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Exercise Referral and Social Prescribing for Physical Activity

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 62188

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Special Issue Editors

Dr. Paul Kelly

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Guest Editor

Physical Activity for Health Research Centre, Institute of Sport, Physical Education, and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Old College, South Bridge, Edinburgh EH8 8AQ, UK
Interests: physical activity; wellbeing; active transport; walking; cycling; physical activity measurement; physical activity messaging
Special Issues, Collections and Topics in MDPI journals

Dr. Coral Hanson

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Guest Editor

School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
Interests: physical activity referral for people with non-communicable diseases; health behaviour change; mobile health behaviour change; pragmatic evaluation of physical activity interventions

Dr. Kelly Morgan

E-Mail Website
Guest Editor

DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff CF10 3BD, UK
Interests: physical activity; development and evaluation of public health interventions; data linkage; interventions to promote physical activity and reduce sedentary behaviour across the lifecourse
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on Exercise Referral and Social Prescribing for Physical Activity in the International Journal of Environmental Research and Public Health. This is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Physical inactivity is a global pandemic leading to poor health outcomes. Increasing physical activity levels are therefore a priority for public health and policy makers. For decades, health care professionals have been able to refer patients with a range of medical conditions to physical activity interventions delivered at community level. Despite the popularity of such interventions, there is a need to improve the evidence base for ‘what works best’. Research that contributes to a better understanding of delivery mechanisms and appropriate measures of success can offer a critical guide for policy efforts and planning for public health.

This Special Issue is open to quantitative and qualitative submissions in any subject area related to the design, implementation, and impact of community-based interventions that involve a referral for physical activity. The listed keywords suggest just a few of the many possibilities.

Dr. Paul Kelly
Dr. Coral Hanson
Dr Kelly Morgan
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Physical activity
Public health
Primary care
Secondary care
Quality of life
Evaluation
Social participation
Leisure

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Published Papers (13 papers)

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Research

17 pages, 723 KiB

Open AccessCommunication

The National ReferAll Database: An Open Dataset of Exercise Referral Schemes Across the UK

by James Steele, Matthew Wade, Robert J. Copeland, Stuart Stokes, Rachel Stokes and Steven Mann

Int. J. Environ. Res. Public Health 2021, 18(9), 4831; https://doi.org/10.3390/ijerph18094831 - 30 Apr 2021

Cited by 7 | Viewed by 4258

Abstract

In 2014, The National Institute for Health and Care Excellence (NICE) called for the development of a system to collate local data on exercise referral schemes (ERS). This database would be used to facilitate continued evaluation of ERS. The use of health databases can spur scientific investigation and the generation of evidence regarding healthcare practice. NICE’s recommendation has not yet been met by public health bodies. Through collaboration between ukactive, ReferAll, a specialist in software solutions for exercise referral, and the National Centre for Sport and Exercise Medicine, which has its research hub at the Advanced Wellbeing Research Centre, in Sheffield, data has been collated from multiple UK-based ERS to generate one of the largest databases of its kind. This database moves the research community towards meeting NICEs recommendation. This paper describes the formation and open sharing of The National ReferAll Database, data-cleaning processes, and its structure, including outcome measures. Collating data from 123 ERSs on 39,283 individuals, a database has been created containing both scheme and referral level characteristics in addition to outcome measures over time. The National ReferAll Database is openly available for researchers to interrogate. The National ReferAll Database represents a potentially valuable resource for the wider research community, as well as policy makers and practitioners in this area, which will facilitate a better understanding of ERS and other physical-activity-related social prescribing pathways to help inform public health policy and practice. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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16 pages, 1001 KiB

Open AccessArticle

Current Practice of Physical Activity Counselling within Physiotherapy Usual Care and Influences on Its Use: A Cross-Sectional Survey

by Shiyi Zhu, Catherine Sherrington, Matthew Jennings, Bernadette Brady, Marina Pinheiro, Sarah Dennis, Lauren J. Christie, Balwinder Sidhu, Abby Haynes, Colin Greaves and Leanne Hassett

Int. J. Environ. Res. Public Health 2021, 18(9), 4762; https://doi.org/10.3390/ijerph18094762 - 29 Apr 2021

Cited by 7 | Viewed by 4603

Abstract

Physical activity counselling has demonstrated effectiveness at increasing physical activity when delivered in healthcare, but is not routinely practised. This study aimed to determine (1) current use of physical activity counselling by physiotherapists working within publicly funded hospitals; and (2) influences on this behaviour. A cross-sectional survey of physiotherapists was conducted across five hospitals within a local health district in Sydney, Australia. The survey investigated physiotherapists’ frequency of incorporating 15 different elements of physical activity counselling into their usual healthcare interactions, and 53 potential influences on their behaviour framed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model. The sample comprised 84 physiotherapists (79% female, 48% <5 years of experience). Physiotherapists reported using on average five (SD:3) elements of physical activity counselling with at least 50% of their patients who could be more active. A total of 70% of physiotherapists raised or discussed overall physical activity, but less than 10% measured physical activity or contacted community physical activity providers. Physiotherapists reported on average 25 (SD:9) barriers influencing their use of physical activity counselling. The most common barriers were related to “opportunity”, with 57% indicating difficulty locating suitable community physical activity opportunities and >90% indicating their patients lacked financial and transport opportunities. These findings confirm that physical activity counselling is not routinely incorporated in physiotherapy practice and help to identify implementation strategies to build clinicians’ opportunities and capabilities to deliver physical activity counselling. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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19 pages, 828 KiB

Open AccessArticle

Inequalities and Inclusion in Exercise Referral Schemes: A Mixed-Method Multi-Scheme Analysis

by Emily J. Oliver, Caroline Dodd-Reynolds, Adetayo Kasim and Dimitrios Vallis

Int. J. Environ. Res. Public Health 2021, 18(6), 3033; https://doi.org/10.3390/ijerph18063033 - 16 Mar 2021

Cited by 7 | Viewed by 3739

Abstract

Physical activity prescription, commonly through exercise referral schemes, is an established disease prevention and management pathway. There is considerable heterogeneity in terms of uptake, adherence, and outcomes, but because within-scheme analyses dominate previous research, there is limited contextual understanding of this variance. Both the impact of schemes on health inequalities and best practices for inclusion of at-risk groups are unclear. To address this, we modelled secondary data from the multi-scheme National Referral Database, comprising 23,782 individuals across 14 referral schemes, using a multilevel Bayesian inference approach. Scheme-level local demographics identified over-sampling in uptake; on the basis of uptake and completion data, more inclusive schemes (n = 4) were identified. Scheme coordinators were interviewed, and data were analyzed using a grounded theory approach. Inequalities presented in a nuanced way. Schemes showed promise for engaging populations at greater risk of poor health (e.g., those from more deprived areas or of an ethnic minority background). However, the completion odds were lower for those with a range of complex circumstances (e.g., a mental health-related referral). We identified creative best practices for widening access (e.g., partnership building), maintaining engagement (e.g., workforce diversity), and tailoring support, but recommend changes to wider operational contexts to ensure such approaches are viable. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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14 pages, 670 KiB

Open AccessArticle

“People Associate Us with Movement so It’s an Awesome Opportunity”: Perspectives from Physiotherapists on Promoting Physical Activity, Exercise and Sport

by Kerry West, Kate Purcell, Abby Haynes, Jennifer Taylor, Leanne Hassett and Catherine Sherrington

Int. J. Environ. Res. Public Health 2021, 18(6), 2963; https://doi.org/10.3390/ijerph18062963 - 14 Mar 2021

Cited by 14 | Viewed by 7709

Abstract

Insufficient physical activity (PA) is a critical public health issue especially in the context of COVID-related deconditioning. Health professionals are well placed to promote community-based PA but there is little supporting implementation research. We aimed to explore physiotherapists’ knowledge, views, attitudes and experiences regarding the promotion of physical activity, exercise and sport within daily clinical practice in order to guide development of strategies to support implementation of PA promotion by physiotherapists, in particular those treating older people, and adults and children with a disability. We conducted interviews and focus groups with 39 physiotherapists. Two researchers coded transcripts with an iterative coding approach. Analysis returned five main themes: putting principles into practice; working with conflicting priorities; multiple client barriers; connections build confidence; and the battle for information. The physiotherapists accepted their legitimate role in PA promotion. Limited clinical and administrative time and acute treatment priorities often superseded PA promotion but the lack of updated information regarding suitable community-based PA opportunities and lack of trust in community providers were the biggest barriers. Strategies to enhance PA promotion by physiotherapists should address time and information constraints, and build partnership connections between health professionals and community-based PA providers. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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14 pages, 371 KiB

Open AccessArticle

Understanding Leisure Centre-Based Physical Activity after Physical Activity Referral: Evidence from Scheme Participants and Completers in Northumberland UK

by Jordan Bell, Lis Neubeck, Kai Jin, Paul Kelly and Coral L. Hanson

Int. J. Environ. Res. Public Health 2021, 18(6), 2957; https://doi.org/10.3390/ijerph18062957 - 13 Mar 2021

Cited by 3 | Viewed by 3020

Abstract

Physical activity referral schemes (PARS) are a popular physical activity (PA) intervention in the UK. Little is known about the type, intensity and duration of PA undertaken during and post PARS. We calculated weekly leisure centre-based moderate/vigorous PA for PARS participants (n = 448) and PARS completers (n = 746) in Northumberland, UK, between March 2019–February 2020 using administrative data. We categorised activity levels (<30 min/week, 30–149 min/week and ≥150 min/week) and used ordinal regression to examine predictors for activity category achieved. PARS participants took part in a median of 57.0 min (IQR 26.0–90.0) and PARS completers a median of 68.0 min (IQR 42.0–100.0) moderate/vigorous leisure centre-based PA per week. Being a PARS completer (OR: 2.14, 95% CI: 1.61–2.82) was a positive predictor of achieving a higher level of physical activity category compared to PARS participants. Female PARS participants were less likely (OR: 0.65, 95% CI: 0.43–0.97) to achieve ≥30 min of moderate/vigorous LCPA per week compared to male PARS participants. PARS participants achieved 38.0% and PARS completers 45.3% of the World Health Organisation recommended ≥150 min of moderate/vigorous weekly PA through leisure centre use. Strategies integrated within PARS to promote PA outside of leisure centre-based activity may help participants achieve PA guidelines. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

14 pages, 791 KiB

Open AccessArticle

Veterinary-Prescribed Physical Activity: Feasibility and Acceptability among Veterinary Staff and Dog Owners

by Katrina Oselinsky, Colleen G. Duncan, Heather E. Martinez and Dan J. Graham

Int. J. Environ. Res. Public Health 2021, 18(5), 2339; https://doi.org/10.3390/ijerph18052339 - 27 Feb 2021

Cited by 2 | Viewed by 2932

Abstract

Physical inactivity remains a global epidemic leading to an estimated 5 million preventable deaths per year. Although there exist numerous public-health campaigns aimed at increasing physical activity (PA), a potentially fruitful but underexplored avenue to promote both human and animal health is veterinary-prescribed PA programs. The aim of this study was to determine the feasibility and acceptability of incorporating veterinary-prescribed PA programming into a diverse array of clinic settings. Participants (n = 722 veterinary-clinic staff (VS); n = 1028 dog owners (DOs)) completed an online survey assessing: (a) the perceived importance of PA for promoting health and preventing disease, (b) willingness to participate in a veterinary-prescribed PA program, and (c) potential benefits and barriers of such a program. Both groups of participants indicated that PA is important for both human and animal health (97% and 98% of VS and 92% and 93% of DOs said PA is very or extremely important for animal and human health, respectively). Additionally, most participants in both groups expressed an interest in participating in a veterinary-prescribed PA program in the future, with only 11% of DOs and 10% of VS saying they were not interested. Benefits and barriers of this type of intervention for both practitioners and patients were also identified. Incorporating veterinary-prescribed PA programming into veterinary clinics seems to be acceptable to both DOs and VS. Additionally, many VS believe such programming would be feasible at their clinics; thus, pursuing such programs appears to be a promising avenue for promoting human and animal health. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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16 pages, 356 KiB

Open AccessArticle

Multi-Stakeholder Retrospective Acceptability of a Peer Support Intervention for Exercise Referral

by Robert M. Portman, Andrew R. Levy, Anthony J. Maher and Stuart J. Fairclough

Int. J. Environ. Res. Public Health 2021, 18(4), 1720; https://doi.org/10.3390/ijerph18041720 - 10 Feb 2021

Cited by 1 | Viewed by 2736

Abstract

Perceived social support opportunities are central to successful exercise referral scheme (ERS) client experiences. However, there remains a lack of guidance on how ERSs can embed social support opportunities within their provision. This study presents retrospective acceptability findings from a 12-week social-identity-informed peer support intervention to enhance perceived social support among clients of an English ERS. Five peer volunteers were recruited, trained, and deployed in supervised ERS sessions across two sites. Peers assisted exercise referral officers (EROs) by providing supplementary practical, informational, motivational, and emotional support to ERS clients. Individual semi-structured interviews were conducted with peers (n = 4), EROs (n = 2), and clients (n = 5) and analysed thematically. The analysis identified three primary themes. The first theme detailed how EROs utilised peer volunteers to supplement the ERS client experience. This theme delineated peer roles within the ERS context and identified salient individual peer characteristics that contributed to their success. The second theme described peer acceptability among the various stakeholders. Peers were valued for their ability to reduce burden on EROs and to enhance perceptions of comfort among ERS clients. The final theme presented participant feedback regarding how the intervention may be further refined and enhanced. Peers represented a cost-effective and acceptable means of providing auxiliary social support to ERS clients. Moving forward, the structured integration of peers can improve the accessibility of social support among ERS participants, thus facilitating better rates of ERS completion. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

19 pages, 662 KiB

Open AccessArticle

Gender Differences in Uptake, Adherence and Experiences: A Longitudinal, Mixed-Methods Study of a Physical Activity Referral Scheme in Scotland, UK

by Coral L. Hanson, Lis Neubeck, Richard G. Kyle, Norrie Brown, Robyn Gallagher, Robyn A. Clark, Sheona McHale and Susan Dawkes

Int. J. Environ. Res. Public Health 2021, 18(4), 1700; https://doi.org/10.3390/ijerph18041700 - 10 Feb 2021

Cited by 7 | Viewed by 5106

Abstract

Physical activity referral schemes (PARS) are implemented internationally to increase physical activity (PA), but evidence of effectiveness for population subgroups is equivocal. We examined gender differences for a Scottish PARS. This mixed-methods, concurrent longitudinal study had equal status quantitative and qualitative components. We conducted 348 telephone interviews across three time points (pre-scheme, 12 and 52 weeks). These included validated self-reported PA and exercise self-efficacy measures and open-ended questions about experiences. We recruited 136 participants, of whom 120 completed 12-week and 92 completed 52-week interviews. PARS uptake was 83.8% (114/136), and 12-week adherence for those who started was 43.0% (49/114). Living in less deprived areas was associated with better uptake (p = 0.021) and 12-week adherence (p = 0.020), and with male uptake (p = 0.024) in gender-stratified analysis. Female adherers significantly increased self-reported PA at 12 weeks (p = 0.005) but not 52 weeks. Males significantly increased exercise self-efficacy between baseline and 52 weeks (p = 0.009). Three qualitative themes and eight subthemes developed; gender perspectives, personal factors (health, social circumstances, transport and attendance benefits) and scheme factors (communication, social/staff support, individualisation and age appropriateness). Both genders valued the PARS. To increase uptake, adherence and PA, PARS should ensure timely, personalised communication, individualised, affordable PA and include mechanisms to re-engage those who disengage temporarily. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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11 pages, 312 KiB

Open AccessArticle

“You’ve Got to Pick Your Battles”: A Mixed-Methods Investigation of Physical Activity Counselling and Referral within General Practice

by Benjamin J. R. Buckley, Stephanie J. Finnie, Rebecca C. Murphy and Paula M. Watson

Int. J. Environ. Res. Public Health 2020, 17(20), 7428; https://doi.org/10.3390/ijerph17207428 - 12 Oct 2020

Cited by 15 | Viewed by 3714

Abstract

One in four people say they would be more active if advised by a general practitioner (GP), yet 72% of GPs do not discuss physical activity (PA) with patients and 80% of GPs are unaware of the PA guidelines. The aim of this study was therefore to investigate GP perspectives on PA counselling and referral and interpret these within the context of the socio-ecological model (SEM). Fifty-six GPs completed an online survey to investigate factors influencing PA counselling and referral. Semi-structured interviews were then conducted with seven GPs to explore topics in more depth. Interview data were analysed thematically and mapped to the SEM. GPs were more likely to discuss PA with patients if they were physically active themselves (p = 0.004). Influences on PA counselling and referral were identified at the policy (provision of education, priority), organisational (feedback, e-referral), interpersonal (PA as everybody’s business, patient factors) and intrapersonal (knowledge, GP PA levels) levels of the SEM. Multi-level strategies are required to help GPs promote PA and make use of exercise referral schemes, including making PA a strategic priority, introducing systems for feedback from referrals, and involving other members of the care team in PA counselling and referral. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

13 pages, 576 KiB

Open AccessArticle

Green Health Partnerships in Scotland; Pathways for Social Prescribing and Physical Activity Referral

by Sheona McHale, Alice Pearsons, Lis Neubeck and Coral L. Hanson

Int. J. Environ. Res. Public Health 2020, 17(18), 6832; https://doi.org/10.3390/ijerph17186832 - 18 Sep 2020

Cited by 25 | Viewed by 7131

Abstract

Increased exposure to green space has many health benefits. Scottish Green Health Partnerships (GHPs) have established green health referral pathways to enable community-based interventions to contribute to primary prevention and the maintenance of health for those with established disease. This qualitative study included focus groups and semi-structured telephone interviews with a range of professionals involved in strategic planning for and the development and provision of green health interventions (n = 55). We explored views about establishing GHPs. GHPs worked well, and green health was a good strategic fit with public health priorities. Interventions required embedding into core planning for health, local authority, social care and the third sector to ensure integration into non-medical prescribing models. There were concerns about sustainability and speed of change required for integration due to limited funding. Referral pathways were in the early development stages and intervention provision varied. Participants recognised challenges in addressing equity, developing green health messaging, volunteering capacity and providing evidence of success. Green health interventions have potential to integrate successfully with social prescribing and physical activity referral. Participants recommended GHPs engage political and health champions, embed green health in strategic planning, target mental health, develop simple, positively framed messaging, provide volunteer support and implement robust routine data collection to allow future examination of success. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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21 pages, 1925 KiB

Open AccessArticle

The Northumberland Exercise Referral Scheme as a Universal Community Weight Management Programme: A Mixed Methods Exploration of Outcomes, Expectations and Experiences across a Social Gradient

by Caroline J. Dodd-Reynolds, Dimitris Vallis, Adetayo Kasim, Nasima Akhter and Coral L. Hanson

Int. J. Environ. Res. Public Health 2020, 17(15), 5297; https://doi.org/10.3390/ijerph17155297 - 23 Jul 2020

Cited by 8 | Viewed by 3466

Abstract

Exercise referral schemes (ERS) are internationally recognised, yet little attention has been paid to discrete referral groups or the influence of wider social determinants of health. The primary quantitative element of this mixed methods study used a mixed effects linear model to examine associations of sociodemographic predictors, obesity class and profession of referrer on weight and physical activity (PA) variables for weight-related referrals (n = 3624) to an established 24-week ERS. Chained equations modelling imputed missing data. The embedded qualitative element (n = 7) used individual semi-structured interviews to explore participant weight-related expectations and experiences. Age, gender and profession of referrer influenced weight loss. PA increased and was influenced by age and gender. The weight gap between the most and least obese narrowed over time but the PA gap between most and least widened. Age, employment and obesity class were most predictive of missing data but would unlikely alter overall conclusions. Qualitative themes were weight-loss support, personal circumstances and strategies, and weight expectations versus wellbeing rewards. This ERS worked, did not widen existing obesity inequalities, but demonstrated evidence of PA inequalities for those living with deprivation. To improve equity of experience, we recommend further stakeholder dialogue around referral experience and ongoing support needs. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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11 pages, 546 KiB

Open AccessArticle

Social Return on Investment Analysis of the Health Precinct Community Hub for Chronic Conditions

by Carys Jones, Ned Hartfiel, Paul Brocklehurst, Mary Lynch and Rhiannon Tudor Edwards

Int. J. Environ. Res. Public Health 2020, 17(14), 5249; https://doi.org/10.3390/ijerph17145249 - 21 Jul 2020

Cited by 23 | Viewed by 5821

Abstract

Local governments and Health Boards are seeking to develop integrated services to promote well-being. Social participation and physical activity are key in promoting well-being for older people. The Health Precinct is a community hub in North Wales that people with chronic conditions are referred to through social prescribing. To improve community-based assets there is a need to understand and evidence the social value they generate. Data collection took place October 2017–September 2019. Social Return on Investment (SROI) analysis was used to evaluate the Health Precinct. Stakeholders included participants aged 55+, participants’ families, staff, the National Health Service and local government. Participants’ health and well-being data were collected upon referral and four months later using the EQ-5D-5L, Campaign to End Loneliness Scale and the Rosenberg Self-Esteem Scale. Family members completed questionnaires at four months. Baseline data were collected for 159 participants. Follow-up data were available for 66 participants and 38 family members. The value of inputs was £55,389 (attendance fees, staffing, equipment, overheads), and the value of resulting benefits was £281,010; leading to a base case SROI ratio of £5.07 of social value generated for every £1 invested. Sensitivity analysis yielded estimates of between 2.60:1 and 5.16:1. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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16 pages, 1996 KiB

Open AccessArticle

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

by Kelly Morgan, Muhammad Rahman and Graham Moore

Int. J. Environ. Res. Public Health 2020, 17(11), 3942; https://doi.org/10.3390/ijerph17113942 - 2 Jun 2020

Cited by 19 | Viewed by 5551

Abstract

Exercise referral schemes have shown small but positive impacts in randomized controlled trials (RCTs). Less is known about the long-term reach of scaled up schemes following a RCT. A RCT of the National Exercise Referral Scheme (NERS) in Wales was completed in 2010, and the scheme scaled up across Wales. In this study, using a retrospective data linkage design, anonymized NERS data were linked to routine health records for referrals between 2008 and 2017. Rates of referral and uptake were modelled across years and a multilevel logistic regression model examined predictors of uptake. In total, 83,598 patients have been referred to the scheme and 67.31% of eligible patients took up NERS. Older adults and referrals for a musculoskeletal or level four condition were more likely to take up NERS. Males, mental health referrals, non-GP referrals and those in the most deprived groupings were less likely to take up NERS. Trends revealed an overall decrease over time in referrals and uptake rates among the most deprived grouping relative to those in the least deprived group. Findings indicate a widening of inequality in referral and uptake following positive RCT findings, both in terms of patient socioeconomic status and referrals for mental health. Full article

(This article belongs to the Special Issue Exercise Referral and Social Prescribing for Physical Activity)

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