Patterning in patient referral to and uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: a data linkage study

Exercise referral schemes have shown small but positive impacts in randomized controlled trials (RCTs). Less is known about the long-term reach of scaled up schemes following a RCT. A RCT of the National Exercise Referral Scheme (NERS) in Wales was completed in 2010, and the scheme scaled up across Wales. In this study, using a retrospective data linkage design, anonymized NERS data were linked to routine health records for referrals between 2008 and 2017. Rates of referral and uptake were modelled across years and a multilevel logistic regression model examined predictors of uptake. In total, 83,598 patients have been referred to the scheme and 67.31% of eligible patients took up NERS. Older adults and referrals for a musculoskeletal or level four condition were more likely to take up NERS. Males, mental health referrals, non-GP referrals and those in the most deprived groupings were less likely to take up NERS. Trends revealed an overall decrease over time in referrals and uptake rates among the most deprived grouping relative to those in the least deprived group. Findings indicate a widening of inequality in referral and uptake following positive RCT findings, both in terms of patient socioeconomic status and referrals for mental health