Physical activity-related health competence differs by social and health-related factors: findings from a nationwide population-based study in Germany

Insufficient physical activity remains a major public health challenge and is socially unequally distributed. Physical activity-related health competence (PAHCO) specifies the personal skills that enable health-enhancing physical activity. It integrates aspects of health literacy and comprises movement competence, control competence and self-regulation competence. This study examined the distribution of PAHCO in the adult population living in Germany and its associations with characteristics of social inequalities, health-related vulnerability, and limited social resources.

We used data from a cross-sectional nationwide population-based survey of German-speaking adults conducted via standardised computer-assisted telephone interviews between January and May 2023 (n = 3,986). Bivariate and multiple logistic regression analyses were employed to examine the relationship between low PAHCO levels (overall score and its three sub-competencies) and characteristics of social inequalities, including sociodemographic factors (older age, female gender, lower education, and lower equivalent income), health-related vulnerability (poor self-rated general and mental health, chronic conditions), and social resources (low social support).

Overall, 38.2% of the population showed low/rather low PAHCO levels. Higher odds of low/rather low PAHCO were observed among adults aged 65 years and older compared to 18-29-year-olds (OR = 3.77, 95% CI: 2.28-6.22), among individuals with low versus high formal education (OR = 1.96, 95% CI: 1.37-2.82), and among those in the lowest versus highest income group (OR = 1.95, 95% CI: 1.23-3.10). The further relevant predictors of lower PAHCO were poor self-rated general, mental health and chronic conditions as well as low social support. These patterns were consistent across all three sub-competences, but age and gender differences were observed only for movement competence.

The findings indicate a need to strengthen PAHCO in more than one third of the population and suggest that PAHCO could help reduce insufficient physical activity associated with social inequalities and health-related vulnerability. Strategies to promote movement competence, control competence, and self-regulation competence should particularly address the needs and living conditions of older adults, individuals with lower education levels, poorer health status, or lower social support. Physical activity promotion programmes should address all three sub-competences of PAHCO in a target-group-specific manner.