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Background: Physical activity referral schemes (PARS) are composed of various components, such as a written prescription or a person-centered approach. The role of these components in their effectiveness is yet to be understood. Therefore, we aimed to explore the relationships between PARS components and physical activity, scheme uptake, and adherence rate; and to estimate the effect of PARS. Methods: We searched Scopus, PubMed, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE. Eligible studies were published between 1990 and November 2023 in English or German, investigated PARS with participants aged ≥ 16 years, and reported physical activity, scheme uptake, or scheme adherence. Separate random-effects meta-analysis by comparison group were conducted for physical activity. Scheme uptake and adherence rates were pooled using proportional meta-analysis. The components were analyzed via univariate meta-regression. We rated the risk of bias using RoB2 and ROBINS-I, and the certainty of evidence using GRADE. Results: Fifty-two studies were included. PARS were more effective in increasing physical activity than usual care (k = 11, n = 5046, Hedges' g = 0.18, 95%CI 0.12 to 0.25; high certainty of evidence). When PARS were compared with physical activity advice or enhanced scheme versions, the pooled Hedges' g values for physical activity were -0.06 (k = 5, n = 1082, 95%CI -0.21 to 0.10; low certainty of evidence), and 0.07 (k = 9, n = 2647, 95%CI -0.03 to 0.18; low certainty of evidence) respectively. Scheme uptake was 87% (95%CI 77% to 94%, k = 14, n = 5000) across experimental studies and 68% (95%CI 51% to 83%, k = 14, n = 25,048) across non-experimental studies. Pooled scheme adherence was 68% (95%CI 55% to 80%, k = 16, n = 3939) and 53% (95%CI 42% to 63%, k = 18, n = 14,605). The meta-regression did not detect any significant relationships between components and physical activity or scheme uptake. A person-centered approach, screening, and brief advice were positively associated with scheme adherence, while physical activity sessions were negatively associated. Conclusion: PARS are more effective in increasing physical activity than usual care only. We did not identify any components as significant predictors of physical activity and scheme uptake. Four components predicted scheme adherence, indicating that the component-effectiveness relationship warrants further research. [ABSTRACT FROM AUTHOR]

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 effects of physical therapy and exercise therapy, including PAP interventions. Patient-reported and device-based measures of physical activity (PA) outcomes were included. Qualitative and quantitative data from systematic reviews were extracted by 2 independent reviewers. Assessment of the methodological quality of the included systematic reviews was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). 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-analyses (67%; 8/12) provided evidence supporting the short- and long-term efficacy of PAP interventions, but not all pooled estimates were clinically relevant. Only three of the systematic reviews with meta-analysis included an assessment of the certainty of the 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 in improving PA for patients with NCDs in the short 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 the 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 in improving PA for patients with NCDs. [ABSTRACT FROM AUTHOR]

Individuals are recommended to lead active lifestyles throughout the life course. The model of physical activity‐related health competence (PAHCO) adopts a competence approach by integrating physical, cognitive, and motivational determinants for health‐enhancing PA (movement competence, control competence, self‐regulation competence). Drawing on a comprehensive dataset pooling, the goal of the present study was to model the idiosyncratic courses of 10 PAHCO indicators over the life span. We identified studies that empirically operationalized PAHCO, combining data of 7134 individuals (age range: 15–97 years; 61% female) from 18 different populations (prevention and rehabilitation sectors). We applied a stepwise multilevel analysis approach with disjunct sub‐samples (n = 48) to examine linear and quadratic associations between age and PAHCO. Indicators of movement competence (i.e., manageability of endurance, strength, and balance demands; task‐specific self‐efficacy) congruently showed negative associations with age (0.054 ≤ Rmarg2 ${R}_{\text{marg}}^{2}$ ≤ 0.211). However, parameters of control competence remained stable across the life span (−0.066 ≤ β ≤ 0.028). The three indicators of self‐regulation competence revealed an inconsistent relationship with age, though uncovering positive associations for self‐control (β = 0.106) and emotional attitude toward PA (β = 0.088). The associations of some indicators varied significantly across sub‐samples. The results suggest differential analyses for associations between PAHCO and age. While the physically determined PAHCO indicators (movement competence) probably decline across the life span, the ability to ensure regularity of PA (self‐regulation competence) or align PAs with an individual's health (control competence) appear to remain constant or improve with increasing age. The findings reinforce a de‐stigmatizing approach for PA promotion practices with considerable space for aligning activities with health also in the elderly. Highlights: As hypothesized, movement competence appears to decline throughout the life span.The ability to align physical activities with an individual's health (control competence) appears to remain stable throughout the life span.Unexpectedly, an individual's ability to ensure regularity of physical activity (PA; self‐regulation competence) appears to improve throughout the life span and, therefore, conflicts with actual PA behavior.Age‐related changes in competencies for health‐enhancing PA systematically vary between samples (i.e., groups with a certain disease or working environment). [ABSTRACT FROM AUTHOR]

Background: Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. Methods: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. Results: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2–13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7–100.0%) and adherence rates (8.5–95.0%). Conclusions: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact. [ABSTRACT FROM AUTHOR]

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. The 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. [ABSTRACT FROM AUTHOR]

Background: Physical activity promotion requires a multi-layered assessment that does not only assess body functions but which in particular also includes the measurement of personal factors (e.g. exercise self-efficacy). Objectives: The purpose was to review the utilisation of standardised measurements (SMs), admission interviews and interdisciplinary information sharing, and to analyse the content of these practices with respect to physical activity promotion. Design: Observational, cross-sectional national survey. Method: A Germany-wide, quantitative survey, collecting information from 713 exercise therapy departments, was conducted. Measurements were classified as standardised or non-standardised and assigned to the International Classification of Functioning (ICF). Admission interviews and information from other professionals were analysed using a qualitative content analysis. Results: In total, 1008 SMs included 9007 ICF concepts: 16% were classified as personal factors, but none were clearly related to physical activity promotion. Admission interviews contained several non-standardised assessments of personal factors: goals (40%), exercise experiences/activity bibliography (10%), activity level (5%), exercise preferences (2%). Information sharing does not contain relevant information for physical activity promotion. Discussion: Exercise therapists have scant information about the personal factors that influence clients' physical activity behaviour. An assessment for physical activity promotion that includes physical functioning and personal factors has, so far, barely been implemented in practice. [ABSTRACT FROM AUTHOR]