Effectiveness of physical activity promotion and exercise referral in primary care: a systematic review and meta-analysis of randomised controlled trials

Problem

Physical inactivity is the fourth leading risk factor for global mortality. Reducing sedentary behaviour and increasing physical activity are efficacious for improving many physical and mental health conditions including cardiovascular disease, type 2 diabetes and depression. Reducing sedentary behaviour and increasing physical activity can also be effective at reducing obesity, however sedentary behaviour and reduced physical activity are also associated with mortality independently. Despite this most adults in the UK do not currently meet the UK Chief Medical Officers’ guidelines for weekly physical activity. As most adults visit their general practitioner at least once a year, the primary care consultation provides a unique opportunity to deliver exercise referral or physical activity promotion interventions. Synthesising the most up to date literature is required in order to gain a better understanding of the most effective methods for supporting patients to participate in more physical activity. This is systematic review of randomised controlled trials for the effectiveness of physical activity promotion and referral in primary care.

Approach

This study is ongoing and is currently at the screening stage. A comprehensive literature search of Embase, MEDLINE (Ovid), Web of Science (Core Collection), SCOPUS, CINAHL, PsycINFO and The Cochrane Library (CENTRAL) has been conducted for studies with a minimum follow-up of 12-months that report physical activity as an outcome measure (by either self-report or objective measures) including an intention to treat analysis. Rayyan software was used to facilitate blind screening. The authors have independently screened papers by title and abstract. On completion authors will independently: screen paper by full text, assess studies for inclusion, appraise for risk of bias and extract data. The quality of the evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) approach. The primary outcome will be participation in physical activity at 12-months. Pooled effects will be calculated using random effects models. The protocol is registered with PROSPERO the international prospective register of systematic reviews, ID CRD42019130831.

Findings

At present the combined searches have returned 13,626 results. After the removal of duplicate records 6,372 unique titles and abstracts remain. These will be independently screened by the authors. The full results of the systematic review and meta-analysis will be reported early next year.

Consequences

This systematic review and meta-analyses will summarise the evidence for the effectiveness of physical activity promotion and referral as interventions for improving physical activity, as well as whether studies using objective measures of physical activity have similar effects to those studies using self-report measures. This knowledge has importance for primary care clinicians, patients and, given the focus of the recent NHS long term plan on preventive medicine, for those making policy decisions.