This review critically explores the development, impact and evaluation of exercise referral schemes (ERS) in the UK. A rapid expansion in the use of such ERSs has been recorded throughout leisure and primary care settings, but the evidence underpinning their implementation has been sparse and predominantly limited to randomized control trial (RCT) research design. Consequently, understanding of exercise referral as a 'real world' intervention has been limited. Considering the increasing importance being placed on evidence-based practice and clinical effectiveness, it is no longer sufficient for service providers of exercise referral to ignore the need to evaluate schemes. The guidelines on evaluation provided by the National Quality Assurance Framework for Exercise Referral are limited, hence practitioners are often unsure of the best measures to use when assessing effectiveness. Predominantly, exercise professionals focus on the collection of physiological data but tend to ignore relevant psychological and environmental parameters. Also, few UK studies have followed participants up in the long term, to see if physical activity behaviour is sustained over time. Here, evidence from two on-going, large-scale (n = 1600/annum) evaluation studies of exercise referral schemes, based in urban localities in the northwest of England, are described. A participatory action research framework for evaluation was utilized and incorporated multi-method research approaches for the assessment of both ERS participants and health professionals involved in intervention delivery. This framework is an appropriate methodology for the evaluation and development of complex interventions, and here incorporates case study, focus groups, interviews and survey questionnaires. Included was a 12-month tracking study of a cohort of exercise referral participants (n = 342), which measured leisure-time physical activity levels (Godin leisure time score), at baseline (entry to exercise referral) and at 3 monthly intervals thereafter. Adherence to the ERS was approximately 35-45%, with the older participants more likely to complete. Physiological changes during the ERS, although statistically significant, were not of a magnitude to convey any real health benefit to an individual's health status. Although small in scale, physiological changes were all in a positive direction (e.g. reduction in blood pressure) and, if maintained over time, could bring about population-level benefits in health. Participants referred from cardiac and practice nurses had higher levels of adherence than participants referred by general practitioners. Scheme B showed that the participants who adhered (n = 103) until the end of the ERS (12 weeks) were able to sustain a small increase in physical activity at the end of 12 months (increase of 21 min moderate activity/week compared with baseline). In conclusion, this research shows that the process of exercise referral benefits certain segments of the population, but not necessarily all.

Purpose: This paper reports a synopsis of a recent systematic review of the literature regarding the effectiveness of workplace physical activity interventions, commissioned by the National Institute for Health and Clinical Excellence (NICE), UK (Dugdill et al., 2007). Methods:A search for English-language papers published between 1996-2007 was conducted using 12 relevant databases and associated grey literature. Search protocols and analysis regarding study quality as recommended by NICE were utilised (NICE, 2006). Key inclusion criteria were 1) workplace intervention aiming to increase physical activity, 2) intervention aimed at working adults, 3) intervention initiated/endorsed by the employer, 4) physical activity outcome. Thirty three studies (38 papers) met the inclusion criteria and were independently reviewed (checked by 2 reviewers) with a narrative synthesis of findings.Findings: Fourteen studies were graded as ++ (high quality) or + (good quality). Evidence from previous systematic reviews was inconclusive. Data regarding the effectiveness of stair walking interventions was limited and intervention effects were short-lived. Three public sector studies provided evidence that workplace walking interventions using pedometers can increase daily step counts. One good quality study reported a positive intervention effect on walking to work behaviour (active travel) in economically advantaged female employees. There was strong evidence that workplace counselling influenced physical activity behaviour. There is a dearth of evidence for small and medium enterprises (SMEs).Limitations: Due to the necessary UK focus and time constraints, only studies from Europe, Australia, New Zealand and Canada were included.Implications: There is a growing evidence base that workplace physical activity interventions can positively influence physical activity behaviour.

Primary school-based behavioural interventions for preventing caries (Review)

Primary-care patients seem to view the concept of exercise referral schemes positively but practitioners remain reluctant to refer many of their sedentary patients. There is doubt that exercise referral schemes like this will influence population levels of sedentary behaviour, when considered alongside their impact on physical activity in the longer term.

We assessed segmental and global left ventricular (LV) diastolic function via tissue-Doppler imaging (TDI) as well as Doppler flow variables before and after a marathon race to extend our knowledge of exercise-induced changes in cardiac function. Twenty-nine subjects (age 18-62 year) volunteered to participate and were assessed pre-and post-race. Measurements of longitudinal plane TDI myocardial diastolic velocities at five sites on the mitral annulus included peak early myocardial tissue velocity (E ), peak late (or atrial) myocardial tissue velocity (A ) and the ratio E /A . Standard pulsed-wave Doppler transmitral and pulmonary vein flow indices were also recorded along with measurements of body mass, heart rate, blood pressures and cardiac troponin T (cTnT), a biomarker of myocyte damage. Pre-to post-race changes in LV diastolic function were analysed by repeated measures ANOVA. Delta scores for LV diastolic function were correlated with each other and alterations in indices of LV loading. Diastolic longitudinal segmental and mean TDI data were altered post-race such that the mean E /A ratio was significantly depressed (1.51 ± 0.34 to 1.16 ± 0.35, P < 0.05). Changes in segmental and global TDI data were not related to an elevated post-race HR, a decreased post-race pre-load or an elevated cTnT. The pulsed wave Doppler ratio of peak early transmitral flow velocity (E)/peak late (or atrial) flow velocity (A) was also significantly reduced post-race (1.75 ± 0.46 to 1.05 ± 0.30, P < 0.05); however, it was significantly correlated with post-race changes in heart rate. The lack of change in E/E from pre-to post-race (3.4 ± 0.8 and 3.3 ± 0.7, respectively) suggests that the depression in diastolic function is likely to be due to altered relaxation of the left ventricle; however, the exact aetiology of this change remains to be determined.