Physical literacy in Europe: The current state of implementation in research, practice, and policy

Background/objective

The holistic concept of physical literacy (PL) embraces different person-centered qualities (physical, cognitive, affective/psychological) necessary to lead physically active lifestyles. PL has recently gained increasing attention globally and Europe is no exception. However, scientific endeavors summarizing the current state of PL in Europe are lacking. Therefore, the goal of this study was to comprehensively assess and compare the implementation of PL in research, policy, and practice across the continent.

Methods

We assembled a panel of experts representing 25 European countries. Employing a complementary mixed-methods design, the experts first prepared reviews about the current state of PL in their countries (categories: research, practice/policy). The reviews underwent comparative document analysis, ensuring a transnational four-eyes principle. For re-validation purposes, the representatives completed a quantitative survey with questions reflecting the inductive themes from the document analysis.

Results

The document analysis resulted in ten disjunct themes (related to "concept", "research", "practice/policy", "future/prospect") and yielded a heterogenous PL situation in Europe. The implementation state was strongly linked to conceptual discussions (e.g., existence of competing approaches), linguistic issues (e.g., translations), and country-specific traditions. Despite growing scholarly attention, PL hesitantly permeates practice and policy in most countries. Nevertheless, the experts largely anticipate increasing popularity of PL for the future.

Conclusion

Despite the heterogeneous situation across Europe, the analysis has uncovered similarities among the countries, such as the presence of established yet not identical concepts. Research should intensify academic activities (conceptual-linguistic elaborations, empirical work) before PL may gain further access into practical and political spheres in the long term.

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.

Challenging German physical education teacher educators' health-related beliefs through Cooperative Planning

Physical education teacher educators’ health-related beliefs can impact public health. An interactive knowledge-to-action approach, such as Cooperative Planning, might challenge the health-related beliefs of physical education teacher educators, thus contributing to innovation in teacher education. We investigated what health-related beliefs physical education teacher educators had before a Cooperative Planning intervention, how these developed throughout the intervention and how teacher educators’ perceptions of Cooperative Planning can explain the identified changes and continuities. We established two Cooperative Planning groups that included physical education teacher educators (university lecturers and teacher trainers), researchers, study course coordinators and prospective teachers. The data of 13 teacher educators were collected before (t₀) and after (t₁) the Cooperative Planning using two methods: observations of teaching practice and interviews. The data analysis was based on the following categories: (i) epistemic beliefs about health (e.g. salutogenic understanding), (ii) beliefs about the health topic in physical education (e.g. health-related knowledge and understanding), (iii) beliefs about the health topic in physical education teacher education (e.g. health-related pedagogical content knowledge) and (iv) process-related beliefs about Cooperative Planning. The findings revealed that teacher educators’ health-related beliefs were rather stable but could be challenged through a Cooperative Planning intervention. Epistemic beliefs about health remained, whereas more practice-related beliefs about the health topic in physical education and physical education teacher education changed in individual ways. Here, a change in beliefs was more likely when the participants were open to change and when Cooperative Planning offered opportunities to engage in concrete lesson planning.

The health-related beliefs of physical education teacher educators are assumed to play an important role in fostering and implementing the public health agenda. In this article, we report on a Cooperative Planning intervention in which physical education teacher educators (university lecturers and teacher trainers), physical education teacher students, study course coordinators and researchers worked together to develop health-related courses for physical education teacher education. Specifically, we investigated what health-related beliefs teacher educators had before a Cooperative Planning intervention, how these developed throughout the intervention and how teacher educators’ opinions of Cooperative Planning can explain how their beliefs changed. Based on interviews and observations, we analysed teacher educators’ epistemic beliefs about health, that is, their general understanding of health, their beliefs about the health topic in physical education and physical education teacher education and their process-related beliefs about Cooperative Planning. The findings showed that teacher educators’ health-related beliefs were rather stable but could be challenged through Cooperative Planning. Epistemic beliefs about health remained, whereas more practice-related beliefs about the health topic in physical education and physical education teacher education changed in individual ways. A change in beliefs was more likely when the Cooperative Planning participants were open to change and when the Cooperative Planning offered opportunities to engage in concrete lesson planning.

Physical Literacy – to be discussed: eine Perspektive aus Sicht der deutschsprachigen Sportwissenschaft

Mit dem vorliegenden Beitrag möchten wir in der deutschsprachigen Sportwissenschaft zur Diskussion um das Konzept der Physical Literacy anregen. Im ersten Schritt soll dabei aufgezeigt werden, wie das Konzept der Physical Literacy aktuell sowohl international als auch im deutschsprachigen Raum rezipiert wird. Gerade mit Blick auf die deutschsprachige Sportwissenschaft möchten wir diesbezüglich einige Beobachtungen herausarbeiten. Es wird deutlich, dass Physical Literacy nur zögerlich in der Forschungslandschaft der deutschsprachigen Sportwissenschaft anzukommen scheint. Zudem ist erkennbar, dass gegenwärtige deutschsprachige Konzepte nachträglich über Physical Literacy begründet und erweitert werden. Die vorhandenen Entwürfe variieren dabei in ihrer inhaltlichen Schwerpunktsetzung. Darüber hinaus wird Physical Literacy in der deutschsprachigen Sportwissenschaft bislang kaum interdisziplinär diskutiert. Im zweiten Teil setzen wir an diesen Beobachtungen an und stellen Herausforderungen und Chancen zur Diskussion, warum sich die deutschsprachige Sportwissenschaft intensiver mit Physical Literacy beschäftigen sollte. In diesem Zusammenhang erkennen wir vier Herausforderungen. Dabei geht es darum, Physical Literacy begrifflich und konzeptionell zu deuten. Außerdem sollte die deutschsprachige Sportwissenschaft Physical Literacy interdisziplinär denken und entsprechend handeln. Die Auseinandersetzung mit Physical Literacy könnte zudem internationale Sichtbarkeit schaffen und bietet Impulse, Bewegungspraxis ganzheitlicher zu gestalten.

[Cooperative planning of measures to promote physical activity : New paths for expanding capabilities-results from the Capital4Health research consortium]

BACKGROUND

Despite various national and international political initiatives for promoting physical activity at the population level, the development of effective interventions for physical activity promotion remains a challenge. In this context, there is a growing interest in participatory approaches that actively involve central setting actors in the development of specific measures.

AIM OF THE ARTICLE

This article reports on the experience made by the Capital4Health research consortium while using a participatory approach called "cooperative planning" to increase capabilities for physical activity across different age groups.

RESULTS

Capital4Health employed the cooperative planning approach in the childcare, school, vocational training (car mechatronics and nursing), and community setting (with a focus on men 50+). While the central elements of the approach were implemented in all settings, planning processes varied significantly with respect to the spectrum of involved actors, the number of participants and sessions, the specific measures developed, the evaluation methods, and the effects achieved at an individual and systems level.

CONCLUSION

From the perspective of the Capital4Health principal investigators, the preliminary empirical results from the different settings allow for the overall conclusion that the cooperative planning approach can work and generate health promotion impact in very different settings. However, it must (and can) be adapted to the respective setting, especially in relation to involving population groups. Actors' readiness for change is crucial, as physical activity does not always have top priority in settings. In this context, key individuals can make a decisive contribution to a project's success.

Effects of a Participatory School-Based Intervention on Students' Health-Related Knowledge and Understanding

Introduction: The development of knowledge and understanding in relation to movement and health is a basic requirement to facilitate lifelong engagement in physical activity with its accompanying possible health benefits. To train teachers in applying adequate strategies, implementation studies have often shown little acceptance of traditional top-down approaches. Thus, the purpose of the Health.edu project was to develop, implement and evaluate effective and feasible measures addressing students' health-related knowledge and understanding (HKU) in physical education (PE) via a participatory approach.

Materials and Methods: For evaluation, a controlled pre-post-test study with 233 students from eight different secondary schools in Germany was carried out. Four schools (with two PE teachers at each school) comprised the intervention group and they participated in a 1-year participatory planning process to conceptualize and implement evidence-based PE lessons addressing students' HKU. Control schools carried out their regular PE lessons. Evaluation followed a mixed-methods research design, assessing program implementation via written documentary technique as well as program effectiveness using a standardized questionnaire.

Results: Results show a significant intervention effect on students' HKU with a medium effect size. However, due to the participatory process, there were considerable differences between the intervention schools that were involved. Student's HKU improved most in schools where program implementation corresponded to relevant principles of fostering HKU.

Discussion: The present study purposefully dispensed with any structured intervention programs for PE teachers to follow. The results show the potential effects of this participatory approach to strengthen student's HKU. However, the participatory planning does not always work in the intended manner, emphasizing that numerous contextual factors influence the implementation process.

Analysis of closure of the pancreatic remnant after distal pancreatic resection

BACKGROUND

The appropriate management of the pancreatic remnant following distal pancreatic resection remains a clinically relevant problem. We carried out a retrospective analysis which focused on this issue and compared the two favored techniques of suture and staple closure.

PATIENTS AND METHODS

Forty-six patients underwent distal pancreatectomy between October 1999 and January 2006. The patients were retrospectively analysed based on the management of the remaining pancreatic gland. Thirty-seven patients had suture and nine patients had staple closure. The morbidity, mortality, incidence of pancreatic fistula, necessity of secondary surgical intervention, and the duration of hospital stay for the two groups were compared. Pancreatic fistula was considered according to the novel international standard definition (ISGPF). In addition, subgroup analysis of patients receiving octreotide was carried out.

RESULTS

Overall, postoperative morbidity due to pancreatic fistula occurred in seven patients (19%) after suture and in one patient (11%) after staple closure (p = 0.54), with no deaths. The number of patients with surgical revision related to pancreatic leakage was two (5%) after suture closure vs no revision after staple closure (p = 0.65). The median number of total hospital days for the suture group was 19 (range 7-78 days) vs 21 (range 12-96 days) for the stapler group (p = 0.21). No significant benefit for the octreotide application could be determined.

CONCLUSION

According to the data, no significant difference for either suture or stapler closure was observed, with the tendency for staple closure to be superior.

Nematode infection of the liver mimicking metastasis of malignant melanoma

BACKGROUND

The differential diagnoses of a circumscribed mass of the liver are varied. Especially if a malignant tumor, capable of setting metastases to the liver, is known in a patient's medical history, there might be difficulties in differentiating the tumor's entity. CASUISTRY: We report a case of a 40-year-old male with a history of malignant melanoma in whom follow-up investigations revealed a mass in the liver.

RESULTS

The histopathological and microbiological results, however, showed an infestation of liver tissue with nematodes. Malignant tumor cells could not be detected.

CONCLUSIONS

Roundworm-infections of the liver can present as lesions suspicious of being malignant. Therefore, along with e.g. microhamartoma, microabscesses and hepatocellular carcinoma, infestation with nematodes should be taken into consideration.

[Thoughts on the problem of expert assessment of severe disability in very young children]

Opinions on the necessity of nursing severely disabled infants (section 53 SGB V) are very often difficult for experts of sickness insurances, because even healthy infants in their first years require a much assistance and must be permanently looked after. By evaluating 17 such cases an attempt is made to find aspects of retardation of development and possibly simultaneously existing mental handicaps and moreover factors to substantiate a considerably greater need for help compared to normal infants of the same age.