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Benefits of exercise referral schemes not as large as hoped

Roll-out of schemes should be rethought to maximise effectiveness, say researchers

Ingrid Torjesen

Wednesday, 20 November 2019

Exercise referral schemes are associated with many improvements in health and wellbeing, but the changes aren’t as large as hoped, finds an analysis* published online in the Journal of Epidemiology & Community Health.

As a result UK roll-out of these schemes needs to be rethought to maximise their effectiveness, say the researchers.

Exercise referral schemes were first introduced in primary care in England in the 1990s to boost physical activity levels among those with, or at risk of, long-term conditions. The programmes last up to 16 weeks and often include both cardio exercises and resistance training at a sports or leisure centre. 

Most evaluations of these schemes have focused primarily on whether they increase physical activity levels, rather than improve health and wellbeing, so the researchers tried to address this. They looked at data from 23,731 active participants in 13 different schemes, lasting between six weeks and three months, which had been entered into the dedicated UK-wide National Referral Database.

They looked at measurements of weight (BMI), blood pressure and resting heart rate, along with validated scores on mental health, wellbeing, quality of life and exercise confidence recorded at the beginning and end of the schemes.

They found significant improvement in most of the included measures after participation in the programmes, with the exceptions being resting heart rate, which is a known risk factor for death from cardiovascular disease, and diastolic blood pressure.

However, when these figures were compared with thresholds for clinical “meaningfulness,” the changes didn’t reach these thresholds. The researchers also noted considerable variation in the schemes, in terms of length and content, and in the characteristics of the participants, so it’s not clear which combination of activities and length of scheme might be most effective, or for whom, they said.

“As noted, currently there is a lack of agreement of what constitutes ‘impact’ with respect to the evaluation of [exercise referral schemes] and the evidence presented here from one of the largest databases of [them] does little to support the use of [them], broadly speaking,” the researchers concluded.

Given how widely used these schemes are, a more critical approach is needed, they added. “These findings support the need to consider exercise referral schemes, particularly their implementation, more critically, using real world data to understand how best to maximise their potential, particularly considering the known benefits of exercise and the research of [exercise referral schemes] across the UK.”


*Wade M, Mann S, Copeland RJ, et al. Effect of exercise referral schemes upon health and well-being: initial observational insights using individual patient data meta-analysis from the National Referral Database. J Epidemiol Community Health Published Online First: 18 November 2019. doi: 10.1136/jech-2019-212674

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