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

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.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: TGP, AHT, KRF, MH, PT, and RST have support from NIHR HTA for the submitted work; JS is chief medical officer of the Fitness Industry Association, which meets his receipted expenses, but the post attracts neither a salary nor fees; no non-financial interests that may be relevant to the submitted work.

Figures

Fig 1 Flow diagram of study inclusion process

Fig 2 Meta-analysis of patients achieving 90-150 minutes of physical activity of at least moderate intensity per week, using denominators as reported by study authors and denominators adjusted to all randomised groups. Fixed effects model used. M-H=Mantel-Haenszel

Fig 3 Meta-analysis of patients’ cardiorespiratory fitness, at 6-12 month follow-up. SD=standard deviation. Random effects model used. IV=inverse variance

Fig 4 Meta-analysis of body mass index and body fat (%) in patients, at 6-12 month follow-up. SD=standard deviation. Fixed effects model used. IV=inverse variance. Data for body mass index are values for weighted mean difference and data for body fat are values for standardised mean difference

Fig 5 Meta-analysis of systolic and diastolic blood pressure in patients, at 6-12 month follow-up. SD=standard deviation. Fixed effects model used. IV=inverse variance

Fig 6 Meta-analysis of depression and anxiety in patients, at 6-12 month follow-up. SE=standard error. Fixed effects model used. IV=inverse variance