Evaluation of cardiovascular risk-lowering health benefits accruing from laboratory-based, community-based and exercise-referral exercise programmes

Abstract

BackgroundTo evaluate the ability of community-based exercise programmes to facilitate public participation in exercise and hence improved cardiovascular health, we assessed the respective impacts of: a continuously monitored exercise programme based within our university (study 1); a Valleys Regional Park-facilitated community-based outdoor exercise programme (study 2); a Wales National Exercise Referral Scheme-delivered exercise-referral programme (study 3).MethodsBiomolecular (monocytic PPARγ target gene expression), vascular haemodynamic (central/peripheral blood pressure, arterial stiffness), clinical (insulin sensitivity, blood lipids) and anthropometric (body mass index, waist circumference, heart rate) parameters were investigated using RT-PCR, applanation tonometry, chemical analysis and standard anthropometric techniques.ResultsIn studies 1–3, 22/28, 32/65 and 11/14 participants adhered to their respective exercise programmes, and underwent significant increases in physical activity levels. Importantly, beneficial effects similar to those seen in our previous studies (eg, modulations in expression of monocytic PPARγ target genes, decreases in blood pressure/arterial stiffness, improvements in blood lipids/insulin sensitivity) were observed (albeit to slightly differing extents) only in participants who adhered to their respective exercise programmes. While study 1 achieved more intense exercise and more pronounced beneficial effects, significant cardiovascular risk-lowering health benefits related to biomolecular markers, blood pressure, arterial stiffness and blood lipids were achieved via community/referral-based delivery modes in studies 2 and 3.ConclusionsBecause cardiovascular health benefits were observed in all 3 studies, we conclude that the majority of benefits previously reported in laboratory-based studies can also be achieved in community-based/exercise-referral settings. These findings may be of use in guiding policymakers with regard to introduction and/or continued implementation of community/referral-based exercise programmes.

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

“…The mean baseline SBP for participants in the database was 131.70±16.91 mmHg; thus, considering the results of Bundy et al 47 highlighting that large SBP reductions produce the greatest mortality risk reduction, in combination with the small reduction reported here, it is unclear whether sufficient reduction might have occurred to have meaningfully reduced risk. Though other studies of ERSs also report reductions in SBP, these are either similarly small (−2.84 mmHg (−6.57 to 0.82) and −3.53 mmHg (−7.31 to 0.25)22; −3.2 mmHg (−4.6 to 1.7) and −2.9 mmHg (−4.4 to 1.4)38) or variable in their point estimates (−6.1 to +4.8 mmHg40). This is perhaps unsurprising as meta-analysis48 suggests reductions are small for endurance type exercise (−3.5 mmHg (−4.6 to −2.3) and dynamic resistance training (−1.8 mmHg (−3.7 to −0.011)).…”

“…Indeed, in their systematic review and meta-analysis, Pavey et al 18 reported no significant (or meaningful considering the criteria used here) differences for the effects of ERSs compared with other comparator interventions on BMI. Studies of ERS ranging from 8 weeks to 4 months show similarly little changes in BMI (ie, ranging from no change to ~0.6 kg/m 2 22 38–40). Considering that participants undergoing ERSs in our sample were obese (BMI 31.53±6.53 kg/m 2 ), lack of effectiveness could be considered an issue, particularly as ERSs have been noted as being tied to the current ‘obesity agenda’ 41.…”

“…Only one paper reporting the results of three small studies (n’s ranged from 11 to 65) has reported changes in RHR from ERS, and our data are supportive of these. Webb et al 40 reported point estimates ranging from +2.0 to −6.8 f c as a result of an 8 week ERS. Heart rate data from FitBit covering 150 billion hours of activity suggest that in those who are 55 years of age (similar to the sample in the current database), an increase of 180 min physical activity is needed to see an improvement in RHR of around ~6.5 f c 45.…”

Are exercise referral schemes associated with an increase in physical activity? Observational findings using individual patient data meta-analysis from The National Referral database

“…Indeed, it may be that if longer schemes where present in the database for analysis these may reveal greater physical activity increases compared with shorter schemes. Although other research by Webb, et al (2016) suggests shorter schemes can be effective as it was found that after completing an 8-week ERS, categorical IPAQ scores significantly increased.…”

“…In addition, ERSs have been described as 'wild and woolly', with a lack of agreement between stakeholders on how to determine impact (Henderson, et al 2018). Although increasing physical activity levels is a primary aim of ERS there has been little research documenting change in physical activity levels after scheme completion; and what has been conducted appears conflicting (Chalder, et al 2012;Murphy, et al 2012;Pavey, et al 2011;Webb, et al 2016). This is of particular relevance as recent observational findings reported alongside this manuscript from ERSs schemes in The National Referral Database suggest that changes in health and wellbeing outcomes may not reach meaningful levels (Wade et al 2019).…”