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An evaluation of the efficacy of the exercise on referral scheme in Northumberland, UK: association with physical activity and predictors of engagement. A naturalistic observation study.

ABSTRACT: Exercise on referral schemes (ERS) are widely commissioned in the UK but there is little evidence of their association with physical activity levels. We sought to assess the Northumberland exercise on referral scheme in terms of increased levels of physical activity and identify predictors of engagement.A naturalistic observational study.9 local authority leisure sites in Northumberland.2233 patients referred from primary and secondary care between July 2009 and September 2010.A 24-week programme including motivational consultations and supervised exercise sessions for participants.Uptake, 12-week adherence, 24-week completion, changes in Godin Leisure-Time Exercise Questionnaire scores after 24-weeks and attendance levels at supervised exercise sessions during the scheme. Three binary logistic regressions were used to examine demographic and referral factors associated with initial uptake, 12-week adherence and 24-week completion.Uptake was 81% (n=1811), 12-week adherence was 53.5% (n=968) and 24-week completion was 42.9% (n=777). Participants who completed significantly increased their self-reported physical activity levels at 24-weeks t (638)=-11.55, p<0.001. Completers attended a mean of 22.87 (12.47 SD) of a target 48 supervised sessions. Increasing age, being female and leisure site were associated with uptake, increasing age, Index of Multiple Deprivation and leisure site were associated with 12-week adherence and Body Mass Index and leisure site were associated with 24-week completion. Each regression significantly increased the prediction accuracy of stage of exit (non-starters vs starters 81.5%, dropouts before 12 weeks vs 12-week adherers 66.9%, and dropouts between 13 and 24 weeks 82.2%).Completers of the Northumberland ERS increased physical activity at 24 weeks, although the levels achieved were below the current UK guidelines of 150 min of moderate exercise per week. Leisure site was associated with uptake, adherence and completion.

SUBMITTER: Hanson CL

PROVIDER: S-EPMC3733299 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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An evaluation of the efficacy of the exercise on referral scheme in Northumberland, UK: association with physical activity and predictors of engagement. A naturalistic observation study.

Hanson Coral L CL Allin Linda J LJ Ellis Jason G JG Dodd-Reynolds Caroline J CJ

BMJ open 20130802 8

<h4>Objectives</h4>Exercise on referral schemes (ERS) are widely commissioned in the UK but there is little evidence of their association with physical activity levels. We sought to assess the Northumberland exercise on referral scheme in terms of increased levels of physical activity and identify predictors of engagement.<h4>Design</h4>A naturalistic observational study.<h4>Setting</h4>9 local authority leisure sites in Northumberland.<h4>Participants</h4>2233 patients referred from primary and ...[more]

PMID: 23913772

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Project description:ObjectivesExercise referral schemes (ERSs) are internationally widespread. This study aimed to gain an insight into differential engagement through understanding participant experiences of patients referred by healthcare professionals to one such scheme in the UK.DesignThe study employed a qualitative longitudinal approach using semistructured interviews, with results reported using Consolidated criteria for Reporting Qualitative research guidelines.SettingTwo leisure centres providing an 'emerging best-practice' ERS in northeast England.ParticipantsReferred patients (n=11), who had not yet commenced the scheme, were recruited on a voluntary basis. Seven females and four males, with a range of non-communicable diseases, such as cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems, participated.Intervention24-weeks, two times per week, of supervised exercise sessions and three one-to-one assessments (prescheme, 12?weeks and 24?weeks) for patients referred from primary and secondary care.Primary outcome measuresTwo longitudinal semistructured interviews, prior to commencement and 12-20 weeks later, were thematically analysed using the framework approach. Analysis comprised seven stages: transcription, familiarisation, coding, development and application of an analytical framework, charting data using a matrix and interpretation of data. Interpretation went beyond descriptions of individual cases to develop themes, which identified and offered possible explanations for differing participant experiences.ResultsThree overarching themes emerged. First, 'success', with engaged participants focused on health outcomes and reported increases in physical activity. Second, 'struggle', with short-term success but concerns regarding continued engagement. Participants reported scheme dependency and cyclical needs. Finally, 'defeat', where ill health, social anxiety and/or poor participation experience made engagement difficult.ConclusionSome success in engaging those with non-communicable diseases was reported, resulting in positive effects on health and well-being. The study highlights complexity within ERSs and inequality of access for those with challenging health and social circumstances. Improved, or different, behaviour change support is required for referrals finding engagement difficult.

Project description:ObjectivesUK exercise referral schemes (ERSs) have been criticised for focusing too much on exercise prescription and not enough on sustainable physical activity (PA) behaviour change. Previously, a theoretically grounded intervention (coproduced PA referral scheme, Co-PARS) was coproduced to support long-term PA behaviour change in individuals with health conditions. The purpose of this study was to investigate the effectiveness of Co-PARS compared with a usual care ERS and no treatment for increasing cardiorespiratory fitness.DesignA three-arm quasi-experimental trial.SettingTwo leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control.Participants68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment.Intervention16-weeks of PA behaviour change support delivered at 4, 8, 12 and 18 weeks, in addition to the usual care 12-week leisure centre access.Outcome measuresCardiorespiratory fitness, vascular health, PA and mental well-being were measured at baseline, 12 weeks and 6 months (PA and mental well-being only). Fitness centre engagement (co-PARS and usual care) and behaviour change consultation attendance (co-PARS) were assessed. Following an intention-to-treat approach, repeated-measures linear mixed models were used to explore intervention effects.ResultsSignificant improvements in cardiorespiratory fitness (p=0.002) and vascular health (p=0.002) were found in co-PARS compared with usual care and no-treatment at 12 weeks. No significant changes in PA or well-being at 12 weeks or 6 months were noted. Intervention engagement was higher in co-PARS than usual care, though this was not statistically significant.ConclusionA coproduced PA behaviour change intervention led to promising improvements in cardiorespiratory and vascular health at 12 weeks, despite no effect for PA levels at 12 weeks or 6 months.Trial registration numberNCT03490747.

Project description:Affective interethnic ties are highly effective for improving out-group attitudes, especially during adolescence. Yet, young people face several obstacles to developing such ties in society. One potential means of fostering greater interethnic connectivity is through youth engagement: that is, formal, organized social participation in groups, clubs, or activities. However, little is still known about its effectiveness; especially for overcoming structural obstacles to contact in society, such as residential segregation. This study has two aims: to robustly examine whether youth engagement can build positive interethnic contact among young people; and, to perform the first systematic test of whether sites of engagement can act as "Associational Bridges", providing greater opportunities for contact among youth from more segregated environments. To pursue these aims, the study exploited a unique data opportunity to perform a quasi-experimental analysis of a large-scale, nationally-implemented youth engagement scheme in the United Kingdom. The study uses pre-test/post-test data on N = 1371 participants (Mage = 16.7; 63% Female; 36% non-White) and N = 1946 propensity-score matched controls (Mage = 16.7; 62% Female; 36% non-White). Applying a (matched) difference-in-difference approach, the findings demonstrate that participation led to an increase in affective interethnic ties, which were evident at least 4-6 months after involvement had ended. Participation also had a stronger positive impact on youth from more residentially segregated areas: although joining the scheme with fewer interethnic ties, post-participation they reported just as many ties as their peers from less segregated areas. However, participation had no difference in effects for youth from more or less ethnically diverse areas. Youth engagement may thus be an effective tool for fostering positive contact; particularly among those from more segregated environments. However, attention should be paid to the design and recruitment practices of engagement programs to understand which structural barriers to contact in society they can overcome.

Project description:IntroductionIn its attempt to establish effective physical activity promotion methods, research on physical activity referral schemes (PARS) is attracting significant attention. Sometimes known as physical activity on prescription schemes, PARS involve a well-defined procedure whereby a primary healthcare professional introduces a participant to the topic of physical activity and employs prescription or referral forms to connect the participant to physical activity opportunities, such as local fitness offers. The planned systematic review will focus on these referral routes and scheme components and how they are integrated into various PARS models worldwide. We seek to identify the evidence-based core components that play the most important roles in the effectiveness of PARS.Methods and analysisThe development and reporting of the protocol follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We plan to conduct a systematic main literature search on PubMed, Scopus, Web of Science, CINAHL, HTA, SpringerLink and other databases. We will include studies that report outcomes on physical activity, PARS uptake and adherence rates or descriptive information about PARS models. We intend for all review stages, citation screening, data extraction and risk of bias assessment to be conducted by at least two independent reviewers. As a broad spectrum of study designs, including randomised and non-randomised studies of interventions and mixed methods, will be eligible, we will use three separate tools to assess the risk of bias in individual studies. The data will be primarily synthesised narratively, following Intervention Component Analysis. If the data allow, we will perform a random-effects meta-analysis and meta-regression to investigate the impact of specific PARS components on effect sizes.Ethics and disseminationThis systematic review does not require formal ethics approval. The results will be submitted to a peer-reviewed journal and international conferences to reach the scientific community.Prospero registration numberCRD42021233229.

Project description:BACKGROUND: Although the benefits of physical activity (PA) on to prevent and manage non-communicable diseases are well known, strategies to help increase the levels of PA among different populations are limited. Exercise-referral schemes have emerged as one effective approach to promote PA; however, there is uncertainty about the feasibility and effectiveness of these schemes in settings outside high-income countries. This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities (PHCU) of the Mexican social security institution to a group PA program offered in the same institution. METHODS AND DESIGN: We will describe the methods of a cluster randomized trial study designed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme. Four PHCU were selected for the study; the PHCU will take part as the unit of randomization and sedentary hypertensive patients as the unit of assessment. 2 PHCU of control group (GC) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely. 2 PHCU of intervention group (IG) will refer patients to sports facilities at the same institution, to follow a group-based PA program developed to increase the PA levels with a designed based on the Transtheoretical Model and Social Cognitive Theory. To evaluate the effects of the intervention as well as short-term maintenance of the intervention's effects, PA will be assessed at baseline, at 24 and 32 weeks of follow-up.The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA between and within intervention and control groups. PA will be measured through self-report and with objective measure by accelerometer. DISCUSSION: This study will allow us to evaluate a multidisciplinary effort to link the primary care and community-based areas of the same health care system. Our findings will provide important information about the feasibility and effectiveness of an exercise-referral scheme and will be useful for decision-making about the implementation of strategies for increasing PA among hypertensive and other clinical populations in Mexico and Latin America. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01910935. Date of registration: 07/05/2013.

Project description:INTRODUCTION:Studies had not yet overcome the most relevant barriers to physical activity (PA) adherence. An exercise referral scheme (ERS) with mechanisms to promote social support might enhance adherence to PA in the long term. SETTING:A randomised controlled trial in 10 primary care centres in Spain. OBJECTIVE:To assess the effectiveness of a primary care-based ERS linked to municipal resources and enhancing social support and social participation in establishing adherence to PA among adults over a 15-month period. PARTICIPANTS:422 insufficiently active participants suffering from at least one chronic condition were included. 220 patients (69.5 (8.4) years; 136 women) were randomly allocated to the intervention group (IG) and 202 (68.2 (8.9) years; 121 women) to the control group (CG). INTERVENTIONS:The IG went through a 12-week standardised ERS linked to community resources and with inclusion of mechanisms to enhance social support. The CG received usual care from their primary care practice. OUTCOMES:The main outcome measure was self-report PA with the International Physical Activity Questionnaire and secondary outcomes included stages of change and social support to PA practice. DATA COLLECTION:Participant-level data were collected via questionnaires at baseline, and at months 3, 9 and 15. BLINDING:The study statistician and research assessors were blinded to group allocation. RESULTS:Compared with usual care, follow-up data at month 15 for the ERS group showed a significant increase of self-reported PA (IG: 1373±1845?metabolic equivalents (MET) min/week, n=195; CG: 919±1454?MET min/week, n=144; P=0.009). Higher adherence (in terms of a more active stage of change) was associated with higher PA level at baseline and with social support. CONCLUSIONS:Prescription from ordinary primary care centres staff yielded adherence to PA practice in the long term. An innovative ERS linked to community resources and enhancing social support had shown to be sustainable in the long term. TRIAL REGISTRATION NUMBER:NCT00714831; Results.

Dataset Information

An evaluation of the efficacy of the exercise on referral scheme in Northumberland, UK: association with physical activity and predictors of engagement. A naturalistic observation study.

Publications

An evaluation of the efficacy of the exercise on referral scheme in Northumberland, UK: association with physical activity and predictors of engagement. A naturalistic observation study.

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