Nine types of recommendations, guidelines and policies: an exploratory test of a proposed typology of physical activity promotion documents

Background The field of physical activity abounds with recommendations, guidelines, action plans and other documents published by experts, organizations and institutions at the national and international level. However, working with these documents is difficult since similar names (e.g. “recommendations”) may be used to label substantially different contents, while identical topics may hide behind different monikers (e.g. “guidelines” and “strategy”). Methods We built on an existing framework conceptualizing categories of physical activity evidence and on the Doern continuum for policy instruments to develop a nine-field matrix that classifies physical activity-related publications based on their evidence type and degree of coercion. We used a selection of eleven physical activity documents to perform an exploratory test of the functions and utility of the typology. Results Placing central physical activity documents into the typology shows that recommendations, guidelines, and policies are found across the entire matrix, regardless of their denomination. It also suggests that some documents transcend boundaries between types by falling into more than one category, and that some categories may be underrepresented in current physical activity promotion. Conclusions A typology to classify physical activity guidelines, recommendations, and policies can help us acquire a better overview of the landscape of existing physical activity documents than simple distinctions based on document names. It may guide both current initiatives and future development work in the field. It could also serve as a point of departure for future research, as conducting systematic overviews of the literature based on this typology may help reveal important gaps in current physical activity promotion

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

Towards a harmonized European surveillance for dietary and physical activity indicators in young and adult populations

Background The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action. Methods In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems. Results In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems’ use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform. Conclusion We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process

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

Psychological and physiological impacts of a fast-track diagnostic workup for men with suspected prostate cancer : Preliminary report from a randomized clinical trial

Funding Information: This study was funded by The Swedish Cancer Society (CF2016/795 and 2018/765) and Nyckelfonden, Örebro, Sweden (2015). The funders had no role in the design and conduct of the study, collection, analysis, and interpretation of the data, and writing and approval of the manuscript. Funding Information: This study was funded by The Swedish Cancer Society (CF2016/795 and 2018/765) and Nyckelfonden, ?rebro, Sweden (2015). The funders had no role in the design and conduct of the study, collection, analysis, and interpretation of the data, and writing and approval of the manuscript. This randomized clinical trial was approved by the ethics committee at ?rebro University Hospital and was registered at the ISRCTN registry www.isrctn.com (No. ISRCTN45953686). Written informed consent was obtained from all individual participants included in the study. All authors accept the publication of this work and all patients provided signed inform consent to use their data. The datasets generated and/or analyzed during the current study are not publicly available to protect participant confidentiality but can be partly provided from authors on reasonable request. The authors declare that they have no competing interest. This study was funded by The Swedish Cancer Society (CF2016/795 and 2018/765) and Nyckelfonden, ?rebro, Sweden (2015). The funders had no role in the design and conduct of the study, collection, analysis, and interpretation of the data, and writing and approval of the manuscript. JZ, RC, OA, SOA, UV, FF, and KF conceived of and designed the study; JZ, SD, JC, AME, JF, OA, and SOA contributed to collection of the data; JZ and RC analyzed the data; JZ drafted the manuscript; JZ, RC, SD, JC, AME, JF, OA, SOA, UV, FF, and KF revised the manuscript critically for important intellectual content; All authors read and approved the final manuscript. The authors thank all the subjects who have participated in this clinical trial.Peer reviewe

Research- vs. government-driven physical activity policy monitoring: a systematic review across different levels of government

Abstract Background Even though the importance of physical activity policy monitoring has increased in the last decade, there is a lack of understanding what different approaches exist and which methodology they employ. In order to address this research gap, this review attempts to map existing approaches of physical activity policy monitoring and to analyse methodological aspects, especially with regards to the roles of governments and researchers. Methods A systematic search was conducted in five scientific databases (PubMed, Scopus, SportDiscus, Psycinfo, Web of Knowledge) in July 2021, and the identified records were screened independently by two reviewers. Records were included if they (a) focused on the monitoring of public policies to promote PA, (b) allowed to compare policies across time, across nations/regions or across policy sectors, and (c) were written in English, German or Russian. During full text analysis, information on methodological aspects was extracted and studies were categorized based on the level of government involvement. Results The search yielded in a total of 112 studies. 86 of these studies (76.8%) followed a research-driven approach (little or no government involvement) while only two studies (1.8%) were based on a government-driven approach (led by governments). The remaining 24 studies (21.4%) were based on a co-production approach (strong collaboration between researchers and governments). All in all, 18 different tools for physical activity policy monitoring were identified; key examples are the Report Cards on Physical Activity for Children and Youth (research-driven approach), the HEPA Monitoring Framework (government-driven approach) and the HEPA Policy Audit Tool (co-production approach). Conclusions The level of government involvement in policy monitoring differs significantly, and research-driven, government-driven and co-production approaches can be distinguished. These approaches have different strengths and weaknesses, and can be linked to distinct theories of change and models on research-policy relations. Increasing awareness on the implications of these approaches is key to improve the understanding and further development of physical activity policy monitoring

Politik zur Bewegungsförderung in Deutschland: Eine Analyse anhand eines Policy-Audit-Tools der Weltgesundheitsorganisation

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.HINTERGRUND: Da Bewegungsmangel eine entscheidende Ursache für nichtübertragbare Erkrankungen ist, wurden sowohl von der Weltgesundheitsorganisation (WHO) als auch von Wissenschaftlerinnen und Wissenschaftlern weltweit verschiedene Tools zum Monitoring und Audit bewegungsfördernder Politik entwickelt. Allerdings wurden diese Tools bisher noch nicht genutzt, um systematisch und umfassend Daten zu bewegungsfördernder Politik in Deutschland zu erheben und zu analysieren. ZIEL DER ARBEIT: Die Studie hat zum Ziel, die politischen Anstrengungen zur Bewegungsförderung in Deutschland in einem systematischen Überblick darzustellen. MATERIAL UND METHODEN: Die Erhebung wurde im Rahmen des Projekts „Policy Evaluation Network“ (www.jpi-pen.eu) unter Nutzung des Health-Enhancing Physical Activity (HEPA) Policy Audit Tools (PAT) der WHO durchgeführt. Datenquellen waren Erhebungen der WHO für das European Union Physical Activity Monitoring Framework, eigene Recherchearbeiten sowie eine Expertenbefragung. ERGEBNISSE: Die Ergebnisse zeigen das Spektrum der relevanten Akteure und bieten einen Überblick über aktuelle politische Maßnahmen sowie die Bereiche Surveillance, Evaluation und finanzielle Förderung. Darüber hinaus identifizieren sie wichtige Erfolge der aktuellen deutschen Politik sowie bestehende Herausforderungen. DISKUSSION: Im internationalen Vergleich fällt auf, dass andere Länder im Gegensatz zu Deutschland messbare nationale Ziele für die Förderung von Bewegung formuliert haben. Hervorzuheben ist, dass Deutschland zu der Minderheit der Staaten mit spezifischen Bewegungsempfehlungen für Menschen mit nichtübertragbaren Erkrankungen zählt. Eine besonders hohe Relevanz hat die Weiterentwicklung von Strukturen für Bewegungsförderung in Deutschland

Physical activity promotion and planetary health – a conceptual framework and suggested research priorities

Due to the many benefits of physical activity for human health, its promotion has established itself as an important public health topic. Global warming is influencing how and when people can be physically active, requiring adaptation measures to combat heat. At the same time, many physical activities, particularly when it comes to sport and exercise, cause carbon emissions and effect environments negatively, which opens discussions on potential ways of mitigation. This commentary lays out a framework for research priorities in the field of physical activity promotion from a perspective of planetary health. Its intent is to stimulate discussions on how research in this field can be aligned with planetary health