“You’ve Got to Pick Your Battles”: A Mixed-Methods Investigation of Physical Activity Counselling and Referral within General Practice

One in four people say they would be more active if advised by a general practitioner (GP), yet 72% of GPs do not discuss physical activity (PA) with patients and 80% of GPs are unaware of the PA guidelines. The aim of this study was therefore to investigate GP perspectives on PA counselling and referral and interpret these within the context of the socio-ecological model (SEM). Fifty-six GPs completed an online survey to investigate factors influencing PA counselling and referral. Semi-structured interviews were then conducted with seven GPs to explore topics in more depth. Interview data were analysed thematically and mapped to the SEM. GPs were more likely to discuss PA with patients if they were physically active themselves (p = 0.004). Influences on PA counselling and referral were identified at the policy (provision of education, priority), organisational (feedback, e-referral), interpersonal (PA as everybody’s business, patient factors) and intrapersonal (knowledge, GP PA levels) levels of the SEM. Multi-level strategies are required to help GPs promote PA and make use of exercise referral schemes, including making PA a strategic priority, introducing systems for feedback from referrals, and involving other members of the care team in PA counselling and referral

Exercise on Referral – Symposium hosted by the Physical Activity Special Interest Group of the Wolfson Research Institute for Health and Wellbeing, Durham University

THE Physical Activity Special Interest Group of the Wolfson Research Insti- tute for Health and Wellbeing (Durham University) hosted a symposium focused on exercise referral schemes (ERS), on 14 October 2016 at the College of St Hild and St Bede, Durham. Exercise referral schemes typically allow health professionals, such as general practitioners, nurses and physiotherapists to refer inactive individuals with long-term health conditions to a third party leisure provider for a supervised exercise programme, with the aim of increasing physical activity levels. The symposium was lively and thought-provoking with pres- entations divided into two core themes: ‘Emerging Evidence for ERS’ and ‘Future Developments for ERS’

Cardiac rehabilitation meta-analysis of trials in patients with coronary heart disease using individual participant data (CaReMATCH): Project protocol

Background: Exercise-based cardiac rehabilitation (CR) has long been a cornerstone in the secondary prevention of coronary heart disease (CHD). Despite meta-analyses of randomised trials demonstrating a positive impact of CR on cardiovascular mortality, hospitalisation, exercise capacity and health related quality of life, the impact of CR on all-cause mortality remains uncertain, especially in the context of contemporary clinical practice. This CR meta-analysis of trials in patients with coronary heart disease using individual participant data (IPD) (CaReMATCH) seeks to (1) provide definitive estimates of the effectiveness of CR in terms of all-cause mortality, cardiovascular mortality, hospitalisation and health-related quality of life, and (2) determine the influence of individual patient characteristics (e.g. age, sex, risk factors) on the effectiveness of CR to inform a personalised CR-approach. Methods: Randomised controlled trials will be identified that were performed in the last decade, to ensure that CR was performed in combination with contemporary medical care (2010–2020). For our first aim, outcomes of interest include all cause- and CVD-related mortality and hospitalisations. To answer our second research question, we will collect data on exercise capacity, health-related quality of life, and patient baseline demographic and clinical data. Original IPD will be requested from the authors of all eligible trials; we will check original data and compile a master dataset. IPD meta-analyses will be conducted using a one-step meta-analysis approach where the IPD from all studies are modelled simultaneously whilst accounting for the clustering of participants within studies. Discussion: Findings from CaReMATCH will inform future (inter)national clinical and policy decision-making on the (personalised) application of exercise-based CR for patients with CHD

Facilitators and challenges in delivering a peer-support physical activity intervention for older adults: a qualitative study with multiple stakeholders

Background:Involving peer volunteers in intervention delivery can provide social support and improve adherence. Whilst such interventions have the potential to reduce physical activity (PA) intervention costs, little is known about the process of delivering them in practice. This qualitative study explored the facilitators and challenges of delivering a peer-support PA intervention for older adults, with a view to making recommendations for the delivery of future interventions.Methods: Data were collected via (7) semi-structured interviews and a focus group with stakeholders involved in a peer-support PA intervention for older adults in a large city in the North-West of England. Participants included local authority staff (n = 3), peer volunteers (n= 2) and service users (n = 7). Audio data were transcribed verbatim and thematically coded to identify perceived facilitators and challenges.Results:Facilitators to delivery included social interaction, community referral pathways, suitable facilities, peer volunteers and high-quality instructors. Challenges surrounded inconsistent practice, staff capacity, safety and accountability, and awareness raising.Conclusions:Peer volunteers can provide an additional support mechanism alongside qualified instructors for increasing social interaction within PA interventions. For optimal intervention delivery, consideration needs to be given to equipment and space, safety and accountability and consistency of practice