title: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the impact of exercise referral schemes on physical activity and health outcomes. Design Systematic review and meta-analysis.
  
  
  METHODS
  Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references. Study selection Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals.
  
  
  METHODS
  sedentary individuals with or without medical diagnosis. Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. Comparators: usual care, no intervention, or alternative exercise referral schemes.
  
  
  RESULTS
  Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference -0.82, -1.28 to -0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings. Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.
authors: Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, Exeter EX2 4SG, UK. toby.pavey@pcmd.ac.uk
authors: T G
authors: TG
authors: Pavey
authors: A H
authors: AH
authors: Taylor
authors: K R
authors: KR
authors: Fox
authors: M
authors: M
authors: Hillsdon
authors: N
authors: N
authors: Anokye
authors: J L
authors: JL
authors: Campbell
authors: C
authors: C
authors: Foster
authors: C
authors: C
authors: Green
authors: T
authors: T
authors: Moxham
authors: N
authors: N
authors: Mutrie
authors: J
authors: J
authors: Searle
authors: P
authors: P
authors: Trueman
authors: R S
authors: RS
authors: Taylor
mesh_terms: D003362:Cost-Benefit Analysis; D015444:Exercise / Q000502:physiology / Q000523:psychology; D006305:Health Status Indicators; D006801:Humans; D009043:Motor Activity; D010809:Physical Fitness; D011320:Primary Health Care / Q000191:economics; D011788:Quality of Life; D012017:Referral and Consultation / Q000191:economics