Exercise Referral/Chronic Conditions

This page contains resources related to the organised use of exercise and physical activity as a means of treating or managing a range of chronic conditions.

Scroll down for: 

Key Publications (UK)

Information on Specific Health Conditions

Exercise Referral Schemes (A Reading & Resource List)

Further Reading: Textbooks

American College of Sports Medicine (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics 

Biddle, S., Mutrie, N., & Gorely, T. (2015). Psychology of Physical Activity: Determinants, Well-Being and Interventions. Oxon: Routledge [full text

Buckley, J. (Ed) (2008) Exercise Physiology in Special Populations. Oxford; Elsevier. 

Ehrman, J., Gordon, P., Visich, P.S., Keteyianby, S. (2018) Clinical Exercise Physiology (4th Ed). Champaign IL: Human Kinetics [google books

Lawrence, D (2013) Exercise Referral Schemes. London: Bloomsbury 

Scott, A., & Gidlow, C. (2016). Clinical exercise science. Routledge. 

Swain, D.P. & Leutholtz, B.C. (2007) Exercise Prescription: A case study approach to the ACSM Guidelines (2nd Ed). Champaign, IL: Human Kinetics. [google books

Williamson, P. (2011) Exercise for Special Populations Philadelphia, PA: Lippincott Williams & Wilkins [google books

Woolf-May, Bird, S.R. (2006) Exercise Prescription: Physiological foundations: A guide for health, sport and exercise professionals. London: Churchill Livingstone [google books

Further Reading: Journal Articles 

Albert, F. A., Crowe, M. J., Malau-Aduli, A. E., & Malau-Aduli, B. S. (2020). Functionality of physical activity referral schemes (PARS): a systematic review. Frontiers in public health, 8, 257. https://doi.org/10.3389/fpubh.2020.00257 

Albert, F. A., Malau-Aduli, A. E., Crowe, M. J., & Malau-Aduli, B. S. (2021). Australian Patients’ Perception of the Efficacy of the Physical Activity Referral Schemes (PARS). Patient Education and Counseling. https://doi.org/10.1016/j.pec.2021.04.001 

Albert, F. A., Malau-Aduli, A. E., Crowe, M. J., & Malau-Aduli, B. S. (2021). The ‘PRICE’of Physical Activity Referral Schemes (PARS): Stakeholders’ Recommendations for Delivering Quality Care to Patients. International journal of environmental research and public health, 18(16), 8627. https://doi.org/10.3390/ijerph18168627  

Andersen, P., Holmberg, S., Årestedt, K., Lendahls, L., & Nilsen, P. (2020). Physical Activity on Prescription in Routine Health Care: 1-Year Follow-Up of Patients with and without Counsellor Support. International journal of environmental research and public health, 17(16), 5679. https://doi.org/10.3390/ijerph17165679 

Anokye, N.K., Trueman, P., Green, C. Pavey, T., Hillsdon, M., Taylor, R.S. (2011) The cost-effectiveness of exercise referral schemes BMC Public Health, 11:954 doi:10.1186/1471-2458-11-954 [full text

Arsenijevic, J., & Groot, W. (2017). Physical activity on prescription schemes (PARS): do programme characteristics influence effectiveness? Results of a systematic review and meta-analyses. BMJ open, 7(2), e012156. http://bmjopen.bmj.com/content/7/2/e012156 

AuYoung, M., Linke, S. E., Pagoto, S., Buman, M. P., Craft, L. L., Richardson, C. R., ... & Gorin, S. S. (2016). Integrating physical activity in primary care practice. The American journal of medicine, 129(10), 1022-1029. https://doi.org/10.1016/j.amjmed.2016.02.008 

Beck, F. E., Gillison, F. B., Koseva, M. D., Standage, M., Brodrick, J. L., Graham, C., & Young, H. (2016). The systematic identification of content and delivery style of an exercise intervention. Psychology & health, 31(5), 605-621. https://doi.org/10.1080/08870446.2015.1132718 

Beedie, C., Mann, S., Domone, S., & Wade, M. (2016). Combining supervised exercise and physical activity counselling might increase retention to GP exercise referral programmes. Medicine & Science in Sports & Exercise (MSSE), 48(5S (S1)), 79-80. https://doi.org/10.1249/01.mss.0000485247.50764.f8 

Bell, J., Neubeck, L., Jin, K., Kelly, P., & Hanson, C. L. (2021). Understanding Leisure Centre-Based Physical Activity after Physical Activity Referral: Evidence from Scheme Participants and Completers in Northumberland UK. International Journal of Environmental Research and Public Health, 18(6), 2957. https://doi.org/10.3390/ijerph18062957  

Biddle, S.J., Fox, K.R. & Edmunds, L. (1994) Physical activity promotion in primary health care in England. London: Health Education Authority. 

Birtwistle, S. B., Ashcroft, G., Murphy, R., Gee, I., Poole, H., & Watson, P. M. (2019). Factors influencing patient uptake of an exercise referral scheme: a qualitative study. Health education research, 34(1), 113-127. https://doi.org/10.1093/her/cyy038 

Buckley, B. J. R., Thijssen, D. H. J., Murphy, R. C., Graves, L. E. F., Whyte, G., Gillison, F. B., ... & Watson, P. M. (2018). Making a move in exercise referral: co-development of a physical activity referral scheme. Journal of Public Health. https://doi.org/10.1093/pubmed/fdy072 

Buckley, B. J., Newton, J., Knox, S., Noonan, B., Smith, M., & Watson, P. M. (2022). Multi-stakeholder perspectives on co-production: Five key recommendations following the Liverpool Co-PARS project. Qualitative Research in Sport, Exercise and Health, 1-15. https://doi.org/10.1080/2159676X.2022.2152085  

Buxton, K. and McGeorge, S. (2018) Audit of Exercise Referral Schemes in Scotland: A Snapshot of Current Practice; NHS Health Scotland: Edinburgh, UK, pp. 1–38. 

Campbell, F., Holmes, M., Everson-Hock, E., Davis, S., Woods, H. B., Anokye, N., ... & Kaltenthaler, E. (2015). A systematic review and economic evaluation of exercise referral schemes in primary care: a short report. Health Technology Assessment, 19(60). http://dx.doi.org/10.3310/hta19600 

Chalder, M., Wiles, N. J., Campbell, J., Hollinghurst, S. P., Haase, A. M., Taylor, A. H., ... & Winder, R. (2012). Facilitated physical activity as a treatment for depressed adults: randomised controlled trial. BMJ, 344, e2758. https://doi.org/10.1136/bmj.e2758 

Craike, M., Wiesner, G., Enticott, J., Bennie, J. A., & Biddle, S. J. (2018). Equity of a government subsidised exercise referral scheme: A population study. Social Science & Medicine, 216, 20-25. https://doi.org/10.1016/j.socscimed.2018.09.023 

Cunningham, K. B., Rogowsky, R. H., Sullivan, F., Ozakinci, G., & Carstairs, S. A. (2020). Methods of connecting primary care patients with community- based physical activity opportunities : A realist scoping review. Health and Social Care in the Community, (October), 1–31. https://doi.org/10.1111/hsc.13186 

Department of Health (2007) Best practice guidance: statement on Exercise Referral. Gateway Reference 7930 London: Department of Health. 

De Lyon, A. T., Neville, R. D., & Armour, K. M. (2017). The role of fitness professionals in public health: a review of the literature. Quest, 69(3), 313-330. https://doi.org/10.1080/00336297.2016.1224193 

Deidda, M., Coll-Planas, L., Giné-Garriga, M., Guerra-Balic, M., i Figuls, M. R., Tully, M. A., ... & Blackburn, N. E. (2018). Cost-effectiveness of exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: protocol for an economic evaluation alongside the SITLESS three-armed pragmatic randomised controlled trial. BMJ open, 8(10), e022266. 

Din, N. U., Moore, G. F., Murphy, S., Wilkinson, C., & Williams, N. H. (2015). Health professionals’ perspectives on exercise referral and physical activity promotion in primary care: findings from a process evaluation of the National Exercise Referral Scheme in Wales. Health Education Journal, 74(6), 743-757. https://doi.org/10.1177/0017896914559785 

Downey, J., Shearn, K., Brown, N., Wadey, R., & Breckon, J. (2021). Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation. BMC health services research, 21(1), 1-9. https://doi.org/10.1186/s12913-021-06349-9 

Downey, J., Shearn, K., Brown, N., Wadey, R., & Breckon, J. (2024). The implementation of behaviour change practices in Physical Activity Referral Schemes: a narrative review. Health Psychology and Behavioral Medicine, 12(1), 2278293. https://doi.org/10.1080/21642850.2023.2278293 

Downey, J., & Golder, E. (2022). How can Exercise Referral Schemes increase physical activity: Developing initial programme theory. https://www.shu.ac.uk/-/media/home/research/awrc/projects/social-prescribing/exercise-referral-schemes-physical-activity.pdf  

Duda, J. L., Williams, G. C., Ntoumanis, N., Daley, A., Eves, F. F., Mutrie, N., ... & Jolly, K. (2014). Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 10. https://doi.org/10.1186/1479-5868-11-10 

Dugdill, L., Graham, R. C., & McNair, F. (2005). Exercise referral: the public health panacea for physical activity promotion? A critical perspective of exercise referral schemes; their development and evaluation. Ergonomics, 48(11-14), 1390-1410. https://doi.org/10.1080/00140130500101544 

Edmunds, J., Ntoumanis, N., & Duda, J. L. (2007). Adherence and well-being in overweight and obese patients referred to an exercise on prescription scheme: A self-determination theory perspective. Psychology of Sport and Exercise, 8(5), 722-740. [full text

Edwards, R. T., Linck, P., Hounsome, N., Raisanen, L., Williams, N., Moore, L., & Murphy, S. (2013). Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial. BMC Public Health, 13(1), 1021. https://doi.org/10.1186/1471-2458-13-1021 

Eynon, M., Foad, J., Downey, J., Bowmer, Y., & Mills, H. (2019). Assessing the psychosocial factors associated with adherence to exercise referral schemes: a systematic review. Scandinavian Journal of Medicine & Science in Sports. https://doi.org/10.1111/sms.13403 

Graham, R.C., Dugdill, L. and Cable, N.T. (2005) Health Professionals perspectives in exercise referral: implications for the referral process. Ergonomics, 48 (11-14):1411-1422.[abstract

Gidlow, C., Johnston, L.H., Crone, D., Morris, C., Smith, A., Foster, C., James, D.V.B. (2007) Socio-demographic patterning of referral, upake and attendance in Physical Activity Referral Schemes. Journal of Public Health 29(2): 107-13. https://doi.org/10.1093/pubmed/fdm002 

Halbert, J.A., Silagy, C.A., Finucane, P.M., Withers, R.T. & Hamdorf, P.A. (2000) Physical activity and cardiovascular risk factors: effect of advice from an exercise specialist in Australian general practice. Medical Journal of Australia, 173 (2): 84-87. https://doi.org/10.5694/j.1326-5377.2000.tb139250.x 

Hanson, C. L., Allin, L. J., Ellis, J. G., & Dodd-Reynolds, C. J. (2013). 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. BMJ Open, 3(8).[full text

Hanson, C. L., Oliver, E. J., Dodd-Reynolds, C. J., & Allin, L. J. (2019). How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK. BMJ Open, 9(2), e024370. http://dx.doi.org/10.1136/bmjopen-2018-024370 

Hanson, C. L., Oliver, E. J., Dodd-Reynolds, C. J., & Kelly, P. (2019). We are failing to improve the evidence base for ‘ ‘exercise referral’: how a physical activity referral scheme taxonomy can help. British Journal of Sports Medicine, 1–2. https://doi.org/10.1136/bjsports-2019-101485  

Hanson, C. L., Oliver, E. J., Dodd-Reynolds, C. J., Pearsons, A., & Kelly, P. (2020). A modified Delphi study to gain consensus for a taxonomy to report and classify physical activity referral schemes (PARS). International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1-11. https://doi.org/10.1186/s12966-020-01050-2 

Harrison, R.A., McNair, F. Dugdill, L. (2005) Access to exercise referral schemes-a population based analysis. Journal of Public Health Medicine 27(4): 326-330 https://doi.org/10.1093/pubmed/fdi048 

Henderson, H. E., Evans, A. B., Allen-Collinson, J., & Siriwardena, N. A. (2018). The ‘wild and woolly’world of exercise referral schemes: contested interpretations of an exercise as medicine programme. Qualitative Research in Sport, Exercise and Health, 10(4), 505-523. https://doi.org/10.1080/2159676X.2017.1352018

Hillsdon, M., Thorogood, M., White, I., & Foster, C. (2002). Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care. International Journal of Epidemiology, 31(4), 808-815. https://doi.org/10.1093/ije/31.4.808 

Hoffmann, T. C., Maher, C. G., Briffa, T., Sherrington, C., Bennell, K., Alison, J., ... & Glasziou, P. P. (2016). Prescribing exercise interventions for patients with chronic conditions. Cmaj, 188(7), 510-518. https://doi.org/10.1503/cmaj.150684 

Howlett, N., Trivedi, D., Troop, N. A., & Chater, A. M. (2019). Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis. Translational behavioral medicine, 9(1), 147-157. https://doi.org/10.1093/tbm/iby010 

James,D.V.B., Johnston, L.H., Crone, D., Sidford, A.H., Gidlow, C., Morris, C., Foster, C. (2009) Factors associated with physical activity referral uptake and participation. Journal of Sports Sciences Vol. 26, No. 2, 217-224 [abstract

Joelsson, M., Bernhardsson, S., & Larsson, M. E. (2017). Patients with chronic pain may need extra support when prescribed physical activity in primary care: a qualitative study. Scandinavian journal of primary health care, 35(1), 64-74. 

Joyce, K. E., Smith, K. E., Henderson, G., Greig, G., & Bambra, C. (2009). Patient perspectives of Condition Management Programmes as a route to better health, well-being and employability. Family Practice, 27(1), 101-109. https://doi.org/10.1093/fampra/cmp083 

Lamming, L., Pears, S., Mason, D., Morton, K., Bijker, M., Sutton, S., & Hardeman, W. (2017). What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews. Preventive medicine, 99, 152-163. https://doi.org/10.1016/j.ypmed.2017.02.017 

Law, R. J., Langley, J., Hall, B., Burton, C., Hiscock, J., Williams, L., ... & Williams, N. (2021). ‘Function First’: how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods. BMJ open, 11(7), e046751. http://dx.doi.org/10.1136/bmjopen-2020-046751  

Leijon, Bendtsen, Ståhle, A., Ekberg, K., Festin, K. and Nilsen, P. (2010 Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care. BMC Family Practice 2010, 11:38 [full text

Leenaars, K. E. F., Smit, E., Wagemakers, A., Molleman, G. R. M., & Koelen, M. A. (2015). Facilitators and barriers in the collaboration between the primary care and the sport sector in order to promote physical activity: a systematic literature review. Preventive medicine, 81, 460-478.

Levy, A., Midgley, A., Pilsworth, S., Mcgonigle, A., Wigelsworth, L., Jones, L., ... & Matata, B. (2019). Applying the Social Identity Approach to Public Health. A Case Example of Theory in Practice. The European Health Psychologist, 21 (1), 595-601.

Lion, A., Vuillemin, A., Thornton, J. S., Theisen, D., Stranges, S., & Ward, M. (2018). Physical activity promotion in primary care: a Utopian quest?. Health Promotion International, 1, 10. https://doi.org/10.1093/heapro/day038 

Littlecott, H. J., Moore, G. F., Moore, L., & Murphy, S. (2014). Psychosocial mediators of change in physical activity in the Welsh national exercise referral scheme: secondary analysis of a randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 109. https://doi.org/10.1186/s12966-014-0109-9 

Lyon, A. T. C. De, Neville, R. D., Armour, K. M., Lyon, A. T. C. De, Neville, R. D., & The, K. M. A. (2017). The Role of Fitness Professionals in Public Health : A Review of the Literature The Role of Fitness Professionals in Public Health : A Review of the Literature. Quest, 69(3), 313–330. https://doi.org/10.1080/00336297.2016.1224193 

McGeechan, G. J., Phillips, D., Wilson, L., Whittaker, V. J., O’Neill, G., & Newbury-Birch, D. (2018). Service Evaluation of an Exercise on Referral Scheme for Adults with Existing Health Conditions in the United Kingdom. International journal of behavioral medicine, 25(3), 304-311. https://doi.org/10.1007/s12529-017-9699-3 

MacAuley, D., Bauman, A., & Frémont, P. (2016). Exercise: not a miracle cure, just good medicine. Br J Sports Med, 50(18), 1107-1108.

Mann, S., Jimenez, A., Domone, S., & Beedie, C. (2016). Comparative effects of three 48-week community-based physical activity and exercise interventions on aerobic capacity, total cholesterol and mean arterial blood pressure. BMJ Open Sport & Exercise Medicine, 2(1), e000105. http://dx.doi.org/10.1136/bmjsem-2015-000105 

Markland, D., & Tobin, V. J. (2010). Need support and behavioural regulations for exercise among exercise referral scheme clients: The mediating role of psychological need satisfaction. Psychology of Sport and Exercise, 11 (2), 91-99. https://doi.org/10.1016/j.psychsport.2009.07.001 

Martín-Borràs, C., Giné-Garriga, M., Puig-Ribera, A., Martín, C., Solà, M., & Cuesta-Vargas, A. I. (2018). A new model of exercise referral scheme in primary care: is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial. BMJ open, 8(3), e017211. http://dx.doi.org/10.1136/bmjopen-2017-017211 

Mills, H., Crone, D., James, D. V., & Johnston, L. H. (2012). Exploring the perceptions of success in an exercise referral scheme: a mixed method investigation. Evaluation Review, 36(6), 407-429. https://doi.org/10.1177/0193841X12474452 

Moore, G. F., Moore, L., & Murphy, S. (2011). Facilitating adherence to physical activity: exercise professionals' experiences of the National Exercise Referral Scheme in Wales. a qualitative study. BMC public health , 11 (1), 1-12. https://doi.org/10.1186/1471-2458-11-935 

Morgan, F., Battersby, A., Weightman, A. L., Searchfield, L., Turley, R., Morgan, H., ... & Ellis, S. (2016). Adherence to exercise referral schemes by participants–what do providers and commissioners need to know? A systematic review of barriers and facilitators. BMC Public Health, 16(1), 227. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-2882-7 

Morgan, K. (2018). The National Exercise Referral Scheme in Wales: exploring scheme implementation over 10 years: Kelly Morgan. European Journal of Public Health, 28(suppl_4), cky218-099. https://doi.org/10.1093/eurpub/cky218.099 

Morgan, O. (2005) Approaches to increase physical activity: reviewing the evidence for exercise-referral schemes. Public Health; 119(5):361-370. 

Murphy, S. M., Edwards, R. T., Williams, N., Raisanen, L., Moore, G., Linck, P., ... & Moore, L. (2012). An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative. J Epidemiol Community Health, 66(8), 745-753.http://jech.bmj.com/content/66/8/745 

The effects of exercise and drug interventions compared with control on mortality outcomes in coronary heart disease, stroke, heart failure, and prediabetes Image from Naci, H., & Ioannidis, J. P. (2013)

Naci, H., & Ioannidis, J. P. (2013). Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ, 347, f5577. doi: https://doi.org/10.1136/bmj.f5577  

National Institute of Health and Clinical Excellence (2006) Four commonly used methods to increase physical activity: Brief interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling. Public Health Intervention Guidance no2. London: National Institute of Health and Clinical Excellence.[full text

Niemeijer, A., Lund, H., Stafne, S. N., Ipsen, T., Goldschmidt, C. L., Jørgensen, C. T., & Juhl, C. B. (2020). Adverse events of exercise therapy in randomised controlled trials: a systematic review and meta-analysis. British journal of sports medicine, 54(18), 1073-1080. http://dx.doi.org/10.1136/bjsports-2018-100461 

Netherway, J., Smith, B. and Monforte, J. (2021) Training Healthcare Professionals on How to Promote Physical Activity in the UK: A Scoping Review of Current Trends and Future Opportunities. International Journal of Environmental Research and Public Health 18, no. 13: 6701. https://doi.org/10.3390/ijerph18136701 

Normansell, R., Smith, J., Victor, C., Cook, D. G., Kerry, S., Iliffe, S., ... & Harris, T. (2014). Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention. BMC Public Health, 14(1), 1272.

Nunan, D., Mahtani, K. R., Roberts, N., & Heneghan, C. (2013). Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews. Systematic Reviews, 2(1), 56. https://doi.org/10.1186/2046-4053-2-56 

Nunan, D. (2016). Doctors should be able to prescribe exercise like a drug. BMJ: British Medical Journal (Online), 353. https://doi.org/10.1136/bmj.i2468 

O'Brien, M. W., Bray, N. W., Kivell, M. J., & Fowles, J. R. (2021). A Scoping Review of Exercise Referral Schemes Involving Qualified Exercise Professionals in Primary Health Care. Applied Physiology, Nutrition, and Metabolism, (ja). https://doi.org/10.1139/apnm-2020-1070 

O'Regan, A., Pollock, M., D'Sa, S., & Niranjan, V. (2021). ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients. BMJ Open Sport & Exercise Medicine, 7(2), e001050. http://dx.doi.org/10.1136/bmjsem-2021-001050 

Oliver, E. J., Hanson, C. L., Lindsey, I. A., & Dodd-Reynolds, C. J. (2016). Exercise on referral: evidence and complexity at the nexus of public health and sport policy. International Journal of Sport Policy and Politics, 8(4), 731–736. https://doi.org/10.1080/19406940.2016.1182048   

Oliver, E. J., Buckley, B., Dodd-Reynolds, C. J., Downey, J., Hanson, C., Henderson, H., ... & Watson, P. M. (2021). Where next for the design, delivery, and evaluation of community-based physical activity prescription? Emerging lessons from the United Kingdom. Applied Physiology, Nutrition, and Metabolism, 46(11), 1430-1434. https://doi.org/10.1139/apnm-2021-0101  

Oliver, E. J., Dodd-Reynolds, C., Kasim, A., & Vallis, D. (2021). Inequalities and Inclusion in Exercise Referral Schemes: A Mixed-Method Multi-Scheme Analysis. International journal of environmental research and public health, 18(6), 3033. https://doi.org/10.3390/ijerph18063033  

Olsson, S. J., Börjesson, M., Ekblom-Bak, E., Hemmingsson, E., Hellénius, M. L., & Kallings, L. V. (2015). Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial. BMC public health, 15(1), 687. https://doi.org/10.1186/s12889-015-2036-3 

Orrow, G., Kinmonth, A. L., Sanderson, S., & Sutton, S. (2012). Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ, 344, e1389. https://doi.org/10.1136/bmj.e1389 

Parretti, H. M., Bartington, S. E., Badcock, T., Hughes, L., Duda, J. L., & Jolly, K. (2017). Impact of primary care exercise referral schemes on the health of patients with obesity. Pragmatic and observational research, 8, 189.  https://dx.doi.org/10.2147%2FPOR.S118648  

Pavey, T.G., Taylor, A.H., Fox, K.R., et al (2011) Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis BMJ Vol. 343:d6462 [full text

Pavey, T., Taylor, A., Hillsdon, M., Fox, K., Campbell, J., Foster, C., ... & Taylor, R. (2012). Levels and predictors of exercise referral scheme uptake and adherence: a systematic review. Journal of epidemiology and community health, jech-2011.[researchgate

Pavey, T.G., Anokye, N., Taylor, A.H., Trueman, P., Moxham, T., Fox, K.R., et al. (2011) The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess. 15(44) https://doi.org/10.3310%2Fhta15440 

Persson, G., Brorsson, A., Hansson, E. E., Troein, M., & Strandberg, E. L. (2013). Physical activity on prescription (PAP) from the general practitioner’s perspective–a qualitative study. BMC Family Practice, 14(1), 128. 

Portman, R. M., Levy, A. R., Mooney, K. M., Whittaker, E. M., & Fairclough, S. J. (2019). Towards an understanding of the social identity approach in exercise referral schemes: A brief commentary. Sport & Exercise Psychology Review, 15(11), 25–30. 

Portman, R. M., Levy, A. R., Maher, A. J., & Fairclough, S. J. (2022). A Commentary on the Development of a Physical Activity Community-Based Peer Mentorship Intervention: Theoretical and Practical Insights from the Social Identity Approach. European Health Psychologist, 22 (5), 858-863. https://www.ehps.net/ehp/index.php/contents/issue/view/111/166  

Prior, F., Coffey, M., Robins, A., & Cook, P. (2019). Long-term health outcomes associated with an exercise referral scheme: an observational longitudinal follow-up study. Journal of Physical Activity and Health, 16(4), 288-293. https://doi.org/10.1123/jpah.2018-0442 

Pullen, E., & Malcolm, D. (2018). Assessing the side effects of the ‘exercise pill’: the paradox of physical activity health promotion. Qualitative Research in Sport, Exercise and Health, 10(4), 493-504. https://doi.org/10.1080/2159676X.2017.1388833 

Raustorp, A., & Sundberg, C. J. (2014). The Evolution of Physical Activity on Prescription (FaR) in Sweden. Swiss Sports & Exercise Medicine, 62(2). https://doi.org/10.34045/SSEM/2014/10 

Reid, H., Ridout, A. J., Tomaz, S. A., Kelly, P., & Jones, N. (2021). Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. British Journal of Sports Medicine. http://dx.doi.org/10.1136/bjsports-2021-104281 

Riddoch, C., Puig-Ribera, A. & Cooper, A. (1998). Effectiveness of physical activity promotion schemes in primary care: a review. London: HEA.[full text

Rouse, P. C., Ntoumanis, N., Duda, J. L., Jolly, K., & Williams, G. C. (2011) In the beginning: Role of autonomy support on the motivation, mental health and intentions of participants entering an exercise referral scheme. Psychology and Health, 26(6), 729-749 [full text

Rowley, N., Mann, S., Steele, J., Horton, E., & Jimenez, A. (2018). The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review. BMC Public Health, 18(1), 949. https://doi.org/10.1186/s12889-018-5868-9 

Rowley, N., Steele, J., Mann, S., Jimenez, A., & Horton, E. (2021). Delivery Approaches Within Exercise Referral Schemes: A Survey of Current Practice in England. Journal of Physical Activity and Health, 18(4), 357-373. https://doi.org/10.1123/jpah.2020-0388 

Schmidt, M., Absalah, S., Nierkens, V., & Stronks, K. (2008). Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes?. BMC Public Health, 8(1), 371. https://doi.org/10.1186/1471-2458-8-371 

Sharma, H., Bulley, C., & van Wijck, F. M. (2012). Experiences of an exercise referral scheme from the perspective of people with chronic stroke: a qualitative study. Physiotherapy, 98(4), 336-343. https://doi.org/10.1016/j.physio.2011.05.004 

Shaw, R., Gillies, M., Barber, J., MacIntyre, K., Harkins, C., Findlay, I. N., ... & MacIntyre, P. D. (2012). Pre-exercise screening and health coaching in CHD secondary prevention: a qualitative study of the patient experience. Health Education Research, 27(3), 424-436. https://doi.org/10.1093/her/cys005 

Shore, C. B., Hubbard, G., Gorely, T., Polson, R., Hunter, A., & Galloway, S. D. (2019). Insufficient Reporting of Factors Associated With Exercise Referral Scheme Uptake, Attendance, and Adherence: A Systematic Review of Reviews. Journal of Physical Activity and Health, (00), 1-10. https://doi.org/10.1123/jpah.2018-0341 

Shore, C. B., Galloway, S. D., Gorely, T., Hunter, A. M., & Hubbard, G. (2022). Exercise Referral Instructors’ Perspectives on Supporting and Motivating Participants to Uptake, Attend and Adhere to Exercise Prescription: A Qualitative Study. International Journal of Environmental Research and Public Health, 19(1), 203. https://doi.org/10.3390/ijerph19010203 

Slade, S. C., & Keating, J. L. (2011). Exercise prescription: a case for standardised reporting. British journal of sports medicine, 1–6. doi:10.1136/bjsports-2011-090290 http://dx.doi.org/10.1136/bjsports-2011-090290 

Sowden, S.L., Raine, R. (2008) Running along parallel lines: how political reality impedes the evaluation of public health interventions. A case study of exercise referral schemes in England J Epidemiol Community Health;62:835-841 [abstract] [phd thesis

Sousa Matias, T, Piggin, J. (2020) Physical activity promotion: can a focus on disease limit successful messaging? Lancet Global Health DOI:https://doi.org/10.1016/S2214-109X(20)30355-7 

Sørensen J, Sørensen JB, Skovgaard T, et al. (2011) Exercise on prescription: changes in physical activity and health-related quality of life in five Danish programmes. Eur J Public Health, 21:56–62. https://doi.org/10.1093/eurpub/ckq003 

Speake, H., Copeland, R. J., Till, S. H., Breckon, J. D., Haake, S., & Hart, O. (2016). Embedding physical activity in the heart of the NHS: the need for a whole-system approach. Sports Medicine, 46(7), 939-946.https://doi.org/10.1007/s40279-016-0488-y 

Steele, J., Wade, M., Copeland, R. J., Stokes, S., Stokes, R., & Mann, S. (2021). The National ReferAll Database: An Open Dataset of Exercise Referral Schemes Across the UK. International Journal of Environmental Research and Public Health, 18(9), 4831. https://doi.org/10.3390/ijerph18094831 

Stewart, L., Dolan, E., Carver, P., & Swinton, P. A. (2017). Per-protocol investigation of a best practice exercise referral scheme. Public Health, 150, 26-33. https://doi.org/10.1016/j.puhe.2017.04.023 

Taylor, A.H, Doust, J. & Webborn, N. (1998) Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors. Journal of Epidemiology and Community Health, 52 (2): 595-601 http://dx.doi.org/10.1136/jech.52.9.595 

Thornton, J. S., Frémont, P., Khan, K., Poirier, P., Fowles, J., Wells, G. D., & Frankovich, R. J. (2016). Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. British Journal of Sports Medicine, 50(18), 1109-1114. http://bjsm.bmj.com/content/50/18/110 

Tobi, P., Estacio, E. V., Yu, G., Renton, A., & Foster, N. (2012). Who stays, who drops out? Biosocial predictors of longer-term adherence in participants attending an exercise referral scheme in the UK. BMC Public Health, 12(1), 347. https://doi.org/10.1186/1471-2458-12-347 

Vishnubala, D., Iqbal, A., Marino, K., Whatmough, S., Barker, R., Salman, D., ... & Nykjaer, C. (2022). UK Doctors Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study. International Journal of Environmental Research and Public Health, 19(19), 12030. https://doi.org/10.3390/ijerph191912030 

Vuori, I. M., Lavie, C. J., & Blair, S. N. (2013, December). Physical activity promotion in the health care system. In Mayo Clinic Proceedings (Vol. 88, No. 12, pp. 1446-1461). Elsevier. https://doi.org/10.1016/j.mayocp.2013.08.020 

Wackerhage, H. and Schoenfeld, B.J. (2021) Personalized, Evidence-Informed Training Plans and Exercise Prescriptions for Performance, Fitness and Health. Sports Medicine https://doi.org/10.1007/s40279-021-01495-w   

Wade, M., Brown, N., Steele, J., Mann, S., Dancy, B., Winter, S., & Majumdar, A. (2021). The impact of signposting and group support pathways on a community-based physical activity intervention grounded in motivational interviewing. Journal of Public Health. fdab198, https://doi.org/10.1093/pubmed/fdab198 

Wade, M., Mann, S., Copeland, R. J., & Steele, J. (2019, January 12). The effect of exercise referral schemes upon health and wellbeing: Initial observational insights using individual patient data meta-analysis from The National Referral database. https://doi.org/10.31236/osf.io/yebmr  

Waterman, M. R., Wiecha, J. M., Manne, J., Tringale, S. M., Costa, E., & Wiecha, J. L. (2014). Utilization of a free fitness center-based exercise referral program among women with chronic disease risk factors. Journal of Community Health, 39(6), 1179-1185. https://doi.org/10.1007/s10900-014-9874-2 

Watson, P. (2017). Stuck in the “exercise” trap: Current issues and future directions for UK exercise referral schemes. European Journal of Public Health, 27(suppl_3). https://doi.org/10.1093/eurpub/ckx187.057 

Webb, R., Thompson, J. E. S., Ruffino, J. S., Davies, N. A., Watkeys, L., Hooper, S., ... & Morris, K. (2016). Evaluation of cardiovascular risk-lowering health benefits accruing from laboratory-based, community-based and exercise-referral exercise programmes. BMJ Open Sport & Exercise Medicine, 2(1), e000089. http://bmjopensem.bmj.com/content/2/1/e000089

Werbrouck, A., Schmidt, M., Putman, K., Seghers, J., Simoens, S., Verhaeghe, N., & Annemans, L. (2022). Cost-effectiveness of exercise referral schemes: a systematic review of health economic studies. European journal of public health, 32(1), 87-94. https://doi.org/10.1093/eurpub/ckab189 

West, S. L., Banks, L., Schneiderman, J. E., Caterini, J. E., Stephens, S., White, G., ... & Wells, G. D. (2019). Physical activity for children with chronic disease; a narrative review and practical applications. BMC Pediatrics, 19(1), 12. https://doi.org/10.1186/s12887-018-1377-3 

Wiles, R., Demain, S., Robison, J., Kileff, J., Ellis-Hill, C., & McPherson, K. (2008). Exercise on prescription schemes for stroke patients post-discharge from physiotherapy. Disability and Rehabilitation, 30(26), 1966-1975. https://doi.org/10.1080/09638280701772997

Williams, N.H. (2011) Promoting physical activity in primary care BMJ 2011;343:d6615 https://doi.org/10.1136/bmj.d6615 

Williams, N.H., Hendry, M. France, B Lewis, R. Wilkinson, C (2007) Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review Br J Gen Pract. 57(545): 979–986.[full text

Williams, T. L., Hunt, E. R., Papathomas, A., & Smith, B. (2018). Exercise is medicine? Most of the time for most; but not always for all. Qualitative Research in Sport, Exercise and Health, 10(4), 441-456. https://doi.org/10.1080/2159676X.2017.1405363 

Wormald, H. & Ingle, L. (2004) GP exercise referral schemes: Improving the patient’s experience. Health Education Journal, 63 (4):362-373. (abstract)

Exercise Referral Specialists on Twitter

Dr James Steele - @JamesSteeleII 

Nikita Rowley - @nikitarowley 

Bex Townley - @BexTownley 

Dr Hayley Mills - @drhbomb 

Prof Alfonso Jimenez - @ProfA_Jimenez

Dr Andrew Scott - @andyscott247 

Dr Coral Hanson - @HansonCoral 

Dr Faye Prior - @FayePrior

Dr Benjamin Buckley - @BuckleyBenjamin 

John Downey - @JohnJDowney 

Colin Shore - @Exe_therapy_Col  

Hannah Henderson - @HEHenderson80 

Prof Nanette Mutrie - @nanettemutrie

Lindsey Dugdill - @LDUGDILL

Matthew Wade - @_MattWade 

Anthony Crozier - @crowie_raven  

Sebastià Mas Alòs - @SebasMasAlos