The role of physical activity promotion in typical exercise therapy concepts: a latent class analysis based on a national survey in German rehabilitation settings

[Physical Activity Promotion in Exercise Therapy in Medical Rehabilitation: Consequences of the Nationwide Survey for Quality Development]

AIM

This article aims to summarize the status quo of exercise therapy in medical rehabilitation with regard to the establishment of the biopsychosocial understanding of health with a special focus on physical activity promotion; based on this, consequences for the optimization of exercise therapy are derived.

METHODOLOGY

A three-step procedure was chosen, which builds on the elaboration of quality dimensions and quality-relevant areas of physical activity promotion in exercise therapy: 1.) the analysis of the current status quo of exercise therapy with regard to the quality-relevant characteristics. This is based on the current results from the project "Exercise therapy in medical rehabilitation: a national survey at facility and practitioner level" (BewegtheReha); 2.) the elaboration of optimization potential and 3.) the derivation of consequences for the systematic quality development of exercise therapy.

RESULTS

We analyzed the status quo of exercise therapy for the following areas: Assessment and information gathering, targets and impact areas, therapeutic contents, working methods and implementation, therapy control as well as allocation to exercise therapy (step 1). The results show that the physical activity promoting potential of exercise therapy within medical rehabilitation has not yet been optimally exploited. In particular, there is a need for more interdisciplinarity, more patient orientation, therapeutic work on the basis of theory- and evidence-based biopsychosocial therapy concepts with stronger manualization and standardization (step 2). Starting points for quality improvement can be found at the therapist level as well as at the program level and the system level. The derived recommendations for quality improvement of physical activity promotion in exercise therapy (step 3) refer to three levels: a) human resource development, e. g. with regard to improved use and quality of the education system, b) organizational development, e. g. promotion of interprofessional cooperation, and c) provision of resources, e. g. access to information.

CONCLUSION

The derived consequences form the basis for the systematic further development and optimization of physical activity in exercise therapy in the context of medical rehabilitation. Based on the results, next steps for improving quality of exercise therapy with a focus on the goal of physical activity promotion can be identified and initiated.

Long-Term Benefits of Adding a Pedometer to Pulmonary Rehabilitation for COPD: The Randomized Controlled STAR Trial

Purpose

This Stay Active after Rehabilitation (STAR) study examined the effects of a pedometer-based behavioral intervention for individuals with COPD during three weeks of inpatient pulmonary rehabilitation (PR) on patients' physical activity levels six weeks and six months after PR, including steps (primary outcome), moderate-intensity physical activity, and sedentary time as well as patient quality of life, symptoms, and other psychological and clinical variables.

Patients and Methods

Rehabilitation patients with COPD wore a triaxial accelerometer (ActiGraph wGT3X) for seven days two weeks before (T0) as well as six weeks (T3) and six months (T4) after PR. In addition to the three-week inpatient PR (control group, CG), the randomly allocated intervention group (IG) received a brief pedometer-based behavioral intervention with the application of the following behavior-change techniques: performing the behavior, individual goal-setting, self-monitoring, and feedback. The effects were analyzed using analysis of covariance with an intention-to-treat approach.

Results

A total of 327 patients (69% male, age: 58 years, FEV₁ (%): 53.5, six-minute walk distance: 447.8 m) were randomly allocated to either the IG (n = 167) or CG (n = 160). Although both groups increased their daily steps after PR (IG: M_T3-T0 = 1152, CG: M_T3-T0 = 745; IG: M_T4-T0 = 795, CG: M_T4-T0 = 300), the slightly higher increases in daily steps in the IG compared to the CG at T3 (Δ388 steps, d = 0.16) and T4 (Δ458 steps, d = 0.15) were not statistically significant (p > 0.05 for all). Patients in both groups showed moderate to high pre-post-changes in terms of secondary outcomes, but no advantage favoring the IG was found.

Conclusion

The results show that adding a pedometer-based behavioral intervention to standard German three-week inpatient PR for COPD patients did not result in more physical activity in terms of steps and moderate-intensity physical activity or less sedentary time. However, both groups (IG and CG) showed remarkably enhanced physical activity levels six weeks and six months after PR, as well as improvements in other secondary outcomes (eg, quality of life).

Bewegungstherapie und Bewegungsförderung in der Rehabilitation – Aufgaben und Ziele für Forschung und Entwicklung

Während bewegungstherapeutische Maßnahmen einen Großteil der Leistungen in der medizinischen Rehabilitation ausmachen, war die wissenschaftliche Auseinandersetzung mit Bewegungstherapie in der Rehabilitation lange Zeit vergleichsweise gering ausgeprägt. Dieses Missverhältnis war 2009 Anlass zur Gründung einer Arbeitsgruppe Bewegungstherapie in der Deutschen Gesellschaft für Rehabilitationswissenschaft (DGRW). Dadurch sollte eine differenzierte wissenschaftliche Auseinandersetzung gefördert und ein Beitrag zur Sicherung einer qualitativ hochwertigen Bewegungstherapie geleistet werden. Mehr als ein Jahrzehnt nach der Gründung ist die Evidenz für Gesundheitswirkungen körperlicher Aktivität weiter erheblich gewachsen. Es sind zahlreiche nationale und internationale Initiativen zur Stärkung der Bewegungsförderung entstanden. Vor diesem Hintergrund verfolgt dieser Beitrag 2 Zielsetzungen: Erstens soll ein Überblick über bisherige Aktivitäten und Arbeitsschwerpunkte der Arbeitsgruppe Bewegungstherapie gegeben werden, der sich (a) auf die Förderung der Rehabilitationsforschung mit Bewegungsbezug, (b) auf den Austausch zwischen Wissenschaft und Reha-Praxis sowie (c) auf die wissenschaftlich fundierte Qualitätsentwicklung in der Bewegungstherapie bezieht. Zweitens werden darauf aufbauend aktuelle und zukünftige Handlungsbedarfe und Fragestellungen für Forschung und Reha-Praxis aus Sicht der AG Bewegungstherapie formuliert.

Exercise Therapy Teamwork in German Rehabilitation Settings: Results of a National Survey Using Mixed Methods Design

A key prerequisite for implementing biopsychosocial exercise therapy concepts as parts of multimodal rehabilitation programs is interprofessional teamwork. Based on a nationwide survey of exercise therapy using a mixed methods design, it is of interest to determine to what extent there are links between team-related processes (e.g., interprofessional exchange) and structural features of the exercise therapy departments (e.g., department size) and the individual rating of interprofessional teamwork. The first part of the study involved a questionnaire-based survey, where exercise therapy heads of 1146 rehabilitation facilities were contacted. In the second part of the study, 58 exercise therapy heads held discussions in six focus groups. The results from both parts showed that interprofessional teamwork was rated positively overall. Team meetings were seen as the central platform for exchange. However, particularly in larger facilities, the hierarchical position of medical management and lacking resources were negatively associated with interprofessional exchange. The results affirm empirically that a more binding provision of adequate structural and organizational conditions, such as sufficient time slots for liaising on content, are essential for effective teamwork. This would facilitate and improve the promotion of physical activity in multimodal rehabilitation programs.

Physical activity promotion in daily exercise therapy: the perspectives of exercise therapists in German rehabilitation settings

Background

This study aims to explore exercise therapists' perspectives on the topic of physical activity promotion (PAP) with a focus on identifying (i) the intervention content and methodological approaches used for promoting physical activity (PA) in daily practice and (ii) the barriers and facilitators that affect PAP.

Methods

This qualitative study comprised the heads of exercise therapy departments (n = 58; 41% women; mean age = 45 years) from different rehabilitation clinics in Germany. Each participant took part in a semi-structured focus-group discussion on PAP in exercise therapy. The findings of the focus groups were processed and interpreted using a conventional qualitative content analysis.

Results

The exercise therapists demonstrated detailed didactic-methodological strategies and action orientations for PAP. The identified core topics of the content and methods of PAP were (1) conceptualization, (2) exercise and PA for enjoyment and pleasure, (3) education with practice-theory combinations, (4) media and materials for self-directed training, and (5) strategies to enhance personal responsibility and independence. The core topics for the associated barriers and facilitators were (1) structural conditions, (2) the role of exercise therapists, (3) the interdisciplinary rehabilitation team, (4) rehabilitant experiences and expectations, and (5) aftercare services.

Conclusion

The topic of PAP is addressed with a high level of variability; exercise therapists involved in this study identify various methods and content for the promotion of PA within their individual practices. However, they display a limited awareness of existing evidence- and theory-based concepts for the promotion of PA as well as underlying theories of behavioural change. This variability may be due to the lack of a defined common framework for promoting PA, insufficient emphasis being placed on PA promotion in the current curricula and training, or extensive conceptual differences within German exercise therapy departments (e.g. different weighting of PAP).