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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., (© 2024. The Author(s).)

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., Competing Interests: Declaration of interests SP declares that the German Association for Health-Enhancing Physical Activity and Exercise Therapy maintains a training programme for psychiatry, psychosomatics, and addiction. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

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., (© 2024. The Author(s).)

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., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: 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 students from grade 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, and soft drinks as well as 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, 15.3 to 37.5% of adolescents reported difficulties in acquiring and dealing with digital health information. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showed a limited digital HL. Adolescents with moderate and low digital HL reported higher levels of low physical activity and non-daily fruit and daily soft drink consumption., Discussion: 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. The school as a place of teaching and learning is a suitable setting because, among other things, of its fit with the mandatory strategy of media literacy education in schools., (© 2022. The Author(s).)

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.

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.

Purpose: Contemporary multidisciplinary rehabilitation programs include the promotion of physical activity as a central goal. Exercise therapy is an essential element in rehabilitation programs working towards this goal. However, little is known about the role of physical activity promotion in exercise therapy practice in rehabilitation settings. The aim is to identify typical exercise therapy concepts in rehabilitation programs regarding the role of physical activity promotion. Further, we want to assess the representation of physical activity promotion among exercise therapy departments across Germany and in relation to different diagnostic categories. Methods: Heads of 713 exercise therapy departments participated in a nationwide questionnaire-based survey collecting information on therapy goals, contents, and methods. Participating facilities treated health conditions in the areas of cardiology, orthopedics, neurology, oncology, psychosomatics and addiction. We applied factor analyses to identify behavior-oriented goals, contents and methods of exercise therapy concepts and used latent class analyses to categorize typical exercise therapy concepts. Results: Six typical exercise therapy concepts were identified. Two of the classes (together 45% of the departments) emphasized physical activity promotion and used related methods. Other concepts focused primarily on physical functioning and exercise or focused on psychosocial goals and positive experiences with physical activity. Typical exercise therapy concepts are only partially determined by the type of health condition. Conclusions: The dissemination of content and methods for a substantial physical activity promotion in exercise therapy, has so far partly taken place in Germany. The results imply that the different status quo in rehabilitation facilities have to be considered to foster the knowledge exchange between science and practice.Implications for rehabilitationThe results on typical exercise therapy concepts give a structured overview of different priorities with regard to aims, content, and methods of exercise therapy in the light of the International Classification of Functioning, Disability, and Health.The study reveals that the dissemination of theoretically sound, evidence-based concepts for physical activity promotion has reached a half of the institutions in German rehabilitation settings. This national example generally suggests that there is a need for an increased exchange of knowledge between science and practice related to exercise therapy in rehabilitation settings.The results enable practitioners to reflect on their exercise therapy concepts with respect to contemporary exercise therapy concepts that integrate physical activity promotion appropriately.Stakeholders and rehabilitation professionals can use the results to design strategies for quality development, taking into account the different status quo of therapy concepts in the "real world" of rehabilitation practice.The results of the survey provide the basis for a scientifically-based comparison of exercise therapy across countries and health care systems.

Aim: The aim of this article is to obtain nationwide information about contentual and conceptual characteristics of exercise therapy in medical rehabilitation. It investigates the question to what extend these characteristics differ, depending on indication fields and structural features of rehabilitation centres., Methodology: In a nationwide cross-sectional study, 1146 rehabilitation centres of all indication fields have been contacted in order to recruit exercise therapists in charge for a pseudonymised written survey., Results: For the analysis, 713 questionnaires from 529 rehabilitation centres were consulted. Analysis of variance of the indication fields has shown significant differences in evaluation of influenceability of the rehabilitants' starting conditions as well as in the estimated importance of exercise-therapy-related content. Also structural features of the rehabilitation centres contributed to further clarification of variance., Conclusion: There is a contentual and conceptual variety in exercise therapy. Besides indication-specific differences, there are considerable variances which suggest differences between rehabilitation centres within the same indication field., Competing Interests: Die Autoren geben an, dass kein Interessenskonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: One central goal of physical education in many countries is to empower students to be physically active throughout their lifespan. Physical activity-related health competence (PAHCO) encompasses physical, cognitive, and motivational elements associated with the individuals' ability to be physically active in a health-enhancing way. To date, there is a lack of empirical evidence concerning effective programs and methods to promote PAHCO in physical education. The purpose of this study is to examine to what extent a health and physical fitness-related program that includes learning tasks integrating theoretical and practical elements promotes students' PAHCO in physical education., Design/methods: This study is a cluster randomized controlled trial that compares two physical education intervention programs on health and physical fitness (IG-run, IG-game play) with regular physical education lessons (CG-run, CG-game play) in secondary schools in Germany. Forty-eight physical education classes (ninth grade) were recruited and randomly allocated to the four study groups. The intervention programs include six physical education lessons on health and physical fitness and only differ in the type of physical activity that is executed (running and jumping vs. small-sided games). The students' PAHCO is examined both pre- and post-intervention and after 8-12 weeks of follow-up. We also determine various process variables during the intervention period to analyze the intervention fidelity., Discussion: The results of this study provide evidence on whether a combination of theoretical and practical elements in physical education can enhance students' PAHCO. Beyond that, our process analyses will allow differentiated insights into the mechanism of how the intervention programs work., Trial Registration: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00016349 . Retrospectively registered on 10 January 2019.