*3.9. Summary*

Table 5 summarizes the results of the Polish HEPA PAT obtained from both the expert interviews and the Polish HEPA Focal Point with the help of the SWOT analysis. It indicates the strengths and weaknesses of the PA policy approach and highlights external opportunities and threats that may influence its future development.


**Table 5.** SWOT analysis of PA promotion in Poland.

#### **Table 5.** *Cont*.


## **4. Discussion**

HEPA PAT turned out to be a powerful tool for identifying the strengths and weaknesses of PA policy approach in Poland. The summary of results of its application presented in Table 5 allows conclusions to be drawn on what are the successes, what are the failures, where is a room for improvement, and what needs to be done from scratch regarding the efforts to increase the national PA level.

It is clear that the most important weakness of the Polish PA policy approach is the lack of clear leadership and the lack of mechanisms to coordinate efforts at different levels and to ensure effective collaboration (both vertically across different levels of governmen<sup>t</sup> and horizontally across different sectors). In the meantime, governments are encouraged by the WHO to set up a national coordinating mechanism that addresses PA within the context of a comprehensive plan for noncommunicable-disease prevention and health promotion. Local authorities should be closely involved. WHO recommendations underlie that multisectoral and multidisciplinary expert advisory boards should be established. They should include technical experts and representatives of governmen<sup>t</sup> agencies, and have an independent chair to ensure that scientific evidence is interpreted without any conflict of interest [21]. None of these currently exist in Poland.

There are governmen<sup>t</sup> structures that are actively promoting PA in the areas they are responsible for (i.e., sports, health, urban policy, transport, etc.), but their potential as policy makers is untapped. Their actions are undertaken independently and without linkage to

policies in other sectors, even when they have the same goal of making the Polish society healthier and more active.

Not only governmental structures, but also many processes, are already in place and dealing with PA promotion. Providing an umbrella covering all PA policies and activities is, therefore, an extremely important issue to be addressed in Poland. This is exactly what the WHO [21] recommended to its member states, emphasizing that it is governments that create the conditions for change in promotion of healthy lifestyles.

There are also strengths of the Polish PA policy approach. One of these is a regular PA monitoring. Data are collected in different population groups (i.e., adults, schoolaged children, and adolescents) and mostly on a regular basis, with the use of different methodologies. However, the existing monitoring tools and methods do not account for different external and internal conditions that may be influential (e.g., age group and weather conditions). The surveillance data come mainly from self-reported surveys (e.g., IPAQ). According to Winckers et al. [59], who compared IPAQ results with accelerometer data, using subjective PA measures leads to a general overestimation of PA; low data validity is especially observed in a lower-educated adult group. This may raise a question of validity of the surveillance data, which is not complemented with objective measurements.

Despite the amount of data being collected, these are rarely used in policy formulation or evaluation. The only policy document that is based upon the data and uses these data for evaluation is the National Sport Development Program [41], developed by the Ministry of Sport and Tourism. Lack of a clear evaluation plan makes it impossible to monitor whether other programs or interventions have met their objectives and how they should be changed in the future to be more effective. With single exemptions, the data are also not used for PA promotion or communicated to the society.

Based on WHO guidelines [11], Poland sets the recommended daily PA for most population groups. However, the recommendations are communicated to the society to a low extent. It is not evaluated to what extent people are aware of their existence. An important problem identified during the HEPA PAT data collection process was the lack of Polish recommendations on reducing sedentary behavior, which affects a large share of population [57].

While the surveillance data enable regular monitoring and evaluation, not all major policy documents have an evaluation plan included. The need for improvement in policy evaluation both in Poland and in other countries was also highlighted by Gelius et al. [24].

The results of this study show the potential of the efforts taken so far in improving PA level across society. Numerous actions are undertaken at different levels; different policy documents are in place, different sectors are engaged, and a large amount of data are collected. What is missing is effective coordination making the linkage between different activities and bodies engaged, and between actions undertaken at different levels (i.e., national, regional, and local). Poland may benefit from this comprehensive assessment in numerous ways. The country may use the results to prioritize actions regarding PA promotion that has to be undertaken and formulate recommendations for further activities. The methodology may be used by the country in order to monitor particular areas of PA policy approach. Other countries may also benefit from this comprehensive assessment. They may use the adopted methodology in order to identify strengths and weaknesses of their PA promotion policy approach; they may use the results to identify and compare the weak and strong points of the PA policy. Finally, they may use some practices that were assessed as successful in Poland.

The present study suffers from some limitations. The research was conducted at the national level only, and no regional or local level PA-related activities were included. Thus, the subnational level requires investigation and will be a subject of further research.

As data collection took place in 2019, the influence of the COVID-19 pandemic on policies promoting physical activity in Poland could not be assessed in this study.
