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Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials

BMJ 2012; 344 doi: (Published 26 March 2012) Cite this as: BMJ 2012;344:e1389
  1. Gillian Orrow, academic clinical fellow in general practice,
  2. Ann-Louise Kinmonth, foundation professor of general practice,
  3. Simon Sanderson, senior clinical research associate,
  4. Stephen Sutton, professor of behavioural science
  1. 1General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
  1. Correspondence to: G Orrow ghlo2{at}
  • Accepted 29 December 2011


Objectives To determine whether trials of physical activity promotion based in primary care show sustained effects on physical activity or fitness in sedentary adults, and whether exercise referral interventions are more effective than other interventions.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Medline, CINAHL, PsycINFO, EMBASE, SPORTDiscus, Centre for Reviews and Dissemination, the Cochrane Library, and article reference lists.

Review methods Review of randomised controlled trials of physical activity promotion in sedentary adults recruited in primary care, with minimum follow-up of 12 months, reporting physical activity or fitness (or both) as outcomes, and using intention to treat analyses. Two reviewers independently assessed studies for inclusion, appraised risk of bias, and extracted data. Pooled effect sizes were calculated using a random effects model.

Results We included 15 trials (n=8745). Most interventions took place in primary care, included health professionals in delivery, and involved advice or counselling given face to face or by phone (or both) on multiple occasions. Only three trials investigated exercise referral. In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months (odds ratio 1.42, 95% confidence interval 1.17 to 1.73; standardised mean difference 0.25, 0.11 to 0.38). The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (7 to 33). In four trials reporting cardiorespiratory fitness, a medium positive effect at 12 months was non-significant (standardised mean difference 0.51, −0.18 to 1.20). Three trials of exercise referral found small non-significant effects on self reported physical activity at 12 months (odds ratio 1.38; 0.98 to 1.95; standardised mean difference 0.20, −0.21 to 0.61).

Conclusions Promotion of physical activity to sedentary adults recruited in primary care significantly increases physical activity levels at 12 months, as measured by self report. We found insufficient evidence to recommend exercise referral schemes over advice or counselling interventions. Primary care commissioners should consider these findings while awaiting further trial evaluation of exercise referral schemes and other primary care interventions, with longer follow-up and use of objective measures of outcome.


  • We thank Julian Higgins for his statistical advice relating to methods used in the meta-analysis, Melvyn Hillsdon for his advice on trials eligible for inclusion in our review, and the authors of primary studies included in our review who responded to requests for clarification or further information about study data.

  • Contributors: GO, ALK, and SSa contributed to the design of the review. GO executed the search strategy, screened the initial results of the literature searches, drafted the manuscript, and is guarantor of the study. GO and SSu assessed studies for inclusion, appraised and extracted data from the included studies, and undertook statistical analysis. GO, ALK, and SSu interpreted the findings. All authors contributed to the critical revision of the manuscript and approved the final version.

  • Funding: GO is funded by an academic clinical fellowship from the National Institute for Health Research (NIHR) at the UK Department of Health. ALK is funded by the University of Cambridge and is an NIHR senior investigator. SSu’s contribution to the study was funded by an NIHR Programme Grant for Applied Research (RP-PG-0608-10079). SSa’s contribution was funded by the NIHR School for Primary Care Research.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: support for the submitted work from the NIHR and University of Cambridge; no financial relationships with commercial entities that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work other than their involvement in current primary research in the topic area of the systematic review (ALK, SSu, and GO) and clinical practice in primary care (GO) (ALK is principal investigator of the MRC ProActive trial, SSu and ALK are involved in NIHR funded research on brief interventions to promote physical activity (RP-PG-0608-10079), GO is a clinician in a general practice that uses exercise referral schemes).

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

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