Physical Activity Guideline Adherence In A Large Population-based Cohort In Germany

Physical activity (PA) benefits health. The World Health Organization (WHO) recommends a combination of moderate-to-vigorous intensity aerobic PA (MVPA) and muscle-strengthening activities (MSAs). Previous studies on PA guideline adherence in Germany have important limitations, such as exclusive reliance on self-reports. PURPOSE: To examine adherence to the 2020 WHO PA guidelines in Germany based on the multimodal assessment of PA in the baseline examination of the German National Cohort (NAKO study) - a large population-based cohort study with over 205,000 participants. METHODS: MVPA was assessed using hip-worn accelerometers in a subsample of more than 70,000 participants. Two summary metrics derived from raw acceleration data were used to quantify PA intensities: the Euclidean norm minus one (ENMO) and the Mean Amplitude Deviation (MAD). MVPA was operationalized as time spent above intensity thresholds for these metrics, and compared against the WHO recommendation of ≥150 minutes of moderate-intensity aerobic PA or ≥ 75 minutes of vigorous-intensity aerobic PA or an equivalent combination of MVPA per week. Data on MSAs were derived from the Questionnaire on Annual Physical Activity Patterns, completed by approximately 60,000 participants. Given the lack of consensus on defining MSAs, we applied two operationalizations: a conservative approach (including only conventional MSAs like resistance exercise) and a liberal approach (also including activities like yoga). Results were compared against the WHO recommendation of performing MSAs on ≥2 days/week and with ≥moderate intensity. RESULTS: Most participants (>70%) with valid accelerometry data met the MVPA guideline, with exact adherence rates varying by the metric (ENMO vs. MAD) and acceleration thresholds used. However, only a minority of participants (<20%) adhered to the MSAs guideline, with results depending on the operationalization of MSAs. CONCLUSION: MSAs, as compared to MVPA, appear to be the primary barrier to meeting overall PA guidelines in the German population. Further analyses, including sensitivity tests with varying MVPA acceleration thresholds, are planned to further validate these findings. Supported by: Perplexity AI was used to generate and double-check parts of the R code for the statistical analysis.