BewegtVersorgt: co-development of a physical activity referral scheme for use in the German healthcare system

Background and status of (inter)national research: Physical activity referral schemes (PARSs) are a well-known method of promoting physical activity among the inactive primary care population with or at risk of developing non-communicable diseases. Despite significant expansion throughout Europe, a national scheme has not yet been established in Germany. Thus, similar efforts were initiated in June 2019 through the BewegtVersorgt project.

Objectives: To design a PARS model with the premise of future integration into the German healthcare system.

Methods: A co-production approach, including scenario thinking elements and cooperative planning, was utilized to develop the PARS. The research team worked closely together with twelve organizations from various sectors - health insurances, physicians, physiotherapists, sports, and patient organizations. Twelve bilateral meetings were conducted from June to September 2019, with the stakeholders exploring their PARS vision. These were followed by three half-day co-production meetings held in presence, which took place from October 2019 until January 2020. Successive negotiation meetings were organized to refine and finalize the co-developed work. The final PARS was held forward for approval by the end of 2020 in an online stakeholder meeting.

Results: The co-produced PARS starts with the primary care physician, as the gatekeeper in the German healthcare system, who offers 10 min physical activity advice to the patients who would benefit from physical activity participation. Afterward, the patients are referred to an exercise professional through a referral form. The exercise professional delivers the remaining central components of the intervention - initial assessment, six 1-hour individual physical activity counseling sessions spread throughout 12 weeks, final assessment, a progress report to the general practitioner, and one follow-up visit at six months. The intervention uses a patient-centered approach and motivational interviewing. The end goal is an adaptation of an active lifestyle and transfers to local physical activity opportunities.

Discussion: This PARS was comprehensively designed based on coordinated efforts from various areas of expertise. The involvement of key stakeholders ensured that the final PARS incorporates scheme providers, funders, and service-users perspectives. The combination of international scientific evidence and practical knowledge ensures higher feasibility and acceptability of the intervention.

Practical implications: If proved efficacious, the successful integration of the PARS in routine practice will likely benefit the chronically ill population. Consequently, this would translate into favorable economic implications. Further, this PARS has implications for health and exercise professionals who contemplate integrating physical activity promotion and behavior change aspects into their care standards.

Appeal to practice (science and/or care) in one sentence: This health insurance covered PARS presents an opportunity for inter-sectoral collaboration between sport/physical activity and healthcare professionals.