1. Table 1: Patient BMI data pre and post a 12-week ER programme.
Relationship between patient attendance and completion with BMI after participation in Lincolnshire’s Exercise Referral programme
Henderson, H1. Middleton, G.1 Mullineaux, D.R.1
1 School of Sport and Exercise Science, University of Lincoln, Lincoln, UK.
Introduction
In the promotion of physical activity, Exercise Referral (ER) has a become a popular primary care-based intervention (1). ER is characterised by a health professional initiating the referral of a patient with a ‘condition’, to a third party (typically a gym facility) for a tailored, supervised exercise programme (2). Evidence highlights the benefits of participating in ER for a number of health outcomes (3) however this is reliant on the uptake of the referral and continued participation (1). Reported completion rates vary with one survey suggesting a range from 20 to 90% (4).
In Lincolnshire, the ER is coordinated by Lincolnshire Sport, in collaboration with Public Health Lincolnshire. The partnership provides a county wide approach to delivering ER across all of Lincolnshire’s seven county districts.
The aim of this research, as part of a larger project evaluation, was to evaluate attendance and Body Mass Index (BMI) changes in completers of an ER scheme.
Methodology
Secondary analysis of a multi-site Lincolnshire Exercise Referral database ( ) was conducted. Chi-squared was used to test the association between completing the ER programme (completer or non-completer) and patient attendance (total number of sessions attended). A completer was defined as a patient that attended the final session of a 12-week period, regardless of the number of weeks attended overall. Logistic regression was then used to test the association between BMI and patient attendance.
Results
Out of all patients (6637), 4134 (62.3%) completed the ER programme.
96.7% of completers attended 9 or more weeks (75% of the weeks).
The patients attending less than nine weeks had significantly greater odds of not completing the ER programme (p<0.001), whereas those attending 9, 10, 11 and 12 weeks (odds of 2.6, 7.6, 21.7 and 62.1 times respectively) were more likely to complete (see Figure 1).
There was a significant (p<0.001) decrease in BMI of 1.1 kg/m2 in patients who completed the 12-week programme (32.7±7.0 to 31.6±7.5 kg/m2) (see table 1) however no significant relationship was detected between the overall number of sessions attended and the decrease in BMI (p>0.05).
Table 1: Patient BMI data pre and post a 12-week ER programme.
Pre BMI
Mean ± SD (kg/m2)
Post BMI
Completers (n=4134)
32.7 ± 7.0
31.6 ± 7.5
Non-completers (n=2348)
33.6 ± 7.4
n/a
Figure 1: Weekly attendance in relation to completion of a 12 week ER scheme.
Discussion and Conclusion
Data emphasises the importance of encouraging weekly attendance.
Literature (James et al., 2009; Gidlow et al., 2007) has previously defined a completer as someone who attends the final assessment (regardless of the number of weeks attended), however these current findings go further to suggest that by attending 9 (75%) or more weeks can lead to improved overall completion rates of a 12-week ER scheme.
For those who do complete improved health outcomes are noted, in this instance a reduction in BMI.
Despite this the number of sessions a patient attends seems less important. This was regardless of how many sessions the patient attended overall therefore again, placing emphasis on the completion of the 12-week programme. This also questions the need to record attendance data on a session by session basis.
Importance should be placed on consistent weekly attendance, regardless of the number of sessions a patient can attend each week.
References and Funding
1. Pavey. T., Taylor. A., Hillsdon. M., et al. (2012) Levels and predictors of exercise referral scheme uptake and adherence: a systematic review. Journal of Epidemiological Community Health, 66,
2. National Institute for Health and Clinical Excellence (2006) Four commonly used methods to increase physical activity: Brief interventions in primary care, Exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling. London: National Institute for Clinical Excellence.
3. Pavey. T., Taylor. A.H., Fox. K.R. et al. (2011) Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. British Medical Journal, 343:d6462.
4. British Heart Foundation National Centre (2010) A toolkit for the design, implementation and evaluation of exercise referral schemes. Guidance for referring health professionals, exercise referral professionals and exercise referral scheme commissioners. (accessed 15/08/16)
5. James D., Mills H., Crone D., Johnston L.H., Morris C., Gidlow C.J. (2009) Factors associated with physical activity referral completion and health outcomes. Journal of Sports Sciences, 27 (10),
6. Gidlow, C., Johnston, L.H., Crone, D., Morris, C., Smith, A., Foster, C., James, D.V.B. (2007). Socio-demographic patterning of referral, uptake, and attendance in physical activity referral schemes. Journal of Public Health, 29 (2),
This research was funded by Public Health Lincolnshire and Lincolnshire Sport.