Characteristics of the local ERS involved in the study
| South West England (predominantly Plymouth) | West Midlands (Birmingham) | Greater Glasgow and Clyde (GGC) Health Board Area | |
| Population of city/locality and general characteristics | 264 000 93% White British. Average age is 39 years. Plymouth has higher than average levels of poverty and deprivation (26.2% of population among the poorest 20.4% nationally). Life expectancy, at 78.3 years for men and 82.1 for women, is the lowest of any region in the South West of England. | 1 244 438 White British (53.1%), Pakistani (13.5%) and Indian (6%). Birmingham is ranked the sixth most deprived local authority in the UK. Approximately 40% of the population lives in highly deprived areas. The average life expectancy in Birmingham is 77.1 years for males and 81.9 years for females. | 1 161 370 GGC is the largest health board in the UK, comprising six local authority areas: 92.5% white, 5.3% Asian, Asian Scottish or Asian British, 1.2% African, 0.2% Caribbean or black, 0.4% mixed, 0.4% other. There is large variation in deprivation across GGC, but as a whole, it experiences higher than average levels of deprivation and poverty (34.4% population among the poorest 12.4% national average). Life expectancy at 74.9 years for males and 80.0 years for females, is the lowest in Scotland. |
| Number of centres/facilities where referrals are made to in the ERS | One main ERS run by Everyone Active in Plymouth and two smaller ones in rural locations. Referrals for ERS came from 31 local GP practices. | One main ERS, Be Active Plus run by Birmingham City Council Wellbeing Service. Referrals for ERS came from 286 local GP practices. | One main ERS (Live Active) delivered by six local leisure trusts in six local authority areas of GGC (Glasgow, East Renfrewshire, Renfrewshire, East Dunbartonshire, West Dunbartonshire and Inverclyde). Referrals are possible from any health professional in primary and secondary care. |
| Weeks, sessions and general details about ERS | Schemes vary from 6 to 12 weeks, attendees should commit to a minimum of two sessions/week in the gym with drop-in swimming, aquafit and gentle exercise group sessions available to all. All ERS referrals are risk assessed as low or medium risk. Those classed at medium risk may only attend a supervised session. Additionally, a ‘walking for health’ scheme is highlighted by one ERS provider. | Patients meet with a health and fitness advisor to discuss their preferences for physical activity and an individually tailored 12-week exercise programme is designed for them. Activities include the use of gyms, swimming, fitness classes, badminton and table tennis. The gyms are local authority or privately owned. Privately owned gyms are obliged to offer their facilities to Be Active Plus participants. Patients are also told about activities such as the use of parks and open spaces in Birmingham and walking to work, etc. Participants are also contacted after 3 and 6 months and a report is sent to their GP at their 12-week exit interview. | Patients meet with an ERS advisor for behavioural change support and to design a suitable physical activity plan. Patients are given information on a variety of physical activity options including those offered by leisure centres (eg, fitness classes, swimming, gym, etc) as well as health walks, home exercise, active travel, apps, etc and are able to offer specialist guidance on activities suitable for those with medical conditions and/or disabilities. Patients assessed as high risk at referral are screened by a cardiologist prior to being accepted to the scheme. There are fixed contact points of 1, 3, 6 and 12 months, but patients can choose how often they wish support (telephone, email or face-to-face) from the advisor in addition to these over a 12-month period. |
| Cost for patients in ERS (if applicable) | Costs vary related to age/concessions. 3 months ERS costs between £14.90 and £70 inclusive of all activities. Pay as you go: £2.10–£3.50 per session. | Patients are not charged for their assessment and support by the health and fitness advisor. The costs of the programme depend on chosen activities and leisure centre attended. Patients in receipt of state benefits or tax credits are eligible for a Passport to Leisure which entitles them to a 30% discount on most activities offered at Birmingham City Council run leisure centres, well-being centres and swimming pools. They can attend free Be Active sessions which take place at restricted times in leisure centres. | Live Active behavioural support is free to the patient for 12 months. If patients wish to use leisure facilities, they are entitled to access this at a concessionary rate (usually around 30% reduction). |
| Number of people referred to local ERS from 1 August 2015 to 31 March 2017 (ie, during the recruitment period of the study) | 300 | 3470 | 6500 |
| Most common primary reason for referrals (1 August 2015 to 31 March 2017)* | Depression/anxiety/stress: 24% | BMI>30: 28% | BMI≥30: 58% |
↵*The data on primary reason for referral are subjective as many patients have multiple conditions and a practitioner may favour recording one condition (eg, obesity) rather than another (eg, low mood). Within the respective schemes, the quality of recording the referral reason also appears to be variable.
BMI, body mass index; ERS, exercise referral scheme; GP, general practitioner.