Access to exercise referral schemes - a population based analysis

Background Sedentary behaviour is a public health priority in many countries. Hundreds of community-based exercise referral schemes have been established in Europe and USA, to increase physical activity. Experimental evidence questions the effectiveness of these schemes. No previous evaluations have considered a population approach nor provide detailed information on the types of people accessing these schemes. This is of concern given increasing health inequalities in other areas of care. Our register-based study quantified the numbers and characteristics of patients referred and accessing a district-wide exercise referral scheme. The analysis considers the effectiveness of these schemes to a geographically defined population. Methods Data were collected prospectively from a patient register for referrals made to a district-wide exercise referral scheme in north-west England. Analysis examined referral rates and the influence of practitioner and patient characteristics on access to the scheme. Results Over 5 years, 6610 adults were referred from 125 general practices, with 60.8 per cent female and a mean age of 51.3 years (SD 12.6). This represents 4 per cent of the adult sedentary population in that district. The most common reason for referral was musculoskeletal or cardiovascular risk. Overall, 79 per cent attended at least the first appointment, with statistically significant predictors by age and reason for referral. Those referred for 'fitness' or 'mental health' were most likely to attend. Patients in the youngest and oldest age groups were least likely to attend. Patient's sex and deprivation and the number of patients referred by each general practice did not influence attendance. Conclusions Primary-care patients seem to view the concept of exercise referral schemes positively but practitioners remain reluctant to refer many of their sedentary patients. There is doubt that exercise referral schemes like this will influence population levels of sedentary behaviour, when considered alongside their impact on physical activity in the longer term.