Main contact: Dr Patrick Tobi
Project team: Dr Patrick Tobi (Principal Investigator), Justine Cawley (Co-Investigator), Dr Emee Vida Estactio, Anouchka Seesaghur, Susan Nabingi
Start date: February 2008
End date: September 2008
Project funder: NHS Greenwich and Greenwich Leisure Limited
Background
Since the early 1990s there has been a huge increase in the number of exercise referral schemes in the UK making them one of the most popular forms of physical activity intervention in primary care settings. Exercise referral is the practice of referring patients from primary care to a programme of physical activity supervised by qualified exercise professionals and usually lasting from 10-12 weeks. The objective is to increase opportunities for physical activity by providing access to exercise facilities or activities in the notion that this will encourage long-term change in exercise behaviour. Schemes typically operate as a partnership between the local authority, Primary Care Trust (PCT) and private leisure service providers.
Healthwise is the result of a partnership between Greenwich Leisure Limites (GLL), NHS Greenwich, Woolwich Development Agency (WDA) and the Healthy Greenwich Network (HGN) aimed at raising levels of physical activity in the borough by linking the services of health professionals and leisure providers. Black and Minority Ethnic (BME) groups, in whom levels of physical activity are lower than in the general population, are particularly targeted. The scheme has been operating since 2005 as a subsidised programme aimed at adult residents with existing health conditions as well as those at risk of developing health conditions where physical activity can improve their well being. Over 20 - 26 weeks, participants receive an individually tailored programme and access to a number of classes and courses designed to help them manage and improve their condition. A range of classes are available including group exercise, healthy walks, gym-based sessions, water workouts, and swimming. By January 2008, 3,500 participants had been enrolled onto the scheme. The evaluation was commissioned to generate evidence about the effectiveness of the scheme in sustaining exercise behaviour and shifting patterns of demand on NHS resources in Greenwich over the long term.
Aims
Methods
A mixed methods design was used to implement the evaluation consisting of descriptive and correlational analysis of monitoring data and qualitative interviews with service providers and users. These were complemented with a rapid review of the literature on exercise referral schemes, documentary analysis including review of the results and recommendations of a prior evaluation, and non-participant observation.
Documents/References:
There was no significant change in the BMI of service users who completed the scheme. However, extending the BMI trajectories for completers and non-completers seems to suggest that participation in Healthwise is at least effective in halting a worsening of BMI. However, the data is not so straightforward to interpret as not everyone enrolled on the scheme did so for the purpose of losing weight. Responses from the interviews highlighted other outcomes that indicate benefit. These include a reduction in frequency of visits to GP, a reduction in medications, improved self-assesses health and better social cohesion. The exercise behaviour of service users post-completion is still a grey area and merits further investigation.
Learning from the evaluation has supported NHS Greenwich to make an informed decision on continued commissioning of exercise referral in the borough.
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