Physical activity interventions in workplace health promotion: objectives, related outcomes, and consideration of the setting-a scoping review of reviews.

Background: The workplace is a recognized setting for promoting health among adults, and physical activity (PA) interventions are an integral part of workplace health promotion (WHP). Objectives: The present review of reviews aims to provide an overview of the main objectives and related outcomes addressed in WHP-related PA interventions, as well as the setting-specific aspects considered in the research field. Methods: A scoping review of reviews was conducted. Reviews were included if they were peer-reviewed, written in English, and focused on PA interventions conducted in the context of WHP. A literature search was conducted in PubMed, SPORTDiscus, and Web of Science. Reviews were included if they had been published after the year 2000. Information on the following dimensions was extracted: author, region, number of primary studies included, target group(s), PA interventions included, main objective(s), related outcomes, and setting-specific aspects. Results: A total of 17 reviews were included. Six reviews aimed at solely identifying the effectiveness of promoting daily PA and reducing sedentary behavior. Eleven reviews showed a combined approach considering physical activity behavior and/or health and job-related outcomes. Outcomes in the primary studies were heterogeneous. None of the reviews had an explicit definition of WHP and setting-specific information was very general and sparse. The reported setting-specific information was referred to the general importance of the workplace setting, the specific importance as an access route to target groups, and implementation aspects. Regarding the additional characteristics of the reviews, the selection of primary studies was restricted to a specific region in 2 of the 17 reviews in advance. Three reviews restricted the target group (sedentary workers, women, desk-based workers), while eleven reviews included working adults in general and, three reviews gave no information about the target group. Eleven intervention approaches of the reviews were behaviorally oriented, two focused solely on environmental interventions, and four reviews can be attributed to a combined approach considering behavioral and environmental interventions. Conclusion: For sustainable future developments, the present results indicate a strong need for conceptual consolidation of WHP in the research field of PA interventions. Therefore, both WHP and health-related PA interventions need to take a comprehensive approach comprising behavioral and environmental interventions.

Experiences in the application of logic models in the context of workplace health promotion - A focus group discussion.

Gathering evidence on complex workplace health promotion interventions faces methodological challenges. Therefore, the application of logic models as a theory of change is recommended to support outcome and process evaluations. The present study explores challenges and opportunities of applying logic models in application-oriented intervention research on workplace health promotion. A focus group (n = 6), consisting of scientists and workplace health promotion practitioners, was conducted using a semi-structured interview guide. The recorded qualitative data were transcribed and analysed using the structuring content analysis method. According to the focus group, logic models provide several opportunities for planning and evaluating complex workplace health promotion interventions. Logic models support the communication between science and practice, and have benefits for the provider of workplace health promotion interventions. The main challenges in working with logic models were dealing with the complex and constantly developing intervention and with the derivation and implementation of reasonable evaluation methods. The focus group exposed repeated application and a shared understanding between stakeholders as facilitators for working with logic models. In conclusion, at the science-practice interface, logic models could enhance the integrative understanding and the further development of evidence-based workplace health promotion.

Therapist competencies in the context of group-based exercise programs in medical rehabilitation: a qualitative study with patients and exercise therapists from Germany.

BACKGROUND: Group-based exercise programs account for nearly half of exercise therapy services provided in German medical rehabilitation facilities. However, information about necessary therapist competencies for the successful execution of these programs is sparse. Thus, the aim of this qualitative study was to explore relevant therapist competencies in the context of group-based exercise programs from the patients' and therapists' perspective. METHODS: Semi-structured interviews were conducted with five rehabilitation patients following a 3-week inpatient orthopedic rehabilitation program as well as five exercise therapists with work experience in group-based exercise therapy. Data were analyzed using structuring content analysis according to Kuckartz. RESULTS: From 155 topic-related text passages, collected over 10 interviews, four competency categories with 16 subcategories and respective characteristics were identified. In addition to professional expertise like biomedical knowledge, exercise therapists were expected to possess a multitude of didactic-methodological, personal, and social-communicative abilities. CONCLUSION: Our results suggest that the psychosocial, behavioral and educational goals of group-based exercise programs necessitate a wide range of therapist competencies. These conform to the multidimensional nature of exercise therapy and should therefore be covered in vocational and continuing education.

Organizational facilitators and barriers for participation in workplace health promotion in healthcare: A qualitative interview study among nurses.

Background: There is evidence for the positive effects of workplace health promotion (WHP) for nurses. Although this highly stressed target group also actively desires WHP, the number of participants is low. Individual reasons play a role in the decision to engage in WHP activities, yet it is interesting to consider which organizational factors a company could address to improve participation. In this regard, the question arises of what organizational factors facilitate participation in WHP activities from the perspective of nurses in inpatient care facility (ICF), outpatient care service (OCS), and acute care hospitals (ACH). Method: Sixteen semi-structured interviews were conducted in different care settings between May and September 2021. Questions about everyday working life, WHP activities, and organizational framework conditions were asked. Result: The results show that there is a wide range of influencing factors at the organizational level, some overall settings, and others setting-specific. High workload and the fit of WHP activities with shift times were particularly inhibiting overall settings. A negative association with the employer worked as a barrier in ICF and ACH. Conclusion: When implementing WHP activities, it can be useful to consider organizational facilitators and barriers to promote sustainable and attractive WHP activities and higher participation rates in the different settings of nursing.

The effects of exercise therapy feedback on subjective treatment outcome and patient satisfaction: study protocol for a mono-centric, randomized, controlled trial in orthopedic rehabilitation (FeedYou).

BACKGROUND: The disease burden of musculoskeletal disorders necessitates multidisciplinary and patient-centered models of care. Exercise therapy represents a first-line treatment strategy and a central component of medical rehabilitation. In order to realize the goals of long-term physical activity and participation as proposed by the ICF, exercise therapy can be supplemented by interventional techniques from the field of psychotherapy. Although psychotherapist feedback has been shown to improve therapeutic outcome and patient satisfaction, feedback use in exercise therapy is mostly limited to motor learning and exercise instruction. The present paper therefore describes the use of multidimensional exercise therapy feedback in medical rehabilitation. The aims of the trial presented in this study protocol are to evaluate the effects of this novel feedback approach on rehabilitation outcomes in comparison to usual care. METHODS: The study is designed as a prospective, mono-centric, randomized controlled, superiority trial (RCT) with two parallel groups and three measuring points: T0 = start of three-week inpatient rehabilitation, T1 = end of three-week inpatient rehabilitation, T2 = 12-week follow-up. In total, 132 patients suffering from chronic neck, shoulder and/or lumbar spine disorders will be recruited. The intervention involves multidimensional exercise therapy feedbacks during the initial and final physical therapist examination, as well as short exercise therapy feedbacks during the course units of the mandatory group-based exercise therapy program. Primary outcomes are the subjective treatment outcome, assessed by BPI and indication-specific questionnaires, as well as patient satisfaction, assessed by ZUF-8 and an intervention-specific questionnaire. The final data collection is expected by May 2023. DISCUSSION: This study may provide a valuable insight into the effectiveness of multidimensional exercise therapy feedback to improve treatment outcomes and patient satisfaction in medical rehabilitation. This could contribute to rehabilitation quality assurance and the long-term physical activity behavior of rehabilitation patients. Trial registration The trial has been registered with the German Clinical Trial Register (DRKS) under the Registration Number DRKS00027263.

Influencing factors on the health of nurses-a regression analysis considering individual and organizational determinants in Germany.

BACKGROUND: The care sector is characterized by high absenteeism of nursing care employees due to illness. Organizational determinants that can affect the mental health of nurses are known. Although nurses are confronted with different framework conditions in different care settings, there is a lack of comparative data in Germany. METHODS: The purpose of this study was to examined the relationship between work demands and employee health in different care settings. This cross-sectional survey was conducted between June and October 2021 in four acute care hospitals, seven inpatient care facilities, and five outpatient care services in Germany. 528 nursing care employees (acute care hospitals n = 234; inpatient care facilities n = 152; outpatient care services n = 142) participated in the survey (participation rate: 22.6%-27.9%). For each care setting, data was collected via questionnaire on individual determinants (gender, age, profession, working time), organizational work demands (quantitative workload, qualitative workload, organization of work, social work climate, after work situation, verbal violence, threats, physical violence) and employee health (subjective health status and work ability). Descriptive statistics and binary logistic regressions were performed. RESULTS: Increasing age (OR = 0.650, 95% CI = 0.424-0.996) as an individual determinant and organization of work (OR = 0.595, CI = 0.362-0.978) as an organizational determinant were negatively associated with subjective health. Furthermore, age (OR = 0.555, 95% CI = 0.353-0.875), a demanding organization of work (OR = 0.520, CI = 0.315-0.858), increasing quantitative workloads (OR = 0.565, CI = 0.343-0.930) and a poorer perceived social work climate (OR = 0.610, CI = 0.376-0.991) were associated with lower work ability. CONCLUSIONS: Based on the study results, health programs should target both individual and organizational factors. The findings seem to support the importance to include nursing care employees in the planning process, as it can have an impact on their health. TRIAL REGISTRATION: The project was registered in the German Clinical Trial Register (DRKS00024961, 09/04/2021).

[Necessity and Ways to Develop Care Goals for the Health System in Germany - a Position Paper of the DNVF]. / Notwendigkeit und Wege zur Entwicklung von Versorgungszielen für das Gesundheitssystem in Deutschland ­ ein Positionspapier des DNVF.

Goals for health and health care are an indispensable basic requirement for a functioning health care system. The dilemma of the German health care system is that it has not been designed in a planned way, but that it has grown historically. In recent years, it has developed through the free play of forces into what it is today. The OECD characterizes the current state as follows: The costs of the German health system do not correspond to the often only average health outcomes for the population. To meet the legal requirements (especially SGB V §§ 12, 27 and 70), health care/the health system in Germany needs concrete goals. An orientation towards health care goals entails measures on all levels of health care: on the macro level (overall system/total population), on the meso level (subdivided according to regions, specific population groups, etc.) as well as on the micro level (patients and health care providers). Based on national and international experiences, this position paper of the DNVF e.V. (German Network for health services research) shows the potential of how operationalised health care targets can ensure effective, affordable and high-quality health care. The coalition agreement of the current government propagates a reorientation with patient-related health care goals. Now it is important to derive concrete and realisable goals from this declaration of intent and to involve all important groups in the process. In addition, values and ethical standards for implementation shall be agreed upon in this process. The Health Ministry (BMG) should facilitate and promote the process of societal will-building for the definition of national health care goals. This requires a clear political will. As a result, the National Health Care Goals are available at the end of the process, which are published and maintained together with evidence-based facts as well as valid and resilient data in a Manual "National Health Care Goals". The operational responsibility for implementation could lie with the newly to be founded Federal Institute of Public Health, as already announced in the agreement of the governing coalition. The DNVF is willing to actively participate in the development of health care targets.

Attention to Progression Principles and Variables of Exercise Prescription in Workplace-Related Resistance Training Interventions: A Systematic Review of Controlled Trials.

Background: The workplace is an important setting for adult health promotion including exercise training such as resistance training (RT). Since the reporting of exercise training interventions is generally inconsistent, the objective of this systematic review was to investigate the attention to principles of RT progression and variables of RT exercise prescription in workplace-related RT interventions. Methods: A systematic literature search was conducted in the databases LIVIVO, PubMed, SPORTDiscus, and Web of Science (2000-2020). Controlled trials with apparently healthy "employees" and a main focus on RT were included. RT principles and variables were extracted and rated by two reviewers (reported, not reported, or unclear). Sum scores for each RT intervention and percentages regarding each principle and variable were calculated. Results: Overall, 21 articles were included (18 primary studies, 3 protocols). Summarized narratively, the interventions showed different positive effects on strength- or performance-related and/or health- or complaint-related outcomes. The reporting of the RT principles and variables was varied [progressive overload: 94% of the studies, specificity: 78%, variation (periodization): 39%, muscle action: 94%, loading: 94%, volume; 67%, exercise selection: 89%, exercise order: 47%, rest periods between sets: 33%, rest periods between exercises: 27%, repetition velocity: 44%, and frequency: 100%]. Conclusion: Several key RT principles and variables were reported inconsistently, reducing reproducibility and pointing to the need for standardized RT intervention reporting in workplace-related interventions. Exercise science and workplace promotion should be further linked, since accurate reporting is a prerequisite for transferring robust findings into practice.

Association Between Health Literacy and Work Ability in Employees With Health-Related Risk Factors: A Structural Model.

INTRODUCTION: In workplace health promotion (WHP), health literacy and work ability are considered as outcomes of high interest. Therefore, the question arises as to what extent individual health literacy skills have an impact on work ability alongside sociodemographic influences. OBJECTIVES: This study aimed to examine the associations between a structural model of health literacy as well as sociodemographic context factors and the work ability among employees with health-related risk factors. MATERIALS AND METHODS: The study was based on baseline data of a workplace-related intervention (158 employees with health-related risk factors, 53.8% women, 48 ± 10 years). Health literacy skills were assessed with Lenartz's Questionnaire (measuring "self-perception", "proactive approach to health", "dealing with health information", "self-control", "self-regulation", and "communication and cooperation"). Work ability was measured by the German Short Form of the Work Ability Index (WAI). As sociodemographic context factors, sex, age, and educational level were assessed. The associations were examined using structural equation modeling with partial least squares (SmartPLS 2.0.M3). Common quality criteria were applied and significance level was set at α = 5%. RESULTS: Model's reliability, validity, and structure could be validated. Regarding the impact on work ability, "self-regulation" showed a statistically significant direct effect (ß = 0.32, t (∞) = 4.00, p < 0.01, f 2 = 0.09) and "self-perception" had a significant indirect effect (ß = 0.13, t (∞) = 2.53, p < 0.05). The only additional association with work ability was found for age (ß = -0.25, t (∞) = 3.82, p < 0.01, f 2 = 0.04). The WAI score variance was explained to 17.5% by the health literacy skills and to 27.5% considering the additional sociodemographic context factors. CONCLUSION: According to the structural model of health literacy, in employees with health-related risk factors, a target group-specific WHP approach could be the encouragement of self-regulation and self-perception. However, additional resources and conditions influencing work ability should be considered.

Organizational Framework Conditions for Workplace Health Management in Different Settings of Nursing-A Cross-Sectional Analysis in Germany.

Studies show that workplace health promotion (WHP) can reduce sickness-related absenteeism among employees and secure long-term workability. Embedding WHP in workplace health management (WHM) can contribute to sustainability and holism. This study aimed to investigate organizational framework conditions for WHM in different settings of nursing in Germany (acute care hospital, long-term care (LTC) facilities and home-based LTC). In a project on WHM implementation, managers with personnel responsibility for nurses (n = 16) were surveyed. In total, 46 close-ended questions on organizational framework conditions of WHM in their care facility were answered at the beginning of the project. No significant differences were found for the indexes of health promoting willingness, health promoting management, social capital and workplace health activity. Descriptive analysis showed that home-based LTC performed slightly better on average. Home-based LTC and LTC facilities had higher ratings in health promoting willingness than in actually managing the process (health promoting management), while the results for acute care hospitals were reversed. Acute care hospitals showed the lowest values for the topics of health as a leadership topic and evaluation of incidents of violence, which were generally rated lower among all settings. Need for action can be identified in improving personal, financial and time resources, evaluation and information on WHM.

Workplace health promotion interventions for nurses in Germany: a systematic review based on the RE-AIM framework.

BACKGROUND: The German health care system is faced with a serious shortage of nurses. This is associated, amongst other things, with difficult working conditions and work-related health burdens. Workplace health promotion (WHP) is considered a promising approach to promote the health of nurses. The present review aims to give an overview on existing interventions in different nursing settings (acute care hospitals, long-term care (LTC) facilities and home-based long-term care) in Germany. METHODS: A systematic literature search was conducted in PubMed and PubPsych. Studies were included if published after 2010 and provided data of intervention studies on workplace health promotion among nurses in Germany (RCTs, non-RCTs, non-controlled intervention studies and pilot studies). The setting in which the study was conducted (acute medical care hospital, inpatient LTC facilities, home-based LTC, cross-setting) as well as the health issue assessed (physical health, mental health and/or violence experience) were extracted. The intervention was reported against the background of the quality criteria for prevention measures of the statutory health insurers in Germany. The results of the studies were presented according to the RE-AIM framework. RESULTS: Eleven studies on WHP for nurses were included, whereof seven studies were conducted in acute medical care hospitals and four in LTC facilities. No study reported results on WHP for nurses working in the setting of home-based LTC. Most studies aimed at improving mental health. The intervention contents and forms of implementation were heterogeneous. According to the RE-AIM criteria, the reporting of most studies showed several limitations, especially a lack of reporting on Implementation and Adoption. Most studies showed no statistically significant effect on the respective outcomes (Effectiveness). Four studies reported results on Maintenance indicating a sustained effectiveness. CONCLUSION: Despite the high relevance for health promotion for nurses, our review showed a striking lack of intervention studies in this field. From this we derive a high need of tailored interventions, taking into account the setting-specific development, implementation of WHP interventions for nurses. With regard to the evaluation, the RE-AIM criteria should be taken more into account in order to meet the requirements of evaluating complex interventions and thus contribute to evidence development of WHP in nursing. In terms of content, the topic of violence prevention and dealing with experiences of violence should also be taken into account. Regarding the settings, the working conditions and health burdens in LTC facilities, home-based LTC and acute medical hospitals must be considered. TRIAL REGISTRATION: PROSPERO registration number: CRD42021231891.

Work-Related Health Burdens of Nurses in Germany: A Qualitative Interview Study in Different Care Settings.

Background: The growing need for nursing care is offset by a shortage of nurses, who are exposed to high physical and psychological demands in their daily work and have above-average absences that vary between different care settings. Based on the data on sick days, the question arises: What are the subjective work-related health burdens of nurses in acute care hospitals, inpatient care facilities, and outpatient care services? Methods: Sixteen semi-structured interviews were conducted in different care settings between May and September 2021. Questions about the professional career, everyday working life and personal health, violence in the workplace, and organizational framework conditions were asked. Results: The experiences of the nurses highlighted that health-related burdens have varying manifestations in different care settings. This was reflected in three main categories: health, everyday working life, and experiences of violence. In particular, the different structural framework conditions that trigger stress and the occurrence of violence are important from the perspective of the nurses. Conclusions: The results of this exploratory study can serve as a baseline for obtaining further setting-specific quantitative data that can contribute to the development, implementation, and evaluation of target group-specific health promotion programs.

Evaluation of the communication strategy for promoting physical activity in a cross-company network in Germany: A mixed-methods analysis.

Introduction: The workplace is considered a promising setting for reaching physically inactive adults, but participation quotes in workplace health promotion (WHP) remain low. Regarding the low participation in WHP, the question emerges concerning the importance of health communication strategies. This paper presents the results from the evaluation of the communication strategy of a cross-company network for promoting physical activity and derives findings for the successful communication of measures. Materials and methods: Quantitative and qualitative data sources were used to evaluate the communication strategy. The methods applied included individual semi-structured interviews (n = 14) and the monitoring of the usage of digital communication channels. Results: The analysis revealed that the usage of the digital communication channels within this study was subjected to major fluctuations and a variety of factors must be considered when communicating physical activity measures in a cross-company network. It is important to engage in appropriate communication management that explicitly takes the interpersonal communication and the organizational circumstances into account. Conclusion: This study revealed which factors may have an influence on the successful communication of physical activity measures in the context of WHP in cross-company networks. Thus, it makes an important contribution to the transfer of science and practice as it captured relevant questions from the field of WHP. Trial registration: German Clinical Trials Register (DRKS)-ID: DRKS00020956; Date of registration: 18 June 2020, https://drks.de/search/de/trial/DRKS00020956.

Health problems and violence experiences of nurses working in acute care hospitals, long-term care facilities, and home-based long-term care in Germany: A systematic review.

BACKGROUND: Working in the nursing sector is accompanied by great physical and mental health burdens. Consequently, it is necessary to develop target-oriented, sustainable profession-specific support and health promotion measures for nurses. OBJECTIVES: The present review aims to give an overview of existing major health problems and violence experiences of nurses in different settings (acute care hospitals, long-term care facilities, and home-based long-term care) in Germany. METHODS: A systematic literature search was conducted in PubMed and PubPsych and completed by a manual search upon included studies' references and health insurance reports. Articles were included if they had been published after 2010 and provided data on health problems or violence experiences of nurses in at least one care setting. RESULTS: A total of 29 studies providing data on nurses health problems and/or violence experience were included. Of these, five studies allowed for direct comparison of nurses in the settings. In addition, 14 studies provided data on nursing working in acute care hospitals, ten on nurses working in long-term care facilities, and four studies on home-based long-term care. The studies either conducted a setting-specific approach or provided subgroup data from setting-unspecific studies. The remaining studies did not allow setting-related differentiation of the results. The available results indicate that mental health problems are the highest for nurses in acute care hospitals. Regarding violence experience, nurses working in long-term care facilities appear to be most frequently affected. CONCLUSION: The state of research on setting-specific differences of nurses' health problems and violence experiences is insufficient. Setting-specific data are necessesary to develop target-group specific and feasible interventions to support the nurses' health and prevention of violence, as well as dealing with violence experiences of nurses.

Health literacy, health status and health behaviors of German students- study protocol for the "Healthy Habits" cohort study.

BACKGROUND: The emerging adulthood is traditionally viewed as a time of optimal health, but also as a critical life span, characterized by changing life circumstances and the establishment of an individual lifestyle. Especially university life seems to hold several challenges impeding the manifestation of a health supporting manner, as many students tend to show a poorer health behavior and a higher amount of health-related problems than comparable age groups. This, along with a steady growth of the higher education sector, brings increased attention to the university setting in the context of prevention. To date, there are few empirical longitudinal and coherent cross-sectional data on the status of students' health literacy, health status, and health behaviors, and on the impact of the study format on students' health. The aim of this prospective cohort study is to reduce this research gap. METHODS: Starting during winter semester 2020/21, the prospective cohort study collects data on health literacy, health status and health behavior on a semester-by-semester basis. All enrolled students of the IST University of Applied Sciences, regardless of study format and discipline, can participate in the study at the beginning of their first semester. The data are collected digitally via a specifically programmed app. A total of 103 items assess the subjectively perceived health status, life and study satisfaction, sleep quality, perceived stress, physical activity, diet, smoking, alcohol consumption, drug addiction and health literacy. Statistical analysis uses (1) multivariate methods to look at changes within the three health dimensions over time and (2) the association between the three health dimensions using multiple regression methods and correlations. DISCUSSION: This cohort study collects comprehensive health data from students on the course of study. It is assumed that gathered data will provide information on how the state of health develops over the study period. Also, different degrees of correlations of health behavior and health literacy will reveal different impacts on the state of students' health. Furthermore, this study will contribute to empirically justified development of target group-specific interventions. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00023397 (registered on October 26, 2020).

Impact Model-Based Physical-Activity Promotion at the Workplace: Study Protocol for a Mixed-Methods Study in Germany (KomRueBer Study).

There is great potential for the implementation of physical-activity measures at the workplace, especially in smaller companies. The present paper describes the study protocol for evaluating an impact-model-based multicomponent intervention promoting physical activity at the workplace within a cross-company network. The evaluation is based on a logic model focusing on outputs and short-term outcomes for the purpose of physical-activity promotion, physical-activity-related health competence, and knowledge about physical activity. A mixed-methods approach is applied. The quantitative evaluation is conducted as a natural design, and combines a retrospective evaluation of the acceptance, usage, and satisfaction (output) at the end of the measures, and two surveys that capture physical activity, knowledge about physical activity, and physical-activity-related health competence (outcome) of the employees in the form of a trend study. The qualitative evaluation comprises semistructured interviews to investigate knowledge of the existence of and attitude towards the content of the multicomponent intervention and the study. The challenges evaluating complex interventions are widely debated. Through an impact-model-based approach, the study will provide a promising framework for the systematic evaluation of a multicomponent intervention promoting physical activity.

Supporting Cross-Company Networks in Workplace Health Promotion through Social Network Analysis-Description of the Methodological Approach and First Results from a Model Project on Physical Activity Promotion in Germany.

Cross-company networking and counseling is considered to be a promising approach for workplace health promotion in small and medium-sized enterprises. However, a systematic and empirical approach on how such networks can be developed is lacking. The aims of the present paper are to describe the approach of a social network analysis supporting the development of a cross-company network promoting physical activity and to present first results. In the process of developing the methodological approach, a common understanding of the nodes and edges within the project was elaborated. Based on the BIG-model as the theoretical framework of the project, five measuring points and an application-oriented data collection table were determined. Using Gephi, network size, degree, and distance measures, as well as density and clustering measures, were calculated and visualized in the course of the time. First results showed a continuous expansion and densification of the network. The application experience showed that the application of social network analysis in practical cross-company network development is promising but currently still very resource intensive. In order to address the current major challenges and enable routine application, the development of an application-oriented and feasible tool could make an essential contribution.

Questionnaire choice affects the prevalence of recommended physical activity: an online survey comparing four measuring instruments within the same sample.

BACKGROUND: Since prevalence estimates of recommended physical activity (PA) considerably vary between different surveys, prevalence might be crucially affected by the choice of measuring instrument. The aim of the present study is to compare the results of four PA questionnaires regarding the current moderate- and vigorous-intensity aerobic PA (MVPA) recommendations of the World Health Organization. METHODS: Within an online survey, participants answered the German Health Interview and Examination Survey for Adults (DEGS), the European Health Interview Survey PA Questionnaire (EHIS), the Eurobarometer (EURO), and a single-item measure (SIM). Weekly volume of MVPA was compared via a Friedman test and the prevalence of participants achieving the WHO's MVPA recommendation via Cochran's Q. Agreement between all questionnaire pairs was evaluated via Kappa statistics. RESULTS: One hundred seventy-six participants were included in the analyses (70.5% female, mean age: 33.1 years (SD=12.2)). Between the four questionnaires, the weekly volume of MVPA statistically significant differed (SIM: MED=90.0 (MIN=0.0, MAX=210.0), DEGS: MED=120.0 (MIN=0.0, MAX=420.0), EHIS: MED=24.0 (MIN=0.0, MAX=1395.0), EURO: MED=51.0 (MIN=0.0, MAX=2430.0), p<.001, all pairwise comparisons p<.01), as well as the prevalence of participants achieving the MVPA recommendations (SIM 31.3% (95% CI 24.5-38.7), DEGS 43.2% (95% CI 35.8-50.8), EHIS 67.0% (95% CI 59.6-73.9), EURO 87.5% (95% CI 81.7-92.0), p<.001), except between SIM and DEGS (p=.067). Agreement was weak between all questionnaire pairs (all κ< 0.60). CONCLUSIONS: Questionnaire choice crucially affects the resulting MVPA data and hence the prevalence of achieving recommended PA levels within the same sample. Therefore, for PA surveillance, standardised survey and analysis methods and efforts to harmonise monitoring systems are needed, since whether recommended levels of PA are achieved should not be determined by the choice of one measuring instrument or another.