The ukactive Research Institute has called for the physical activity sector to share more evidence on exercise referral schemes in order to maximise their contribution to the NHS, and create further opportunities for collaboration.

Following the release of the NHS Long Term Plan, ukactive has published a research paper outlining development plans for the National Referral Database, a resource produced in collaboration with the National Centre for Sport and Exercise Medicine in Sheffield, and exercise referral specialists ReferAll.

The database is designed to collect evidence of the outcomes for patients both before and after their participation in an exercise referral scheme. Researchers believe it could hold the key to unlocking best practice – driving continuous improvement of the effectiveness of delivery.

The new proposal is supported by two pre-print papers on exercise referral, which show that the data currently available for analysis of schemes in the UK does not provide conclusive evidence of the consistent effectiveness of exercise referral schemes, due to its variability.

Though the findings show participation in exercise referral schemes is associated with changes in physical activity, health and wellbeing, the meaningfulness and impact of the changes are less clear.

The ukactive Research Institute is working to grow the National Referral Database by encouraging more schemes to share data. At present, the data represents only a small proportion of schemes and data from those taking part, with a limited range of outcomes and participant characteristics being collected.

By making the database an open resource and improving the quality of the data captured for exercise referral schemes, the ukactive Research Institute will encourage the wider academic community to access data for further research, provide greater contextualisation of the outcomes recorded with broader lifestyle behaviours, and allow policymakers and practitioners to put the findings into practice.

Led by ukactive Research Institute Principle Investigator Dr James Steele, the research team will continue to evaluate the data as it grows and as referral schemes evolve through the learnings of practitioners using it. The team will test the accuracy of each scheme in relation to its intended outcomes and provide feedback to improve effectiveness.

As evidence from new schemes such as Golf on Referral is uploaded to the database, the breadth of data will help to shape standards for quality.

ukactive has also partnered with the Social Prescribing Network to facilitate the inclusion of other referral pathways that incorporate physical activity and exercise, in order for the sector to learn from the effectiveness of other schemes.

ukactive CEO Steven Ward said: “The physical activity sector represents the preventative frontline of the NHS. We know for a fact that the UK is home to some fantastic exercise referral schemes that are having an incredible impact on the lives of those who need support to achieve improved health and happiness.

“Across the UK, I have met hundreds of people who have transformed their lives via referral programmes that have helped recovery from conditions such as strokes, cancer and heart attacks, and served to managed long-term conditions such as diabetes. This immense impact which is so evident at the individual level, is not currently seen in the aggregated data, and there is more that we must do as a sector to address this reality.

“Implemented correctly, exercise referral schemes have the potential to play a crucial role in supporting the NHS Long Term Plan, its focus on social prescribing and its shift toward prevention rather than cure. Our latest research shows there is a gap in the effectiveness of schemes, with a limited range of outcomes and participant characteristics being collected.

“The past is the past and a line must be drawn – if our sector wants to play its full role in our health and social care systems, it is time to take the effectiveness of our programmes to another level, with professional evidence-based processes that enable continuous improvement cycles which are the norm in other parts of the healthcare service.

“We look forward to working with key partners such as NHS England and Sport England to ensure this once-in-a-generation opportunity to embed prevention in frontline practice is not lost.”

Dr James Steele, Principal Investigator at the ukactive Research Institute, said: “We understand better than ever the efficacy of physical activity interventions, yet we still don’t know what works best with respect to wider public health interventions – we don’t really understand what is effective.

“Our research shows that further evidence is required in order to deepen our understanding about what makes some schemes appear more effective than others. It also highlights a lack of evidence around other possible benefits of physical activity, such as improved wellbeing and social connections.

“These findings herald the start of an incredibly exciting time for research in the physical activity sector, and I urge anyone practising exercise referral schemes to share your data with us to help improve all schemes.

“The opportunity for collaboration with key bodies such as the National Institute for Health and Care Excellence and the National Institute for Health Research is vast. That opportunity must now be taken, so we set off on the right foot for the NHS Long Term Plan’s ambitions.”

Prof Sir Muir Gray, an advisor to Public Health England, said: “The best exercise referral schemes provide a high-value service that helps people with chronic conditions to be more physically active, improving their health and wellbeing throughout life.

“We have strong evidence that physical activity can not only prevent disease but that it can also prevent disability, dementia and frailty in people who are already affected by disease. Exercise referral schemes can be a huge asset to the NHS and the preventative agenda, so we must do all we can to make sure we learn what makes them work well.

“Exercise prescription and referral should become as standardised as drug prescription and hospital referral – it is a lottery at present and that has to stop.”

Dr Ben Kelly, Head of Clinical Research and Outcomes at Nuffield Health, said: “Understanding the effectiveness of treatments is vital to improving referrals for individuals. Access to larger data sets is important to enable a better understanding of how exercise referrals can maximise their delivery.”

Exercise referral schemes were first introduced in the 1990s in primary care settings to facilitate exercise participation in those with chronic disease who were inactive. In 2014 the National Institute for Health and Care Excellence (NICE) made the recommendation that a system to collate local data on exercise referral schemes should be implemented for evaluation and to inform future practice. ReferAll, which provides a fast and efficient online referral pathway for exercise referral schemes, formed a partnership with ukactive in 2016 to address this.

Stuart Stokes, Commercial Director at ReferAll, said: “We have been at the forefront of collating and assessing data since 2010 and work with over 250 services. ReferAll’s customers are ideally placed to bring the evidence to the forefront and to celebrate the good work of schemes already in existence.”

Last year a systematic review of exercise referral schemes in the UK reported that these schemes may be effective and that longer schemes may be more so than shorter schemes.

If you are interested in learning more about the database, or are an exercise referral scheme provider that wants to contribute, please email: researchinstitute@ukactive.org.uk


For further reading: 

The National Referral Database: An initial overview https://osf.io/preprints/sportrxiv/rgywq/

The effect of exercise referral schemes upon health and wellbeing: Initial observational insights using individual patient data meta-analysis from The National Referral Database. https://osf.io/preprints/sportrxiv/yebmr/

Are exercise referral schemes associated with an increase in physical activity? Observational findings using individual patient data meta-analysis from The National Referral Database. https://osf.io/preprints/sportrxiv/ckdwn/

ukactive Research Institute and open science principles: https://www.ukactive.com/blog/towards-open-science-in-sport-exercise-and-physical-activity/