Background Intermediaries are health-related workers who facilitate connections to non-medical services and supports in the community, including physical activity and exercise services (local PA). There is preliminary evidence supporting their role in PA promotion. However, little is known about the processes of intermediaries when connecting individuals to local PA, or the outcomes of these connections.

Methods The objectives of this scoping review were to identify and summarise the literature describing i) connection to an intermediary, ii) demographic and health characteristics of individuals referred to intermediaries, iii) the practices of intermediaries when connecting individuals to local PA, and iv) outcomes of this connection. A comprehensive search strategy was developed in consultation with a medical librarian. Four electronic databases (Embase, Medline, Web of Science, CINAHL) were searched from inception to June 2022, as well as an extensive grey literature search. Full-text peer reviewed and non-peer reviewed studies were considered for inclusion.

Results The search identified 10,257 records, 261 were retrieved for full-text screening, and 35 reports of N=28 studies were included in the final review. Research was mainly carried out in the UK and USA and had a variety of designs; qualitative (N=7), randomised controlled trials (N=5), before-after studies (N=5), feasibility studies (N=4) and mixed/other methods (N=14). The studies included 10,104 participants. Individuals referred to an intermediary tended to be female (57%), with a mean age of 58.1 (SD 9.9) years and a clinical or pre-clinical diagnosis. Where reported, the most common referral route was through primary care staff. Referrals to specifically improve PA were low. Intermediaries generally followed up with an individual over a number of sessions to promote participation in local PA, using a personalised approach and/or motivational interviewing. Individuals were most commonly connected to fitness or walking groups. PA outcomes (e.g., increased caloric expenditure, steps/day, PA levels) were generally positive in the short-term but evidence was mixed at longer-term follow-up.

Conclusion To the best of our knowledge, this was the first scoping review to describe how intermediaries establish connections to local PA, and the profile of individuals undergoing this intervention. Information regarding the processes of intermediaries was heterogeneous across included studies or under-reported. While PA outcomes tended to be positive, critical appraisal of evidence is not a common component of scoping reviews and was not performed. More research is needed to determine the processes of intermediaries to inform future evaluation of this intervention, and to develop appropriate referral pathways.