesity programmes.

Nationally, concern is growing about the types of food children are consuming, contributing

to the lack of nutrients needed for current and future health. Ruxton and Derbyshire (2011,

pp20-33) suggest only 22% of boys and 7% of girls meet the national five-portions-a-day

target, whilst in 2012 only 21% of children in England met the recommendations of three

days per week of sixty minutes of vigorous activity (Townsend et al, 2015, pp25-27).

In Barnstaple, my targeted intervention location, the situation is worse. North Devon, and

the Barnstaple catchment area in particular, has the greatest number of obese Reception

and Year 6 children in the county (National Child Measurement Programme, 2007, in Devon

Primary Care Trust, 2008, pp7-9). The South West also suffers against national averages,

with only 13% of boys meeting physical activity guidelines in comparison with 25% in the

South East of the country (Townsend et al, 2015, p8).

Page | 2

Tom Lake

Statistics also reveal that in the county, North Devon has the worst levels of circulatory

diseases and coronary heart disease mortality in people under 75 (NHS Devon, 2011, p8) of

which poor diet and lack of exercise are both contributory factors. Whilst this is a national

problem, with 26% of deaths in England attributable to cardiovascular diseases (Townsend

et al, 2014, p22), it is important that the lifestyles of young people are monitored to avoid

these statistics increasing.

The evidence collected suggests that creating a national behavioural change in early years

can promote a healthier lifestyle, saving money for the NHS which can be prioritised

elsewhere. It also demonstrates that in North Devon children are exercising less than

regional counterparts, resulting in continual cycle where the most obese Year 6’s in the

county are leaving North Devon primary schools, passing the problem onto secondary

schools and beyond.

My proposal can directly tackle both issues of inactivity and poor diets in children. Devon

Primary Care Trust (2008, pp14-17), in their Healthy Weight Strategy for Devon, actually

identify five out of their twenty-five recommendations are to improve childhood obesity and

exercise. This demonstrates the realisation of the issues and subsequent need for

intervention, which can make a positive difference to both the nutritional understanding

and physical activity levels of children in the Barnstaple catchment area and beyond.

Exploring and Analysing Current Interventions

To create a competent and systematic proposal, the use of a planning model such as the

one created by Nutbeam and Harris (2004, in Sidell and Douglas, 2010, p256) can help to

ensure that the demand is evident enough to justify an intervention. Having used phase one

of the planning model to establish that the issue of healthy eating and activity in children is

a worthwhile cause for intervention, phase two involves finding a solution and creating

objectives and strategies for a successful intervention.

Nationally, high profile interventions have attempted to curb childhood and adult obesity,

with varying results. Non-intrusive methods, such as those exhibited in the Change4Life

programme (Department of Health, 2009, p15) and the development of the Active Kids

initiative (J Sainsbury PLC, 2014), have helped to deliver change, however these

programmes are difficult to quantify to demonstrate their success.

Page | 3

Tom Lake

Some programmes are more quantifiable; the Walk Once a Week programme (Living

Streets, 2012) costs just £1.31 per head and provides students who walk to school

collectable badges, increasing walking by 26%. This perhaps creates a greater impact as

parents can be involved too, addressing the concerns of Bandesha and Litva (2013, pp179-

184) that time is a constraint that prevents engagement; the school drop is a busy time yet

is usually allocated as parent and child time. There are of course exceptions to this with

working families and shift workers but the main rationale is that some parents are with their

children at that time anyway, making participation more likely.

Other initiatives specifically target schools, for example The School Fruit and Vegetable

Scheme (NHS, 2013) and National Healthy Eating Week (British Nutrition Foundation, 2014)

giving student’s exposure to healthier foods. These projects, whilst offering healthier

alternative foods, still don’t solve the issue of encouraging parents or carers to change their

eating habits, which has been shown to be the most effective treatment in child obesity in a

study based in Israel (Golan et al, 1998, p1133).

There are also programmes that simply collect data and give personalised advice to parents

about their child. The National Child Measurement Programme (Public Health England,

2013, pp5-6) measures the height and weight of children in Reception and Year 6, producing

body mass index score (BMI) and subsequently contacting parents if this BMI is too high,

offering advice on alternative healthier lifestyles. This is a non-compulsory intervention, yet

has a 99% participation rate due to its opt-out only basis (Public Health England, 2013, p7),

however this high rate maybe due to parent’s fears of their child being in a minority,

creating the ethical argument regarding emotionally forced participation and going against

social normality.

Unreliability is also a factor; the BMI measurement for children is questionable due to

growth patterns of children (Jones, 2012b, p430) which can distort scores, subsequently

leading to bad publicity for the programme (Thompson, 2015) and possibly a lower

participation rate. This frank language can possibly add harm (Devon, 2013) with evidence

suggesting a link between body image dissatisfaction and eating disorders (Butryn and

Wadden, 2005, pp290-291).

Page | 4

Tom Lake

Despite its remoteness, there have been interventions in both North Devon and Devon as a

whole, using a variety of methods. Attempts by PEDPASS (2010, pp19-23) to incorporate

cycling qualifications for Key Stage 2 students are ongoing, therefore its success cannot be

determined until the project’s conclusion in 2016. Other programmes have a clearer

projection of their success; the backlash from parents due to the confiscation of foods

deemed unhealthy by staff at Caen Primary School made both regional and national news

(Langston, 2014; Russell, 2014) which in an era of improved communications can damage

the reputation of the school.

Two other local programmes, Two Moors Primary School’s chef intervention (Healthy

Schools Plus, 2011, pp1-2) and the Food for Life Partnership at Collaton Primary School

(Food for Life, 2015) involve children interacting and working with the school and outside

chefs to create meals and taste new foods. These programmes offer varying characteristics;

children at Two Moors School created purchasable cookery books, whilst Collaton Primary

School incorporated themes into the National Curriculum such as ‘Indian days’ where they

tried different cultural delicacies.

From analysing these different approaches, there isn’t any local interventions’ focusing on

both the healthy living and active lifestyle elements on children. By using these two different

stimuli in the same fashion as Mottola et al (2010, pp265-272) the intervention may appeal

to more people, particularly those who struggle academically or in physical education. This

approach also helps to reduce inequalities in public health; giving poorly-nourished children

a chance to experience a wider range of healthier foods, whilst similarly adding more

structured exercise and play into a child’s life.

Further Outlining the Proposal

Using phase three of the Nutbeam and Harris planning model (2004, in Sidell and Douglas,

2010, p256), it is evident that to make a successful intervention lessons need to be learnt

from previous programmes, to generate public support.

Having studied prior interventions, it is clear that in an era of increased communication any

proposal must be deeply analysed before it begins, to ensure a welcomed response. This

also involves community empowerment and a bottom up approach, ensuring influence is

‘not flowing from a single institutional or structural source’ (McGuirk, 2000, in Brigden,

Page | 5

Tom Lake

p220). As seen with Caen Primary School, this didactic approach can indicate too much of a

nanny state and is summarised well by Lott (2014, in Russell 2014) who states the

programme made a ‘shift from encouragement to enforcement’.

By creating a programme which is voluntary to schools rather than a targeted approach,

there are elements of the upstream approach and distributed leadership (Jones, 2008, in

Bowns and Griffiths, 2012, p94) from the club, to the coaches, to the schools and then the

pupils. This upstream approach also follows the principles of McKinlay and Marceau (2000,

in The Open University, 2014b) in that there must be a sociocultural awareness; a realisation

that the programme is being delivered to impressionable children and its aim is to

encourage, not demand change.

The evaluation and success of the programme therefore must simply be in participatory

numbers, as opposed to believing that an in-school programme will help a child to change

their family’s eating habits, particularly accepting the varying socioeconomic statuses of

each family involved. Recognising limitations of an approach can be beneficial and afford the

programme more credibility, with Judge and Bauld (2006, pp341-344) suggesting attempting

too much change can cause disillusionment and negatively affect the success of a

programme.

It can also be difficult to gauge public opinion on interventions, with the example of the

James Report (1997, in Jones, 2012b, p432), being criticised for being too invasive. This

demonstrates the difficulty in assessing public opinion and the need for degrees of

community participation (Scriven, 2007, in Scriven, 2012, p381) to demonstrate whether an

intervention is needed. Public opinion will be achieved by using a cascade approach; firstly

determining the opinions of the twenty two primary schools in the Barnstaple area through

promotional literature and meetings, then school assemblies to gather support from

students.

This collaboration with individual schools to offer personalised programmes demonstrates

the flexibility and respect that partnerships need to work (Scriven, 2012, p380) with the

school being able to implement their own evaluation process to measure whether to

continue with the partnership. Student and staff feedback sheets could form the basis of the

feedback for Exeter City Football Club, with the six week programme a school-termly

Page | 6

Tom Lake

commitment from both parties to ensure continuity and the opportunity to positively

influence as many students as possible without sudden cancellations.

In terms of targeted populations; the programme focusses on Year 6’s in an area statistically

deemed as struggling with childhood obesity and activity (NHS Devon, 2011, p8; Townsend

et al, 2015, p8) rather than targeting individuals, which can stigmatize and demoralise them

(Bird and Whitehead, 2012, p58). From a safety point of view, Year 6’s are the oldest in

Primary School and with knives involved in the food preparation, there is a need to follow

the ethical and moral themes of the Health Cities Network (WHO, 2009, in Dooris, 2012,

pp354-355) of creating an environment that supports health, wellbeing and safety.

There are merits to intervene in Secondary School where students have access to a larger

array of fast food, yet the size difference makes planning and intervening difficult,

particularly ethically if only some students get the experience while others do not.

Phase four of Nutbeam and Harris’ planning model (2004, in Sidell and Douglas, 2010, p256)

involves implementing the programme, where the hard work of planning becomes a reality.

During the introductory phases of the programme, continual assessment would be applied,

using similar methods such as those shown by Hawe (1998, in Sidell and Douglas, 2012,

p269) by ensuring correct protocol is followed and participants are enjoying the experience.

This should be done by all parties involved, cementing the idea of partnership and equal

decision making as to how to improve the programme for future participants.

Reflective Analysis

Phase five, the final stage of the planning model by Nutbeam and Harris (2004, in Sidell and

Douglas, 2010, p256), encompasses the need to evaluate the programme, measuring it

against initial targets and offering methods of development for the future.

This evaluation can be done against pre-defined targets such as quantitative measurements

of participation and qualitative opinions of affected personnel, or in a more detailed

approach, similar to that of Hawe et al (1998, in Scriven, 2012, pp257-258). This

approach evaluates both the impact and outcome which can be vastly different; for example

the impact of the programme may have reached the desired number of students due to its

strong, easy repeatability, yet its outcome of encouraging behavioural change may not be

fulfilled.

Page | 7

Tom Lake

What both of the planning models (Nutbeam and Harris 2004, in Sidell and Douglas, 2012,

p256; Hawe et al (1998, in Sidell and Douglas, 2012, pp257-258) do not evaluate however is

the moral and ethical implications that the approach brings unless highlighted in qualitative

feedback. Offering a free health programme strongly appeals to schools in a recessive

economy, although the secondary aim of securing new sign-ups and fans may be subliminal

but could still be considered unethical by some. This is demonstrated further by Walker and

Kent (2009, p760), who suggest disregarding the idea of corporate social responsibility is

counter-productive to a company’s reputation.

This draws parallels with the smoking case study of Activity 21 (The Open University, 2014c)

in which the shopkeeper, in a recessive economic environment sells to underage customers

to keep him in business. Whilst the fundamentals of business are to capitalize on supply and

demand, following this model in an aggressive fashion may present a weakness and limit

business in the future.

As Bowns and Griffiths (2012, p80) identified, agencies need to work together when dealing

with multifaceted public health issues. The proposal involves the collaboration of five

parties; Exeter City Football Club as providers, Active Devon as funders, the Chartered

Institute of Environmental Health as educators, the school as the facilitator and the

parents/carers and children as participants.

The amount of partners used in the programme therefore presents an attractive proposition

to schools; the strength of using experts in their respective fields allows the highest quality

product to be produced, delivering a greater experience to all participants involved.

This collaboration presents a potential weakness; food preparation training is needed for

the coaches yet with Devon an isolated part of the country these courses are infrequent and

limited (Plymouth City Council, 2015, p4). With training fundamental to the programme, this

reliance on outside agencies could have a knock-on effect on elements of the programme,

such as start dates and promotional literature.

In addition to this reliance on outside agencies there is also dependence on coaching staff;

of whom the club has invested in via paid-for qualifications to help run the course. With only

seven staff, should one or two leave the club loses two important elements; the importance

of continuity in teaching (Fuss et al, 2008, p792) and also the necessary training, recreating

Page | 8

Tom Lake

the vicious cycle of being at the mercy of available training courses to continue the

programme.

To summarise, there are many principles that practitioners need to be aware of before

implementing any public health policy. There must also be an acceptance that working in

the public domain will rarely present universal agreement and many alternative viewpoints.

Interventions where practitioners undertake detailed research, collaborate with others and

empower communities stand a better chance of making a difference to the livelihood of

others, in our ever-changing world of public health.

Page | 9

Tom Lake

Reference List

Bandesha, G., and Litva, A. (2013) ‘Perceptions of community participation and health gain

in a community project for the South Asian population: a qualitative study’ in Douglas J.,

Earle S., Handsley S., Jones L., Lloyd C., and Spurr S. (eds) ‘A reader in promoting public

health, challenge and controversy’ London, Sage; Milton Keynes, The Open University, p181

Bird, P. and Whitehead, M. (2012) ‘The public health challenge’ in Jones. L & Douglas, J.

(Eds) ‘Public health: building innovative practice’ London, Sage & Milton Keynes, The Open

University, p58

Bowns, I., Griffiths, J. with Jones, L. and Lucas, M. (2012) ‘Working in organisations: skills and

approaches’ in Jones. L & Douglas, J. (eds) ‘Public health: building innovative practice’

London, Sage & Milton Keynes, The Open University, pp80-94

Brigden, P. (2013) ‘Evaluating the empowering potential of community-based health

schemes: the case of community health policies in the UK since 1997’ in Douglas J., Earle S.,

Handsley S., Jones L., Lloyd C., and Spurr S. (eds) ‘A reader in promoting public health,

challenge and controversy’ London, Sage; Milton Keynes, The Open University, p220

British Nutrition Foundation (2015) ‘British Nutrition Foundation Healthy Eating Week 2014’

[online] Available at: http://www.foodafactoflife.org.uk/Sheet.aspx?

siteId=20&sectionId=114&contentId=727 (Accessed 3rd May 2015)

Butryn, M.L. and Wadden, T.A. (2005) ‘Treatment of overweight in children and adolescents:

does dieting increase the risk of eating disorders? In ‘International journal of eating

disorders’ Volume 37, Issue 4, pp290-291

Chartered Institute of Environmental Health (2015) ‘CIEH level 2 awards in food safety’

[online] Available at: http://www.cieh.org/training/level_2_food_safety.html (Accessed

23rd April 2015)

Department of Health (2009) ‘Change4Life marketing strategy: in support of healthy weight,

healthy lives’ London, Central Office of Information, p15

Devon, N. (2013) ‘Sure you can tell your child they are fat. If you want them to live a lifetime

of insecurity’ [online] Available at: http://www.independent.co.uk/voices/comment/sure-

Page | 10

Tom Lake

you-can-tell-your-child-they-are-fat-if-you-want-them-to-live-a-lifetime-of-insecurity-

8879656.html (Accessed 4th May 2015)

Devon Primary Care Trust (2008) ‘Healthy weight strategy for Devon 2008-2011’ Exeter,

Devon Primary Care Trust, pp7-17

Dobbs, R., Sawers, C., Thompson, F., Manyika, J., Woetzel, J., Child, P., McKenna, S. and

Spatharou, A. (2014) ‘Overcoming obesity: An initial economic analysis’ London, McKinsey

Global Institute, pp19-23

Dooris, M. (2012) ‘Settings for promoting health’ in Jones. L & Douglas, J. (eds) ‘Public

health: building innovative practice’ London, Sage & Milton Keynes, The Open University,

pp354-355

Dutta, H. (2014) ‘Less than 1% of public health budget is used to treat obesity in children’

[online] Available at: http://www.independent.co.uk/news/uk/politics/less-than-1-of-

public-health-budget-is-used-to-treat-obesity-in-children-9180199.html (Accessed 6th May

2015)

Food for Life (2015) ‘Food glorious food - improving the lunchtime experience’ [online]

Available at: http://www.foodforlife.org.uk/what-is-food-for-life/case-studies/food-

glorious-food-improving-the-lunchtime-experience (Accessed 2nd May 2015)

Fuss, F.K., Subic, A. and Ujihashi, S. (2008) ‘The impact of technology on sport ii’ Boca

Ranton, United States, Taylor and Francis, p792

Golan, M., Weizman, A., Apter, A. and Fainaru, M. (1998) ‘Parents as the exclusive agents of

change in the treatment of childhood obesity’ in ‘American journal of clinical nutrition’,

Volume 67, Issue 6, p1133

Healthy Schools Plus (2011) ‘Case study - increase in uptake of 5 a- increase in uptake of 5 a-

day’ Bristol, South West Public Health Observatory, pp1-2

J Sainsbury PLC (2014) ‘Sainsbury’s invest millions to get Active Kids in the kitchen’ [online]

Available at: http://www.j-sainsbury.co.uk/media/latest-stories/2014/0129-sainsburys-

invest-millions-to-get-active-kids-in-the-kitchen/

Page | 11

Tom Lake

Jones, L. (2012a) ‘Public health in context’ in Jones. L & Douglas, J. (eds) ‘Public health:

building innovative practice’ London, Sage & Milton Keynes, The Open University, pp27-28

Jones, L. (2012b) ‘Understanding and influencing policy change’ in Jones. L & Douglas, J.

(eds) ‘Public health: building innovative practice’ London, Sage & Milton Keynes, The Open

University, pp430-432

Judge, K. and Bauld, L. (2006) ‘Learning from policy failure? health action zones in England’

in ‘European journal of public health’, Volume 16, Issue 4, pp341–344

Karnik, S. and Kanekar, A. (2012). Childhood obesity: a global public health crisis’ in

‘International journal of preventive medicine, Volume 3, Issue 1, pp1–7.

Langston, K. (2014) ‘Parents attack school lunch box checks’ [online] Available at:

http://www.westernmorningnews.co.uk/Parents-attack-school-lunch-box-checks/story-

23040578-detail/story.html (Accessed 3rd May 2015)

Living Streets (2012) ‘Living Streets' groundbreaking Walk once a Week scheme - or WoW -

encourages more than 300,000 children to walk to school by rewarding them with collectible

badges’ [online] Available at: http://www.livingstreets.org.uk/walk-with-us/walk-to-

school/primary-schools/walk-once-a-week (Accessed 3rd May 2015)

Mottola, M.F., Giroux, I., Gratton, R., Hammond, J.A., Hanley, A., Harris, S., McManus, R.,

Davenport, M.H. and Sopper, M.N (2010) ‘Nutrition and exercise prevent excess weight gain

in overweight pregnant women’ in ‘Medicine and science in sports and exercise’ Volume 42,

Issue 2, pp265-272

National Health Service (2013) ‘5 a day school scheme’ [online] Available at:

http://www.nhs.uk/Livewell/5ADAY/Pages/Schoolscheme.aspx (Accessed 3rd May 2015)

National Health Service Devon (2011) ‘Joint strategic needs assessment local authority

health profile 2010-11’ Exeter, Devon Health and Wellbeing, p8

Russell, B. (2014) ‘Parents blast school for 'bullying' children after it clamps down on lunch

box junk food’ [online] Available at: http://www.mirror.co.uk/news/uk-news/parents-blast-

school-bullying-children-4334241 (Accessed 3rd May 2015)

Page | 12

Tom Lake

Ruxton, C.H.S. and Derbyshire E. (2011) ‘Diet adequacy in UK schoolchildren’ in ‘Nutrition &

food science’ Volume 41, Issue 1, pp20-33

PEDPASS (2010) ‘every move is a good move: the Devon PEDPASS strategy 2011–2016’

Exeter, Devon Learning and Development Partnership, pp19-23

Plymouth City Council (2015) ‘Training and business services 2015 to 2016’ [online] Available

at: http://www.plymouth.gov.uk/training_and_business_services_2015_to_2016.pdf

(Accessed 2nd May 2015)

Public Health England (2013) ‘National Child Measurement Programme 2013-14 information

for schools’ London, Public Health England, pp5-7

Scriven, A. (2012) ‘Building partnerships and alliances’ in Jones. L & Douglas, J. (eds) ‘Public

health: building innovative practice’ London, Sage & Milton Keynes, The Open University,

pp380-381

Sidell, M. and Lloyd, C. (2012) ‘Building evidence-based practice: statistics and epidemiology’

in Jones. L & Douglas, J. (eds) ‘Public health: building innovative practice’ London, Sage &

Milton Keynes, The Open University, pp256-269

The Open University (2014a) ‘Promoting health’ K311 Public health in context: promoting

health [online] Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?

id=535010&section=1.2.3 (Accessed 4th May 2015)

The Open University (2014b) ‘Downstream and upstream’, K311 Public health: building

innovative practice - chapter 1 [online] Available at:

https://learn2.open.ac.uk/mod/oucontent/view.php?id=535010&section=1.5.1 (Accessed

9th May 2015)

The Open University (2014c) ‘Activity 21: reflecting on ethical dilemmas’ K311 6.1 Making

ethical decisions [online] Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?

id=534818&section=7.1 (Accessed 13th April 2015)

Thompson, C. (2015) ‘This North Tyneside four-year-old has been deemed 'very overweight' -

what do you think?’ [online] Available at:

Page | 13

Tom Lake

http://www.chroniclelive.co.uk/news/health/north-tyneside-four-year-old-been-deemed-

9160087 (Accessed 4th May 2015)

Townsend, N., Wickramasinghe, K., Williams, J., Bhatnagar, P. and Rayner, M. (2014)

‘Cardiovascular disease statistics, 2014’ London, British Heart Foundation, p22.

Townsend, N., Wickramasinghe, K., Williams, J., Bhatnagar, P. and Rayner, M. (2015)

‘Physical activity statistics 2015’ London. British Heart Foundation, pp8-27

Walker, M and Kent, A. (2009) ‘Do fans care? Assessing the influence of corporate social

responsibility on consumer attitudes in the sport industry’ in ‘Journal of sport management’

Volume 23, Issue 6, p760

Page | 14