Physical activity advice from general practitioners in Germany: Findings from a cross-sectional population survey of individuals with chronic ischemic heart disease (OptiCor study)

Objectives: The current German treatment guideline for chronic ischemic heart disease (IHD) recommends that general practitioners (GPs) deliver brief advice on physical activity (PA) to IHD patients. Such advice consists of at least three elements (i.e., 3As): (1) assessing the PA level, (2) advising on PA, and (3) assisting with recommendations. This study examined the extent to which individuals with IHD in Germany reported the receipt of such advice. Design: Cross-sectional population-based face-to-face survey (06/2023-08/2024). Setting: Germany. Participants: 1,004 individuals aged 35+ with self-reported IHD and GP contact. Outcome measures: Primary outcome: Self-reported proportions of receipt of GP-delivered PA advice according to the 3As. Main secondary outcome: Associations between person characteristics and the likelihood of receiving PA advice. Results: Among individuals with IHD, 36.4% (95% CI=33.4 to 39.4) received all 3As of PA advice, 42.1% (95% CI=39.1 to 45.2) received one or two elements, 9.9% (95% CI=8.1 to 11.8) received no advice at all, and 3.8% (95% CI=2.7 to 5.1) were advised to avoid PA (7.9% did not remember/refused to answer). Women (vs. men) were more likely to receive no advice (OR=1.74, 95% CI=1.11 to 2.72), while individuals with higher PA levels (OR=0.82, 95% CI=0.75 to 0.90, per hour/week) and those with higher (vs. lower) education were less likely to receive no advice (OR=0.39, 95% CI= 0.20 to 0.76). Individuals living in urban (vs. rural) areas were less likely to receive only one or two (vs. all) of the 3As (OR=0.65, 95% CI=0.46 to 0.88). Of those who received at least one element of advice (n=766), 72.5% reported they were more active afterwards, with a higher proportion when all 3As (vs. only some elements) were provided (86.8% vs. 59.6%). Conclusions: Only one-third of individuals with IHD in Germany received comprehensive PA advice. Specific person characteristics, such as female gender and lower education, were associated with lower proportions of received PA advice. Efforts are needed to improve GP-led PA guidance, particularly for underserved groups. Trial registration: German Clinical Trials Register (DRKS00031304)