Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors.

Taylor, A H; Doust, J; Webborn, N

doi:10.1136/jech.52.9.595

Cited by 130Physical Activity and HealthCardiac Health and Mental HealthCardiovascular and exercise physiology

Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors.

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Taylor, A H, Doust, J, Webborn, N·1998·Journal of Epidemiology and Community Health

DOI 10.1136/jech.52.9.595PMC PMC1756762

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Abstract

OBJECTIVE: To examine the effects of a GP exercise referral programme on modifiable coronary heart disease risk factors. DESIGN: Randomised controlled trial. A battery of validated measures were carried out at 0, 8, 16, 26, and 37 weeks. SETTING: Two community health centres and a leisure centre in Hailsham, East Sussex. SUBJECTS: 389 patients (smokers, hypertensive or overweight) were selected from medical records, screened for contraindications to exercise and 345 were invited into the study. Of 142 patients randomly allocated, 40 (41%) completed the study in the exercise group and 31 (69%) in the control group. Sixty (35%) invited smokers (48% of non-smokers), 71 (38%) invited hypertensive patients (45% of non-hypertensive patients), and 107 (45%) overweight patients (33% of non-overweight patients) were randomised. Of those randomised, 27 (45%) smokers, 52 (48%) overweight, and 43 (61%) hypertensive patients completed the study. INTERVENTION: The exercise group was offered 20, half price sessions over 10 weeks at a leisure centre. Patients engaged in moderate and vigorous aerobic type activity on various exercise machines, in a semi-supervised, informal environment. RESULTS: 87% of those referred used the prescription and 28% (high adherers)(45% of obese patients) did at least 15 sessions. The exercise group reduced sum of skinfolds by 8.1% (2.9 to 13.3, 95% confidence intervals) more than the control group, up to 16 weeks after baseline. High adherers reduced sum of skinfolds by 9.2% (0.9 to 17.5) more than the control group, up to 26 weeks. High adherers reduced systolic blood pressure by 7.2% (-0.7 to 14.9) (that is, 9 mm Hg) more than low adherers, up to 37 weeks. Non-smokers and obese patients attended more prescribed sessions than smokers and non-overweight patients. CONCLUSIONS: Reduction in sum of skinfolds was maintained up to 26 weeks, among high adherers compared with controls. Reduction in systolic blood pressure was evident up to 37 weeks among high adherers, but only in comparison with low adherers. Selection of appropriate referees and use of other strategies to improve exercise adherence will help to maximise the benefits from GP exercise prescription schemes.

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IR within the SM can develop independently of and decades prior to the onset of β-cell failure and the onset of T2D in those at high metabolic risk.
“Indeed, IR within the SM can develop independently of and decades prior to the onset of β-cell failure and the onset of T2D in those at high metabolic risk [17,21].”
From Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management (2025) · cites this paper as [21]

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Evaluating the Effectiveness of a Physical Activity Referral Scheme Among Women
Galaviz, K., Lévesque, L., & Kotecha, J. (2013) · Journal of Primary Care & Community Health · doi:10.1177/2150131912463243 · Cited by 18 · see citing works
“Our findings differ from those in which the referral strategy achieved superior short-term improvements on selfreported PA as compared with prescription/counseling alone.(13,16,17) It may be that the referral intervention in this study had no added value because the community program to which patients were referred wa…”
Result
Interventions aimed at increasing the level of physical activity by including organised follow-up: a systematic review of effect
Denison, E., Vist, G. E., Underland, V., & Berg, R. C. (2014) · BMC Family Practice · doi:10.1186/1471-2296-15-120 · Cited by 18 · see citing works
“The interventions comprised referral to an exercise specialist with follow-up 3–6 times over 12 weeks [20,23]; referral to an exercise specialist at a local centre with follow-up 3 times over 12 weeks [19], or at the end of the intervention [21,22]; referral to a local centre with subsidised access to a gym and follow…”
BackgroundMethodInfluential
Utilization of a Free Fitness Center-Based Exercise Referral Program Among Women with Chronic Disease Risk Factors
Waterman, M., Wiecha, J., Manne, J., Tringale, S., Costa, E., & Wiecha, J. (2014) · Journal of community health · doi:10.1007/s10900-014-9874-2 · Cited by 17 · see citing works
“Nonetheless, exercise prescription by a primary care provider has had mixed results [18, 24–28].”
Background
Exercise, service and support: client experiences of physical activity referral schemes (PARS)
Vinson, D., & Parker, A. (2012) · doi:10.1080/2159676x.2011.653501 · Cited by 17
Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management
Barber, T. M., Kabisch, S., Pfeiffer, A. F. H., & Weickert, M. O. (2025) · Metabolites · doi:10.3390/metabo15020085 · Cited by 19 · see citing works
“Indeed, IR within the SM can develop independently of and decades prior to the onset of β -cell failure and the onset of T2D in those at high metabolic risk [17,21].”
Retrospective cohort study of the South Tyneside Exercise Referral Scheme 2009‐14: predictors of dropout and barriers to adherence
Kelly, M. C., Rae, G., Walker, D., Partington, S., Dodd-Reynolds, C., & Caplan, N. (2017) · Journal of public health · doi:10.1093/pubmed/fdw122 · Cited by 16
An evaluation of the effectiveness of 'Active for Life': an exercise referral scheme in West Suffolk.
Lee, A., Griffin, S. J., & Simmons, R. (2009) · Public Health · doi:10.1016/j.puhe.2009.09.005 · Cited by 14
Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project
Camhi, S. M., Debordes-Jackson, G., Andrews, J., Wright, J., Lindsay, A. C., Troped, P. J., & Hayman, L. L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168726 · Cited by 12 · see citing works
“For example, in some studies, adherence varied by type of chronic disease: improved adherence in those with diabetes versus cardiovascular disease or obesity [18,48] or with increasing numbers of health conditions and/or medications [49].”
BackgroundResult
Are physical activity referral scheme components associated with increased physical activity, scheme uptake, and adherence rate? A meta-analysis and meta-regression
Mino, E., Pfeifer, K., Hanson, C. L., Schüler, M., Brandmeier, A., Klamroth, S., Naber, I., Weißenfels, A., McHale, S., Abu‐Omar, K., et al. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01623-5 · Cited by 13 · see citing works
Per-protocol investigation of a best practice exercise referral scheme
Stewart, L., Dolan, E., Carver, P., & Swinton, P. A. (2017) · Public Health · doi:10.1016/j.puhe.2017.04.023 · Cited by 25 · see citing works
A systematic review and narrative synthesis of physical activity referral schemes’ components
Mino, E., Hanson, C. L., Naber, I., Weißenfels, A., McHale, S., Saftig, J., Klamroth, S., Gelius, P. C., Abu‐Omar, K., Whiting, S., et al. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01518-x · Cited by 23 · see citing works
“Eighteen different schemes were included from the UK [45, 46, 50, 51, 63, 64, 68, 69, 73–83 ,”
Result
“Exercise is Medicine” in Latin America: training health care professionals in physical activity prescription
Duperly, J., Collazos, V., Páez, C., Donado, C., Pratt, M., & Lobelo, F. (2014) · Swiss Sports & Exercise Medicine · doi:10.34045/ssem/2014/15 · Cited by 12 · see citing works
The Feasibility of a Physical Activity Referral Network for Pediatric Obesity
Madsen, K. A., Garber, A. K., Martín, M. Á. G., Gonzaga, M., & Linchey, J. K. (2014) · Childhood Obesity · doi:10.1089/chi.2013.0118 · Cited by 7 · see citing works
“<High school 38 33 39 [ - 16, 17] 41 35 [ - 16, 26]”
General health checks in adults for reducing morbidity and mortality from disease
Krogsbøll, L. T., Jørgensen, K. J., Grønhøj, C., & Gøtzsche, P. C. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009009.pub2 · Cited by 288 · see citing works
Impact of primary care exercise referral schemes on the health of patients with obesity
Parretti, H., Bartington, S. E., Badcock, T., Hughes, L., Duda, J., & Jolly, K. (2017) · Pragmatic and Observational Research · doi:10.2147/por.s118648 · Cited by 6 · see citing works
Factors influencing participation in outdoor physical activity promotion schemes: the case of South Staffordshire, England
Curry, N., Crone, D., James, D., & Gidlow, C. J. (2011) · Leisure Studies · doi:10.1080/02614367.2011.600322 · Cited by 5 · see citing works
“A range is identified in Taylor, Doust, and Webborn ( 1998 ), Stevens, Hillsdon, Thorogood, and McArdle ( 1998 ), Sorensen, Kragstrup, Skovgaard, and Puggaard ( 2008 ) and Isaacs et al.”
Background
Levels of Adherence of an Exercise Referral Scheme in Primary Health Care: Effects on Clinical and Anthropometric Variables and Depressive Symptoms of Hypertensive Patients
Gallegos-Carrillo, K., García-Peña, C., Salgado-de-Snyder, N., Salmerón, J., & Lobelo, F. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.712135 · Cited by 5
Service Evaluation of an Exercise on Referral Scheme for Adults with Existing Health Conditions in the United Kingdom
McGeechan, G., Phillips, D., Wilson, L., Whittaker, V., O'Neill, G., & Newbury-Birch, D. (2017) · International Journal of Behavioral Medicine · doi:10.1007/s12529-017-9699-3 · Cited by 5 · see citing works
“Whilst a number of government schemes have been proposed which aim to increase levels of PA nationwide, exercise referral schemes (ERSs) have been shown to significantly increase the proportion of people becoming moderately active [11, 12]; however, these changes may not persist over time [13, 14].”
Background
Exercise on Prescription: A Cross-sectional Study With Self-reported Outcome.
Pedersen, H., Helmer-Nielsen, M., Dieperink, K., & Østergaard, B. (2016) · Journal of Physical Activity and Health · doi:10.1123/jpah.2015-0015 · Cited by 4
“Moderate + hard activity 10 (5) 47 (21) P < .”
Physical training program for people at risk of cardiovascular disorders in the primary care setting: A randomized clinical trial
García-Ortún, F., Jaén, Á., Solá, L., González-Gil, L., Garreta, R., & de la Sierra, A. (2022) · Medicina Clínica · doi:10.1016/j.medcli.2022.01.020 · Cited by 5 · see citing works
The match between what is prescribed and reasons for prescribing in exercise referral schemes: a mixed method study
Shore, C. B., Hubbard, G., Gorely, T., Hunter, A., & Galloway, S. (2021) · BMC Public Health · doi:10.1186/s12889-021-11094-z · Cited by 3 · see citing works
“reported attendance at ERS [17, 18, 10]; it may be unlikely to observe a change in magnitude of the prescription.”
Background
Changes in Mood during Exercise
O'Halloran, P., Kirkby, R. J., & Webster, K. (2001) · Australian Journal of Primary Health · doi:10.1071/py01030 · Cited by 3 · see citing works
Literature review of interventions to reduce the burden of harm from tobacco smoking, poor nutrition, alcohol misuse and physical inactivity.
Segal, L., Dalton, A., Robertson, I., Scollo, M., Lal, A., Simms, J., Fawcett, J., Gates, J., Shand, F., Mattick, R., et al. (2005) · doi:10.4225/03/59fab675472e9 · Cited by 2
Incorporating Weight Control into Management of Patients with Early Breast Cancer in the U.K.
Howell, A., & Harvie, M. (2005) · Nutrition and disease prevention · doi:10.1201/9781420026641.ch35 · Cited by 1 · see citing works
Bayesian re-analysis suggests participation rather than referral underlies the benefits of social prescribing for chronic diseases
Huang, M., Fu, G.-Q., & Du, Z. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1951236
Utilizing social media as a platform to facilitate primary care physicians’ exercise referrals among cancer patients and the general public
Niksirat, N., & Niksirat, P. (2019) · Health Science Inquiry · doi:10.29173/hsi175
A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation
Murphy, S., Raisanen, L., Moore, G. F., Edwards, R. T., Linck, P., Williams, N. H., Din, N., Hale, J., Roberts, C., McNaish, E., et al. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-352 · Cited by 43 · see citing works
Predictors of health behaviours among people with recently diagnosed Type 2 diabetes
Nair, R. (2013) · International Journal of Medical Science and Public Health · doi:10.5455/ijmsph.2013.2.378-389

Authors: Taylor, A. H., Doust, J., & Webborn, N.
Affiliations: University of Brighton (GB)
ORCID: Taylor, A H
Webborn, N
Venue: Journal of Epidemiology and Community Health
Publisher: BMJ
Published: 1998-09
Volume: 52
Issue: 9
Pages: 595-601
ISSN: 0141-7681 (ISSN-L)
0143-005X
1470-2738
DOI: 10.1136/jech.52.9.595
PMC: PMC1756762
OpenAlex: W2123565529
Cited by: 130
References: 19
Citations by year: 2026: 2 · 2025: 1 · 2024: 16 · 2023: 3 · 2022: 2 · 2021: 7 · 2020: 6 · 2019: 3 · 2018: 2 · 2017: 6 · 2016: 3 · 2015: 4 · 2014: 10 · 2013: 2 · 2012: 5
FWCI: 0.41
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Epidemiology & Community Health (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
University of Brighton Repository (University of Brighton) (submittedVersion)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords: exercise referral, coronary risk factors, exercise adherence, aerobic exercise, smoking, hypertension, overweight, fat loss, skinfold thickness, systolic blood pressure, general practitioner referral
MeSH terms: Coronary Disease, England, Exercise Therapy, Family Practice, Female, Humans, Male, Middle Aged, Referral and Consultation, Risk Factors, Program Evaluation, Treatment Outcome

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Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors.

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