5 Recommendations for research
The Public Health Advisory Committee (PHAC) recommends that the following research questions should be addressed. It notes that 'effectiveness' in this context relates not only to the size of the effect, but also to the duration of effect and cost effectiveness. It also takes into account any harmful or negative side effects.
All the recommended research should aim to identify differences in effectiveness among groups, based on characteristics such as socioeconomic status, age, gender and ethnicity. It should also focus on exercise referral schemes that seek to improve the health of sedentary or inactive adults with an existing health condition – or other factors that put them at increased risk of developing a health condition.
The research recommendations do not cover people for whom exercise referral schemes are not recommended (see recommendations 1 and 2).
They assume that exercise referral schemes benefit health by helping people to be more physically active. Changes in physical activity levels should, therefore, be the primary outcome measured, ideally at 1 year and beyond. The potential health benefit of someone doing some physical activity, albeit below current UK physical activity guidelines rather than none at all, should be taken into account. (See the Department of Health's Start active, stay active.)
If other outcomes or determinants of health – such as reducing social isolation or improving community engagement – are seen as key benefits, then they should be clearly set out and measured against a suitable control intervention. This is not, however, the focus of these research recommendations.
5.1 How effective and cost effective are different types of exercise referral scheme? Compare the relative effects of different models in controlled studies. Include health-related quality of life as an outcome. Compare exercise referral schemes that vary by:
setting – for example, home-based, gym-based, community-based or outdoors
intensity and duration – for example, a 12‑week scheme involving 1 session a week, or a 6‑week scheme involving 4 1‑hour sessions per week
the techniques used, for example, some use additional 'supportive' techniques such as 'motivational interviewing' and education sessions
the target group, for example, people who are overweight and obese, people with raised blood pressure or cholesterol levels or those experiencing mild depression, anxiety or stress; or by age, gender, race or socioeconomic status
other scheme characteristics including: design, content and delivery; referral mechanisms; choice of activity; cost and qualifications of instructors; and whether it is commissioned and delivered by an NHS, non-NHS or community-based organisation.
5.2 What factors encourage uptake of, and adherence to, an exercise referral scheme? Factors to consider include: design, content and delivery; referral mechanisms; choice of activity; qualifications and cost of instructors. Also identify any barriers preventing participation and factors that encourage it.
5.3 What factors encourage under-represented groups to participate in and complete an exercise referral scheme? What factors prevent these groups from participating? Under-represented groups include: people from black and minority ethnic groups, people with disabilities and those from lower socioeconomic groups.
5.4 What is the comparative effectiveness and cost effectiveness of exercise referral schemes compared with other interventions that aim to help people to become more physically active? Relative effectiveness and cost effectiveness should be compared in controlled trials.
More detail identified during development of this guideline is provided in gaps in the evidence.