Health professionals' perspectives in exercise referral: implications for the referral process

Abstract

The number of exercise referral schemes expanded rapidly across the UK during the 1990s. Health professionals are thought to be one of the most credible sources of health advice for patients and, hence, are thought to have a pivotal role to play in exercise referral schemes. The aim of the study was to investigate the exercise referral process from the health professional's perspective, specifically examining perceived barriers to referral, priority given to an exercise referral scheme in day-to-day consultations, perceived importance of their role in the process and referring practices. Quantitative and qualitative research methods were utilized with 49% (n = 71) of general practitioners and practice nurses (collectively referred to as health professionals throughout), in a large North West borough (population size approximately 287,000) responding to a postal survey and 11 health professionals (general practitioners n = 9 and practice nurses n = 2) volunteering to take part in a semi-structured interview. Barriers to the referral of patients included lack of time, lack of feedback regarding the patients referred, medico-legal responsibility, a feeling that patients may not take exercise advice given and the belief that physical activity promotion is not a priority during routine consultations. Health professionals refer individuals to an exercise referral scheme on an unsystematic basis and express mixed opinions regarding their perceived role in patient physical activity behaviour change. This study calls for closer partnership working, involving training for promoting physical activity in general practice. Also, greater feedback with regard to patient benefits is needed, in order to overcome some of the practical and perceived barriers for health professionals when referring patients to an exercise referral scheme.

Attendance of exercise referral schemes in the UK: A systematic review

“…As a result, a recommendation from a GP might improve or even be necessary for uptake and attendance [29]. On the other hand, some health professionals perceive barriers to referral [30,31] and do not prioritise physical activity promotion. Therefore, they may be far more reluctant to promote schemes in comparison with researchers who have a vested interest in recruitment.…”

Call to Action: Enhancing 'Exercise is Medicine' from the Perspective of Fitness Professionals

“…This links back to the need for implementing a system to allow communication between physicians and FPs. Studies have found that physicians are hesitant to refer patients for exercise to FPs because they do not have any way to follow up on the patient's progress [13,16]. By including a progression and follow up section on the prescription pad, EIM can close the communication gap between FPs and physicians.…”

“…Studies have examined how to improve the exercise prescription and referral procedure from the perspective of physicians [9,11,12,16,17], yet EIM believes both physicians and FPs are key members in promoting and implementing the inclusion of exercise in the healthcare system [5]. By conducting a focus groups with personal trainers employed at a campus recreation facility, we are the first pilot study to document information from the perspective of FPs.…”

“…In a focus group setting participants were asked to describe barriers to and enablers of the exercise prescription and referral procedure. It was hypothesized that FPs would primarily discuss the lack of communication between FPs and physicians as this has been previously identified as the main reason physicians choose not to make exercise referrals [16]. As EIM is a relatively recent initiative, and the majority of Promotion and educational opportunities have been mainly directed at physicians, it was hypothesized that FPs would have limited knowledge of EIM.…”

Mechanisms to absorb load in amputee running

“…1,2 Running is a fundamental exercise which enhances many aspects associated with health. During the running gait cycle, initial loading of the limb occurs in the early part of the support phase as a result of the foot's collision with the ground at footstrike.…”