The effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation (ERS)

Background:

Physical activity contributes to the prevention and management of numerous medical conditions and diseases. UK data suggests that less than 40% of men and 30% of women meet the 5 x 30 minutes per week public health target with variations across age, sex, class and ethnicity. In the UK since the early 1990s there has been a rapid development of exercise referral schemes (ERS) where individuals at risk of lifestyle diseases are referred in the primary care setting to an exercise professional who then prescribes a programme of exercise delivered in a public leisure facility with follow-up checks of adherence and progression.

A number of systematic reviews have concluded the ERS has small effect on enhancing short-term physical activity with little or no evidence of long-term sustainability. These previous reviews have a number of limitations in terms of addressing the current UK policy question of effectiveness and clinical effectiveness of ERS in people with diagnosed conditions i.e. lack consistency in definition of ERS, limited consideration of diseased populations and outcomes outside of physical activity and programme attendance, little exploration of the factors that might influence the effectiveness of ERS and limited cost effectiveness analysis.

Research Objectives:

1. To assess the effectiveness of exercise referral schemes in people with a diagnosed condition known to benefit form physical activity.
2. To assess the cost-effectiveness of exercise referral schemes in people with a diagnosed condition known to benefit form physical activity.
3. To explore the factors that might influence the effectiveness and cost-effectiveness of exercise referral schemes in people with a diagnosed condition known to benefit from physical activity.
4. To formulate guidance for the future use of exercise referral schemes in the NHS and to indentify priorities for future primary research in this area.

Methods of Analysis/Synthesis:

Effectiveness and cost-effectiveness will be tabulated and discussed in a narrative review. Where appropriate, meta-analysis (e.g. RCTs reporting change in physical activity levels) will be employed to estimate a summary measure of effect on relevant outcomes based on intention to treat analysis. A decision-analytic modelling framework will be developed to explore the cost-effectiveness of ERS.

Core Staff

Professor Adrian Taylor (Co-Principal Investigator; Exeter-SSHS)
Dr Paul Trueman (Health Economist; York-YHEC)
Ms Tiffany Moxham (Information Specialist; Exeter-PenTAG)
Professor Ken Fox, Professor Melvyn Hillsdon (Advisers; Bristol)
Dr Colin Green (Advisers; Exeter)
(Nanette Mutrie, Charlie Foster, David Russell; Project Advisor Group)
Professor John Campbell - Professor of General Practice & Primary Care
Dr Toby Pavey, Associate Research Fellow
Professor Rod Taylor, Professor in Health Services Research