An analysis of patients referred to a primary care exercise referral scheme : attendance, completion, 12 month adherence and the experiences of overweight participants
The purpose of an Exercise Referral Scheme (ERS) is to offer supervised, safe and appropriate group exercise and activities for individuals who can benefit physiologically and psychologically from increasing their level of physical activity. Referral from a health professional for activities is usually to a local leisure centre or alternative location. Assessments are carried out by professional, qualified staff who prescribe activity type and frequency. The activities are usually subsidised over a 10-14 week period, after which the cost is incurred by the individual. In recent years there has been a proliferation of ERS's as a means of increasing physical activity in the UK. Primary Care Trusts have invested in ERS, yet the evidence base for their ability to increase physical activity is debatable. Consequently, the overall aim of this research was to gain a greater understanding of the process of ERS through a case study example. By improving the services an ERS can offer to its participants, attendance and completion are likely to increase, ultimately resulting in increases in physical activity levels and therefore health. The present research has used mutli-methodological design to evaluate a community ERS in the North West of England. Four separate studies have allowed evaluation of characteristics of those who do not attend against those who do attend (study 1); those who complete an ERS against those who do not (study 2) and those who subsequently sustain physical activity 12 months post intervention (study 3). Furthermore, a qualitative tracking study followed participants' experiences whilst on an ERS specific to overweight individuals, over a 12 week period (study 4). Results indicate variances in individuals referred to the scheme; females being more likely to be referred and attend an ERS than males (p < 0.05) and those in the 46-60 year bracket being significantly more likely to attend (p < 0.05). Reason for referral was significant for attendance (p < 0.05), as well as month of referral (p < 0.05). Completion rates on the scheme were 42% at 12 weeks and were greatest for 31-45 year old males. However, overall there was a significant difference between age and likelihood of completing an ERS; individuals aged between 41-75 years were more likely to complete (p < 0.05). Family and friend participation support was significant to completion of the ERS. Gender (p > 0.05), pre-intervention physical activity levels (p > 0.05), family reward support (p > 0.05) and referral category (p > 0.05) were not significant to completion of an ERS. Post-intervention, physical activity levels were significantly increased by 15 METS (equivalent to 3, 15 minute bouts of moderate intensity exercise) (p < 0.05), although this was not significant at any other time over a 12 month period. Participants who perceived themselves to be participating in the nationally recommended levels of physical activity, increased from 41% at baseline, to 84% at 12 weeks (post-intervention), and 72% at 12 months. Qualitative analysis with overweight participants on an ERS showed problematic issues such as others perceptions relating to their inactive lifestyle. Participants gained most support from other overweight participants on the scheme, compared to significant others (e.g. spouse, friends) due to their clinical similarities. 58% of participants monitored completed the scheme, which is greater than completion of the general ERS. Outcomes of success on such interventions are discussed, along with experiences of participation in an ERS. The research has shown that the use of ERSs in primary care can increase the short term physical activity levels of previously sedentary individuals. Characteristics of individuals, who are more likely to attend, complete and sustain physical activity long term, have been determined. Future success of such schemes should involve psychological outcomes, and physiological factors other than increases in physical activity.