Practice recommendations for physical activity promotion in exercise therapy, physical therapy, and other movement-based therapies: a co-design project (PRO-BT) in German medical rehabilitation

Physical activity (PA) benefits individuals with noncommunicable diseases, yet its promotion is inconsistently implemented in medical rehabilitation. In Germany, exercise and physical therapists are central to PA promotion, but a lack of practical, evidence-based guidance has hindered integration into therapy. The PRO-BT project addresses this gap by developing consensus-based, evidence-informed practice recommendations for movement-based therapies. The project employed a structured four-step approach: (1) evidence update via scoping review, overview of systematic reviews on intervention effectiveness, and national guidelines analysis; co-design phase with (2) iterative draft development through expert workshops and patient focus groups; (3) nationwide stakeholder consultation with rehabilitation professionals to evaluate completeness, clarity, and practical relevance; (4) a final consensus meeting for approval. The process resulted in 15 evidence-based practice recommendations for PA promotion in movement-based therapies across German medical rehabilitation, organised into 3 sections: overarching competence-oriented guidance; didactic-methodological orientation; and specific therapeutic processes (e.g., assessment, goal setting, delivery, and monitoring). Each recommendation includes background text providing theoretical rationale, examples, and implementation advice. Stakeholder feedback showed strong approval of the recommendations (86%–100% full endorsement) and positive ratings for background texts in terms of completeness (93%), clarity (89%), and practical relevance (78%). The PRO-BT project provides nationally endorsed practice recommendations for PA promotion in movement-based therapies in German rehabilitation. These recommendations provide guidance for movement-based therapists to integrate PA promotion into routine practice, particularly for individuals with noncommunicable diseases. The co-design process underpins broad acceptance and applicability, offering an internationally adaptable methodological model for developing context-specific rehabilitation guidance.