Audit of Exercise Referral Scheme activityin Scotland March 2010

Abstract

Background: Although current guidelines recommend that healthy levels of activity are 30 minutes per day for adults and 1 hour per day for children and young people, there are concerns that these levels are not being met by large numbers of people in Scotland and that greater numbers of sedentary people are found in the lower socioeconomic groups. Research has also found general inequalities in health related to income levels, with higher clusters of ill health within disadvantaged or deprived communities.'Let's Make Scotland More Active' was published in 2003 by the then Scottish Executive and sets out the recommendations for increasing levels of physical activity within the population. Exercise referral schemes (ERS) aim to increase participation in physical activity and, more specifically, aim to treat or prevent ill health in individuals who have, or are at risk of, ill health by encouraging participation in physical activity for the improvement of health and well-being. The majority of schemes offer activity to 'at risk' groups of people as well as the general population via primary care professionals and local service providers. Most schemes also promote the benefits of a healthy lifestyle and encourage long-term adherence to physical activity. The aim of this audit was to identify all exercise referral schemes in Scotland andto provide some basic information on these schemes. Methods: We used a range of methods to identify schemes including contacting leisure centres, GPs, and relevant professionals in health boards, community health partnerships and local authorities. We also used existing contacts and snowballing techniques. We collected and collated the data into an Excel spreadsheet and undertook some descriptive analysis of the data. Results: We identified 49 exercise referral schemes which primarily target primary care populations and a further 13 which primarily target secondary care populations or specific groups. There were 21 large or medium sized exercise referral schemes (all targeting the primary care population), and a further 41 small schemes (e.g. covering a single practice, targeted secondary care populations or only including outdoor activities). Over 80% of the medium and large schemes (n=21) had been in existence for over 5 years. Overall, approximately 70% of the 1014 Scottish general practices have access to an exercise referral scheme with around 60% of local authority leisure centres involved. However, coverage differs by health board and local authority area. Four of the 14 health boards (21%) had almost complete geographical coverage (Greater Glasgow and Clyde, the Western Isles, Ayrshire and Arran and Lanarkshire). Three of the health boards (21%) had no ERS at all - Borders, Shetlands and Orkney. All had had some form of ERS in the past but these had finished. The other eight health boards varied in the coverage, which depended to some extent on the number of local authority areas within the health board area. For example, Lothian Health Board covers four LA areas, three of which have exercise referral schemes. Highland Health Board has two main LA areas; one of which (Argyll and Bute) has an organised exercise referral scheme covering a wide geographical area, whereas the other LA (Highland), has a range of smaller schemes. Many of the schemes were run by local authorities, with funding from NHS sources and used local authority leisure centres. Seventeen out of the 32 local authority areas (53%) had exercise referral schemes which covered the whole of their geographical area, and included most of the leisure centres. Six out of the 32 local authority areas (22%) had no exercise referral scheme aimed at the general primary care population which used leisure centres (two of these LA areas had condition specific schemes only, such as for cardiac rehabilitation patients or those with lower back pain referred by physiotherapists). The other nine LAs had some coverage in their geographical area but it is not complete. For example, Highland LA hasfour small schemes, but these only covered small and very geographically defined areas. Conclusions: Although 49 primary care exercise referral schemes were identified, coverage is not universal and several large geographical areas have no access at all to exercise referral schemes.Three out of the 14 health boards and six out of the 32 local authorities had no such scheme provision. Although over 70% of general practices have access to one or more exercise referral schemes, it was not possible through this audit to ascertain the number of general practices who referred onto such schemes, or the number of referred patients who completed and benefited from such schemes.