GP referrals for exercise could benefit cardiovascular patients, finds study

New research published by the National Institute for Health Research’s Health Technology Assessment (NIHR HTA) programme suggests that GP referral for exercise classes, community-based walking, and advice on increasing physical activity may be equally effective methods to help people at risk of cardiovascular disease to improve their levels of physical activity in the short term.

The clinical trial compared the effectiveness of a leisure centre-based exercise programme, an instructor-led walking programme and advice only, in patients referred for exercise by their GPs.

“Exercise helps to reduce the risk of cardiovascular disease, but seven out of 10 adults in the UK do not take enough regular physical activity,” says lead researcher Dr Anthony Isaacs. “Primary care is an important setting for encouraging people to exercise more. Exercise referral schemes, also known as exercise on prescription, have been developed to address this issue and are increasingly popular, but they have not been extensively evaluated.”

Researchers used a large local exercise referral scheme in London as the setting for the trial. The research included 943 patients aged between 40 and 74 who were not currently physically active and were identified as “at risk” of cardiovascular disease. Patients were referred by their
GP to be assessed at a local leisure centre and were then randomly allocated to one of three groups: a leisure centre-based exercise programme, an instructor-led walking programme, or provision of advice only in the form of tailored advice and information about physical activity, including information on local exercise facilities.

Patients were assessed for changes in self-reported exercise behaviour, blood pressure and cholesterol levels, and the costs of providing and making use of the services were measured for economic evaluation.

Following up after 10 weeks and six months, the researchers found that all three study groups had increased their levels of activity, and blood pressure and cholesterol levels were reduced. However, there was no significant difference between groups.

The researchers concluded that, on cost-effectiveness grounds, referral for advice, supported by written materials that include details of locally available facilities, may be the most appropriate method to initiate action in the first instance.

The Exercise Evaluation Randomised Trial (EXERT) is published in Health Technology Assessment Vol 11.10. To download the full report visit www.hta.ac.uk/project.asp?PjtId=1032