Uptake and Participation in Physical Activity Referral Schemes in the UK: An Investigation of Patients Referred with Mental Health Problems

Crone, Diane; Johnston, Lucy; Gidlow, Christopher; Henley, Caroline; James, David

doi:10.1080/01612840802319837

Cited by 61 publications

(94 citation statements)

References 22 publications

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“…> 80% attendance). For four studies, [37][38][39][40] attendance at a post-ERS consultation was also required to meet the definition of adherence. The uptake of ERSs across the RCTs ranged from 35% to 100%.…”

Section: Barriers and Facilitators Of Referral Uptake And Adherence mentioning

confidence: 99%

A systematic review and economic evaluation of exercise referral schemes in primary care: a short report

Campbell

Holmes

Everson-Hock

et al. 2015

Health Technol Assess

121

159

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BackgroundIt is estimated that only 39% of men and 29% of women in England achieve the levels of physical activity that are recommended to protect health and prevent disease. One approach to addressing this problem has been the development of exercise referral schemes (ERSs), in which health professionals refer patients to external exercise providers. These schemes have been widely rolled out across the UK despite concerns that they may not produce sustained changes in levels of physical activity and, therefore, may not be cost-effective interventions. The evidence to determine clinical effectiveness and cost-effectiveness was evaluated in 2009. This review seeks to update this earlier work by incorporating new evidence and re-examining the cost-effectiveness.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of ERSs compared with usual care.DesignExhaustive searches of relevant electronic databases and journals were undertaken to identify new studies evaluating ERSs using a randomised controlled trial (RCT) design. RCTs that incorporated a qualitative evaluation of the intervention were identified in order to explore the barriers and facilitators to the uptake of and adherence to ERSs. Data were extracted using a previously designed tool and study quality assessed for potential bias. Where data could be pooled, meta-analyses were carried out. Qualitative analysis was also undertaken using a thematic approach. The cost-effectiveness was evaluated using a Markov structure which estimated the likelihood of becoming physically active and the subsequent risk reduction on coronary heart disease (CHD), stroke and type 2 diabetes mellitus. The model adopts a lifetime horizon, and a NHS and Personal Social Services perspective was taken with discounting at 1.5% for both costs and benefits.ResultsThe search identified one new RCT and one new qualitative study. The new data were pooled with existing data from the 2011 review by Paveyet al.[Pavey TG, Anokye N, Taylor AH, Trueman P, Moxham T, Fox KR,et al.The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation.Health Technol Assess2011;15(44)] to give a total of eight studies with 5190 participants. The proportion of individuals achieving 90–150 minutes of at least moderate-intensity activity per week at 6–12 months’ follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). Older patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. Exercise referral gained 0.003 quality-adjusted life-years (QALYs) at an additional cost of £225 per person. The estimated mean incremental cost-effectiveness ratio (ICER) in the probabilistic sensitivity analysis was £76,276. In the univariate sensitivity analysis the results were very sensitive (ICERs ranged from < £30,000 to > £100,000) to changes in the effect of ERSs on physical activity uptake and the duration of the protective effects and the direct health-related quality-of-life gains attributable to physical activity.ConclusionsExercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. The cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around £76,000 per QALY, although the cost-effectiveness of ERSs is subject to considerable uncertainty.Study registrationThis study is registered as PROSPERO CRD42013005200.FundingNational Institute for Health Research Health Technology Assessment programme.

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Section: Barriers and Facilitators Of Referral Uptake And Adherence mentioning

confidence: 99%

A systematic review and economic evaluation of exercise referral schemes in primary care: a short report

Campbell

Holmes

Everson-Hock

et al. 2015

Health Technol Assess

121

159

View full text Add to dashboard Cite

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“…The findings we have presented offer a radically different perspective on client expectation and perception than has been frequently reported elsewhere (e.g. Crone et al, 2005;Crone, Johnston, Gidlow, Henley and James, 2008;O'Sullivan et al, 2010;Stathi et al, 2004). Our findings demonstrate that client perceptions of professional competence may constitute an inherent problem for PARS; that is, clients appear to draw confidence from both the procedures and knowledge of the wider medical community and, to this end, it is imperative that Scheme Organisers (and those who work with them) maintain a professional approach to their work in order to provide on-going reassurances to a client group who frequently encounter a sense of anxiety and vulnerability as a consequence of their medical conditions and circumstances.…”

Section: Discussionmentioning

confidence: 48%

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

Vinson

Parker

2012

Qualitative Research in Sport, Exercise and Health

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Physical Activity Referral Schemes (PARS) continue to represent one of the most prevalent interventions in the fight against chronic illness such as Coronary Heart Disease (CHD) and obesity. Despite this, issues surrounding low retention and adherence continue to hinder the potential effectiveness of such schemes on public health. This article reports on the second stage of a larger investigation into client experiences of PARS focussing specifically on findings from five client focus groups and interviews with five scheme organisers. The analysis reveals three main factors impacting on participants' perceptions of the quality of service and support at the scheme: the organisation of PARS provision, engagement with the PARS community, and the client support networks. The article demonstrates that staff have a considerable role to play in engaging clients in the PARS system and that scheme organisers should give serious thought to ensuring that clients have valuable and sustainable networks of support. Furthermore, it is suggested that scheme organisers need to facilitate a system in which staff are genuinely engaged with the needs of clients and are able to provide individualised programmes of physical activity.

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“…Previous findings from both qualitative [15,18,20,25] and quantitative [23,27,28,32] research in exercise referral has shown that ERS can promote physical activity in the short to medium-term (12-26 weeks). In our analysis of 12 seriously ill patients participating in an ERS, we found that long-term engagement with a practice-based scheme aided physical activity adherence and increased combined (walking and exercise classes) physical activity levels, in the long-term.…”

Section: Discussionmentioning

confidence: 99%

“…The study design contrasts with other studies on exercise referral in 3 specific ways. First, the majority of studies on exercise referral tend to be from a positivist theoretical perspective [20][21][22][23][24], rather than an interpretivist perspective [15,17,18,25]. Second, the deployment of 3 data collection and analysis phases differed to traditional schemes that have a 12 week intervention [15,[26][27][28][29][30] and a 12 week follow up [31,32].…”

Section: E T Hod De Signmentioning

confidence: 99%

Long-term engagement with a practice-based exercise referral scheme: Patients’ perceptions of effectiveness

Queen

Crone

Parker

2015

EJPCH

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DisclaimerThe University of Gloucestershire has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material.The University of Gloucestershire makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited.The University of Gloucestershire makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights.The University of Gloucestershire accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. We recommend you cite the published (post-print) version.The URL for the published version is http://ubplj.org/index.php/ejpch/article/view/1006 DisclaimerThe University of Gloucestershire has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material.The University of Gloucestershire makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited.The University of Gloucestershire makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights.The University of Gloucestershire accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. PLEASE SCROLL DOWN FOR TEXT.Europe a n J ourna l for Pe rson Ce nt e re d H e a lt hc a re 2 0 1 5 V ol 3 I ssue 3 pp 3 6 9 -3 76 Abst ra c t Objectives: Limited and contradictory evidence exists on the long-term effectiveness of exercise referral schemes (ERS) for physical activity promotion and its impact on perceived health status. The intention of this study was to investigate patients' views of a physical activity intervention on their self-assessed health status, a key component of person-centered healthcare. Methods: A longitudinal qualitative study design was employed with 12 patients aged 55-74 attending a primary care physical activity intervention. Semi-structured interviews took place on 3 occasions over a 12 month period in a Primary Care Health Centre. Transcripts of recorded interviews were coded and thematically analysed using grounded theory techniques. 369 ARTICLE Long-t e rm e nga ge m e nt w it h a pra c t ic e -ba se d e x e rc ise re fe rra l sc he m e : Pa t ie nt s' pe rc e pt ions of e ffe c t ive ne ss Results:The majority of patients believed that their engagement with the Scheme and resultant long-term increase in physical activity behaviour, helped to improve their health status. This was evident through i...

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Uptake and Participation in Physical Activity Referral Schemes in the UK: An Investigation of Patients Referred with Mental Health Problems

Cited by 61 publications

References 22 publications

A systematic review and economic evaluation of exercise referral schemes in primary care: a short report

A systematic review and economic evaluation of exercise referral schemes in primary care: a short report

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

Long-term engagement with a practice-based exercise referral scheme: Patients’ perceptions of effectiveness

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