Gesundheitswesen
DOI: 10.1055/a-2925-4082

In numerous chronic conditions, the positive effects of physical activity and exercise on health and health-related quality of life are beyond discussion. Thereby, a clear distinction must be made between physical activity, exercise therapy, and training. Clinical practice guidelines (CPGs) aim to provide evidence- and/or consensus-based decision-making frameworks within the context of healthcare. To date, however, it remains unclear how exercise, physical training, and movement-based health care services are addressed in German CPGs.A systematic document analysis was conducted of all available German CPGs on chronic conditions for which positive or at least inconclusive evidence regarding the effectiveness of physical activity was available. The present study examined the presentation of indication-specific evidence regarding physical activity, general recommendations on physical activity, recommendations on specific healthcare services, the involvement of professional associations with physical activity expertise, and information on indication-specific training recommendations (FITT principle: frequency, intensity, time, and type of exercise).A total of 79 CPGs on chronic conditions with positive evidence for physical activity and 15 CPGs with unclear evidence were included in the analysis. Indication-specific evidence regarding physical activity was reported in 65 CPGs (82%) referring to indications with positive evidence for physical activity and exercise and 12 (80%) on CPGs that referred to indications with unclear evidence. Recommendations on specific movement-based healthcare services were reported in 40 (51%) and 4 (27%) of CPGs, respectively. Complete training-specific recommendations in accordance with the FITT criteria were reported in 18 (23%) and 2 (13%) CPGs. Professional associations with physical activity expertise were involved in the development of 36 (46%) CPGs with positive evidence and 2 (13%) CPGs with unclear evidence for physical activity.Despite the well-documented health benefits of physical activity and exercise for chronic conditions, they have not yet been sufficiently integrated into relevant CPGs. This results in a relevant gap in healthcare provision and a reduction in the quality of care within the healthcare system. Consequently, expertise in physical activity and exercise should always be systematically integrated into the development of CPGs and physical activity-related healthcare services should be specifically promoted and expanded.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Gesundheitswesen
DOI: 10.1055/a-2930-2321

Digitale bewegungsbezogene Versorgungsleistungen (dbVL) gewinnen zunehmend in der deutschen Gesundheitsversorgung an Bedeutung, während aktuell Qualitätsanforderungen und Wirksamkeitskriterien noch einem dynamischen Entwicklungsprozess unterliegen. Ziel des Beitrags ist eine begriffliche Einordnung von dbVL sowie die systematische Darstellung des Status quo der Einsatzmöglichkeiten und der Qualitätsanforderungen in der Versorgungspraxis.Für die begriffliche Einordnung wurden bestehende Perspektiven der Bewegungsversorgung sowie internationale Klassifikationssysteme digitaler Gesundheitsinterventionen berücksichtigt. Gesetzliche Rahmenbedingungen sowie spezifische Qualitäts- und Wirksamkeitsanforderungen für die Versorgung mit dbVL wurden aus verfügbaren, versorgungsrelevanten Dokumenten systematisch synthetisiert.In allen Versorgungskontexten ermöglichen die gesetzlichen Rahmenbedingungen grundsätzlich den Einsatz von dbVL. Die Analyse zeigt jedoch eine erhebliche, teils sektoral bedingte Heterogenität und Fragmentierung hinsichtlich der Qualitäts- und Wirksamkeitsanforderungen.Die Analyse verdeutlicht den Bedarf einheitlicher und kontextübergreifender Systematisierungen, Qualitätsanforderungen und Evaluationskriterien für dbVL. Zentrale abgeleitete Positionen sind die Einbindung bewegungsbezogener Expertise, nutzerinnen- und nutzerzentrierte Entwicklung und technologieadäquate Evaluationsansätze. Zugleich wird sichtbar, dass die derzeitige sektorale Fragmentierung konsensfähige, kontextübergreifende Evidenz- und Nutzenkonzepte sowie perspektivisch eine kohärentere regulatorische Neu-/Umordnung erfordert.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Gesundheitswesen
DOI: 10.1055/a-2786-4697

Pediatric cancer leads to various health issues that call for long-term, cross-sectoral aftercare. Physical activity and exercise are effective regarding many outcomes, but remain underused in pediatric oncology. Initiatives like the German ActiveOncoKids network (NAOK) aim to integrate physical activity into usual care. Effective cross-sectoral networks require coordination and leadership. NAOK has made recent advancements in network coordination. This study aimed to better understand the role of network coordination to strengthen future network development and explored the tasks of network coordination and the required competencies from the viewpoint of NAOK stakeholders.In an exploratory approach, qualitative, partly structured interviews were led with 23 stakeholders of NAOK: members of the project team and the advisory board, physicians and exercise therapists from acute clinics and aftercare as well as affected families. The interviews were analyzed using structuring content analysis with concurrent deductive and inductive creation of main categories, dimensions and expressions.Based on the interviews, 3 main categories were created: current tasks on an organizational level, current tasks on an individual level and required competencies with 11 dimensions and 33 expressions overall. Regarding organizational-level tasks, network management as well as public relations were mentioned. Additionally, contact with locations such as clinics and both research and implementation efforts were stressed. Tasks at the individual level were identified by interviewees in counseling for both affected families as well as professionals. Mentioned competencies stretched across professional, socio-communicative and personal ones.The findings provide first insights into tasks and competencies in network coordination at NAOK. Both tasks and competencies that are being mentioned are very broad, which reflects the nature of pediatric oncology and cross-sectoral physical activity promotion. The study offers hints for future task allocation of network coordination and indicates the need for a competency framework.
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Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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