Getting off the couch - this is how it’s done

The importance of physical activity for health is undisputed. A session at the 2021 DDG Congress shed light on various aspects of physical activity promotion in diabetes.

Digital training, with better motivation

The importance of physical activity for health is undisputed. Adults should be physically active for at least 150 minutes per week - not even half of the people manage to do this. Therefore, a session at the DDG congress will shed light on various aspects of physical activity promotion in diabetes. Dr. Meinolf Behrens, specialist for internal medicine, nutritionist, sports physician and diabetologist, spoke on "Movement support in a digital world".

Sitting at the computer is certainly not one of the healthiest activities. But digitalisation nevertheless also has positive aspects for diabetics who want to and should exercise. Dr. Behrens therefore highlighted the opportunities and possibilities of the digital world - especially the benefits of apps, wearables, fitness portals, digital coaching and exergaming.


Digital health applications must be certified in order to be approved. A diabetes app seal should provide clarity here. Currently, there is only one approved app for diabetology: Zanadio. It is about nutrition, exercise and behavioural therapy. It can be prescribed like a medicine. Other apps are being tested.


They record vital parameters - the spectrum is broad: pedometers, smart glasses, smart headphones, smart jewellery. The number of parameters to be recorded is gigantic: steps, activity times, soon also glucose values, all the way to emotional status and cognitive functions. An initiative of European sports scientists is currently working on recommendations for the validation of pedometers and heart rate monitors in order to obtain good scientific results in this way.


This combination of computer games with physical activity via virtual reality glasses has potential. There is encouraging data that exergaming improves BMI, body fat and HbA1c levels, as well as cardiovascular parameters.


Dynamic pump and sensor development in its own way promotes physical activity in type 1 diabetes patients. Further positive effects can be expected through the new approval of therapies.

Digital coaching

Telemedicine facilitates the treatment and care of patients. One example is the VIDEA app, which is intended to encourage exercise. It has been approved by the German Central Testing Centre for Prevention (Zentrale Prüfstelle für Prävention). offers an interesting initiative. Here, doctors go for a walk with celebrities, talk about exercise and invite people to copy the walk.

Fitness portals

The advantage here is the wide selection of workouts, there is no need to travel, you can work out whenever you want. Prices: From 13 euros a month. However, there is no personal qualified guidance.

Motivation to exercise

One of the most important tasks in promoting physical activity is to activate self-motivation. The Hamburg psychologist and diabetological psychotherapist Susan Clever spoke about the so-called Motivational Interviewing (MI). This is a technique for intrinsic motivation to exercise.

The core message: You can't really motivate people from the outside. MI is about shared decision making. People are usually ambivalent about health-related behaviour change. They are experts on themselves. There is no evidence that people are more likely to change if you make them feel bad, for example through fear or shame. The conversation has to link to the patient's needs. It is about patient autonomy, the outcome of the conversation must be open. If the decision is made respectfully and empathically, the patient will come back to the conversation if their circumstances change. Even two in-depth, empathetic counselling sessions show a significant effect in studies.

This is called Change Talk. The question is what the patient wants to change. Why he or she wants to change. That is the starting point. The opposite is Sustain Talk, where patients report on inner barriers. Here, the ambivalence and resistance of the patient becomes apparent. This has to be dealt with reflectively. Physicians must be aware of resistance, but Change Talk is the primary focus. Follow-up is very important. It is essential to evaluate if the patient has done something that was discussed.

The talk should include

The interview technique


Architecture for healthy living

Architectural urban development also offers an opportunity to promote everyday movement. Architect Prof. Dr. Martin Knöll from Darmstadt spoke about how to design a city in a movement-friendly way.  Among other things, he researches urban factors influencing movement and diabetes therapy. "Inclusive, green, open" was the title of his talk.

Fewer cars, more cycling, green spaces - these were his topics. Good urban design can indeed be documented by health parameters of the inhabitants. One example: The app Walk Score can calculate how exercise-friendly a residential area is. This is only a small indication of what is known as walkability. It becomes clear here how housing and movement are connected. The influence of the built environment on individual health, i.e. also on the absence of type 1 or type 2 diabetes, is very great. This means a great responsibility and at the same time a huge potential for urban planners and architects. In any case, Prof. Knöll wants to work on more walkability.

DDG Congress 13.5.2021, Various Aspects of Physical Activity Promotion in Diabetes