Physical activity promotion in daily exercise therapy: the perspectives of exercise therapists in German rehabilitation settings

Background This study aims to explore exercise therapists’ perspectives on the topic of physical activity promotion (PAP) with a focus on identifying (i) the intervention content and methodological approaches used for promoting physical activity (PA) in daily practice and (ii) the barriers and facilitators that affect PAP. Methods This qualitative study comprised the heads of exercise therapy departments (n = 58; 41% women; mean age = 45 years) from different rehabilitation clinics in Germany. Each participant took part in a semi-structured focus-group discussion on PAP in exercise therapy. The findings of the focus groups were processed and interpreted using a conventional qualitative content analysis. Results The exercise therapists demonstrated detailed didactic–methodological strategies and action orientations for PAP. The identified core topics of the content and methods of PAP were (1) conceptualization, (2) exercise and PA for enjoyment and pleasure, (3) education with practice–theory combinations, (4) media and materials for self-directed training, and (5) strategies to enhance personal responsibility and independence. The core topics for the associated barriers and facilitators were (1) structural conditions, (2) the role of exercise therapists, (3) the interdisciplinary rehabilitation team, (4) rehabilitant experiences and expectations, and (5) aftercare services. Conclusion The topic of PAP is addressed with a high level of variability; exercise therapists involved in this study identify various methods and content for the promotion of PA within their individual practices. However, they display a limited awareness of existing evidence- and theory-based concepts for the promotion of PA as well as underlying theories of behavioural change. This variability may be due to the lack of a defined common framework for promoting PA, insufficient emphasis being placed on PA promotion in the current curricula and training, or extensive conceptual differences within German exercise therapy departments (e.g. different weighting of PAP)

Dose–response relationship between physical activity and mortality in people with non-communicable diseases: a study protocol for the systematic review and meta-analysis of cohort studies

Introduction This study protocol outlines our planned systematic review and dose-response meta-analysis of postdiagnosis physical activity and mortality in people with non-communicable diseases (NCDs). Methods and analysis This study is based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols. A systematic literature search will be conducted in various databases—namely, PubMed, Scopus and Web of Science—by two researchers in order to identify prospective observational studies that investigate postdiagnosis physical activity or activity-related energy expenditure and mortality in individuals with NCDs. The target population is adults (≥18 years of age) with one of the following nine NCDs: low back pain, type 2 diabetes mellitus, osteoarthritis, depressive disorder, chronic obstructive pulmonary disease, breast cancer, lung cancer, stroke or ischaemic heart disease. We will focus on all-cause mortality as the primary outcome and investigate indication-specific mortality as the secondary outcome. For each study identified as a result of the literature search, we will conduct graphical dose-response analyses of mortality as a function of activity-related energy consumption. If more than two studies are available for one disease, we will perform linear and non-linear dose-response meta-analyses for said disease using random-effects models. We will investigate the heterogeneity of the studies and publication bias. To assess the risk of bias and the quality of the included studies, we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool, which is a Cochrane tool

Physical Activity and Sedentary Behaviour Patterns in 326 Persons with COPD before Starting a Pulmonary Rehabilitation: A Cluster Analysis

This study applies a cluster analysis to identify typical physical activity (PA) and sedentary behaviour (SB) patterns in people with chronic obstructive pulmonary disease (COPD) before starting pulmonary rehabilitation (PR). We implemented an observational design which assessed baseline data of objectively measured PA and SB from the STAR (Stay Active after Rehabilitation) study. A total of 355 persons wore an accelerometer (Actigraph wGT3X) for seven days before the start of their PR. Sociodemographic and disease-related parameters were assessed at the start of PR. We applied cluster analysis and compared clusters applying univariate variance analyses. Data was available for 326 persons (31.6% women; age ø = 58 years). Cluster analysis revealed four movement clusters with distinct PA and SB patterns: Sedentary non-movers (28.5%), sedentary occasional movers (41.7%), sedentary movers (19.6%), and sedentary exercisers (10.1%). The four clusters displayed varying levels of moderate PA before rehabilitation (Ø daily min: 9; 28; 38; 70). Notably, all four clusters displayed considerably long average sedentary time per day (Ø daily minutes: 644; 561; 490; 446). The clusters differed significantly in disease-related parameters of GOLD severity, FEV1, CAT, and 6-Min-Walk-Test. In addition to PA promotion, PR programs should consider the reduction of sedentary behaviour as a valuable goal

Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR

Developing a policy brief on physical activity promotion for children and adolescents

IntroductionWhile there are several approaches to collect basic information on physical activity (PA) promotion policies, some governments require more in-depth overviews on the situation in their country. In Germany, the Federal Ministry of Health expressed its interest in collecting detailed data on target group specific PA promotion, as relevant competences are distributed across a wide range of political levels and sectors. This study describes the development of a policy brief on physical activity promotion for children and adolescents in Germany. In particular, it addresses two major gaps in the current literature by systematically assessing good practice examples and “routine practices,” i.e., PA promotion activities already taking place on large scale and regular basis.Materials and methodsBased on relevant national and international guidelines, the TARGET:PA tool was co-produced by researchers and ministry officials. It includes (1) PA recommendations, (2) national prevalence rates, (3) recommendations for PA promotion, and data on national (4) routine practices, (5) good practice projects and (6) policies. Data were collected for children and adolescents in Germany using desk research, semi-structured interviews and secondary data analysis.ResultsA policy brief and scientific background document were developed. Results showed that 46% of the 4–5-year-olds fulfil WHO recommendations but only 15% of the 11–17-year-olds, and that girls are less active than boys. Currently, in Germany no valid data are available on the PA behaviour of children under the age of three. An overview of routine practices for PA promotion for children and adolescents was compiled, and experts were asked to critically assess their effectiveness, reach and durability. Overall, 339 target group specific projects for PA promotion were found, with 22 classified as examples of good practice. National PA policies for children and adolescents were identified across different sectors and settings.ConclusionThe study provides a comprehensive overview of the current status of PA promotion for children and adolescents in Germany. The co-production of the policy brief was a strength of the study, as it allowed researchers to take the needs of ministry officials into account, and as it supported the immediate uptake of results in the policymaking process. Future studies should test the applicability of the TARGET:PA tool to different target groups and countries

Promoting regular physical activity in rehabilitation: behavioural exercise therapy and the role of exercise-related affective associations

Der Schlüssel zur Erreichung der Rehabilitationsziele und einer nachhaltigen Gesundheitsförderung bei Menschen mit chronischen Krankheiten ist die Förderung eines angemessenen Gesundheitsverhaltens. Den Ausgangspunkt dieser Arbeit bildet die als verbesserungswürdig charakterisierte Wirksamkeit bewegungsbezogener Rehabilitationsmaßnahmen bezüglich überdauernder Änderungen des Bewegungsverhaltens. Im Rahmen der Dissertation „Aufbau eines körperlich aktiven Lebensstil in der Rehabilitation chronischer Erkrankungen“ werden zwei übergeordnete Problemstellungen bearbeitet: 1. Konzeptionelle Entwicklung einer verhaltensbezogenen Bewegungstherapie (VBT) und deren Einbettung in ein ICF-basiertes Rahmenkonzept sowie 2. Integration der affektiven Einstellungskomponente gegenüber Sporttreiben innerhalb des sozial-kognitiven Prozessmodells des Gesundheitsverhaltens bei Menschen mit Typ 2 Diabetes und/oder Adipositas im Setting der Rehabilitation. Zusammenfassend leistet diese Arbeit einen Beitrag dazu, das Bewegungsverhalten von Menschen mit chronischen Erkrankungen besser zu verstehen und die Wirksamkeit bewegungsbezogener Rehabilitationsmaßnahmen bzgl. überdauernder Bewegungsverhaltensänderungen zu erhöhen.Promoting regular physical activity in rehabilitation is a key for the long term success of rehabilitation interventions. The beneficial effects of exercise have led to a general adoption of exercise therapy in the rehabilitation of chronic conditions. Nevertheless, adherence to exercise programmes and long-term physical activity behaviour changes are often low. The doctoral thesis “Promoting regular physical activity in rehabilitation” addresses 1. the conceptual development of an ICF-based behavioural exercise therapy (BET) and 2. the integration of exercise-related affective associations into the Health Action Process Approach (HAPA) to better predict long-term physical activity behaviour changes amongst individuals with obesity and type 2 diabetes subsequent to an exercise-based rehabilitation. In summary, this doctoral thesis advances the understanding of physical activity behaviour changes, offers explicit methods and contents for physical therapists to promote physical activity behaviour, and introduces the ICF-based conceptual idea of a behavioural exercise therapy. Some parts of this doctoral thesis are available as a pre-release in English: “Geidl, W., Semrau, J. & Pfeifer, K. (2014). Health behaviour change models and theories: contributions to an ICF-based behavioural exercise therapy for individuals with chronic diseases (BET). In: Disability and Rehabilitation, 36(24), 2091-2100.

Measuring stroke patients’ exercise preferences using a discrete choice experiment

Physical activity post stroke improves health, yet physical inactivity is highly prevalent. Tailored exercise programs considering physical activity preferences are a promising approach to promote physical activity. Therefore, this study seeks to measure exercise preferences of stroke survivors. Stroke survivors conducted a discrete choice experiment (DCE). DCE was presented in a face-to-face interview where patients had to choose eight times between two different exercise programs. Exercise programs differed by characteristics, with the six attributes under consideration being social situation, location, type of exercise, intensity, frequency, and duration. Utilities of the exercise attributes were estimated with a logit choice model. Stroke survivors (n=103, mean age: 67, SD=13.0; 60% male) show significant differences in the rated utilities of the exercise attributes (P<0.001). Participants had strong preferences for light and moderate intense physical activity and favored shorter exercise sessions. Stroke survivors have remarkable exercise preferences especially for intensity and duration of exercise. Results contribute to the tailoring of physical activity programs after stroke thereby facilitating maintenance of physical activity

Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies

BACKGROUND: This study aims to investigate the relationship between post-diagnosis physical activity and mortality in patients with selected noncommunicable diseases, including breast cancer, lung cancer, type 2 diabetes, ischemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), osteoarthritis, low back pain and major depressive disorder. METHODS: A systematic search was conducted of PubMed, Scopus and the Web of Science from their inception to August 2018. Additionally, the search was updated in August 2019. Eligibility criteria included prospective observational studies examining the relationship between at least three physical activity categories (e.g. low, moderate, high) and all-cause mortality as the primary outcome. RESULTS: In total, 28 studies were included in the meta-analysis: 12 for breast cancer, 6 for type 2 diabetes, 8 for ischemic heart disease and 2 for COPD. The linear meta-analysis revealed that each 10 metabolic equivalent task hours increase of physical activity per week was associated with a 22% lower mortality rate in breast cancer patients (Summary Hazard Ratio [HR], 0.78; 95% CI: 0.71, 0.86; I²: 90.1%), 12% in ischemic heart disease patients (HR, 0.88; 95% CI: 0.83, 0.93; I²: 86.5%), 30% in COPD patients (HR, 0.70; 95% CI: 0.45, 1.09; I²: 94%) and 4% in type 2 diabetes patients (HR, 0.96; 95% CI: 0.93, 0.99; I²: 71.8%). There was indication of a non-linear association with mortality risk reductions even for low levels of activity, as well as a flattening of the curve at higher levels of activity. The certainty of evidence was low for breast cancer, type 2 diabetes and ischemic heart disease but only very low for COPD. CONCLUSION: Higher levels of post-diagnosis physical activity are associated with lower mortality rates in breast cancer, type 2 diabetes, ischemic heart disease and COPD patients, with indication of a no-threshold and non-linear dose–response pattern