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Table 2 Articles selected for review of ERS effects on (2) MH disorders

From: The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review

Study

Design

Comparison

Time points

N, age (mean, SD)

Disorder

Length (weeks)

Prescription

Measures

Effect

Outcomes

Anokye, et al. 2011 [42]

Decision analytic model, Quantitative

Retrospective

Completion

N = 701 40–60 years

Mean age = 50

SD = n/a

Mental health Cardiovascular

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.

Chalder, et al. 2012 [48]

RCT, Quantitative

ERS vs. usual care

Baseline

4 months

8 months

12 months

N = 361 18–69 years

Mean = 40.9

SD = 12.5

Mental health

8

Group aerobic exercise classes, 1-4× weekly

BDI 7D PAR

a, b -0.54 p = 0.68

a, b p = 0.08

Increased PA, improved mood. No reduction in antidepressant use in ERS group. A mean 7.2 (SD 4.1) sessions was completed. More people reported increased PA at the follow up in ERS, than those in usual care.

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

Mental health Cardiovascular

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

Mental health Cardiovascular

16

Gym based & 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%.

Littlecott, et al. 2014 [40]

RCT, Quantitative

ERS (N = 1080) vs. control (N = 1080)

Baseline

6 months

12 months

N = 2160 16–88 years Mean = n/a SD = n/a

Mental health Cardiovascular

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.

Murphy, et al. 2012 [41]

RCT, Quantitative

ERS vs. usual care

12 months

N = 2160 16–88 years

Mean = 52

SD = 14.7

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

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

Mental Health Cardiovascular

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 = 46.4

SD = 13.85

Mental health (n = 141) Musculoskeletal (orthopaedic n = 164) Cardiovascular (n = 111) 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.

  1. CVD cardiovascular disease, CHD coronary heart disease, BDI Beck depression inventory, QALY quality adjusted life-year, 7D PAR 7-day physical activity recall scale, IPAQ international physical activity questionnaire, GPPAQ general practice physical activity questionnaire, BMI body mass index, BP blood pressure, HADS hospital anxiety and depression scale, EQ-5D EuroQol 5 dimension, GLTEQ Godin leisure-time exercise questionnaire, BREQ-behavioural regulation in exercise questionnaire, SVS subjective vitality scale, IOCQ important other climate questionnaire
  2. = reductions in scores, = increase in scores, no change
  3. aall comparisons are with baseline value
  4. ball comparisons are with control
  5. -not available in the results
  6. ***p < 0.001, ** p < 0.01, * p < 0.05