RT Journal Article SR Electronic T1 Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review JF British Journal of General Practice JO Br J Gen Pract FD British Journal of General Practice SP 979 OP 986 VO 57 IS 545 A1 Nefyn H Williams A1 Maggie Hendry A1 Barbara France A1 Ruth Lewis A1 Clare Wilkinson YR 2007 UL http://bjgp.org/content/57/545/979.abstract AB Background Despite the health benefits of physical activity, most adults do not take the recommended amount of exercise.Aim To assess whether exercise-referral schemes are effective in improving exercise participation in sedentary adults.Design of study Systematic review.Method Studies were identified by searching MEDLINE, CINAHL, EMBASE, AMED, PsycINFO, SPORTDiscus, The Cochrane Library and SIGLE until March 2007. Randomised controlled trials (RCTs), observational studies, process evaluations and qualitative studies of exercise-referral schemes, defined as referral by a primary care clinician to a programme that encouraged physical activity or exercise were included. RCT results were combined in a meta-analysis where there was sufficient homogeneity.Results Eighteen studies were included in the review. These comprised six RCTs, one non-randomised controlled study, four observational studies, six process evaluations and one qualitative study. In addition, two of the RCTs and two of the process evaluations incorporated a qualitative component. Results from five RCTs were combined in a meta-analysis. There was a statistically significant increase in the numbers of participants doing moderate exercise with a combined relative risk of 1.20 (95% confidence intervals = 1.06 to 1.35). This means that 17 sedentary adults would need to be referred for one to become moderately active. This small effect may be at least partly due to poor rates of uptake and adherence to the exercise schemes.Conclusion Exercise-referral schemes have a small effect on increasing physical activity in sedentary people. The key challenge, if future exercise-referral schemes are to be commissioned by the NHS, is to increase uptake and improve adherence by addressing the barriers described in these studies.