Making exercise referral schemes more ‘clinically meaningful’

by Stuart Stokes on January 22, 2020

Peer reviewed evidence, recently published in the Journal of Epidemiology and Community Health, stated the benefits of exercise referral schemes (EOR) is not as large as hoped and concluded that UK roll-out needs to be rethought, to maximise effectiveness.

The report drew on data from 23,731 active participants in 13 different six-week to three-month schemes. It looked at measurements including BMI, BP, resting heart rate and internationally validated mental health and wellbeing scores, recorded at the beginning and end of schemes.

Despite analysis revealing statistically significant improvements in most of the measures, when these figures were compared with thresholds for clinical meaningfulness, the size of changes was small, meaning their impact is unclear. The researchers called for more real-world data to better understand how to maximise EoR schemes.

 In a bid to achieve this, in partnership with the ukactive Research Institute and the National Centre for Sport and Exercise Medicine Sheffield, we’re working to acquire funding to grow and develop the National Referral Database, powered by ReferAll, and improve the quality of data captured. This will produce an open and transparent resource for researchers to better evaluate EOR schemes.

But how, as an EOR provider, can you ensure you’re producing ‘meaningful’ results? As the researchers pointed out, the issue isn’t solely a lack of data – this was the largest study in the world to date – it is also that EOR schemes still aren’t consistently recruiting the right people.

If we go back to basics, EOR is designed to increase activity levels; this is how ‘success’ is measured. Therefore, to get meaningful results, schemes need to appropriately assess patients and only recruit those who are genuinely inactive.

If a person who doesn’t meet inclusion criteria for EOR takes up the offer, not only are you potentially undermining the impact of your service you are also losing a place for someone who is more appropriate.

A key issue with last years’ report was that people surveyed were, on aggregate, already ‘moderately active’ when they entered an EOR scheme. Although they became more active, this change was not seen as positive as they started from an already active point. In order to get those sought-after ‘clinically meaningful’ results, operators need to reconsider inclusion criteria and further tighten up the access to EOR – considering not just current activity levels but also the patient’s desire to change. 

Don’t feel obliged to take inappropriate people simply because they have been referred. Be strict about pre-screening. Consider deploying a standardised questionnaire at pre-screening stage, for example, IPAQ or Physical Activity Single Item Measure. Bearing in mind these can be self-completed you may wish to consider asking questions alongside these about sleeping and dietary patterns and even wellbeing scores. Being inactive has a significant effect on all these areas of our health. Your aim is to move people from an inactive status to an active one. Only then can you collect the right type of data to demonstrably prove that EOR works.

It’s never black and white; I know there are anomalies, but if you’re saying your scheme is going to significantly improve activity levels and people are already active, you just won’t get the results.

It’s what goes in that matters. Who you select will, quite literally, determine the success or failure of your EOR scheme, funding for future schemes and, further down the line, the results of future studies such as these.

Topics: Referral Schemes