Effectiveness and implementation success of a co-produced physical activity referral scheme in Germany: study protocol of a pragmatic cluster randomised trial

Anja Weissenfels, Sarah Klamroth, Johannes Carl, Inga Naber, Eriselda Mino, Wolfgang Geidl, Peter Gelius, Karim Abu-Omar, Klaus Pfeifer, Anja Weissenfels, Sarah Klamroth, Johannes Carl, Inga Naber, Eriselda Mino, Wolfgang Geidl, Peter Gelius, Karim Abu-Omar, Klaus Pfeifer

Abstract

Background: While effective physical activity referral schemes (PARSs) and related structures for promoting physical activity (PA) already exist in several countries, in Germany, PARSs have not yet been implemented systematically and nationwide. Through a co-production approach with relevant actors in the German healthcare system, a PARS was developed, and an implementation plan was created (e.g. financing). This study protocol aims to evaluate the developed PARS for people with non-communicable diseases (NCDs) in Germany regarding its potential effectiveness and implementation success.

Methods: To evaluate the effectiveness and implementation success of the PARS, we will apply a pragmatic cluster-randomised controlled trial (cRCT) in Hybrid II design by comparing two intervention groups (PARS vs PA advice [PAA]). The trial will take place in the Nürnberg metropolitan region, with 24 physician practices recruiting 567 people with NCDs. Both groups will receive brief PA advice from a physician to initially increase the participants' motivation to change their activity level. Subsequently, the PARS group will be given individualised support from an exercise professional to increase their PA levels and be transferred to local exercise opportunities. In contrast, participants in the PAA group will receive only the brief PA advice as well as information and an overview of regional PA offerings to become more active at their own initiative. After 12 and 24 weeks, changes in moderate to vigorous PA and in physical activity-related health competence (movement competence, control competence, self-regulation competence) will be measured as primary outcomes. Secondary outcomes will include changes in quality of life. To measure implementation success, we refer to the RE-AIM framework and draw on patient documentation, interviews, focus groups and surveys of the participating actors (physicians, exercise professionals).

Discussion: Through a between-group comparison, we will investigate whether additional individual support by an exercise professional compared to brief PA advice alone leads to higher PA levels in people with NCDs. The acceptance and feasibility of both interventions in routine care in the German healthcare system will also be evaluated.

Trial registration: ClinicalTrials.gov, NCT04947787 . Registered 01 June 2021.

Keywords: Cluster design; Physical activity; Physical activity-related health competence; Physician-initiated PA promotion; Pragmatic trial.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Schedule of enrolment, interventions, and assessments following SPIRIT. PA physical activity; PARS physical activity referral scheme; PAA physical activity advice; EQ-5D-5L European Quality of Life – 5 Dimensions – 5 Level; SSA self-efficacy towards physical activity; HCCQ-D Health Care Climate Questionnaire; SSK sport- and movement-related self-concordance; PREMs patient-reported outcome measures
Fig. 2
Fig. 2
Study design with both groups (PARS vs PAA)

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