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Table 6 NICE guidance on physical activity and the environment

From: A translational framework for public health research

Case study
The National Institute for Health and Clinical Excellence (NICE) provides evidence-based guidance for clinical practice in the National Health Service (NHS) in England. Each piece of guidance is based on the systematic review of evidence for the effectiveness and cost-effectiveness of interventions and is subsequently translated into a set of implementation materials. In principle, the NICE process therefore fits neatly into the 'health technology assessment' component of the linear translational medicine pathway.
However, NICE's remit was expanded in 2005 to include public health, and its recent guidance on physical activity and the environment illustrates the need for a more inclusive translational framework. Most intervention studies reviewed for this guidance were of comparatively low quality and few demonstrated unequivocal changes in physical activity. However, rather than conclude that the evidence was insufficient, the programme development group drew on other types of evidence admissible under NICE procedures – including evidence about environmental correlates of physical activity, and interdisciplinary expert consensus – to make constructive recommendations based on a more inclusive approach to evidence synthesis. Most recommendations were intended for recipients outside the NHS such as transport planners, who have not previously been the target of NICE guidance and are under no obligation to take account of it. The successful implementation of this guidance is therefore likely to depend more on the 'indirect insinuation' of the recommendations into the practice of those working outside the health sector, perhaps by articulating an additional, public health case for interventions primarily motivated by other aims such as reducing traffic [35].