HEALTH PROMOTION

RECRUITMENT STRATEGIES FOR EXERCISE PRESCRIPTION

By Dr Melvyn Hillsdon

Despite a large body of evidence sup- porting the many health benefits of physical activity and the high prevalence of inactivity, little research exists on effective ways to increase the amount of physical activity that people do.

A systematic review of physical activity interventions identified only 17 studies, only two of which were from England. Of the studies identified, successful out- comes were associated with informal home-based physical activity of moderate intensity, usually walking, with regular support from health professionals. Another review focused on interventions in primary care settings which in England have become increasingly popular (1). The review found that advice from a doc- tor to increase physical activity can have an effect but only in the short term.

In 1994, 157 primary care based physical activity promotion schemes were identi- fied and recent estimates suggest there are now more than double this number. The most common form of primary care scheme involves GPs identifying patients who would benefit from increased physi- cal activity during routine visits and then providing them with an exercise prescrip- tion to be undertaken at a local

leisure centre. Presenting the prescription at the leisure centre usually entitles the holder to 10-12 weeks of exercise at little or no cost.

Scheme weaknesses Both the review of 1994 and a more recent one have highlighted the lack of rigorous evaluation as an important char- acteristic common to the majority of schemes (2). Despite this, ‘exercise on prescription’ schemes are now promoted by the government in the policy docu- ment ‘Saving Lives: Our Healthier Nation’.

A major limitation of these schemes has been their inability to recruit those most at risk from a sedentary way of life, and therefore with most to gain from increased activity. Not only is it impor- tant to have effective interventions at our disposal but we must also be able to expose sufficient numbers of a target pop- ulation to those interventions.

Target groups Observational studies and computer simu- lations of different interventions have suggested that the greatest health gain from increased physical activity would be achieved by targeting sedentary, middle aged men. It has also been estimated that interventions

aimed at this target group would be the most cost-effective. In addition, recruit- ment rates for primary care physical activ- ity interventions have been shown to be the most important variable influencing the cost-effectiveness of such interven- tions in terms both of absolute numbers, as well as which people are recruited.

Recruitment approaches This article reviews three different approaches to recruiting people into pri- mary care exercise interventions and their ability to recruit those with most to gain.

1. Opportunistic recruitment

RESEARCH EVIDENCE ‘Exercise on prescription’ schemes normal- ly depend on GPs to recruit patients dur- ing routine practice. Studies of doctors and nurses’ knowledge of the benefits of physical activity suggest that they may not be sufficiently informed to identify the most suitable patients. In one scheme the most common reasons for referral were overweight and stress relief, with 73% of those receiving a prescription being female. Only 5% of referrals were for lack of exercise. Others have observed the very low referral rate when GPs are

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