Large-scale assessment of physical activity in a population using high-resolution hip-worn accelerometry: the German National Cohort (NAKO).

Large population-based cohort studies utilizing device-based measures of physical activity are crucial to close important research gaps regarding the potential protective effects of physical activity on chronic diseases. The present study details the quality control processes and the derivation of physical activity metrics from 100 Hz accelerometer data collected in the German National Cohort (NAKO). During the 2014 to 2019 baseline assessment, a subsample of NAKO participants wore a triaxial ActiGraph accelerometer on their right hip for seven consecutive days. Auto-calibration, signal feature calculations including Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD), identification of non-wear time, and imputation, were conducted using the R package GGIR version 2.10-3. A total of 73,334 participants contributed data for accelerometry analysis, of whom 63,236 provided valid data. The average ENMO was 11.7 ± 3.7 mg (milli gravitational acceleration) and the average MAD was 19.9 ± 6.1 mg. Notably, acceleration summary metrics were higher in men than women and diminished with increasing age. Work generated in the present study will facilitate harmonized analysis, reproducibility, and utilization of NAKO accelerometry data. The NAKO accelerometry dataset represents a valuable asset for physical activity research and will be accessible through a specified application process.

Changes in physical activity and sedentary behavior during the first COVID-19 pandemic- restrictions in Germany: a nationwide survey : Running head: physical activity during the COVID-19 restrictions.

BACKGROUND: The COVID-19 pandemic restrictions posed challenges to maintaining healthy lifestyles and physical well-being. During the first mobility restrictions from March to mid-July 2020, the German population was advised to stay home, except for work, exercise, and essential shopping. Our objective was to comprehensively assess the impact of these restrictions on changes in physical activity and sedentary behavior to identify the most affected groups. METHODS: Between April 30, 2020, and May 12, 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). This questionnaire gathered information about participants' physical activity and sedentary behavior currently compared to the time before the restrictions. We integrated this new data with existing information on anxiety, depressive symptoms, and physical activity. The analyses focused on sociodemographic factors, social relationships, physical health, and working conditions. RESULTS: Out of 152,421 respondents, a significant proportion reported altered physical activity and sedentary behavioral patterns due to COVID-19 restrictions. Over a third of the participants initially meeting the WHO's physical activity recommendation could no longer meet the guidelines during the restrictions. Participants reported substantial declines in sports activities (mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they also increased recreational physical activities (M = 0.12; 95% CI: .117; .126) while engaging in more sedentary behavior (M = 0.24; 95% CI: .240; .247) compared to pre-restriction levels. Multivariable linear and log-binomial regression models indicated that younger adults were more affected by the restrictions than older adults. The shift to remote work, self-rated health, and depressive symptoms were the factors most strongly associated with changes in all physical activity domains, including sedentary behavior, and the likelihood to continue following the physical activity guidelines. CONCLUSIONS: Mobility patterns shifted towards inactivity or low-intensity activities during the nationwide restrictions in the spring of 2020, potentially leading to considerable and lasting health risks.

Determinants promoting and hindering physical activity in primary school children in Germany: a qualitative study with students, teachers and parents.

Background: Determinants affecting children's physical activity (PA) at an early age are of particular interest to develop and strengthen strategies for increasing the levels of children's PA. A qualitative study was conducted to investigate the views of primary school-aged children, their teachers and parents regarding barriers and facilitators to engage in PA. Methods: Focus groups were conducted separately with primary school children, parents and teachers in a city in Northern Germany between October 2021 and January 2022. The semi- structured focus groups with children and teachers took part in person within school, whereas the focus groups with parents took place online. Data were transcribed verbatim and analysed using thematic analysis. During analysis, the socio-ecological model was identified as useful to map the determinants mentioned and was consequently applied to organize the data. Results: Teachers (n = 10), parents (n = 18) and children (n = 46) of five primary schools in Germany participated in the focus groups. Participants of the three groups identified similar barriers and facilitators of PA in primary school-aged children, ranging across all four layers of the socio-ecological model. The barriers encountered were the preferences of children for sedentary activities (individual characteristics), the preference of parents to control their child's actions (microsystem), a lack of financial resources from parents and long sitting times in class (mesosystem), and barriers related to rainy weather and Covid-19 restrictions (exosystem). Facilitators mentioned were the childrens' natural tendency to be active (individual characteristics), involvement and co-participation of parents or peers in engaging in PA, support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities and favorable weather conditions (exosystem). Conclusion: A range of determinants promoting and hindering PA, ranging across all layers of the socio-ecological model were identified by children, parents and teachers in this study. These determinants need to be kept in mind when developing effective PA intervention programs for primary school-aged children. Future interventions should go beyond individual characteristics to also acknowledge the influence of childrens' social surrounding, including parents, peers and teachers, and the wider (school) environment.

Use of a toolbox of tailored evidence-based interventions to improve children's physical activity and cardiorespiratory fitness in primary schools: results of the ACTIPROS cluster-randomized feasibility trial.

BACKGROUND: School-based physical activity (PA) promotion is usually conducted by providing one specific intervention. In contrast, the ACTIvity PROmotion via Schools (ACTIPROS) toolbox provides a set of twelve evidence-based PA interventions serving different domains of the Health Promoting Schools framework that primary schools can select according to their requirements. In this study, we tested the feasibility of the toolbox approach in primary schools. METHODS: A two-arm cluster-randomized feasibility trial at primary schools (n = 5 intervention schools [IS], n = 5 control schools) located in the Federal State of Bremen, Germany, was conducted. Children's habitual PA (GENEActiv, Activinsights Ltd.) and motor skills (Deutscher Motorik Test; DMT) were measured at the beginning (t0: Sept and Oct 2021) and at the end of the school year (t1: June and July 2022). Between Oct 2021 and July 2022, the ACTIPROS toolbox was implemented at IS. Teachers documented intervention choices and implementation within a short questionnaire (SIQ) at t1. RESULTS: IS successfully implemented at least one intervention of the toolbox. In total, seven out of twelve possible interventions were selected. Two schools decided to replace an intervention with another during the trial. Results of the SIQ indicated that IS tended to choose similar interventions while implementation frequency was highly different. N = 429 students from two classes per school were recruited. The mean consent rate was 75.1% (n = 322). At t0 and t1, n = 304 (94.4%) and n = 256 (79.3%) of consented children took part in the DMT, respectively. The accelerometry sample included one class per participating school. At t0 and t1, n = 166 and n = 151 devices were handed out to students and n = 133 (80.1%) and n = 106 (70.2%) valid records could be retrieved, respectively. Linear mixed models showed an intervention effect of 15.5 min (95% CI: 4.5; 26.6) in children's daily MVPA at IS between t0 and t1 compared to controls. CONCLUSIONS: All IS were able to implement at least one intervention from the toolbox, and unsuitable interventions were successfully replaced in a timely manner, highlighting the feasibility of implementing the ACTIPROS toolbox. Good consent rates for accelerometer and motor skills data were achieved. Results indicate a substantial increase in MVPA associated with the ACTIPROS toolbox and need to be tested in a larger sample. TRIAL REGISTRATION: German Clinical Trials Register DRKS00025840.

How to select interventions for promoting physical activity in schools? Combining preferences of stakeholders and scientists.

BACKGROUND: The failure to scale-up and implement physical activity (PA) interventions in real world contexts, which were previously successful under controlled conditions, may be attributed to the different criteria of stakeholders and scientists in the selection process of available interventions. Therefore, the aim of our study was to investigate and compare the criteria applied by local stakeholders and scientists for selecting amongst suitable school-based PA interventions for implementation. METHODS: We conducted a three-round repeated survey Delphi study with local stakeholders (n = 7; Bremen, Germany) and international scientific PA experts (n = 6). Independently for both panels, two rounds were utilized to develop a list of criteria and the definitions of criteria, followed by a prioritization of the criteria in the third round. For each panel, a narrative analysis was used to rank-order unique criteria, list the number of scorers for the unique criteria and synthesize criteria into overarching categories. RESULTS: The stakeholders developed a list of 53 unique criteria, synthesized into 11 categories with top-ranked criteria being 'free of costs', 'longevity' and 'integration into everyday school life'. The scientists listed 35 unique criteria, synthesized into 7 categories with the top-ranked criteria being 'efficacy', 'potential for reach' and 'feasibility'. The top ranked unique criteria in the stakeholder panel were distributed over many categories, whereas four out of the top six criteria in the scientist panel were related to 'evidence'. CONCLUSIONS: Although stakeholders and scientists identified similar criteria, major differences were disclosed in the prioritization of the criteria. We recommend an early collaboration of stakeholders and scientists in the design, implementation, and evaluation of PA interventions.

[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.

Longitudinal association of childhood physical activity and physical fitness with physical activity in adolescence: insights from the IDEFICS/I.Family study.

BACKGROUND: This study aimed to examine associations of early childhood physical fitness and physical activity (PA) with PA during later childhood/early adolescence while accounting for gender differences. METHODS: We selected data of N = 4329 children from the IDEFICS/I. Family cohort (age 2.4-11.7 years) with data on baseline fitness and accelerometer measurements. At baseline, physical fitness tests were conducted including Flamingo balance, Backsaver sit and reach, Handgrip strength, Standing Long Jump, 40-m sprint and 20-m Shuttle run (to estimate cardio-respiratory fitness levels). PA was measured with Actigraph accelerometers over 3 days at baseline (ActiTrainer or GT1M) and 7 days at follow-up (GT3X). Evenson cutpoints were used to determine moderate-to-vigorous PA (MVPA) time, and children with ≥60mins/day of average MVPA were deemed as having met WHO guidelines at baseline and follow-up. Linear and logistic regressions were performed to examine longitudinal associations between meeting WHO guidelines, MVPA, and physical fitness tests at baseline with meeting WHO guidelines and MVPA at follow-up. Models were conducted on the entire sample, the sex-stratified sample, and stratified by sex and pubertal status at follow-up. RESULTS: Results showed that meeting WHO guidelines for MVPA at baseline was positively associated with MVPA (Standardized Beta (B) = 0.13, 95%CI:(5.6;11.1)) and meeting WHO guidelines at follow-up for the entire sample (OR = 2.1, 95%CI:(1.5; 3.14), and stratified by males (OR = 2.5, 95%CI:(1.5; 4.1)) and females (OR = 1.8, 95%CI:(1.0; 3.2)). This was also found for both male pre/early pubertal and pubertal groups but only in the female pre/early pubertal group, and not the female pubertal group (MVPA: B = .00, 95%CI:(- 6.1; 5.6), WHO: OR = 0.61, 95%CI:(0.23;1.6)). Models indicated that Standing Long jump, 40-m sprint, Shuttle run and Flamingo balance at baseline were associated with MVPA and meeting the guidelines at follow-up. CONCLUSIONS: Meeting WHO guidelines and certain fitness tests at baseline were strongly associated with MVPA and meeting WHO guidelines at follow-up, but this association varied with sex and pubertal status. Consequently, these findings underline the importance of ensuring sufficient physical activity in terms of quality and quantity for children at the earliest stages of life. TRIAL REGISTRATION: ISRCTN62310987.

DE-PASS Best Evidence Statement (BESt): modifiable determinants of physical activity and sedentary behaviour in children and adolescents aged 5-19 years-a protocol for systematic review and meta-analysis.

INTRODUCTION: Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5-19 years) and to quantify their effect on, or association with, PAB/SB. METHODS AND ANALYSIS: A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane's RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health's tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used. ETHICS AND DISSEMINATION: No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. SYSTEMATIC REVIEW REGISTRATION: CRD42021282874.

Ringing the bell for quality P.E.: What are the realities of remote physical education?

BACKGROUND: To date, few data on the quality and quantity of online physical education (P.E.) during the COVID-19 pandemic have been published. We assessed activity in online classes and reported allocated curriculum time for P.E. in a multi-national sample of European children (6-18 years). METHODS: Data from two online surveys were analysed. A total of 8395 children were included in the first round (May-June 2020) and 24 302 in the second round (January-February 2021). RESULTS: Activity levels during P.E. classes were low in spring 2020, particularly among the youngest children and in certain countries. 27.9% of students did not do any online P.E. and 15.7% were hardly ever very active. Only 18.4% were always very active and 14.9% reported being very active quite often. In winter 2020, we observed a large variability in the allocated curriculum time for P.E. In many countries, this was lower than the compulsory requirements. Only 65.7% of respondents had the same number of P.E. lessons than before pandemic, while 23.8% had less P.E., and 6.8% claimed to have no P.E. lessons. Rates for no P.E. were especially high among secondary school students, and in large cities and megapolises. CONCLUSIONS: During the COVID-19 pandemic, European children were provided much less P.E. in quantity and quality than before the pandemic. Countermeasures are needed to ensure that these changes do not become permanent. Particular attention is needed in large cities and megapolises. The critical role of P.E. for students' health and development must be strengthened in the school system.

Are we underestimating the impact of COVID-19 on children's physical activity in Europe?-a study of 24 302 children.

This repeat cross-sectional study investigated the impact of lockdown in Europe in Winter (January and February 2021) on children's and adolescent's physical activity (PA) and recreational screen time (RST), and compared PA to the lockdown in Spring 2020. An online survey was administered (n = 24 302; 6-18 years; 51.7% boys) in nine countries. PA and RST were assessed by 7-day recall. In total, 9.3% of children (95% confidence interval: 6.9-11.7) met WHO PA recommendation, which was half of the proportion observed in Spring 2020 [19.0% (18.2-19.9)]. Sixty percent exceeded the RST recommendations. This suggests that winter lockdown could have a more negative impact on PA than in spring.

A scoping review on characteristics of school-based interventions to promote physical activity and cardiorespiratory fitness among 6- to 10-year-old children.

Physical inactivity, a leading cause of mortality, tracks from childhood to adulthood. Effective interventions to promote physical activity (PA) at a young age are therefore needed. The aim of this scoping review was to provide an overview of school-based interventions for the promotion of PA, cardiorespiratory fitness (CRF), and the reduction of sedentary behaviours (SB) among six- to ten-year-old school children, and map these interventions to the WHO Health Promoting Schools framework. Arksey and O'Malley's scoping review methodology framework guided the conduct of this review. A systematic electronic search of six databases was combined with a hand search of reference lists to retrieve studies published between 2010 and 2019. Data extraction included information on study and intervention characteristics, effectiveness on PA, SB and CRF outcomes, and features of the WHO HPS framework. 192 papers investigating 178 interventions were included. The majority of the identified interventions were single feature interventions (n = 84, 47%) while none of them encompassed all six features of the HPS framework. 'Health skills and education' (n = 104, 58%) was the most frequent feature followed by 'Links with parents or community' (n = 95, 53%). A higher percentage of effective interventions were found for theory-based interventions. Some single-feature interventions were found to be effective while no specific feature combination seemed to be associated with better intervention effectiveness. Theory-based single- as well as multi-feature interventions seem to have the potential to improve effectiveness with regard to PA, CRF, and SB outcomes.

Physical activity, screen time and the COVID-19 school closures in Europe - An observational study in 10 countries.

To date, few data on how the COVID-19 pandemic and restrictions affected children's physical activity in Europe have been published. This study examined the prevalence and correlates of physical activity and screen time from a large sample of European children during the COVID-19 pandemic to inform strategies and provide adequate mitigation measures. An online survey was conducted using convenience sampling from 15 May to 22 June, 2020. Parents were eligible if they resided in one of the survey countries and their children aged 6-18 years. 8395 children were included (median age [IQR], 13 [10-15] years; 47% boys; 57.6% urban residents; 15.5% in self-isolation). Approximately two-thirds followed structured routines (66.4% [95%CI, 65.4-67.4]), and more than half were active during online P.E. (56.6% [95%CI, 55.5-57.6]). 19.0% (95%CI, 18.2-19.9) met the WHO Global physical activity recommendation. Total screen time in excess of 2 h/day was highly prevalent (weekdays: 69.5% [95%CI, 68.5-70.5]; weekend: 63.8% [95%CI, 62.7-64.8]). Playing outdoors more than 2 h/day, following a daily routine and being active in online P.E. increased the odds of healthy levels of physical activity and screen time, particularly in mildly affected countries. In severely affected countries, online P.E. contributed most to meet screen time recommendation, whereas outdoor play was most important for adequate physical activity. Promoting safe and responsible outdoor activities, safeguarding P.E. lessons during distance learning and setting pre-planned, consistent daily routines are important in helping children maintain healthy active lifestyle in pandemic situation. These factors should be prioritised by policymakers, schools and parents. HighlightsTo our knowledge, our data provide the first multi-national estimates on physical activity and total screen time in European children roughly two months after COVID-19 was declared a global pandemic.Only 1 in 5 children met the WHO Global physical activity recommendations.Under pandemic conditions, parents should set pre-planned, consistent daily routines and integrate at least 2-hours outdoor activities into the daily schedule, preferable on each day. Schools should make P.E. lessons a priority. Decision makers should mandate online P.E. be delivered by schools during distance learning. Closing outdoor facilities for PA should be considered only as the last resort during lockdowns.

[Evidence-based primary prevention and health promotion: methods and procedures in 5 research consortia]. / Evidenzbasierung in Primärprävention und Gesundheitsförderung: Methoden und Vorgehensweisen in 5 Forschungsverbünden.

Between 2014 and 2022, the 5 German research networks AEQUIPA, CAPITAL4HEALTH, HLCA, PartKommPlus, and SMARTACT are investigating topics of primary prevention and health promotion with the aim of further deepening the evidence base in these areas. The work of the 5 research networks for primary prevention and health promotion is presented, analysed, and discussed from an internal perspective. A model of evidence-based public health serves as a structuring framework.The 5 research networks use a variety of access routes for the generation of evidence with regard to the participation of nonacademic, civil society actors and users. There is a wide range of study designs - from randomised controlled trials and systematic reviews to diverse qualitative designs. The use of models and theories supports the evidence base. Beyond evidence generation, all research networks focus on at least exemplary implementation of new evidence.Due to the diversity of methods, a diversified evidence-based approach can be realised, taking into account network-specific aspects. Structural circumstances limit the further systematic strengthening of the evidence base. In particular, the involvement of nonacademic, civil society actors for the work with hard-to-reach target groups often cannot be financed or is considered too time consuming under the given circumstances. The COVID-19 pandemic highlights the importance of a flexible spectrum of methods, employing both digital and analogue methods in a meaningful way.

[Reference Values for Cardiorespiratory Fitness of the General Population: The German National Health Interview and Examination Survey for Adults (DEGS1) 2008-2011]. / Referenzwerte für die kardiorespiratorische Fitness der allgemeinen Bevölkerung: Die Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) 2008­2011.

AIM OF STUDY: This study aims to provide population-based reference values for heart rate-based indicators of cardiorespiratory fitness for adults with physical activity readiness aged 18 to 64 years living in Germany. METHODS: Based on data on 2,826 individuals who participated in a submaximal cycle ergometer exercise test as part of the German National Health Interview and Examination Survey for Adults (DEGS1) between 2008 and 2011, we calculated the following indicators: physical working capacity at 150 and 130 beats/min and at 75% of estimated maximum heart rate (PWC150, PWC130 and PWC75%) as well as heart rate-based estimated maximum oxygen uptake (VO2max). We used the LMS method by Cole & Green 1992 to calculate reference values. RESULTS: 25th, 50th and 75th percentiles of PWC150 were 1.5, 1.77 and 2.08 watts/kg among men and 1.18, 1.44 and 1.69 among women. 25th, 50th and 75th percentiles of PWC130 were 1.16, 1.41 and 1.68 watts/kg among men and 0.81, 1.05 and 1.29 among women. Age-dependent median PWC75% values among men and women were 1.87 - age in years× 0.01 and 1.31 - (age in years/100)2× 0.98, respectively, and VO2max among men is 41.7 - age× 0.15. CONCLUSIONS: The references values presented can be used for individual rating of cardiorespiratory fitness among adults living in Germany. Furthermore, they can serve as a basis for regular monitoring purposes.

Protocol for a scoping review to identify and map intervention components of existing school-based interventions for the promotion of physical activity and cardiorespiratory fitness among school children aged 6-10 years old.

INTRODUCTION: Physical inactivity is known as a leading cause of mortality and tracks from childhood to adulthood. Many types of school-based single-component and multicomponent interventions to promote physical activity (PA) have been undertaken and evaluated, with mixed findings overall. Enlarging the intervention areas beyond the school setting is a promising approach. WHO's Health Promoting School (WHO HPS) framework is a holistic, setting-based approach where health is promoted through the whole school environment with links to other settings such as the home environment and wider community. In this paper, we outline our scoping review protocol to systematically review the published literature from the last 10 years to identify existing school-based interventions to promote PA and cardiorespiratory fitness among children aged 6-10 years old and to map intervention components according to the features of this framework. METHODS AND ANALYSIS: Arksey and O'Malley's scoping review methodology framework will guide the conduct of this review. We will search Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sports Medicine & Education Index, Education Resources Information Centre and CENTRAL and hand search the reference lists of key studies to identify studies appropriate for inclusion. Any empirical study that evaluated the effectiveness of a school-based intervention promoting PA and/or cardiorespiratory fitness in children aged 6-10 years old will be included. Two reviewers will independently screen all abstracts and full texts for inclusion. One reviewer will extract general information, study characteristics and intervention contents to classify them according to the features of the WHO HPS framework. Results will be synthesised narratively. ETHICS AND DISSEMINATION: Findings will be disseminated in conference presentations and peer-reviewed publications. A condensed version of the results will be made available for the public. Stakeholder meetings will be arranged to discuss and disseminate the findings.

Impact of "JolinchenKids-Fit and Healthy in Daycare" on Children's Objectively Measured Physical Activity: A Cluster-Controlled Study.

BACKGROUND: To evaluate a multicomponent health promotion program targeting preschoolers' physical activity (PA). METHODS: PA of children from 23 German daycare facilities (DFs; 13 intervention DFs, 10 control DFs) was measured via accelerometry at baseline and after 12 months. Children's sedentary time, light PA, and moderate to vigorous PA were estimated. Adherence was tracked with paper-and-pencil calendars. Mixed-model regression analyses were used to assess intervention effects. RESULTS: PA data were analyzed from 183 (4.2 [0.8] y, 48.1% boys) children. At follow-up, children in DF groups with more than 50% adherence to PA intervention components showed an increase of 9 minutes of moderate to vigorous PA per day (ß = 9.28; 95% confidence interval [CI], -0.16 to 18.72) and a 19-minute decrease in sedentary time (ß = -19.25; 95% CI, -43.66 to 5.16) compared with the control group, whereas children's PA of those who were exposed to no or less than 50% adherence remained unchanged (moderate to vigorous PA: ß = 0.34; 95% CI, -13.73 to 14.41; sedentary time: ß = 1.78; 95% CI, -26.54 to 30.09). Notable effects were found in children with migration background. CONCLUSIONS: Only small benefits in PA outcomes were observed after 1 year. A minimum of 50% adherence to the intervention seems to be crucial for facilitating intervention effects.

[Measuring physical fitness in the German National Cohort-methods, quality assurance, and first descriptive results]. / Messung der körperlichen Fitness in der NAKO Gesundheitsstudie ­ Methoden, Qualitätssicherung und erste deskriptive Ergebnisse.

Physical fitness is defined as an individual's ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality.The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort.In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO2max) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20-73 years, 47% men).Males showed higher values of physical fitness compared to women (males: GS = 47.8 kg, VO2max = 36.4 ml·min-1 · kg-1; females: GS = 29.9 kg, VO2max = 32.3 ml · min-1 · kg-1). GS declined from the age of 50 onwards, whereas VO2max levels decreased continuously between the age groups of 20-29 and ≥60 years. GS and VO2max showed a linear positive association after adjustment for body weight (males ß = 0.21; females ß = 0.35).These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality.

[Physical activity in the German National Cohort (NAKO): use of multiple assessment tools and initial results]. / Körperliche Aktivität in der NAKO Gesundheitsstudie: erste Ergebnisse des multimodalen Erhebungskonzepts.

BACKGROUND: Physical activity is a complex behavior that is difficult to measure validly and reliably in large, population-based studies. Data on physical activity are available for the initial 100,000 participants of the German National Cohort. OBJECTIVES: To describe the baseline physical activity assessment in the cohort and to present initial descriptive results. MATERIAL AND METHODS: Physical activity was assessed using a combination of tools, including two self-administered questionnaires, the Questionnaire on Annual Physical Activity Pattern (QUAP) and the Global Physical Activity Questionnaire (GPAQ); a computer-based 24­h physical activity recall (cpar24); and 7­day accelerometry (Actigraph GT3X/+; ActiGraph, Pensacola, FL, USA). RESULTS: The availability of data varied between assessment instruments (QUAP: n = 16,372; GPAQ: n = 90,900; cpar24: n = 23,989; accelerometry: n = 35,218). Analyses across measurement tools showed that on average, women spent 75 to 216 min/d, and men spent 73 to 224 min/d in moderate or higher intensity total physical activity. Persons aged 20-39 years spent 66 to 200 min/d, and persons aged 40-69 years spent 78 to 244 min/d in moderate or higher intensity total physical activity. CONCLUSIONS: Initial baseline analyses of physical activity in this cohort show the value of using a combination of questionnaires, 24­h recalls, and a movement sensor. The comprehensive data collection represents a valuable resource for future analyses and will improve our understanding of the association between physical activity and disease prevention.

[Lung function in the German National Cohort: methods and initial results]. / Lungenfunktion in der NAKO Gesundheitsstudie: Methoden und erste Ergebnisse.

BACKGROUND: A nationwide assessment of the respiratory status on the basis of standardized lung function measurements has so far not been available in Germany. The present work describes the lung function tests in the German National Cohort (GNC) and presents initial results based on the GNC Midterm Baseline Dataset. MATERIAL AND METHODS: The assessment of lung function in the GNC comprised spirometry (level 1) and the determination of exhaled nitric oxide (FeNO, level 2). Our quality assurance concept included regular training of lung function test procedures at various GNC sites, interim evaluations of test quality, as well as regular calibration/measurement checks of test equipment. For spirometry, we established a stepwise procedure for offline quality control based on raw flow volume curves. RESULTS: In the present dataset (n = 101,734), spirometry was available for 86,893 study participants and FeNO was available for 15,228 participants. The average (±SD) FEV1 Z score (according to GLI 2012) was -0.321 ± 1.047, the FVC Z score was -0.153 ± 0.941, and the FEV1/FVC Z score was -0.337 ± 0.901. The difference in FEV1/FVC between current smokers and never-smokers increased with age. The average FeNO was 14.2 ÷ 2.0 ppb. Current smoking reduced FeNO levels by 43%, whereas respiratory allergy increased FeNO levels by 16% in nonsmokers. DISCUSSION: The results of spirometry and the FeNO measurements are in the expected range with regard to their distributions and correlates. The GNC provides a valuable basis for future investigations of respiratory health and its determinants as well as research into the prevention of respiratory diseases in Germany.

[DEVASYS - Development of an Online Tool to Support Systematic Evaluation of Intervention Projects in Prevention and Health Promotion]. / DEVASYS ­ Entwicklung eines Online-Tools zur Unterstützung der systematischen Evaluation von Interventionsprojekten der Prävention und Gesundheitsförderung.

OBJECTIVES: To date, knowledge about the effects and implementation quality of disease prevention and health promotion projects in Germany is limited. Only a few structured evaluation systems exist that can be easily used and which include features for evaluating research and practice projects. The aim of the current project was to develop and carry out a pilot study of an online evaluation tool that enables structured self-evaluation of projects in disease prevention and health promotion practice and contributes to an improved documentation and cyclical development of projects. METHODS: The mixed-methods approach taken in this project included 2 steps: a) search of literature and database to develop a theoretical framework for the tool and b) adaptation process to test the fit of the tool for practice, including a focus group discussion and a usability test with different disease prevention and health promotion stakeholders (N=12). RESULTS: The resulting documentation and evaluation system (DEVASYS) is comprised of the components "planning", "documentation", and "evaluation" which can be used independently of one another. The conceptual basis of the tool is the RE-AIM framework. To determine the quality of an individual project, dimensions of both the output (reach, acceptance, implementation) and the outcome levels (effectiveness, maintenance) can be documented with the tool. CONCLUSION: DEVASYS is a practice-oriented tool contributing to an improved evaluation of existing practice-related intervention projects and the overall quality of future projects in the area of disease prevention and health promotion. Systematic dissemination and implementation of the tool are the next steps to be taken.