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Original research
Pragmatic evaluation of a coproduced physical activity referral scheme: a UK quasi-experimental study
  1. Benjamin JR Buckley1,2,
  2. Dick HJ Thijssen1,3,
  3. Rebecca C Murphy1,
  4. Lee EF Graves1,
  5. Madeleine Cochrane1,
  6. Fiona Gillison4,
  7. Diane Crone5,
  8. Philip M Wilson6,
  9. Greg Whyte1,
  10. Paula M Watson1
  1. 1Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
  2. 2Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
  3. 3Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
  4. 4Department for Health, University of Bath, Bath, UK
  5. 5Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
  6. 6Department of Kinesiology, Brock University, Saint Catharines, Ontario, Canada
  1. Correspondence to Dr Benjamin JR Buckley; Benjamin.Buckley{at}


Objectives UK exercise referral schemes (ERSs) have been criticised for focusing too much on exercise prescription and not enough on sustainable physical activity (PA) behaviour change. Previously, a theoretically grounded intervention (coproduced PA referral scheme, Co-PARS) was coproduced to support long-term PA behaviour change in individuals with health conditions. The purpose of this study was to investigate the effectiveness of Co-PARS compared with a usual care ERS and no treatment for increasing cardiorespiratory fitness.

Design A three-arm quasi-experimental trial.

Setting Two leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control.

Participants 68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment.

Intervention 16-weeks of PA behaviour change support delivered at 4, 8, 12 and 18 weeks, in addition to the usual care 12-week leisure centre access.

Outcome measures Cardiorespiratory fitness, vascular health, PA and mental well-being were measured at baseline, 12 weeks and 6 months (PA and mental well-being only). Fitness centre engagement (co-PARS and usual care) and behaviour change consultation attendance (co-PARS) were assessed. Following an intention-to-treat approach, repeated-measures linear mixed models were used to explore intervention effects.

Results Significant improvements in cardiorespiratory fitness (p=0.002) and vascular health (p=0.002) were found in co-PARS compared with usual care and no-treatment at 12 weeks. No significant changes in PA or well-being at 12 weeks or 6 months were noted. Intervention engagement was higher in co-PARS than usual care, though this was not statistically significant.

Conclusion A coproduced PA behaviour change intervention led to promising improvements in cardiorespiratory and vascular health at 12 weeks, despite no effect for PA levels at 12 weeks or 6 months.

Trial registration number NCT03490747.

  • cardiovascular health
  • self-determination theory
  • exercise referral
  • behaviour change
  • translational research
  • vascular medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors BB contributed to the study design, data collection, data analysis and preparation of the final document. PMW, DT and RM contributed to the study design, data analysis and preparation of the final document. MC contributed to the data collection and approved the final version. LG, FG, DC, PW and GW intellectually contributed to this paper and approved the final version.

  • Funding This project was supported by a PhD studentship for Benjamin Buckley from Liverpool John Moores University. The 6-month data collection and analysis was supported by a financial grant from NHS Liverpool Clinical Commissioning Group (LCCG) RCF Award 2018/2019.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by NHS Research Ethics Committee (REC: 18/NW/0039 - Project: 238547).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Additional data were collected to investigate psychosocial processes of change, intervention fidelity and cost-effectiveness; due to space limitations they are not considered in the present manuscript, but findings can be obtained on request from

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