Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only

Abstract

The results of this trial suggest that referral for tailored advice, supported by written materials, including details of locally available facilities, supplemented by detailed assessments may be effective in increasing physical activity. The inclusion of supervised exercise classes or walks as a formal component of the scheme may not be more effective than the provision of information about their availability. On cost-effectiveness grounds, assessment and advice alone from an exercise specialist may be appropriate to initiate action in the first instance. Subsidised schemes may be best concentrated on patients at higher absolute risk, or with specific conditions for which particular programmes may be beneficial. Walking appears to be as effective as leisure centre classes and is cheaper. Efforts should be directed towards maintenance of increased activity, with proven measures such as telephone support. Further research should include an updated meta-analysis of published exercise interventions using the standardised mean difference approach.

Exercise, service and support: client experiences of physical activity referral schemes (PARS)

“…These findings extend the related literature (e.g. Crone et al, 2005, Isaacs et al, 2007and Williams et al, 2007 concerning the nature of the relationship between staff and clients, forcing such professionals to seriously re-consider the importance of client expectation and perception in terms of their competence, experience and professionalism.…”

“…They're either too busy or they didn't want to know. (Sheila) This issues are again illustrative of Williams et al's, (2007) and Isaacs et al's, (2007) findings surrounding the consistency and visibility of staff support, but add the extra dimension of how a failure to demonstrate an authentic interest in clients can contribute to a disengagement with the service. Exercise professionals acknowledged the need to individualise client care in this respect but one of their number, Gary, was quick to point out the benefits which cardiac rehabilitation patients brought with them especially with regard to a familiarity with exercise regimes and a stronger sense of ownership and dependence in terms of engagement with the ERS community: They [clients] maybe need more motivation, if they've never exercised in their life, and it's something new to them and they might need that motivation of somebody being there all the time pushing them on … I find that the cardiac rehab clients are a lot better when it comes to that, because they've come from the hospital where they've done their Phase 3 4 they've already got into the routine of exercise, they understand what they're meant to be doing, they understand what level they're working at.…”

“…PARS successfully increasing the levels of clients' physical activity could cost just £300 per life saved (Harrison, Roberts and Elton, 2004), although Isaacs et al, (2007) suggest that PARS are not so cost effective. Despite this, Schutzer and Graves (2004) have underlined the potential cost benefit to the NHS by suggesting that increased physical activity would reduce future GP visits and lessen future client dependence on medication.…”

“…Likewise, long-term follow-up has been shown to be an effective method of improving adherence (Isaacs et al, 2007).…”

“…Hence, the part that professional support plays in eliminating barriers to adherence is well established. Support from staff should be consistent and continuous; clients may need to hear a message repeatedly in order to affect behaviour (Isaacs et al, 2007). Clients who are regularly contacted by staff are more likely to maintain their participation (Hillsdon et al 2005;Seefeldt et al 2002).…”