Benefits of Exercise Referrals 'Less Meaningful Than Hoped'

Peter Russell

November 20, 2019

Referring patients to exercise schemes contributes to health and wellbeing, but improvements and changes might not be as significant as hoped, new research suggested.

A study in the Journal of Epidemiology & Community Health concluded that schemes should be rethought to maximise their effectiveness.

Physical activity has been widely considered an effective way of preventing, managing, and treating a range of chronic health disorders. However, a recent UK survey found that physical activity levels have remained unchanged in recent years, with a large proportion of the population classed as inactive.

The costs of physical inactivity to the NHS were estimated as £900 million in 2015.

Exercise referral schemes (ERS) were introduced in primary care in England in the 1990s to boost physical activity levels among those with, or at risk of, long term conditions.

Scheme membership is usually initiated by GP referral to a programme lasting from 10 to 16 weeks. It normally includes both cardiovascular exercises and resistance training at a sports or leisure centre.

UK-wide Database

Studies evaluating the schemes have tended to focus on whether they increase physical activity levels, rather than on actual improvements in health and wellbeing, according to researchers at ukactive in London; St Mary's University, Twickenham, and Sheffield Hallam University.

To help unravel the worth of ERSs, they drew on data from 23,731 active participants in 13 different schemes, lasting between 6 weeks and 3 months. The data had been entered into a dedicated UK-wide national referral database for ERS.

Measurements at the beginning and end of the schemes were recorded for outcomes including blood pressure, resting heart rate, body mass index (BMI), mental health, wellbeing, and quality of life.

"We found that there was an effect for almost all the outcomes that we looked at," said James Steele, an associate professor of sport and exercise science at Solent University in Southampton, and principal investigator at ukactive's Research Institute, who led the study.

He stressed that what was really important was whether those outcomes were significant enough for healthcare professionals, policy makers, and patients to care about.

He said that when the team examined these statistically significant changes further, "we found that for most of the changes, they didn't meet those clinically important thresholds to consider them to be meaningful".

Differences were observed in how ERSs affected health and wellbeing. Prof Steele said systolic blood pressure "almost passed the threshold that we had for minimally important clinical changes, [and mental wellbeing]".

However, some changes from the schemes were less convincing. "Resting heart rate barely changed, and also diastolic blood pressure had very little change," he said. "BMI improved, but certainly not to any kind of meaningful extent," he added.

'More Critical Analysis Needed'

The researchers said the results of their observational study demonstrated the need to consider the implementation of ERSs more critically.

One barrier was a lack of data on how all the ERSs were being delivered. "Some of the schemes could be walking groups, some of the schemes could be in-the-gym personal training," said Prof Steele. "There's so much potential variation of how the schemes are being delivered, that we don't know exactly whether there are certain schemes that actually are working well."

The researchers said they were now looking for funding to develop their database into an open resource for other researchers, as well as policymakers, to examine working practise and inform decision making.

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