Impact of primary care exercise referral schemes on the health of patients with obesity

Abstract

Primary care exercise referral schemes (ERSs) are a potentially useful setting to promote physical activity (PA). It is not established, however, whether interventions to increase PA, such as ERSs, have differing health outcomes according to the participants’ body mass index (BMI). This paper summarizes evidence for the impact of primary care ERSs on the health of people with obesity and reports findings of a reanalysis of the EMPOWER study, providing the first data to report differential outcomes of ERSs by BMI category. Our literature review revealed a paucity of published data. A 2011 Health Technology Assessment review and 2015 update were identified, but normal-weight participants were neither excluded nor were results stratified by weight in the included studies. A study of the effect of exercise referral in overweight women reported a significantly greater increase in PA levels in the ERS group than the control group at 3 months. Reanalysis of the EMPOWER study data showed a significant improvement in PA at 3 months in both obese and overweight/normal BMI groups, with the effect size attenuated to 6 months. There was no significant difference from baseline to 6 months in blood pressure for either BMI category. At 6 months, there was a significant decrease in weight from baseline for the obese category. Comparison of crude mean differences between BMI groups revealed a significant mean difference in PA at 3 months favoring the overweight/normal BMI group, but not at 6 months. There were no further significant differences in unadjusted or adjusted mean differences for other outcomes at follow-up. We report some evidence of a differential impact of ERS on PA by BMI category. However, the effect of ERSs in primary care for patients with obesity remains unclear due to the small number of published studies that have reported outcomes by BMI category. Further research is needed.

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

“…Exercise referral is not intended as a weight loss programme per se [ 5 ], yet our study found that participants did experience weight loss. Our findings are favourable compared to little or no weight loss reported for general referrals across a number of other ERS [ 9 , 22 ]. In total, 1061 participants completed the ERS and reported some level of increased PA, indicating that that the scheme is to a large extent successful in its intended outcome (PA change) for those who adhere.…”

“…Notwithstanding this issue, the impact on ERS effectiveness for other referral conditions has been examined previously with some success indicated for cardiovascular and mental health referrals [ 17 ]. For weight-related referrals, the evidence is scarce, however, and the true impact of referring patients with elevated weight to ERS needs to be understood, in terms of both PA and weight change, and engagement and retention [ 12 , 18 , 19 , 20 , 21 , 22 ]. What is clear is that ERS does not work for all; “success” can be influenced by socioeconomic and demographic factors, and participant relationships with ERS can be problematic and heavily influenced by complex life circumstance [ 21 , 23 ].…”

The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review

“…Length of schemes, and mode and type of exercise used with each sub-group, was reviewed due to inconsistencies in previous research [ 2 ]. At present, strong research is lacking to support ERS of 12-week duration which are recommended by NICE [ 22 ], particularly with respect to adherence to PA prescribed; evidence suggests schemes do not tailor the mode and type of exercise specifically to suit health disorders; and the evidence to support ERS in specific disorders in relation to adherence and improving health outcomes is poor [ 2 , 25 , 28 ]. These two key variables will be discussed further in detail.…”

“…Conversely, the success of ERS is highly swayed by uptake to schemes and adherence [ 27 ]. Important evidence of the efficacy of ERS has been generated [ 2 , 21 , 26 , 28 ], although effectiveness is influenced by the quantity of referrals who participate until completion.…”

Motivations and barriers to engagement with a technology-enabled community wide physical activity intervention

“…[6] Previous attempts to reduce physical inactivity have focussed on individualistic approaches, such as exercise referral/on prescription programs, clinical populations and community groups and whilst some have shown improvement for specific population groups, they have made little impact at community-wide level. [7][8][9][10][11] In 2017, Schiphorst et al, identified the seven best investments to increase population physical activity levels. These included, 1) Communication and public education, 2) Transport and the environment, 3) Urban design and infrastructure, 4) Healthcare and health education, 5) Education, 6) Community-wide programs, and 7) Sport and recreation.…”