P07-11 Physical activity promotion in the German healthcare system - Establishing pathways of exercise referral for persons with noncommunicable diseases

Abstract Background Exercise referral schemes (ERS) are embedded in the routine practice of healthcare systems in many countries (e.g. Sweden and New Zealand). In primary healthcare, ERS are recommended to sustainably increase physical activity (PA) levels among patients with noncommunicable diseases (NCD). Yet, the German health care system currently only incorporates interventions that primarily focus on improving functional outcomes but hardly aim at increasing PA levels. This presentation introduces an ongoing research project that aims to develop, implement and evaluate an ERS to promote PA for persons with NCD within the German healthcare system. Methods In the first phase of the project, a concept of an ERS was developed using a participatory research approach that involved relevant stakeholders such as physicians, funding agencies, PA providers, and patient representatives. The development process comprised three steps: 1) interviews to gather stakeholders' ideas of an ERS; 2) a literature review to collect evidence on key elements of international ERS; 3) three stakeholder meetings to combine scientific evidence with stakeholders' perspectives (co-creation). Subsequently, the ERS will be implemented, tested and evaluated in a regional pilot project using a pragmatic trial design. Finally, a concept for scaling-up the ERS to the German national level will be developed. Results As result of the co-creation process, the following key elements were defined to be part of the ERS: Screening, short counselling and provision of a referral form by a physician; initial assessment, counselling, individual PA recommendations, re-assessment and follow-up by exercise professionals. Additional aspects considered important for the implementation of the ERS were ensuring good communication and feedback between all participating health professionals, as well as an overview of all local physical activity offers and exercise professionals (database). These preliminary findings were combined into a draft of the ERS. Conclusions The participatory research approach employed by our project yielded the first draft of an ERS with a specific focus on PA promotion among persons with NCD within the German healthcare system. In the upcoming project stage, this ERS concept will be further elaborated and prepared for implementation and evaluation at a regional level.


Background
Exercise referral schemes (ERS) are embedded in the routine practice of healthcare systems in many countries (e.g. Sweden and New Zealand). In primary healthcare, ERS are recommended to sustainably increase physical activity (PA) levels among patients with noncommunicable diseases (NCD). Yet, the German health care system currently only incorporates interventions that primarily focus on improving functional outcomes but hardly aim at increasing PA levels. This presentation introduces an ongoing research project that aims to develop, implement and evaluate an ERS to promote PA for persons with NCD within the German healthcare system.

Methods
In the first phase of the project, a concept of an ERS was developed using a participatory research approach that involved relevant stakeholders such as physicians, funding agencies, PA providers, and patient representatives. The development process comprised three steps: 1) interviews to gather stakeholders' ideas of an ERS; 2) a literature review to collect evidence on key elements of international ERS; 3) three stakeholder meetings to combine scientific evidence with stakeholders' perspectives (co-creation). Subsequently, the ERS will be implemented, tested and evaluated in a regional pilot project using a pragmatic trial design. Finally, a concept for scaling-up the ERS to the German national level will be developed.

Results
As result of the co-creation process, the following key elements were defined to be part of the ERS: Screening, short counselling and provision of a referral form by a physician; initial assessment, counselling, individual PA recommendations, re-assessment and follow-up by exercise professionals. Additional aspects considered important for the implementation of the ERS were ensuring good communication and feedback between all participating health professionals, as well as an overview of all local physical activity offers and exercise professionals (database). These preliminary findings were combined into a draft of the ERS.

Conclusions
The participatory research approach employed by our project yielded the first draft of an ERS with a specific focus on PA promotion among persons with NCD within the German healthcare system. In the upcoming project stage, this ERS concept will be further elaborated and prepared for implementation and evaluation at a regional level. Keywords: exercise referral, physical activity promotion, primary healthcare, noncommunicable diseases Abstract citation ID: ckac095.112 P07-12 Stakeholders perspectives on exercise referral schemes in Germany Inga Naber 1 , Eriselda Mino 1 , Sarah Klamroth 1 , Anja Weissenfels 1 , Wolfgang Geidl 1 , Peter Gelius 1 , Karim Abu-Omar 1 , Klaus Pfeifer 1 1 Department of Sport Science and Sport -Physical Activity and Health, Friedrich-Alexander University, Erlangen, Germany Corresponding author: inga.naber@fau.de

Background
There is a growing popularity of exercise referral schemes (ERS) and they are widely implemented in nations such as New Zealand and Sweden. To this point, the German health care system (GHCS) is not utilising a structurally implemented ERS, but a research project is currently conducted to develop and test a German ERS. In the first project phase, the aim was to introduce the topic of ERS to relevant stakeholders of the GHCS and to gather their expert opinions on such a potential ERS. Further, the aim was to familiarise the stakeholders to the project and its collaborative approach in developing and testing an ERS. Methods Semi-structured interviews were conducted with 12 relevant stakeholder of the GHCS. In each case, two researchers conducted the interviews between June to September 2019. Main topics addressed during the interviews were potential target groups for an ERS, their own role within an ERS, PA counselling and dropouts that would be expected. During the interviews, stakeholders were encouraged to sketch their ideas for how to organise an ERS on paper. In the analysis, we digitalised these sketches into flow-chart diagrams.

Results
The analysis of the interviews showed that the sketches proposed innovative additions and alternative PA promotion strategies within the GHCS. The stakeholders identified barriers within the GHCS such as the rigid costing of treatments and performance measurements. Some reoccurring important core elements for an ERS in Germany were suggested: having a supportive person, implementing PA behaviour impact, utilising existing PA programs and tailoring individual PA counselling. Some stakeholders envisioned an ERS focusing on their perspectives and desired role within the ERS while others outlined ERS that largely excluded them.

Conclusions
All stakeholders clearly expressed the need for collaboration to develop and test an ERS in Germany. Previous studies have been focused on factors that influence effectiveness, as uptake and adherence. In contrast, these interviews resulted in the ii104 European Journal of Public Health, Volume 32 Supplement 2, 2022