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Systematic Review
"This systematic review aimed to re-assess the evidence for Exercise Referral Schemes in order to determine clinical effectiveness and estimate cost effectiveness using a previously developed Markov model."
"The authors identified eight randomised controlled trials to be included in the review. The total number of participants in all eight studies was 5190. One additional primary study was included (4 publications), a mixed methods evaluation, incorporating RCT and qualitative evidence, undertaken in Wales in the UK, 2160 participants. Referral to exercise referral schemes was in most instances made by the GP. In four of the studies, referral was made due to an individual’s health risk that could be attenuated by increased levels of physical activity, most commonly risk of coronary heart disease. In the other four studies, patients were referred on the basis of being sedentary.
The most consistently reported PA outcome across studies was the proportion of individual achieving 90-150 minutes of at least moderate-intensity activity per week. When pooled across studies the relative risk was RR 1.12 (95%CI 1.04 to 1.20) of achieving this outcome with ERS compared with usual care at 6-12 months follow-up. In the pooled ITT analyses, the proportion achieving the PA threshold in the ERS group compared with usual care was RR 1.08 (95%CI 1.00 to 1.17). When total minutes of physical activity data were pooled, there was a significant increase in the number of minutes of physical activity per week in the ERS group; mean difference 55.10 (95% CI 18.47 to 91.73).
In terms of cost-effectiveness, exercise referral gained 0.003 quality adjusted life years (QALYs) at an additional cost of £225 per person. The estimate for the mean incremental cost effectiveness ratio (ICER) in the probabilistic sensitivity analysis was £76,276."
"There is evidence that ERS schemes can lead to improvements in self reported levels of physical activity when compared to receiving advice only. Increasing age is a factor that appears to support uptake and adherence to ERS, as does a greater level of physical activity at baseline. There is some evidence that for patients referred with CHD risk factors, there is more likelihood of increases in levels of physical activity. It is not possible to identify what elements of the intervention support successful uptake of ERS, adherence to ERS and long term behaviour change. Qualitative evidence suggests that interventions which enable the development of social support networks might be beneficial in promoting adherence and long term improvements in levels of physical activity.
Our analysis indicates that the ICER for ERS compared to usual care is around £76,000 per QALY, although the cost-effectiveness of ERS is subject to considerable uncertainty and is particularly sensitive to the assumptions made regarding the effectiveness ERS in increasing physical activity and the size and duration of process utility gains."