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

Specific Conditions

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

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.

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

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

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

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.

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) [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)

Exercise Referral Specialists on Twitter

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Dr Hayley Mills - @drhbomb

Prof Alfonso Jimenez - @ProfA_Jimenez

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