A transdiagnostic group exercise intervention for mental health outpatients in Germany (ImPuls): results of a pragmatic, multisite, block-randomised, phase 3 controlled trial

BACKGROUND

Globally, mental health conditions pose a substantial burden of disease. Despite the availability of evidence-based pharmacological and psychological treatments, the symptoms of a substantial subgroup of patients do not respond to these interventions, and only a minority of patients have access to them. This study aimed to assess the efficacy of ImPuls, a 6-month transdiagnostic group exercise intervention, plus treatment-as-usual, compared with treatment-as-usual alone in outpatients with various mental disorders.

METHODS

In this pragmatic, two-arm, multisite, randomised controlled trial in Germany, ten outpatient rehabilitative and medical care facilities were involved as study sites. Participants were outpatients diagnosed according to ICD-10 with one or more of the following disorders based on structured clinical interviews: moderate or severe depression, primary insomnia, post-traumatic stress disorder (PTSD), panic disorder, or agoraphobia. Participants were required to be aged between 18 years and 65 years, insured by the health insurers Allgemeine Ortskrankenkasse Baden-Württemberg or Techniker Krankenkasse, fluent in German, and without medical contraindications for exercise. Blocks of six participants were randomly allocated to ImPuls plus treatment-as-usual or treatment-as-usual alone (allocation ratio: 1:1), stratified by study site. The randomisation sequence was generated by an external data manager. The team responsible for data collection and management was masked to the randomisation sequence. The ImPuls intervention comprised evidence-based outdoor exercises lasting 30 min, and aimed at achieving at least moderate intensity. It also incorporated behavioural change techniques targeting motivational and volitional determinants of exercise behaviour. Treatment-as-usual was representative of typical outpatient health care in Germany, allowing patients access to any standard treatments. The primary outcome was global symptom severity at 6 months after randomisation, measured using self-report on the Brief Symptom Inventory (BSI-18) and analysed in the intention-to-treat sample. No individuals with lived experience of mental illness were involved in conducting the study or writing the final publication. Safety was assessed in all participants. The trial was registered with the German Clinical Trials Register (DRKS00024152) with a completion date of June 30, 2024.

FINDINGS

600 patients provided informed consent, were recruited to the study, and underwent a diagnostic interview between Jan 1, 2021, and May 31, 2022. Following this, 199 were excluded on the basis of inclusion and exclusion criteria and one withdrew consent during the baseline assessment. Of the 400 eligible participants, 284 (71%) self-identified as female, 106 (27%) self-identified as male, and nine (2%) self-identified as other. The mean age was 42·20 years (SD 13·23; range 19-65). Ethnicity data were not assessed. 287 (72%) participants met the criteria for moderate or severe depression, 81 (20%) for primary insomnia, 37 (9%) for agoraphobia, 46 (12%) for panic disorder, and 72 (18%) for PTSD. 199 participants were allocated to the intervention group of ImPuls plus treatment-as-usual and 201 to the control group of treatment-as-usual alone. 38 (19%) participants did not receive the minimum ImPuls intervention dose. ImPuls plus treatment-as-usual demonstrated superior efficacy to treatment-as-usual alone in reducing global symptom severity, with an adjusted difference on BSI-18 of 4·11 (95% CI 1·74-6·48; d=0·35 [95% CI 0·14-0·56]; p=0·0007) at 6 months. There were no significant differences in the total number of adverse events or serious adverse events between the two groups. There was one serious adverse event (male, torn ligament) related to the intervention.

INTERPRETATION

ImPuls is an efficacious transdiagnostic adjunctive treatment in outpatient mental health care. Our findings suggest that exercise therapy should be implemented in outpatient mental health care as an adjunctive transdiagnostic treatment for mental disorders such as depression, insomnia, panic disorder, agoraphobia, and PTSD. Transdiagnostic group exercise interventions might ameliorate the existing disparity in care provision between the many individuals in need of evidence-based treatment and the few who are receiving it.

FUNDING

The German Innovation Fund of the Federal Joint Committee of Germany.

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

OBJECTIVE

The objective of this study was to synthesize the evidence from systematic reviews on the efficacy of physical therapy and exercise therapy including interventional elements explicitly aiming at physical activity promotion (PAP) in patients with noncommunicable diseases (NCDs).

METHODS

PubMed, Scopus, PsycINFO, and Cochrane Database of Systematic Reviews were searched from inception to February 28, 2023. Two independent reviewers screened the literature to identify systematic reviews that evaluated the effect of physical therapy and exercise therapy including PAP interventions. Patient-reported and device-based measures of physical activity outcomes were included. Qualitative and quantitative data from systematic reviews were extracted by 2 independent reviewers. Assessment of the methodological quality of included systematic reviews was performed using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews). We assessed primary study overlap by calculating the corrected covered area and conducted the evidence synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Fourteen systematic reviews were included in the present overview, including patients with a variety of NCDs. Most included systematic reviews had critically low (n = 5) to low (n = 7) methodological quality. Most meta-analysis (67%; 8/12) provided evidence supporting the short- and long-term efficacy of PAP interventions but not all pooled estimates were clinically relevant. Only 3 of the systematic reviews with meta-analysis included an assessment of the certainty of evidence. The evidence from systematic reviews without meta-analysis was inconclusive.

CONCLUSIONS

The results of the present overview suggest that PAP interventions in physical therapy or exercise therapy may be effective to improve physical activity for patients with NCDs in the short term and long term. The results should be interpreted with caution due to the limited certainty of evidence and critically low to low methodological quality of included systematic reviews. Both high quality primary studies and systematic reviews are required to confirm these results.

IMPACT

There is limited evidence that PAP interventions in physical therapy and exercise therapy may be effective to improve physical activity for patients with NCDs.

Physical activity of older children and adolescents in Germany - Results of the HBSC study 2022 and trends since 2009/10

Background

Physical activity is central to health, beginning in childhood and adolescence, and regular monitoring provides important information for strategic decisions on promoting physical activity in Germany.

Methods

The current survey cycle of the Health Behaviour in School-aged Children (HBSC) study gives an insight into the prevalence of the indicators daily recommended physical activity, high and low physical activity, and sporting activity among students aged between 11 and 15 for 2022. In addition, the data is compared to the survey cycles of the 2009/10, 2013/14, and 2017/18 school years and analysed over time.

Results

The results of the current survey cycle show that 10.8 % of girls, 20.9 % of boys, and 12.4 % of gender diverse adolescents fulfil the daily physical activity recommendation. There are also major gender-specific differences for the other indicators. The group of gender diverse adolescents needs to be analysed further. The changes over time between 2009/10 and 2022 are relatively small. While girls' physical activity habits decreased slightly for the various indicators between 2009/10 and 2022, boys' prevalence remained relatively stable over the same period.

Conclusions

Overall, in part due to the effects of the various COVID-19 lockdowns, the need for effective and population-based measures to promote physical activity in childhood and adolescence remains high.

Trends in health inequalities in childhood and adolescence in Germany: Results of the HBSC study 2009/10 - 2022

Background

Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic.

Methods

Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods.

Results

In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found.

Conclusions

Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.

Concept and methodology of the Health Behaviour in School-aged Children (HBSC) study - Insights into the current 2022 survey and trends in Germany

Background

Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18.

Method

174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347).

Discussion

The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.

Health literacy of students in Germany - Results of the HBSC study 2022

Background

Health literacy (HL) encompasses knowledge and skills for dealing critically and confidently with health information in individual and social contexts. Current studies show that a high proportion of children and adolescents have limited health literacy, depending on aspects of their social background. Health literacy is considered an important factor influencing health. Little is known about the development of health literacy over time and its connection with psychosomatic complaints in young people.

Methods

Based on the results of the Health Behaviour in School-aged Children (HBSC) study, this article focusses on the level of HL in 11-, 13-, and 15-year-old students (N = 6,475) over time and taking social differences into account. Finally, the relationship between HL and psychosomatic complaints is analysed. Univariate, bivariate, and multivariate analyses were carried out for this purpose.

Results

At 24.4 %, slightly more students have low HL in 2022 than in 2017/18 (21.4 %). There are differences in HL according to gender, age, type of school, and family affluence. Low HL is associated with a high psychosomatic burden.

Conclusions

The results highlight the need for target group-specific measures to promote young people's HL, which address individual and organisational aspects of HL.

Physical activity improves stress load, recovery, and academic performance-related parameters among university students: a longitudinal study on daily level

BACKGROUND

Physical activity has been proven to be beneficial for physical and psychological health as well as for academic achievement. However, especially university students are insufficiently physically active because of difficulties in time management regarding study, work, and social demands. As they are at a crucial life stage, it is of interest how physical activity affects university students' stress load and recovery as well as their academic performance.

METHODS

Student´s behavior during home studying in times of COVID-19 was examined longitudinally on a daily basis during a ten-day study period (N = 57, aged M = 23.5 years, SD = 2.8, studying between the 1st to 13th semester (M = 5.8, SD = 4.1)). Two-level regression models were conducted to predict daily variations in stress load, recovery and perceived academic performance depending on leisure-time physical activity and short physical activity breaks during studying periods. Parameters of the individual home studying behavior were also taken into account as covariates.

RESULTS

While physical activity breaks only positively affect stress load (functional stress b = 0.032, p < 0.01) and perceived academic performance (b = 0.121, p < 0.001), leisure-time physical activity affects parameters of stress load (functional stress: b = 0.003, p < 0.001, dysfunctional stress: b = -0.002, p < 0.01), recovery experience (b = -0.003, p < 0.001) and perceived academic performance (b = 0.012, p < 0.001). Home study behavior regarding the number of breaks and longest stretch of time also shows associations with recovery experience and perceived academic performance.

CONCLUSIONS

Study results confirm the importance of different physical activities for university students` stress load, recovery experience and perceived academic performance in home studying periods. Universities should promote physical activity to keep their students healthy and capable of performing well in academic study: On the one hand, they can offer opportunities to be physically active in leisure time. On the other hand, they can support physical activity breaks during the learning process and in the immediate location of study.

A 10-step participatory program for developing, implementing, and evaluating physical activity promoting actions in nursing homes in Germany

BACKGROUND

Since multidimensional barriers challenge nursing homes, a socio-ecological approach is needed for physical activity promotion in this setting. So far, little is known about how such an approach can be transferred into the successful development and implementation of PA-promoting actions together with stakeholders on-site. We aimed to investigate the actions and dimensions of PA-promoting actions and their sustainable implementation. To contribute to closing this gap, we present a 10-step program for co-developing and co-evaluating PA-promoting actions in nursing homes through an integrated counselling approach.

METHODS

We used a multiple case study approach that built upon manifold data sources, collected in 7 nursing homes over 3 years between 2021 and 2023. We collected fieldnotes and photologs from 14 future workshops (2 per home); 7 evaluation workshops (1 per home); 36 individual counsellings (2 sessions per resident), as well as 87 implementation protocols (action type and frequency), 11 evaluation questionnaires (changes among resources, cooperations, and collaborations); 7 goal attainment scales and 18 individual activity schedules. In addition, we retrieved and documented progress information at regular intervals by phone or email.

RESULTS

With staff, residents, relatives, and volunteers, we co-developed 112 ideas for PA promotion; from which 54 ideas were implemented and integrated into everyday life, differentiated into "activities of daily living," "structured activities," and "activity-friendly environments."; 18 residents in 4 homes participated in individual counselling to develop individual activity schedules. Eighteen actions were rated as "(much) more successful than expected"; 10 "(much) worse than expected," and 23 "as successful as expected." Three actions were not evaluated.

DISCUSSION

The participatory integrated counselling approach led to home-specific actions and promoted implementation into everyday life. The number and dimensions of actions implemented largely depended on the mission and vision of the respective home. The lack of staff could partially be compensated for by involving neighbourhoods, volunteers, and community organisations, such as local clubs.

CONCLUSION

To effectively promote PA in nursing homes, a tailored approach considering structural conditions, locations, volunteer engagement, and organisational visions is essential. Long-lasting partnerships and low-threshold opportunities prove promising. Future research should delve into structural-level change processes and outcomes in this context.

Occupational health literacy and work ability: a moderation analysis including interpersonal and organizational factors in healthy organizations

Introduction

Healthy organizations approach to occupational safety and health should holistically include individual, interpersonal, and organizational levels. There is an empirical research gap in considering different levels in organizations for health promotion in the context of maximizing work ability. This study aims to investigate the association of (1) occupational health literacy (on an individual level), (2) health-oriented leadership (interpersonal level), (3) participation possibilities in health, and (4) values of health in companies (both organizational levels) on work ability. Additionally, we examined the potentially moderating role of health-oriented leadership, participation possibilities in health, and values of health between occupational health literacy and work ability.

Methods

Cross-sectional data were obtained from 828 employers and employees in small and medium-sized enterprises. Self-report measures included occupational health literacy, health-oriented leadership, work ability, participation possibilities in health at work, and values of health in the company. Occupational health literacy comprises two factors: a knowledge-/skill-based approach to occupational health and a willingness/responsibility for occupational health. Participation possibilities in health are measured regarding participatory opportunities and co-creation of health at work. Values of health in the company capture the importance of health in the workplace and the scope for improving employees' health. Data were analyzed using latent regression and latent moderation analyses controlling for age, gender, and educational level.

Results

Occupational health literacy (knowledge-/skill-based), health-oriented leadership, participation possibilities in health, and values of health in companies showed positive associations with work ability. Health-oriented leadership on an interpersonal level was found to moderate the positive relationship between (knowledge-/skill-based) occupational health literacy and work ability. Participation possibilities in health on an organizational level acted as a moderator on the relationship between both occupational health literacy factors and work ability.

Discussion

Individual, interpersonal, and organizational factors play important roles in maintaining work ability in healthy organizations. This study highlights the importance of promoting occupational health literacy among employees and leaders, creating a healthy workplace through health-oriented leadership, and providing participatory opportunities for co-creation in health promotion at work. Future research should further explore these factors' roles in different industries and contexts and how they may be addressed effectively in tailored workplace interventions.

Correlates of physical activity enjoyment in children and adolescents for a new perspective on the treatment of overweight: A systematic literature review

The purpose of this systematic literature review was to systematically compile the state of knowledge on correlates of physical activity enjoyment in children and adolescents to influence the perspective of future physical activity promotion approaches especially for children and adolescents affected by overweight or obesity. The electronic database search was executed in the five databases PubMed, PsychINFO, SPORTDiscus, Web of Science, and BISp-SURF, from inception to December 6, 2021. A semi-quantitative method was used for summarizing the resulted correlates. For final analysis, 85 studies comprising 48,144 children and adolescents were included. Fifty-seven variables could be coded for their relationship with physical activity enjoyment. Of these, 12 psychological variables, for example, the basic psychological needs, task orientation, or self-efficacy; six interpersonal variables, for example, peer/group acceptance, parental support, and autonomy support; and one behavioral variable, the higher self-reported physical activity, are consistent positively associated to physical activity enjoyment. A scientifically based overview could be extracted for the promotion of physical activity enjoyment in children and adolescents. There is a gap in literature focusing the perception of physical activity enjoyment in the subgroup of children and adolescents affected by overweight or obesity. Therefore, recommendations were made to enable the development of further innovative research approaches in this population.

[Sarcopenia, physical activity and sedentary behavior among nursing home residents in Germany]

BACKGROUND

Residents in nursing homes show a high prevalence of the musculoskeletal syndrome sarcopenia and tend not to achieve current physical activity recommendations.

OBJECTIVE

The aim of this study is to identify differences in physical activity and sedentary behavior of sarcopenic residents compared with nonsarcopenic and presarcopenic residents.

METHODS

Sarcopenia assessment was performed among 63 nursing home residents in Baden-Wuerttemberg (D) using the European Working Group on Sarcopenia in Older People 2 specifications. Structured activity sessions (per week), accelerometer-based physical activity (steps/day), and sedentary behavior (percentual/day) were examined. The group comparisons were determined with Kruskal-Wallis tests and Dunn-Bonferroni post hoc tests.

RESULTS

Significant differences were found for number of steps (p = 0.005) and percentual sedentary behavior (p = 0.019). Moreover, steps per day presented significant results in group comparison for no sarcopenia (2824.4 [423-14275]) with probable sarcopenia (1703.9 [118-5663]) and confirmed/severe sarcopenia (1571.2 [240-2392]) (both p = 0.022; |r| = 0.34). Sedentary behavior demonstrated significant differences in groups with no sarcopenia (87.9% [69.1-94.3]) and with probable sarcopenia (91.7% [80.4-9835]) (p = 0.018; |r| = 0.35).

CONCLUSION

Nonsarcopenic residents demonstrated a higher number of steps and lower sedentary behavior compared with presarcopenic and sarcopenic residents. Increasing steps, reducing sedentary behavior and promoting activities of daily living can contribute to the prevention and treatment of sarcopenia in the nursing home setting.

What Counteracts Problematic Social Media Use in Adolescence? A Cross-National Observational Study

PURPOSE

Social media use has increased rapidly during the past decade, raising concerns about adolescents who display problematic social media use (PSMU), as indicated by addiction-like symptoms (e.g., preoccupation, tolerance). We aimed to assess the extent to which an individual resource (health literacy), and social resources (friend support and family support), moderated the association between a range of individual characteristics (gender, age, family affluence, and depressive feelings) and PSMU; also the association between PSMU and health outcomes (self-rated health, life satisfaction, and sleep difficulties), both cross-nationally and nationally.

METHODS

Our sample included 22,226 adolescents from six European countries. We used data from the Health Behaviour in School-aged Children cross-sectional survey (2017/2018). Random-effects models and moderator analyses were applied.

RESULTS

Six moderations were found, with the resources moderating the association between individual characteristics and PSMU. One moderation emerged cross-nationally, namely that a higher level of family support was associated with a lower likelihood of PSMU, especially among adolescents who did not have frequent depressive feelings. In addition, five national moderations were identified. For example, a higher level of health literacy was associated with a lower likelihood of PSMU among Finnish girls. The resources were also found to moderate the association between PSMU and health outcomes, with two moderations emerging cross-nationally. For instance, a higher level of family support was related to higher self-rated health, especially among problematic users. In addition, nine national moderations were identified; these included a higher level of health literacy being associated with having less sleep difficulties, especially among problematic users in Germany.

DISCUSSION

In adolescence, health literacy, family support, and friend support have the potential to moderate the association between individual characteristics and PSMU, and between PSMU and health outcomes, cross-nationally and nationally. We recommend the use of universal and targeted interventions to promote individual and social resources to counteract PSMU.

The association of changes in leisure-time physical activity on depressive symptoms during Covid-19 in German adults: A longitudinal study

This longitudinal survey assessed preventive and curative antidepressant effects of at least 75 min/week of leisure-time physical activity (LTPA) at different timepoints of the Covid-19 pandemic. We further investigated if high self-regulation skills were associated with higher odds of initiating or maintaining LTPA during the pandemic. Data was collected online from 4253 participants (age: m = 33.65 years, SD = 0.79; 79 % female) during the first quarantine measures in Germany (T1), as well as 4 weeks (T2), and 8 months (T3) later. We performed linear mixed models with changes (T2-T1, T3-T1) in LTPA and baseline major depressive disorder (MDD) as predictors (main effects and interaction effect) and depressive symptoms (at T2, T3) as the primary outcome. We found significant interaction effects of baseline depression and change in LTPA on depressive symptoms at T2 and T3 (p < 0.001). For probable cases of MDD an increasing LTPA to ≥75 min/week (vs. no change, <75 min/week) was associated with less depressive symptoms at T2 and T3 (p = 0.003, d = 0.28). For absence of depression at baseline, remaining at ≥75 min/week of LTPA was associated with less depressive symptoms at T2 and T3 compared to remaining at <75 min/week (p = 0.006, d = 0.11) or decreasing LTPA to <75 min/week (p = 0.018, d = 0.11). Reporting high self-regulation at T1 was associated with higher odds of performing ≥75 min/week of LTPA at T2/T3 (OR = 1.74, p < 0.001). In general, studies report reduced LTPA during Covid-19. To benefit from the reported preventive and interventional effects, further interventions should focus on improving physical activity related self-regulation to identify and overcome barriers for LTPA.

Patterns of physical activity among nursing home residents before and during the Covid 19 pandemic-a systematic observation

BACKGROUND

The Covid-19 outbreak in spring of 2020 posed an array of challenges for nursing homes, including promoting resident physical activity (PA). Given the diversity of factors affecting resident PA, we explored how activity patterns outside weekly-scheduled structured activities changed during the pandemic and what factors promoted or inhibited PA during the pandemic.

METHODS

We conducted systematic direct observations over 823.5 h in eight nursing homes in Southern Germany in 2020 and 2021.

RESULTS

In 2020, 84.7% of person observation units were classified as sedentary (average activity level: 1.14 MET). In 2021, the percentage increased to 91.6% of observed person units (average activity level: 1.08 MET) (t = 6.947; p = .000). According to tree classification, influencing factors of PA included mealtime and daytime in 2020 and 2021, as well as presence of men residents only in 2020 and guided low threshold activities in 2021.

CONCLUSIONS

Nursing homes constitute highly sedentary places-an issue exacerbated by access restrictions for external activity experts and significant others as well as behavioural restrictions for residents during the Covid-19 pandemic. Staff could not compensate due to existing time restraints and lack of training in PA promotion. Based on our findings, we recommend future studies to develop feasible and resource-low activities to be integrated into the daily routines of nursing homes.

Occupational resource profiles for an addressee orientation in occupational health management: a segmentation analysis

Introduction

In order to make sustainable decisions in precision prevention and health promotion, it is important to adequately assess people's demands and resources at work. To reach them in an addressee-oriented way, a segmentation of employers and employees based on occupational resources is a promising option. We identified profiles based on personal and perceived organizational resources. Furthermore, we used job demands for profile descriptions to obtain a deeper understanding of the profiles, characterizing people with similar occupational resources.

Methods

Personal occupational resources (occupational health literacy and self-efficacy) and perceived organizational resources (job decision latitude and participation in health at work) were assessed among employers and employees (n = 828) in small- and medium-sized enterprises in Germany. Job demands, socioeconomic status, and hierarchy levels in the company were used for further profile descriptions.

Results

A six-profile solution fitted best to the data based on cluster and profile analyses. One profile was characterized by above-average occupational resources, and another profile was characterized by below-average resources. The other four profiles showed that the individual and perceived organizational resources contrasted. Either organizational resources such as job decision latitude existed and personal resources were not highly developed or people had high individual motivation but few possibilities to participate in health at work. People with medium or high job demands as well as people with low socioeconomic status were most frequently in below-average resource profiles. Employers with high hierarchy levels were overrepresented in the above-average profiles with high organizational resources.

Discussion

Following the segmentation of the addressees, organizations might be supported in identifying needs and areas for prevention and health promotion. Interventions can be optimally developed, tailored, and coordinated through a deeper understanding of job demands and resources. Especially employees with low socioeconomic status and high job demands might profit from an addressee-orientated approach based on resource profiles. For example, employees obtain an overview of their occupational resource profile to recognize the development potential for safe and healthy behavior at work. Follow-up research should be used to examine how this feedback to employers and employees is implemented and how it affects the sustainability of tailored interventions.

Contextualizing Flexible Nonlinear Periodization as a Person-Adaptive Behavioral Model for Exercise Maintenance

There is a growing focus on developing person-adaptive strategies to support sustained exercise behavior, necessitating conceptual models to guide future research and applications. This paper introduces Flexible nonlinear periodization (FNLP) - a proposed, but underdeveloped person-adaptive model originating in sport-specific conditioning - that, pending empirical refinement and evaluation, may be applied in health promotion and disease prevention settings. To initiate such efforts, the procedures of FNLP (i.e., acutely and dynamically matching exercise demand to individual assessments of mental and physical readiness) are integrated with contemporary health behavior evidence and theory to propose a modified FNLP model and to show hypothesized pathways by which FNLP may support exercise adherence (e.g., flexible goal setting, management of affective responses, and provision of autonomy/variety-support). Considerations for future research are also provided to guide iterative, evidence-based efforts for further development, acceptability, implementation, and evaluation.

"I just had the feeling that the interval training is more beneficial": young adults' subjective experiences of physical fitness and the role of training modes

Objective

Compelling evidence has shown that high-intensity interval training (HIIT) is associated with substantial increases in physical fitness. However, little is known about whether and how individuals experience these adaptations over time. The purpose of this study is, therefore, to explore how physically inactive young adults subjectively experience physical fitness and its development as they start to exercise and how these experiences relate to different intensity domains (i.e., moderate and severe) as well as to training modes [i.e., HIIT and moderate intensity continuous training (MICT)] and their sequential administration (i.e., HIIT-MICT and MICT-HIIT).

Methods

Thirty-one inactive participants completed a 15-week two-period sequential exercise intervention in which they first trained for six weeks in a HIIT or a MICT group and subsequently switched training modes. Interviews using the biographical mapping method were conducted at the end of the intervention to assess participants' exercise- and fitness-related experiences over the past weeks. To assess experiential patterns, we conducted a reflexive thematic analysis.

Results

We developed three themes that represent the temporal and processual character of starting to exercise after a prolonged period of inactivity: (1) Inactive young adults are not all the same when starting to exercise; (2) Developing physical fitness is a multi-faceted and individual experience; and (3) Feeling physically fit (or not) fosters large-scale effects.

Conclusion

Our results show that, in retrospect, participants mostly deemed HIIT to be more effective than MICT. Our findings also emphasize that physical fitness is a complex and subjective experience that manifests in various ways over time. The idiosyncrasy of physical fitness experiences reiterates the necessity for individually tailored exercise prescriptions instead of one-size-fits-all approaches.

Concept and study protocol of the process evaluation of a pragmatic randomized controlled trial to promote physical activity in outpatients with heterogeneous mental disorders-the ImPuls study

BACKGROUND

Evidence suggests that patients suffering from different mental disorders benefit from exercise programs combined with behavior change techniques. Based on this evidence, we have developed an exercise program (ImPuls) specifically designed to provide an additional treatment option in the outpatient mental health care system. The implementation of such complex programs into the outpatient context requires research that goes beyond the evaluation of effectiveness, and includes process evaluation. So far, process evaluation related to exercise interventions has rarely been conducted. As part of a current pragmatic randomized controlled trial evaluating ImPuls treatment effects, we are therefore carrying out comprehensive process evaluation according to the Medical Research Council (MRC) framework. The central aim of our process evaluation is to support the findings of the ongoing randomized controlled trial.

METHODS

The process evaluation follows a mixed-methods approach. We collect quantitative data via online-questionnaires from patients, exercise therapists, referring healthcare professionals and managers of outpatient rehabilitative and medical care facilities before, during, and after the intervention. In addition, documentation data as well as data from the ImPuls smartphone application are collected. Quantitative data is complemented by qualitative interviews with exercise therapists as well as a focus-group interview with managers. Treatment fidelity will be assessed through the rating of video-recorded sessions. Quantitative data analysis includes descriptive as well as mediation and moderation analyses. Qualitative data will be analyzed via qualitative content analysis.

DISCUSSION

The results of our process evaluation will complement the evaluation of effectiveness and cost-effectiveness and will, for example, provide important information about mechanisms of impact, structural prerequisites, or provider qualification that may support the decision-making process of health policy stakeholders. It might contribute to paving the way for exercise programs like ImPuls to be made successively available for patients with heterogeneous mental disorders in the German outpatient mental health care system.

TRIAL REGISTRATION

The parent clinical study was registered in the German Clinical Trials Register (ID: DRKS00024152, registered 05/02/2021, https://drks.de/search/en/trial/DRKS00024152 ).

Does Exercise Modality Matter Affectively? Contrasting Type and Sequence of Moderate-Intensity Continuous Training Versus High-Intensity Interval Training in a Randomized Within-Subject Study

Over the past two decades, affective determinants of exercise behavior have received increasing attention in research on health promotion and prevention. To date, however, little is known about changes in affective exercise determinants during multi-week training programs in insufficiently active individuals. This applies in particular to the currently discussed advantages and disadvantages of high-intensity interval training (HIIT) compared with moderate-intensity continuous training (MICT) with regard to the affective experience of these two training types (e.g., reduced monotony vs. more aversive response during HIIT), which is important for exercise adherence. Referring to the Affect and Health Behavior Framework (AHBF), this within-subject study investigated changes in affective exercise determinants as a function of training type and sequence consisting of MICT and HIIT. Forty insufficiently active healthy adults (M _age = 27 ± 6 years; 72% women) underwent two 6-week training periods in a randomized sequence (MICT - HIIT vs. HIIT - MICT) within 15 weeks. Pre-post questionnaires and in-situ measurements, during and after a standardized vigorous-intensity continuous exercise session (VICE), were used to assess affective attitude, intrinsic motivation, in-task affective valence, as well as post-exercise enjoyment. These four affect-related constructs were collected before, between, and after the two training periods. Mixed models revealed a significant effect for training sequence (p = 0.011) - but not for training type (p = 0.045; non-significant after Bonferroni alpha adjustment) - on changes in in-task affective valence in favor of the MICT - HIIT sequence. Moreover, no significant training type or sequence effects were found for the constructs of reflective processing: exercise enjoyment, affective attitude, and intrinsic motivation. Therefore, individual-based training recommendations should consider the effects of variety and training sequence to develop tailored interventions that lead to more positive affective experiences - in particular during exercise - and promote the maintenance of exercise behavior in previously inactive individuals.

Occupational Health Literacy Scale (OHLS): development and validation of a domain-specific measuring instrument

Occupational health literacy (OHL) is a domain-specific approach that can empower people to make health-appropriate decisions in the work environment. OHL comprises the knowledge, skills and willingness of people to access and process health-related information and to apply it in work situations. The aim of this study was to evolve a conceptual model and validate a scale for OHL, that can be used in many sectors in the Western industrial countries, which does not yet exist. After piloting, item selection and alteration were carried out in a pretest with n = 163 working adults in diverse small- and medium-sized enterprises in Germany. The resulting OHL items were validated in a main survey with n = 828 participants working in small- and medium-sized enterprises and among them 47.5% people with migration background. The final 12-item questionnaire had good structural characteristics and is reliable and valid for measuring OHL. Using exploratory structural equation modeling, good fit indices (root mean square error of approximation = 0.063, comparative fit index = 0.940) confirmed a two-factor structure: (i) knowledge and skill-based processing of health information (internal consistency α = 0.88) and (ii) willingness and responsibility for occupational health (α = 0.74). The OHL scale fills the gap regarding domain-specific OHL questionnaires for working adults in diverse sectors in Western industrial countries. The Occupational Health Literacy Scale can be used to identify the needs of employees and companies and then to adapt and evaluate health promotion measures. Further research could include validation and use in other countries and large companies.

Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills

BACKGROUND

Exercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects.

METHODS

Physically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling.

RESULTS

From T1 to T3, the intervention group significantly improved on global symptom severity (d = -0.43, p = .031), depression among a depressed subsample (d = -0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = -0.28, p = .037) and clinically significant changes (ß = -0.24, p = .042).

CONCLUSIONS

The exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.

Supporting families to achieve a healthy weight development for their child with overweight/obesity using the STARKIDS intervention: study protocol for a cluster-randomized controlled trial

Background

Childhood and adolescent overweight and obesity are among the most serious health challenges today. Structured weight reduction programs can be helpful to reduce severe health consequences but evidence is partly scarce. The STARKIDS program aims to improve on some of these limitations and is designed to be a structured, stepwise, digitally supported intervention program for the whole family. It is divided into two intervention steps spanning over 1.5 years and aims at promoting a healthy weight development of children/adolescents with overweight/obesity and an increase in quality of life.

Methods

The STARKIDS intervention is evaluated in a cluster-randomized study design by comparing it with a control group receiving a one-time structured counselling in the pediatric practice. The study aims to include 1000 families with children/adolescents with overweight/obesity from 100 pediatric practices. The main outcomes are reduction in body mass index percentiles and improvements in children’s/adolescent’s quality of life, secondary outcomes refer to the contents of the intervention such as diet, physical activity, stress, and media habits. All outcomes are measured on three measurement time points: (T0) at baseline/inclusion in the study, (T1) baseline + 12 months which is the end of step 1 of the STARKIDS intervention, and (T2) baseline + 18 months which is the end of step 2 of the STARKIDS intervention.

Discussion

The stepwise, e-health-supported STARKIDS program is a low-threshold intervention program for families with children/adolescents with overweight/obesity. With the proof of concept, STARKIDS provides the potential to be implemented as a standard care tool for the prevention and intervention of childhood/adolescence obesity in the German health system.

Trial registration

German Clinical Trials Register (DRKS) DRKS00022813 (acknowledged primary register of the World Health Organization). Registered on 27 November 2020 (Universal Trial Number U1111-1254-9536).

Nudging digital physical activity breaks for home studying of university students-A randomized controlled trial during the COVID-19 pandemic with daily activity measures

University students are of particular public health interest because they are at high risk for physical inactivity and sedentary behaviors. In conjunction with the COVID-19 pandemic, sedentariness and physical inactivity were reinforced, as the pandemic led to an increase in home studying. Physical activity (PA) breaks have been identified as promoting factors for university students' physical and mental health. Therefore, the present study explored an approach to nudge students to take PA breaks at home while studying. The purpose was to test the effectiveness of digital nudging for PA breaks for 10 days using a randomized intervention design during the COVID-19 pandemic. It included an intervention group who received daily digital motivational prompts for PA break videos and a minimal intervention control group who got low-level access to PA break videos via a one-time link sent to the media library. Using a sample of university students in the southwest of Germany (n = 57), two-level binary logistic regression models were calculated to predict daily participation in PA breaks during the intervention period depending on the nudging intervention, as well as previous participation in PA breaks, the general PA level of the subjects before the intervention, the time spent on PA and on home studying in a day, the kind of day during the intervention (weekday vs. weekend), and the students' age. Results revealed that the digital nudging intervention did not show any significant effect on the likelihood to participate in PA breaks on a given day (0.69 ≤ β ≤ 0.75, p > 0.3). Instead, an individual-level effect revealed that the longer a student studied at home over the course of a day, the more likely he or she was to take a PA break (1.07 ≤ β ≤ 1.11, p < 0.001). Current findings show that individual characteristics such as daily time spent on home studying, which can change over the course of the intervention phase, are relevant considerations within nudging intervention in university setting. This provides initial insights especially for digital PA breaks for students during home studying.

Digital health literacy and health behaviors of eighth and ninth graders from Germany

Background

Due to the high availability and use of digital media, health-related information is increasingly shifting into the digital space. While there are increasing empirical findings on general health literacy (HL), there is a lack of evidence on digital HL in adolescence and its association with health behavior.

Methods

A cross-sectional study of 490 secondary school students (grades eight and nine) from the federal state of Hesse was conducted from October 2019 to February 2020. Digital HL was assessed using five subscales of the Digital Health Literacy Instrument (DHLI), while consumption of fruits, vegetables, soft drinks, and weekly physical activity were used as indicators of health behavior. In addition to gender and grade level, subjective social status (SSS) was used as a social characteristic. Univariate, bivariate, and multivariate analyses were performed, with binary-logistic regression adjusted for gender and SSS.

Results

Across all items, the percentage of adolescents reporting difficulties in acquiring and dealing with digital health information ranges from 15.3 % to 37.5 %. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showing a limited digital HL. Adolescents with moderate and low digital HL report higher levels of low physical activity, non-daily fruit and daily soft drink consumption. Depending on the health behavior, different relationship patterns can be observed for the dimensions of digital HL.

Conclusions

The findings suggest a need for interventions to promote digital HL among adolescents, particularly for those of low SSS. In this context, the differential relationship patterns with health behaviors provide an avenue for the development of specific interventions.

Measuring Health Literacy in Childhood and Adolescence with the Scale Health Literacy in School-Aged Children – German Version

Abstract. Health literacy can help explain health inequalities in childhood and adolescence. However, suitable instruments for assessing health literacy in this age group are rare, especially in the German-speaking countries. One economical measure is the 10-item Health Literacy in School-Aged Children (HLSAC) scale, developed and reviewed as part of the WHO Child and Adolescent Health Study (HBSC, Health Behavior in School-Aged Children). In the present study, we tested dimensionality, measurement invariance, and associations with health-related measures of the German version of the scale (HLSAC–German), using data from the 2018 national German HBSC study ( N = 4,347 students aged 11, 13, and 15 years). We also tested HLSAC–German with 11-year-olds, representing an expansion of the original scale. Exploratory and confirmatory factor analyses consistently demonstrated the unidimensionality of the scale (α = .88). Complete scalar measurement invariance was found for sex and partial scalar measurement invariance for age groups and school type, allowing for the comparison of means. Associations with indicators of health and health behavior further demonstrate the construct validity of the scale. The analyses show that the scale is suitable for the economic measurement of a general factor of health literacy in 11- as well as in 13- and 15-year-olds.

Physical activity improves body image of sedentary adults. Exploring the roles of interoception and affective response

To reduce the number of sedentary people, an improved understanding of effects of exercise in this specific group is needed. The present project investigates the impact of regular aerobic exercise uptake on body image, and how this effect is associated with differences in interoceptive abilities and affective response to exercise. Participants were 29 sedentary adults who underwent a 12-week aerobic physical activity intervention comprised of 30–36 sessions. Body image was improved with large effect sizes. Correlations were observed between affective response to physical activity and body image improvement, but not with interoceptive abilities. Explorative mediation models suggest a neglectable role of a priori interoceptive abilities. Instead, body image improvement was achieved when positive valence was assigned to interoceptive cues experienced during exercise.

Acute effects of a motor coordination intervention on executive functions in kindergartners: a proof-of-concept randomized controlled trial

BACKGROUND

Executive functions are pivotal for future academic and social functioning. Causal effects of physical activity on executive functions have been shown in adults. The primary objective of this study was to test the proof-of-concept (i.e., feasibility of implementation and acceptance) of a motor coordination intervention and a sedentary control condition in kindergartners and its preliminary effectiveness on subsequent executive function performance.

METHODS

The study used a two-group post-test only design. All children aged between 4 and 7 years old were eligible. One hundred and three children (46% girls; age: M = 5.71 years, 95% CI = 5.50 to 5.92) recruited in a middle-sized town in Germany were randomly assigned to a 20-min motor coordination intervention (n = 51) or a sedentary control condition (n = 52), both of which were conducted in a one-on-one experimenter-child setting in the university or kindergarten. A second blinded-to-condition experimenter assessed the executive function outcomes directly following the conditions. Proof-of-concept criteria were the implementation of the intervention with a moderate-to-vigorous physical activity level assessed via heart rate sensors, and with motor coordination demands, analyzed via video recordings; children's acceptance via self-reported enjoyment of the conditions; and the post-assessments of executive functions with a behavioral and computerized task.

RESULTS

The motor coordination intervention and the control condition were feasible in a one-on-one setting with kindergartners. The intervention revealed heart rate increases and challenging motor coordination tasks. Children in both conditions indicated they enjoy them. Performance in the two executive function tasks did not differ between children in the motor coordination intervention and the control condition.

CONCLUSIONS

A one-on-one experimenter-child setting was feasible to deliver in kindergartners. Future intervention studies should consider pre-testing of executive functions and take into account children's characteristics as potential moderators, such as motor coordination skills.

Proof of Concept of a 6-Month Person-Oriented Exercise Intervention 'MultiPill-Exercise' among Patients at Risk of or with Multiple Chronic Diseases: Results of a One-Group Pilot Trial

Physical exercise has been shown to be effective in the treatment of non-communicable chronic diseases. However, patients with multiple chronic diseases (multimorbidity) have received little attention in health policy. This pilot trial served as a proof of concept of a 6-months person-oriented exercise intervention for people at risk of or with diagnosed cardiovascular diseases, diabetes mellitus type 2, overweight and/or hip/knee osteoarthritis, regarding effects on health outcomes as well as adherence and safety. The intervention (‘MultiPill-Exercise’) was designed to promote physical exercise participation, considering an individual perspective by addressing personal and environmental factors. Outcomes were assessed at baseline (t0) and after three- (t3) and six-months (t6). The primary outcome was self-reported physical exercise participation in minutes/week comparing t3 and t6 vs. t0. Secondary outcomes included cardio-respiratory fitness (maximum oxygen uptake VO2peak during incremental cycling ergometry), isometric peak torque of knee extensors and flexors, health-related quality of life (Veterans Rand 12 with its subscales of perceived general health (GH), mental health (MCS), and physical health (PCS)) and blood levels. Adherence to exercise (% of attended sessions during the first 12-weeks of the intervention) and adverse events were monitored as well. Data were analyzed using a non-parametric procedure for longitudinal data, estimating rank means (MRank) and relative treatment effects (RTE) as well as linear-mixed effect models for parametric data. The primary endpoint of physical exercise participation was significantly higher at t3 and t6 compared to baseline (t3 vs. t0: MRank = 77.1, p < 0.001, RTE: 0.66; t6 vs. t0: MRank = 70.6, p < 0.001, RTE = 0.60). Improvements at both follow-up time points compared to t0 were also found for relative VO2peak (t3 vs. t0 = 2.6 mL/kg/min, p < 0.001; t6 vs. t0 = 2.0 mL/kg/min, p = 0.001), strength of knee extensors (t3 vs. t0 = 11.7 Nm, p = 0.007; t6 vs. t0= 18.1 Nm, p < 0.001) and GH (t3 vs. t0 = 16.2, p = 0.003; t6 vs. t0 = 13.4, p = 0.008). No changes were found for MCS, PCS and for blood levels. Overall exercise adherence was 77%. No serious adverse events were recorded. Results of this pilot trial represent a first proof of concept for the intervention ‘MultiPill-Exercise’ that will now be implemented and evaluated in a real-world health care setting.

Implementation and evaluation of an individualized physical exercise promotion program in people with manifested risk factors for multimorbidity (MultiPill-Exercise): a study protocol for a pragmatic randomized controlled trial

BACKGROUND

Multimorbidity is a major problem in Europe, increasing the need for prevention and rehabilitation programs. In Germany no guidelines have been developed that focus on patients with multiple chronic non-communicable diseases (NCDs). Benefits of physical activity (PA) and exercise in NCDs have been proven, but most interventions focus on single conditions. The evaluation of the effectiveness, efficiency and safety of PA programs in patients suffering from multiple NCDs and the feasibility of the implementation within the health care service remain open research questions.

METHODS

The multi-site randomized controlled pragmatic trial includes 320 sedentary subjects with at least two of the following NCDs, either manifested or in a pre-stage with evident risk factors: Cardio-vascular disease, Diabetes mellitus type 2, knee/ hip osteoarthritis and obesity. Participants will be recruited from general practitioners and medical specialists and randomized to standard care of a statutory health insurance or MultiPill-Exercise. Standard care includes a choice of one or a maximum of two 8- to 12-week health programs, including nutrition, exercise, relaxation or special disease management programs. MultiPill-Exercise is based on the bio-psycho-social health model, considering a person-oriented perspective in light of given individual characteristics and context factors. The 24-weeks intervention focuses on aerobic and strengthening exercises in line with the WHO PA recommendations. Psychological and pedagogical elements along with behavior change techniques are implemented to ease the initiation and maintenance of exercise participation and lifestyle change, including nutrition. Primary outcome will be short- and long-term PA measured with the European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ). Secondly, the effectiveness of the program on generic, disease specific, economic, and exercise behavioral parameters, as well as program adherence and safety will be evaluated.

DISCUSSION

Results of this trial evaluate the PA intervention program in people with multiple NCDs in a real-life scenario. It will serve as a proof of concept with the opportunity of translation into routine practice. This approach, as a multi-site RCT with its rigorous methods and standardized operating procedures for the conduction of the intervention, will allow valid conclusions for the implementation of PA interventions in people with multimorbidity.

TRIAL REGISTRATION

The trial was registered at www.drks.de (ID: DRKS00025033 ) on 30th September 2021.

[Digital health literacy of pupils. Level and associations with physical activity and dietary behavior]

Hintergrund

Während vermehrt Studienbefunde zur allgemeinen Gesundheitskompetenz (GK) vorliegen, mangelt es an Erkenntnissen zur digitalen GK im Jugendalter und deren Assoziationen mit Indikatoren des Gesundheitsverhaltens.

Methodik

Empirische Basis bildet eine von Oktober 2019 bis Februar 2020 im Bundesland Hessen durchgeführte Querschnittstudie mit 490 Schülerinnen und Schülern der Klassenstufe 8 und 9. Die digitale GK wurde mithilfe von 5 Subskalen des Digital Health Literacy Instrument (DHLI) erfasst, während der Verzehr von Obst, Gemüse und Softdrinks sowie die körperliche Aktivität als Indikatoren des Gesundheitsverhaltens herangezogen wurden. Als soziales Merkmal wurde neben dem Geschlecht und der Klassenstufe der subjektive Sozialstatus (SSS) berücksichtigt. Die Datenauswertung erfolgte uni-, bi- und multivariat, wobei binärlogistische Regressionen für das Geschlecht und den SSS adjustiert wurden.

Ergebnisse

Über alle Items hinweg berichten 15,3–37,5 % der befragten Jugendlichen Schwierigkeiten bei der Beschaffung von und im Umgang mit digitalen Informationen. Differenziert nach sozialen Merkmalen finden sich für 2 Dimensionen der digitalen GK Unterschiede zuungunsten der Mädchen sowie durchgehend ein sozialer Gradient zuungunsten von Befragten mit niedrigem SSS. Jugendliche mit mittlerer und geringer digitaler GK weisen ein höheres Maß an geringer körperlicher Aktivität, nichttäglichem Obstverzehr und täglichem Konsum von zuckerhaltigen Getränken auf.

Diskussion

Die Befunde weisen auf einen Interventionsbedarf zur Förderung der digitalen GK insbesondere bei Jugendlichen mit geringem SSS hin. Die differenziellen Zusammenhangsmuster mit dem Gesundheitsverhalten bieten Ansatzpunkte für die Entwicklung spezifischer Interventionen. Als Lehr- und Lernort stellt die Schule u. a. aufgrund der Passung mit verpflichtenden Strategien der schulischen Medienkompetenzbildung ein geeignetes Setting dar.

The effect of exercise and affect regulation skills on mental health during the COVID-19 pandemic: A cross-sectional survey

BACKGROUND

COVID-19-related confinements pose a threat to mental health. We investigated prevalence rates of symptoms of depression, generalized anxiety and insomnia in German adults. Furthermore, we explored associations of exercise behavior with disorder-specific symptoms and assessed whether specific affect regulation skills enhance the effect of exercise on symptom alleviation.

METHODS

Cross-sectional survey-based data collected during the first lockdown is presented: 4268 adults completed questionnaires on mental health, exercise behavior and Covid-related lifestyle factors. Primary outcome was depression (PHQ-9), secondary outcomes generalized anxiety (PHQ-D) and sleep quality (PSQI). Multiple linear regression analyses were performed to examine the association of exercise behavior with the outcomes.

RESULTS

Analyses resulted in elevated symptoms of psychological distress (probable cases of depressive disorder: 31.2%, anxiety disorder: 7.5%, sleeping disorder: 43.0%). A change towards less exercise during the lockdown was significantly associated with higher levels of depression (t=5.269; β=0.077, p<.001), anxiety (t=3.397; β=0.055, p<.001) and insomnia (t=3.466; β=0.058; p<.001). Physical activity (PA)-related affect regulation enhanced the effect of exercise on mental health.

CONCLUSION

Results suggest a demand for measures which promote the maintenance of exercise during a pandemic and improve PA-related affect regulation to optimize effects of exercise on mental health.

The Relation of Attitude Toward Technology and Mastery Experience After an App-Guided Physical Exercise Intervention: Randomized Crossover Trial

Background

Physical exercise has been found to assert a positive impact on many muscular conditions. Exercise under face-to-face supervision is the gold standard, but access to it is limited, for instance, for economic reasons. App-guided therapy is an intervention that is more affordable and easily accessible. However, attitude toward technology is a key predictor for media adoption and is therefore expected to shape user experience during app-guided therapy. This might be of particular importance for mastery experience, which is crucial for promoting exercise-related self-efficacy and perceived usefulness of the interaction. Both should empower patients to continuously exercise.

Objective

This study sought to test whether attitudes toward technology predict mastery experience and perceived usefulness of the interaction after an app- versus a physiotherapist-guided treatment. We expect that attitudes toward technology positively predict both outcomes in case of the app-guided but not in case of the physiotherapist-guided treatment.

Methods

Patients (n=54) with clinically diagnosed hip osteoarthritis participated in 2 training sessions with the same exercise intervention, once guided by an app on a tablet computer and once guided by a physiotherapist in a German university hospital. The order of the sessions was randomized. Attitude toward technology was assessed as predictor before the first session, while mastery experience and the global perceived usefulness of interaction as self-reported outcomes after each session.

Results

In line with our hypotheses, attitude toward technology predicted mastery experience (b=0.16, standard error=0.07, P=.02) and usefulness of interaction (b=0.17, standard error=0.06, P=.01) after the app-based training but not after the training delivered by a physiotherapist (P>.3 in all cases). Mastery experience was lower for the app-based training but reached a very similar level as the physiotherapist-guided training for those holding a very positive attitude toward technology.

Conclusions

The attitude toward technology predicts the extent of mastery experience after app-guided exercise therapy. As mastery experience is highly important for self-efficacy and future exercise behavior, attitudes toward technology should be considered when delivering app-guided exercise treatments.

Trial Registration

German Clinical Trials Register DRKS00015759; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015759

[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.

Efficacy and cost-effectiveness of a Transdiagnostic group-based exercise intervention: study protocol for a pragmatic multi-site randomized controlled trial

BACKGROUND

Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD).

METHODS

This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention "ImPuls", among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block-randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios.

DISCUSSION

Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Register (ID: DRKS00024152 , 05/02/2021).

Identification of Sarcopenic Obesity in German Nursing Home Residents-The Role of Body Composition and Malnutrition in the BaSAlt Cohort-Study

Background: Sarcopenic obesity (SO) is a phenotype, which is defined by reduced muscle strength, muscle mass, and obesity. Limited mobility leads to increased sedentary behavior and decreased physical activity. Both sarcopenia and obesity are aggravated by these factors. In combination, SO is an additional challenge for the setting nursing home (NH). Previous studies have shown a low prevalence of residents with SO in comparable settings, such as community-dwelling. We hypothesize that the BaSAlt cohort also has a small proportion of residents with SO. Methods: For the analysis, 66 residents (women: 74.2%) aged ≥ 65 years from NH, were screened for SO based on EWGSOP2 specifications and cut-off values to classify obesity. Results: Severe sarcopenia was quantified in eleven residents (16.7%). The majority of sarcopenic residents were women (n = 10) compared to men (n = 1). However, no SO could be identified by assessment of body mass index, fat mass in percentage, and fat mass index. Conclusion: As expected, the setting-specific cohort showed a low number of SO. Furthermore, no case of SO was identified in our study. Sarcopenia was associated with an increased fat-free mass in NH residents. Nevertheless, sarcopenia and obesity play important roles in the preservation of residents’ health.

The Natural Environment of Physical Activity and Perceived Stress: The Mediating Role of Specific Recovery Experiences

Objective: The purpose of this study was to investigate a potential psychological mechanism of green exercise on perceived stress. More precisely, it was analyzed whether the relationship between the natural environment of physical activity and perceived stress was mediated by recovery experiences, namely by psychological detachment and relaxation. An ecological momentary assessment approach was used, meaning that specific recovery experiences were assessed directly in real-life situations and multiple times.

Materials and methods: Thirty five women and 27 men took part in the ecological momentary assessment study over seven days (M_age = 32.30 years, SD = 10.23, 53% had a degree from a university or a university of applied science). If participants were involved in PA lasting at least 10 min on a given day, they had to answer questionnaires on the smartphone both prior to the activity and immediately afterwards. Perceived naturalness, psychological detachment and relaxation were assessed after physical activity events, whereas perceived stress was measured before and after each physical activity event. A two-level mediation analysis was conducted. The direct and indirect effect of perceived naturalness on perceived stress after engagement in physical activity was analyzed on the within- and between-person levels.

Results and conclusion: Results showed that the relaxation as a recovery experience served as mediator between perceived naturalness and perceived stress after engagement in physical activity, but only on a within-person level. This means that the more natural a given individual appraised the physical activity environment, the more relaxed he or she felt during physical activity (β = 0.322, p < 0.0005). Furthermore the more relaxed the individual was, the less stress he or she perceived after exercising (β = −0.221, p < 0.0005). The psychological detachment as a recovery experience in contrast, did not serve as mediator, neither at the within- and the between-person level. Considering the indirect effect of perceived naturalness on perceived stress and the importance of relaxation experiences, current findings suggest that research should put greater emphasis on examining the specific psychological mechanisms of green exercise to make even better use of its beneficial effects in the future.

Different Endurance Exercise Modalities, Different Affective Response: A Within-Subject Study

Affect experienced during an exercise session is supposed to predict future exercise behavior. However, empirical evidence reveals high variability in affective response to different exercise modalities. Thus, the purpose of the present study was to compare acute affective response and its variation during three different endurance exercise modalities: (a) moderate-intensity continuous exercise (MICE), (b) vigorous-intensity continuous exercise (VICE), and (c) high-intensity interval exercise (HIIE). Using the dual-mode theory as a theoretical framework, cognitive and interoceptive factors were considered as potential predictors of in-task affective response. In a within-subject design, 40 insufficiently active healthy participants (aged from 20 to 40 years) attended three sessions per exercise modality on a cycle ergometer. Affective valence (measured by the Feeling Scale), two cognitive factors (perceived competence and awareness of interoceptive cues), and one interoceptive factor (heart rate) were assessed before, during, and after each exercise session. Mixed models with three levels (subject, exercise session, and time point) revealed more positive affective valence during MICE compared with VICE (p < 0.001) and HIIE (p < 0.01), while there was no significant difference between the latter two. Levene's test results showed the highest variability of in-task affective valence during VICE (ps < 0.01). Regarding the course across the session, MICE was associated with a constant slight increase in affective valence from pre- to post-exercise (p < 0.05), whereas VICE and HIIE caused a decline in pleasure, followed by an affective rebound immediately after exercise termination (ps < 0.01). The highest importance of cognitive and interoceptive factors for in-task affective valence was observed in VICE (ps < 0.05). The current findings provide support for the tenets of the dual-mode theory, however, indicating that there may be differences in the affect-intensity relationship between continuous and interval exercise. In conclusion, the study results concerning previously insufficiently active individuals extend the knowledge of how exercise can positively shape affective well-being depending on exercise modality and psychophysiological influences. This knowledge enables public health practitioners to design more individualized activity recommendations, thereby improving the subjective experience of exercise.

Competencies for a Healthy Physically Active Lifestyle-Validation of an Integrative Model

Purpose: The model of physical activity-related health competence (PAHCO) provides an integrative and interdisciplinary view on competencies that are necessary when people want to lead a healthy, physically active lifestyle. Given the need to accumulate potential further evidence on the validity of this model through the development of an assessment tool, the goal of the present study was to extend first measurement models on PAHCO. Method: In Study 1, a measurement model with five predictors on PAHCO was tested with 341 COPD patients undergoing inpatient rehabilitation. In Study 2, data from 745 apprentices were used to create an extended eight-factor measurement model. We undertook reliability analysis, confirmatory factor analysis (CFA), and structural equation modeling (SEM) to assess the validity of the models. Results: The analyses showed good results for the reliability and discriminant validity of the factors. Accordingly, the CFA demonstrated satisfactory overall fits for the five-factor as well as for the extended eight-factor measurement model. The associations with physical activity and physical health parameters indicated criterion validity for seven of the eight PAHCO factors. The explained variance of the multivariate models lay between 9.8% and 10.4% in Study 1 and between 9.5% and 21.3% in Study 2. Conclusion: In the present study, it was possible to extract a well-fitting, eight-factor measurement model and accumulate further evidence on the validity of the PAHCO model. Future research should strive for a cross-validation of the measurement model and more deeply investigate the internal structure of the eight factors.

BaSAlt - A mixed-methods study protocol on setting-based physical activity promotion and counseling in nursing homes

Introduction

Physical activity (PA) is a major contributor to healthy aging. However, physical inactivity is prevalent among the elderly in Germany, particularly in institutionalized settings such as nursing homes. This paper aims to describe the study objectives, design, methods, assessment types, collection schedules and considerations for analyzing the data within the BaSAlt study on facilitators and barriers for PA promotion in nursing homes.

Methods

We designed the BaSAlt study as a participatory intervention study with multiple measurement points in six to eight nursing homes with a total of approx. 200 residents using four main modules: (1) setting-level analysis of physical activity patterns, physical activity-related climate and physical activity-related interaction with ‘significant others,’ and organizational facilitators and barriers to physical activity, (2) physical-activity related individual-level analysis of objective and self-reported physical activity and sedentary behavior, a geriatric assessment with established procedures, assessment of people's activity and health biographies (biographical mapping) as well as their motivational, subjective well-being and distress status, and (3) a counseling module that integrates counseling at the setting level as well as individual physical activity counseling for residents. In module (4) evaluation, the effects of integrated counseling with regard to the implementation of PA promotion strategies are analyzed.

Discussion

This study will extend our knowledge of physical activity promotion in German nursing homes. Its findings will inform governmental authorities, care professionals, and academics on how to reach a particular group, characterized by inactivity, multimorbidity, and a high prevalence of dementia, residing in nursing homes, a setting that will gain further relevance in the future.

Health-related fitness knowledge in adolescence: evaluation of a new test considering different psychometric approaches (CTT and IRT)

Fostering health-related fitness knowledge is a common goal across physical education curricula. However, carefully developed knowledge tests that satisfy the psychometric criteria of educational assessment are lacking. Therefore, two studies were conducted to evaluate a newly developed health-related fitness knowledge test within the framework of classical test and item response theory regarding item quality, test reliability, construct validity, and dimensionality. Overall, 794 ninth graders (Mage = 14.3 years, 50.6% girls) took part in Study 1. They differed in the type of physical education classes (minor or major subject) and school (lower or higher educational level) they attended. Study 2 incorporated 834 ninth graders at the same educational level (Mage = 14.2 years, 52.5% girls). Item–test correlation, test reliability, and validity were examined. In addition, item and test quality were investigated using unidimensional two-parameter logistic item response models. In Study 1, pupils at the same educational level with physical education as a major achieved higher knowledge scores than pupils with physical education as a minor (t = −5.99, p < 0.001; d = 0.58), which confirmed the test’s construct validity. In Study 2, the weighted likelihood estimate reliability of the final 27 items was 0.65, and the test–retest reliability reached rtt = 0.70. The items satisfied the assumption of local independence. The final test fulfilled the psychometric criteria of reliability and construct validity to assess health-related fitness knowledge in cross-sectional and interventional studies. This test extends the possibilities of research on health-related fitness knowledge in physical education.

Feasibility of a Geriatric Assessment to Detect and Quantify Sarcopenia and Physical Functioning in German Nursing Home Residents-A Pilot Study

Background: Entering into a nursing home leads to increased immobility and further reductions in physical and cognitive functioning. As a result, there is a risk of sarcopenia, which is characterized by loss of muscle strength, muscle mass and physical functioning. To our knowledge, the feasibility of sarcopenia screening has not yet been performed in the German nursing home setting. Methods: For sarcopenia screening, the specifications of EWGSOP2 were applied. The quantification of sarcopenia was performed according to the corresponding cut-off values. The collection of anthropometric data and the morbidity status were recorded. SARC-F, mini-mental state examination, Barthel Index, Short Physical Performance Battery and Timed Up and Go tests were implemented. Results: In one participant, severe sarcopenia could be identified. The quantification was not possible for four participants. A suspicion of sarcopenia was not confirmed in five participants. Only one person was able to perform all assessments. Conclusions: Sarcopenia screening according to EWGSOP2 presented satisfactory feasibility by nursing home residents. However, further tests to assess the physical functioning of the participants often could not be performed. Moreover, inconsistencies in individual assessments became apparent, leading to inconclusive analyses. The recording of sarcopenia prevalence in German nursing homes should be the goal of further research.

Transdiagnostic efficacy of a group exercise intervention for outpatients with heterogenous psychiatric disorders: a randomized controlled trial

BACKGROUND

Exercise efficaciously reduces disorder-specific symptoms of psychiatric disorders. The current study aimed to examine the efficacy of a group exercise intervention on global symptom severity and disorder-specific symptoms among a mixed outpatient sample.

METHODS

Groups of inactive outpatients, waiting for psychotherapy, with depressive disorders, anxiety disorders, insomnia, and attention-deficit/hyperactivity disorders were randomized to a manualized 12-week exercise intervention, combining moderate to vigorous aerobic exercise with techniques for sustainable exercise behaviour change (n = 38, female = 71.1% (n = 27), M_age = 36.66), or a passive control group (n = 36, female = 75.0% (n = 27), M_age = 34.33). Primary outcomes were global symptom severity and disorder-specific symptoms, measured with the Symptom Checklist-90-Revised and Pittsburgh Sleep Quality Index pre- and post-treatment. Secondary outcome was the self-reported amount of exercise (Physical Activity, Exercise, and Sport Questionnaire), measured pre-treatment, intermediate-, and post-treatment. Intention-to-treat analyses were conducted using linear mixed models. Linear regressions were conducted to examine the effect of the change of exercise behaviour on the change of symptoms.

RESULTS

The intervention significantly improved global symptom severity (d = 0.77, p = .007), depression (d = 0.68, p = .015), anxiety (d = 0.87, p = .002), sleep quality (d = 0.88, p = .001), and increased the amount of exercise (d = 0.82, p < .001), compared to the control group. Post-treatment differences between groups were significant for depression (d = 0.63, p = .031), sleep quality (d = 0.61, p = .035) and the amount of exercise (d = 1.45, p < .001). Across both groups, the reduction of global symptom severity was significantly predicted by an increase of exercise (b = .35, p = .012).

CONCLUSIONS

The exercise intervention showed transdiagnostic efficacy among a heterogeneous clinical sample in a realistic outpatient setting and led to sustained exercise behaviour change. Exercise may serve as an efficacious and feasible transdiagnostic treatment option improving the existing treatment gap within outpatient mental health care settings.

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (ID: NCT03542396 , 25/04/2018).

Saving lives through life-threatening measures? The COVID-19 paradox of infection prevention in long-term care facilities

The current SARS Cov-2 infection control measures have paradoxical effects. On the one hand, the lockdown measures help to protect vulnerable populations in particular. On the other hand, these measures inevitably have the effect that those who are to be protected not only become socially isolated and are exposed to enormous psychological stress, but also break down physically due to inactivity. Thus, the activation that is omitted in the lockdown is not compensated by external reference groups, which also indicates that important conditions for healthy ageing are not given in long-term care facilities.

Relaxation or Regulation: The Acute Effect of Mind-Body Exercise on Heart Rate Variability and Subjective State in Experienced Qi Gong Practitioners

Mind-body exercises such as Yoga or Qi Gong have demonstrated a wide range of health benefits and hold great promise for employment in clinical practice. However, the psychophysiological mechanism underlying these effects remains unclear. Theoretical frameworks highlight regulation as a characteristic and specific mechanism of mind-body exercise for which empirical evidence is scarce. To investigate the exact nature of this mechanism, we tracked acute changes in autonomic nervous system (ANS) activity and subjective state over a common form of mind-body exercise (Qi Gong). Heart rate variability (HRV) and subjective state were assessed in 42 Qi Gong practitioners from China and Germany during a standard moving Qi Gong exercise (Baduanjin). Relaxation in supine position prior and after the exercise served as a control condition to Qi Gong and to assess changes before and after the exercise. Following Qi Gong, all practitioners reported significantly increased subjective calmness and perceived body activation, attentional focus, and subjective vitality. On the physiological level, a significant decrease of parasympathetic modulation and increase in heart rate indicated a pattern of moderate general physiological activation during Qi Gong. A significant increase in overall RR-interval modulation and cardiac coherence during Qi Gong were indicative of a mechanism of active regulation. Examination of the RR-interval trajectories revealed a rhythmic pattern of ANS activation and deactivation in sync with activating and relaxing segments of the exercise. Significant changes in subjective state, not on the physiological level, before and after the exercise were observed. Significant associations between Qi-Gong-specific beliefs, age, cultural background, and experiential and physiological measures demonstrated the complexity of mind-body exercises as multicomponent interventions. Overall, this study highlights moderate general physiological activation, exercise-dependent rhythmic ANS modulation, and induction of a characteristic state of eutonic calmness as potential psychophysiological mechanisms underlying the health benefits of mind-body exercise.

Do adults with non-communicable diseases meet the German physical activity recommendations?

Introduction

The numerous health benefits of physical activity (PA) for people with non-communicable diseases (NCDs) are well-documented. In Germany, there are limited data on whether adults with NCDs fulfill health-oriented PA recommendations. This study describes the prevalence of meeting PA recommendations among adults with select NCDs.

Method

Based on the national representative GEDA-2014/2015-EHIS (N = 24,016), the self-reported PA data of the European Health Interview Survey–Physical Activity Questionnaire (EHIS-PAQ) were classified with respect to fulfilling recommendations for health-enhancing aerobic activities (≥ 150 min per week with at least moderate intensity) and muscle strengthening (≥ 2 times per week). These binary indicators were used to analyze the association between the prevalence of sufficient PA and the self-reported presence of certain NCDs and multiple NCDs to reflect multimorbidity.

Results

Compared to the general adult population, sufficient aerobic PA was lower for most NCDs, with the lowest level among people with diabetes mellitus, obesity, stroke, chronic obstructive pulmonary disease (COPD), and depression. Compared to the general adult population, sufficient muscle strengthening was lower for some NCDs (diabetes mellitus, obesity, depression), but it was higher in people with musculoskeletal diseases (osteoarthritis, lower back pain). Multimorbidity was negatively associated with sufficient PA levels.

Conclusion

The study specifies the need to promote PA among adults with select NCDs to counteract insufficient levels of health-enhancing PA and to reduce the individual and societal burden of NCDs.

Why Do Students Walk or Cycle for Transportation? Perceived Study Environment and Psychological Determinants as Predictors of Active Transportation by University Students

University students are particularly at risk to suffer from physical and psychological complaints and for not fulfilling health-oriented physical activity (PA) recommendations. Since PA is linked with various benefits for health and educational outcomes, the group of students is of particular interest for PA promotion. Although active commuting has been identified as a relevant domain of PA in order to gain the various benefits of PA, little knowledge is available with respect to university students. This study tested conditions in the study environment, as well as personal motivators and barriers, as determinants for the active transportation of university students. Using a cross-sectional convenience sample of a university in the southwest of Germany (n = 997), we applied factor analyses to bundle relevant information on environmental and psychological determinants (adapted NEWS-G; adapted transport-related items from an Australian university survey) and blockwise hierarchical regressions. The objective was to analyze associations between the bundled determinants and self-reports on PA for transport-related walking and cycling (measured by the EHIS-PAQ). Results revealed associations between transport-related cycling and the perceived study environment (e.g., high automobile traffic) as well as certain personal motivators and barriers (e.g., time effort or weather conditions). The study contributes to the knowledge about determinants that are important for the development and improvement of public health interventions for students in a university setting.

Choosing an activity that suits: development and validation of a questionnaire on motivational competence in exercise and sport

The current study presents the development and validation of a questionnaire on motivational competence in exercise and sport. Motivational competence characterises the self-determined ability to choose a suitable exercise and sport activity. Knowing one’s own preferences and what to expect in different activities helps people to make this choice, which, in turn, supports them in maintaining their physical activity (PA) on a long-term and regular basis. The developed items cover the following three components of motivational competence: 1) knowing one’s own preferences, 2) knowing what to expect in different exercise and sport activities, and 3) choosing and arranging an exercise and sport activity. Psychometric properties were checked using a sample with N = 667 adults (Mage = 42.49, SD = 14.71, 62% female). The final one-dimensional scale consists of four items. Construct validity showed positive relationships to intrinsic and identified motivation modes of self-concordance and conversely no relationship to introjected and low negative to extrinsic motivation. For criterion validity, the structural equation modeling demonstrated that motivational competence and PA-specific self-control are independently and positively associated with exercise and sport behaviour. Overall, the newly developed scale is a psychometrically sound and economical instrument to be used in exercise and sport promotion (e.g. counselling) and research.

Competencies for a Healthy Physically Active Lifestyle: Second-Order Analysis and Multidimensional Scaling

The physical activity-related health competence (PAHCO) model assumes that individuals require movement competence, control competence, and self-regulation competence to lead a healthy, physically active lifestyle. Although previous research has already established some measurement factors (n = 8) of the three dimensions, no attempts have so far been made to statistically aggregate them on the sub-competence level. Therefore, the goal of the present study was to test two additional factors for PAHCO and subsequently model the second-order structure with two samples from the fields of rehabilitation and prevention. We conducted two questionnaire surveys with persons with multiple sclerosis (n = 475) and teaching students undergoing a basic qualification course in physical education (n = 502). After performing exploratory items analysis, we used second-order confirmatory factor analysis (CFA) and multidimensional scaling to investigate whether the scales could be bundled in accordance with the PAHCO model. The CFAs with 10 factors (42 items) demonstrated a good model fit. In contrast, the second-order analysis with a simple loading structure on the three sub-competencies revealed an unacceptable model fit. Instead, a second-order model variant was preferred [comparative fit index (CFI) = 0.926, root mean square error of approximation (RMSEA) = 0.048, standardized root mean square residual (SRMR) = 0.065] in which body awareness and self-efficacy had theory-conform cross-loadings. The results of multidimensional scaling (two-dimensional solution) were in line with the extracted second-order structure. The present results suggested that the extension of the measurement instrument to 10 first-order factors was psychometrically justified for the two populations. The results from the second-order analyses provided the basis for the creation of sum scores, representing manifest indicators of movement competence, control competence, and self-regulation competence. Future studies are needed that cross-validate the extended measurement model with other populations and that relate the sub-competencies of PAHCO to indicators of health-enhancing physical activity.

[Sports Activity and Mental Diseases]

Current meta-analyses demonstrate convincing evidence regarding the efficacy of exercise on depression, insomnia, anxiety disorders, schizophrenia and ADHD. However, exercise and sports therapy approaches for patients with psychological disorders are mostly integrated in psychiatric inpatient or rehabilitation settings, but not applied in the outpatient sector. Thus, the German Health sector does not take the advantage of the compelling therapeutic effects of exercise. This review covers the theoretical and empirical fundamentals of the effects of exercise and illustrates practical implications by means of the presentation of the group-therapeutic exercise program ImPuls, that was specifically designed for patients with psychological disorders in outpatient settings. ImPuls integrates current evidence of the effects of exercise (type of sport, duration, frequency, intensity) and the facilitation of motivational and volitional strategies to support patients to integrate exercise in their daily life routines.