In the pursuit of evidence-based practice, the common focus on controlled research within physical activity and health promotion has created a restricted view of the acceptable type of evidence on which practice should be based. To improve our understanding of physical activity (and other behavioral) interventions, a more holistic approach to evaluation is required. In the context of physical activity referral schemes, this article considers the implications of adhering to this narrow definition of “acceptable” evidence and the importance of recognizing alternative evaluative approaches.
Webb D.Current approaches to gathering evidence. In: Perkins ER, Simnett I, Wright L, eds. Evidence-Based Health Promotion . Chichester, England: John Wiley ; 1999.
2.
Evans D.Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. J Clin Nurs. 2003;12:77-84.
Riddoch C., Puig-Ribera A., Cooper A.Effectiveness of Physical Activity Promotion Schemes in Primary Care: A Review. London, England: Health Education Authority; 1998.
5.
Blamey A., Mutrie N.Changing the individual to promote health enhancing physical activity: the difficulties of producing evidence and translating it into practice. J Sports Sci.2004;22:741-754.
6.
Gidlow C., Johnston L., Crone D., James D.Attendance of exercise referral schemes in the UK: a systematic review. Health Educ J. 2005;64:168-186.
7.
Crone D., Johnston L., Grant T.Maintaining quality in exercise referral schemes: a case study of professional practice. Prim Health Care Res Dev.2004;5:96-103.
8.
Dugdill L., Graham RC, McNair F.Exercise referral: the public health panacea for physical activity promotion? A critical perspective of exercise referral schemes; their development and evaluation. Ergonomics. 2005;48:1390-1410.
9.
Wright Foundation. 4th National GP Referral Conference ; 2003; NEC, Birmingham .
10.
Harland J., White M., Drinkwater C., Chinn D., Farr L., Howel D.The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care. BMJ.1999;319:828-832.
11.
Kerse N., Walker S., Petrovic M., et al. Rapid responses to: The Newcastle exercise project. BMJ.1999;320:1470.
12.
Hillsdon M., Foster C., Naidoo B., Crombie H.The Effectiveness of Public Health Interventions for Increasing Physical Activity Among Adults: A Review of Reviews. London, England: Health Development Agency; 2004.
13.
National Institute for Health and Clinical Excellence.Four Commonly Used Methods to Increase Physical Activity: Brief Interventions in Primary Care, Exercise Referral Schemes, Pedometers and Community-Based Exercise Programmes for Walking and Cycling. Public Health Intervention Guidance No. 2. London, England: NICE; 2006.
14.
Sheldon TA, Sowden AJ, Lister-Sharp D.Systematic reviews include studies other than randomised controlled trials . BMJ.1998;316:703a.
15.
Harrison RA , Roberts C., Elton PJDoes primary care referral to an exercise programme increase physical activity one year later? A randomized controlled trial. J Public Health (Oxf). 2005;27:25-32.
16.
Harrison RA , McNair F., Dugdill L.Access to exercise referral schemes—a population based analysis. J Public Health Med.2005;27:326-330.
17.
Gidlow C., Johnston L., Crone D., et al. Socio-demographic patterning of referral, uptake and attendance in physical activity referral schemes. J Public Health (Oxf). 2007;29:107—113.
18.
Rothwell PMExternal validity of randomised controlled trials: “To whom do the results of this trial apply?” Lancet. 2005;365:82-93.
19.
Shephard RJLimits to the measurement of habitual physical activity by questionnaires . Br J Sports Med.2002;37:197-206.
20.
Taylor AH, Doust J., Webborn N.Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors. J Epidemiol Community Health. 1998 ;52:595-601.
21.
Tai SS, Iliffe S.Considerations for the design and analysis of experimental studies in physical activity and exercise promotion: advantages of the randomised controlled trial . Br J Sports Med.2000;34:220-224.
22.
Hardman AEPhysical activity intervention studies with health-related outcomes: some issues. J Sports Sci.1999;17:685-687.
23.
Chinn DJ, White M., Howel D., Harland JO, Drinkwater CKFactors associated with non-participation in a physical activity promotion trial. Public Health. 2006;120:309-319.
24.
James D., Johnston L., Crone D., Sidford A., Gidlow C., Morris C., et al. Factors associated with physical activity referral uptake and participation. J Sports Sci. In press.
25.
Stevens W., Hillsdon M., Thorogood M., McArdle D.Cost-effectiveness of a primary care based physical activity intervention in 45-74 year old men and women: a randomized controlled trial. Br J Sports Med.1998;32:236-241.
26.
Department of Health.Exercise Referral Systems: A National Quality Assurance Framework. London, England: The Stationery Office; 2001.
27.
Hammond JM, Brodie DA, Bundred PEExercise on prescription: guidelines for health professionals. Health Promot Int. 1997;12:33-41.
28.
Jackson C., Bell F., Smith RA, Dixey R.Do adherers and non-adherers to a GP exercise referral scheme differ in their long-term physical activity levels?J Sports Sci.1998;16:84.
29.
Lord JC, Green F.Exercise on prescription: does it work?1995;54:453-464.
30.
Martin C., Woolf-May K.The retrospective evaluation of a general practitioner exercise prescription programme. J Hum Nutr Diet. 1999;12:32-42.
31.
Dugdill L., Graham R.Promoting physical activity: building sustainable interventions. In: Gormley J, Hussey J, eds. Exercise in the Prevention and Treatment of Disease. Oxford, England : Blackwell; 2004.
32.
Crone D., Smith A., Gough B. “ I feel totally at one, totally alive and totally happy”: a psycho-social explanation of the physical activity and mental health relationship. Health Educ Res.2005;20:600-611.
33.
Britton A., Thorogood M., Coombes Y., Lewando-Hunt G.Quantitative outcome evaluation with qualitative process evaluation is best . BMJ.1998;316:703-704.
34.
McNair F., Graham RC, Dugdill L., et al. Determining the indicators of success in Exercise Referral Schemes. J Sports Sci.2005;23:222-223.
35.
Puska P.Commentary: physical activity promotion in primary care. Int J Epidemiol.2001;30:815-816.
36.
Barreto MLEfficacy, effectiveness, and the evaluation of public health interventions . J Epidemiol Community Health. 2005;59:345-346.