How Exercise Referral Schemes Can Improve Health and Wellbeing Outcomes

Introduction

People who are referred to exercise referral schemes are 12% more likely to achieve 150 minutes of exercise compared to those who are not involved in a scheme [1]. That’s according to a National Institute for Health Care and Excellence (NICE) study which outlines the profound impact exercise referral schemes can have on public health.

However, more recent studies have demonstrated that referral schemes might not be
so effective in their prescription. On average, 17 sedentary people need to be referred to a scheme for just one to become independently active – likely the result of poor participation and compliance rates [2].

While more research on the long-term adherence and success of exercise referral schemes is required, there is simply no denying that exercise can help people living with chronic diseases improve or better manage their condition.

How Exercise Can Improve Health and Wellbeing Outcomes

As Benjamin Franklin so eloquently explained, “an ounce of prevention is worth a pound of cure.” In fact, the effects of exercise can be likened to that of a drug, because if the wrong exercises are prescribed, the consequences can potentially be fatal.

Conversely, exercise has a potent and positive effect on many chronic illnesses and diseases. Physical activity can improve the extent to which a person’s medical condition limits their quality of life and level of independence. Theoretically, people who exercise regularly are far less likely to require ongoing medical attention or support from clinical staff (e.g., doctors, specialist nurses, occupational therapists, or physiotherapists).

Studies consistently show that those who exercise for a minimum of 20 to 30 minutes per day are less likely to develop a long-term condition or chronic illness compared to those who are sedentary. Similarly, people who are already managing one or more of these conditions are likely to experience marked improvements in their health, often to a greater extent than the use of medication alone.

What Role Can Exercise Referral Schemes Play in Improving Health and Wellbeing?

Exercise referral schemes give patients living with long-term health conditions the opportunity to work with a qualified exercise referral instructor to explore the most appropriate and effective type of exercise based on their individual needs, goals, preferences, and medical history.

When the right exercises are prescribed at the right volume and intensity, many people with long-term conditions describe the effects of exercise as being somewhat liberating. It is also well-documented that physical activity can relieve many mental health symptoms that are so commonly associated with long-term chronic illness.

On the flip side, unstructured exercise often results in lower levels of motivation and adherence, because good habits tend to be stacked on top of each other. This approach also typically results in a greater risk of injury and lower levels of compliance.

So, what difference can exercise referral schemes make in helping to reverse the UK’s current physical inactivity and health epidemic? And how can the correct volume and intensity of exercise help people better manage their long-term health conditions?

Below, we discuss the different modes of exercise that can benefit people living with specific long-term conditions:

This information illustrates just some of the benefits. It is NOT intended to be an all-encompassing guide.

Cardiovascular Conditions

Hypertension – Regular exercise helps strengthen the heart, reduces stress hormones (especially cortisol), and keeps blood vessels healthy by improving their ability to dilate and constrict. This helps lower blood pressure and improve general cardiovascular health.

Hypercholesterolemia – Cardiovascular training can help reduce triglyceride and LDL cholesterol profiles in the blood. Evidence also demonstrates that resistance training improves resting metabolic rate, resulting in increased energy expenditure even at rest, which can help people with hypercholesterolemia better manage their weight.

Respiratory Conditions

Asthma – Exercise strengthens breathing efficiency, respiratory muscles, and aerobic capacity to help those living with asthma improve and better manage their symptoms.

Chronic Obstructive Pulmonary Disease (COPD) – Moderate exercise for patients with COPD can improve lung function, exercise tolerance, and symptoms of dyspnoea (breathlessness). Low-moderate intensity aerobic exercise should be encouraged for all COPD patients – regardless of how low intensity that exercise is.

Neuromuscular Conditions

Parkinson’s disease – Controlled physical activity can improve everything from motor control, balance, and coordination – all of which help reduce tremors and rigidity that are associated with Parkinson’s disease. Exercise can also improve mobility, which makes daily activities easier, safer, and generally more manageable.

Multiple Sclerosis – There is some evidence suggesting exercise improves coordination and reduces the severity of MS symptoms, especially with fatigue and low mood. Physical activity also helps to maintain muscular strength, preventing muscle atrophy. Programs should be customised to each patient’s specific needs and abilities while avoiding overexertion given that fatigue and stress can worsen symptoms.

Musculoskeletal Conditions

Osteoarthritis – Moderate exercise helps to increase joint mobility, reduce stiffness, and can alleviate pain arising from the affected joints. Regular low-impact physical activity such as swimming or walking can also have a profound impact on joint mobility. Swimming is often beneficial for arthritis patients because it is non-weightbearing, although those who have had hip joint replacement surgery must proceed with care.

Osteoporosis – Weight-bearing exercises such as walking or strength training can improve bone density and slow the progression of osteoporosis. Regular exercise also helps with balance and coordination which may help reduce the risk of falls and fractures.

Rheumatoid arthritis – Activity and movement is effective at easing joint inflammation because it helps improve fluid dynamics and circulation to joint tissues. Regular exercise also helps preserve strength by reducing the load on joints affected by rheumatoid arthritis.

Simple mechanical back pain – Core stability training and flexibility exercises can help strengthen and lengthen the areas surrounding the irritated low back tissues, although it is crucial that the right muscles are lengthened/strengthened. The primary aim of physical activity for patients with simple mechanical back pain is to increase exercise tolerance and prevent further pain. Interestingly, physical inactivity can make back pain worse in some cases, so it is important for individuals with back pain to remain active.

Psychological Conditions

Depression – Research suggests that exercise can actually be equally as effective as antidepressants at reducing depressive symptoms. Being physically active can elevate mood, reduce stress, and release endorphins that improve overall sense of wellbeing.

Anxiety – The benefits of exercise for those who are stressed are much the same as those for depression. Physical activity often helps people better manage their adrenal and cortisol responses from stressful situations. It can also provide a much-welcomed ‘escape’ and distraction for people.

Before any exercise programme is implemented, every exercise referral instructor must make sure their patient’s safety is prioritised. That means completing a comprehensive screening and risk stratification process, as well as reviewing their medical condition(s), injury history, medication, and a number of other lifestyle factors and considerations.

Exercise referral instructors are also likely to consult with clients presenting more than one controlled medical condition (multi-morbidity), and as such, will need to consider the wider range of risks associated with participation in physical activity. In these circumstances, referral instructors should prioritise the medical conditions presented in order of risk. For example, cardiovascular conditions like hypercholesterolemia and hypertension must take priority over musculoskeletal conditions such as back pain.

If you want to find out how to become an exercise referral specialist, our complete exercise referral guide has everything you need to know. You’ll learn how to qualify, how much you could earn, and what job opportunities are available.

If you are considering becoming an exercise referral instructor, head to our exercise referral course page where you will find all the information and advice you need to become a qualified exercise referral specialist.

References

[1] Campbell, F., Holmes, M., Everson-Hock, E., Davis, S., Woods, H. B., Anokye, N., & et al. (2015). A systematic review and economic evaluation of exercise referral schemes in primary care: A short report. Health Technology Assessment, 19 (60). https://doi.org/10.3310/hta19600

[2] Williams, N. H., Hendry, M., France, B., Lewis, R., & Wilkinson, C. (2007). Effectiveness of exercise-referral schemes to promote physical activity in adults: Systematic review. British Journal of General Practice, 57 (545), 979–986. https://doi.org/10.3399/096016407782604866