We know that exercise helps people who are going through mental health difficulties, but how can we encourage people to become more active?

Exercise referral schemes aim to identify inactive adults in the primary care setting. The GP or healthcare professional then refers the patient to a third-party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the individual.

This new health technology assessment report from the NIHR HTA programme looks at the clinical effectiveness and cost effectiveness of exercise referral schemes by conducting a systematic review and economic evaluation.

The scope of the review did not focus on people with mental health issues, but the broader group of individuals without a diagnosed condition who are sedentary.

The reviewers found 7 randomised controlled trials that met their inclusion criteria:

• 5 comparing exercise referral schemes with usual care
• 2 comparing exercise referral schemes with an alternative physical activity intervention
• 1 investigating exercise referral schemes plus a self-determination theory intervention

Here’s what they found:

• Compared to usual care, there was weak evidence of an increase in the number of exercise referral scheme participants who achieved a self-reported 90–150 minutes of at least moderate-intensity physical activity per week at 6–12 months’ follow-up [pooled relative risk 1.11, 95% confidence interval 0.99 to 1.25]
• There was no consistent evidence of a difference between exercise referral schemes and usual care in the duration of moderate/vigorous intensity and total physical activity or other outcomes, for example physical fitness, serum lipids, health-related quality of life
• There was no between-group difference in outcomes between exercise referral schemes and alternative physical activity interventions, or exercise referral schemes plus a self-determination theory intervention
• Women and older people were more likely to take up exercise referral schemes but women, when compared with men, were less likely to adhere
• Compared with usual care, the mean incremental cost for exercise referral schemes was £169 and the mean incremental QALY was 0.008, with the base-case incremental cost-effectiveness ratio at £20,876 per QALY in sedentary people without a medical condition and a cost per QALY of £14,618 in sedentary obese individuals, £12,834 in sedentary hypertensive patients, and £8,414 for sedentary individuals with depression

The authors concluded:

There remains considerable uncertainty as to the effectiveness of exercise referral schemes for increasing activity, fitness or health indicators or whether they are an efficient use of resources in sedentary people without a medical diagnosis. We failed to identify any trial-based evidence of the effectiveness of exercise referral schemes in those with a medical diagnosis.

Future work should include randomised controlled trials assessing the clinical effectiveness and cost-effectiveness of exercise referral schemes in disease groups that may benefit from physical activity.

Pavey TG, Anokye N, Taylor AH, Trueman P, Moxham T, Fox KR, et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation (PDF). Health Technol Assess 2011;15(44).