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Conclusions are misleading

Ngaire Kerse, senior lecturer (n.kerse@auckland.ac.nz),
Sue Walker, research and information manager

Department of General Practice and Primary Health Care, Auckland, New Zealand
Hillary Commission for Sport Fitness and Leisure, Wellington, New Zealand
North Wales Health Authority, Preswylfa, Mold, Flintshire CH7 1PZ
Department of Epidemiology and Public Health, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN
NHS Executive, Wessex Deanery, Highcroft, Winchester SO22 5DH
Department of General Practice and Public Health, University of Melbourne, 3182 Victoria, Australia
Centre for Exercise Science and Medicine, University of Glasgow, Glasgow G12 8LT
Greater Glasgow Health Board, Glasgow G3 8YY
Addenbrooke's Hospital, Cambridge CB2 2QQ
Barnet Health Authority, London NW9 6QQ
London Borough of Barnet, Barnet Copthall Centre, London NW4 1PS
Exeter EX1 1SE
Department of Medicine, Ninewells Hospital and Medical School, Dundee DD1 9SY
Trescobeas Surgery, Falmouth, Cornwall TR11 2UN
Health Promotion Research Group, School of Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
Primary Care Development Centre, University of Northumbria at Newcastle, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE
Centre for Health and Medical Research, School of Health, University of Teesside, Middlesbrough TS1 3BA
Bendon Valley House, London SW18 4EA
University Department of Geriatric Medicine, Royal Free Hospital, London NW3 2QG
College of Ripon and York St John, York YO3 7EX
School of PE, Sport, and Leisure, De Montfort University, Bedford MK40 2BZ
c/o Medical College of St Bartholomew's Hospital, London EC1M 6BQ

EDITOR—We welcome the article by Harland et al on promoting physical activity in primary care but dispute the conclusion that these schemes are of questionable effectiveness.1 The title for the paragraph for This week in the BMJ that “exercise on prescription” is a waste of scarce resources is also misleading and not justified by evidence to date.

Our response stems from concerns about their intervention approach and our experience in two research endeavours: implementing a physical activity prescription scheme in New Zealand and a recently published randomised controlled trial resulting in long term improvement in physical activity for older people.2

Firstly, we question whether the level of intervention with the control group (information and recommendations about activity) resulted in a comparison with a lesser intervention, rather than a true control group, perhaps underestimating the efficacy of exercise counselling.

Secondly, is lengthy motivational interviewing appropriate and replicable in a general practice setting? This approach is time intensive for general practitioners and practice nurses and perhaps limits effective long term follow up. In New Zealand 51% of general practitioners are prescribing physical activity through the Hillary commission's “green prescriptions” scheme.3 One of the barriers to exercise prescription is lack of time during the consultation.4 5 We contend that interventions that are quick and simple to implement with regular practice based reinforcement offer more potential for sustainability and long term effectiveness.

Individualised assessment and programme design benefit outcome in health promotion trials. The judgment of the general practitioner is key in this area. The intervention design of a recent successful randomised controlled trial, set in Melbourne, Australia,2 raised the consciousness of the general practitioner through an effective educational programme, but it left the details of whom to target and the exact content of advice to the professional judgment …