Scotland’s Tiered Approach to Physical Activity: A System-Wide Opportunity for Local Authorities

In June, Public Health Scotland (PHS) launched Scotland’s Tiered Approach to Physical Activity—a strategic framework designed to support physical activity interventions and empower individuals to become independently active. This guidance is particularly relevant for those working in local authorities as well as health professionals across NHS Scotland, as it provides a practical tool to help address inactivity and improve population health outcomes across communities.

Why Physical Activity Matters More Than Ever

Physical activity is a proven intervention in both the prevention and management of long-term conditions. Even modest increases in activity levels can yield significant health benefits. Yet, despite this, The Scottish Health Survey highlights 22% of adults in Scotland report engaging in less than 30 minutes of physical activity per week – a level associated with increased risk of chronic illness and reduced quality of life.

According to the PHS 2024 Estimating the Burden of Disease Attributable to Physical Inactivity study, it is estimated over 3,000 deaths and almost 12,000 years of healthy life are attributable to physical inactivity.  More than 80% of these deaths and DALYs are due to the ‘very low’ physical activity category (those doing less than 30 mins/week of moderate physical activity per week).

Understanding the Barriers

Nearly 48% of adults in Scotland live with one or more long-term condition, and 37% report that these conditions limit their daily activities. Among those not meeting Chief Medical Officer (CMO) guidelines, 41% cite poor health as their primary barrier. These figures underscore the need for a system that supports people to be active despite health challenges.

A National Commitment to Change

Scotland has committed to reducing physical inactivity by 15% by 2030, aligning with the World Health Organization’s Global Action Plan on Physical Activity. This ambition is embedded in the Population Health Framework (2025–2035), which prioritises prevention and healthy weight—both of which are directly influenced by physical activity.

The Physical Activity for Health Framework serves as the implementation vehicle for these ambitions, linking national policy to local delivery.

Bridging Health and Community Locally

The tiered model was initially developed to provide a clear definition of Physical Activity Referral (Tier 2), clarifying its position within a broader framework of physical activity approaches and interventions. This helped improve consistency across referral schemes in Scotland. The updated guidance now places greater emphasis on embedding the tiered approach across all levels to ensure a continuum of community-based opportunities. This is key to bridging the gap between health services and local provision, enabling more seamless transitions for individuals into supportive, accessible physical activity options. Local authorities play a pivotal role in this process by ensuring that robust community support mechanisms are in place and aligned with health pathways.

The Tiered Model: A Practical Tool for Local Action

The tiered model emerged from the development of the Physical Activity Referral Standards (2022), which aimed to reduce service variability and provide a consistent framework for designing and delivering physical activity interventions.

Following extensive feedback from practitioners, PHS reviewed and refined the model to better reflect the realities of local delivery. The updated guidance now offers:

• Clear definitions of each tier

• Target audience identification

• Behaviour change needs and techniques

• Support for movement across tiers throughout the life course

This model is designed to help individuals progress toward mainstream physical activity, with support tailored to their needs and circumstances.

What This Means for Local Authorities

The tiered approach is a valuable resource for local commissioners, health professionals and service providers in order to support:

• Commissioning and planning physical activity services

• Mapping existing provision

• Designing new interventions based on local needs

• Supporting referral pathways that are person-centred and evidence-based.

Ultimately, this guidance is a crucial piece of the jigsaw to help both healthcare professionals and physical activity providers work together to support actions that will improve life expectancy, reduce health inequalities, and enable people to live longer, healthier lives.

Watch the webinar on Scotland’s tiered approach to physical activity

Read more on Scotland’s tiered approach to physical activity

Read more on  Estimating the Burden of Disease attributable to physical inactivity in Scotland

Find out more about the Scottish Health Survey

Find out more about the World Health Organization Global Action Plan on Physical Activity

Find out more about Scotland’s Population Health Framework