Table 1 Articles selected for review of ERS effects on (1) CV disorders

Anokye, et al. 2011 [42]

Decision analytic model, Quantitative

Retrospective

Completion

N = 701

40–60 years

Mean age = 50

SD = n/a

Cardiovascular Mental health

12

Gym based exercise, 2× weekly

QLAY

⇑ 51–88% cost-effective

ERS is associated with modest increase in lifetime costs and benefits. Cost-effectiveness of ERS is highly sensitive to small changes in the effectiveness. ERS cost is subject to significant uncertainty mainly due to limitations in clinical effectiveness evidence base.

Duda, et al. 2014 [25]

RCT, Quantitative

ERS SDT (N = 184) vs. Standard ERS (N = 163)

Baseline

3 months

6 months

N = 347 30–65+

Mean = n/a

SD = n/a

Cardiovascular Mental health

10–12

Gym based exercise, 2× weekly

7D PAR

BP (mmHg)

BMI (kg/m²)

Weight (kg)

HADS anxiety

HADS depression

⇑^a 120 ***

⇔^a

⇓^a − 0.24*

⇓^a -0.77*

⇓^a-0.24

⇓^a-0.47*

Standard ERS: No sig. Changes in BP, but reductions in weight and BMI (reduced sig. at 6 months compared to baseline). 3 months’ follow-up: increase of 187 min (from baseline) in self-reported moderate/vigorous PA. 6 months’ follow-up: increase of 120 min. Sig. reduction in HADS depression scores, no sig. Diff. in anxiety.

SDT-ERS: 3 months’ follow-up: increase of 196 min in self-reported moderate/vigorous PA compared to baseline. Sig. improvements in HADS anxiety and depression scores. 6 months’ follow-up: No sig. Diff. from baseline to 6 months’ in BP, BMI or weight. Increase of 114 min in self-reported moderate/vigorous PA. Sig reduction in HADs anxiety and depression.

Edwards, et al. 2013 [24]

RCT, Quantitative

Between time points

Baseline

6 months

12 months

N = 798

16+ years

Mean = n/a

SD = n/a

Cardiovascular Mental health

16

Gym based exercise & exercise classes, 1–2 x weekly

EQ-5D Adherence

⇑^a

⇑^a

Participants with risk of CHD, were more likely to adhere to the full programme than those with mental health conditions/combination of mental health and risk of CHD. Those living in areas of high deprivation were more likely to complete the programme. Results of cost-effectiveness analyses suggest NERS is cost saving in fully adherent participants. Adherence at 16 weeks was 62%.

Hanson, et al. 2013 [44]

Observational cohort study, Quantitative

Between time points

Baseline 12 weeks Completion

N = 2233

Mean = 53

SD = 15.9

Cardiovascular

24

Gym based exercise, 2× weekly

GLTEQ Adherence

⇑^a***

⇑^a***

ERS was more successful for over 55 s, and less successful for obese participants. Completers increased PA at 24 weeks. Leisure site attended was a significant predictor of uptake and length of engagement. Uptake n = 181, 12-week adherence n = 968, 24-week adherence n = 777.

Littlecott, et al. 2014 [40]

RCT, Quantitative

Between time points and ERS vs. usual care

Baseline

6 months

12 months

N = 2160

16–88 years

Mean = n/a

SD = n/a

Cardiovascular Mental health

16

Group aerobic exercise sessions, 2× weekly

Adherence BREQ

⇑^a, ⇓^b

⇑^a

Improved adherence and improved psychosocial outcomes. Significant intervention effects were found for autonomous motivation and social support for exercise at 6 months. No intervention effect was observed for self-efficacy. Greatest improvements in autonomous motivation observed among patients who were least active at baseline. Individuals with CHD risk in the control group participated in more PA per week than those in the intervention group with CHD risk factors.

Mills, et al. 2013 [45]

Observational cohort study,

Mixed method

Prediction of completion

Baseline

N = 1315

31–68 years

Mean = 54

SD 12.4

Cardiovascular

26

Group, 1-to-1, gym, studio, swimming, 1–2 x weekly

BP (mmHg) Body mass (kg) Adherence

⇓^a 1.87***

⇓^a 3.541***

⇑^a

Increased confidence and self-esteem. Link between age and attendance. Increased age, increased likelihood of adherence. 57% completed scheme, 33% achieved weight loss, 49% reduced BP. Those with CVD, more likely to attend and adhere, compared to pulmonary disorders.

Murphy, et al. 2012 [41]

RCT, Quantitative

ERS vs. usual care

12 months

N = 2160

16–88 years

Mean = 52

SD = 14.7

Cardiovascular (N = 1559) Mental Health (N = 522)

16

1-to-1, aerobic and resistance exercise, 1–2 x weekly

7D PAR

Adherence

HADS depression

HADS anxiety

⇑^b 1.19*

⇑^{a, b}1.46*

⇓^a − 0.71*

⇓^a − 0.54

Increase PA observed among those randomised to ERS intervention compared to usual care, and those referred with CHD only. For those referred for MH alone, or in combination with CHD, there were sig. Lower levels of anxiety/depression, but no effect on PA.

Rouse, et al. 2011 [46]

Exploratory, Quantitative

SDT theory based program

Baseline

N = 347

Mean = 50.4

SD = 13.51

Cardiovascular Mental Health

12

Gym based exercise sessions, 1× weekly

IOCQ BREQ-2 SVS HADS

⇑^a

⇑^a 0.24 **

⇑^a 0.17 *

⇓^a **

Autonomy support increased intrinsic motivation. Autonomous motivation was positively associated with vitality and PA intentions. Those who scored high on HADS, had high scores for PA intentions. Regression analyses revealed that the effects of autonomy support on mental health and PA intentions differed as a function of who provided the support (offspring, partner or physician), with the offspring having the weakest effects. Autonomy support and more autonomous regulations led to positive mental health outcomes.

Tobi, et al. 2012 [43]

Retrospective, Quantitative

Adherers vs. non-adherers

13 weeks Completion

N = 701

Mean age = 46.4

SD = 13.85

Cardiovascular (n = 111) Musculoskeletal (orthopaedic n = 164) Mental health (n = 141) Respiratory (n = 34) Other (n = 23) Metabolic (n = 228)

20–26

1-to-1, aerobic and resistance exercise, 1–2 x weekly

Adherence (DV) BMI (kg/m²) BP (mmHg)

⇑^b **

^-

^-

Longer term schemes increased adherence. Longer-term adherence was found for increasing age and medical condition. For every 10-year increase in age, the odds of people continuing exercise increased by 21.8%. Participants referred with metabolic conditions were more likely to adhere than those with orthopaedic, CV and other disorders. Longer-term schemes offer the opportunity to maintain adherence to exercise.

Webb, et al. 2016 [47]

Evaluation, Quantitative

NERS vs. community-based exercise vs. continuously monitored exercise programme

Baseline Completion

N = 107 Mean = 44.6 SD = 11.4

Cardiovascular

8

Group exercise sessions, 2× weekly

IPAQ (min/week) BMI (kg/m²) Systolic BP (mmHg) Diastolic BP (mmHg) Adherence

⇑^{a, b} 540***

⇓^{a, b} 0.4 + 0.1**

⇓^{a, b} -6.1 + 2.6*

⇓^a -0.6 + 1.8

⇑^b *

CV health benefits were observed in all three interventions. CV health benefits achieved in laboratory based studies were achieved in ERS settings. BMI had bigger reductions in NERS compared to the other two conditions. Systolic BP and Diastolic BP were also reduced more in NERS compared to the other two conditions.