A presentation from a workshop held at The University of St Mark & St john in November, 2014. The session was an information exchange session on the new NICE guidelines PH54 (exercise referral schemes to promote physical activity)

1. Exercise Referral Schemes:
A Professional Update
Welcome
Ben Jane

2. Outline
• Brief Updates
– E-CoachER project
– UKActive Summit
• The New NICE Guidelines PH54
• Discussion
• Lunch
• Housekeeping

3. • NIHR Project ref: 13/25/20
• Prof Adrian Taylor, et al.
• “A multi-centred RCT of an augmented
exercise referral scheme using web-based
behavioural support in individuals with
metabolic, musculo-skeletal and mental
health conditions”

4. 1. To determine whether the e-coach intervention, compared to control, increases the
proportion of participants who achieve the public health target of 150 mins of
moderate/vigorous physical activity (MVPA) at 12 months.
2. To determine whether the e-coach intervention, compared to control, increases the proportion of
participants who take up the opportunity to attend an initial consultation with an exercise
practitioner (uptake), maintain objectively assessed and self-reported physical activity (PA), and
improve health related quality of life at 4 and 12 months.
3. To quantify the additional costs of delivering the intervention and determine the differences in
health utilisation and costs between intervention and control at 12 months.
4. To assess the intervention cost-effectiveness compared with control at 12 months
(incremental cost per quality adjusted life years [QALY]) and over the lifetime perspective
(incremental cost per QALY) using a previously developed decision model to estimate future costs
and benefits.
5. To quantitatively and qualitatively explore if the impact of the intervention is moderated by
medical condition, age, gender and socioeconomic status, or ERS characteristics.
6. To quantitatively and qualitatively explore the mechanisms through which the e-coach
intervention may impact on the outcomes.

5. • 2 arms: control and intervention
• 700 per group across three areas (Plymouth,
Birmingham, Glasgow)
• Success…10% increase in those achieving PA
guidelines in 12 months time

6. • Potential Benefits:
– Improved behaviour change outcomes
– Improve schemes run by L3 ERS qualified
– Standardised approach to Behav Change
• Look out for updates…

7. UKActive Summit Update
• Bruce Lockie
– Cornwall Sports Partnership

8. NICE Guidance PH54 - The Context
• 2001 – NQAF Exercise Referral
• 2010 – BHFNC Exercise Referral Toolkit
• 2011 – Start Active, Stay Active
• Let’s Get Moving Pathway
• PH54 replaces PH2 (2006) recommendation 5
“Practitioners, policy makers and commissioners
should only endorse exercise referral schemes to
promote physical activity that are part of a
properly designed and controlled research study to
determine effectiveness”

9. PH54
• Aimed at:
– Primary care practitioners
– Policy makers
– Commissioners
– Practitioners
• Development:
– Systematic review (update)
– Focus Groups
– Interviews
– PHAC

10. What is an ERS?
The scope of the guidelines…
• An assessment involving a primary care or allied health
professional to determine that someone
is sedentary or inactive, that is, they are not meeting
current UK physical activity guidelines.
• A referral by a primary care or allied health professional
to a physical activity specialist or service.
• A personal assessment involving a physical activity
specialist or service to determine what programme of
physical activity to recommend for their specific needs.
• An opportunity to participate in a physical activity
programme.

11. Recommendations
1. Schemes should not be funded for people
who are sedentary/inactive but otherwise
healthy
2. Schemes should only be funded if…
– Incorporates BCTs see PH49
– Collects data
– Makes data available
3. PHE collate local data

12. Behaviour Change Techniques (BCTs)
• Recognise Readiness to Change
• Goals and Action Plans
• Social Support
• Individualised Approach
• Monitoring and Feedback
• Relapse Prevention

13. Collecting Data
• Programme details
• Evaluation details
• Demographics of individual
participants
• Baseline data
• Follow-up data (impact
evaluation)
• Process evaluation

14. Advanced Exercise Referral
• MI
• Stroke
• Chronic Heart Failure
• COPD
• Depression
• CLBP
• Chronic Fatigue Syndrome
• Require L4 instructor
• Outside the scope of
PH54

15. Evidence of Effectiveness
• Few studies since Pavey et al (2011 )
• 1.08 relative risk of participants meeting
CMO recommendations
– 36 people to take part in ERS for 1 of them to be
more active
• Limited medium to long term
• Assessment of activity levels

16. Economic Modelling
• Cost - £217
• ICER - £72k-£113k per QALY (best £31k)
• NICE guidelines
– £20k-£30k QALY not cost effective
• Benefits only PA relative to
CMOs guidelines
• Multiple morbidities not
accounted for

17. Barriers to Success
• Poor referral practices
• Staff Training and intervention fidelity
• Content of schemes

18. Potential for research
• Effectiveness/Cost-effectiveness of different
ExRef schemes
• Factors that effect uptake & adherence
• Sub-groups
• Differences between ERS & other schemes

19. Discussion
• How do you think it might affect your
practice?
• How might it affect those that commission
schemes?
– GPs, CCGs etc
• Sharing best practice

20. Thanks for coming
bjane@marjon.ac.uk
@marjonuniHEPA
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