Impact of primary care exercise referral schemes on the health of patients with obesity

Abstract

Primary care exercise referral schemes (ERSs) are a potentially useful setting to promote physical activity (PA). It is not established, however, whether interventions to increase PA, such as ERSs, have differing health outcomes according to the participants’ body mass index (BMI). This paper summarizes evidence for the impact of primary care ERSs on the health of people with obesity and reports findings of a reanalysis of the EMPOWER study, providing the first data to report differential outcomes of ERSs by BMI category. Our literature review revealed a paucity of published data. A 2011 Health Technology Assessment review and 2015 update were identified, but normal-weight participants were neither excluded nor were results stratified by weight in the included studies. A study of the effect of exercise referral in overweight women reported a significantly greater increase in PA levels in the ERS group than the control group at 3 months. Reanalysis of the EMPOWER study data showed a significant improvement in PA at 3 months in both obese and overweight/normal BMI groups, with the effect size attenuated to 6 months. There was no significant difference from baseline to 6 months in blood pressure for either BMI category. At 6 months, there was a significant decrease in weight from baseline for the obese category. Comparison of crude mean differences between BMI groups revealed a significant mean difference in PA at 3 months favoring the overweight/normal BMI group, but not at 6 months. There were no further significant differences in unadjusted or adjusted mean differences for other outcomes at follow-up. We report some evidence of a differential impact of ERS on PA by BMI category. However, the effect of ERSs in primary care for patients with obesity remains unclear due to the small number of published studies that have reported outcomes by BMI category. Further research is needed.

Keywords:

• primary care
• exercise referral scheme
• overweight
• obesity

Supplementary material

Medline search strategy

1. “referral and consultation”/

2. ((physical^* or exercise^*) adj2 (superv^* or subsid^* or prescrib^*)).ti,ab.

3. (exercise^* or physical^*).ti,ab.

4. (exercise^* adj2 (fit^* or train^* or activit^* or promot^* or program^* or intervention^*)).ti,ab.

5. (physical^* adj2 (fit^* or train^* or activit^* or promot^* or program^* or intervention^*)).ti,ab.

6. ((physical^* or exercise^*) and referral^*).ti,ab.

7. randomized controlled trial.pt.

8. randomized controlled trial/

9. (random$ or placebo$).ti,ab,sh.

10. ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$)).tw,sh.

11. 1 and 3

12. 2 or 4 or 5 or 6

13. 7 or 8 or 9 or 10

14. controlled clinical trial.pt.

15. (retraction of publication or retracted publication).pt.

16. 13 or 14 or 15

17. (family medicine$ or family practice$ or general practice$ or primary care or primary health care or primary health service$ or primary healthcare or primary medical care or family medical practice$ or family doctor$ or family physician$ or family practitioner$ or general medical practitioner$ or general practitioner$ or local doctor$).ti,ab.

18. family practice/

19. primary health care/

20. physicians, family/

21. community health centers/

22. (community healthcare or community health care).ti,ab.

23. (GP or GPs).ti,ab.

24. general practic^*.ti,ab.

25. 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24

26. (referral^* or promot^* or program^* or intervent^*).ti,ab.

27. 25 or 26

28. 28. Exercise/

29. exercise therapy/

30. 28 or 29

31. 27 and 30

32. 11 or 12 or 31

33. (child^* or adolescent^* or school^* or pediatric^* or paediatric^*).ti.

34. 32 not 33

35. 16 and 34

36. (animals not humans).sh.

37. 35 not 36

38. (“2013 June^**” or “2013 July^**” or “2013 August^**” or “2013 September^**” or “2013 October^**” or “2013 November^**” or “2013 December^** 2014^*” or “2015^*” or ““2016^*”).dp.

39. 37 and 38

40. limit 39 to English language

Acknowledgments

KJ is part funded by the Collaboration for Leadership in Applied Health Research and Care West Midlands. HMP is an NIHR academic clinical lecturer. SB is a Clinical Research Fellow funded by Health Education West Midlands. TB is an NIHR academic clinical fellow. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or the University of Birmingham. The writing of the report and the decision to submit the article for publication rested with the authors from the University of Birmingham.

Disclosure

The authors report no conflicts of interest in this work.