Exercise Referral/Chronic Conditions
This resource page contains links to key exercise referral documents and peer-reviewed research as well as recommended textbooks, lecture slides and sub-pages that cover specific conditions often addressed by exercise referral schemes.
Key UK Publications
NICE Guidance PH54 - Exercise referral schemes to promote physical activity - Sept, 2014
NICE guidance PH44 - Physical activity: brief advice for adults in primary care - May, 2013
NICE Guidance PH49 - Behaviour change: individual approaches
NICE pathways - Encouraging physical activity to prevent or treat specific conditions
National Obesity Observatory - Standard Evaluation Framework for Physical Activity Interventions
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 2011;343:d6462 [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://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5868-9
Exercise Referral Schemes
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
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.
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.
Biddle, S.J., Fox, K.R. & Edmunds, L. (1994) Physical activity promotion in primary health care in England. London: Health Education Authority.
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
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.
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
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.
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.[full text]
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. [full text]
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
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
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 [full text]
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.
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
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.
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
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.
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
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
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]
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
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.
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.
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) [full text]
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.
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
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
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
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 [full text]
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
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.[full text]
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
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
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
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.
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
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 [editorial]
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)