The German recommendations for physical activity promotion

Population-based physical activity promotion with a focus on health equity: a review of reviews

BACKGROUND

The extent to which people are physically active is dependent upon social gradients. Numerous studies have shown that especially people with social disadvantages do not meet the physical activity (PA) recommendations. A promising strategy to alleviate this issue are approaches that promote PA in the general population. In addition, several researchers have raised concerns that population-based health interventions may increase health inequities. The aim of the current review of reviews was therefore to identify successful population-based PA promotion approaches with a particular focus on health equity.

METHODS

Six electronic databases were examined for systematic reviews on population-based PA promotion for the period 2015 to 2021. A reference list and grey literature search were also conducted. Two independent reviewers used inclusion/exclusion criteria to screen titles and abstracts of the potentially relevant literature and conducted a quality assessment for each identified review. All included reviews of population-based approaches for PA promotion with a focus on disadvantaged populations and/or health equity were narratively summarized.

RESULTS

Our search resulted in 4,411 hits. After a systematic review process, six reviews met the inclusion criteria and were included after they were all rated as high quality. We identified that mass-media campaigns, point-of-decision prompts, environmental approaches, policy approaches, and community-based multi-component approaches can promote PA in the general population. Across populations with social disadvantages mass-media campaigns, point-of-decision prompts and policy approaches are likely to be effective as long as they are tailored. Regarding environmental approaches, the results are inconsistent. None of the reviews on community-based multi-component approaches provided evidence on health equity.

CONCLUSION

There are several effective approaches to promote PA in the general population but evidence regarding health equity is still sparse. Future studies should therefore pay more attention to this missing focus. Furthermore, there is a lack of evidence regarding the type of tailoring and the long-term impact of population-based approaches to PA promotion. However, this requires appropriate funding programmes, complex study designs and evaluation methods.

[Policies to promote physical activity in Germany : An analysis based on a policy audit tool from the World Health Organization]

BACKGROUND

Physical inactivity is a key determinant of noncommunicable diseases. Therefore, the World Health Organization (WHO) as well as researchers worldwide have developed different tools to monitor and audit policies to promote physical activity. However, these tools have so far not been used to systematically collect and analyse data on physical activity promoting policies in Germany.

AIM

This study aims to provide a systematic overview of policies to promote physical activity in Germany.

METHODS

The study was conducted as part of the Policy Evaluation Network ( www.jpi-pen.eu ). Data from the European Union Physical Activity Monitoring Framework, desk research, and an expert survey were utilised and collected with the WHO's health-enhancing physical activity (HEPA) policy audit tool (PAT).

RESULTS

The results highlight the wide range of relevant stakeholders and provide an overview of current policies as well as surveillance, evaluation, and funding. Significant accomplishments and persistent challenges are identified.

DISCUSSION

An international comparison shows that, in contrast to Germany, other countries have formulated measurable goals for physical activity promotion on a national level. However, Germany is among a minority of countries with specific physical activity recommendations for adults with noncommunicable diseases. Further structural development of physical activity promotion in Germany is necessary.

Co-producing an action-oriented framework for community-based Physical Activity Promotion in Germany

German National Recommendations for Physical Activity (PA) and PA Promotion recommend community-based approaches to promote PA at the local level with a focus on health equity. In addition, the German Federal Prevention Act addresses health equity and strengthens setting-based health promotion in communities. However, the implementation of both in the local context remains a challenge. This article describes Phase 1 of the KOMBINE project that aims to co-produce an action-oriented framework for community-based PA promotion focusing on structural change and health equity. (i) In a series of workshops, key stakeholders and researchers discussed facilitators, barriers and needs of community-based PA promotion focusing on health equity. (ii) The research team used an inductive approach to cluster all findings and to identify key components and then (iii) compared the key components with updated literature. (iv) Key components were discussed and incorporated into a gradually co-produced framework by the participants. The first result of the co-production process was a catalog of nine key components regarding PA-related health promotion in German communities. The comparison of key components with scientific evidence showed a high overlap. Finally, a six-phase action-oriented framework including key components for community-based PA promotion was co-produced. The six-phase action-oriented framework integrates practice-based and scientific evidence on PA-related health promotion and health equity. It represents a shared vision for the implementation of National Recommendations for PA and PA Promotion in Germany. The extent to which structural changes and health equity can be achieved is currently being investigated in pilot-studies.

[Dissemination of National Physical Activity Recommendations: Participatory Development of Dissemination Strategies in Germany]

BACKGROUND

In 2016, the first evidence-based National Recommendations for Physical Activity and Physical Activity Promotion were published in Germany. These recommendations are primarily intended for experts, decision makers and stakeholders.

OBJECTIVES

This study aims to describe the development of dissemination strategies for these recommendations.

PROCESS

To facilitate the co-production of knowledge between practitioners, decision makers, and researchers, a participatory approach was applied. This approach involved the development of target group-specific strategies for disseminating the recommendations. This was achieved in two workshops and one working group phase; 92 professionals and decision makers participated in the process.

RESULTS

The working groups developed specific dissemination strategies that were grouped into the following strategy types: (1) inform multipliers, (2) activate multipliers, (3) use existing and develop new networks, (4) initiate policy change.

CONCLUSION

The participatory approach adopted in this project was successful in developing dissemination strategies and is unique from an international perspective. To improve the evaluation of such co-production processes, future research should determine and operationalize appropriate indicators.

Sociodemographic correlates of physical activity and sport among adults in Germany: 1997–2018

Introduction

Promoting physical activity (PA) is a key strategy to prevent noncommunicable diseases worldwide. In order to monitor physical activity levels in Germany, several large-scale studies have reported on prevalence rates and correlates. However, a comprehensive analysis of correlates of PA over time is currently lacking for Germany.

Methods

For the analysis, 13 national cross-sectional data sets were utilized. Data analysis was restricted to respondents aged 18 and older. In a first step, data sets were kept separate in order to explore social gradients of PA and sport. In the second step, data sets were pooled, demographic factors harmonized and binary logistic regressions were conducted.

Results

Regarding sports participation, different data sets indicate comparable social gradients. People with a higher age, lower income, lower levels of education, or a migrant background consistently have a higher risk of not engaging in sports. Compared to sports participation, social gradients are less pronounced for engaging in vigorous PA. Higher age, lower education, and lower income are also markers for an increased risk of not engaging in vigorous PA.

Discussion

The study confirms that factors of age, income, education and migrant background continue to contribute to differentials in sport and vigorous PA participation in Germany. For policy-making, this implies that PA promotion should focus on systems-based actions that might reduce population-wide inequalities. Future research might focus on pooling single studies with smaller samples in order to investigate PA and sports participation in specific disadvantaged target groups.

German recommendations for physical activity and physical activity promotion in adults with noncommunicable diseases

Background

Existing physical activity guidelines predominantly focus on healthy age-stratified target groups. The objective of this study was to develop evidence-based recommendations for physical activity (PA) and PA promotion for German adults (18–65 years) with noncommunicable diseases (NCDs).

Methods

The PA recommendations were developed based on existing PA recommendations. In phase 1, systematic literature searches were conducted for current PA recommendations for seven chronic conditions (osteoarthrosis of the hip and knee, chronic obstructive pulmonary disease, stable ischemic heart disease, stroke, clinical depression, and chronic non-specific back pain). In phase 2, the PA recommendations were evaluated on the basis of 28 quality criteria, and high-quality recommendations were analysed. In phase 3, PA recommendations for seven chronic conditions were deducted and then synthesised to generate generic German PA recommendations for adults with NCDs. In relation to the recommendations for PA promotion, a systematic literature review was conducted on papers that reviewed the efficacy/effectiveness of interventions for PA promotion in adults with NCDs.

Results

The German recommendations for physical activity state that adults with NCDs should, over the course of a week, do at least 150 min of moderate-intensity aerobic PA, or 75 min of vigorous-intensity aerobic PA, or a combination of both. Furthermore, muscle-strengthening activities should be performed at least twice a week. The promotion of PA among adults with NCDs should be theory-based, specifically target PA behaviour, and be tailored to the respective target group. In this context, and as an intervention method, exercise referral schemes are one of the more promising methods of promoting PA in adults with NCDs.

Conclusion

The development of evidence-based recommendations for PA and PA promotion is an important step in terms of the initiation and implementation of actions for PA-related health promotion in Germany. The German recommendations for PA and PA promotion inform adults affected by NCDs and health professionals on how much PA would be optimal for adults with NCDs. Additionally, the recommendations provide professionals entrusted in PA promotion the best strategies and interventions to raise low PA levels in adults with NCDs. The formulation of specific PA recommendations for adults with NCDs and their combination with recommendations on PA promotion is a unique characteristic of the German recommendations.

How Can Physical Activity Be Promoted Among Children and Adolescents? A Systematic Review of Reviews Across Settings

Introduction: A vast majority of children and adolescents are physically inactive. As a result, high obesity rates and related diseases have made physical activity promotion a politically relevant topic. In order to form the basis for political decision making, evidence is required regarding the efficacy and effectiveness of interventions for physical activity promotion. In contrast to previous research, this systematic review of reviews targets three key settings (family and home, childcare, school), and is among the largest to have been conducted. Methods: A systematic review of reviews was conducted as part of a large-scale project to develop national recommendations for physical activity promotion in Germany. Six electronic databases were searched and inclusion criteria were defined. Two independent reviewers screened the titles and abstracts of potentially relevant literature. 213 reviews were identified and categorised by target group. A total of 74 reviews were identified dealing with children and adolescents. Each review underwent a quality assessment. Results: 39 reviews with the highest quality and relevance were analysed. Three reviews focused on the family and home setting, 4 on the childcare setting, 28 on the school setting and 4 on other settings. Evidence revealed the key role played by parents in promoting physical activity in children within each setting. Furthermore, evidence pointed toward the efficacy of multi-component interventions in the childcare and school setting. Several evidence-based intervention strategies were identified for childcare facilities and schools. Discussion: The review of reviews identified a number of promising strategies for PA promotion among children and adolescents. Among reviews, multi-component interventions in childcare facilities and schools stand out prominently. At the same time, the review of reviews indicated that there is still a lack of studies on the efficacy of interventions that go beyond the individual level. We recommend that future research should also target community and policy level interventions and interventions other than the school setting. In order to make more specific recommendations regarding the scale-up of promising intervention strategies, further knowledge about the effectiveness, health equity and cost effectiveness of interventions is needed.

How can the impact of national recommendations for physical activity be increased? Experiences from Germany

BACKGROUND

Clearly stated national recommendations for physical activity (PA) are available in many nations. Yet, their impact on national level policy-making might be considered modest at best. This paper analyses the approach selected to curtail this problem in Germany.

MAIN TEXT

Academics, government institutions and relevant stakeholders worked in collaboration to produce a series of national recommendations for PA and PA promotion published in 2016. Since their publication, these recommendations have achieved a measurable political impact through a systematic approach focused on dissemination and implementation strategies. For example, the German Conference of Health Ministers has acknowledged the national recommendations, endorsed their dissemination and proposed that they are included in measures within the Federal Prevention Act.

CONCLUSION

Since their publication, the national recommendations have yielded satisfactory political impact. The contributing aspects might partially be explained by the Multiple Streams Approach.