21 The German government is implementing this for example within the framework of the Na tional Action Plan IN FORM Germany s Initiative for Healthy Food and More Physical Activity in cooperation with the DOSB www in form de In order to bring about a change in physical ac tivity patterns in Germany it could also make sense to further strengthen the preventive ap proach in the health care system and for example to make it more broadly based in the health objectives sport and exercise It is interesting to note that recommendations and support programs predominantly include to increase physical activity in everyday life but rarely the recommendation to engage in sport This is probably due to the partly negative effects of sport on health However as the present report shows the implementation of recommendations without sport is currently low and it is unlikely that it will make sense to forego the potential of sport for health maintenance in the fu ture Sport should therefore be given a much higher priority in promoting exercise and avoiding inactivity To this end research considers it necessary that sport also pursues health objectives more explicitly and specifically reduces harmful behavior Edwards Rowe 2019 In line with WHO recommendations the greater integration of muscle strengthening activities in the con text of endurance sports can contribute to this Organized non profit sports are also increasingly seeing themselves as providers of preventive and rehabilitation sports Nationwide there are about 15 000 prevention courses with the qual ity seal SPORT PRO GESUNDHEIT21 and of currently about 115 000 rehabilitation sport groups about 90 000 originate from non profit sports 34 of the approximately 90 000 sports clubs in Germany offer programs for health promotion prevention and rehabilitation Breuer 2015 The market share of sports clubs in the health sector prevention and or rehabilitation programs is estimated at approx 20 Breuer 2013 22 The final answer to the economic question also depends on a stronger orientation of sport to wards health objectives What purely from an economic perspective weighs more heavily the cost savings resulting from the positive effects of sport on well being and health or the costs caused by sport direct and indirect costs taken together Even if this question still requires in depth investigation existing studies report predominantly positive balances e g Alt et al 2015 for Austria The Robert Koch Institute also comes to the conclusion that it is generally undis puted that more physical activity results in less health expenditure RKI 2005 21 Courses deposited as eligible for subsidies by the health insurance funds via the Zentrale Prüfstelle Prävention 22 In addition there are currently about 40 000 training licenses for Trainer B Sport in Prevention and about 41 000 li censes for Trainer B Sport in Rehabilitation out of a current total of over 580 000 valid DOSB licenses DOSB mem ber organizations also offer numerous further training courses in areas such as fall prevention exercise in old age child and youth health etc

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