PHYSICAL-ACTIVITY PROMOTION THROUGH PRIMARY HEALTH-CARE IN ENGLAND

Background. There is increasing research supporting the argument for a beneficial link between physical activity and health maintenance and, in the past five years, this has led to a growth in physical activity promotion schemes involving primary health care. Aim. To document and critically examine the extent and nature of physical activity promoti on in general practice in England. Method. A postal survey to all fami ly health services authorities and primary care facilitators was condu cted to identify existing and planned activity promotion schemes invol ving primary health care. Telephone interviews with leaders from 50 se lected schemes and further detailed case studies of 11 schemes provide d descriptive information of the nature of physical activity promotion . Results. The initial phase revealed 157 existing schemes and a furth er 35 planned schemes. Two basic models of physical activity promotion were identified that were distinguishable by the primary location of the management of the patient. Practice-managed interventions (32%) in volve on-site counselling to change the behaviour of patients. Leisure centre-managed projects (68%), sometimes termed 'exercise by prescrip tion' or 'general practioner referral for exercise' schemes, involve t he identification of suitable patients and their referral to 10- to 12 -week-long leisure centre based exercise induction courses. The projec ts in the planning stage were all of the latter type, indicating this as the favoured model. Although such schemes were generally successful in attracting patients, in all cases they involved less than 1% of th e patient base from which they were drawn. Conclusion. There is eviden ce of successful recruitment, increased short-term physical activity a nd fitness, and improvements in the well-being of patients. However, s chemes are inadequately resourced for rigorous long-term evaluation; t herefore, conclusions regarding the cost-effectiveness of the two mode ls are not possible.