Competencies for a Healthy Physically Active Lifestyle—Reflections on the Model of Physical Activity-Related Health Competence

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Background: The World Health Organization’s Global Action Plan on Physical Activity 2018–2030 states that physical activity interventions should strengthen peoples’ competencies for health. Yet, frameworks that bundle pivotal competencies for a healthy and physically active lifestyle have not been extensively discussed in the past. Results: In the present article, the authors therefore present the model of Physical Activity-related Health Competence (PAHCO), an integrative structure model including the 3 areas of movement competence, control competence, and self-regulation competence. After providing a rationale for the use of the competence concept, the authors focus on implications from the PAHCO model to guide interventions for the promotion of a healthy and physically active lifestyle. The authors argue that the PAHCO model is located at the interface between health literacy and physical literacy, research areas that have gained increasing scholarly attention in recent years. In addition, PAHCO appears to be compatible with the concept of health capability because it can represent the important aspect of agency. Conclusions: The article concludes with a scientific positioning of model components and some empirical results that have been accumulated so far.

There is convincing evidence that physical activity (PA) is a key mechanism for the maintenance or promotion of individuals’ health.1 Importantly, the beneficial effects of PA not only refer to the areas of physiology2 and disease prevention3 but also to social interactions4 and mental well-being.5 Accordingly, employees in the applied health sector, such as exercise therapists, health consultants, fitness coaches, and physical education teachers work to familiarize their patients, clients, or students with the domains of PA and exercise. Despite the involvement of a multitude of these stakeholders in the daily lives of many individuals and several campaigns by public health institutions, approximately 27.5% of all adults globally6 still lead physically inactive lifestyles. Notably, in high-income Western countries, the proportion is substantially higher rising to 36.8%.6 The problem is also prevalent in children, with 76.2% of all boys and 84.6% of all girls leading lifestyles that are insufficiently physically active.7 Against this backdrop, the World Health Organization8 recently released a Global Action Plan on PA suggesting measures to achieve a relative reduction of 15% in the global prevalence of physical inactivity by the year 2030. In this policy paper, it is evident that only a well-coordinated combination of system-based approaches and individually focused actions can ensure the achievement of this ambitious goal. Irrespective of the approach selected, the action plan repeatedly highlights that measures should be geared toward increasing people’s competencies and literacy.8 In this context, a central question arises: which are those competencies that empower people to lead healthy, physically active lifestyles?

To date, there is no interdisciplinary competence approach on PA with a specific focus on health, which could serve as a reasonable and practical basis for the development of interventions for health occupations. Consequently, health professionals did not have the chance to explicitly and holistically target physically active lifestyles. The selective focus is exemplified in a recent analysis of the rehabilitation and therapy system in Germany, revealing that health professionals and institutions usually give high priority to the recovery of body structures and functions while comparably less emphasis is placed on activities and participation.9

Accordingly, we plead for the consideration of further abilities, skills, and competencies that are necessary for the adherence to a healthy and physically active lifestyle. This view is strongly supported by behavior change literature which has been traditionally interested in identifying psychological mechanisms for this process.10 Within the scientific community, it is, for instance, common sense that people should have a positive attitude toward PA11 because this increases the likelihood that the corresponding health behavior is perceived as worthwhile and intrinsically appealing. Self-control strategies are essential because the suppression of conflicting interests helps individuals bridge the intention–behavior gap and therefore persevere during exercise programs.12 From the perspective of health promotion, individuals should not only apply a certain physical stimulus to themselves as frequently and intensively as possible, but also they should be able to ensure that the corresponding stimulus has a certain health-related quality. Therefore, an important goal is to increase knowledge about the health-related potential of PA and the appropriateness of different exercises for different goals and target groups.13,14 For the application of an adequate training load, individuals have to learn how to develop strategies to pace themselves throughout an exercise session.15,16

Due to the multidimensional nature of skills required, it is, in our view, worth adopting an integrative understanding of the person-related factors that favor adherence to a health-oriented and physically active lifestyle. Importantly, this integrative understanding is linked to the conception that holistic measures, if adequately designed and implemented, can effectively stimulate processes of health “empowerment”17 or health “enablement.”18 These terms, in turn, highlight that a modern health conception has to stress people’s qualities, resources, and potentials.19 Based on our previous argumentation, it can therefore be concluded that the literature on health-enhancing PA (HEPA) can profit from a broad concept or framework that

  1. (1)paradigmatically acknowledges health as a phenomenon with a positive connotation,
  2. (2)bundles and integrates different skills and abilities (dispositions) that are necessary for a life-long engagement in health-oriented PA, and finally
  3. (3)has the character of a trait (ie, postulates a certain temporal stability) on one hand, but allows intrapersonal modifiability and room for improvement (eg, induced by well-designed interventions) on the other.

In summary, the goal of the present article is to introduce the Physical Activity-related Health Competence (PAHCO) approach as a concept that meets the ideas previously described. We first detail the main assumptions of the PAHCO model and its structural components. Then, we also considered it important to explain why we adopted the term “competence” and derive implications for interventions drawing on the PAHCO approach. Finally, we clarify the relationship to adjacent constructs discussed in the international literature.

The Model of PAHCO

Which competencies must someone have in order to be described as PA-related health competent? To answer this question, we used the general health competence approach by Lenartz20 and deduced a domain-specific competence structure model, the model of PAHCO.21 The PAHCO model assumes that 3 major competence areas are of pivotal and equivalent importance (Figure 1).

Figure 1
Figure 1

—The model of Physical Activity-related Health Competence.21

Citation: Journal of Physical Activity and Health 17, 7; 10.1123/jpah.2019-0442

The Sub-Competence Level

First, for a healthy, physically active lifestyle, people should possess a certain level of movement competence that allows them directly to participate in a wide spectrum of leisure activities (eg, running or swimming) and to accomplish important challenges of daily life (eg, riding a bike or carrying a box of water bottles). Second, individuals need adequate self-regulation competence, which provides the motivational and volitional basis for the regular planning and execution of certain physical activities. Finally, as a third area, people require a certain amount of control competence, guaranteeing that they can apply an appropriate load to their body for both their physical health and their psychological well-being. These 3 sub-competencies are the result of the coupling and integration of basic elements (Figure 1).

The Level of Basic Elements: Integration to Sub-Competencies

The basic elements represent dispositions for PA that are more remote from action and not the competence per se. It is their “integration that reflects the construct of competence.”22 In a theoretical article, Baartman and de Bruijn23 outlined different ways on how skills, knowledge, and attitudes are integrated. According to the PAHCO model, movement competence is the result of the integration of motor abilities and skills, as well as an individual’s body awareness and body perception. Task-specific self-efficacy is important for the uptake and adequate realization of physical challenges and motor tasks in daily life because it supports the confidence needed to realize them.21 Depending on the demands of the task and the experience of a person, the integration process is based on the retrieval of automatized movement patterns (“low-road integration”)23 or the reflection in/on action, for example, if tasks are new to the individual or motor errors occur (“high-road integration”23). Control competence is the result of the integration of declarative (“effect”) and procedural (“action”) knowledge, and an individual’s body awareness and body perception serving as sources of feedback for the identification of an adequate training load.24 Likewise, motivational mechanisms play a role for the integration process of control competence.25 Due to the centrality of knowledge aspects, the PAHCO model can be identified as advocating for a “high-road integration” of control competence, emphasizing reflections on the fit between individual prerequisites and activity programs. From a theoretical standpoint, “transformative integration”23 may become crucial when individuals acknowledge (after critical reflection) that their current knowledge stands in conflict with a health-related execution of PA, which requires accommodation of one’s mental model. Self-regulation competence is the result of the integration of attitudes toward PA (emotional and cognitive26,27) and self-efficacy (task-specific and behavior-specific28,29). Along with an unreflected “low-road integration,” which can typically be found in the context of routines, individuals can use explicit knowledge on strategies how to better coordinate activity plans with other obligations of daily life (“high-road integration”23). Transformative integration takes place when individuals change their attitude toward PA in favor of a more positive one by breaking up negative personal associations with the target behavior. In summary, the coupling of basic elements requires an integration process that depends on an individual’s proficiency and experience.23 The specific integration within the PAHCO model can be traced by conceptualizing links between the basic elements and the sub-competencies both horizontally and diagonally.

Competence Approaches

In general, the competence concepts are used differently across scientific disciplines and cultures.30,31 Nevertheless, there is consensus among experts that competence, albeit inherently oriented toward action, has to be conceptually separated from actual performance.32,33 Competence must rather be considered as the performance disposition inherent to every human being. Unfortunately, these characteristics cannot be directly observed; they are “under the skin.” This undoubtedly poses a considerable challenge to research that is innately interested in gaining empirical access to this human potential which has to be treated as a latent construct. Among the different traditions in the field of competences, the PAHCO model can be most likely attributed to the functional–pragmatic approaches.34 Grounded in the assumption that competence can be defined as “a person’s ability to cope with challenges in particular situations,”34 ambassadors of this tradition have highlighted the domain relatedness and context-boundness of the competence concept.35 Transferred to our issue, this means that the defined sub-competencies can only lead to effective action if the challenges concern the specific field of PA but not if they concern other fields. Consequently, competencies or sub-competencies should always be operationalized in a domain-specific manner. Furthermore, competencies can be acquired and developed.30 Therefore, building competence has a normative or evaluative character (it is good to have/acquire a high competency), which makes this concept attractive for use in educational contexts.34 The PAHCO model, with its 3 sub-competencies, can be interpreted as an attempt to emphasize the role of cognitive and reflective elements within daily HEPA practices. Finally, our approach aligns with those of several researchers from the fields of physical education, HEPA, or sport who cultivated a more open competence concept, not restricting it to the cognitive area.3638 Instead, the term has the potential to cover motivational, volitional, social, and physical-motor aspects at the same time.39 In this regard, the scientific community has adopted a comparably broad position in relation to the general competence literature.34

Implications for Interventions Using the PAHCO Approach

Arising from the competence idea and the integrative coupling of abilities and skills, the PAHCO approach pursues the claim that cognitive elements, psychological qualities (eg, concerning motivation, volition, or affect), and physical aspects should not be targeted and promoted in an isolated manner.40 This conception, supported by a monistic philosophy, appreciates the individual “as a whole person, rather than as composed of a body and a mind.”41 Ideally, individuals are exposed to situations and arrangements that enable “exercise,” “learning,” and “experience” at the same time (Figure 2). In some instances, it is necessary to include some theoretical input. Users are then advised to interweave theory with practice closely in terms of time, space, and content.

Figure 2
Figure 2

—Action model for the promotion of Physical Activity-related Health Competence.40

Citation: Journal of Physical Activity and Health 17, 7; 10.1123/jpah.2019-0442

Related to the fields of primary prevention and exercise therapy, this would mean that supervisors should formulate a wide array of different goals (outcome orientation).35 In accordance with these goals, they subsequently have to derive exercise schemes (input level), which simultaneously induce adequate physical stimuli, transport a message of meaningfulness, enable the experience of joy and success, and promote independent planning and execution of PA measures. Otherwise, some requirements for a health-oriented physically active lifestyle would be neglected, reducing the likelihood to turn a person into a PA-related health competent individual.

Even when specifically targeting the sub-competencies of PAHCO, the responsible providers profit from demonstrating an integrative mindset. Conveying movement competence implicates that motor qualities and physical fitness should be improved, concurrently acknowledging that perceived motor competence37 and task-specific self-efficacy21 should be strengthened in order to guarantee that growth in competence manifests in an application of acquired capacities. The reinforcement of control competence bases on “reflection on action” and “reflection in action,” ingredients of higher road processing,23 with the use of sensory feedback,16 building confidence to structure activities independently,21 and an enhancement of knowledge on physical loads and exercise methods. The promotion of self-regulation competence depends on the improvement of psychological requirements for PA,10 with motivation being ideally nurtured by registerable success in developing physical parameters (eg, endurance performance) and volition being fostered by enduring strenuous activities.

Given the integrative tenet, practitioners are encouraged to thoroughly elaborate their didactical and instructional strategies. In line with the functional-pragmatic understanding of competence positing that “competencies can be acquired through experience gained from relevant situations of demand,”34 practice plays a crucial role on all levels of PAHCO. From a learning psychology perspective, the PAHCO concept stands in the traditional line of theories highlighting active-constructive information processing, emotional processes,42 and active engagement in contexts of application.43 The mere communication of knowledge without addressing the practical relevance (eg, evaluating the individual fit of an exercise both physically and affectively) would only have the danger of “inert knowledge.”

Related Constructs in the Literature

In addition to the rationale of our use of the competence concept, we want to clarify the relationship of the PAHCO concept to the research areas of health literacy (HL) and physical literacy (PL),44 which have attracted increasing attention in recent years. As we outline below, PAHCO is located at the crossroads between these 2 research areas (Figure 3).

Figure 3
Figure 3

—The PAHCO concept at the interface between physical literacy and health literacy. PAHCO indicates Physical Activity-related Health Competence.

Citation: Journal of Physical Activity and Health 17, 7; 10.1123/jpah.2019-0442

Health Literacy

Surveys in the 1990s showed that a substantial portion of the American population had difficulties reading and transmitting health-related information.45 Stimulated by these findings, HL research initially focused on the investigation and promotion of functional aspects of health information processing (“literacy” and “numeracy”). Because the level of an individual’s HL closely follows an education gradient,46 this research field was successful in addressing an important social determinant of health inequality. Profiting from Nutbeam differentiation of functional, interactive, and critical aspects of HL,47 the research field subsequently underwent rapid expansion, which led to a considerable increase in scientific publications in the 2000s.48 Parallel to this development, several authors raised the concern of whether it would be possible to bundle the different definitions of HL into a common understanding.49

Based on an extensive literature review, the consortium members of the European HL Survey derived a public health definition that has received broad acceptance in recent years. According to this consensus, HL “entails people’s knowledge, motivation, and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life.”50 Overall, this definition effectively illustrates that information aspects stand at the center of this concept and mark the starting point (“in order to”) for action. Accordingly, the aforementioned systematic review revealed that the information aspect, identified as a “shared characteristic” across the included primary studies, is a central and separate cluster of the HL definition.50 The information perspective is also reflected in other review articles focusing specifically on assessment tools,51 interventions,52 and health outcomes.53

Transferred to the requirements of our scientific problem of HEPA, we summarize that the HL concept fits well, on one hand, due to its strong orientation toward the outcome of health.53 On the other hand, however, the perspective does not capture the full range of person-related qualities that are required for the execution of health-related physical activities. Motor requirements, for example, have not found a place within HL conceptions yet. The complex interplay of behavioral determinants, finally culminating in “a person’s ability to cope with challenges in particular situations,”34 makes it necessary to adhere to the notion of competence, which has a broad integrative underpinning (detailed in introductory section).

As a consequence, it would have been inappropriate for our purpose to either completely adopt the HL concept or to work out a domain-specific approach under the umbrella of HL (which has, for example, been done on the topics of nutrition and food54). Nevertheless, there remains a substantial relationship between HL and PAHCO because information and knowledge play, for instance, important roles in (1) reading PA guidelines55 (“functional HL”47); (2) exchanging PA-related information with peers, therapists, or consultants (“interactive HL”47); (3) critically reflecting the usefulness of PA-related information for oneself (eg, against the background of one’s biopsychosocial competencies); and (4) transforming informational input into motivational strength (“critical HL”47). Thus, the PAHCO concept can substantially benefit from insights within the field of HL.

Another perspective, which could enrich the discussion on PAHCO (eg, via capabilities, see a later section), was provided by scholars underscoring that HL is strongly determined by social and structural factors. Adhering to a social–ecological paradigm, these researchers emphasized that barriers of the health system can prevent individuals from gaining access to relevant health information.56 Inadequate communication styles within interactions between patients and physicians, for example, undermine a patient’s perceptions of enablement and support.57 Such insights recently led to overview articles suggesting how to promote “organizational health literacy”58 and how to structure “health literate health care organizations.”59

Physical Literacy

The PL literature, in contrast, does not confine the PL concept to information dimensions. This tenet has been maintained since the concept was introduced by Whitehead,60 about 2 decades ago. According to a recent consensus statement, PL can be described as “the motivation, confidence, physical competence, knowledge, and understanding to value and take responsibility for engagement in physical activities for life.”61 In essence, the elaborated and consensually achieved definition illustrates that the PL and PAHCO approaches, which are both multidimensional in nature, share a considerable number of commonalities. Also, the field of PAHCO can highly benefit from findings in the PL literature. Nevertheless, we identify some relevant conceptual, paradigmatic, and philosophical differences (Table 1).

Table 1

Characterization of Commonalities and Differences Between the PAHCO and PL Approaches

PL approachPAHCO approach
Complexity of the approachMultidimensional approachMultidimensional approach
Conceptual rootsPhilosophical roots: monism, existentialism, and phenomenologyOrigins in health science: for example, focus on resources, empowerment/enablement
GoalEngagement in physical activities for lifeHealth-enhancing physical activity
Characterization and overall purposeEducative-philosophical approach;

Offering PA options and experiences, inclusive goal dimensions
More functional approach;

Contribution to biopsychosocial health, ensuring the manageability of daily life
The role of healthHealth as one of 6 potential forms of movementBiopsychosocial health as an explicit goal
Primary target group in past researchSo far mainly used with children and adolescents; first applications with adultsSo far mainly used with adults and populations with diseases; first applications with adolescents
Structural componentsFactors on the person level, PA behavior as part of PLCompetence-oriented, person-related factors for HEPA
Acknowledgement of interindividual differencesYesYes
Attitude toward assessmentsInconsistent—from basic concerns to endorsementEndorsement
Temporal perspectiveStatic and dynamic perspectives, ongoing “process versus outcome” debateAdoptability of a static or dynamic perspective

Abbreviations: HEPA, health-enhancing physical activity; PA, physical activity; PL, physical literacy; PAHCO, Physical Activity-related Health Competence.

The concept of PL has elaborate philosophical underpinnings, especially from the perspectives of monism, existentialism, and phenomenology.60,62 Notably, researchers have even linked the PL concept to descriptions of how to lead or shape a successful overall life, such as “human flourishing”63 or positive youth development.64 Some authors have criticized these philosophical foundations as too difficult to understand, which means they impede the translation of the concept into action by practitioners and policymakers.65,66 However, most relevant articles cherish its broad philosophical substantiations. One study noted that “one cannot truly understand PL without embracing its philosophical roots.”67 In line with its philosophical assumptions, PL literature offers an abundance of opportunities and choices for activities in diverse contexts.41 Highlighting the claim that there is “something for everyone,”41 this concept was designed to engage a maximum number of people in physical activities for life, irrespective of the underlying motives. Accordingly, the PL term is very inclusive with respect to the purpose of physical activities, encompassing adventure, athletic, fitness and health, aesthetic–expressive, competitive, and interpersonal forms of movement.41,68 This openness, however, makes the concept compatible with activity forms that have nothing to do with or that may even run counter to the goals of health, such as risk sports (corresponding to “adventure” in the aforementioned differentiation), excessive performance orientations (compatible with the “athletics” form), or exaggerated opponent orientations (compatible with the “competition” form). This point presumably marks the most important difference between both approaches. The PAHCO approach assumes that PA is only functional when it leads to biopsychosocial health or contributes to the facilitated accomplishment of daily challenges. Accordingly, people who are PA-related health competent possess a pronounced health motive or a motive constellation that allows them to perform physical activities on a self-determined and regular basis while being able to minimize risks of overload and health impairment. The enjoyment or social engagement motives, for instance, typically nurture intrinsic or identified forms of exercise regulation.69,70 In this way, positive health effects of PA can unfold in the long run.

In concert with the somewhat different focus, PL is primarily oriented toward children and adolescents,62,71 whereas PAHCO has until now been mainly explored in adults or populations with diseases.21,40,7275 Despite these clear trends in past projects (for exceptions7678), neither approach is restricted to these target groups, which provides an unexploited perspective for the other age groups.

The inclusive character of the PL concept culminates in the fact that most prominent models and assessments, such as that of the Canadian Assessment of PL,79,80 understand the behavioral component, that is, the PA per se, as an integral element of PL.64,79,81,82 This over-inclusiveness interferes with the prespecified need for studies that predict levels of PA by person-related factors. From a theoretical and an empirical perspective, it is not valuable to use a variable simultaneously as a predictor and an outcome.

Furthermore, researchers within the area of PL have stressed the “reality of differences between learners,”41 usually by anchoring their argumentation in phenomenological grounds.41,63 In our understanding, this assumption fits well with the PAHCO framework because it also acknowledges interindividual differences. However, there is a debate and concern of regarding whether it is possible to capture these differences in an empirical way. Physical literacy has repeatedly underlined the “unique perspective”41(p262) or “individual journey”62,83 of every person. Accordingly, “the International PL Association favors the term ‘charting progress’ for PL, as opposed to measurement, assessment, evaluation, characterizing, and so forth. These reasons include the consideration that each person’s PL is conceived to be quite unique and almost impossible to compare with another person’s development.”74 This statement prefers a qualitative–idiographic methodology for the field of PL. However, this institutional recommendation did not deter researchers from developing standardized PL instruments to characterize the state of individuals at a given time.44,71 This inconsistency has recently intensified the “process versus outcome debate,” which has not been dispersed within PL literature yet.67 Regardless, the underlying conceptualization differs substantially from the PAHCO approach, which is open for the assessment and quantification of individual levels. The competence concept underlying PAHCO explicitly allows both temporal perspectives. A cross-sectional character is given, for instance, if researchers try to identify hierarchical structures (competence structure models) or particular individual constellations (competence profiling). Furthermore, researchers, as well as practitioners, are interested in describing and quantifying different competence levels and developmental processes (competence level/development models). These approaches usually add a temporal element, corresponding to a dynamic–processual perspective of competence.

Health Capability

In the previous sections, we described the conceptual proximity of PAHCO to HL and PL, finally locating it at the interface between these 2 research areas. Another related concept that has increasingly been the object of scientific discussions, especially within sociological contexts, is health capability. The origins of the capability approach lie in the pioneering works of Amartya Sen, who was interested in issues of social and gender justice. While underscoring the relevance of personal freedoms, Sen84,85 repeatedly valued the importance of “what people are effectively able to do and to be.”86 Even though this approach had an overwhelming response from scholars, it took a comparably long time until researchers derived a health-specific framework. Jennifer Prah Ruger, who can be considered a progenitor and decisive promotor of this paradigm, simply defined health capability as the “ability to be healthy.”87,88 In essence, she argued equality of opportunity should not be considered the endpoint of justice. Instead, the focus should be on individuals’ abilities (health agency) and, importantly, also on the outcomes (health functioning) of their life actions.87,88 With this guiding principle in mind, she worked out concrete elements of health capability. These elements can be divided into factors internal (eg, health status, health-related knowledge, or goals) and external (eg, social norms or material circumstances) to the individual.87 Such or similar classifications can also be found in most assessment tools (for an overview89). In summary, the capability approach has made a substantial contribution to the structure-agency tradition in health promotion.90 Transferred to our issue, nevertheless, the paradigm is too inclusive in 2 respects. First, external capability factors include elements such as social norms, material circumstances, and social support. We do not argue that these factors exert no influence on people’s behavior. However, we consider these factors incompatible with the notion of competence because it is not compatible with the predefined exclusive concentration on person-related dispositions. Second, health status and health functioning (as internal factors) are conceptualized as integral elements of the capability framework. We, in contrast, assume that health is an outcome of the target concept rather than a constituting element, thereby acknowledging that competence is a latent disposition that has to be conceptually delimited from health as a medium- or long-term correlate. Therefore, we classify the health capability approach as too inclusive for our purpose as detailed in the introductory section.

The overinclusion, however, has the potential to bridge 2 major horizons within the HEPA literature, that is, the person-related competence orientation on one hand and the structural–systemic analysis on the other (Figure 4). The previously mentioned Global Action Plan on PA, for instance, clearly postulates that promotion of PA nowadays has to heed both strands.8 In this respect, “the capabilities approach expands our horizons and directs our attention to additional elements.”91 Within the scope of the health capability framework, PAHCO can be interpreted as determining the individual agency for a healthy and physically active lifestyle (see the definition by Ruger78). This interpretation is supported by a recent study from the field of PA92 that uses the notion of competence to describe one of the 2 determining factors of capability in the tradition of Gidden’s duality assumption.93 In practical terms, the PAHCO model has the potential to provide listings of health capability or agency, such as the previously mentioned health capability profile by Ruger,87 with a more sophisticated and ordered internal structure. For instance, the PAHCO model, with its empirical findings referring to HEPA, could not only add some valuable elements (eg, affect regulation21,94) to the “internal factors” but also detail interactions between different determinants of health capability.

Figure 4
Figure 4

—The integration of PAHCO into the broader concept of health capabilities. PAHCO indicates Physical Activity-related Health Competence.

Citation: Journal of Physical Activity and Health 17, 7; 10.1123/jpah.2019-0442

Discussion

The latest Global Action Plan on PA 2018–20308 underscored that programs or interventions that focus on adherence to a health-oriented physically active lifestyle should be geared toward increasing people’s literacy and competencies. In the introductory section, we argued that only an integrative view can accurately account for the complex requirements of performing physical activities in a health-oriented way. Through movement competence, control competence, and self-regulation competence, the Model of PAHCO postulates 3 central and interacting sub-competencies. Accordingly, this framework is not only integrative but also interdisciplinary in nature: movement competence is traditionally the subject of exercise science, human movement science, biomechanics, and sports medicine; self-regulation competence, with its behavior change techniques, is a central application field of sport and exercise psychology; and the scientific roots of control competence, as the corresponding area which underlines the relevance of qualitative cognitive aspects, primarily lie in the scientific fields of learning psychology, pedagogy, and adult education. Because the integration of knowledge on health behaviors from different scientific fields has proven a complex and unexhausted issue,95 it is crucial to mention that the PAHCO model is basically open to or rather dependent on new insights from these scientific fields. The PAHCO model, notably, goes one step further by overcoming an isolated integrative perspective on the determinants of HEPA. Following the integrative character of the model, movement competence includes task-specific self-efficacy as an important component, which brings an additional psychological perspective into play. Moreover, it can be assumed that body awareness is required for the adequate alignment of physical load. As a consequence, control competence cannot be fully understood without integrating knowledge from sports medicine (eg, for insights on human heart rate) and psychology (eg, for the interoceptive and phenomenological aspects of body awareness). These examples demonstrate that PAHCO not only endorses interdisciplinary collaborations on the global level of the model, but also on the sub-competence level. Irrespective of these theoretical assumptions, researchers in the area of (health-enhancing) PA are encouraged to interpret new findings or developments through the lens of broader or integrative frameworks. In the case of PAHCO, however, it has to be taken into account that the concept of competence claims a specific perspective that is not adoptable for each potential determinant. For instance, it would not be theoretically sound for the PAHCO model to incorporate general, domain overarching, and context-independent variables, such as extraversion, general anxiety, or intelligence. This is the main reason why we outlined the competence concept in the present article in detail. Moreover, we made clear references to the research fields of PL and HL, finally placing the PAHCO approach at the interface between these 2 person-related research areas. In addition, it was concluded that the health capability concept is too broad for the phenomenon under study because it goes beyond the latent disposition toward health-oriented PA by including determinants such as structural characteristics or interpersonal support. Simultaneously, we argued that the concept of health capability plays an integrating role. In addition to theoretical elaborations, future studies should aim to provide more detailed descriptions of the interactions between PAHCO and the individuals’ structural and environmental factors. In this regard, the present article focused on a detailed characterization of the agency or competence side of capability.

Conclusions

Structure models often serve as starting points for the characterization of sub-competencies or bundles of skills. Recent studies showed that facets of PAHCO are substantially related to indicators of PA behavior21,94 and health.73,94 In light of these insights, it would be worth expanding the implementation of PAHCO in practice by following the action principles that result from the integrative idea of PAHCO. Indeed, a recent survey in the area of exercise therapy has shown that it is well feasible to align the practical work toward competence-oriented contents and methods for PA and health.96 Two research projects in the area of pulmonary rehabilitation97 and physical education76 are currently using the PAHCO model to guide their interventions. Studies involving war and torture survivors,72 apprentices,98 persons with multiple sclerosis,74 and persons with intellectual disabilities75 already provided preliminary evidence that the PAHCO model can serve as a useful framework for the development of PA interventions focusing on health. Further evaluation studies are needed which submit interventions to empirical testing.

Acknowledgment

This research has not been funded.

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If the inline PDF is not rendering correctly, you can download the PDF file here.

Carl and Pfeifer are with the Department of Sport Science and Sport, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany. Sudeck is with the Faculty of Economics and Social Sciences, Institute of Sports Science, University of Tübingen, Tübingen, Germany.

Carl (johannes.carl@fau.de) is corresponding author.
  • View in gallery

    —The model of Physical Activity-related Health Competence.21

  • View in gallery

    —Action model for the promotion of Physical Activity-related Health Competence.40

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    —The PAHCO concept at the interface between physical literacy and health literacy. PAHCO indicates Physical Activity-related Health Competence.

  • View in gallery

    —The integration of PAHCO into the broader concept of health capabilities. PAHCO indicates Physical Activity-related Health Competence.

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