Exercise Referral in Germany

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Primary care physicians in Germany are potentially in a pivotal position to provide physical activity counselling and exercise referral for their patients. The preventative prescription scheme dates back to the late 1970s. This scheme called “green prescription” (Grünes Rezept), however, could not be established as exercise referral scheme in primary care on a regular and systematic basis. After the German Medical Association (Bundesärztekammer), the German Association for Sports Medicine and Prevention (Deutsche Gesellschaft für Sportmedizin und Prävention) and the German Olympic Sports Federation (Deutscher Olympischer Sportbund) had developed the standardized national quality criteria of Physical Activity on Prescription in a joint effort, the German Medical Association has adopted them in 2011 and now recommends them to the Medical Associations of the Federal States for implementation. These national criteria establish a framework, but given the federal structure of Germany, schemes are not implemented in a uniform or centralized way. The federal states rather develop their own delivery methods according to local possibilities and needs. Exercise as a therapeutic means in the rehabilitation phase of a large number of chronic conditions as well as for people with disabilities is a legally established part of health care. The current legal and financial bases as well as the level of institutionalised support for the prescription of physical activity and exercise within health care are markedly different in the areas of prevention and therapy, respectively. While patients with chronic conditions are entitled to receive free exercise as a means of therapy (within certain limitations), no such “right” exists in the area of prevention. Exercise referrals rely on group offers with defined high standards in organised sports, making use of easily accessible sport clubs which are a traditional part of community life. Rigorous scientific evaluations are needed to provide guidance on how to further develop Germany´s exercise referral schemes.