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

Abstract

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.

Do adults with non-communicable diseases meet the German physical activity recommendations?

“…Based on this growing evidence, PA recommendations have been developed and updated since the 1980s, which describe a minimum level of PA required to achieve the health benefits (WHO, 2010). Such recommendations do also exist for people with NCDs for Germany (Geidl, Abu-Omar, Weege, Messing, & Pfeifer, 2020;Pfeifer & Geidl, 2017) and are comparable with national and international recommendations for the general adult population (Füzéki, Vogt, & Banzer, 2017;Rütten & Pfeifer, 2017;WHO, 2010). In terms of aerobic activities, a weekly minimum of 150 min of activity with moderate intensity, 75 min of activity with vigorous intensity, or a combination of these, is recommended.…”

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

“…Our findings reinforce low-dose physical activity recommendations that clearly demonstrate there is no minimum dose of physical activity and that effects on longevity occur at a volume of physical activity significantly below the recommended minimum dose of 150 minutes per week. [60] The “+10 minutes of physical activity per day” from Japan[61] or the “Every Step Counts” message from Germany[62] might be more feasible and efficient physical activity recommendations. Third, for physicians, our results illustrate the medical potential of exercise as medicine and encourage initiatives to anchor assess to and promotion of physical activity in routine medical care.…”

Development, implementation, evaluation and scaling-up of physical activity referral schemes in Germany: protocol for a study using a co-production approach

“…Integrating referral schemes into healthcare is an evidence-based approach for PA promotion, 8 especially in adults with NCDs. 9 The high potential of referral schemes for promoting PA is mainly related to two aspects. First, PARSs prioritise and address one of the least active populations, namely adults with NCDs.…”

“…12 Lack of time, missing manuals and a lack of knowledge about concrete implementation are also inhibiting factors. 22 Although PARSs are explicitly recommended in the recently developed National Recommendations on PA and PA promotion in adults with NCDs, 9 they have not yet been systematically anchored in the German primary care system.…”