Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis

Pavey, T.G., Taylor, A.H., Fox, K.R., Hillsdon, M., Anokye, N., Campbell, J.L., Foster, C., Green, C., Moxham, T., Mutrie, N., Searle, J., Trueman, P., & Taylor, R.S. (2011) Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis. BMJ, 343(d6462).

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Abstract

Objective

To assess the impact of exercise referral schemes on physical activity and health outcomes.

Design

Systematic review and meta-analysis.

Data sources

Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references.

Study selection

  • Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals.

  • Population: sedentary individuals with or without medical diagnosis.

  • Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes.

  • Comparators: usual care, no intervention, or alternative exercise referral schemes.

Results

Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings.

Conclusions

Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.

Impact and interest:

61 citations in Scopus
52 citations in Web of Science®
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ID Code: 92466
Item Type: Journal Article
Refereed: Yes
DOI: 10.1136/bmj.d6462
ISSN: 1468-5833
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Exercise & Nutrition Sciences
Deposited On: 31 Jan 2016 23:56
Last Modified: 11 Feb 2016 03:35

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