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Over 55s more likely to complete exercise on referral

Older patients and those with heart problems are more likely to take up and complete exercise on referral programs than younger or obese patients.

Researchers from the UK's University of Northumbria in Newcastle upon Tyne presented these findings at the British Science Festival in Newcastle this week and reported them in a recent BMJ Open paper.

Their observational study covered over 2,000 patients referred to exercise schemes in the UK and found older age was a strong predictor of take up and adherence, as was the site where the scheme took place, whereas obesity was a significant negative predictor.

The researchers also say that while those who completed their 6-month schemes reported significant changes in self- reported physical activity, the levels achieved were well below the UK recommendations for 150 minutes of moderate physical activity per week.

Exercise on referral
Research shows that patients over the age of 55 are more likely to adhere to exercise schemes recommended by GPs.

Exercise on referral schemes have been widely used in the UK since they were launched in the 1990s. Patients are referred to them from primary and secondary care.

They were set up because, while we know regular physical activity is good for health and reduces risk of conditions like stroke that can lead to early death, less than 40% of men and 30% of women in England do enough to benefit their health, say the study investigators.

Health professionals use the scheme to encourage patients with mental and physical health concerns, such as weight, cardiovascular and musculoskeletal conditions, to take up exercise as part of their treatment plan.

A typical example is where a General Practitioner (GP) refers patients to a local leisure facility or gym and fitness center, where they consult with an exercise specialist and then follow a program of supervised physical activity for about 10 or 12 weeks.

Dr. David Shovlin, a GP at Burn Brae Medical Group in Northumberland, UK, refers some of his patients to such a scheme. He told the press:

"Regular exercise is known to both prevent and improve control in a number of long-term conditions, notably hypertension and type 2 diabetes. It is a useful way to motivate patients initially to become more active, leading to improvements in the management of their condition and reduced need for medication."

Richard Ripley, a 65-year-old patient from Cramlington, Northumberland, was referred to such a scheme to help treat his type 2 diabetes.

He says he doubled his attendance at the gym after being referred on the scheme, and over a year later, is still going there regularly.

After being diagnosed with angina, he added an extra visit a week to his gym workouts, as he explains:

"Finding out that I have angina was quite a shock and it has encouraged me to start an extra Friday session at the gym in September. The longer you attend, the better you get at the various activities which spurs you on to do even more. It definitely gives you a new outlook on life and I fully intend to keep my activity levels up."

Long-term benefits not clear

The study was commissioned because it is not clear how many patients who participate in such schemes actually change their activity levels in the longer term, particularly given many of them only last 12 weeks. Is Richard a typical example, or an exception?

Study leader Coral Hanson, who is working toward her PhD at Northumbria, is also lead for exercise on referral in Northumberland. She says:

"We found that there was little insight into the activity levels associated with exercise on referral schemes. Additionally, of the research in existence, the majority of it took place over just 3 months and it is widely understood that it can take up to 6 months to establish behavioural change."

The study results

The study investigated 2,233 patients who took part in exercise on referral schemes across Northumberland. The schemes lasted for 24 weeks and took place at nine local authority leisure sites. The patients were referred from primary and secondary care between July 2009 and September 2010.

Although 81% of patients referred to the schemes took part, only 53.5% completed 12 weeks and 42.9% completed the full 24 weeks of supervised activity.

Participants who completed the full 24 weeks significantly increased their self-reported levels of exercise after 24 weeks. Those who completed the full program attended an average of 23 out of 48 target supervised sessions.

Increasing age, being female and leisure site were linked to uptake, and increasing age and leisure site were also among the variables linked to adherence at 12 weeks.

Hanson says their study offers "more robust findings that can be used by healthcare professionals to adapt their schemes and ultimately deliver more effective programs."

Dr. Shovlin says the findings should help reduce the waste that results from unused appointments and tailor schemes to give better results for patients:

"This research shows that people who complete the Exercise on Referral programme are more likely to engage in physical activity in the medium term. Additionally, getting a better understanding of which patients are more likely to drop out will make it possible to identify reasons for non-completion and explore alternative ways of helping those individuals to increase their activity levels."

In another US study published recently, researchers found that every minute of minute of brisk exercise counts in the war against weight gain. This is in contrast to recommendations that state bouts of exercise have to last at least 10 minutes to have such an effect.

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