ObjectivesExercise on referral schemes (ERS) are widely commissioned in the UK but there is little evidence of their association with physical activity levels. We sought to assess the Northumberland exercise on referral scheme in terms of increased levels of physical activity and identify predictors of engagement.DesignA naturalistic observational study.Setting9 local authority leisure sites in Northumberland.Participants2233 patients referred from primary and secondary care between July 2009 and September 2010.InterventionA 24-week programme including motivational consultations and supervised exercise sessions for participants.Outcome measuresUptake, 12-week adherence, 24-week completion, changes in Godin Leisure-Time Exercise Questionnaire scores after 24-weeks and attendance levels at supervised exercise sessions during the scheme. Three binary logistic regressions were used to examine demographic and referral factors associated with initial uptake, 12-week adherence and 24-week completion.ResultsUptake was 81% (n=1811), 12-week adherence was 53.5% (n=968) and 24-week completion was 42.9% (n=777). Participants who completed significantly increased their self-reported physical activity levels at 24-weeks t (638)=−11.55, p<0.001. Completers attended a mean of 22.87 (12.47 SD) of a target 48 supervised sessions. Increasing age, being female and leisure site were associated with uptake, increasing age, Index of Multiple Deprivation and leisure site were associated with 12-week adherence and Body Mass Index and leisure site were associated with 24-week completion. Each regression significantly increased the prediction accuracy of stage of exit (non-starters vs starters 81.5%, dropouts before 12 weeks vs 12-week adherers 66.9%, and dropouts between 13 and 24 weeks 82.2%).ConclusionsCompleters of the Northumberland ERS increased physical activity at 24 weeks, although the levels achieved were below the current UK guidelines of 150 min of moderate exercise per week. Leisure site was associated with uptake, adherence and completion.

ObjectivesExercise referral schemes (ERSs) are internationally widespread. This study aimed to gain an insight into differential engagement through understanding participant experiences of patients referred by healthcare professionals to one such scheme in the UK.DesignThe study employed a qualitative longitudinal approach using semistructured interviews, with results reported using Consolidated criteria for Reporting Qualitative research guidelines.SettingTwo leisure centres providing an ‘emerging best-practice’ ERS in northeast England.ParticipantsReferred patients (n=11), who had not yet commenced the scheme, were recruited on a voluntary basis. Seven females and four males, with a range of non-communicable diseases, such as cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems, participated.Intervention24-weeks, two times per week, of supervised exercise sessions and three one-to-one assessments (prescheme, 12 weeks and 24 weeks) for patients referred from primary and secondary care.Primary outcome measuresTwo longitudinal semistructured interviews, prior to commencement and 12–20 weeks later, were thematically analysed using the framework approach. Analysis comprised seven stages: transcription, familiarisation, coding, development and application of an analytical framework, charting data using a matrix and interpretation of data. Interpretation went beyond descriptions of individual cases to develop themes, which identified and offered possible explanations for differing participant experiences.ResultsThree overarching themes emerged. First, ‘success’, with engaged participants focused on health outcomes and reported increases in physical activity. Second, ‘struggle’, with short-term success but concerns regarding continued engagement. Participants reported scheme dependency and cyclical needs. Finally, ‘defeat’, where ill health, social anxiety and/or poor participation experience made engagement difficult.ConclusionSome success in engaging those with non-communicable diseases was reported, resulting in positive effects on health and well-being. The study highlights complexity within ERSs and inequality of access for those with challenging health and social circumstances. Improved, or different, behaviour change support is required for referrals finding engagement difficult.

The micro-level enactment of educational policy has received little attention in the physical education [PE] literature, particularly as it relates to setting policy. This study employs enactment theory to provide original insights into the ways in which setting policy was enacted by PE teachers in three mixed-gender secondary schools in England. The work of Stephen Ball and colleagues is used to examine the distinct and combined influence of the situated, material, professional and external dimensions of context on setting policy and practices in PE in these three schools. Data were generated through in-depth, semi-structured interviews with 15 PE teachers who were responsible for delivering the Year 9 PE curriculum. Our findings highlight notable variation in the ways in which setting policy was translated and enacted in PE in these three schools and the multiple factors shaping decisions about groupings and, in turn, teaching and learning for students in different sets. This study also provides novel findings regarding the dynamic interplay between the external dimensions of context (i.e. neoliberal policy making and pressures and supports from the local education authority [LEA] and the school inspectorate) and the internal dimensions of context (i.e. schoolbased traditions, school demographics, and support and resourcing for PE) in policy enactment. Attention is drawn to equity issues inherent in, and arising from, the varied enactment of setting policy in PE. The paper concludes by arguing for greater scholarly engagement with policy enactment, grouping strategies and constructions of ability in PE.

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