How do Exercise Referral Schemes impact participant healthcare resource utilisation and health-related outcomes? A Rapid evidence summary

The National Exercise Referral Scheme (NERS) was rolled out across Wales in 2012. It is a long-term condition prevention and management programme, which aims to improve the health and well-being of sedentary and inactive adults who are at risk of developing a long-term condition or who have an existing long-term condition.

This Rapid Evidence Summary (RES) was conducted as part of an ongoing economic evaluation of NERS in Wales. The RES aimed to evaluate the impacts that Exercise Referral Schemes (ERSs) have had on participant healthcare resource utilisation (HCRU) and health-related outcomes. The searches included evidence published from January 2000 to November 2025. Eleven evidence sources were identified.

Key Findings:

· The influence of ERSs on HCRU was only reported in 1 study. In this study, the ERS was not effective in reducing HCRU compared to a control group.

· Evidence on the effectiveness of ERSs on participant physical activity levels was mixed. Evidence suggested ERSs were effective in increasing physical activity often reported only marginal improvements compared to usual care.

· Impact on Health-related quality of life (HRQoL) was assessed in 2 studies by reporting change in Quality Adjusted Life Years (QALY). ERSs were effective in improving QALYs, however QALY gains were modest across both studies.

· Identified evidence of ERS impacts on mental health and wellbeing suggests ERSs were effective in improving depression, anxiety and stress outcomes in participants, but these changes were not statistically significant in two studies.

· For outcomes around ‘condition(s)/disease(s) avoided/risk factor(s) modified’, the evidence was mixed, with one review reporting the ERS was effective in decreasing blood pressure amongst participants with cardiovascular disorders, while another review found ERS did not improve anthropometric, physiological or biochemical outcomes. An umbrella review of meta-analyses suggested that improvement in physical activity and aerobic fitness could lead to a reduced risk of experiencing a major adverse cardiovascular event.

From the limited evidence identified, ERSs were not effective in reducing participant HCRU. As a mechanism aimed to solely reduce HCRU, ERSs alone may not be the most effective option. However, ERSs were found to be effective in generating improvements in participant physical activity, HRQoL and blood pressure outcomes. Increasing provision of ERS in Wales for those living with or at risk of developing long-term health conditions may contribute to the better management of conditions or risk factors through ERSs.

HCRU was the least reported outcome within the identified evidence. Future investigation of the effectiveness of ERSs in changing HCRU of participants is warranted.