Physical activity and exercise in clinical practice guidelines in Germany: systematic document analysis

INTRODUCTION: 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. METHODS: 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). RESULTS: 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. DISCUSSION: 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.