Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis

Abstract

Objective To assess the impact of exercise referral schemes on physical activity and health outcomes.Design Systematic review and meta-analysis.Data sources Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references.Study selection Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals. Population: sedentary individuals with or without medical diagnosis. Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. Comparators: usual care, no intervention, or alternative exercise referral schemes.Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of Correspondence to: T Pavey toby.pavey@pcmd.ac.uk Extra material supplied by the author (see http://www.bmj.com/content/343/bmj.d6462/suppl/DC1) Web appendix 1: Literature search strategies Web appendix 2: Summary of excluded studies from systematic review Web figure 1: Meta-analysis of patients' minutes spent in physical activity of at least moderate intensity per week, at 6-12 month follow-up Web figure 2: Meta-analysis of patients' estimated energy expenditure (kcal/kg per day; from self reports) during exercise referral schemes versus usual care, at 6-12 month follow-up Web figure 3: Meta-analysis of patients' total physical activity per week, at 6-12 month follow-up Web figure 4: Meta-analysis of patients' estimated energy expenditure (kcal/kg per day; from self reports during exercise referral schemes versus alternative physical activity interventions, at 6-12 month follow-up Web Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings.Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indi...

Guidelines for Adult Stroke Rehabilitation and Recovery

“…874 A meta-analysis of 8 RCTs showed that exercise referral schemes that provide a clear referral by primary care professionals to third-party professionals to increase exercise or physical activity can increase the number of participants who achieve 90 to 150 min/wk of moderate physical activity and reduce depressive symptoms in sedentary individuals with or without a medical diagnosis (obesity, hypertension, depression, diabetes mellitus). 875 In a qualitative study, stroke survivors described great physical and psychological well-being after participation in an exercise referral scheme. 794,877 There is substantial evidence that rehabilitation services, particularly exercise-based programs, provided in the community after discharge from acute or institutional care can improve cardiovascular health and decrease the risk of cardiovascular events, leading to increased short-term survival rates for individuals who have experienced a stroke.…”

Long-term engagement with a practice-based exercise referral scheme: Patients’ perceptions of effectiveness

“…These patients showed decreases in perceived health status throughout the 12 month data collection period and a continued reliance on medication at the same or a higher rate. Our findings are in contrast to other views that suggest ERS are no better than standard care [11], were ineffective at promoting physical activity in the long-term (over 12 weeks) [12] or only have a marginal effect on increasing physical activity levels [14].…”

“…In our analysis of 12 seriously ill patients participating in an ERS, we found that long-term engagement with a practice-based scheme aided physical activity adherence and increased combined (walking and exercise classes) physical activity levels, in the long-term. These findings are in contrast to recent reviews that found limited evidence to support the use of ERS in primary care [11,14]. The patients in this study were able to give examples of how the physical activity that they had undertaken had positively affected their diagnosed medical conditions over the 12 month period.…”

“…Consequently, research has since focused on randomized controlled trial (RCT) design. Evidence from these studies suggests that ERS may not be an effective means of promoting physical activity, due to high levels of dropout [11]. A review of RCT studies found the numbers of patients achieving 150 minutes of moderate intensity physical activity per week from an ERS were no more than for usual care, no intervention or other exercise interventions [13].…”

“…The proliferation of these schemes have increased from around 200 in 1994 [10], to approximately 600 in 2011 [11]. In 2005 the National Institute for Health and Care Excellence (NICE) of the UK commissioned a study to assess the effectiveness of physical activity interventions [12].…”