Physical activity: exercise referral schemes

Search and selection strategy

We searched for new evidence related to the whole guideline.

We found 3 studies in a search for randomised controlled trials, systematic reviews and qualitative studies published between 1 October 2013 and 6 March 2018.

We also included 2 studies identified in comments received during consultation on the 2018 surveillance decision.

From all sources, we considered 5 studies to be relevant to the guideline.

See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.

Views of topic experts

We sent questionnaires to 14 topic experts and received 6 responses. The topic experts participated in the guideline committee who developed the guideline.

Four of the topic experts felt that the guideline is in need of an update, while 2 did not. Some of the areas for update included emerging evidence on social prescribing interventions, which often include an element of exercise referral. Another factor was a concern that the wording of the recommendations may be open for misinterpretation, resulting in the commissioning of exercise referral schemes for inactive but otherwise healthy people, which is not recommended in the guideline.

See appendix A: summary of evidence from surveillance for details of how these concerns have been addressed.

Views of stakeholders

Stakeholders are consulted on all surveillance decisions except if the whole guideline will be updated and replaced. Because this surveillance decision was to not update the guideline, we consulted on the decision.

Overall, 6 stakeholders commented. Two organisations agreed with the decision, 2 organisations disagreed and 2 organisations noted that they had no comments to make on the proposal. A concern was raised around the lack of recommendations on the required length of an exercise referral scheme, with suggestions made of further evidence in this area. The research highlighted during consultation have either been previously considered during original guideline development or are not yet published. We have added the ongoing research onto our event tracker and will review this area once the results have been made available. The guideline also recognises the need for further evidence that compares exercise referral schemes that vary by intensity and duration (see research recommendation 5.1).

A concern was raised around the barriers to uptake and adherence of exercise referral schemes and how the guideline could be more specific in this area. We acknowledge that evidence has emerged in this area since the guideline was published, see appendix A. However, after careful consideration of the findings, it was concluded that the barriers identified are adequately covered by the recommendations in both NICE guideline PH54 and NICE's guideline on behaviour change: individual approaches, therefore no impact on the guideline is expected. In addition, the consultee also highlighted that exercise referral schemes may not be a suitable option for people with multiple conditions and that the guideline should specify this. Whilst we acknowledge that exercise referral schemes may not be suitable for all groups, it is expected that by taking into account individual needs and monitoring progress, as set out in recommendation 2, clinicians and professionals would recognise any issues and consider alternative options accordingly. Therefore it is unlikely that the guideline will be impacted.

See appendix B for full details of stakeholders' comments and our responses.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

Equalities

No equalities issues were identified during the surveillance process.

Editorial amendments

During surveillance of the guideline we identified the following points in the guideline that should be amended: