The effectiveness of exercise referral schemes on patient health and their cost: an umbrella review

Exercise referral schemes (ERS) involving referrals from primary care providers to exercise programs and professionals may be a useful strategy for helping patients lead more active lifestyles. We performed an umbrella review to determine the impact of ERS on patient activity/fitness, clinical outcomes, and their cost-effectiveness. The review was pre-registered in Prospero (CRD42023443094) and conducted in July 2023. PRISMA reporting was followed. Our umbrella review screened 2129 citations with 12 studies meeting our inclusion criteria (n = 8 meta-analyses) that included 110 unique individual studies of 62 815 unique participants. The average study quality was 8.9 +/- 1.9 (out of 11). Studies examined patient physical activity or fitness (n = 9/12), a clinical outcome (n = 8/12), and/or cost-effectiveness (n = 4/12). Earlier reviews observed that physical activity or fitness was unchanged following ERS, but more recent (post-2015), larger sample size studies observe low-to-moderate improvements. Recent reviews reported that ERS lowered blood pressure, body mass index, and depression. ERS cost-effectiveness was conflicting. Altogether our umbrella review of high-quality reviews with a low risk of bias demonstrated that although early work indicated null effects, more up-to-date reviews of ERS observe improved patient activity/fitness, cardiometabolic, and mental health. ERS are an effective strategy to improve patient health.