Population-based physical activity promotion with a focus on health equity: evidence challenges

Abstract Issue Physical activity (PA) approaches that target the entire population hold great promise for public health particularly in terms of health equity due to their broad reach. During the process of developing national recommendations for PA and PA promotion in Germany, followed by a partial update, it became evident that there is limited evidence regarding population-based PA interventions with a focus on health equity. Our objective was to present an overview of the underlying reasons for this scarcity of evidence. Methods The methodology used in the development of the German recommendations to identify evidence for population-based health equity interventions was applied. Five scientific databases were searched for reviews published between 2015-2021. References of the included reviews were checked for additional reviews. Publications without any focus on health equity were not considered. The identified evidence was summarized narratively, followed by a description of existing challenges in evaluating. Results Our search yielded 4,411 reviews, of which 79 met the inclusion criteria but 75 were excluded because approaches did not focus on the whole population, or did not address health equity. Two reviews were found in the search for gray literature. Thus, the result is a total of 6 articles. None of these reviews reported the application of a theory. The consideration of quality criteria used before, during and after the practical implementation of interventions is not common. The complexity of population-based approaches proved to be a challenge. Conclusions Overall, there is a need for more emphasis on health equity in the implementation and evaluation of population-based PA approaches. The consideration of a theoretical underpinning of such complex approaches in complex systems and the application of standardised quality criteria are an important prerequisite for the generation of evidence. Key messages • There is little evidence of population-based PA approaches aimed at health equity. • A standardized and comprehensive evaluation assessment that is accepted by all public health stakeholders is needed.