Jonas David Finger

Background: Despite the importance of physical activity (PA) for the physical, cognitive, and socio-emotional development of children, the effects of public policies on PA outcomes in early childhood education and care have only recently been investigated. As the available evidence is relatively recent, it has not yet been integrated into existing policy assessment tools. To address this gap, this study aimed to develop an instrument to assess the PA-related content of policies in early childhood education and care. Methods: The instrument was developed through a multi-phase co-production process involving researchers and representatives from state-level health reporting authorities in Germany. Development was guided by a conceptual framework for policy content analysis and comprised three phases: (1) prototype development based on a systematic analysis of all 16 German educational framework plans, a systematic literature review on the effectiveness of public policies promoting PA in early childhood education and care, and a structured search for national and international policy recommendations; (2) expert consultation using a two-round Delphi survey ( n = 24 in round 1; n = 26 in round 2), with indicators rated on a 10-point Likert scale and summarized using median scores; and (3) pilot testing in five German federal states to assess feasibility, clarity, and applicability of the instrument. Results: The initial prototype of the assessment instrument comprised 24 indicators. Several revisions throughout the development process resulted in a final version containing 28 indicators across eight thematic domains (e.g., pedagogical concept, education-related objectives, outdoor PA opportunities, indoor PA opportunities). Pilot testing confirmed the instrument’s applicability and feasibility within state-level health reporting, and minor refinements were made to improve the clarity and completeness of individual indicators. Time needed to complete the instrument ranged from approximately one to six hours. Conclusions: This study developed the first instrument specifically designed to assess the PA-related content of early childhood education and care policies. This may support intersectoral collaboration between the health and youth sector, and could inform future decision-making processes. Moreover, future studies may test its applicability in other countries.

Background: Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy. Methods: Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status. Results: High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39–1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75–0.95). The associations persisted after adjusting for covariates. Conclusion: High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach.

Introduction: The numerous health benefits of physical activity (PA) for people with non-communicable diseases (NCDs) are well-documented. In Germany, there are limited data on whether adults with NCDs fulfill health-oriented PA recommendations. This study describes the prevalence of meeting PA recommendations among adults with select NCDs. Method: Based on the national representative GEDA-2014/2015-EHIS (N = 24,016), the self-reported PA data of the European Health Interview Survey–Physical Activity Questionnaire (EHIS-PAQ) were classified with respect to fulfilling recommendations for health-enhancing aerobic activities (≥ 150 min per week with at least moderate intensity) and muscle strengthening (≥ 2 times per week). These binary indicators were used to analyze the association between the prevalence of sufficient PA and the self-reported presence of certain NCDs and multiple NCDs to reflect multimorbidity. Results: Compared to the general adult population, sufficient aerobic PA was lower for most NCDs, with the lowest level among people with diabetes mellitus, obesity, stroke, chronic obstructive pulmonary disease (COPD), and depression. Compared to the general adult population, sufficient muscle strengthening was lower for some NCDs (diabetes mellitus, obesity, depression), but it was higher in people with musculoskeletal diseases (osteoarthritis, lower back pain). Multimorbidity was negatively associated with sufficient PA levels. Conclusion: The study specifies the need to promote PA among adults with select NCDs to counteract insufficient levels of health-enhancing PA and to reduce the individual and societal burden of NCDs.

Zusammenfassung: Ziel der Studie Das Ziel dieser Auswertung ist die Erstellung bundesweiter, bevölkerungsbezogener Referenzwerte für herzfrequenzbasierte Indikatoren der kardiorespiratorischen Fitness sporttauglicher Erwachsener im Alter von 18 bis 64 Jahren.Methodik Auf der Datenbasis von 2826 Teilnehmenden des submaximalen Fahrradergometer-Tests in der „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1) 2008–2011 wurden folgende körpergewichtsbezogene Indikatoren gebildet: Physical Working Capacity (herzfrequenzbezogene Leistung) bei 150 und 130 S/min, bei 75% der geschätzten maximalen Herzfrequenz (PWC130, PWC150 und PWC75%) sowie die herzfrequenzbasiert geschätzte maximale Sauerstoffaufnahme (VO2max). Die Referenzwerteberechnung erfolgte mit der LMS-Methode nach Cole & Green 1992.Ergebnisse Das 25., 50. und 75. Perzentil der PWC150 liegt bei Männer bei 1,50, 1,77 und 2,08 Watt/kg. Die entsprechenden Werte bei Frauen sind 1,18, 1,44 und 1,69. Das 25., 50. und 75. Perzentil der PWC130 liegt bei Männer bei 1,16, 1,41 und 1,68 Watt/kg. Die entsprechenden Werte bei Frauen sind 0,81, 1,05 und 1,29. Die altersabhängigen Mediane bei Männern und Frauen sind für die PWC75% 1,87 – Alter in Jahren× 0,01 und 1,31 – (Alter in Jahren/100)2 x 0,98 und für die VO2max bei Männern 41,7 – Alter× 0,15.Schlussfolgerung Die präsentierten Ergebnisse können als Referenzwerte für die Einschätzung der individuellen kardiorespiratorischen Fitness von in Deutschland lebenden Erwachsenen eingesetzt werden. Sie können außerdem als Basis für ein regelmäßiges Monitoring dienen.

Increased cardiorespiratory fitness is related to decreased risk of major chronic illnesses, including cardiovascular disease, type 2 diabetes, and cancer, but its association with colorectal cancer specifically has received very little attention. We examined the relation of cardiorespiratory fitness to colorectal cancer in 59,191 UK Biobank participants aged 39–70 years without prevalent cancer at baseline, followed from 2009 to 2014. Submaximal bicycle ergometry was conducted at study entry, and cardiorespiratory fitness was defined as physical work capacity at 75% of the maximum heart rate, standardised to body mass (PWC_75%). Multivariable Cox proportional hazards regression was performed to obtain hazard ratios (HR) and corresponding 95% confidence intervals (CI). During a mean follow-up of 4.6 years, 232 participants developed colorectal cancer (151 colon cancers; 79 rectal cancers). When comparing the 75th to the 25th percentiles of PWC_75%, the multivariable-adjusted HR of colorectal cancer was 0.78 (95% CI 0.62–0.97). That relation was largely driven by an inverse association with colon cancer (HR 0.74, 95% CI 0.56–0.97) and less so with rectal cancer (HR 0.88, 95% CI 0.62–1.26; p value for difference by colorectal cancer endpoint = 0.056). The inverse relation of cardiorespiratory fitness with colorectal cancer was more evident in men (HR 0.72, 95% CI 0.55–0.94) than women (HR 0.99, 95% CI 0.71–1.38), although the gender difference was not statistically significant (p value for interaction = 0.192). Increased cardiorespiratory fitness is associated with decreased risk of colorectal cancer. Potential heterogeneity by colorectal cancer anatomic subsite and gender requires further study.

This study aimed at estimating the prevalence in adults of complying with the aerobic physical activity (PA) recommendation through transportation-related walking and cycling. Furthermore, potential determinants of transportation-related PA recommendation compliance were investigated. 10,872 men and 13,144 women aged 18 years or older participated in the cross-sectional ‘German Health Update 2014/15 – EHIS’ in Germany. Transportation-related walking and cycling were assessed using the European Health Interview Survey-Physical Activity Questionnaire. Three outcome indicators were constructed: walking, cycling, and total active transportation (≥600 metabolic equivalent, MET-min/week). Associations were analyzed using multilevel regression analysis. Forty-two percent of men and 39% of women achieved ≥600 MET-min/week with total active transportation. The corresponding percentages for walking were 27% and 28% and for cycling 17% and 13%, respectively. Higher population density, older age, lower income, higher work-related and leisure-time PA, not being obese, and better self-perceived health were positively associated with transportation-related walking and cycling and total active transportation among both men and women. The promotion of walking and cycling among inactive people has great potential to increase PA in the general adult population and to comply with PA recommendations. Several correlates of active transportation were identified which should be considered when planning public health policies and interventions.

Regelmäßige körperliche Aktivität und eine gute motorische Leistungsfähigkeit stellen die Grundlage für eine gesunde körperliche Entwicklung im Kindesalter dar und gelten als Schutzfaktor für verschiedene Gesundheitsrisiken. Kinder und Jugendliche in Deutschland sind jedoch zu wenig körperlich aktiv, u. a. weil sitzende Tätigkeiten zugenommen haben. Eine Folge ist der Rückgang der motorischen Leistungsfähigkeit, also der Gesamtheit der Strukturen und Funktionen, die für die Durchführung von Bewegungshandlungen verantwortlich sind. In der zweiten Folgebefragung der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS Welle 2, 2014–2017) wurde die motorische Leistungsfähigkeit (LF) 4‑ bis 10-jähriger Kinder mit drei motorischen Tests untersucht: Einbeinstand (EIN), Rumpfbeugen (RB) und seitliches Hin- und Herspringen (SHH). Ziel des vorliegenden Beitrags ist es, die Ergebnisse der Tests vorzustellen und diese mit den Daten der KiGGS-Basiserhebung (2003–2006) zu vergleichen. Zudem wird analysiert, inwiefern sich die motorische Leistungsfähigkeit in Bezug auf verschiedene Merkmale wie soziodemografische Faktoren, Übergewicht und sportliche Aktivität unterscheidet. Im Vergleich zu KiGGS-Basis hat sich die motorische Leistungsfähigkeit 4‑ bis 10-Jähriger in KiGGS Welle 2 zwar im EIN geringfügig verbessert, im RB und SHH dagegen stagniert sie auf niedrigem Niveau. Die Testergebnisse deuten darauf hin, dass ein mittlerer und hoher Sozialstatus, Vereinssportaktivität und „kein Übergewicht“ mit einer überdurchschnittlichen motorischen Leistungsfähigkeit in Zusammenhang stehen. Damit alle Kinder die gleiche Chance auf eine gute motorische Leistungsfähigkeit haben, sollten Gesundheitspolitik, Sportorganisationen, Schulen und Kindergärten verstärkt zusammenarbeiten. Regular physical activity and good motor performance are the basis for healthy physical development in childhood and are considered a protective factor for various health risks. However, children and adolescents in Germany are not physically active enough because sedentary activities have increased. One consequence is the decline in motor capacity, the totality of structures and functions that are responsible for the performance of motor actions. In the second follow-up survey of the study on the health of children and adolescents in Germany (KiGGS Wave 2, 2014–2017), the motor performance (LF) of 4‑ to 10-year-old children was examined with three motor tests: one-leg stand (EIN), stand and reach (RB), and jumping sideways (SHH). The purpose of this paper is to present the results of the tests and to compare them with data from the KiGGS baseline survey (2003–2006). It also analyzes how motor performance differs in terms of different characteristics such as sociodemographic factors, obesity, and physical activity. Compared to the KiGGS baseline survey, the 4‑ to 10-year-olds’ motor performance in KiGGS Wave 2 has slightly improved in EIN, but RB and SHH are stagnating at low level. The test results indicate that middle and high social status, club sport activity, and “no overweight” are associated with above-average motor performance. Health policy, sports organizations, schools, and kindergartens should work together more closely so that all children have the same chance of good motor performance.

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. 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. 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. 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.

Enhanced cardiorespiratory fitness (CRF) is now a well-established predictor of numerous adverse health outcomes. Knowledge about the pathways leading to enhanced CRF is essential for developing appropriate interventions. Hence, the aim of this review was to provide a detailed overview of the current state of research regarding individual factors associated with or influencing CRF among the general adult population. We searched the PubMed, EMBASE, and Cochrane Library databases and also conducted a search for grey literature (Google Scholar). Eligible indicators of CRF were objectively assessed measures of CRF by submaximal or maximal exercise testing measured using treadmill or cycle ergometer tests. We included quantitative observational studies of the general adult population. Using a semi-quantitative approach, we compiled summary tables aggregating the study results for each potential correlate or determinant of CRF. We identified 3005 studies, 78 of which met the inclusion criteria. Almost all of these studies were conducted in high-income countries. Study quality scores assessing the risk of bias in the individual studies ranged from 40 to 100%. Male sex, age (inverse), education, socioeconomic status, ethnicity, body mass index (inverse), body weight (inverse), waist circumference, body fat (inverse), resting heart rate (inverse), C-reactive protein (inverse), smoking (inverse), alcohol consumption, and multiple measures of leisure-time physical activity were independently and consistently associated with CRF. In synthesizing the current research on the correlates and determinants of CRF among adults, this systematic review identified gaps in the current understanding of factors influencing CRF. Beyond the scope of this review, environmental and interpersonal determinants should be further investigated. PROSPERO, CRD42017055456.