December 2024

Author: Haoxuan Liu1, Sophie Inkpen2, Myles O’Brien3, 4, 5

Affiliation:

  1. Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
  2. Division of Kinesiology, Dalhousie University, Halifax, Nova Scotia, Canada.
  3. Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
  4. Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada.
  5. Geriatric Medicine Research, Nova Scotia Health, Halifax, Nova Scotia, Canada.

Reference: Inkpen SJL, Liu H, Rayner S, Shields E, Godin J, O’Brien MW. [Exercise referral schemes increase Patients’ cardiorespiratory Endurance: A systematic review and Meta-Analysis] Preventive Medicine Reports. 2024; 45-102844.

Take home message
  • Exercise referral schemes involve primary care providers referring patients to qualified exercise professionals.
  • Exercise referral schemes involving supervised exercise programs effectively improve cardiorespiratory fitness, particularly in older adults.
Background
  • Exercise referral schemes involve primary care providers referring patients to qualified exercise professionals for physical activity counselling, exercise prescription, and/or supervised exercise training to promote physical activity and improve health outcomes.
  • Higher cardiorespiratory fitness is associated with lower risks of chronic diseases (e.g., stroke, heart failure, hypertension), reduced mortality, and improved prognosis in individuals with existing chronic conditions. Therefore, cardiorespiratory fitness has become a key target for exercise referral schemes.
How the study was done
  • Five research databases were searched for studies examining the effectiveness of exercise referral schemes from a primary healthcare provider to a qualified exercise professional on patients’ cardiorespiratory fitness.
  • A qualified exercise professional was defined as a person with a recognized certification or a minimum level of educational training (e.g., kinesiology degree).
  • Participants included any adult, with or without a medical diagnosis. Intervention studies with or without a control group (e.g., usual care, no intervention, or alternative forms of exercise referral schemes) were eligible for inclusion.
  • A quantitative meta-analysis was performed to synthesize the results, with subgroup analyses conducted to explore the effects of different characteristics of exercise referral schemes.
What the researchers found
  • The 29 eligible studies were moderate-to-high quality and included 6326 patients (average age: 62 years).
  • Exercise referral schemes interventions improved patients’ cardiorespiratory fitness in 20 of the 29 studies.
  • Exercise referral schemes had a small but significant effect on cardiorespiratory fitness, with an effect size of 0.31 (95% Confidence Interval: 0.09-0.52) compared to control groups.
  • Exercise training was more effective at increasing cardiorespiratory fitness than physical activity counselling.
  • Exercise referral schemes interventions lasting at least 12 weeks consistently led to improved cardiorespiratory fitness.
Conclusion
  • Exercise referral schemes are an effective strategy to improve cardiorespiratory fitness in primary care patients.
  • To achieve greater benefits, exercise referral schemes interventions should include exercise programs spanning at least 12 weeks.