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ZusammenfassungLebensstil, insbesondere regelmäßige körperliche Aktivität, ist ein wichtiger Bestandteil in der Prävention und Therapie des Typ 2 Diabetes mellitus und sollte fester Bestandteil jeglicher Betreuung von Patient:innen sein. Es besteht breiter Konsens, dass eine effiziente Diabetes-Prävention und Therapie in den meisten Fällen auch von einer Modifikation des Lebensstils begleitet sein muss.Ziele der Förderung der körperlichen Aktivität sind zunächst das Training des Herz-Kreislaufsystems, Kräftigung der Muskulatur, Steigerung des Energieumsatzes und die Reduktion von Inaktivität. Für einen substanziellen gesundheitlichen Nutzen sind wöchentlich mindestens 150 min aerobe körperliche Aktivität mit mittlerer oder höherer Intensität und zusätzlich muskelkräftigende Bewegungen erforderlich.Das Ausmaß des positive Effektes von Bewegung steht in direktem Verhältnis zum Grad der erreichten kardiorespiratorischen Fitness, und kann nur durch entsprechendes Training aufrechterhalten werden. Körperliches Training ist in jedem Alter für beide Geschlechter wirksam und effektiv. Durch die Reduktion der Insulinresistenz und funktionelle Verbesserung der Insulinsekretion hat körperliches Training positiven Einfluss auf die Glykämie und zusätzlich wird das kardiovaskuläre Risiko gesenkt.Im Speziellen hat Training nicht nur positiven Einfluss auf die Glykämie durch Verbesserung der Insulinresistenz und funktionelle Verbesserung der Insulinsekretion zu nehmen, sondern ist auch in der Lage, das kardiovaskuläre Risiko zu senken.Inaktivität per se gilt unabhängig vom Konstrukt der körperlichen Aktivität als Risikofaktor. Insbesondere langandauernde sitzende Tätigkeit soll vermieden werden.Standardisierte, regionale und angeleitete Bewegungsprogramme sind bestens geeignet, um ein ausreichendes wöchentliches Ausmaß an gesundheitsfördernder körperlicher Aktivität zu erreichen. Zusätzlich fordert die Österreichische Diabetes Gesellschaft die Position der Bewegungsberater:in als fixen Bestandteil eines multidisziplinären Behandlungsansatzes. Leider gab es in den letzten Jahren weder im Aufbau standardisierter Bewegungsangebote noch in der Bewegungsberatung erfolgsversprechende Entwicklungen.

Background In 2015 a co-operation between the social insurance and the organized sport has been established in order to install Jackpot.fit, a standardized sports club based program, initially in 8 regions in Styria, a federal state of Austria. Inactive adults receive information about the long-term exercise program during a 3-week residential stay in a health resort. We aim to investigate who attends Jackpot.fit, the adherence to the program in 2019 as well as the progress of dissemination of Jackpot.fit since 2016. Methods Participantś personal data were collected by telephone at the registration. Instructors documented the participants' attendance each single session with a standardized form. The number of participating regions as well as courses within the regions were monitored by the evaluator. Results Between 2016 and 2019 2624 people (70.8% female; age: M = 57.1, SD = 9.1 years; BMI = 25.8, SD = 4.3 kg/m2) registered for Jackpot.fit and 84.3% (n = 2212) attended as participants in at least one session. Between September and December 2019, 824 people registered for the courses with an adherence rate as follows: 291 (35.3%) visited 75% or more, 200 (24.3%) between 50% and 74.9% and 232 (28.2%) less than 49.9% of all 638 provided sessions. 101 (12.3%) registered but never attended once. The number of regions rose from 8 in 2016 to 28 in 2019 and the number of courses from 25 to 55 over the same period. Conclusions According to the total number of participants, regions, and courses the dissemination moves forward. Further strategies to improve adherence must be developed. Acknowledgement The project is supported by the Gesundheitsfonds Steiermark and the Bundessport Förderungsfonds.

Background Joining forces through collaboration between the health- and sports-sector led to the project Jackpot.fit, which aimed at increasing physical activity (PA) among inactive adults in Styria (a state of Austria). The main objective was to assess the short- and long-term effectiveness of a mixed PA intervention, consisting of counselling in a health care setting combined with a standardised sports club programme, on PA in an adult population. Methods In a quasi-experimental study with two follow-up time points (4 and 12 months after baseline), participants from eight regions were allocated to the intervention group (IG) and participants from three other regions to the comparison group (CG). Half of the study participants were women and the mean participants' age was 53 (SD ± 6) years. During the health resort stay, the IG received PA counselling and coupons for 12 complimentary, standardised training sessions in a sports club near the participants' home. Participants of the CG received identical PA counselling, but written material only. PA was measured with an accelerometer (GENEActive). Linear mixed-effects models were applied to examine changes of PA within and between groups over time. Results From 217 participants (IG = 167; CG = 50) at least one follow-up measurement was available. IG data showed a significant increase in moderate-intensity PA from baseline (101 min/week) to 4 months (+58 min; 95% CI = 36 to 80) and 12 months (+24 min; 95% CI = 2 to 46) whereas there was no significant change in CG. Between-group comparisons revealed a significant difference after 4 but not after 12 months. Conclusions The study confirms the feasibility of coordinated actions between health care institutions and sport clubs to recruit people into a standardized PA programme. In addition, those who participated in the sports club programme increased their PA in a long term.

Background: Not smoking, performing &gt, 150 min of aerobic physical activity (PA) and muscle strengthening exercises/week, and consuming &gt, 5 portions of fruit and vegetables/day are lifestyle recommendations for both the general population and people with diabetes mellitus (DM). Methods: A total of 15,771 and 15,461 persons from the Austrian Health Interview Surveys 2014 and 2019, respectively, including 4.9% and 6.0% of people with DM, were analysed in terms of their smoking, PA, and nutritional behaviours. Logistic regression models were performed for the lifestyle factors, adjusted for socio-demographic and health-related factors. Adjusted interactions between the survey year and DM on the lifestyle factors were computed. Results: The proportions of smokers were 23.9% and 20.2%, of people complying with the PA recommendations were 24.9% and 21.4%, and with fruit and vegetables recommendations were 7.1% and 5.5%, respectively, with significantly lower proportions of smokers and persons complying with the PA recommendations among people with DM. The fully adjusted odds ratios (95% confidence interval) for people with DM were 1.09 (0.94–1.26), 1.44 (1.23–1.69), and 0.90 (0.71–1.13) for smoking, not complying with PA recommendations, and not complying with fruit and vegetables recommendations, respectively. The proportion of people complying with PA recommendations decreased to a greater extent (p &lt, 0.001) in people with DM (16.5% to 8.3%) compared to people without DM (25.3% to 22.3%). Conclusion: Diabetogenic lifestyle behaviours increased in the general Austrian population in recent years, which was especially true for people with DM regarding PA.

Summary Background Physical activity (PA) is an important tool in health promotion, prevention, curation, and rehabilitation and should be part of general practitioners (GP) consultations. For tailoring GP’s service it is important to know the PA habits of the clients. Methods Data from the Austrian Health Interview Survey 2014 with 15,770 subjects were analyzed. The association between PA, measured with the Physical Activity Questionnaire of the European Health Intervies Survey (EHIS-PAQ) and having visited a GP within the last 4 weeks was examined in different age groups (15–29, 30–64, and 65+ years). In multivariate analyses we adjusted for sociodemographic and health-related variables (body mass index, 17 chronic diseases, and the use of medication). Results In subjects aged 15–29 years and 30–64 years fulfilling aerobic PA recommendations was significantly associated with a lower chance of having consulted the GP with unadjusted OR (95% CI) 0.82 (0.70–0.96) and 0.90 (0.82–0.99), respectively, whereas work-related PA was associated with a higher chance, with OR 1.21 (1.03–1.42) and 1.10 (1.00–1.20), respectively. Adjusting for sociodemographic and health-related factors led to loss of significance. In subjects aged 30–64 years, muscle strengthening PA was associated with a higher chance for GP consultation with OR 1.12 (1.00–1.24) in the fully adjusted model. In subjects aged 65+ years, PA was associated with a lower chance of having visited the GP with OR 0.74 (0.64–0.86) and 0.83 (0.71–0.97) for work related PA and total PA, respectively, in the fully adjusted model. Conclusion The association of PA and GP consultation is dependent on age and type of PA, and partly mediated by sociodemographic and health-related factors.

Lebensstil, insbesondere regelmasige korperliche Aktivitat ist ein wichtiger Bestandteil in der Pravention und Therapie des Typ 2 Diabetes mellitus und sollte fester Bestandteil jeglicher Betreuung von Patienten sein. Es besteht breiter Konsens, dass eine effiziente Diabetes-Pravention und Therapie in den meisten Fallen auch von einer Modifikation des Lebensstils begleitet sein muss. Ziele der Forderung der korperlichen Aktivitat sind zunachst das Training des Herz-Kreislaufsystems, Kraftigung der Muskulatur, Steigerung des Energieverbrauchs und die Reduktion von Inaktivitat. Fur einen substanziellen gesundheitlichen Nutzen sind wochentlich mindestens 150 min aerobe korperliche Aktivitat mit mittlerer oder hoherer Intensitat und zusatzlich muskelkraftigende Bewegungen erforderlich. Der positive Effekt von Bewegung steht in direktem Verhaltnis zum Grad der erreichten kardiorespiratorischen Fitness, der erreicht wird. und halt nur so lange an, wie diese aufrechterhalten werden kann. Der Effekt von Bewegung ist alters- und geschlechtsunabhangig und reproduzierbar. Korperliches Training im Speziellen hat die Potenz nicht nur positiven Einfluss auf die Glykamie durch Verbesserung der Insulinresistenz und funktionelle Verbesserung der Insulinsekretion zu nehmen, sondern ist auch in der Lage, das kardiovaskulare Risiko zu senken. Inaktivitat per se gilt unabhangig vom Konstrukt der korperlichen Aktivitat als Risikofaktor. Insbesondere langandauernde sitzende Tatigkeit soll vermieden werden. Angeleitete Bewegungsprogramme sind bestens geeignet, um ein ausreichendes wochentliches Ausmas an gesundheitsfordernder korperlicher Aktivitat zu erreichen. Groses Potential liegt in standardisierten, regionalen Bewegungsangeboten, jedoch gibt es aktuell noch viele Barrieren in der Verordnung von korperlicher Aktivitat. Um dieser Herausforderung gerecht zu werden, fordert die Osterreichische Diabetes Gesellschaft die Position des Bewegungsberaters als fixen Bestandteil eines multidisziplinaren Behandlungsansatzes.

Background: Regular physical activity is a corner stone for healthy living, and preventing the onset or progression of diseases. The Social Insurance Fund for Public Service, Railway and Mining Industries is building an intramural health promotion facility in Austria with the aim to provide a comprehensive evidence-based health promotion programme for their insured. The target group are all people who, regardless of their health status and the presence of diseases, are ready to make their lifestyle more health-oriented. The health promotion facility offers health promotion measures in five areas: promoting physical training, optimizing nutritional patterns, managing everyday stress, increasing social capital, and improving health literacy. The focus is on increasing resources and on overcoming barriers. Depending on age, previous illnesses, range of motion, stress level, body weight and personal aims and expectations, the measures are individually tailored. The stay is divided into a two-week initial stay and a follow-up week. A comprehensive scientific evaluation concept of all measures and the entire stay is an integral part of the design. Conclusion: This project combines the advantages of comprehensive active health promotion, and an intramural stay. It is a pioneering social insurance project for sustainable health promotion and integrated care.

OBJECTIVE In our randomized controlled trial, we investigated the impact of healthy eating (HE) aiming for restricted gestational weight gain (GWG) and physical activity (PA) interventions on maternal and neonatal lipid metabolism. RESEARCH DESIGN AND METHODS Obese pregnant women (n = 436) were included before 20 weeks’ gestation and underwent glucose testing (oral glucose tolerance test) and lipid profiling at baseline and 24–28 and 35–37 gestational weeks after an at least 10-h overnight fast. This secondary analysis had a factorial design with comparison of HE (n = 221) versus no HE (n = 215) and PA (n = 218) versus no PA (n = 218). Maternal changes in triglycerides (TG), LDL cholesterol, HDL cholesterol, free fatty acids (FFAs), and leptin from baseline to end of pregnancy and neonatal outcomes were analyzed using general linear models with adjustment for relevant parameters. RESULTS At 24–28 weeks’ gestation, FFAs (mean ± SD, 0.60 ± 0.19 vs. 0.55 ± 0.17 mmol/L, P < 0.01) were increased after adjustment for FFA at baseline, maternal age, BMI at time of examination, gestational week, insulin resistance, self-reported food intake, self-reported physical activity, and maternal smoking, and GWG was lower (3.3 ± 2.6 vs. 4.3 ± 2.8 kg, P < 0.001, adjusted mean differences −1.0 [95% CI −1.5; −0.5]) in HE versus no HE. Fasting glucose levels (4.7 ± 0.4 vs. 4.6 ± 0.4 mmol/L, P < 0.05) and 3-β-hydroxybutyrate (3BHB) (0.082 ± 0.065 vs. 0.068 ± 0.067 mmol/L, P < 0.05) were higher in HE. Significant negative associations between carbohydrate intake and FFA, 3BHB, and fasting glucose at 24–28 weeks’ gestation were observed. No differences between groups were found in oral glucose tolerance test or leptin or TG levels at any time. Furthermore, in PA versus no PA, no similar changes were found. In cord blood, elevated FFA levels were found in HE after full adjustment (0.34 ± 0.22 vs. 0.29 ± 0.16 mmol/L, P = 0.01). CONCLUSIONS HE intervention was associated with reduced GWG, higher FFAs, higher 3BHB, and higher fasting glucose at 24–28 weeks of gestation, suggesting induction of lipolysis. Increased FFA was negatively associated with carbohydrate intake and was also observed in cord blood. These findings support the hypothesis that maternal antenatal dietary restriction including carbohydrates is associated with increased FFA mobilization.

(1) Background: Collaboration between the health care sector and the sports sector to increase physical activity (PA) behaviour among inactive adults is still rare. The objective of the study was to evaluate the short- and long-term effectiveness of a mixed PA intervention on the PA behaviour in an adult population. (2) Methods: In a quasi-experimental study with two follow-up measurements (four and 12 months), adults were contacted by post before their stay in a health resort. During the health resort stay, the intervention group (IG) received PA counselling and a coupon for 12 standardised free-of-charge sessions in a sports club. The participants in the comparator group (CG) received PA counselling and written material. PA was measured with an accelerometer (GENEActive). Linear mixed-effects models were applied to examine the change in PA behaviour, both within and between groups in moderate- to vigorous-intensity PA over time. (3) Results: We obtained at least one follow-up measurement from 217 participants (IG = 167, CG = 50), who were 50% female, with an average age of 53 (&plusmn, 6) years. PA significantly increased from the baseline to the four-month measurement by 58 min./wk (95% CI 36, 80) and to the 12-month measurement by 24 min./wk (95% CI 2, 46) within the IG. No change in PA occurred in the CG. We also found a short-term between-group (IG vs. CG) difference in change over time, but not a long-term difference. (4) Conclusions: The study confirms that a collaboration between the health care sector and local sports clubs is a feasible method of recruiting people into a standardised PA programme and to increase their PA over the long term.

Lifestyle in general and particularly health enhancing physical activity is known to be an important component in the prevention and therapy of type 2 diabetes mellitus.To gain substantial health benefits a minimum of 150 min of moderate or vigorous intense aerobic physical activity and muscle strengthening activities per week are needed. Additionally, inactivity should be recognised as health hazard and prolonged episodes of sitting should be avoided.Exercise in particular is not only useful in improving glycaemia by lowering insulin resistance and positively affect insulin secretion, but to reduce cardiovascular risk. The positive effect of training correlates directly with the amount of fitness gained and lasts only as long as the fitness level is sustained. The effect of exercise is independent of age and gender. It is reversible and reproducible.Supervised exercise classes are well known to be attractive for adults to reach a sufficient level of health enhancing physical activity. The potential of regional, standardised exercise programmes could have been shown, although existing barriers to entry must be reduced. To tackle this public health challenge and based on the large evidence of exercise referral and prescription the Austrian Diabetes Associations aims to implement the position of a "physical activity adviser" in multi-professional diabetes care.

Background: Little is known about the implementation of lifestyle interventions in frail, community-dwelling people. This study highlights different domains of adherence to explain an effectively delivered home-based intervention. Methods: Eighty prefrail and frail persons (≥65 years) participated in a physical training, nutritional, and social support intervention over 24 weeks. A detailed log book was kept for comprehensive documentation in order to assess adherence and further organizational, exercise, and nutritional parameters. Results: Participants reached an adherence rate (performed home visits/number of planned visits) of 84.0/80.5% from week 1–12/13–24. Out of those, 59% carried out ≥75% of the offered visits. Older age was associated with a higher adherence rate. A mean of 1.5 (0.6) visits/week (2 were planned) were realized lasting for a mean of 1.5 (0.9) hours (154% of the planned duration). Per visit, 1.2 (0.6) circuits of strength training were performed (60.5% of the planned value) and 0.5 (0.3) nutritional interventions (47%). After twelve months, 4.2% still carried out the home visits regularly and 25.0% occasionally. Conclusion: Adherence is much more than “being there”. Adherence rate and category are limited parameters to describe the implementation of a complex lifestyle intervention, therefore a comprehensive documentation is needed.

Lifestyle in general (nutrition, exercise, smoking habits), besides the genetic predisposition, is known to be a strong predictor for the development of diabetes. Exercise in particular is not only useful in improving glycaemia by lowering insulin resistance and positively affect insulin secretion, but to reduce cardiovascular risk.To gain substantial health benefits a minimum of 150 min of moderate or vigorous intense aerobic physical activity and muscle strengthening activities per week are needed. The positive effect of training correlates directly with the amount of fitness gained and lasts only as long as the fitness level is sustained. The effect of exercise is independent of age and gender. It is reversible and reproducible.Based on the large evidence of exercise referral and prescription the Austrian Diabetes Associations aims to implement the position of a "physical activity adviser" in multi-professional diabetes care.

AIM Previous research suggests that multicomponent interventions including physical training, and nutritional and social support are required to improve a person's behavior. As a pre-specified secondary outcome, this analysis aimed to ascertain whether a "buddy-style" intervention could produce physical activity and nutritional behavior changes in older adults. METHODS A 12-week, home-based, randomized controlled trial was carried out with 80 older persons, who were randomly assigned to an intervention group (n = 39), including physical training and nutritional support, and a control group (n = 41). Trained non-professional volunteers visited the participants at home twice a week. Physical activity and nutritional behavior were assessed through validated questionnaires. RESULTS In total, 36 participants in the intervention group and 26 participants in the control group completed the final questionnaire. The intervention group showed significant improvements in physical activity behavior, such as light sport activity (β = 9.13, 95% CI 0.90-17.37 min/day; P = 0.030), muscle strength exercise (β = 68.18, 95% CI 46.45-89.91 min/week; P

Bewegungsmangel ist einer der wesentlichen Risikofaktoren bei der Entstehung von Ubergewicht und Adipositas. Um einen substantiellen gesundheitlichen Nutzen zu erreichen, sollten Erwachsene wochentlich mindestens 150 min aerobe Aktivitat mit mittlerer bzw. 75 min mit hoherer Intensitat erreichen und zusatzlich muskelkraftigende Ubungen durchfuhren. Diese Empfehlung stellt die Untergrenze und nicht das Optimum dar. Um deutlich an Gewicht zu verlieren, ist ein wesentlich hoheres Ausmas an korperlicher Aktivitat erforderlich. Bewegungsprogramme konnen einen wichtigen Beitrag dazu leisten. Die osterreichischen Pilotprojekte „Aktiv Bewegt“ und „GEHE-Adipositas“ konnten zeigen, dass sich Frauen und Manner mit Adipositas fur strukturierte Bewegungsprogramme interessieren und diese auch nutzen. Wichtig dabei waren klare Qualitatskriterien, die Abgrenzung zu herkommlichen Programmen fur bereits aktive und fitte Personen, sowie die Information uber eine(n) ArztIn oder andere Gesundheitsberufe.

Background: For developed countries, healthy aging is one of the challenges and the number of healthy life years and especially the quality of life (QoL) are important. Objective: This study aimed to assess the association between nutritional status and different domains of QoL in (pre)frail community-dwelling elders. Design: Baseline data from persons, who participated in a 12-week nutritional and physical training intervention program, conducted from September 2013 - July 2015. Setting: (Pre)frail community-dwelling elders living in Vienna, Austria. Participants: A total of 83 older persons living at home, 12 men and 71 women (86%) aged 65 to 98 years. Measurements: Structured interviews were conducted at participants’ homes. Mini Nutritional Assessment® long-form (MNA®-LF) was used to investigate the nutritional status. The QoL domains were assessed with the World Health Organization Quality of Life questionnaires. Simple and multiple linear regression analyses were performed to evaluate the association between nutritional status and QoL domains, adjusted for possible confounders. Results: 45% of the participants were at risk of malnutrition and 3% were malnourished. Compared to normal nourished people, persons who had an impaired nutritional status, significantly differed in the QoL domain ‘autonomy’ with mean (SD) scores of 50.0 (14.9) vs. 57.3 (13.7); p=0.022 and in the QoL domain ‘social participation’ with scores of 40.1 (13.6) vs. 47.0 (11.2); p=0.014, respectively. According to linear regression analyses, the MNA®-LF score was significantly associated with ‘overall QoL’ (β=0.26; p=0.016) and the QoL domains ‘physical health’ (β=0.23; p=0.036), ‘autonomy’ (β=0.27; p=0.015), and ‘social participation’ (β=0.28; p=0.013). Conclusions: There was a significant association between nutritional status and QoL in elderly (pre)frail community-dwelling people, in particular for the QoL domains ‘autonomy’ and ‘social participation’. However, it remains unclear whether malnutrition was the cause or the consequence, or it was mediated through a third possible factor e.g. the functional status.

Actions in partnership across sectors is one principle for the promotion of health behaviours. The objective of this study was to describe the participation in a sports club-based exercise programme—named JACKPOT—following an intervention in a health care setting. Focus was given to the recruitment into JACKPOT, the attendance level, and whether the different programme elements were implemented as intented. The practicability of the project was also retrospectively rated. Participants were 238 inactive people (50% women) between 30 and 65 years of age who attended a health resort. Of these, 77% were assigned to the intervention group (IG). The recruitment into the 12 JACKPOT sessions and the attendance levels were recorded via attendance lists. The implementation of the intervention standards was assessed with structured interviews and participatory observation. The Pragmatic Explanatory Continuum Indicator Summary (PRECIS)-2 tool served to rate the practicability of the project. Almost 50% of the IG subjects attended JACKPOT sessions at least once and 54% of the attenders visited ≥75% of the 12 sessions. Some of the programme elements were not delivered fully. The process evaluation results showed that the project worked in a real-world setting, and also uncovered potential reasons such as incomplete information delivery for the moderate recruitment and attendance level.

The aim of the study was to compare the effects of home visits with physical training and nutritional support on inflammatory parameters to home visits with social support alone within a randomized controlled trial. Prefrail and frail persons received home visits from lay volunteers twice a week for 12 weeks. Participants in the physical training and nutritional intervention group (PTN, n = 35) conducted two sets of six strength exercises and received nutritional support. The social support group (SoSu, n = 23) received visits only. TNF-α, IL-6, CRP, and total leukocyte count were assessed at baseline and after 12 weeks. Changes over time within groups were analyzed with paired t-tests; differences between groups were analyzed with ANCOVA for repeated measurements. In the PTN group, IL-6 and CRP remained stable, whereas in the SoSu group, IL-6 increased significantly from a median value of 2.6 pg/l (min-max = 2.0-10.2) to 3.0 pg/l (min-max = 2.0-20.8), and CRP rose from 0.2 mg/dl (min-max = 0.1-0.9) to 0.3 mg/dl (min-max = 0.1-3.0) after 12 weeks. In CRP, a significant difference between groups was found. TNF-α and total leukocyte count did not change in either the PTN group or the SoSu group. Persons showing an increase in physical performance (OR 4.54; 95% CI = 1.33-15.45) were more likely to have constant or decreased IL-6 values than persons who showed no improvement. In conclusion, in non-robust older adults, a physical training and nutritional support program provided by lay volunteers can delay a further increase in some inflammatory parameters.

Background Due to the demographic ageing process and the increasing number of pre-frail and frail individuals, new lifestyle interventions to enhance the quality of life (QoL) in community-dwelling older adults are necessary. Therefore, we performed a randomised controlled trial (RCT) to compare effects of a lay-led home-based physical and nutritional intervention programme with social support alone on different QoL domains in community-dwelling pre-frail and frail older adults. Methods In this analysis within a RCT (12 weeks), lay volunteers visited one-on-one pre-frail or frail older adults at home twice a week. Participants in the physical training and nutritional intervention (PTN) group performed six strength exercises and discussed main nutritional issues during each visit. The social support (SOSU) group received home visits twice a week for social exchanges. The QoL was assessed with the WHOQOL-BREF and the WHOQOL-OLD instruments. Analyses of covariance (ANCOVA) were used to examine differences between groups with baseline values as the covariate. Changes within groups were assessed with paired t-tests. Results Eighty participants (n = 39 in the PTN group and n = 41 in the SOSU group) were included. No significant differences were found between the two groups except in past, present and future activities domain [β = 3.66 (95% confidence interval 0.13 to 7.18)] in favour of the PTN group. However, there was some evidence of greater within group improvements in the PTN group particularly in overall QoL, social relations and social participation. In the SOSU group, no significant effect was observed in any QoL domain. Conclusion A combination of a home-based physical and nutritional intervention was not more effective compared to social support alone, on QoL in community-dwelling pre-frail and frail older adults. However, the small but significant improvement within the PTN group suggests that a home-based physical and nutritional intervention delivered by volunteers may influence the QoL in a positive way. Trial registration The study protocol was registered on 6 November 2013 at ClinicalTrials.gov (identifier: NCT01991639 ).

Background Frailty is a common geriatric syndrome that carries an increased risk for poor health outcomes. Therefore it must be a public health priority. The common initial manifestation of frailty is weakness (low grip strength). As frailty might be reversible, the aim of the study was to examine the effects of a physical training and nutritional intervention provided by volunteers on frailty status and handgrip …

A randomized controlled trial was performed to compare the effects of a home-based physical and nutritional intervention program carried out by lay-volunteers to home visits with social support alone. Buddies visited 80 prefrail or frail older persons at home twice a week for 12 weeks. The physical training and nutrition group (PTN, n = 39) performed two sets of six strength exercises, discussed nutritional topics and received social support. The social support group (SoSu, n = 41) received home visits with social support only. In the PTN group, handgrip strength increased significantly by 2.4 kg (95% CI: 1.0-3.8). In the SoSu group we did not see a significant improvement. However, no significant between-group difference was found. Physical performance increased in both groups, although with a higher increase of 1.0 point (95% CI: 0.1-2.0) in the PTN group. In none of the groups muscle mass changed. Further results showed that frail individuals benefit more from the intervention than prefrail individuals (OR: 2.78; 95% CI: 1.01-7.66). Handgrip strength in the intervention group increased by a clinically relevant value and this effect is comparable to that obtained by health-care professionals. Therefore, home visits with a physical training and nutritional program could offer a new perspective in the care of community-dwelling prefrail and frail older persons.

Background In older adults, fear of falling (FOF) leads to a decline in daily physical activity quality of life and an increased risk of falling. The aim of this randomised controlled trial was to assess the effects of a 12-week home-based intervention program carried out by lay volunteers on FOF in frail older adults. Methods Thirty-nine participants were randomised to a physical training and nutrition (PTN) group and 41 participants to a social support (SOSU) group. In the PTN group, strength training and conversation about optimising nutrition were performed twice weekly, and the SOSU group received home visits without intervention. FOF and change of FOF were assessed using the Falls Efficacy Scale – International (FES-I). The Short Physical Performance Battery (SPPB), the Physical Activity Scale for the Elderly (PASE) and maximum handgrip strength and their changes were also assessed. Results The mean FES-I score at baseline was 42.7 points and was significantly associated with the SPPB and PASE scores. The FES-I score significantly changed in the PTN group from 44.1 to 39.9 points over the course of the intervention. Twenty-seven percent of the participants showed a decreased FES-I score of at least 4 points. This decrease was associated with an increase in the SPPB score and an increase in handgrip strength Conclusion A 12-week structured physical training and nutrition intervention carried out by lay volunteers, which leads to an increase in physical activity and improved physical performance, can reduce FOF by about 10%.

Lifestyle in general (nutrition, exercise, smoking habits), besides the genetic predisposition, is known to be a strong predictor for the development of diabetes. Exercise in particular is not only useful in improving glycaemia by lowering insulin resistance and positively affect insulin secretion, but to reduce cardiovascular risk.To gain substantial health benefits a minimum of 150 min of moderate or vigorous intense aerobic physical activity and muscle strengthening activities per week are needed. The positive effect of training correlates directly with the amount of fitness gained and lasts only as long as the fitness level is sustained. The effect of exercise is independent of age and gender. It is reversible and reproducible.Based on the large evidence of exercise referral and prescription the Austrian Diabetes Associations aims to implement the position of a "physical activity adviser" in multi-professional diabetes care.

The aim of this study was to examine the effects of a home-based and volunteer-administered physical training and nutritional intervention program compared with social support intervention on nutritional and frailty status in prefrail and frail community-dwelling older persons.This was a randomized controlled trial in which community-dwelling persons (mean age = 83 years) were recruited and randomly assigned to the physical training and nutritional intervention group (PTN, n = 39) and the social support group (SoSu, n = 41). The study was conducted by trained lay nonprofessionals.The community-dwelling older persons in both groups were visited twice a week by trained nonprofessional volunteers (buddies) in Vienna, Austria.Eighty prefrail and frail adults aged 65 years or older.In the PTN group, both the buddies and older persons performed 6 strength exercises within a circuit training session and discussed nutrition-related aspects. The active control group (SoSu) had the opportunity to perform cognitive training in addition to the social contact.Outcome measures as nutritional (Mini Nutritional Assessment long form [MNA-LF]) and frailty status (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe [SHARE-FI]) were obtained at baseline and after 12 weeks.Significant improvements in the MNA-LF score (1.54 points, 95% confidence interval [CI] 0.51-2.56; P = .004) and the SHARE-FI score (-0.71 discrete factor score values, 95% CI -1.07, -0.35; P .001) were observed in the PTN group after 12 weeks. In both groups, the prevalence of impaired nutritional status and frailty decreased significantly over time. The prevalence of impaired nutritional status decreased by 25% in the PTN group and by 23% in the SoSu group. Moreover, the prevalence of frailty decreased by 17% in the PTN group and by 16% in the SoSu group. The presence of impaired nutritional status at baseline was independently associated with greater changes in the nutritional (adjusted odds ratio [OR] 3.18, 95% CI 1.26-7.98; P = .014) and frailty status (adjusted OR 3.16, 95% CI 1.01-9.93; P = .049) after 12 weeks.The results indicate that a home-based physical training, nutritional, and social support intervention conducted by nonprofessionals is feasible and can help to tackle malnutrition and frailty in older persons living at home. Furthermore, social support alone also can result in improvement. In particular, older adults with impaired nutritional status at baseline can benefit more from the intervention. Such a home visit program might also have the potential to prevent future health risks and could allay isolation and loneliness.

ObjectiveTo evaluate self-assessed knowledge about diabetes mellitus, to assess determinants of health knowledge and to evaluate consequences of health knowledge on appraisal about consequences of the disease.DesignPopulation-based computer-assisted web interview survey, supplemented with a paper-and-pencil survey via post.SettingRepresentative sample of the general Austrian population aged 15 years and older.SubjectsMen (n 1935) and women (n 2065) with and without diabetes mellitus.ResultsSome 20·5 % of men and 17·7 % of women with diabetes, and 46·2 % of men and 36·7 % of women without diabetes, rated their knowledge about diabetes mellitus to be ‘very bad’ or ‘rather bad’. Individuals with diabetes and individuals with a family member with diabetes rated their information level more often as ‘very good’ or ‘rather good’, with adjusted OR (95 % CI) of 1·7 (1·1, 2·8) and 2·1 (1·6, 2·7), respectively, in men and 2·7 (1·5, 4·8) and 2·7 (2·1, 3·5), respectively, in women. Additional significant influencing factors on diabetes knowledge were age and educational level in both sexes, and city size in men. Independent of personal diabetes status, diabetes knowledge was associated with a lower perception of restrictions on daily life of diabetes patients and with a lower probability of underestimating health consequences of diabetes.ConclusionsHealth knowledge is associated with fewer misconceptions and less underestimation of health consequences in individuals both with and without diabetes mellitus. Thus health information about diabetes is important on the individual level towards disease management as well as on the public health level towards disease prevention.

We aimed to evaluate if an outpatient department is a suitable place to recruit people who suffer from Diabetes Mellitus for exercise programs. Therefore, a survey was conducted at the outpatient department of Endocrinology and Metabolism of the Medical University of Vienna. All in all, 104 persons (44 women, 60 men; age: 62.38 ± 13.69 years) were included in the study. We evaluated their interest in exercise programs, which consisted of cardiovascular exercise, strength- and flexibility-training and were offered in the 10th and 13th districts of Vienna. Almost half of the interviewed patients (43%) were interested in exercise programs and eventually almost one quarter (23%) participated in the program. Crucial factors were young age (p = 0.034) and a good economic situation (p = 0.046), which positively affected the participation in the exercise program. We could also detect gender-specific health awareness, as more women than men were interested and finally took part in the courses (3 of 10 women vs. 1 of 10 men, p = 0.023). Our results show that an outpatient department is a suitable place to recruit diabetic patients for exercise programs. However, the limited number of high-quality exercise programs might have decreased the number of participants, as the courses were only offered in two districts. Due to that, the majority of the interviewed persons could not be offered these programs in the vicinity of their places of residence. To promote health awareness and to cover the demand of exercise courses, more high-quality facilities and more focused health care provider services are needed.

Physical inactivity is one of the major risk factors for people to become overweight or obese. To achieve a substantial health benefit, adults should do at least 150 min of moderate or 75 min of high intensity aerobic activity per week and additionally they should do muscle strengthening exercises. This recommendation represents the lower limit and not the optimum. To loose body weight a significantly higher level of physical activity is required. Exercise programs can play an important part to reach the required level of health-enhancing physical activity. The Austrian pilot projects "Aktiv Bewegt" and "GEHE-Adipositas" showed that obese adults were interested in structured exercise programs and that they were also willing to use them. Clear defined quality criteria, the differentiation from conventional programs for already active and fit people and a recommendation from a doctor or other health professionals were important motivation reasons.

Weekly 150 min of moderate to vigorous physical activity and muscle-strengthening activities are a major public health goal. The International Physical Activity Questionnaire—short form was applied in 467 students of the 4th year at the Medical University of Vienna and compared with subsamples of data from the Austrian Health Interview Survey, 795 subjects with and 1131 subjects without higher education aged 20–29 years. Median values for weekly total energy expenditure were 3083, 3048, and 3816 MET-minutes (P < 0.001) in medical students, higher and lower educated subjects of the general population. Energy expenditure with vigorous intensity was highest in medical students. A total of 39.4 % of medical students reached the minimum requirements of the national physical activity recommendations. Although medical students are taught those recommendation and are aware of their health benefits, only a minority reach them. If medical students engage in physical activity, they do it with higher intensity than the general population.

Background:Although the infrastructure of Austrians’ sports clubs is well developed, exercise classes for people suffering from type II diabetes mellitus (T2DM) do not exist. This feasibility study evaluates factors for participating in target group specific exercise courses (TGSEC) and changes in physical activity.Methods:This intervention study was performed in 22 communities of Austria. Initial TGSEC were offered to T2DM patients over 2 months. Participants were surveyed at 4 time points with a questionnaire: before the program, 2, 6 and 12 months after the initial questionnaire.Results:881 patients aged 59.0 (SD: 9.6) years took part in TGSEC. At baseline a lack of suitable exercise groups prevented 51% from being active. 58% were encouraged by the medical sector. After 12 months the weekly time spent on exercise training was increased from 1.40 (SD: 2.55) hours to 2.15 (SD: 3.00) hours (P < .001). The dropout rate during the first 2 months was 12.9%. The rate of return for the 12 months questionnaire was 42%.Conclusion:TGSEC provided by sports clubs attract people suffering from T2DM and effectively enhance physical activity.

This study aimed to explore the association between the impaired nutritional status and frailty in acute hospitalised elderly patients by using two tools, the MNA®-SF (Mini Nutritional Assessment® short-form) and the SHARE-FI (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe).Cross-sectional study.Acute hospitalised, community-dwelling elderly patients were recruited at internal medicine wards in Vienna, Austria.133 men (39%) and women (61%) aged 74 (65-97) years.MNA®-SF was used to investigate malnutrition (7 points) and patients at risk of malnutrition (8 to 11 points). By using the SHARE-FI, subjects were classified as frail, pre-frail or robust. A factor analysis was applied to identify overlaps between the MNA®-SF and SHARE-FI items. Internal consistency of different dimensions was assessed by using Cronbach's Alpha.Malnutrition or risk of malnutrition was found in 76.7% of the total sample and in 46.8% of robust, in 69.0% of pre-frail, and in 93.0% of frail participants. Frailty or prefrailty was found in 75.9% of the total sample and in 45.1% of the subjects with no risk of malnutrition, in 80.9% of subjects at risk of malnutrition, and in 94.1% of malnourished patients. The two used tools show overlaps in three dimensions: (1) nutrition problems, (2) mobility problems and (3) anthropometric items with a moderate to strong internal consistency (Cronbach's Alpha of 0.670, 0.834 and 0.946, respectively). 64.7% of the total sample (79.5% of frail and 87.9% of malnourished subjects) would participate in a home-based muscle training and nutritional intervention program.This study underlines the association and the overlap between frailty and impaired nutritional status. There is a high readiness to participate in a program to tackle the problems associated with malnutrition and frailty, especially in those, who would benefit most from it.

Background In elderly persons frailty and malnutrition are very common and can lead to serious health hazards such as increased mortality, morbidity, dependency, institutionalization and a reduced quality of life. In Austria, the prevalence of frailty and malnutrition are increasing steadily and are becoming a challenge for our social system. Physical training and adequate nutrition may improve this situation. Methods/design In this randomized controlled trial, 80 malnourished frail community-dwelling patients (≥ 65 years) hospitalized at wards for internal medicine are recruited. Additionally, 80 lay volunteers (≥ 50 years), named buddies are recruited and subsequently trained regarding health enhancing physical activity and nutrition in four standardized training sessions. These buddies visit the malnourished frail persons at home twice a week for about one hour during an initial period of 10–12 weeks. While participants allocated to the intervention group (n = 40) receive intervention to improve their fluid intake, protein and energy intake, perform strength training and try to increase their baseline activities, the control group (n = 40) only gets home visits without any intervention. After 10–12 weeks, both, the intervention and the control group, receive the nutritional intervention and the physical training. Health, nutritional and frailty status, physical fitness, body composition and chronic inflammation of buddies and frail persons are recorded before the intervention, after 10–12 weeks, 6 and 12 months. Discussion To your knowledge this trial is the first of its kind to provide nutritional and physical activity interventions to malnourished frail community-dwelling persons by trained lay buddies, in which an improvement of the frail persons´ and the buddies’ health status is measured. This study assesses the efficacy of such an intervention and may offer new perspectives for the management of frailty and malnutrition. Trail registration ClinicalTrials.gov, NCT01991639

Purpose The aim of this study was to examine the associations between daily physical activity (DPA), handgrip strength, appendicular skeletal muscle mass (ASMM) and physical performance (balance, gait speed, chair stands) with quality of life in prefrail and frail community-dwelling older adults. Methods Prefrail and frail individuals were included, as determined by SHARE-FI. Quality of life (QoL) was measured with WHOQOL-BREF and WHOQOL-OLD, DPA with PASE, handgrip strength with a dynamometer, ASMM with bioelectrical impedance analysis and physical performance with the SPPB test. Linear regression models adjusted for sex and age were developed: In model 1, the associations between each independent variable and QoL were assessed separately; in model 2, all the independent variables were included simultaneously. Results Eighty-three participants with a mean age of 83 (SD: 8) years were analysed. Model 1: DPA (ß = 0.315), handgrip strength (ß = 0.292) and balance (ß = 0.178) were significantly associated with ‘overall QoL’. Balance was related to the QoL domains of ‘physical health’ (ß = 0.371), ‘psychological health’ (ß = 0.236), ‘environment’ (ß = 0.253), ‘autonomy’ (ß = 0.276) and ‘social participation’ (ß = 0.518). Gait speed (ß = 0.381) and chair stands (ß = 0.282) were associated with ‘social participation’ only. ASMM was not related to QoL. Model 2: independent variables explained ‘overall QoL’ (R 2 = 0.309), ‘physical health’ (R 2 = 0.200), ‘autonomy’ (R 2 = 0.247) and ‘social participation’ (R 2 = 0.356), among which balance was the strongest indicator. Conclusion ASMM did not play a role in the QoL context of the prefrail and frail older adults, whereas balance and DPA were relevant. These parameters were particularly associated with ‘social participation’ and ‘autonomy’.

More than 10 % (approximately 60,000) of the adult population in Styria, a federal state in the south of Austria, is granted a residential stay in a health resort each year. The target group for these stays is the general population aged between 30 and 65 years with minor symptoms such as risk factors for cardio-metabolic diseases. Stays are financed by health insurance companies and last up to three weeks. The treatment during the stays consists of exercise and nutritional intervention as well as psychological support when needed. However, because of the absence of regional programmes linked with the residential stay, the sustainability of the interventions is questionable. This prospective, controlled, multicentre, open-label study will compare two groups. Participants will be included in the study if they live in any of eight predefined Styrian regions and do not meet the minimal WHO physical activity guidelines. Those allocated to the intervention group will receive a voucher for 12 regional, standardised, sports club based exercise sessions. The members of the control group will come from different but matched Styrian regions and will receive an informative written brochure. The primary outcome will be the weekly level of health-enhancing physical activity, which will be objectively measured with an accelerometer and supplemented by an activity log book. Together with potential determinants of physical activity it will be assessed before, 10 weeks after and 12 months after the residential stay. Additionally, psychosocial determinants will be assessed by questionnaire and fitness (cardiorespiratory fitness, handgrip, balance) will be measured. In addition to the changes in measurable parameters, processes will be evaluated to learn about the facilitators and barriers of the implementation of the programme. It is known that during the residential stay, participants are receptive to new opportunities supporting health behaviour change, but that these measures are not sustained after discharge. The structured cooperation between the health sector that has to inform the participants and the sports sector that provides the wide network of standardised programmes is the strength of the study, but at the same time a challenge. ClinicalTrials.gov (Identifier: NCT02552134 ; date of registration: 15 September 2015)