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Levels and predictors of exercise referral scheme uptake and adherence: a systematic review
  1. Toby Pavey1,7,
  2. Adrian Taylor2,
  3. Melvyn Hillsdon2,
  4. Kenneth Fox3,
  5. John Campbell1,
  6. Charlie Foster4,
  7. Tiffany Moxham1,
  8. Nanette Mutrie5,
  9. John Searle6,
  10. Rod Taylor1
  1. 1Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
  2. 2School of Sport and Health Sciences, University of Exeter, Exeter, UK
  3. 3Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
  4. 4Department of Public Health, University of Oxford, Oxford, UK
  5. 5School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
  6. 6Fitness Industry Association, London, UK
  7. 7School of Human Movement Studies, University of Queensland
  1. Correspondence toDr Toby Pavey, School of Human Movement Studies, University of Queensland, St. Lucia Campus, Brisbane, QLD 4072, Australia; toby.pavey{at}


Background The effectiveness of exercise referral schemes (ERS) is influenced by uptake and adherence to the scheme. The identification of factors influencing low uptake and adherence could lead to the refinement of schemes to optimise investment.

Objectives To quantify the levels of ERS uptake and adherence and to identify factors predictive of uptake and adherence.

Methods A systematic review and meta-analysis was undertaken. MEDLINE, EMBASE, PsycINFO, Cochrane Library, ISI WOS, SPORTDiscus and ongoing trial registries were searched (to October 2009) and included study references were checked. Included studies were required to report at least one of the following: (1) a numerical measure of ERS uptake or adherence and (2) an estimate of the statistical association between participant demographic or psychosocial factors (eg, level of motivation, self-efficacy) or programme factors and uptake or adherence to ERS.

Results Twenty studies met the inclusion criteria, six randomised controlled trials (RCTs) and 14 observational studies. The pooled level of uptake in ERS was 66% (95% CI 57% to 75%) across the observational studies and 81% (95% CI 68% to 94%) across the RCTs. The pooled level of ERS adherence was 49% (95% CI 40% to 59%) across the observational studies and 43% (95% CI 32% to 54%) across the RCTs. Few studies considered anything other than gender and age. Women were more likely to begin an ERS but were less likely to adhere to it than men. Older people were more likely to begin and adhere to an ERS.

Limitations Substantial heterogeneity was evident across the ERS studies. Without standardised definitions, the heterogeneity may have been reflective of differences in methods of defining uptake and adherence across studies.

Conclusions To enhance our understanding of the variation in uptake and adherence across ERS and how these variations might affect physical activity outcomes, future trials need to use quantitative and qualitative methods.

  • Exercise referral schemes
  • physical activity
  • primary care
  • uptake
  • adherence
  • systematic reviews
  • meta analysis
  • public health
  • health behaviour
  • ageing
  • mental health
  • exercise
  • epidemiology
  • health promotion

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  • Funding This project was funded by the NIHR Health Technology Assessment programme (project number 08/72/01) and will be published in full in the Health Technology Assessment (HTA) journal around September (see HTA programme website for further project information).

  • Disclaimer The views and opinions expressed here are those of the authors and do not necessarily reflect those of the Department of Health.

  • Competing interests JS is Chief Medical Officer of the Fitness Industry Association (FIA). The FIA meets his receipted expenses. The post attracts neither a salary nor fees.

  • Ethics approval This is a systematic review for which ethical approval is not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.