Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis
Pavey, TG; Taylor, AH; Fox, KR; et al.Hillsdon, Melvyn; Anokye, Nana; Campbell, John; Foster, C; Green, C; Moxham, T; Mutrie, N; Searle, J; Trueman, P; Taylor, Rod S.
Date: 6 November 2011
Journal
BMJ
Publisher
BMJ Publishing Group
Publisher DOI
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 ...
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.
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