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Effect of exercise referral schemes upon health and well-being: initial observational insights using individual patient data meta-analysis from the National Referral Database
  1. Matthew Wade1,2,
  2. Steven Mann3,
  3. Rob J Copeland4,
  4. James Steele1,5
  1. 1 Research Institute, ukactive, London, UK
  2. 2 St Mary's University Twickenham, Twickenham, UK
  3. 3 Places for People Leisure, Camberley, UK
  4. 4 The National Centre for Sport and Exercise Medicine, Sheffield Hallam University, Sheffield, UK
  5. 5 School of Sport, Health, and Social Sciences, Solent University, Southampton, UK
  1. Correspondence to Dr James Steele, Research Institute, Ukactive, London WC1R 4HE, UK; jamessteele{at}


Objectives To examine if exercise referral schemes (ERSs) are associated with meaningful changes in health and well-being in a large cohort of individuals throughout England, Scotland, and Wales from the National Referral Database.

Methods Data were obtained from 23 731 participants from 13 different ERSs lasting 6 weeks to 3 months. Changes from pre- to post-ERS in health and well-being outcomes were examined including body mass index (BMI), blood pressure (systolic (SBP) and diastolic (DBP)), resting heart rate (RHR), short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), WHO Well-Being Index (WHO-5), Exercise Related Quality of Life scale (ERQoL), and Exercise Self-Efficacy Scale (ESES). Two-stage individual patient data meta-analysis was used to generate effect estimates.

Results Estimates (95% CIs) revealed statistically significant changes occurred compared with point nulls for BMI (−0.55 kg.m2 (−0.69 to −0.41)), SBP (−2.95 mmHg (−3.97 to −1.92)), SWEMWBS (2.99 pts (1.61 to 4.36)), WHO-5 (8.78 pts (6.84 to 10.63)), ERQoL (15.26 pts (4.71 to 25.82)), and ESES (2.58 pts (1.76 to 3.40)), but not RHR (0.22 f c (−1.57 to 1.12)) or DBP (−0.93 mmHg (−1.51 to −0.35)). However, comparisons of estimates (95% CIs) against null intervals suggested the majority of outcomes may not improve meaningfully.

Conclusions We considered whether meaningful health and well-being changes occur in people who are undergoing ERSs. These results demonstrate that, although many health and well-being outcomes improved, the changes did not achieve meaningful levels. This suggests the need to consider the implementation of ERSs more critically to discern how to maximise their effectiveness.

  • exercise
  • physical activity
  • health behaviour

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  • Contributors The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. JS/MW/RC/SM had the idea for the article. JS/MW wrote the initial draft. JS conducted the statistical analysis. All authors contributed additional writing to the first draft, critical review and editing, and signed off on the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval As per the Health Research Authority and Research Ethics Committee section 11 of Standard Operating Procedures, ethical approval is not required for research involving patient data that are not identifiable.

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

  • Data availability statement Data are presently available upon reasonable request. We are working to establish the database as an open resource with continuous version controlled datasets (see Steele et al. for details