Why physical activity matters now more than ever

People with multi morbidities are often prescribed medication as the first line of treatment, because supporting lifestyle changes may be seen as more challenging within primary care.

For over 20 years, GPs have been referring patients with long-term conditions such as type 2 diabetes to an Exercise Referral Scheme (ERS), involving aerobics and strengthening along with less strenuous mindful activities like yoga. In addition, or instead, individuals could be referred to community support to find ways to become more physically active, depending on their needs.

Despite the obvious benefits for some people who are referred and engage in schemes, figures show that overall new ways are needed to improve patient uptake and adherence, since approximately three out of every 10 patients referred don’t ever turn up to meet the exercise professional, and less than half then complete the programme.

I recently led a UK-wide team to create a web-based support package (e-coachER) to complement the usual referral scheme in Plymouth (EveryOne Active), Birmingham (BeActive) and Glasgow (LiveActive) and to assess if it was more effective in supporting an increasing device-assessed physical activity over 12 months, than the exercise referral scheme alone. The team consisted of researchers, stakeholders involved in commissioning and delivering referral schemes, and patients with experience of schemes.

Half of the recruited 450 inactive participants with chronic physical and mental health conditions received the additional e-coachER support package, and half didn’t.

This is disappointing, but the findings reiterated just how challenging it is to support changes in physical activity among people with existing chronic conditions who are particularly inactive. 

Providing a basic pedometer to record daily steps, and access to a website explicitly designed to encourage self-monitoring and goal setting, and overcoming barriers to attending the referral scheme and broader physical activity, wasn’t sufficient to augment the usual exercise referral scheme in terms of total minutes of moderate and vigorous physical activity recorded with accurate monitors worn by participants 12 months later.

The five-year study was supported by the NIHR Applied Research Collaboration for the South West Peninsula (PenARC) and the Peninsula Clinical Trials Unit within the University of Plymouth. In Plymouth, the City Council subsidised attendance at the Life Centre and Brickfield for people from GPs surgeries in more economically challenged areas of the city to ensure the study didn’t contribute to health inequalities by only involving those who could afford to attend the gym.

At a time when we need to be taking all the pressure we can off the NHS, we need to know more about how best to support people to be more physically active in a sustainable way. The global epidemic called obesity, high prevalence of poor mental health and increasing health inequalities have been highlighted even more so during the COVID pandemic. Further ways are needed to support people in making important changes to manage their health – and finding other ways than those used in the present study needs to be a research priority.

The full study Randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial is available to view now in the British Journal of Sports Medicine (doi: 10.1136/bjsports-2020-103121).

The corresponding report for the NIHR, entitled Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER Randomised Controlled Trial, is available to view on the NIHR website and DOI.

This study was funded by the National Institute for Health Research (NIHR), Health Technology Assessment Programme (grant reference: 13/25/20). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.