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Evaluation of the National Exercise Referral Scheme


Exercise referral schemes (ERS) have become increasingly popular as a way of addressing CHD risk and mental health issues. In the primary care context, it has been argued that there is both the contact opportunity and the availability of credible sources of health advice to influence health behaviours (Graham et al, 2005). However, it has been stated that “there is no review level of evidence of effectiveness of exercise referral schemes” (Hillsdon et al, 2004:9) and the majority of reported studies are US based with limited applicability to the Welsh and UK context. In addition, recent NICE guidance states that “practitioners, policy makers and commissioners should only endorse exercise referral schemes…that are part of a properly designed and controlled research study to determine effectiveness” (2006).


It is against this background, that a review of the available evidence and an examination of current policy and practice are being undertaken in Wales. The development of national standards and protocol and the rigorous evaluation of a major policy initiative represent an exciting opportunity to add to a developing evidence base in public health improvement and to contribute to the development of Health Challenge Wales. The Welsh Assembly Government is seeking to invest over £4 million over the next three years to support the evaluation and development of exercise referral schemes in Wales. This investment seeks to determine the effectiveness of exercise referral in improving health and increasing physical activity levels, to look at health economic measures and support existing schemes across Wales who may otherwise have to stop due to current short term funding arrangements.

Aims of Project

CISHE recently won the tender from the Welsh Assembly Government to perform an independent evaluation of this national exercise referral scheme (NERS). The evaluation is being conducted in collaboration with the following partners:

  • General Practices, North Wales Clinical School, Cardiff University,
  • Centre for Economics and Policy in Health, Bangor University
  • Sport, Health and Exercise Sciences, Bangor University
  • Department of Exercise and Health Sciences, Bristol University

The aim of the project is to determine the effectiveness of the NERS as it is rolled out in 13 implementation areas using a randomised control trial design over the next two years. The provisional study design involves a period of piloting outcome measures and developing protocols followed by general practice recruitment in partnership with each area's exercise co-ordinators. Participants (n = ~2400) will be randomised to either a treatment or control group and will complete baseline, 6 month, and 12 month follow-up measures. A detailed process evaluation will also be conducted throughout the trial.


Welsh Assembly Government Health Promotion Division. Evaluation of a National Exercise Referral Scheme (Murphy, S PI with 2 co-applicants) 

Project Value




Additional Information

For further information:

For a full list of projects at the Cardiff Institute of Society, Health and Ethics: