A Brief Introduction To Exercise Referral Schemes

What Is Exercise Referral?

Exercise referral schemes help people with specific medical conditions improve their health and wellbeing through physical activity and lifestyle modifications.

Otherwise known as a GP referral, exercise referral schemes were popularised in the mid-1990s to reverse the increasing number of patients who were developing chronic illnesses and other long-term health conditions related to physical inactivity.

According to the National Institute for Health and Clinical Excellence (NICE), exercise referral schemes “direct patients to a local service that offers tailored physical activity programmes to support, monitor, and follow up on the patient’s progress.”

Patients are typically only referred when there is strong enough evidence that their condition can be improved, or at least better managed, through increased physical activity and/or specialist exercise programming.

A History of Exercise Referral Schemes

Exercise referral schemes were introduced in the UK in the 1990s as part of a public health initiative to address rising levels of chronic diseases associated with physical inactivity. Some of those diseases included high blood pressure (hypertension), high cholesterol (hypercholesterolemia), heart disease, strokes, obesity, and mental health disorders.

These schemes were initially operated independently by GPs and other healthcare providers. Naturally, that meant schemes varied in size, scale, and structure, which limited the data that could be collected to determine the effectiveness of exercise referral schemes.

In 2001, the Department of Health published The National Quality Assurance Framework (NQAF) for exercise referral. These guidelines provided formal guidance to help exercise referral scheme organisers raise standards, standardise practice, and formalise the referral and funding process [2].

In 2010, the Department of Health then published a landmark White Paper titled ‘Healthy Lives, Healthy People’ which outlined the government’s public health spending plans [3]. One of the key pledges was to remove the red tape and bureaucracy surrounding the funding of public health initiatives like exercise referral and make access to this type of funding more widely available.

The report read: “For the first time in a generation, central Government will not hold all the purse strings. The majority of public health services will be commissioned by Local Authorities from their ring-fenced budget, or by the NHS, all funded from Public Health England’s new public health budget.”

In 2014, the National Institute for Health and Care Excellence (NICE) published even more specific guidance (Physical Activity: Exercise Referral Schemes, PH54). They recommended that exercise referral schemes should only target ‘high priority’ clients. High priority clients were described as those who were sedentary and had one or more pre-existing health conditions that could be improved through changes in activity levels [4].

This guidance underlined the importance of not referring individuals who were generally healthy, but inactive. PH54 also emphasised the need to tailor exercise programmes to the specific and individual needs of the client, while also incorporating behaviour change techniques and wider lifestyle support.

What Exercises are Prescribed in Exercise Referral Programmes?

Each exercise referral scheme offers different types of exercise and physical activity interventions depending on its stated aim and purpose. For example, schemes that focus on tackling metabolic conditions like obesity and diabetes will have different activities compared to those that are designed to improve respiratory and pulmonary outcomes for patients. Exercise referral schemes generally deliver low-moderate intensity activities according to the patients’ needs and preferences. These activities may include, but are not limited to:

• Yoga and Pilates
• Gym-based exercises
• Chair-based exercise
• Outdoor group walking activities
• Dance and aerobic style sessions
• Water-based exercise
• Adapted sporting activities (seated netball, walking football)

These programmes are also often supported with other ancillary activities, including support with behaviour change, cooking, shopping, and educational workshops.

What Does an Exercise Referral Instructor Do?

Exercise referral instructors are responsible for planning and delivering sessions for their refered clients. However, before any exercise can be delivered, a consultation, appropriate screenings, and physical measurements are undertaken to determine the individual’s suitability for the programme. Common duties include, but are not limited to:

• Conducting a full client risk stratification
• Performing physical and functional assessments with clients
• Designing specialist exercise programmes that deliver tangible results
• Modifying programmes to suit clients’ needs and circumstances
• Developing effective monitoring and evaluation methods to measure success
• Engaging in promotional activities to raise awareness of the scheme
• Deliver training and workshops to referred clients to improve other aspects of their lifestyle (e.g. diet, daily activity, stress, smoking, alcohol consumption)

Exercise referral instructors must have a strong understanding of a myriad of medical conditions, some of which include asthma, arthritis, diabetes, hypertension, stress, obesity, and osteoporosis.

Qualities of an Exercise Referral Instructor

A good exercise referral instructor is patient, empathetic, trustworthy, and genuinely wants to help their clients improve their health.

The majority of people referred to a scheme are deconditioned, have low motivation, and tend to be more vulnerable than the average person.

For these reasons alone, it is clearly not a profession for people who are not willing to build a meaningful connection with their clients.

Any exercise professional wanting to work in a referral setting must be caring and interested in supporting their clients to make a real change to their lives.

How Do You Qualify as an Exercise Referral Instructor?

Those who wish to practice as an exercise referral instructor must hold an appropriate Exercise Referral qualification. The most widely recognised version of this qualification is the Level 3 Diploma in Exercise Referral.

Before qualifying, it is important to check the qualification is certified by a reputable awarding organisation, like YMCA Awards and Active IQ. You should also make sure that the qualification is mapped to CIMSPA’s Professional Standards for Long-Term Conditions. If you would like more information about our exercise referral courses, speak to our Careers Team on 0800 612 4067.

References

[1] Jane B, Downey J. Exercise referral schemes in the UK: mapping provision and aims. J Public Health (Oxf). 2024 Aug 25;46(3):e477-e482. doi: 10.1093/pubmed/fdae057. PMID: 38702841.

[2] Department of Health, 2001. Exercise referral systems: a national quality assurance framework. London: Department of Health.

[3] Department of Health, 2010. Healthy lives, healthy people: our strategy for public health in England. London: The Stationery Office.

[4] National Institute for Health and Care Excellence, 2014. Physical activity: exercise referral schemes (PH54).