What is this guideline about?

This guideline makes recommendations on exercise referral schemes to promote physical activity for people aged 19 and older.

NICE has already recommended structured exercise programmes to manage specific health conditions, or for rehabilitation after recovery from a specific condition (see box 1). These include stroke, cardiac and pulmonary rehabilitation programmes. They are outside the scope of this guideline.

Benefits of physical activity

Physical activity can play an important role in preventing and managing health conditions such as coronary heart disease, type 2 diabetes, stroke, mental health problems, musculoskeletal conditions and some cancers. It also has a positive effect on wellbeing and mood, providing a sense of achievement or relaxation and release from daily stress. (See Chief Medical Officers' Start active, stay active: report on physical activity from the UK.)

The benefits of physical activity are highlighted in a number of NICE guidelines (see the NICE topic page on physical activity).

Evidence on exercise referral

The evidence identified specifically looked at exercise referral schemes that try to increase physical activity. The studies included:

  • people who are sedentary or inactive

  • people who have an existing health condition (for example, coronary heart disease, diabetes or depression)

  • people who have other risk factors for disease, such as being overweight or obese, having raised blood pressure or cholesterol levels, or experiencing mild depression, anxiety or stress.

The evidence suggests that these exercise referral schemes have only a marginal added effect relative to other ways of increasing physical activity. (Examples of other approaches include: giving brief advice and providing information about local facilities and opportunities to be physically active.) The economic evaluation suggests that this added benefit was not likely to be a cost effective use of resources.

However the physical activity programmes offered as part of an exercise referral scheme – and the reasons why people are referred to them – vary considerably. NICE is unable to differentiate between the effectiveness or cost effectiveness of different types of scheme because there is little evidence of effectiveness for specific schemes or subgroups (see recommendations for research).

Other benefits of exercise referral schemes

Exercise referral schemes are popular, and they may offer other benefits aside from physical activity, such as helping people to socialise, providing a means of getting involved with the community and providing affordable access to facilities. However, although not excluded from the scope of this work, no evidence of the impact on these outcomes was identified in the evidence of effectiveness and cost effectiveness, so they were not captured in the economic model.

NICE is therefore unable to judge the effect of exercise referral schemes on these outcomes, compared with other interventions that seek to address the same issues.

Who is this guideline for?

The guideline is for primary care practitioners and policy makers, commissioners and other practitioners with physical activity as part of their remit working in local authorities and the NHS. In addition, it may be of relevance to providers of exercise referral schemes, organisations that provide exercise qualifications and accreditation and members of the public. (For further details, see who should take action?)