Effect of exercise referral schemes upon health and well-being: initial observational insights using individual patient data meta-analysis from the National Referral Database

Wade, Matthew; Mann, Steven; Copeland, Robert J.; Steele, James

doi:10.1136/jech-2019-212674

Cited by 33 publications

(32 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous evidence on primary care PA programs’ impact on HRQoL is mixed. Although some studies have found positive impact [ 12 , 16 , 20 , 37 , 42 – 44 ], our findings are in conflict with other studies showing minimal effects [ 19 , 45 – 48 ].…”

Section: Discussioncontrasting

confidence: 99%

Health-related quality of life and physical activity level after a behavior change program at Norwegian healthy life centers: a 15-month follow-up

et al. 2020

View full text Add to dashboard Cite

Purpose The long-term impact of primary care behavior change programs on health-related quality of life (HRQoL) and physical activity (PA) level is unknown. The aim of this study was to investigate changes in HRQoL and PA among participants after a 3-month behavior change intervention at Norwegian healthy life center (HLCs) and at a 15-month follow-up. Furthermore, we aimed to study associations between changes in PA and HRQoL. Methods We followed 524 adult participants (18–83 years), recruited from 32 HLCs in August 2016–January 2018, who provided data on HRQoL (SF-36) and PA (ActiGraph accelerometers) 12 months after a 3-month behavior change intervention. Changes in HRQoL and PA between baseline, 3-month and 15-month follow-ups, and associations between changes in PA and HRQoL were analyzed by linear mixed models. Results All HRQoL dimensions improved from baseline to 3-month follow-up, and the improvements maintained at 15-month follow-up (mean 3.1–13.1 points, p < 0.001). PA increased from baseline to 3 months (mean 418 steps/day, p < 0.001), but declined from 3 to 15 months (mean − 371 steps/day, p < 0.001). We observed positive associations between changes in PA and HRQoL (0.84–3.23 points per 1000 steps/day, p < 0.023). Conclusions Twelve months after completing a 3-month HLC intervention we found improved HRQoL, but not PA level. Still, there were positive associations between PA and HRQoL over this period, indicating that participants increasing their PA were more likely to improve their HRQoL.

show abstract

Section: Discussioncontrasting

confidence: 99%

Health-related quality of life and physical activity level after a behavior change program at Norwegian healthy life centers: a 15-month follow-up

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The number of existing ERS is thought to be in excess of 600 schemes in the UK. However, evidence concerning their effectiveness remains mixed [7]. A recent review [8] including six Randomised Controlled Trials (RCTs) noted positive impacts among patients referred for cardiovascular or mental health reasons, yet a lack of evidence for musculoskeletal referrals.…”

Section: Introductionmentioning

confidence: 99%

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

Morgan

Rahman

Moore

2020

IJERPH

View full text Add to dashboard Cite

Exercise referral schemes have shown small but positive impacts in randomized controlled trials (RCTs). Less is known about the long-term reach of scaled up schemes following a RCT. A RCT of the National Exercise Referral Scheme (NERS) in Wales was completed in 2010, and the scheme scaled up across Wales. In this study, using a retrospective data linkage design, anonymized NERS data were linked to routine health records for referrals between 2008 and 2017. Rates of referral and uptake were modelled across years and a multilevel logistic regression model examined predictors of uptake. In total, 83,598 patients have been referred to the scheme and 67.31% of eligible patients took up NERS. Older adults and referrals for a musculoskeletal or level four condition were more likely to take up NERS. Males, mental health referrals, non-GP referrals and those in the most deprived groupings were less likely to take up NERS. Trends revealed an overall decrease over time in referrals and uptake rates among the most deprived grouping relative to those in the least deprived group. Findings indicate a widening of inequality in referral and uptake following positive RCT findings, both in terms of patient socioeconomic status and referrals for mental health.

show abstract

“…It is notable that the post-intervention magnitude of change observed in mental well-being for Co-PARS (5) was larger than that observed in a meta-analysis encompassing >23 000 participants across 13 different ERSs (3), which were comparable in nature to the usual care ERS in this study. 49 From the 6-month data, it appeared the scheme was not effective at promoting sustained PA behaviour change or mental well-being improvements. It must be noted, however, that the well-being levels were still higher than baseline and even small magnitudes of change (1-3) may be meaningful in clinical populations.…”

Section: Discussionmentioning

confidence: 98%

Pragmatic evaluation of a coproduced physical activity referral scheme: a UK quasi-experimental study

et al. 2020

View full text Add to dashboard Cite

ObjectivesUK exercise referral schemes (ERSs) have been criticised for focusing too much on exercise prescription and not enough on sustainable physical activity (PA) behaviour change. Previously, a theoretically grounded intervention (coproduced PA referral scheme, Co-PARS) was coproduced to support long-term PA behaviour change in individuals with health conditions. The purpose of this study was to investigate the effectiveness of Co-PARS compared with a usual care ERS and no treatment for increasing cardiorespiratory fitness.DesignA three-arm quasi-experimental trial.SettingTwo leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control.Participants68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment.Intervention16-weeks of PA behaviour change support delivered at 4, 8, 12 and 18 weeks, in addition to the usual care 12-week leisure centre access.Outcome measuresCardiorespiratory fitness, vascular health, PA and mental well-being were measured at baseline, 12 weeks and 6 months (PA and mental well-being only). Fitness centre engagement (co-PARS and usual care) and behaviour change consultation attendance (co-PARS) were assessed. Following an intention-to-treat approach, repeated-measures linear mixed models were used to explore intervention effects.ResultsSignificant improvements in cardiorespiratory fitness (p=0.002) and vascular health (p=0.002) were found in co-PARS compared with usual care and no-treatment at 12 weeks. No significant changes in PA or well-being at 12 weeks or 6 months were noted. Intervention engagement was higher in co-PARS than usual care, though this was not statistically significant.ConclusionA coproduced PA behaviour change intervention led to promising improvements in cardiorespiratory and vascular health at 12 weeks, despite no effect for PA levels at 12 weeks or 6 months.Trial registration numberNCT03490747.

show abstract

Effect of exercise referral schemes upon health and well-being: initial observational insights using individual patient data meta-analysis from the National Referral Database

Cited by 33 publications

References 59 publications

Health-related quality of life and physical activity level after a behavior change program at Norwegian healthy life centers: a 15-month follow-up

Health-related quality of life and physical activity level after a behavior change program at Norwegian healthy life centers: a 15-month follow-up

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

Pragmatic evaluation of a coproduced physical activity referral scheme: a UK quasi-experimental study

Contact Info

Product

Resources

About