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An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative
  1. Simon Mark Murphy1,
  2. Rhiannon Tudor Edwards2,
  3. Nefyn Williams3,
  4. Larry Raisanen1,
  5. Graham Moore1,
  6. Pat Linck2,
  7. Natalia Hounsome2,
  8. Nafees Ud Din3,
  9. Laurence Moore1
  1. 1DECIPHer, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales, UK
  2. 2Centre for Health Economics and Medicines Evaluation, Institute of Medical and Social Care Research, Bangor University, Bangor, UK
  3. 3North Wales Centre for Primary Care Research, Bangor University, North Wales Clinical School, Wrexham, UK
  1. Correspondence to Dr Simon Mark Murphy, DECIPHer, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales, UK; murphys7{at}


Background The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including motivational interviewing, goal setting and relapse prevention.

Method A pragmatic randomised controlled trial with nested economic evaluation of 2160 inactive participants with coronary heart disease risk (CHD, 1559, 72%), mild to moderate depression, anxiety or stress (79, 4%) or both (522, 24%) randomised to receive (1) NERS or (2) normal care and brief written information. Outcome measures at 12 months included the 7-day physical activity recall, the hospital anxiety and depression scale.

Results Ordinal regression identified increased physical activity among those randomised to NERS compared with those receiving normal care in all participants (OR 1.19, 95% CI 0.99 to 1.43), and among those referred for CHD only (OR 1.29, 95% CI 1.04 to 1.60). For those referred for mental health reason alone, or in combination with CHD, there were significantly lower levels of anxiety (OR −1.56, 95% CI −2.75 to −0.38) and depression (OR −1.39, 95% CI −2.60 to −0.18), but no effect on physical activity. The base-case incremental cost-effectiveness ratio was £12 111 per quality adjusted life year, falling to £9741 if participants were to contribute £2 per session.

Conclusions NERS was effective in increasing physical activity among those referred for CHD risk only. Among mental health referrals, NERS did not influence physical activity but was associated with reduced anxiety and depression. Effects were dependent on adherence. NERS is likely to be cost effective with respect to prevailing payer thresholds.

Trial registration Current Controlled Trials ISRCTN47680448.

  • Pragmatic randomised controlled trial
  • exercise referral
  • physical activity
  • anxiety
  • depression
  • cost effectiveness
  • health-related quality of life
  • cost per QALY
  • effectiveness
  • public health policy
  • exercise
  • general practice
  • cost effective
  • health services
  • health promotion
  • health policy
  • addictive behaviour/addiction
  • policy
  • cancer
  • public health
  • primary health care
  • oral health

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  • Funding This study was supported by the Welsh Government.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Thames Valley Multi-centre Research Ethics Committee (MREC) approved the evaluation of the Welsh NERS on 8 Feb 2007 (Ref: 06/MRE12/85).

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

  • Data sharing statement Data is still currently being analysed to address secondary research questions.

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