Table 1 Highest ranked implementation recommendations to improve the healthy PA environment for both the policy and infrastructure support domains

Urban design^a

1. Integrate PA into the Environment Act and establish clear conditions or frameworks for incorporating PA aspects (such as space for active transport, play, exercise, sports and mixed land use) into environmental visions, programs and plans that municipalities must comply with. To achieve this, it is important to establish a dedicated position within local government to monitor the integration of PA into spatial planning. This position should also safeguard, monitor and provide feedback (by complying with the national frameworks)

Education

2. Make physical education even less optional and ensure that the education inspectorate structurally assesses its quality on the basis of a set of core indicators

Urban design

3. Formulate clear guidelines for urban design aimed at attractive and socially safe walking and cycling routes through the neighbourhood, near schools, in industrial areas, to recreational areas and across business parks. The following peripheral issues are important:

a. Sufficient lighting along the pedestrian and cycle paths;

b. Pedestrian and cycle paths along houses (in other words, within sight of residents);

c. Prioritize neighbourhoods with low PA levels (where vulnerable groups live who engage in minimal PA)

Transport

4. Formulate guidelines or clear rules in which the STOMP principle^b is central to promote active transport. (Local) Policymakers must take these guidelines/rules into account when constructing new neighbourhoods and redeveloping existing neighbourhoods. CROW, a Dutch independent knowledge centre for infrastructure, public space and traffic and transport, can play a role in this guideline development. These guidelines pay attention to:

a. Car-free policy, including (limiting) the number of parking spaces in neighbourhoods;

b. Number of cycle paths (including doorfietsroutes, which are spacious and comfortable bike paths that connect urban regions);

c. Amount of high-quality, socially safe and accessible walking paths

Education^a

5. Increase schools’ obligation to participate in lifestyle programs in which PA plays a role, such as the Healthy School (Gezonde School) or the Healthy Primary School of the Future (Gezonde Basisschool van de Toekomst). As a precondition, the administrative work for these programs, such as the application process, must be simplified for schools. This is especially important for schools that already face many (administrative) burdens

Sport and Recreation for All^a

6. Implement measures to ensure that financial PA schemes (subsidies) can be used by and are accessible to as many vulnerable groups as possible. For example:

a. Increase awareness of the financial schemes;

b. Reduce the restrictions of the regulations that limit access;

c. Ensure uniform regulations across all municipalities (in other words, expand the regulations in specific municipalities);

d. Reduce the administrative burden for applying for schemes (in other words, simplify the application procedure). For example, pay attention to groups facing language barriers who wish to utilize these schemes

Sport and Recreation for All^a

7. Facilitate co-creation of national PA initiatives targeting the least active and vulnerable groups, involving stakeholders (including at least representatives of the target group), and considering structural barriers for PA (such as poverty and stress). The goal is to integrate PA as a structural component of a broader strategy to address challenges faced by these groups. For example, PA can be included as a potential intervention within poverty policy. It is important for the PA sector to remain flexible and recognize that PA may not always be a high priority for these groups

Urban design^a

8. Establish requirements for municipalities to ensure universal accessibility of public spaces, guaranteeing accessibility for all users (including pedestrians). Consider the following requirements:

a. A bench must be available every x meters;

b. There must be x public toilets in a neighbourhood;

c. x playgrounds must be designed according to the samenspeelnorm:

100 – a playground where everyone (100%) is welcome;

70 – a playground that is at least for 70% accessible to everyone;

50 – a playground where at least 50% of the playground equipment is playable for every child and is aimed at meeting and playing together

Leadership

1. Implement structural PA policy (and associated PA goals) that extends beyond a usual 4-year government term, ensuring long-term commitment

Funding and resources

2. Increase funding for prevention initiatives, with a significant focus on cross-domain PA

Leadership

3. Develop PA guidelines (potentially on the basis of the WHO PA guidelines) tailored for vulnerable groups (such as the chronically ill, pregnant women and people with disabilities), to complement the guidance provided by Knowledge Centre for Sport & PA

Governance

4. Promote/facilitate the implementation of toolboxes and toolkits developed by Knowledge Centre for Sport & PA and the National Institute for Public Health and the Environment, aimed at securing and utilizing knowledge (including elements of proven effective interventions) in the development of (local) PA policy. This will aid in the effective use of available knowledge

a. As a condition for subsidies for scientific research, require collaboration with a semi-governmental organization (such as Knowledge Centre for Sport & PA or the National Institute for Public Health and the Environment) to ensure practical translation

Governance

5. Launch media campaigns and additional communication strategies to increase awareness and the importance of PA, with a specific focus on the PA guidelines, amongst the general population