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Cited by 740Physical Activity and HealthCardiovascular and exercise physiologyBehavioral Health and Interventions

Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials

Open access
Orrow, G., Kinmonth, A.-L., Sanderson, S., Sutton, S.·2012·BMJ
DOI 10.1136/bmj.e1389PMC PMC3312793
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Abstract

OBJECTIVES: To determine whether trials of physical activity promotion based in primary care show sustained effects on physical activity or fitness in sedentary adults, and whether exercise referral interventions are more effective than other interventions. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, CINAHL, PsycINFO, EMBASE, SPORTDiscus, Centre for Reviews and Dissemination, the Cochrane Library, and article reference lists. REVIEW METHODS: Review of randomised controlled trials of physical activity promotion in sedentary adults recruited in primary care, with minimum follow-up of 12 months, reporting physical activity or fitness (or both) as outcomes, and using intention to treat analyses. Two reviewers independently assessed studies for inclusion, appraised risk of bias, and extracted data. Pooled effect sizes were calculated using a random effects model. RESULTS: We included 15 trials (n=8745). Most interventions took place in primary care, included health professionals in delivery, and involved advice or counselling given face to face or by phone (or both) on multiple occasions. Only three trials investigated exercise referral. In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months (odds ratio 1.42, 95% confidence interval 1.17 to 1.73; standardised mean difference 0.25, 0.11 to 0.38). The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (7 to 33). In four trials reporting cardiorespiratory fitness, a medium positive effect at 12 months was non-significant (standardised mean difference 0.51, -0.18 to 1.20). Three trials of exercise referral found small non-significant effects on self reported physical activity at 12 months (odds ratio 1.38; 0.98 to 1.95; standardised mean difference 0.20, -0.21 to 0.61). CONCLUSIONS: Promotion of physical activity to sedentary adults recruited in primary care significantly increases physical activity levels at 12 months, as measured by self report. We found insufficient evidence to recommend exercise referral schemes over advice or counselling interventions. Primary care commissioners should consider these findings while awaiting further trial evaluation of exercise referral schemes and other primary care interventions, with longer follow-up and use of objective measures of outcome.

AI snapshot

Written from the paper’s full text.

TL;DR

Physical activity promotion based in primary care for sedentary adults produced small to medium improvements in self-reported physical activity at 12 months, with a number needed to treat of 12 for one additional adult to meet recommended activity levels. Evidence was insufficient to show that exercise referral schemes are more effective than advice or counselling.

Key findings

  • In 15 trials (n=8745), pooled analysis of 13 trials reporting self-reported physical activity at 12 months found small to medium positive effects: odds ratio 1.42 (95% CI 1.17 to 1.73); standardised mean difference 0.25 (0.11 to 0.38); number needed to treat 12 (7 to 33).
  • Four trials reporting cardiorespiratory fitness found a medium but non-significant pooled effect at 12 months: standardised mean difference 0.51 (−0.18 to 1.20); only one study reported objective physical activity and found no significant effect (−0.04, −0.16 to 0.08).
  • Three exercise referral trials found small non-significant effects on self-reported physical activity at 12 months: odds ratio 1.38 (0.98 to 1.95); standardised mean difference 0.20 (−0.21 to 0.61).
  • Subgroup analysis found larger effects in trials with no-intervention controls (OR 1.74, 1.39 to 2.18; SMD 0.36, 0.28 to 0.43) than with comparator controls (OR 1.18, 0.95 to 1.48; SMD −0.03, −0.17 to 0.11), with significant differences between these sets.

Methods

  • Systematic review and meta-analysis of randomised controlled trials of physical activity promotion in sedentary adults aged 16 years or over recruited through primary care, with minimum 12 months’ follow-up, reporting physical activity or fitness, and using intention-to-treat analyses.
  • Searched Medline, CINAHL, PsycINFO, EMBASE, SPORTDiscus, Centre for Reviews and Dissemination, and the Cochrane Library (May 2009; repeated May 2010), plus reference lists and expert check; two reviewers independently assessed inclusion, risk of bias, and extracted data.
  • Pooled effect sizes used a random effects model; odds ratios and standardised mean differences with 95% confidence intervals were calculated, with I² used to assess heterogeneity and a formula used to calculate number needed to treat.

Limitations

  • The paper states that most included trials used self-reported physical activity as the main outcome, which is susceptible to differential social desirability bias and lacks precision; few trials used objective measures.
  • The paper states that intervention content was often poorly reported, participants were mostly white with socioeconomic characteristics poorly reported, no unpublished trials were identified, only one reviewer screened titles and abstracts, and follow-up was limited to 12 months so clinical outcomes could not be assessed.
  • Evident from the text: all but two studies were judged at high risk of bias in at least one domain, including lack of blinding, inadequate management of incomplete outcome data in six studies, and selective outcome reporting in one study; some pooled estimates had high heterogeneity (I²=70% for continuous self-reported physical activity; I²=97% for fitness).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmj.e1389

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 62 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In 13 trials presenting self reported physical activity, the pooled odds ratio for intervention effect at 12 months was 1.42 (95% CI 1.17 to 1.73).

    “In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months (odds ratio 1.42, 95% confidence interval 1.17 to 1.73; standardised mean difference 0.25, 0.11 to 0.38).”
    Quote in the paperSubstantial claim
  • Findingown data

    The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (95% CI 7 to 33).

    “The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (7 to 33).”
    Quote in the paperSubstantial claim
  • Findingown data

    In three trials of exercise referral, the pooled standardised mean difference for effect on self reported physical activity at 12 months was 0.20 (95% CI −0.21 to 0.61).

    “Three trials of exercise referral found small non-significant effects on self reported physical activity at 12 months (odds ratio 1.38; 0.98 to 1.95; standardised mean difference 0.20, −0.21 to 0.61).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In 13 trials presenting self reported physical activity, the pooled standardised mean difference for intervention effect at 12 months was 0.25 (95% CI 0.11 to 0.38).

    “In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months (odds ratio 1.42, 95% confidence interval 1.17 to 1.73; standardised mean difference 0.25, 0.11 to 0.38).”
    Quote in the paperSubstantial claim
  • Findingcitation

    In nine studies, dichotomous outcome measures related to whether participants had achieved a specified target level of physical activity in keeping with accepted guidelines, most commonly at least 30 minutes of moderate intensity activity each day for at least five days per week.

    “In nine studies, dichotomous outcome measures related to whether participants had achieved a specified target level of physical activity in keeping with accepted guidelines (most commonly the achievement of at least 30 minutes of moderate intensity activity each day for at least five days per week).18 19 20 21 22 23 28 29 36”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [18] Van Sluijs EM, van Poppel MN, Twisk JW, Chin APM, Calfas KJ, van MW. Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial. Am J Public Health 2005; 9510: 1825-31. PMC1449443 16186461

      Not checked in the free run.

    • cites [19] Jimmy G, Martin BW. Implementation and effectiveness of a primary care based physical activity counselling scheme. Patient Educ Couns 2005; 56: 323-31. 15721975

      Not checked in the free run.

    • cites [20] Harrison RA, Roberts C, Elton PJ. Does primary care referral to an exercise programme increase physical activity one year later? A randomized controlled trial. J Public Health 2004; 271: 25-32. 15564275

      Not checked in the free run.

  • May combine two claims. 33
  • Classified as probably not a substantial claim. 26

  • May combine two claims.

    Findingcitation

    Most studies selected participants for sedentary behaviour, but the percentage meeting recommended guidelines for physical activity at baseline ranged from 0% to 44% in the nine studies reporting this outcome.

    “Most studies selected participants for sedentary behaviour, but the percentage meeting recommended guidelines for physical activity at baseline ranged from 0%19 20 to 44%18 in the nine studies reporting this outcome.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [18] Van Sluijs EM, van Poppel MN, Twisk JW, Chin APM, Calfas KJ, van MW. Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial. Am J Public Health 2005; 9510: 1825-31. PMC1449443 16186461

      Not checked in the free run.

    • cites [19] Jimmy G, Martin BW. Implementation and effectiveness of a primary care based physical activity counselling scheme. Patient Educ Couns 2005; 56: 323-31. 15721975

      Not checked in the free run.

    • cites [20] Harrison RA, Roberts C, Elton PJ. Does primary care referral to an exercise programme increase physical activity one year later? A randomized controlled trial. J Public Health 2004; 271: 25-32. 15564275

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Data for self reported physical activity were collected in 14 studies using various assessment tools, including questionnaires or logbooks either self administered or administered by an interviewer.

    “Data for self reported physical activity were collected in 14 studies using various assessment tools, including questionnaires or logbooks either self administered or administered by an interviewer (table 4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In four trials reporting cardiorespiratory fitness, the pooled standardised mean difference for intervention effect at 12 months was 0.51 (95% CI −0.18 to 1.20), which was non-significant.

    “In four trials reporting cardiorespiratory fitness, a medium positive effect at 12 months was non-significant (standardised mean difference 0.51, −0.18 to 1.20).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The review included 15 randomised controlled trials with 8745 participants aged 17 to 92 years.

    “We included 15 trials (n=8745).”
    • Also stated in: § Study and participant characteristics · plain
      “In 15 trials, 8745 participants aged between 17 and 92 years were randomised.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most interventions included health professionals in delivery.

    “Most interventions took place in primary care, included health professionals in delivery, and involved advice or counselling given face to face or by phone (or both) on multiple occasions.”
    • Also stated in: § Intervention characteristics · plain
      “Primary care doctors or nurses were involved in eight studies; physiotherapists in two studies; and health visitors, health educators, health counsellors, health promotion specialists, or trained facilitators from a range of health professions in a further five studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only three trials investigated exercise referral.

    “Only three trials investigated exercise referral.”
    • Also stated in: § Intervention characteristics · plain
      “Of the three exercise referral studies, one involved referral to a leisure centre based programme, one to a community walks programme, and one involved small group exercise sessions at an unspecified location.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In two studies, dichotomous outcome measures related to whether participants had increased their level of physical activity from baseline.

    “In two studies, they related to whether participants had increased their level of physical activity from baseline.26 27”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Harland J, White M, Drinkwater C, Chinn D, Farr L, Howel D. The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care. BMJ 1999; 319: 828-32. 10496829 PMC314213

      Not checked in the free run.

    • cites [27] Chambers R, Chambers C, Campbell I. Exercise promotion for patients with significant medical problems. Health Educ J 2000; 59: 90-8.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All studies reported outcome data at 12 months after randomisation, apart from one reporting at 14 months and another reporting at 24 months.

    “All studies reported outcome data at 12 months after randomisation, apart from one19 reporting at 14 months, and another28 reporting at 24 months.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Jimmy G, Martin BW. Implementation and effectiveness of a primary care based physical activity counselling scheme. Patient Educ Couns 2005; 56: 323-31. 15721975

      Not checked in the free run.

    • cites [28] The Writing Group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care: the activity counseling trial: a randomized controlled trial. JAMA 2001; 286: 677-87. 11495617

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Only one study found a significant intervention effect on adverse events, reporting a relative 11% increase in falls and a 6% increase in injuries among intervention participants between baseline and 12 months' follow-up, compared with control participants.

    “Only one study found a significant intervention effect on adverse events, reporting a relative 11% increase in falls and a 6% increase in injuries among intervention participants between baseline and 12 months’ follow-up, compared with control participants.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Lawton BA, Rose SB, Elley CR, Dowell AC, Fenton A, Moyes SA. Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial. BMJ 2008; 337: a2509. 19074218 PMC2769033

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In the six studies that compared physical activity promotion to no intervention, there was a medium, positive, and significant intervention effect on self reported physical activity at 12 months (odds ratio 1.74, 95% confidence interval 1.39 to 2.18; I2=21% (0% to 71%); standardised mean difference 0.36, 95% confidence interval 0.28 to 0.43; I2=0%).

    “In the six studies that compared physical activity promotion to no intervention, we saw a medium, positive, and significant intervention effect on self reported physical activity at 12 months (odds ratio 1.74 (95% confidence interval 1.39 to 2.18), I2=21% (0% to 71%); standardised mean difference 0.36 (0.28 to 0.43), I2=0% (I2 0% to 61%)).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Nine studies reported the proportion of participants meeting recommended levels of physical activity at baseline and 12 months (or at the next available time point, if 12 month data were not available).

    “Nine studies reported the proportion of participants meeting recommended levels of physical activity at baseline and 12 months (or at the next available time point, if 12 month data were not available).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eleven studies reported positive intervention effects on self reported physical activity at 12 months; these effects were significant in six studies.

    “Eleven studies reported positive intervention effects on self reported physical activity at 12 months; these effects were significant in six studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sensitivity analysis showed that the high heterogeneity in cardiorespiratory fitness was attributable to one outlying study with strong positive results; without it heterogeneity was low (I2=0%).

    “a sensitivity analysis showed that this was attributable to one outlying study with strong positive results,31 without which heterogeneity was low (I2=0%).”
    • Also stated in: § Summary and interpretation of findings · hedged
      “The effect sizes showed high heterogeneity, and sensitivity analyses suggested that this was attributable to one outlying study with strong positive findings.31”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Petrella RJ, Koval JJ, Cunningham DA, Paterson DH. Can primary care doctors prescribe exercise to improve fitness?: The step test exercise prescription (STEP) project. Am J Prev Med 2003; 24: 316-22. 12726869

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In the meta-analysis of continuous physical activity data, removal of two studies that did not present an outcome measure for total activity reduced the pooled effect estimate but did not affect the direction or significance of the findings (standardised mean difference 0.20, 95% confidence interval 0.05 to 0.35; I2=72% (18% to 85%)).

    “In the meta-analysis of continuous physical activity data (fig 4), removal of two studies that did not present an outcome measure for total activity reduced the pooled effect estimate but did not affect the direction or significance of the findings (standardised mean difference 0.20 (0.05 to 0.35), I2=72% (18% to 85%)).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The pooled standardised mean difference for cardiorespiratory fitness at 12 months had a medium effect size but was non-significant (0.51, 95% confidence interval −0.18 to 1.20; I2=97% (96% to 98%)).

    “The pooled standardised mean difference had a medium effect size but was non-significant (0.51 (95% confidence interval −0.18 to 1.20); fig 5). Heterogeneity was high (I2=97% (96% to 98%))”
    • Also stated in: § Summary and interpretation of findings · plain
      “Only four trials reported cardiorespiratory fitness and pooled analysis showed no significant effect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    A third study used a no intervention control and found small to medium sized positive effects on self reported activity, which were significant for continuous (frequency of exercise sessions) but not dichotomous data (proportion of participants who had become more active from study entry).

    “A third study used a no intervention control, and found small to medium sized positive effects on self reported activity, which were significant for continuous (frequency of exercise sessions) but not dichotomous data (proportion of participants who had become more active from study entry).27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Chambers R, Chambers C, Campbell I. Exercise promotion for patients with significant medical problems. Health Educ J 2000; 59: 90-8.

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The additional percentage of participants who reported meeting international activity recommendations at 12 months, compared with baseline, was 11-47% in participants allocated to receive an intervention, 8-47% in those allocated to receive a comparator intervention, and −2% to +19% in those allocated to receive no intervention.

    “The additional percentage of participants who reported meeting international activity recommendations at 12 months, compared with baseline, was 11-47% in participants allocated to receive an intervention, and 8-47% in those allocated to receive a comparator intervention. The corresponding range for those allocated to receive no intervention was from −2% to +19% (fig 8).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Three studies examined exercise referral interventions.

    “Three studies examined exercise referral interventions.20 27 36”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [20] Harrison RA, Roberts C, Elton PJ. Does primary care referral to an exercise programme increase physical activity one year later? A randomized controlled trial. J Public Health 2004; 271: 25-32. 15564275

      Not checked in the free run.

    • cites [27] Chambers R, Chambers C, Campbell I. Exercise promotion for patients with significant medical problems. Health Educ J 2000; 59: 90-8.

      Not checked in the free run.

    • cites [36] Lamb SE, Bartlett HP, Ashley A, Bird W. Can lay-led walking programmes increase physical activity in middle aged adults? A randomised controlled trial. J Epidemiol Community Health 2002; 56: 246-52. 11896130 PMC1732126

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    There were significant differences in effect size between studies with no intervention controls and those with comparator interventions for both dichotomous and continuous data (dichotomous χ2=6.9 df=1, P=0.008; continuous χ2=21.7, df=1, P<0.00001).

    “For both dichotomous and continuous data, we found significant differences in effect size between these two sets of studies (dichotomous data, χ²=6.9 df=1, P=0.008; continuous data, χ²=21.7, df=1, P<0.00001).”
    • Also stated in: § Summary and interpretation of findings · plain
      “A planned subgroup analysis showed significantly larger intervention effects on self reported activity in studies where control participants received no intervention than where they received a comparator intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Four studies reported cardiorespiratory fitness.

    “Four studies reported cardiorespiratory fitness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Our search was systematic but we did not identify any unpublished trials.

    “At a review level, our search was systematic but we did not identify any unpublished trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Although all the interventions in our review are potentially reproducible in real life settings in primary care, most involved multiple contacts over time.

    “Although all the interventions in our review are potentially reproducible in real life settings in primary care, most involved multiple contacts over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Trial personnel or outcome assessors were not blinded to allocation in five studies, and management of incomplete outcome data was inadequate in six studies.

    “Trial personnel or outcome assessors were not blinded to allocation in five studies, and management of incomplete outcome data was inadequate in six studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    No additional studies were identified by an independent expert on the topic.

    “Furthermore, no additional studies were identified by an independent expert on the topic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The funnel plots did not suggest publication bias, although these plots are difficult to interpret with a small number of studies.

    “The funnel plots did not suggest publication bias, although these plots are difficult to interpret with a small number of studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Two reviewers independently assessed studies for inclusion, appraised risk of bias, and extracted data.

    “Two reviewers independently assessed studies for inclusion, appraised risk of bias, and extracted data.”
    • Also stated in: § Search methods, study selection, and data extraction · plain
      “Two reviewers (GO and SSu) assessed retrieved papers independently.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The analysis adjusted for clustering in two studies by calculating the effective sample size.

    “We adjusted for clustering in two studies18 29 by calculating the effective sample size.37”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.0.2 (updated September 2009). Chapter 16.3.4. Cochrane Collaboration, 2009.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Five prespecified meta-analyses were conducted using a random effects model in RevMan.

    “Five prespecified meta-analyses were conducted using a random effects model in RevMan.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Sensitivity analyses explored effects of decisions about outcome selection and design effects, and these analyses were planned after data extraction but before undertaking the meta-analyses.

    “Sensitivity analyses explored effects of decisions about outcome selection and design effects. These analyses were planned after data extraction but before undertaking the meta-analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Blinding of participants to study group allocation was achieved in one study, not achieved in one, not reported in seven, and not possible in six.

    “Blinding of participants to study group allocation was achieved in one study, not achieved in one, not reported in seven, and not possible in six (in which control participants received no intervention).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A third reviewer resolved any conflicts.

    “A third reviewer (ALK) resolved any conflicts.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    When a study presented both a trial completers' analysis and a full intention to treat analysis using imputed values, the intention to treat analysis was used.

    “If a study presented both a trial completers’ analysis and a full intention to treat analysis using imputed values, we used the intention to treat analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Assessing the sustainability of impact of interventions is important, because observational research shows that the health benefits of physical activity are lost with reversion to a sedentary lifestyle.

    “Assessing the sustainability of impact of interventions is important, because observational research shows that the health benefits of physical activity are lost with reversion to a sedentary lifestyle.16”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Paffenbarger RS Jr, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 1978; 108: 161-75. 707484

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Social desirability bias could explain why control participants who received an intervention reported more activity at 12 months than those who received no intervention.

    “Alternatively, social desirability bias could explain why control participants who received an intervention reported more activity at 12 months than those who received no intervention.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: It is difficult to conceal the study group from participants in physical activity trials.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self reported achievement of recommended activity levels was associated with a 19% reduction in the rate of all cause mortality, compared with sedentary behaviour, in a large meta-analysis of cohort studies.

    “Self reported achievement of these activity levels was associated with a 19% reduction in the rate of all cause mortality, compared with sedentary behaviour, in a large meta-analysis of cohort studies.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Woodcock J, Franco OH, Orsini N, Roberts I. Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol 2011; 40: 121-38. 20630992

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The United Kingdom's chief medical officers recommend that adults undertake at least 150 minutes of moderate intensity activity each week.

    “The United Kingdom’s chief medical officers recommend that adults undertake at least 150 minutes of moderate intensity activity each week.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Chief medical officers of England, Scotland, Wales and Northern Island. Start active, stay active: a report on physical activity from the four home countries’ chief medical officers. Department of Health, 2011.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The absence of effect on cardiorespiratory fitness could have been due to the small number of studies recruiting through primary care that reported fitness data, three of which also found no significant effect on self reported physical activity.

    “This absence of effect could have been due to the small number of studies recruiting through primary care that reported fitness data, three of which also found no significant effect on self reported physical activity.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A Cochrane systematic review of interventions to promote physical activity in community dwelling adults showed a moderate effect on self reported physical activity and cardiorespiratory fitness at a minimum of six months of follow-up.

    “A Cochrane systematic review of interventions to promote physical activity in community dwelling adults showed a moderate effect on self reported physical activity and cardiorespiratory fitness at a minimum of six months of follow-up.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Hillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. Cochrane Database Syst Rev 2005; 1: CD003180. 15674903 PMC4164373

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The UK has seen a marked expansion in exercise referral schemes over the past two decades.

    “The UK has seen a marked expansion in exercise referral schemes over the past two decades,24 but there are concerns that these might not produce sustained changes in physical activity beyond the typical programme length of 12 weeks.25”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Labour Research Department. Exercise on prescription: a report for the Chartered Society of Physiotherapists. Labour Research Department, 2004.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients are interested in discussing health promotion issues with primary care health professionals.

    “In developed countries, 70-80% of adults visit their general practitioner at least once a year,6 and patients are interested in discussing health promotion issues with primary care health professionals.7”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Stott NC, Pill RM. “Advise yes, dictate no.” Patients’ views on health promotion in the consultation. Fam Pract 1990; 7: 125-31. 2369980

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    We found no effect of interventions on cardiorespiratory fitness at 12 months across four trials, by contrast with the systematic review by Hillsdon and colleagues, which identified a positive effect on fitness at a minimum of six month follow-up.

    “We found no effect of interventions on cardiorespiratory fitness at 12 months across four trials, by contrast with the systematic review by Hillsdon and colleagues, which identified a positive effect on fitness at a minimum of six month follow-up.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Hillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. Cochrane Database Syst Rev 2005; 1: CD003180. 15674903 PMC4164373

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Only 39% of men and 29% of women achieved recommended activity levels in the 2008 Health Survey for England.

    “Yet only 39% of men and 29% of women achieved these levels in the 2008 Health Survey for England.3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Joint Health Surveys Unit. Health survey for England 2008. Physical activity and fitness. The Stationery Office, 2009.

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The best estimate of the number needed to treat with a physical activity promotion intervention for one additional sedentary adult to report recommended levels of activity at 12 months was 12, which compares favourably to the estimated numbers needed to treat of 50-120 for smoking cessation advice.

    “The best estimate of the number needed to treat with a physical activity promotion intervention for one additional sedentary adult to report recommended levels of activity at 12 months was 12, which compares favourably to the estimated numbers needed to treat of 50-120 for smoking cessation advice.8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008; 2: CD000165. 18425860

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Participants in the included trials could have been more motivated to increase their physical activity than the primary care populations from which they were recruited.

    “Furthermore, participants in the included trials could have been more motivated to increase their physical activity than the primary care populations from which they were recruited.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent research suggests that most physical activity interventions based in primary care have comparable cost effectiveness to funded pharmaceutical interventions.

    “Cost effectiveness was not assessed in this review, but recent research suggests that most physical activity interventions based in primary care have comparable cost effectiveness to funded pharmaceutical interventions.44”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Garrett S, Elley CR, Rose SB, O’Dea D, Lawton BA, Dowell AC. Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence. Br J Gen Pract 2011; 61: 125-33. PMC3047345 21375895

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    It is difficult to conceal the study group from participants in physical activity trials, and self reported measures are therefore susceptible to differential social desirability bias, which could inflate estimates of intervention effect.

    “It is difficult to conceal the study group from participants in physical activity trials, and self reported measures are therefore susceptible to differential social desirability bias, which could inflate estimates of intervention effect.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: It is difficult to conceal the study group from participants in physical activity trials.

  • May combine two claims.

    Interpretationown data

    Removal of non-parametric data in a sensitivity analysis led to an increase in the pooled intervention effect on self reported physical activity that retained statistical significance, suggesting that the decision to include these studies in the main analysis led, at worst, to an underestimation of the pooled intervention effect.

    “Removal of these data in a sensitivity analysis led to an increase in the pooled intervention effect on self reported physical activity that retained statistical significance, suggesting that the decision to include these studies in the main analysis led, at worst, to an underestimation of the pooled intervention effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Our findings extend the evidence from two previous systematic reviews of community based interventions by including only studies recruiting through primary care and by including studies with longer follow-up.

    “Our findings extend the evidence from two previous systematic reviews of community based interventions17 41 in two ways. Firstly, we included only studies recruiting through primary care to more directly inform commissioning in general practice. Secondly, we included studies with longer follow-up to inform sustainability of effect.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Hillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. Cochrane Database Syst Rev 2005; 1: CD003180. 15674903 PMC4164373

      Not checked in the free run.

    • cites [41] Muller-Riemenschneider F, Reinhold T, Nocon M, Willich SN. Long-term effectiveness of interventions promoting physical activity: a systematic review. Prev Med 2008; 47: 354-68. 18675845

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    When reported, most trial participants were white, and socioeconomic characteristics were poorly reported; therefore, we do not know whether our findings apply to adults with different ethnic, social, and economic characteristics.

    “When reported, most trial participants were white, and socioeconomic characteristics were poorly reported; therefore, we do not know whether our findings apply to adults with different ethnic, social, and economic characteristics.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Brief interventions have shown effectiveness in the promotion of smoking cessation and alcohol reduction.

    “Brief interventions have shown effectiveness in the promotion of smoking cessation and alcohol reduction,8 9 and further research is warranted to assess their effectiveness for physical activity promotion.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [8] Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008; 2: CD000165. 18425860

      Not checked in the free run.

    • cites [9] Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007; 2: CD004148. 17443541

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pavey and colleagues found a 16% increase in the relative risk of achieving recommended levels of physical activity at six to 12 months with exercise referral schemes compared with usual care, but no significant difference between exercise referral schemes and alternative physical activity interventions.

    “They found a 16% increase in the relative risk of achieving recommended levels of physical activity at six to 12 months with exercise referral schemes compared with usual care, but no significant difference between exercise referral schemes and alternative physical activity interventions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Pavey TG, Taylor AH, Fox KR, Hillsdon M, Anokye N, Campbell JL, et al. Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. BMJ 2011; 343: d6462. 22058134 PMC3209555

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Only one reviewer screened titles and abstracts, and although papers could have been missed at this stage, seven databases were systematically searched on two occasions (May 2009; repeated May 2010), supplemented by hand searching of reference lists.

    “Only one reviewer screened titles and abstracts, and although papers could have been missed at this stage, seven databases were systematically searched on two occasions (May 2009; repeated May 2010), supplemented by hand searching of reference lists.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Two fifths of included studies were conducted in the UK and most of the remaining trials took place in countries with broadly comparable primary care services, enhancing the generalisability of our findings to these settings.

    “Two fifths of included studies were conducted in the UK and most of the remaining trials took place in countries with broadly comparable primary care services, enhancing the generalisability of our findings to these settings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Although no significant pooled effect was found, in individual studies, the likelihood of meaningful effect was highest in the comparison of exercise referral schemes with no intervention and weakest for the comparison of exercise referral schemes with advice given face to face.

    “In summary, although no significant pooled effect was found, in individual studies, the likelihood of meaningful effect was highest in the comparison of exercise referral schemes with no intervention and weakest for the comparison of exercise referral schemes with advice given face to face.”
    Quote in the paperSubstantial claim
54 of 54

  • The paper relies on this without support.

    In 2006, the UK National Institute for Health and Clinical Excellence advised that exercise referral schemes should not be commissioned in primary care outside of well designed research studies.

    “In 2006, the UK National Institute for Health and Clinical Excellence (NICE) advised that exercise referral schemes should not be commissioned in primary care outside of well designed research studies.”

  • The paper relies on this without support.

    Exercise referral schemes remain widely used in the UK despite the NICE recommendation.

    “Despite this recommendation, the schemes remain widely used”

  • The paper relies on this without support.

    Physical activity promotion in primary care improves self reported physical activity in the short term (3-6 months), but its effect in the longer term is unclear.

    “Physical activity promotion in primary care improves self reported physical activity in the short term (3-6 months), but its effect in the longer term is unclear”

  • The paper relies on this without support.

    Exercise referral schemes are popular yet costly, and their effectiveness compared with other types of intervention over the medium to long term is unknown.

    “Exercise referral schemes are popular yet costly, and their effectiveness compared with other types of intervention over the medium to long term is unknown”

  • The paper relies on this without support.

    Self reported measures of physical activity lack precision.

    “Self reported measures of physical activity also lack precision and our findings would have been strengthened if complemented by greater use of objective measures.”

  • The paper relies on this without support.

    It is difficult to conceal the study group from participants in physical activity trials.

    “It is difficult to conceal the study group from participants in physical activity trials, and self reported measures are therefore susceptible to differential social desirability bias, which could inflate estimates of intervention effect.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Exercise referral study described as both significant and non-significant

    Major

    The results state that none of the three exercise referral studies found a significant effect on self-reported physical activity at 12 months. The discussion says the third study found a significant effect for its continuous activity measure.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. [33]Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.0.2 (updated September 2009). Chapter 8. Cochrane Collaboration, 2009.
  2. [34]Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.0.2 (updated September 2009). Chapter 7.7.3.8. Cochrane Collaboration, 2009.
  3. [37]Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.0.2 (updated September 2009). Chapter 16.3.4. Cochrane Collaboration, 2009.

Cited by

Sorted by citations

Related

Authors
Orrow, G., Kinmonth, A.-L., Sanderson, S., & Sutton, S.
Affiliations
University of Cambridge (GB)
Corresponding author
Orrow, G.
ORCID
Sutton, S.
Venue
BMJ
Publisher
BMJ
Published
2012-03-26
Volume
344
Issue
mar26 1
Pages
e1389-e1389
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.e1389
PMC
PMC3312793
OpenAlex
W2042918999
Semantic Scholar
0a174ab0223bbd7717ddc5e15780ad7502b72b2d
Cited by
739
References
38
Citations by year
2026: 28 · 2025: 32 · 2024: 54 · 2023: 36 · 2022: 39 · 2021: 60 · 2020: 126 · 2019: 54 · 2018: 49 · 2017: 53 · 2016: 45 · 2015: 51 · 2014: 56 · 2013: 43 · 2012: 13
FWCI
5.61
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute for Health and Care Research (RP-PG-0608-10079, PB-PG-0110-20199, NF-SI-0507-10182, ACF-2008-14-008)
  • University of Cambridge
  • NIHR School for Primary Care Research
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
physical activity promotion, primary care, sedentary adults, exercise referral schemes, physical activity counseling, cardiorespiratory fitness, health behavior change, number needed to treat, long-term intervention effects, telephone counseling, self-reported physical activity, health disparities, health inequalities reduction
MeSH terms
Counseling, Exercise Therapy, Health Promotion, Humans, Motor Activity, Primary Health Care, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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