The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review

Abstract

BackgroundExercise referral schemes within clinical populations may offer benefits for inactive and sedentary individuals, and improve and aid treatment of specific health disorders. This systematic review aims to provide an overview, and examine the impact, of exercise referral schemes in patients with cardiovascular, mental health, and musculoskeletal disorders. This review focuses on populations within the United Kingdom (UK) only, with an aim to inform national exercise referral policies and guidelines.MethodData was collected from specific sources using validated methodology through PRISMA. Systematic searches were performed using Locate, PubMed, Scopus and Pro Quest: Public Health databases. Thirteen studies met inclusion criteria set for each sub group. This included that all studies aimed to prevent, observe, or decrease ill-health relating to the disorder, participants over the age of sixteen, and health disorders and outcomes were reviewed. All studies were conducted in the UK only.ResultsIn the 13 articles, a variety of modes and types of exercise were utilised. One-to-one supervised exercise sessions based in a gym environment were most frequently employed. Results showed that longer length schemes (20+ weeks) produced better health outcomes, and had higher adherence to physical activity prescribed, than those of shorter length (8–12 weeks). In patients referred with cardiovascular disorders, cardiovascular-related measures showed significant decreases including blood pressure. Schemes increased physical activity levels over the length of scheme for all disorders.ConclusionLonger length schemes (20+ weeks) improved adherence to physical activity prescribed over the course of the scheme, and could support longer term exercise adherence upon completion, however additional research on larger samples should examine this further. An implication is that schemes currently recommended in guidelines do not tailor programmes to support long term adherence to exercise, which must be addressed. There is currently a lack of research examining programmes tailored to suit the individual’s health conditions thus further research might allow providers to tailor delivery and build upon policy recommendations in the UK.

Healthy Life Centres: a 3-month behaviour change programme’s impact on participants’ physical activity levels, aerobic fitness and obesity: an observational study

“…► This is a large-scale observational study of 32 Healthy Life Centres, which strengthens the external validity of this study. ► We used objective measurements of physical activity (PA) level by accelerometers, which enabled us to measure intensity-specific PA and overall PA more precisely than subjective measurement methods.…”

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

“…Given the substantial psychological challenges among participants attending the HLC program [ 50 , 51 ], the staffs’ competence on how to promote socio-psychological health is of particular importance [ 62 ]. Furthermore, extensive follow-up has been found more beneficial than less comprehensive interventions to achieve long-term behavior changes within high-risk groups [ 49 , 59 , 63 , 64 ]. Thus, we suggest that future studies should investigate the impact of the staffs’ expertise on socio-psychological support and a comprehensive follow-up on HLC participants’ PA level over the long term.…”

Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review

“…31 Yet data across other European countries show variance in scheme adherence and PA changes with most of the literature suggesting that that the UK has a particularly variable adherence level. [32][33][34][35] Despite emergent data outlining key characteristics of successful engagement in UK ERS, 36 there has not been a comprehensive exploration of psychosocial mechanisms of adherence. Importantly, qualitative literature provides a wealth of data to enhance the quantitative work which is restricted by a lack of theory-informed practice, selective outcome frameworks, and poor practitioner fidelity.…”