title: Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review.
abstract: BACKGROUND
  Despite the health benefits of physical activity, most adults do not take the recommended amount of exercise.
  
  
  OBJECTIVE
  To assess whether exercise-referral schemes are effective in improving exercise participation in sedentary adults.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Studies were identified by searching MEDLINE, CINAHL, EMBASE, AMED, PsycINFO, SPORTDiscus, The Cochrane Library and SIGLE until March 2007. Randomised controlled trials (RCTs), observational studies, process evaluations and qualitative studies of exercise-referral schemes, defined as referral by a primary care clinician to a programme that encouraged physical activity or exercise were included. RCT results were combined in a meta-analysis where there was sufficient homogeneity.
  
  
  RESULTS
  Eighteen studies were included in the review. These comprised six RCTs, one non-randomised controlled study, four observational studies, six process evaluations and one qualitative study. In addition, two of the RCTs and two of the process evaluations incorporated a qualitative component. Results from five RCTs were combined in a meta-analysis. There was a statistically significant increase in the numbers of participants doing moderate exercise with a combined relative risk of 1.20 (95% confidence intervals = 1.06 to 1.35). This means that 17 sedentary adults would need to be referred for one to become moderately active. This small effect may be at least partly due to poor rates of uptake and adherence to the exercise schemes.
  
  
  CONCLUSIONS
  Exercise-referral schemes have a small effect on increasing physical activity in sedentary people. The key challenge, if future exercise-referral schemes are to be commissioned by the NHS, is to increase uptake and improve adherence by addressing the barriers described in these studies.
authors.affiliation: Department of Primary Care and Public Health School of Medicine, Cardiff University, North Wales Clinical School, Wrecsam. williamsnh@cf.ac.uk
authors.forename: Nefyn H
authors.initials: NH
authors.lastname: Williams
authors.forename: Maggie
authors.initials: M
authors.lastname: Hendry
authors.forename: Barbara
authors.initials: B
authors.lastname: France
authors.forename: Ruth
authors.initials: R
authors.lastname: Lewis
authors.forename: Clare
authors.initials: C
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D015444:Exercise; D015438:Health Behavior; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D009043:Motor Activity; D010349:Patient Compliance; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000191:economics; D006113:United Kingdom