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Background: The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. Methods: A data set of 18,058 adults aged 25–69 years from three population-based national health examination surveys 1990–92, 1997–99 and 2008–11 with complete information for five healthy behavior factors was used. A ‘daily intake of both fruits and vegetables, ‘sufficient physical exercise’, ‘no current smoking’ and ‘no current risk drinking’ were assessed with self-reports and ‘normal body weight’ was calculated based on measured body weight and height. A dichotomous ‘healthy lifestyle’ indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25–34, 35–44, 45–54 and 55–69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990–92 and 2008–11. Results: In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990–92 to 13.5% in 1997–99 and to 14.7% in 2008–11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45–54 years. The RC of increasing healthy lifestyle prevalence between 1990–92 and 2008–11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990–92 and 2008–11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. Conclusions: The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990–92 to 2008–11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level. [ABSTRACT FROM AUTHOR]

Background: Intensity and duration of physical activity are associated with the achievement of health benefits. Our aim was to characterize physical activity behavior in terms of intensity, duration pattern, and adherence to the WHO physical activity recommendations in a population-based sample of adults from southern Germany. Further, we investigated associations between physical activity and sex, age, and body mass index (BMI), considering also common chronic diseases. Methods: We analyzed 475 subjects (47% males, mean age 58 years, range 48–68 years) who wore ActiGraph accelerometers for up to seven days. Measured accelerations per minute obtained from the vertical axis (uniaxial) and the vector magnitude of all three axes (triaxial) were classified as sedentary, light or moderate-to-vigorous physical activity (MVPA) according to predefined acceleration count cut-offs. The average minutes/day spent in each activity level per subject served as outcome. Associations of sex, age, BMI, and seven chronic diseases or health limitations, with the activity levels were analyzed by negative binomial regression. Results: Most of the wear time was spent in sedentarism (median 61%/day), whereas the median time spent in MVPA was only 3%, with men achieving more MVPA than women (35 vs. 28 minutes/day, p<0.05). Almost two thirds of MVPA was achieved in short bouts of less than 5 minutes, and 35% of the subjects did not achieve a single 10-minute bout. Hence, only 14% adhered to the WHO recommendation of 2.5 hours of MVPA/week in at least 10-minute bouts. Females, older subjects and obese subjects spent less time in MVPA (p<0.05), but no clear association with hypertension, asthma, diabetes, chronic obstructive pulmonary disease, anxiety/depression, pain or walking difficulties was observed in regression analyses with MVPA as outcome. Conclusions: Activity behavior among middle-aged German adults was highly insufficient, indicating a further need for physical activity promotion in order to gain health benefits. [ABSTRACT FROM AUTHOR]

In cooperation with the Sports Association of the Palatinate (SBP), a survey was conducted on substance use by recreational and amateur athletes. Distribution of the online questionnaire took place by means of chain-referral sampling, and questions on substance use were presented using the randomized response technique (RRT) to protect the anonymity of respondents and prevent socially desirable answers. The estimated lowest limit for the population share for use of prohibited substances during the last season (4%) and for lifetime use (3.6%) did not differ significantly. Approximately 21% of respondents had used substances for training or competitions that were taken for a purpose other than performance enhancement (e.g., to improve their mood or to help with recuperation from a minor injury or illness) in the last year. 49% had done so at some point in their life. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is a well-known and underused protective factor for numerous health outcomes, and interventions are hampered by lack of objective data. We combined accelerometers with diaries to estimate the contributions to total activity from different domains throughout the day and week in adolescents. Methods: Accelerometric and diary data from 1403 adolescents (45% male, mean age 15.6 ± 0.5 years) were combined to evaluate daily levels and domains of sedentary, light, and moderate-to-vigorous activity (MVPA) during a typical week. Freedson’s cutoff points were applied to determine levels of activity. Total activity was broken down into school physical education (PE), school outside PE, transportation to school, sport, and other time. Results: About 2/3 of adolescents’ time was spent sedentary, 1/3 in light activity, and about 5% in MVPA. Boys and girls averaged 46 (SD 22) and 38 (23) minutes MVPA per day. Adolescents were most active during leisure sport, spending about 30% of it in MVPA, followed by PE (about 20%) transport to school (14%) and either school class time or other time (3%). PE provided 5% of total MVPA, while leisure sport provided 16% and transportation to school 8%. School was the most sedentary part of the day with over 75% of time outside PE spent sedentary. Conclusions: These German adolescents were typical of Europeans in showing low levels of physical activity, with significant contributions from leisure sport, transportation and school PE. Leisure sport was the most active part of the day, and participation did not vary significantly by sex, study center (region of Germany) or BMI. Transportation to school was frequent and thus accounted for a significant fraction of total MVPA. This indicates that even in a population with good access to dedicated sporting activities, frequent active transportation can add significantly to total MVPA. [ABSTRACT FROM AUTHOR]

Background: This study aimed 1) to provide data estimates concerning overall moderate- and vigorous-intensity physical activity (MVPA) as well as MVPA during work, transport and leisure in Germany and 2) to investigate MVPA and possible associations with socio-demographic correlates. Methods: A cross-sectional telephone survey interviewed 2248 representative participants in the age of 18–65 years (1077 men; 42.4±13.4 years; body mass index: 25.3±4.5kg•m−2) regarding their self-reported physical activity across Germany. The Global Physical Activity Questionnaire was applied to investigate MVPA during work, transport and leisure and questions were answered concerning their demographics. MVPA was stratified by gender, age, body mass index, residential setting, educational and income level. To identify socio-demographic correlates of overall MVPA as well as in the domains, we used a series of linear regressions. Results: 52.8% of the sample achieved physical activity recommendations (53.7% men/52.1% women). Overall MVPA was highest in the age group 18–29 years (p<.05), in participants with 10 years of education (p<.05) and in participants with lowest income levels <1.500€ (p<.05). Regression analyses revealed that age, education and income were negatively associated with overall and work MVPA. Residential setting and education was positively correlated with transport MVPA, whereas income level was negatively associated with transport MVPA. Education was the only correlate for leisure MVPA with a positive association. Conclusions: The present data underlines the importance of a comprehensive view on physical activity engagement according to the different physical activity domains and discloses a need for future physical activity interventions that consider socio-demographic variables, residential setting as well as the physical activity domain in Germany. [ABSTRACT FROM AUTHOR]

Objective: Considering the high number of stressors encountered in the context of elite sports, a high sense of coherence (SOC) is crucial to allow athletes to maintain their health from both short- and long-term perspectives. The aim of this cross-sectional study was to investigate SOC in a population of elite athletes, focusing on identification of subsets of athletes with particularly high and low SOC scores, and any related predictors. The elite athletes' SOC scores were also evaluated for differences with those of the general population of Germany; whether a correlation between SOC and subjective health existed was additionally examined. Method: In total, 698 male and female elite athletes, drawn from Germany's highest-level national track and field squads, and first and second division handball teams, completed a survey that included the SOC-L9 Scale and measures of subjective health, sociodemographic information, and the number of injury lay-offs experienced during the athletes' careers to date. Results: Classification tree analysis reveals six contrast groups with varying SOC scores. Several interacting factors determine the group to which an athlete belongs. Together with overuse injuries, additional factors are age, gender, and completed/not completed apprenticeship/degree. Female athletes aged between 19 and 25, who had already been subject to lay-offs due to overuse injuries, comprise the group with the lowest SOC scores. Overall, the SOC of elite athletes is slightly lower than in the general population. In accordance with other studies, a stronger SOC is also correlated significantly with better global subjective health. Conclusion: The identification of contrast groups with varying SOC scores contributes to the development of more targeted salutogenetic health promotion programs. Such programs would ideally include learning modules pertaining to coping with overuse injuries, as well as social support systems aiming to effectively combine education and elite sport. [ABSTRACT FROM AUTHOR]

Objectives: To assess the relationship between proximity to specific sports facilities and participation in the corresponding sports activities for adolescents in Germany. Methods: A sample of 1,768 adolescents aged 11–17 years old and living in 161 German communities was examined. Distances to the nearest sports facilities were calculated as an indicator of proximity to sports facilities using Geographic Information Systems (GIS). Participation in specific leisure-time sports activities in sports clubs was assessed using a self-report questionnaire and individual-level socio-demographic variables were derived from a parent questionnaire. Community-level socio-demographics as covariates were selected from the INKAR database, in particular from indicators and maps on land development. Logistic regression analyses were conducted to examine associations between proximity to the nearest sports facilities and participation in the corresponding sports activities. Results: The logisitic regression analyses showed that girls residing longer distances from the nearest gym were less likely to engage in indoor sports activities; a significant interaction between distances to gyms and level of urbanization was identified. Decomposition of the interaction term showed that for adolescent girls living in rural areas participation in indoor sports activities was positively associated with gym proximity. Proximity to tennis courts and indoor pools was not associated with participation in tennis or water sports, respectively. Conclusions: Improved proximity to gyms is likely to be more important for female adolescents living in rural areas. [ABSTRACT FROM AUTHOR]