An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative
Open accessAbstract
BACKGROUND: The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including motivational interviewing, goal setting and relapse prevention. METHOD: A pragmatic randomised controlled trial with nested economic evaluation of 2160 inactive participants with coronary heart disease risk (CHD, 1559, 72%), mild to moderate depression, anxiety or stress (79, 4%) or both (522, 24%) randomised to receive (1) NERS or (2) normal care and brief written information. Outcome measures at 12 months included the 7-day physical activity recall, the hospital anxiety and depression scale. RESULTS: Ordinal regression identified increased physical activity among those randomised to NERS compared with those receiving normal care in all participants (OR 1.19, 95% CI 0.99 to 1.43), and among those referred for CHD only (OR 1.29, 95% CI 1.04 to 1.60). For those referred for mental health reason alone, or in combination with CHD, there were significantly lower levels of anxiety (-1.56, [corrected] 95% CI -2.75 to -0.38) and depression (-1.39, [corrected] 95% CI -2.60 to -0.18), but no effect on physical activity. The base-case incremental cost-effectiveness ratio was £12,111 per quality adjusted life year, falling to £9741 if participants were to contribute £2 per session. CONCLUSIONS: NERS was effective in increasing physical activity among those referred for CHD risk only. Among mental health referrals, NERS did not influence physical activity but was associated with reduced anxiety and depression. Effects were dependent on adherence. NERS is likely to be cost effective with respect to prevailing payer thresholds. Trial registration Current Controlled Trials ISRCTN47680448.
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- Authors
- Murphy, S. M., Edwards, R. T., Williams, N., Raisanen, L., Moore, G., Linck, P., Hounsome, N., Din, N. U., & Moore, L.
- Affiliations
- Cardiff University (GB)
- Bangor University (GB)
- Corresponding author
- Murphy, Simon Mark
- ORCID
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2012-05-10
- Volume
- 66
- Issue
- 8
- Pages
- 745-753
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC3402741
- OpenAlex
- W2118385537
- Cited by
- 182
- References
- 34
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 28 · 2023: 8 · 2022: 5 · 2021: 15 · 2020: 14 · 2019: 14 · 2018: 16 · 2017: 12 · 2016: 10 · 2015: 11 · 2014: 22 · 2013: 14
- FWCI
- 10.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of Epidemiology & Community Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by-nc)
- Funders
- Wellcome Trust (WT087640MA)
- Llywodraeth Cymru
- Cancer Research UK
- British Heart Foundation
- Economic and Social Research Council (ES/G007543/1)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- physical activity, coronary heart disease risk, depression, anxiety, motivational interviewing, goal setting, relapse prevention, cost-effectiveness, public health policy, program adherence, Wales
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Coronary Disease, Cost-Benefit Analysis, Depressive Disorder, Exercise Therapy, Female, Health Policy, Health Promotion, Humans, Male, Middle Aged, Patient Compliance, Patient Participation, Psychometrics, Referral and Consultation, Regression Analysis, Risk Factors, Socioeconomic Factors, Wales, Program Evaluation, Case-Control Studies, Outcome Assessment, Health Care, Qualitative Research
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