Title: Long-term implementation and effects of the National Exercise Referral Scheme (NERS) in Wales
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background: Physical inactivity is a major cause of preventable illness with heavy costs to the NHS. In Wales, 71% of adults do not meet recommended levels of physical activity. Increasing physical activity among at-risk populations is a Welsh public health priority. The National Exercise Referral Scheme (NERS) has been running since 2007, and was initially implemented in 12 Welsh local authorities with an embedded randomisation process to test effectiveness. NERS was found to be associated with improvements in physical activity for patients at risk of coronary heart disease and with lower levels of anxiety and depression for patients referred for mental health reasons. Little is known about the long-term maintenance of implementation and effects of Exercise Referral Scheme (ERS) after their evaluation. Aim: The study aims to explore and evaluate the long-term implementation and impacts of NERS implementation, combining a study of clinical effectiveness with research to explore issues of sustainability. This research asks: Has NERS been implemented with sufficient and consistent quality across Wales since the trial, and does it have long-term health benefits for patients, by comparison to propensity-matched counterparts? Plan of investigation: An initial review of NERS studies will identify findings and recommendations that have guided implementation. This will inform Phase 1 qualitative research. Phase 1 explores experiences of programme implementation since evaluation and national rollout and issues of consistency and quality. The research comprises interviews with NERS coordinators (n=23) and with exercise professionals (n=2 per area) in 4 purposively sampled case-study areas to explore scheme adherence over a ten year period. Reasons for adherence or failure to adhere to recommendations will be elicited. The study will explore ways that NERS has adapted to different contexts. Phase 2 will capitalise on Wales’ well established health-informatics platform providing long-term follow up of patients at 3- and 5-years. Secondary analysis of NERS data will make use of two routine health datasets; the Patient Episode Database for Wales and The Primary Care GP Database will enable comparative analysis between NERS patients and a propensity score matched sample of nonparticipants (with additional sub-group analysis). Outcomes will include the prevalence/ incidence of co-morbidities, mental health and health service use. Summary of benefits: The research will enable programme developers to better understanding of the types and extent of adaptation that can be made to NERS without jeopardising the needs of stakeholders or long-term benefits. The study will explore the potential for long-term health benefits from NERS and the variation in outcomes between different patient groups and in different localities.


Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE