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Widespread persistent inactivity makes continued efforts in physical activity promotion a persistent challenge. The precise content of physical activity recommendations is not broadly known, and there are concerns that the general messaging of the guidelines, including the recommendations to perform at least 150 min of at least moderate intensity physical activity per week might seem unattainable for and even actually discourage currently inactive people. Here we show that there are a myriad of ways of being physically active, and provide (in part) out-of-the-box examples of evidence based, pragmatic, easily accessible physical activity regimes below 150 min and/or with lower than moderate intensity that yield meaningful health benefits for currently inactive people.
Ziel der vorliegenden Arbeit ist es, basierend auf den eigenen Publikationen, aktuelle Erkenntnisse aus dem Themenkomplex „Sitzen und Gesundheit“ einschließlich Gesundheitspotentiale leichter Aktivitäten bei Erwachsenen resümierend zusammenzustellen und kritisch zu bewerten.
Das Augenmerk der bewegungsbezogenen Gesundheitsforschung galt anfänglich primär den sportlichen und eher intensiven körperlichen Aktivitäten. Neuere Erkenntnisse lassen annehmen, dass auch andere Bewegungsarten als Sport, z.B. Bewegung im Alltag, gesundheitswirksam sein können. Die besondere Bedeutung dieser Aktivitäten liegt darin, dass sie mit wenigen Ausnahmen für jeden geeignet, risikoarm und niedrigschwellig sind. Die am besten erforschte Alltagsbewegung ist das Gehen. Die gesundheitliche Benefits von Gehen gelten sowohl im Bereich der Prävention als auch der Therapie als wissenschaftlich gesichert. Regelmäßiges Fahrradfahren verbessert die kardiorespiratorische Fitness und mindert das Gesamtmortalitätsrisiko. Die Gesundheitseffekte anderer Alltagsaktivitäten lassen sich u.a aufgrund methodischer Herausforderungen schwieriger nachweisen und quantifizieren. Neuere Arbeiten liefern Hinweise, dass Bewegung schon mit leichter Intensität zumindest bei unfitten und inaktiven Bevölkerungsgruppen ein hohes Gesundheitspotential haben kann.
Veränderte Lebensgewohnheiten in Lebensbereichen wie z.B. Arbeit, Freizeit und Fortbewegung haben dazu geführt, dass ein überwiegender Anteil der Bevölkerung den Tag sitzend verbringt. Seit den letzten 10-15 Jahren widmet sich eine wachsende Anzahl von Arbeitsgruppen der Erforschung möglicher gesundheitlicher Konsequenzen des langen ununterbrochenen Sitzens. „Sendentäres Verhalten“ (sedentary behavior), in Abgrenzung zur Inaktivität, bezeichnet Aktivitäten, die sitzend oder zurücklehnend stattfinden und mit einem Energieverbrauch von 1-1,5 MET einhergehen. In Akzelerometerstudien wird sedentäres Verhalten als Aktivitäten, bei denen das Signal mindestens eine minutelang unter 100 counts per minute (cpm) ausweist, definiert.
Akzelerometerdaten deuten darauf hin, dass sedentäres Verhalten in den Industrieländern weit verbreitet ist: es macht bis zu 69% der wach verbrachten Zeit aus.
Unsere Literaturanalyse nach Reviews und systematischen Reviews zum Thema sedentäres Verhalten und Gesundheit bei Erwachsen ergab 13 Übersichtsarbeiten. Die Übersichtsarbeiten weisen eine hohe methodische Heterogenität auf. 9 der Übersichtsarbeiten sind narrative Reviews. Die Literaturanalyse liefert Hinweise für eine graduelle Abnahme der Evidenz für die Zusammenhänge von sedentärem Verhalten mit Mortalität, Morbidität und gesundheitlichen Risikofaktoren. Die Ergebnisse von Querschnitt- und Langzeitbeobachtungsstudien zu möglichen Auswirkungen sedentären Verhaltens auf die Gesundheit sind durch Interventionsstudien nur sehr bedingt untermauert, (patho)physiologische Wirkmechanismen hinter sedentärem Verhalten nicht gesichert, und ein klarer Dosis-Wirkungszusammenhang nicht definierbar. Dennoch scheint die Evidenzlage beim Endpunkt Mortalität relativ eindeutig, bei den Endpunkten Morbidität und Risikofaktoren aber zunehmend schwach und widersprüchlich. Im Fazit deuten die Ergebnisse dieser Übersicht – besonders beim Endpunkt Mortalität und etwas weniger eindeutig bei kardiovaskulären Erkrankungen und Diabetes – auf die gesundheitsschädliche Wirkung langen ununterbrochenen Sitzens hin. In der Konsequenz ist neben Aktivität gemäß Leitlinien zu empfehlen, längere Sitzphasen nach Möglichkeit zu unterbrechen und durch Bewegung mit zumindest leichter Intensität zu ersetzen.
Es liegen einige Hinweise vor, dass nicht nur die Gesamtzeit des sedentären Verhaltens, sondern auch das Muster, in dem es entsteht, von gesundheitlicher Relevanz sein könnte. Neben der Erforschung (patho)physiologischer Effekte des langen Sitzens, ist die Überprüfung von Machbarkeit und Akzeptanz von Unterbrechungsintervention von großer Relevanz. In unserer eigenen Untersuchung haben wir in vivo überprüft, wie weit Beschäftigte mit einer überwiegend sitzenden Tätigkeit vorgegebenen Unterbrechungsempfehlungen nachkommen können, wie sie diese subjektiv erleben und wie sie ihre eigene Bereitschaft einschätzen, die Empfehlungen auch längerfristig durchzuführen.
Unsere Ergebnisse deuten darauf hin, dass schon eine einmalige Information über die Gesundheitsrisiken langen Sitzens und über Unterbrechungen zu einer zumindest kurzfristigen Reduktion der Sitzphasen führen kann. In unserer Untersuchung erwies sich ein Unterbrechungsintervall von 60 Minuten als am ehesten realisierbar. Dieses Intervall wurde von den Teilnehmern am angenehmsten wahrgenommen.
Lockdown measures including the closure of physical activity facilities were installed against the spread of the novel coronavirus in March 2020. The aim of the current online survey was to assess the lockdown effects on physical activity in German adults. We assessed physical activity using the European Health Interview Survey (EHIS) questionnaire. Pre-lockdown vs. lockdown differences were tested with the X2 test and the Student’s t-test for paired data. Predictor variables to explain compliance with physical activity recommendations were identified using a fixed effects binary logistic regression analysis. Data of 979 respondents were analyzed. Transport related and leisure time physical activity decreased (p < 0.001, d = 0.16; p < 0.001, d = 0.22, respectively). Compliance with physical activity recommendations decreased from 38.1% to 30.4% (chi2 [1, 1958] = 12.754, p < 0.001, V = 0.08). In the regression analysis, BMI (OR 0.944, 95% CI 0.909–0.981; p = 0.003), education (OR 1.111, 95% CI 1.021–1.208; p = 0.015), transport related (OR 1.000, 95% CI 1.000–1.000; p = 0.008) and leisure time physical activity (OR 1.004, 95% CI 1.003–1.004; p < 0.001), muscle strengthening (OR 5.206, 95% CI 4.433–6.114; p < 0.001), as well as the ‘lockdown vs. normal’ categorical variable (OR 0.583, 95% CI 0.424–0.802; p = 0.001) showed a contribution, while sex (p = 0.152), age (p = 0.266), work related physical activity (p = 0.133), and remote working (p = 0.684) did not. Physical activity declined in German adults, and should also be promoted in light of the emerging evidence on its protective effects of against COVID-19. Special attention should be given to muscle strengthening activities and groups with lower educational attainment.
Physical activity counseling in primary health care is regarded as a useful complementary preventive and therapeutic measure and is advocated by leading public health institutions. This integrative review summarizes the available data on physical activity counseling in primary care in Germany. A systematic literature search in various databases (peer reviewed and grey literature) was carried out for quantitative and qualitative studies on physical activity counseling and use of “Exercise on Prescription”. The 25 studies included show a very high methodological diversity and, in some cases, considerable risks of bias, with limited comparability across studies. Counseling was provided in all studies by physicians. They report frequent physical activity counseling, which is partly confirmed and partly refuted by patient data. The use of “Exercise on Prescription” is at a very low level. Information on the frequency of physical activity counseling in Germany varies depending on data source and is sometimes contradictory. Our review provides a synthesis of various perspectives on routine physical activity counseling in primary care in Germany. Future studies using standardized and validated instruments in representative samples are needed to further knowledge on counseling and to be able to establish trends in prevalence. Strengthening the topics of physical activity and health and physical activity counseling in medical curriculum is strongly recommended.
Lockdown measures during the COVID-19 pandemic have led to reductions in physical activity (PA) worldwide. Leading public health organizations have recommended the use of online exercise classes (OEC) to compensate the loss of regular exercise classes. As of now, no data are available on the uptake of OEC and on users’ attitudes. The aim of the current online survey was to assess the use of and attitudes towards OEC in Germany. Respondents indicated awareness and use of OEC, and levels of agreement with statements on OEC. Frequency of awareness and use of OEC according to PA status were calculated with contingency tables and the Χ2 test. Differences between users and non-users were tested with the Student’s t-test and the Mann–Whitney U test. Data on attitudes are presented as percentages, and Spearman correlations were calculated between attitudes and activity status, frequency of use, educational attainment, age and body mass index. A total of 979 datasets were analyzed. Of the respondents, 681 were aware of and 180, 118 and 84 used them <1 per week, 1–2 per week and ≥3 per week, respectively. Significantly more active respondents were aware of and used OEC compared to less active respondents. All in all, regular OEC use was quite limited. OEC was differentially attractive to people according to PA status, frequency of use, BMI and age. Tailoring OEC to current non-users and adding motivational support might enhance the regular use of OEC.
The spread of the COVID-19 virus was met by a strict lockdown in many countries around the world, with the closure of all physical activity (PA) facilities and limitations on moving around freely. The aim of the present online survey was to assess the effect of lockdown on physical activity in Italy. Physical activity was assessed using the European Health Interview Survey questionnaire. A total of 1500 datasets were analyzed. Differences between conditions were tested with a chi2-based (χ2) test for categorical variables, and with the Student’s t-test for paired data. A fixed effects binary logistic regression analysis was conducted to identify relevant predictor variables to explain the compliance with World Health Organisation (WHO) recommendations. We found a substantial decline in all physical activity measures. Mean differences in walking and cycling metabolic equivalent of task minutes per week (METmin/week), respectively, were 344.4 (95% confidence interval (95% CI): 306.6–382.2; p < 0.001) and 148.5 (95% CI: 123.6–173.5; p < 0.001). Time spent in leisure time decreased from 160.8 to 112.6 min/week (mean difference 48.2; 95% CI: 40.4–56.0; p < 0.001). Compliance with WHO recommendations decreased from 34.9% to 24.6% (chi2 (1, 3000) = 38.306, p < 0.001, V = 0.11). Logistic regression showed a reduced chance (OR 0.640, 95% CI: 0.484–0.845; p = 0.001) to comply with WHO PA recommendations under lockdown conditions. Measures to promote physical activity should be intensified to limit detrimental health effects.
Fitness and exercise may counteract the detrimental metabolic and mood adaptations during prolonged sitting. This study distinguishes the immediate effects of a single bout vs. work-load and intensity-matched repeated exercise breaks on subjective well-being, blood glucose, and insulin response (analyzed as area under the curve) during sedentary time; and assesses the influence of fitness and caloric intake on metabolic alterations during sedentariness. Eighteen women underwent cardiopulmonary exercise testing and three 4 h sitting interventions: two exercise interventions (70% VO2max, 30 min, cycle ergometer: (1) cycling prior to sitting; (2) sitting interrupted by 5 × 6 min cycling), and one control condition (sitting). Participants consumed one meal with ad libitum quantity (caloric intake), but standardized macronutrient proportion. Exercise breaks (4057 ± 2079 μU/mL·min) reduced insulin values compared to a single bout of exercise (5346 ± 5000 μU/mL·min) and the control condition (6037 ± 3571 μU/mL·min) (p ≤ 0.05). ANCOVA revealed moderating effects of caloric intake (519 ± 211 kilocalories) (p ≤ 0.01), but no effects of cardiorespiratory fitness (41.3 ± 4.2 mL/kg/min). Breaks also led to lower depression, but higher arousal compared to a no exercise control (p ≤ 0.05). Both exercise trials led to decreased agitation (p ≤ 0.05). Exercise prior to sitting led to greater peace of mind during sedentary behavior (p ≤ 0.05). Just being fit or exercising prior to sedentary behavior are not feasible to cope with acute detrimental metabolic changes during sedentary behavior. Exercise breaks reduce the insulin response to a meal. Despite their vigorous intensity, breaks are perceived as positive stimulus. Detrimental metabolic changes during sedentary time could also be minimized by limiting caloric intake.
Germany experienced a 6-month second lockdown (November 2020–April 2021) during the COVID-19 pandemic, which included the closure of all physical activity (PA) facilities. The use of online exercise classes (OECs) was promoted by public health and exercise organizations. Using the present cross-sectional online survey, we assess the use of and opinion towards OECs in Germany during the second lockdown. We used contingency tables and the Chi2 test to calculate the frequency of awareness and use of OECs according to PA status, well-being and demographic data, and conducted a binary logistic regression with OEC awareness or use and dichotomized independent predictors. The associations between opinion and activity status, frequency of use, educational attainment, age and body mass index were calculated using Spearman correlations. A total of 993 datasets were analyzed in detail. Of the 785 (79.1%) participants reporting awareness of OECs, 536 tried them, and 262, 188 and 85 used them <1 per week, 1–2 per week and ≥3 per week, respectively. The users were typically active, female participants with poorer mental well-being. The opinions towards OECs varied according to participant characteristics, such as activity status, BMI and age. Overall, regular OEC use was quite limited, and, as such, cannot replace in-person exercise opportunities. Keeping physical activity facilities open and safe must be prioritized in the ongoing pandemic.
Hintergrund: Die staatlichen Maßnahmen zur Eindämmung des Coronavirus SARS-CoV‑2 im Jahr 2020 brachten den Trainings- und Wettkampfbetrieb im professionellen Fußball in vielen Ländern zum zeitweiligen Erliegen. In Folge des Lockdowns waren die Trainingsmöglichkeiten zumeist auf unspezifische heimbasierte Trainingsmethoden begrenzt. Es ist unklar, ob sich die fehlenden sportspezifischen Belastungsreize negativ auf die physische Leistungsfähigkeit der Fußballspielenden auswirkten.
Methodik: Im Rahmen eines narrativen Reviews wurde mittels einer selektiven Literaturrecherche in den Datenbanken PubMed, Google Scholar und BISp-Surf nach Studien gesucht, welche die Auswirkungen des Lockdowns auf physische Leistungsparameter bei erwachsenen professionellen Fußballspielenden untersuchten.
Ergebnisse: In die Übersichtsarbeit wurden sechs prospektive Längsschnittstudien eingeschlossen. In allen Studien kam während der Quarantäne ein heimbasiertes Ersatztraining zum Einsatz. Vier Studien verglichen die Leistungsfähigkeit der Fußballer/-innen mit Leistungsdaten aus vorherigen Spielzeiten. Zwei Studien ermittelten die Leistungsfähigkeit der Sportler/-innen unmittelbar vor und nach der Lockdownperiode.
Diskussion: Während die allgemeine Kraft- und Ausdauerleistung durch heimbasierte Ersatztrainingsprogramme erhalten werden kann, weisen die Studien darauf hin, dass sich die fehlenden spezifischen Belastungsreize vor allem negativ auf die Schnelligkeits- und Schnellkraftleistung der Fußballspielenden auswirken könnten. Bei Rückkehr in den regulären Trainingsbetrieb sollte daher auf eine progressive Belastungssteuerung insbesondere im Schnelligkeitstraining geachtet werden, um das Risiko für Verletzungen zu senken.
BACKGROUND: hysical activity exerts a variety of long-term health benefits in older adults. In particular, it is assumed to be a protective factor against cognitive decline and dementia.
METHODS/DESIGN: Randomised controlled assessor blinded 2-armed trial (n = 60) to explore the exercise- induced neuroprotective and metabolic effects on the brain in cognitively healthy older adults. Participants (age ≥ 65), recruited within the setting of assisted living facilities and newspaper advertisements are allocated to a 12-week individualised aerobic exercise programme intervention or a 12-week waiting control group. Total follow-up is 24 weeks. The main outcome is the change in cerebral metabolism as assessed with Magnetic Resonance Spectroscopic Imaging reflecting changes of cerebral N-acetyl-aspartate and of markers of neuronal energy reserve. Imaging also measures changes in cortical grey matter volume. Secondary outcomes include a broad range of psychometric (cognition) and movement-related parameters such as nutrition, history of physical activity, history of pain and functional diagnostics. Participants are allocated to either the intervention or control group using a computer-generated randomisation sequence. The exercise physiologist in charge of training opens sealed and opaque envelopes and informs participants about group allocation. For organisational reasons, he schedules the participants for upcoming assessments and exercise in groups of five. All assessors and study personal other than exercise physiologists are blinded.
DISCUSSION: Magnetic Resonance Spectroscopic Imaging gives a deeper insight into mechanisms of exercise-induced changes in brain metabolism. As follow-up lasts for 6 months, this study is able to explore the mid-term cerebral metabolic effects of physical activity assuming that an individually tailored aerobic ergometer training has the potential to counteract brain ageing.
NCT02343029 (clinicaltrials.gov; 12 January 2015).