Wales National Exercise Referral Scheme
The National Exercise Referral Scheme (NERS) is a Welsh Government funded scheme which has been developed to standardise exercise referral opportunities across all Local Authorities and Local health Boards in Wales. The Scheme targets clients who have a chronic disease or are at risk of developing chronic disease.
The principal aims of the Scheme
• To offer a high quality National Exercise Referral Scheme across Wales.
• To increase the long term adherence in physical activity of clients.
• To improve physical and mental health of clients.
• To determine the effectiveness of the intervention in increasing activity levels and improving health.
Quality standards
All protocols used on the Scheme represent the best current known practice and meet with current national guidance. All exercise professionals operating the Scheme are trained to NVQ level 3, have a qualification that meets occupational standard D449 working with referred patients, and are appropriately insured. All protocols went through ethical approval, and the British Medical Association in Wales was consulted as part of the development of the Scheme.
The evaluation
The evaluation was conducted by the Cardiff Institute of Society, Health and Ethics, Cardiff University in partnership with the North Wales Clinical School, Cardiff University and the Institute of Medical and Social Care Research, Bangor University. The principal investigator was Dr. Simon Murphy. The study was reviewed by the Thames Valley Multi-centre Research Ethics Committee (reference: 06/MRE12/85) and received ethical clearance on 8 February 2007.
The study adopted a randomised controlled trial design and aimed to investigate whether self-reported physical activity (as well as depression and anxiety) at 12 months is different among those patients receiving an exercise referral programme compared to those receiving usual GP care. It also investigated the cost-effectiveness of the Scheme.
See link for full evaluation results http://wales.gov.uk/about/aboutresearch/social/latestresearch/exercise/?lang=en
Main findings of the evaluation:
• All participants in the scheme had higher levels of physical activity than the control group, with this difference being significant for patients referred for coronary heart disease risk factors
• There were positive effects on depression and anxiety
• The economic evaluation demonstrated a cost per QALY of £12,111. For those who adhere to the full programme the scheme there is a marginal cost saving (£-367 per QALY).
NERS was rolled out across Wales in 3 phases;
• Phase 1 began recruiting the first referrals in July 2007; Bridgend, Blaenau Gwent, Cardiff, Conwy, Neath Port Talbot and Swansea.
• Phase 2 began in April 2008 with Flintshire, Denbighshire, Monmouthshire, Torfaen, Vale of Glamorgan, Pembrokeshire and Ceredigion.
• Phase 3 began in January 2009 with Carmarthen, Rhondda Cynon Taff, Merthyr, Caerphilly, Wrexham, Powys, Gwynedd and Anglesey with Newport being the last area to become operational in March 2009.
Since the inception of the NERS new National Occupational Standards (NOS) have been developed at level 4 for chronic disease, and in April 2008 the Welsh Government Minister for Health and Social Services agreed that the NERS could expand to incorporate patients with chronic disease and also agreed to appoint a National Coordinator.
The Welsh Local Government Association (WLGA) appointed a Coordinator in August 2008. The national coordinators role is to monitor the day to day running of the scheme; mentor and support the coordinators and exercise professionals across Wales to improve and develop their schemes performance; commission training and develop standard protocols for each of these chronic conditions based on best practice from across the UK.
Level 4 accredited training has already been provided on;
• Phase IV Cardiac rehabilitation Instructor
• Respiratory Disease Instructor
• Level 4 Postural Stability Instructor (Falls Prevention)
• Level 4 Back Care
• Level 4 Exercise after Stroke
• Level 4 Mental Health
• Level 4 Obesity/Diabetes Weight Management
Standard protocols for these chronic conditions are being implemented where there are rehabilitation programmes in operation and exercise professionals hold the necessary qualifications.
The programme
The Scheme operates in all 22 local authorities and runs for 16 consecutive weeks and consists of 2 fully supervised group-based sessions each week. Each session lasts for approximately one-hour and cost £1.50. The sessions are usually run in Leisure or Community centres but there are some outdoor opportunities available in most areas
What are the benefits of physical activity?
The physical benefits include:
• The heart and lungs become stronger and more efficient
• Muscular strength increases
• Joints become stronger
• The onset of osteoporosis can be delayed
• Body fat and excess weight may be reduced
• Relaxation and sleep might be improved
• Being better able to carry out the activities of daily living
• Feeling more alert and energetic
• Maintaining good posture
• Helping to normalise blood pressure
• Reduce risk of developing diabetes
• A reduced risk of blood clotting
• Helping to maintain independence, rather than becoming dependant
Psychological benefits:
Some comments people have made include:
• “I feel less anxious and stressed”
• “My confidence and self-esteem are better”
• “Being more active helped me to to give up smoking”
• “The activity sessions gave me time for myself”
• “My wife says I look a lot happier”
• “I took more responsibility for my own health”
Social benefits:
Comments have included:
• “It was a good opportunity to meet other people who had the same worries as I did”
• “The sessions made me get out of the house and gave me a new interest”
• “I made new friends and enjoyed the conversations we had”
• “I feel much fitter and can play with my grandchildren for longer now”
Contact details
If you require further information about any aspects of the Scheme please feel free to either contact your local co-ordinator or e-mail the National Exercise Referral Coordinator for Wales at: Jeannie Wyatt-Williams
Exercise Referral Toolkit
The toolkit is divided into several sections:
• Section 1: Background technical report: outlining the rationale for the toolkit and the development process.
• Section 2: A snapshot of exercise referral schemes operating in England, Scotland and Northern Ireland during 2006-2008.
• Section 3: A synopsis of exercise referral research.
• Section 4: A quick reference guide to exercise referral schemes for referring healthcare professionals.
• Section 5: Guidance for exercise professionals working with referred patients.
• Section 6: Guidance for exercise referral schemes.
• Section 7: A guide to commissioning exercise referral schemes.
• Section 8: A guide to evaluating exercise referral schemes.
• Section 9: A qualifications and training guide.
The final section of the toolkit, the appendices, includes sample forms, template letters, tools and questionnaires.
Please visit the Exercise Referral Toolkit