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GP exercise referral 'no better than walking'

There is no convincing evidence that exercise referral schemes are effective and the NHS should consider scrapping them, a new study concludes.

The large Health Technology Assessment meta-analysis found ‘considerable uncertainty' as to the effectiveness of exercise referral schemes for increasing physical activity, fitness or health outcomes.

There was also no clear evidence they were an efficient use of resources in people with or without a medical diagnosis, and the ‘uncertain' impact of the schemes provide a case for ‘disinvestment', researchers concluded.

Referral schemes did increase the chance of patients doing the recommended weekly exercise by 16% and reduced risk of depression by 18%, but there no difference in rates of other clinical outcomes between the exercise referral and control groups.

Dr Toby Pavey, study leader and associate research fellow at Peninsula College of Medicine and Dentistry, said: ‘Our study does not question the importance of physical activity for good health - what it does do is question the effectiveness of the exercise referral programme as it is delivered at present.'

‘It is clear that with increasing pressure on NHS budgets and changes to the way in which services are commissioned as part of current NHS reforms, more work needs to be done to establish how existing referral programmes may be made more effective and who should they be targeted towards.'

One apparent drawback of the programmes – usually a 10-12 week course based in a local gym or sports centre – was a failure to properly address long-term behaviour change.

Yet, writing in the British Medical Journal, the researchers argued strategies to improve physical exercise rates were still needed in primary care – especially for those with pre-existing medical conditions.

But it is unclear whether better targeting or alternative schemes would prove more effective, they said.

The evidence exercise referral schemes were any better than basic advice was found to be weak and there was no difference between taking part in an exercise referral scheme or other physical activity promotion intervention such as a walking programme.

BMJ 2011 online 7 November

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