Public Release: 

Would web support be good for patients in an exercise referral scheme?

University of Plymouth

E-coachER - useful web support for patients in an exercise referral scheme with long-term physical and psychological conditions?

The GP exercise referral scheme (ERS) is an established method whereby doctors can 'prescribe' exercise to patients with medical conditions such as obesity, hypertension, type 2 diabetes, osteoarthritis or a history of depression or low mood. Evidence suggests that such exercise if beneficial, both physiologically and psychologically, but that rates of uptake and ongoing engagement by patients may not be optimised.

A research team led by Plymouth University Peninsula Schools of Medicine and Dentistry (including colleagues from Exeter, Birmingham, Southampton, Brunel, Edinburgh, Marjon and the NHS in Cornwall) has been awarded over £1.3M by the National Institute for Health Research Health Technology Assessment Programme (NIHR HTA) to initiate a multi-centred randomised control trial to investigate the potential of adding web-based coaching (E-coachER) to the ERS as a way to increase uptake and sustained health enhancing physical activity by patients .

The project, which lasts for 37 months with a window of 15 months for recruitment into the trial from July 2015, will also investigate the cost-effectiveness of using e-coaching in this way.

Patients receiving primary care for medical conditions, or with a history of depression, and who are deemed suitable for ERS, will be recruited to the trial from South West England, the West Midlands and Glasgow. Patients will either receive ERS on its own, or with access to e-coachER using the Lifeguide platform, which has been extensively tested for supporting other patients in Southampton and around the world. The e-coachER group will also receive technical support to ensure access to the internet and boost motivation and confidence to use the technology.

The primary objective will be for patients to achieve the public health target of150 minutes of moderate to vigorous physical exercise every week by 12 months. The trial will also investigate whether or not the addition of e-coachER results in more patients taking up ERS and sticking with it for the full programme. There will also be an analysis of cost-effectiveness.

Extensive testing and piloting will take place between now and next July to ensure the web support is doing what exercise referral patients would like. When this is complete the randomised control trial will start with 180 patients, moving to the final phase where a further 1220 patients will be recruited.

The trial will be led by Adrian Taylor, Professor of Health Services Research at Plymouth University Peninsula Schools of Medicine and Dentistry. He said: "We are hoping to see at least 10 per cent more people achieving 150 minutes among those receiving e-coachER, compared with usual exercise referral alone. This would provide an option for local services to support their patients to increase physical activity with a significant health gain. We will also be interested in identifying what participants feel about e-coachER, if it increases physical activity after 12 months, and what they thought were the main ways in which this support was useful to them."

The Plymouth team is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC SWP/ PenCLAHRC).



About Plymouth University

We are one of the leading modern universities in the UK, ranked in the top seven institutions under the age of 50 by Times Higher Education. Awarded the Queen's Anniversary Prize for Higher and Further Education in 2012 for marine and maritime teaching and research, we have won numerous awards and accolades, and are the only university in the world to be awarded the Social Enterprise Mark.

Our 30,000 students, which include those at our partner colleges across the South West, are enrolled on courses from farming to pharmacy, business to biology, and design to dentistry. And the 12,000 paid internships we provide every year for our students is just one of the many ways that we help them to develop new skills and graduate ready-for-work.

We have invested more than £150 million in our campus over the past seven years and are the first modern university to launch a medical school. And through our £100 million network of support facilities and services, we are growing hundreds of businesses across the region and beyond.

To find out how Plymouth is making a difference to its communities, please visit

The National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme funds research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 700 issues published to date. The journal's 2013 Impact Factor (5.116) ranked it two out of 85 publications in the Health Care Sciences and Services category. All issues are available for download, free of charge, from the website. The HTA Programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and the HSC R&D Division, Public Health Agency in Northern Ireland.

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC SWP/PenCLAHRC) aims to bring together local universities and their surrounding NHS organisations to test new treatments and new ways of working in specific clinical areas, to see if they are effective and appropriate for everyday use in the health service. Where potential improvements are identified PenCLAHRC helps NHS staff to incorporate them into their everyday working practices, so that patients across the local community receive a better standard of healthcare.

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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