Exercise Referral/Chronic Conditions

Key UK Publications

Specific Conditions

Exercise Referral Schemes

Cost Effectiveness

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]

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.

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

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

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]

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

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. (2009) Clinical Exercise Physiology (2nd Ed). Champaign IL: Human Kinetics [google books]

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

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]

Further Reading: Journal Articles

American College of Sports Medicine (2010) ACSM Position Stand ‘‘Exercise and Type 2 Diabetes’’ Med Sci Sports Exerc. 42(1 2): 2282-2303 [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.

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.

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]

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]

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]

James,D.V.B., Johnston, L.H., Crone, D., Sidford, A.H., Gidlow, C., Morris, C., Foster, C. (2008) Factors associated with physical activity referral uptake and participation Journal of Sports Sciences Vol. 26, No. 2, 217-224 [abstract]

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.

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

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

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]

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]

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. Vol. 26, No.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://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5868-9

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]

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

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

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.

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

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]

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

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