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

Only 36.4% of individuals with self-reported IHD received all three elements (3As) of GP-delivered physical activity advice.

• Sample consisted of 1004 individuals aged 35+ years with self-reported IHD and GP contact surveyed from June 2023 to August 2024.
• 36.4% (95% CI 33.4% to 39.4%) received all 3As: assessing PA level, advising on PA, and assisting with recommendations.
• 42.1% (95% CI 39.1% to 45.2%) received only one or two elements of the 3As.
• 9.9% (95% CI 8.1% to 11.8%) received no advice at all.
• 3.8% (95% CI 2.7% to 5.1%) were advised to avoid PA, and 7.9% did not remember or refused to answer.

Women were significantly more likely than men to receive no physical activity advice from their GP.

• Women versus men: OR=1.74 (95% CI 1.11% to 2.72%) for receiving no advice.
• This association was identified through multivariable logistic regression analysis.
• Female gender was identified as a characteristic associated with lower proportions of received PA advice.

Middle-aged individuals were less likely to receive no physical activity advice compared to younger individuals.

• Middle-aged versus younger individuals: OR=0.46 (95% CI 0.22% to 0.99%) for receiving no advice.
• This suggests younger patients with IHD were at greater risk of receiving no PA advice.

Higher physical activity levels were associated with lower likelihood of receiving no PA advice.

• Individuals with PA levels of 1–149 min/week versus no PA: OR=0.16 (95% CI 0.08% to 0.31%) for receiving no advice.
• Individuals with PA levels of 150+ min/week versus no PA: OR=0.13 (95% CI 0.07% to 0.23%) for receiving no advice.
• Those with PA of 1–149 min/week were also less likely to receive only one or two versus all 3As (OR=0.59, 95% CI 0.37% to 0.95%).
• Those with PA of 150+ min/week were similarly less likely to receive only one or two versus all 3As (OR=0.55, 95% CI 0.36% to 0.84%).

Higher education was associated with lower likelihood of receiving no physical activity advice.

• Higher versus lower education: OR=0.39 (95% CI 0.20% to 0.76%) for receiving no advice.
• Lower education was identified as a characteristic associated with lower proportions of received PA advice, indicating an underserved group.

Individuals living in urban areas were less likely to receive only one or two elements of PA advice compared to those in rural areas.

• Urban versus rural residence: OR=0.65 (95% CI 0.46% to 0.88%) for receiving only one or two versus all 3As.
• This suggests rural residents were less likely to receive comprehensive (all 3As) PA advice.

Receipt of all three elements of PA advice was associated with a higher proportion of patients reporting increased physical activity afterwards.

• Among those who received at least one element of advice (n=788), 72.5% reported being more active afterwards.
• When all 3As were provided, 86.8% reported being more active afterwards.
• When only some elements were provided, 59.6% reported being more active afterwards.
• This difference suggests a dose-response relationship between comprehensiveness of advice and self-reported behavior change.

The current German treatment guideline for chronic IHD recommends that GPs deliver brief PA advice consisting of at least three elements: assessing PA level, advising on PA, and assisting with recommendations.

• These three components are referred to as the '3As' framework.
• The study was designed to examine the extent to which individuals with self-reported IHD in Germany reported receipt of such guideline-recommended advice.
• The study used a cross-sectional population-based face-to-face survey design conducted across households in Germany.