HEALTH PROMOTION

DEVELOPMENTS & OPPORTUNITES FOR EXERCISE PRESCRIPTION

This article is the first in a series focussing on issues in exercise prescription.

The concept of exercise referral or exercise on prescription is riddled with problems ranging from legal concerns of responsibility, little controlled research proving effectiveness and a severe lack of funding. But despite these problems schemes continue to proliferate.

At the last organised count in 1996 there were around 200 independent schemes being run in the UK. More recent but less formal figures suggest that double this number are now alive and well.

The result is that the subject has become too dangerous to ignore and the legal implications of who is responsible for the welfare of exercisers in these schemes is an issue of considerable concern to GPs.

In January the Health Education Authority (HEA) published a review of exercise schemes entitled `Effectiveness of physical activity promotion schemes in primary care’. Just a month later a consultation paper on exercise referral

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schemes commissioned by the Department of Health was published.

The Quality Assurance Framework, which is expected to be published later this year, will provide guidelines for best practice and best value within the whole system of referral from the selection of patients to recommendations on exercise programmes, long-term follow-up and advice on medico-legal issues.

In March the first National Convention on Exercise Referral took place and was attended by over 130 people.

This sudden burst of regulatory activity has come not a moment too soon for the enthusiasts of exercise prescription, also commonly referred to as GP referral schemes. Nearly 16 years after the first official project was developed, heads are emerging from the sand to help provide solutions to the key problems that continue to hinder these popular projects.

Health Education

Authority Review The purpose of the HEA review was to estimate the effectiveness of schemes in

promoting increased activity and evaluate the impact these schemes had on participants.

The findings, which were based on a thorough review of papers, case studies and documentation from scheme managers, revealed that while evaluation has been taking place in schemes very little stands up to rigorous scientific interrogation. Most neglect to take account of the psychological and social impact of schemes which appears to be one of the most successful aspects of projects.

None of the schemes included models of behaviour change to evaluate the readiness and therefore adherence of potential scheme participants. But all the case studies revealed that projects had a considerable positive impact on the adhering participants and more unexpectedly on staff involved in the scheme including sceptical GPs.

The results of the review have resulted in a set of recommendations for both the design and implementation as well as the evaluation of schemes (see boxes 1 & 2).