Physical activity on prescription schemes (PARS): do programme characteristics influence effectiveness? Results of a systematic review and meta-analyses

Abstract

BackgroundPhysical activity on prescription schemes (PARS) are health promotion programmes that have been implemented in various countries. The aim of this study was to outline the differences in the design of PARS in different countries. This study also explored the differences in the adherence rate to PARS and the self-reported level of physical activity between PARS users in different countries.MethodA systematic literature review and meta-analyses were conducted. We searched PubMed and EBASCO in July 2015 and updated our search in September 2015. Studies that reported adherence to the programme and self-reported level of physical activity, published in the English language in a peer-reviewed journal since 2000, were included. The difference in the pooled adherence rate after finishing the PARS programme and the adherence rate before or during the PARS programme was 17% (95% CI 9% to 24%). The difference in the pooled physical activity was 0.93 unit score (95 CI −3.57 to 1.71). For the adherence rate, a meta-regression was conducted.ResultsIn total, 37 studies conducted in 11 different countries met the inclusion criteria. Among them, 31 reported the adherence rate, while the level of physical activity was reported in 17 studies. Results from meta-analyses show that PARS had an effect on the adherence rate of physical activity, while the results from the meta-regressions show that programme characteristics such as type of chronic disease and the follow-up period influenced the adherence rate.ConclusionsThe effects of PARS on adherence and self-reported physical activity were influenced by programme characteristics and also by the design of the study. Future studies on the effectiveness of PARS should use a prospective longitudinal design and combine quantitative and qualitative data. Furthermore, future evaluation studies should distinguish between evaluating the adherence rate and the self-reported physical activity among participants with different chronic diseases.

Physical activity on prescription in accordance with the Swedish model increases physical activity: a systematic review

“…Several attempts have been made to implement different types of exercise prescription models in different countries with varying results,7 and there is evidence that PA interventions may be useful for increasing PA in healthy adults 8…”

“…Several systematic reviews have also studied key features of exercise prescription that have been successful. These features include follow-up,11 primary care-based intervention12 and duration of the exercise referral scheme 7…”

Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review

“…8 The programmes typically offer free or discounted exercise sessions, motivational support, and planning for environmental barriers. 9 The accumulating evidence related to the impact of PA on health and the subsequent publication of PA guidelines initiated endeavors in the United Kingdom (UK) to increase access to leisure centers. 10 The creation and rapid expansion of ERS occurred in the UK in the 1990s with Scandinavian countries adopting similar schemes in quick succession.…”

“…Belgium, Germany, Portugal, Netherlands, and Spain also adopted programmes utilizing the same aim and overarching | 639 EYNON Et al. format during this period. 9 More recently, Ireland has devised their first national ERS framework to guide prospective services 11 and Switzerland has engaged in a thorough consultation to initiate nationwide ERS. 12 Despite the continued interest across Europe, and historical utilization of ERS, questions have been raised regarding their effectiveness for public health, with a lack of adherence cited as a key issue.…”

“…10,13 The origins of the programme are atheoretical, and the design and implementation are heterogeneous across and within countries. 9,14 The diversity and complex evolution of ERS impinges making direct inferences about what works, for whom, in what circumstances, and why. 15 The recommendation to utilize theory to provide focus and target potential mechanisms of service adherence as well as to refine models in specific circumstances is widespread in the literature.…”