Physical activity: exercise referral schemes

Introduction

Increasing how much physical activity someone does can significantly improve both their physical and mental wellbeing and reduce illnesses and disease throughout life. It can also improve life expectancy.

For example, physical activity can help prevent and manage more than 20 conditions and diseases including coronary heart disease, some cancers, diabetes, musculoskeletal disorders, mild to moderate depression and obesity (Chief Medical Officers' Start active, stay active: report on physical activity from the UK). Evidence also indicates that being sedentary is an independent risk factor for certain diseases such as coronary heart disease and type 2 diabetes, even when achieving the recommended physical activity levels (Lee et al. 2012).

Most adults in England do not meet the national recommended levels of physical activity. In 2008, based on self-reporting, 39% of men and 29% of women aged 16 and older met the recommended minimum (Health and Social Care Information Centre Health Survey for England 2008: physical activity and fitness).

In 2013, the Health and Social Care Information Centre's Health Survey for England (population chapter) re-analysed the 2008 data using the revised national recommendations published in 2011 (see 'National guidelines, resources and indicators' below). It estimated that 65% to 66% of men and 53% to 56% of women were meeting the new recommendations in 2008 – and probably continued to do so up to 2012.

Physical activity levels vary according to income, gender, age, ethnicity and disability. Generally, women are less active than men and people tend to be less active as they get older. Leisure time physical activity levels are also lower among certain minority ethnic groups, people from lower socioeconomic groups and people with disabilities (Chief Medical Officers' Start active, stay active: report on physical activity from the UK).

During 2007/08, an estimated 300 million consultations took place with primary care practitioners, with the average patient attending 5.4 consultations (Trends in consultation rates in general practice: 1995/1996 to 2008/2009: analysis of the QRESEARCH database). Every consultation provides an opportunity to promote physical activity (Boyce et al. 2008).

Lack of physical activity: the costs

Public Health England's health impact of physical inactivity estimates that low levels of physically activity could be the cause of up to 36,815 premature deaths in England a year.

In 2006/07, physical inactivity cost the NHS an estimated £0.9 billion, based on the occurrence of diseases that can be prevented by being physically active (Scarborough et al. 2011). This is a conservative estimate because other health problems, such as osteoporosis and poor mental health, can also be exacerbated by a lack of exercise. There are also wider economic costs, for example sickness absence from work, estimated at £5.5 billion per year.

In 2008, the Department of Health's be active, be healthy estimated that the average cost of physical inactivity for every primary care trust in England was £5 million.

National guidelines, resources and indicators

In 2001, the Department of Health's national quality assurance framework for exercise referral was developed. It focuses primarily on schemes that take place in leisure centres or gyms and involve supervised exercise programmes. This framework aimed to improve existing schemes and help develop new ones. It is currently being updated.

In 2010, the British Heart Foundation National Centre for Physical Activity and Health exercise referral toolkit advised how exercise referral schemes could be designed, implemented and evaluated.

In 2011, the Chief Medical Officers of England, Scotland, Wales and Northern Ireland issued joint UK physical activity guidelines for people of all ages (Chief Medical Officers' Start active, stay active: report on physical activity from the UK).

For adults, the guidelines recommend being active daily and accumulating at least 150 minutes of moderate-intensity activity, or 75 minutes of vigorous activity, in bouts of 10 minutes or more during each week. The guidelines also recommend avoiding being sedentary for prolonged periods (such as sitting for long periods of time). There are additional recommendations on strength for all groups, and to help improve balance among older people.

To help achieve the recommendations, the Department of Health's Let's get moving physical activity care pathway is a systematic approach to identifying and supporting adults who are not currently meeting the national recommended level of physical activity.

The revised Department of Health Public health outcomes framework for England, 2013 to 2016 also highlights the importance of encouraging physical activity and reducing sedentary behaviour (see domain 2).