Evaluation of the ‘Live Active’ exercise referral scheme

Exercise referral schemes (ERSs) are a common approach to physical activity (PA) promotion in the United Kingdom (UK). They aim to reduce levels of physical inactivity amongst adults with long-term health conditions or risk factors.There are over 600 ERSs in the UK, but the evidence base for their impact is relatively small and equivocal, with further research required to understand if they are effective at increasing levels of health enhancing PA. The overall aim of this thesis was to evaluate the impact of an existing ERS, the ‘Live Active’ scheme, at increasing PA levels and improving health outcomes in its participants. This was achieved through four studies, which i) explored engagement levels with the scheme, and if any characteristics could predict engagement; ii) identified the medium to long-term PA behaviour and health outcomes of participation, and if they differed by primary referral condition; iii) determined the perceived benefits of participation in the scheme, and; iv) identified short-term changes in accelerometer-measured PA and sedentary behaviour, and determined how these outcomes compared with self-report. These studies demonstrated that the ‘Live Active’ ERS was successful at engaging participants, increasing long-term PA levels and improving health holistically. Firstly, uptake and adherence to the ERS were higher than expected, and were associated with a small number of factors such as season and smoking status. Analysis of secondary data identified long-term improvements in PA level and a range of health-related outcomes. However, the extent of improvement differed depending on a participant’s primary referral condition. Accelerometer-based measurement of PA demonstrated meaningful, but non-significant, increases in short-term PA. Discrepancies were also found between accelerometer-measured and self-reported PA and sedentary behaviour, the implications of which are discussed. Lastly, mixed methods exploration of the benefits of participation identified a wide range of holistic benefits. Many of the benefits reported qualitatively were not routinely evaluated by the scheme, or included in previous quantitative ERS evaluations. This highlighted that evaluating this scheme based solely on its routine quantitative outcomes would have underestimated the effectiveness of the intervention. Therefore, the findings of this thesis have identified methodological considerations for how ERSs are evaluated in the future, and whether the content of ERS evaluation frameworks provide a framework for a balanced appraisal of schemes