Author ' s response to reviews Title : Who stays , who drops out ? Biosocial predictors of adherence in participants attending a longer term exercise referral scheme in the UK (original) (raw)
Related papers
BMC Public Health, 2012
Background: Exercise referral schemes are one of the most popular forms of physical activity intervention in primary care in the UK and present an opportunity to better understand the factors related to exercise adherence. But standard schemes tend to be delivered over a short period and so provide information about the factors associated with short-term adherence. This retrospective register-based study of a longer-duration scheme allowed investigation of longer-term adherence. Methods: Social, physiological and anthropometric data were extracted from records of a cohort of ERS participants who had enrolled between 01 January and 31 December 2007 (n = 701). Characteristics of adherers and non-adherers were compared and potential predictors of longer-term adherence examined using binomial logistic regression. Results: Significant adjusted odds ratios predicting longer-term adherence were found for age and medical condition. For every 10 year increase in age, the odds of people continuing exercise increased by 21.8% (OR = 1.02; CI = 1.00 to 1.04; p = 0.03). Participants referred with orthopaedic (OR = 0.25; CI = 0.07-0.94; p = 0.04), cardiovascular (OR = 0.18; CI = 0.05-0.70; p = 0.01) and other (OR = 0.20; CI = 0.04-0.93; p = 0.04) problems had significantly lower odds of adhering than those with metabolic conditions. Conclusion: Improved understanding of the factors that influence adherence to exercise referral schemes will enable providers develop better referral guidance and tailor schemes to better meet participants' needs. Longer-term schemes offer the opportunity to understand participants' likelihood of maintaining adherence to exercise.
BMC Public Health, 2016
Background: Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS) continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE) on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Methods: Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were 'inactive' (i.e. they are not currently meeting UK physical activity guidelines). Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement). Results: Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and 'making exercise a habit' post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a dislike of the music and TV and a lack of confidence in operating gym equipment were frequently reported. Conclusions: These findings provide valuable insights that commissioners and providers should consider. The main themes were consistent across a large number of studies and further research should concentrate on programmes that reflect these findings.
Journal of public health (Oxford, England), 2016
Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout. ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors. Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P < 0.001) with dropouts being significantly younger (P < 0.001). Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29-1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25-1.73). Increasing age (OR = 0.98, 95% CI: 0.98-0.99), drinking alcohol (OR = 0.82, 95% ...
Journal of Physical Activity and Health, 2019
Background: Exercise referral schemes (ERS) are prescribed programs to tackle physical inactivity and associated noncommunicable disease. Inconsistencies in reporting, recording, and delivering ERS make it challenging to identify what works, why, and for whom. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this narrative review of reviews. Electronic databases were searched for systematic reviews of ERS. Inclusion criteria and quality assessed through A Measurement Tool to Assess Systematic Reviews (AMSTAR). Data on uptake, attendance, and adherence were extracted. Results: Eleven reviews met inclusion criteria. AMSTAR quality was medium. Uptake ranged between 35% and 81%. Groups more likely to take up ERS included (1) females and (2) older adults. Attendance ranged from 12% to 49%. Men were more likely to attend ERS. Effect of medical diagnosis upon uptake and attendance was inconsistent. Exercises prescribed were unreported; therefore, adherence...
Scandinavian Journal of Medicine & Science in Sports, 2019
This paper aimed to systematically review the evidence base to uncover the key psychosocial factors that underpin adherence to an exercise referral scheme (ERS). Databases PsycINFO, MEDLINE, SPORTDiscus, Web of Science, PubMed, PsycARTICLES, Open Grey, and PsycEXTRA were systematically searched. A parallel results-based convergent synthesis was performed by identifying key themes from quantitative and qualitative studies separately. After applying inclusion and exclusion criteria, the review included 24 eligible studies. Key findings showed intrinsic motivation, psychological need satisfaction, social support, and self-efficacy to be the prominent psychosocial factors associated with ERS adherence. In addition, lower expectations for change when entering the scheme was associated with ERS adherence. This review should serve as a catalyst to provide evidence-based ERS and as such ERS providers should seek to place an emphasis on participants' expectations and beliefs when entering the scheme. Moreover, targeting the key factors of intrinsic motivation, psychological need satisfaction, social support, and self-efficacy throughout the duration of an ERS should serve to facilitate adherence.
2019
Background: Exercise referral schemes (ERSs) within clinical populations offer inactive individuals the opportunity to increase physical activity levels over the length of scheme. Schemes are also intended to support the treatment of specific health conditions of medically referred individuals through increased physical activity behaviours. The extant literature concerning the impact of exercise referral on physical activity levels is inconsistent. It is of interest researchers, policy makers, commissioners and practitioners to to consider broadly whether meaningful change in physical activity levels are observed in people who undergo exercise referral, to identify potential effective policy actions in supporting active living. Purpose: To examine if ERSs increase physical activity levels in a large cohort of individuals throughout England, Scotland and Wales from The National Referral Database. Method: Data were obtained from 5246 participants from 12 different referral schemes. Av...
Objective: While an increasing number of randomised controlled trials report impacts of exercise referral schemes (ERS) on physical activity, few have investigated the mechanisms through which increases in physical activity are produced. This study examines whether a National Exercise Referral Scheme (NERS) in Wales is associated with improvements in autonomous motivation, self-efficacy and social support, and whether change in physical activity is mediated by change in these psychosocial processes. Methods: A pragmatic randomised controlled trial of NERS across 12 LHBs in Wales. Questionnaires measured demographic data and physical activity at baseline. Participants (N = 2160) with depression, anxiety or CHD risk factors were referred by health professionals and randomly assigned to control or intervention. At six months psychological process measures were collected by questionnaire. At 12 months physical activity was assessed by 7 Day PAR telephone interview. Regressions tested intervention effects on psychosocial variables, physical activity before and after adjusting for mediators and socio demographic patterning.
Objective: While an increasing number of randomised controlled trials report impacts of exercise referral schemes (ERS) on physical activity, few have investigated the mechanisms through which increases in physical activity are produced. This study examines whether a National Exercise Referral Scheme (NERS) in Wales is associated with improvements in autonomous motivation, self-efficacy and social support, and whether change in physical activity is mediated by change in these psychosocial processes. Methods: A pragmatic randomised controlled trial of NERS across 12 LHBs in Wales. Questionnaires measured demographic data and physical activity at baseline. Participants (N = 2160) with depression, anxiety or CHD risk factors were referred by health professionals and randomly assigned to control or intervention. At six months psychological process measures were collected by questionnaire. At 12 months physical activity was assessed by 7 Day PAR telephone interview. Regressions tested intervention effects on psychosocial variables, physical activity before and after adjusting for mediators and socio demographic patterning.
Audit of Exercise Referral Scheme activityin Scotland March 2010
2010
The opinions expressed in this publication are those of the author/s and do not necessarily reflect those of NHS Health Scotland. Background Although current guidelines recommend that healthy levels of activity are 30 minutes per day for adults and 1 hour per day for children and young people, there are concerns that these levels are not being met by large numbers of people in Scotland and that greater numbers of sedentary people are found in the lower socioeconomic groups. Research has also found general inequalities in health related to income levels, with higher clusters of ill health within disadvantaged or deprived communities. 'Let's Make Scotland More Active' was published in 2003 by the then Scottish Executive and sets out the recommendations for increasing levels of physical activity within the population. Exercise referral schemes (ERS) aim to increase participation in physical activity and, more specifically, aim to treat or prevent ill health in individuals w...