Competencies for health-enhancing physical activity are associated with body mass: results of an updated data pooling across 18 samples.

OBJECTIVE: Although previous studies have illuminated associations between body mass and physical activity (PA), there have been scant insights regarding the physical, cognitive, and motivational determinants of PA in relationship to body mass. This study aimed to model courses of competencies for health-enhancing PA across the spectrum of BMI. METHODS: We used cross-sectional data of 3670 individuals (mean [SD]: BMI, 25.54 [5.71] kg/m2; age, 46.11 [14.96] years) from a large data pooling with 18 primary samples employing the PA-related health competence (PAHCO) instrument. ANCOVA determined differences in 10 PAHCO indicators by BMI categories (underweight, normal weight, overweight, and obesity). Covariate-adjusted multilevel models described the nonlinear courses of the PAHCO indicators across the BMI spectrum. RESULTS: The levels of all 10 PAHCO indicators differed significantly among the BMI categories (F ≥ 14.8; p < 0.001). All competencies for health-enhancing PA could be best described by cubic functions having their maximum around normal weight while regressing with underweight and with increasing grades of obesity (0.02 ≤ R m arg 2 $$ {R}_{\mathrm{marg}}^2 $$ ≤ 0.31). CONCLUSIONS: This study adds to associations between BMI and PA levels by specifying individuals' multidimensional requirements for health-enhancing PA. The present findings call for an integration of physical, motivational, and cognitive factors in practices of PA promotion and sustainable obesity treatment.

Are physical activity referral scheme components associated with increased physical activity, scheme uptake, and adherence rate? A meta-analysis and meta-regression.

BACKGROUND: Physical activity referral schemes (PARS) are composed of various components, such as a written prescription or a person-centered approach. The role of these components in their effectiveness is yet to be understood. Therefore, we aimed to explore the relationships between PARS components and physical activity, scheme uptake, and adherence rate; and to estimate the effect of PARS. METHODS: We searched Scopus, PubMed, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE. Eligible studies were published between 1990 and November 2023 in English or German, investigated PARS with participants aged ≥ 16 years, and reported physical activity, scheme uptake, or scheme adherence. Separate random-effects meta-analysis by comparison group were conducted for physical activity. Scheme uptake and adherence rates were pooled using proportional meta-analysis. The components were analyzed via univariate meta-regression. We rated the risk of bias using RoB2 and ROBINS-I, and the certainty of evidence using GRADE. RESULTS: Fifty-two studies were included. PARS were more effective in increasing physical activity than usual care (k = 11, n = 5046, Hedges' g = 0.18, 95%CI 0.12 to 0.25; high certainty of evidence). When PARS were compared with physical activity advice or enhanced scheme versions, the pooled Hedges' g values for physical activity were -0.06 (k = 5, n = 1082, 95%CI -0.21 to 0.10; low certainty of evidence), and 0.07 (k = 9, n = 2647, 95%CI -0.03 to 0.18; low certainty of evidence) respectively. Scheme uptake was 87% (95%CI 77% to 94%, k = 14, n = 5000) across experimental studies and 68% (95%CI 51% to 83%, k = 14, n = 25,048) across non-experimental studies. Pooled scheme adherence was 68% (95%CI 55% to 80%, k = 16, n = 3939) and 53% (95%CI 42% to 63%, k = 18, n = 14,605). The meta-regression did not detect any significant relationships between components and physical activity or scheme uptake. A person-centered approach, screening, and brief advice were positively associated with scheme adherence, while physical activity sessions were negatively associated. CONCLUSION: PARS are more effective in increasing physical activity than usual care only. We did not identify any components as significant predictors of physical activity and scheme uptake. Four components predicted scheme adherence, indicating that the component-effectiveness relationship warrants further research.

[DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research]. / DNVF Memorandum ­ Ziele und Methoden bewegungsbezogener Versorgungsforschung.

The DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research summarizes, for the first time, the highly interdisciplinary and interprofessional field of physical activity-based health care in the German healthcare system. In addition to providing a conceptual framework and definition of key measures and concepts in physical activity-related health care research, existing research gaps and needs are identified, and methods for advancing this relatively young field of research are described. A particular focus of this study is the relevant outcome parameters and their standardized assessment using established and valid measurement tools. The memorandum aims to establish a general understanding of the complex subject of promoting physical activity and sports therapy in the context of healthcare, to give an impulse to new research initiatives, and to integrate the currently available strong evidence on the effectiveness of physical activity and exercise into healthcare.

A life span perspective on competencies for a healthy, physically active lifestyle: Findings of a data pooling initiative with over 7000 individuals.

Individuals are recommended to lead active lifestyles throughout the life course. The model of physical activity-related health competence (PAHCO) adopts a competence approach by integrating physical, cognitive, and motivational determinants for health-enhancing PA (movement competence, control competence, self-regulation competence). Drawing on a comprehensive dataset pooling, the goal of the present study was to model the idiosyncratic courses of 10 PAHCO indicators over the life span. We identified studies that empirically operationalized PAHCO, combining data of 7134 individuals (age range: 15-97 years; 61% female) from 18 different populations (prevention and rehabilitation sectors). We applied a stepwise multilevel analysis approach with disjunct sub-samples (n = 48) to examine linear and quadratic associations between age and PAHCO. Indicators of movement competence (i.e., manageability of endurance, strength, and balance demands; task-specific self-efficacy) congruently showed negative associations with age (0.054 ≤  R marg 2 ${R}_{\text{marg}}^{2}$  ≤ 0.211). However, parameters of control competence remained stable across the life span (-0.066 ≤ ß ≤ 0.028). The three indicators of self-regulation competence revealed an inconsistent relationship with age, though uncovering positive associations for self-control (ß = 0.106) and emotional attitude toward PA (ß = 0.088). The associations of some indicators varied significantly across sub-samples. The results suggest differential analyses for associations between PAHCO and age. While the physically determined PAHCO indicators (movement competence) probably decline across the life span, the ability to ensure regularity of PA (self-regulation competence) or align PAs with an individual's health (control competence) appear to remain constant or improve with increasing age. The findings reinforce a de-stigmatizing approach for PA promotion practices with considerable space for aligning activities with health also in the elderly.

Implementation and dissemination of physical activity-related health competence in vocational nursing training: study protocol for a cluster-randomized controlled intervention trial.

BACKGROUND: Although the nursing sector gains growing importance in an aging society, students representing the future workforce often show insufficient health. Acknowledging the health-enhancing effects of adequate physical activity, the educational system in Bavaria, Germany, has recently integrated the promotion of physical activity-related health competence (PAHCO) into the nursing curriculum. However, it cannot be assumed that PAHCO has sufficiently permeated the educational practices and routines of the nursing schools. Therefore, the goal of the present study is to examine and compare the effectiveness as well as implementation of different intervention approaches to address PAHCO in the Bavarian nursing school system. METHODS: We randomly assign 16 nursing schools (cluster-based) to four study arms (bottom-up, top-down led by teachers, top down led by external physical activity experts, control group). Schools in intervention group 1 (IG-1) develop multicomponent inventions to target PAHCO via cooperative planning (preparation, planning, and implementation phase). Intervention groups 2 and 3 (IG-2, IG-3) receive both an expert-based intervention (developed through intervention mapping) via trained mediators to address PAHCO. External physical activity experts deliver the structured PAHCO intervention in IG-2, while teachers from the nursing schools themselves conduct the PAHCO intervention in IG-3. In line with a hybrid effectiveness implementation trial, we apply questionnaire-based pre-post measurements across all conditions (sample size calculation: nfinal = 636) to examine the effectiveness of the intervention approaches and, simultaneously, draw on questionnaires, interview, and protocol data to examine their implementation. We analyze quantitative effectiveness data via linear models (times-group interaction), and implementation data using descriptive distributions and content analyses. CONCLUSION: The study enables evidence-based decisions about the suitability of three intervention approaches to promote competencies for healthy, physically active lifestyles among nursing students. The findings inform dissemination activities to effectively reach all 185 schools of the Bavarian nursing system. TRIAL REGISTRATION: Clinical trials NCT05817396. Registered on April 18, 2023.

Coproducing a physical activity referral scheme in Germany: a qualitative analysis of stakeholder experiences.

OBJECTIVES: This study evaluated stakeholders' experiences of participating in a coproduction process to develop a physical activity referral scheme (PARS) in the German healthcare system. The focus was on examining facilitators and challenges, along with gathering insights on potential modifications to the joint development process, all from the viewpoint of stakeholders. DESIGN: This qualitative study employed one-to-one semi-structured interviews, and the findings were analysed using summarising qualitative content analysis. SETTING: The study focused on the German healthcare system. PARTICIPANTS: Seven stakeholders from the coproduction process were purposefully selected for interviews using maximum variation sampling. The interviewees represented different sectors (physician associations, physical activity professionals' associations, health insurance companies and patient organisations), various positions within their organisations, and different levels of attendance during the coproduction process. RESULTS: In almost all interviews, the following factors were highlighted as facilitators of the development process: coproduction approach, process of coproduction, multi-sector stakeholder group, possibility of active participation, coordinating role of researchers, communication, atmosphere and interaction. In contrast, differences in roles and hierarchy, merging of different perspectives, clarification of intervention costs, and competition and conflicting interests were pointed out as challenges. Only a few suggestions regarding adaptations in terms of group composition and cooperation among stakeholders were mentioned. CONCLUSIONS: Stakeholder experiences with the joint development process were predominantly positive, indicating that coproduction is a beneficial approach for the development of PARS intended for integration into healthcare systems. The effective management of power differences among stakeholders is intricately tied to the coproduction method; therefore, it should be selected carefully. The research team plays a pivotal role in coordinating and negotiating the process, and the team should be equipped with a diverse set of skills and knowledge, particularly to understand the intricacies of the healthcare system where the PARS is intended for implementation. TRIAL REGISTRATION NUMBER: NCT04947787.

Efficacy of Physical Activity Promoting Interventions in Physical Therapy and Exercise Therapy for Persons With Noncommunicable Diseases: An Overview of Systematic Reviews.

OBJECTIVE: The objective of this study was to synthesize the evidence from systematic reviews on the efficacy of physical therapy and exercise therapy, including interventional elements explicitly aiming at physical activity promotion (PAP) in patients with noncommunicable diseases (NCDs). METHODS: PubMed, Scopus, PsycINFO, and Cochrane Database of Systematic Reviews were searched from inception to February 28, 2023. Two independent reviewers screened the literature to identify systematic reviews that evaluated the effects of physical therapy and exercise therapy, including PAP interventions. Patient-reported and device-based measures of physical activity (PA) outcomes were included. Qualitative and quantitative data from systematic reviews were extracted by 2 independent reviewers. Assessment of the methodological quality of the included systematic reviews was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We assessed primary study overlap by calculating the corrected covered area and conducted the evidence synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Fourteen systematic reviews were included in the present overview, including patients with a variety of NCDs. Most included systematic reviews had critically low (n = 5) to low (n = 7) methodological quality. Most meta-analyses (67%; 8/12) provided evidence supporting the short- and long-term efficacy of PAP interventions, but not all pooled estimates were clinically relevant. Only three of the systematic reviews with meta-analysis included an assessment of the certainty of the evidence. The evidence from systematic reviews without meta-analysis was inconclusive. CONCLUSIONS: The results of the present overview suggest that PAP interventions in physical therapy or exercise therapy may be effective in improving PA for patients with NCDs in the short and long term. The results should be interpreted with caution due to the limited certainty of evidence and critically low-to-low methodological quality of the included systematic reviews. Both high-quality primary studies and systematic reviews are required to confirm these results. IMPACT: There is limited evidence that PAP interventions in physical therapy and exercise therapy may be effective in improving PA for patients with NCDs.

The Limitations and Potentials of Evaluating Economic Aspects of Community-Based Health Promotion: A Critical Review.

Community-based health promotion (CBHP) interventions are promising approaches to address public health problems; however, their economic evaluation presents unique challenges. This review aims to explore the opportunities and limitations of evaluating economic aspects of CBHP, focusing on the assessment of intervention costs and outcomes, and the consideration of political-level changes and health equity. A systematic search of the PubMed, Web of Science and PsycInfo databases identified 24 CBHP interventions, the majority of which targeted disadvantaged communities. Only five interventions included a detailed cost/resource assessment. Outcomes at the operational level were mainly quantitative, related to sociodemographics and environment or health status, while outcomes at the political level were often qualitative, related to public policy, capacity building or networks/collaboration. The study highlights the limitations of traditional health economic evaluation methods in capturing the complexity of CBHP interventions. It proposes the use of cost-consequence analysis (CCA) as a more comprehensive approach, offering a flexible and multifaceted assessment of costs and outcomes. However, challenges remain in the measurement and valuation of outcomes, equity considerations, intersectoral costs and attribution of effects. While CCA is a promising starting point, further research and methodological advancements are needed to refine its application and improve decision making in CBHP.

A systematic review and narrative synthesis of physical activity referral schemes' components.

BACKGROUND: Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. METHODS: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. RESULTS: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%). CONCLUSIONS: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.

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

Introduction: While 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 methods: Based 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. Results: A 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. Conclusion: The 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.

The MoXFo initiative - adherence: Exercise adherence, compliance and sustainability among people with multiple sclerosis: An overview and roadmap for research.

We know very little about exercise adherence, compliance and sustainability in multiple sclerosis (MS), yet adherence is seemingly important for yielding immediate and sustained health benefits. This paper is focused on exercise adherence, compliance and sustainability in the context of informing research and practice involving MS. This focus is critical for clarifying terminology for future research and providing a roadmap guiding clinical research and practice. Our objective was accomplished through a narrative summary of the literature by a panel of experts on exercise adherence from the Moving Exercise Research in Multiple Sclerosis Forward (MoXFo) initiative and a concluding summary of the state of the literature and future research directions. The panel of experts identified three overall themes (Background and Importance; Understanding and Promoting Exercise Adherence, Compliance and Sustainability and Challenges to Exercise Adherence, Compliance and Sustainability) that represented a categorization of nine subthemes. These overall themes and subthemes formed the basis of our recommendations regarding future research broadly involving exercise adherence in MS. Overall, there is limited evidence on rates and determinants of exercise adherence and compliance in MS, and little is known about techniques and interventions for immediate and long-term exercise behaviour change.

Multi-level stakeholders' perspectives on implementation and scaling up community-based health promotion in Germany.

Community-based health promotion has the potential to address existing health inequities, although such approaches are scarcely scaled up. For a successful scale up, various stakeholders at different levels and sectors need to be involved. The article's aims are to assess what kind of external support communities need for implementation and to identify facilitators and barriers for scaling up community-based health promotion. Two national digital workshops were conducted in Germany with stakeholders at the community level (n = 161) and with stakeholders at the federal and state levels (n = 84). Protocols were compiled and coded using qualitative content analysis. During the first workshop, we revealed 11 themes for external support needs ('Strategic approach', 'Define & compare indicators', 'International human resource', 'Tools & Aids', 'External conduction of the assessment', 'Involvement of people in difficult life situations', 'Overview of actors', 'Moderation', 'Obtain funding', 'Quality assurance/evaluation' and 'External support'). Eleven facilitators and barriers were identified for scaling up ('Assessment and evaluation', 'Intersectoral collaboration and partnerships', 'Communication', 'Characteristics of the program', 'Political and legal conditions', 'Political support', 'Local coordinator', 'Resources', 'Participation', 'Strategic planning/methods' and 'Intermediary organization'). The identified results provide practice-based evidence on support needed for scaling up, facilitators that promote scaling up and barriers that might hinder scaling up community-based health promotion in Germany. In a next step, this practice-based evidence needs to be systematically integrated with scientific-based evidence on key components for scaling up such approaches for the development of an effective scaling-up concept.

The major aim of this article is to describe how German stakeholders at different levels (local, federal and state) from various sectors (e.g. health, social or sports) were involved to develop a scaling-up concept for a community-based health promotion approach with a focus on health equity in the field of physical activity promotion. Different actors from science, policy and practice discussed facilitators and barriers for the scale up and what external support communities need to implement a community-based health promotion approach, with a focus on people in difficult life situations (e.g. individuals with social disadvantages). We identified 14 different kind of support needs and 11 facilitators and barriers for scaling up community-based health promotion approaches in the field of physical activity promotion. Various actors emphasized the need for improved collaboration and partnerships across several sectors as well as changes in current political and legal conditions. Furthermore, the role and some characteristics of an external organization to support a successful scaling-up process were also discussed among actors.

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.

[Perspective Paper "Future Prevention Research" - Current and Future Coordinated Research on Prevention and Health Promotion]. / Perspektivpapier "Zukunft Präventionsforschung": Koordinierte Forschung zu Prävention und Gesundheitsförderung ­ aktuell und in der Zukunft.

From 2014 to 2022, the BMBF has funded five research networks in prevention research and health promotion that are also jointly coordinated (Research Network Primary Prevention and Health Promotion, www.fp2g.net). The researchers have produced a large number of relevant research outputs with insights gained into essential aspects of prevention research and health promotion. The networks research focused on basic principles, application-relevant findings, and implementation conditions of long-term prevention and health promotion for non-communicable diseases (NCDs). The constraints imposed by the pandemic from 2020 onwards were partly addressed by integrating Corona-related research and transfer activities. The importance of resilience for dealing with multiple health and social challenges got increased attention and was analyzed and discussed during the pandemic. For prevention research, research questions such as how to better implement prevention measures through digital tools are gaining additional importance. Together, the research networks have presented achievements and desiderata for future research. This perspective paper with its nine theses formulated in conclusion is intended as a stimulus for discussion among funders as well as the communty of researchers on the subject of successful prevention and health promotion. It is explicitly part of the continuity of the memoranda on prevention research developed in 2012.

Co-creating physical activity interventions: Findings from a multiple case study using mixed methods.

Introduction: In health and physical activity promotion, there is growing interest in co-creation approaches that involve researchers and non-academic stakeholders in developing new interventions. Previous research has shown the promising results of cooperative planning as a co-creation approach in building new capacities and implementing physical activity-promoting interventions in nursing care and automotive mechatronics. However, it remains unclear whether (1) cooperative planning for physical activity promotion can be successfully transferred to other settings in the nursing care and automotive mechatronic sectors and (2) what key factors influence its success or failure. Methods: We conducted a multiple case study in three settings in the nursing care and automotive mechatronics sectors. Following a mixed methods approach, we collected, analyzed, and triangulated data from documents (n = 17), questionnaires (n = 66), and interviews (n = 6). Quantitative data were analyzed descriptively and through using nonparametric analyses of variance; qualitative data were analyzed using qualitative content analysis by extraction. Results: The transfer of cooperative planning to new settings was realized, though the impact varied by setting. While the interventions were developed and implemented in nursing care settings, interventions were developed but not implemented in the automotive mechatronics setting. In this context, intervention implementation was influenced by 11 key factors: champion, commitment, embedment, empowerment, engagement, health-promoting leadership, ownership, relevance, resources, responsibility, and strategic planning. Furthermore, the transfer of cooperative planning was influenced by different activity characteristics, namely elaboration & reconsideration, group composition, number of meetings, participation, period, prioritization, and researchers' input & support. Discussion: The present article contributes to a better understanding of a co-creation approach utilized for physical activity promotion and provides new insights into (1) the transferability of cooperative planning and (2) the associated key factors influencing intervention implementation. The success of cooperative planning varied by setting and was influenced by several activity characteristics and key factors, some of which showed complex relationships. This raises the question of whether some settings might benefit more from a co-creation approach than others. Therefore, future co-creation initiatives should carefully consider the specific characteristics of a setting to select and apply the most appropriate approach.

Implementing the capability approach in health promotion projects: Recommendations for implementation based on empirical evidence.

OBJECTIVE: The aim of this paper was to develop a framework for the use of the capability approach in health promotion projects, which could guide future projects as well as improve the comparability of the projects' effectiveness. METHOD: The study involved a three-stage process comprising a total of six steps. We first developed a theoretical model and then analyzed data from four empirical studies that had implemented projects using the capability approach between 2015 and 2018 in the settings of kindergartens, schools, vocational training, and communities to promote an active lifestyle. Finally, we developed a framework for the use of the capability approach in health promotion projects based on the analysis of the data. RESULTS: We developed a theoretical model of the "capability cycle," which was used for further analysis. There were divergent understandings of the capability approach due to existing theoretical constructs that are commonly used by the scientific teams of the projects. Further, the conceptualization, implementation, and evaluation of the capability approach within the four settings showed discrepancies, which inhibited a comparison of their effectiveness. The developed framework comprises recommendations regarding the planning of a project, its implementation, and especially its evaluation in future comparisons of project effectiveness. CONCLUSION: This paper provides a comprehensive analysis of four projects for which we developed a framework using a participatory approach. The findings can help research teams in the conceptualization, implementation, and evaluation of future projects that focus on improving capabilities in the field of health promotion. Further, the established framework will help facilitate comparisons of capability-oriented health promotion projects in terms of their effectiveness.

The Effectiveness of Physical Literacy Interventions: A Systematic Review with Meta-Analysis.

BACKGROUND: The holistic concept of physical literacy assumes that individuals require adequate cognitive (knowledge and understanding), affective (motivation and confidence), and physical (physical competence) qualities to engage in lifelong physical activity behavior. In recent years, the research field has undergone rapid development and has also yielded an increasing number of interventions that aim to translate the theoretical-philosophical ideas into practical endeavors. OBJECTIVE: The goal of the present pre-registered systematic review was to (a) provide a general overview of evaluation studies on physical literacy interventions and (b) to quantitatively examine the effectiveness of physical literacy interventions. METHODS: Drawing on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched a total of 18 databases for physical literacy interventions. Inclusion criteria were English language, publication by November 2021, and interventions using physical literacy as a theoretical underpinning or evaluation outcome. Articles that met these criteria were analyzed with respect to their basic delivery characteristics, study quality, evaluation approach, and main findings. We additionally ran meta-analyses with all non-randomized and randomized controlled trials to examine and compare the effect of these interventions on five outcome categories: (i) physical competence, (ii) motivation and confidence, (iii) knowledge and understanding, (iv) physical activity behavior, and (v) total physical literacy. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess the effects on the different categories. RESULTS: The screening process with two independent raters yielded 48 eligible interventions reported in 51 eligible articles. Quantitative evaluations most frequently addressed physical competence (72.2%), followed by motivation and confidence (47.2%), physical activity behavior (41.7%), and knowledge and understanding (33.3%). The controlled intervention studies (n = 24) exerted significant effects on all five physical literacy categories. Despite meaningful heterogeneity across the subgroups, the strongest effects were found for physical competence (SMD 0.90; 95% CI 0.55-1.25), followed by physical literacy aggregate scores (SMD 0.61; 95% CI 0.20-1.01), knowledge and understanding (SMD 0.54; 95% CI 0.30-0.79), physical activity behavior (SMD 0.39; 95% CI 0.23-0.55), and motivation and confidence (SMD 0.30; 95% CI 0.17-0.44). CONCLUSIONS: The present study empirically demonstrated the effectiveness of physical literacy interventions on several outcomes relevant for promoting physical activity and health. To better inform current practices, future studies are advised to identify those program characteristics that significantly influence the effectiveness of physical literacy interventions. CLINICAL TRIAL REGISTRATION: PROSPERO CRD42020188926.

Effectiveness and implementation success of a co-produced physical activity referral scheme in Germany: study protocol of a pragmatic cluster randomised trial.

BACKGROUND: While effective physical activity referral schemes (PARSs) and related structures for promoting physical activity (PA) already exist in several countries, in Germany, PARSs have not yet been implemented systematically and nationwide. Through a co-production approach with relevant actors in the German healthcare system, a PARS was developed, and an implementation plan was created (e.g. financing). This study protocol aims to evaluate the developed PARS for people with non-communicable diseases (NCDs) in Germany regarding its potential effectiveness and implementation success. METHODS: To evaluate the effectiveness and implementation success of the PARS, we will apply a pragmatic cluster-randomised controlled trial (cRCT) in Hybrid II design by comparing two intervention groups (PARS vs PA advice [PAA]). The trial will take place in the Nürnberg metropolitan region, with 24 physician practices recruiting 567 people with NCDs. Both groups will receive brief PA advice from a physician to initially increase the participants' motivation to change their activity level. Subsequently, the PARS group will be given individualised support from an exercise professional to increase their PA levels and be transferred to local exercise opportunities. In contrast, participants in the PAA group will receive only the brief PA advice as well as information and an overview of regional PA offerings to become more active at their own initiative. After 12 and 24 weeks, changes in moderate to vigorous PA and in physical activity-related health competence (movement competence, control competence, self-regulation competence) will be measured as primary outcomes. Secondary outcomes will include changes in quality of life. To measure implementation success, we refer to the RE-AIM framework and draw on patient documentation, interviews, focus groups and surveys of the participating actors (physicians, exercise professionals). DISCUSSION: Through a between-group comparison, we will investigate whether additional individual support by an exercise professional compared to brief PA advice alone leads to higher PA levels in people with NCDs. The acceptance and feasibility of both interventions in routine care in the German healthcare system will also be evaluated. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04947787 . Registered 01 June 2021.