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Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis

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  • TG Pavey
  • A H Taylor
  • K R Fox
  • M Hillsdon
  • N Anokye
  • JL Campbell
  • C Foster
  • T Moxham
  • Nanette Mutrie
  • J Searle
  • P Trueman
  • R.S. Taylor

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    Rights statement: Pavey, T. G., Taylor, A. H., Fox, K. R., Hillsdon, M., Anokye, N., Campbell, J. L., Foster, C., Moxham, T., Mutrie, N., Searle, J., Trueman, P., & Taylor, R. S. (2011). Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. BMJ, 343(d6462), [d6462 ]doi: 10.1136/bmj.d6462

    Final published version, 1.35 MB, PDF document

Original languageEnglish
Article numberd6462
Issue numberd6462
Early online date7 Nov 2011
Publication statusPublished - Nov 2011


To assess the impact of exercise referral schemes on physical activity and health outcomes.

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.

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.

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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