Guidance

Recommendations

Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Definition

Exercise referral schemes seek to increase someone's physical activity levels on the basis that physical activity has a range of positive health benefits. In this guideline, exercise referral schemes consist of all the following components:

  • An assessment involving a primary care or allied health professional to determine that someone is sedentary or inactive, that is, they are not meeting current UK physical activity guidelines. (See Chief Medical Officers' Start active, stay active: report on physical activity from the UK.)

  • A referral by a primary care or allied health professional to a physical activity specialist or service.

  • A personal assessment involving a physical activity specialist or service to determine what programme of physical activity to recommend for their specific needs.

  • An opportunity to participate in a physical activity programme.

Some schemes also review participants' progress at completion of the scheme.

This guideline does not cover structured exercise programmes designed for managing a specific health condition or for rehabilitation following recovery from a specific condition. This includes cancer, cardiac and pulmonary rehabilitation programmes (See box 1.)

Exercise referral for people who are sedentary or inactive but otherwise healthy

Recommendation 1

Policy makers and commissioners should not fund exercise referral schemes for people who are sedentary or inactive but otherwise apparently healthy.

Primary care practitioners should not refer people who are sedentary or inactive, but otherwise apparently healthy, to exercise referral schemes.

Exercise referral for people who are sedentary or inactive and have a health condition or other health risk factors

Recommendation 2

Policy makers and commissioners should only fund exercise referral schemes for people who are sedentary or inactive and have existing health conditions or other factors that put them at increased risk of ill health (such as risk factors for coronary heart disease, stroke or type 2 diabetes) if the scheme:

  • Incorporates the core techniques outlined in recommendations 7 to 10 of NICE's guideline on behaviour change: individual approaches. This includes:

    • recognising when people may or may not be more open to change (recommendations 8 and 9)

    • agreeing goals and developing action plans to help change behaviour (recommendation 7)

    • advising on and arranging social support (recommendations 7 and 10)

    • tailoring behaviour change techniques and interventions to individual need (see recommendation 8)

    • monitoring progress and providing feedback (recommendations 7 and 10)

    • developing coping plans to prevent relapse (recommendations 7 and 8).

  • Collects data in line with the 'essential criteria' outlined in Public Health England's standard evaluation framework for physical activity interventions. Specifically: programme details, evaluation details, demographics of individual participants, baseline data, follow-up data (impact evaluation) and process evaluation.

  • Makes the data collected available for analysis, monitoring and research to inform future practice.

Primary care practitioners should only refer people who are sedentary or inactive and have existing health conditions or other factors that put them at increased risk of ill health (such as risk factors for coronary heart disease, stroke or type 2 diabetes) to an exercise referral scheme if it conforms to the above criteria.

Collating and sharing data on exercise referral schemes

Recommendation 3

This recommendation has been withdrawn. Please see update information for more details.

Other NICE guidance to refer to

Box 1 The role of structured exercise programmes in the management of, and rehabilitation following, a health condition

NICE recommends structured exercise programmes tailored to individual need to manage, and for rehabilitation after, certain health conditions. For examples, see the:

These structured exercise programmes vary in format, the mechanism of referral and content. They include components such as phase 3 and phase 4 rehabilitation activities and structured, tailored and supervised activities delivered by a specialist physical activity and exercise instructor (trained to level 4). They are outside the scope of this guideline.

Box 2 The importance of physical activity in promoting good health and preventing disease

NICE endorses the importance of physical activity as a way to promote good health and prevent disease. We have developed guidelines on physical activity for policy makers, commissioners and practitioners with a remit for increasing physical activity levels. These include:

The absence of NICE guidelines on other physical activity interventions is because they have not been considered by NICE. It does not reflect a judgement on their effectiveness or cost effectiveness.