Does primary care referral to an exercise programme increase physical activity one year later? A randomized controlled trial

Harrison, Roger; Roberts, Chris; Elton, Peter

doi:10.1093/pubmed/fdh197

Cited by 100 publications

(131 citation statements)

References 22 publications

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“…Three out of the six RCTs compared gym-based exercise-referral schemes in leisure centres in the UK, with an information sheet; [18][19][20] one compared exercise classes in church halls or community centres in the UK with no intervention; 21 another compared a walking scheme in the UK with exercise advice (Supplementary Table 2 compared a gym-based exercise-referral scheme in the UK with a walking scheme, or with advice. 23 The unit of randomisation was the individual participant in five trials, [18][19][20]22,23 and the referring practice in one trial.…”

Section: Controlled Studies Including Rctsmentioning

confidence: 99%

“…23 The unit of randomisation was the individual participant in five trials, [18][19][20]22,23 and the referring practice in one trial. 21 A non-randomised controlled study compared a walking programme for patients with type 2 diabetes with no programme.…”

Section: Controlled Studies Including Rctsmentioning

confidence: 99%

“…19,21,22 Participants were recruited by clinicians in two RCTs from UK exercise-referral schemes that were already accepting referrals from primary care. 20,23 The duration of the schemes was 10 or 12 weeks in four RCTs, [18][19][20]23 4 months in one non-randomised study, 24 and up to 2 years in one RCT. 21 There appeared to be no time limit (or none mentioned) for the walking scheme reported by Lamb et al 22 The participants of most schemes were adults (mainly middle-aged) with sedentary lifestyles and cardiac risk factors, and the aims were to increase physical activity and reduce cardiac risk factors.…”

Section: Controlled Studies Including Rctsmentioning

confidence: 99%

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Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review

et al. 2007

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MethodStudies were identified by searching MEDLINE, CINAHL, EMBASE, AMED, PsycINFO, SPORTDiscus, The Cochrane Library and SIGLE until March 2007. Randomised controlled trials (RCTs), observational studies, process evaluations and qualitative studies of exercise-referral schemes, defined as referral by a primary care clinician to a programme that encouraged physical activity or exercise were included. RCT results were combined in a meta-analysis where there was sufficient homogeneity. ResultsEighteen studies were included in the review. These comprised six RCTs, one non-randomised controlled study, four observational studies, six process evaluations and one qualitative study. In addition, two of the RCTs and two of the process evaluations incorporated a qualitative component. Results from five RCTs were combined in a meta-analysis. There was a statistically significant increase in the numbers of participants doing moderate exercise with a combined relative risk of 1.20 (95% confidence intervals = 1.06 to 1.35). This means that 17 sedentary adults would need to be referred for one to become moderately active. This small effect may be at least partly due to poor rates of uptake and adherence to the exercise schemes. ConclusionExercise-referral schemes have a small effect on increasing physical activity in sedentary people. The key challenge, if future exercise-referral schemes are to be commissioned by the NHS, is to increase uptake and improve adherence by addressing the barriers described in these studies.

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Section: Controlled Studies Including Rctsmentioning

confidence: 99%

Section: Controlled Studies Including Rctsmentioning

confidence: 99%

Section: Controlled Studies Including Rctsmentioning

confidence: 99%

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Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review

et al. 2007

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“…PARS successfully increasing the levels of clients' physical activity could cost just £300 per life saved (Harrison, Roberts and Elton, 2004), although Isaacs et al, (2007) suggest that PARS are not so cost effective. Despite this, Schutzer and Graves (2004) have underlined the potential cost benefit to the NHS by suggesting that increased physical activity would reduce future GP visits and lessen future client dependence on medication.…”

Section: Physical Activity Referral Schemes (Pars)mentioning

confidence: 99%

Exercise, service and support: client experiences of physical activity referral schemes (PARS)

Vinson

Parker

2012

Qualitative Research in Sport, Exercise and Health

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Physical Activity Referral Schemes (PARS) continue to represent one of the most prevalent interventions in the fight against chronic illness such as Coronary Heart Disease (CHD) and obesity. Despite this, issues surrounding low retention and adherence continue to hinder the potential effectiveness of such schemes on public health. This article reports on the second stage of a larger investigation into client experiences of PARS focussing specifically on findings from five client focus groups and interviews with five scheme organisers. The analysis reveals three main factors impacting on participants' perceptions of the quality of service and support at the scheme: the organisation of PARS provision, engagement with the PARS community, and the client support networks. The article demonstrates that staff have a considerable role to play in engaging clients in the PARS system and that scheme organisers should give serious thought to ensuring that clients have valuable and sustainable networks of support. Furthermore, it is suggested that scheme organisers need to facilitate a system in which staff are genuinely engaged with the needs of clients and are able to provide individualised programmes of physical activity.

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“…However, there is concern that interventions do not generate sustainable improvements in health dimensions, and that local, short-term interventions are not costeffective (Sevick et al, 2000;Harrison et al, 2004;Hagberg and Lindholm, 2005;Morgan, 2005).…”

Section: Introductionmentioning

confidence: 99%

Evaluating a community lifestyle intervention: adherence and the role of perceived support

Barter-Godfrey

Taket

Rowlands

2007

PHC

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Background: Interventions that increase participation in physical activity and positive dietary changes may improve the health of the community through modifying the lifestyle contribution to preventable disease. However, previous evaluations have identified concerns about inequitable and unsustainable uptake, adherence and retention within healthy lifestyle schemes. Intervention study: The intervention evaluated here was designed to be a 12-week intervention for participants, offering free testing of physiological indicators of health, one-to-one health advice and a range of exercise, activity and cookery classes, at no or reduced cost, at local venues throughout the community. This paper reports the findings from a small qualitative study undertaken to explore the experiences and reflections of those who took part in the intervention to different extents, including those who fully and partially participated as well as those who dropped out or declined to take part. Method: Sixteen respondents took part in semi-structured interviews (5 male, 11 female; 8 black, 8 white; age range 25-85). Findings: The findings suggest that participants assessed the healthy lifestyle intervention in terms of how well it met their pre-existing needs and opportunities for change, and that they selected the aspects of the scheme that suited them, interested them and were perceived as delivering salient results. There is also evidence for a stronger role of perceived support in influencing uptake and maintenance of lifestyle changes, and that support was conceptualised by participants as one of the services offered by the scheme. Perceived support and related perceptions of reliance on the scheme to sustain lifestyle changes also suggested that in some cases full adherence to a scheme is not as likely to produce long-term adherence to lifestyle changes as compared to partial, but more realistic adherence and smaller lifestyle changes. Implications for delivering and evaluating healthy lifestyle interventions are also discussed.

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Does primary care referral to an exercise programme increase physical activity one year later? A randomized controlled trial

Abstract: Community-based physical activity referral schemes have some impact on reducing sedentary behaviour in the short-term, but which is unlikely to be sustained and lead to benefits in terms of health.

Cited by 100 publications

References 22 publications

Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review

Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review

Exercise, service and support: client experiences of physical activity referral schemes (PARS)

Evaluating a community lifestyle intervention: adherence and the role of perceived support

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