Examining the Effects of Exercise Referral Schemes on Changes in Physical Activity Levels

Exercise referral within the United Kingdom (UK) offers individuals an opportunity to take part in physical activities in a non-clinical environment, yet gain clinical health benefits. Referral schemes focus on improving health outcomes, including increased physical activity (PA), of medically referred individuals. However, inconsistencies have been found within the literature reviewing impact of exercise referral on improving PA levels. PURPOSE: To determine if exercise referral schemes (ERS) influence change in PA levels amongst individuals across the UK. METHOD: Data were obtained from 5246 participants (53 ±15 years; 68% = female) who attended 12 different ERSs. Participants self-reported IPAQ scores pre- and post- scheme completion to determine if exercise referral had any impact on PA levels. Schemes were 12 weeks in length and situated in leisure environments including gyms, leisure centres and community halls, throughout the UK. Exercise prescriptions consisted of both aerobic and resistance training. Two-stage individual patient data meta-analysis was performed separately on the pre-ERS, and on the change scores (post- minus pre-ERS scores), for metabolic equivalent (MET)-minutes per week; analysis was chosen due to data being hierarchal and accounting for clustering at scheme level. RESULTS: Analyses were conducted on the continuous data collected through the IPAQ. For pre-ERS MET-minutes the estimate from random effects model was 1183 MET-minutes per week [911 to 1457], p< 0.0001). For ERS change, the estimate from random effects model for was 666 MET-minutes per week [385 to 948], p< 0.0001). Significant heterogeneity was evident among the schemes (Q(11)= 162.22, p< 0.001; I2= 97.71%). Considering the estimate for pre-ERS MET-minutes (1183 MET-minutes), the estimate for change in MET-minutes could be considered meaningful, as it would result in participants moving from the ‘moderate’ to ‘high’ category for PA. CONCLUSION: This change in PA represents greater reductions of risks of specific physical inactivity-related conditions, such as obesity and type 2 diabetes. The results showed meaningful change in MET-minutes, which resulted in participants moving from ‘moderate’ to ‘high’ on the IPAQ, suggesting that a scheme length of 12 weeks is sufficient for changing PA levels.