Guidance
The evidence
Findings of the evidence reviews and economic modelling
The evidence that the PHAC considered included:
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Evidence reviews:
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Review 1: a systematic review and economic evaluation of exercise referral schemes in primary care: a short report was commissioned by the National Institute for Health Research Health Technology Appraisal programme (NIHR HTA). It was carried out by The University of Sheffield, School of Health and Related Research (ScHARR). The principal authors were: Fiona Campbell, Mike Holmes, Emma Everson-Hock E, Sarah Davis, Helen Buckley Woods, Nana Anokye, Paul Tappenden and Eva Kaltenthaler.
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Review 2: the factors that influence referral to, attendance at and successful completion of exercise schemes and longer term participation in physical activity was carried out by the Support Unit for Research Evidence (SURE), Cardiff University. The principal authors were: Fiona Morgan, Ruth Turley, Helen Morgan, Lydia Searchfield, Alison Weightman, Eva Elliot and Simon Murphy.
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Economic modelling: review 1 contains the economic modelling.
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Fieldwork report: field testing NICE guideline on exercise referral schemes to promote physical activity was carried out by Word of Mouth.
In some cases, the evidence was insufficient and the PHAC has made recommendations for research. See also the gaps in the evidence.
Fieldwork findings
Fieldwork aimed to test the relevance, usefulness and feasibility of putting the recommendations into practice. The PHAC considered the findings when developing the final recommendations. For details, see the section on fieldwork in section 8 and fieldwork report: field testing in the NICE guideline on exercise referral schemes to promote physical activity.
Fieldwork participants who have responsibility for commissioning, referring to and developing, managing and delivering exercise referral schemes found the draft guideline unclear and unhelpful. They believed that it would be used to justify existing practice (whether that meant continuing to commission or continuing not to commission exercise referral schemes).
Participants were also concerned that the draft recommendations could undermine physical activity promotion, as they seemed to imply that all exercise referral schemes are ineffective and that any advice on physical activity is not valued by NICE.
In addition, participants felt that the draft recommendations may increase inequalities in health, as many schemes focus on overcoming social isolation and improving people's general participation in the local community, rather than on physical activity alone.
They did not think brief advice to promote physical activity in primary care could replace exercise referrals. This was because primary care professionals do not feel they have the capacity or capability to deliver this advice. In addition, participants said they lack the incentive and belief in the value of promoting physical activity.
Participants were also concerned about the evidence base used to inform the recommendations. It was felt that the NICE process meant that evidence generated by their own schemes was excluded.
Finally, they did not feel that the guideline reflected the ways in which exercise referral schemes are currently commissioned and delivered: exercise referral schemes, they said, are part of a 'physical activity pathway' and, as such, should not be considered a standalone intervention.