{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:17:48Z","timestamp":1772165868292,"version":"3.50.1"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exercise Referral Schemes (ERSs) have been implemented across Western nations to stimulate an increase in adult physical activity but evidence of their effectiveness and cost-effectiveness is equivocal. Poor ERS uptake and adherence can have a negative impact on effectiveness and cost-effectiveness and, if patterned by socio-demographic factors, can also introduce or widen health inequalities. Different modes of ERS delivery have the potential to reduce costs and enhance uptake and adherence. The primary aim of this study was to examine the effect of different programmes of ERS delivery on scheme uptake and adherence. Secondary aims were to examine the effect of socio-demographic factors on scheme uptake and adherence, and the impact of delivery mode on the expected resource and corresponding costs of delivering core parts of the programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an observational cohort study with cost analysis. Routine monitoring data covering a three-year period (2019\u20132021) from one large UK ERS (number of patients\u2009=\u200928,917) were analysed. During this period three different programmes of delivery were operated in succession: standard (all sessions delivered face-to-face at a designated physical location), hybrid (sessions initially delivered face-to-face and then switched to remote delivery in response to the Covid-19 pandemic), and modified (sessions delivered face-to-face, remotely, or a combination of the two, as determined on a case-by-case basis according to Covid-19 risk and personal preferences). Multi-level binary logistic and linear regression were performed to examine the effect of programme of delivery and socio-demographic characteristics on uptake and adherence. Cost data were sourced from regional-level coordinators and through NERS audits supplied by national-level NERS managers and summarised using descriptive statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was no effect of programme of delivery on scheme uptake. In comparison to those on the standard programme (who attended a mean of 23.1 exercise sessions) those on the modified programme had higher adherence (mean attendance of 25.7 sessions) while those on the hybrid programme had lower adherence (mean attendance of 19.4 sessions). Being older, or coming from an area of lower deprivation, increased the likelihood of uptake and adherence. Being female increased the chance of uptake but was associated with lower adherence. Patients referred to the programme from secondary care were more likely to take up the programme than those referred from primary care for prevention purposes, however their attendance at exercise sessions was lower. The estimated cost per person for face-to-face delivery of a typical 16-week cycle of the scheme was \u00a365.42. The same cycle of the scheme delivered virtually (outside of a pandemic context) was estimated to cost \u00a3201.71 per person.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study contributes new evidence concerning the effect of programme of delivery on ERS uptake and adherence and strengthens existing evidence concerning the effect of socio-economic factors. The findings direct the attention of ERS providers towards specific patient sub-groups who, if inequalities are to be addressed, require additional intervention to support uptake and adherence. At a time when providers may be considering alternative programmes of delivery, these findings challenge expectations that implementing virtual delivery will necessarily lead to cost savings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-024-19392-y","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T05:02:09Z","timestamp":1724734929000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Moving an exercise referral scheme to remote delivery during the Covid-19 pandemic: an observational study examining the impact on uptake, adherence, and costs"],"prefix":"10.1186","volume":"24","author":[{"given":"Katie","family":"Newby","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Howlett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam P.","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel","family":"Smeeton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olujoke","family":"Fakoya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel","family":"Lloyd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imogen","family":"Freethy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charis","family":"Bontoft","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary-Ann","family":"McKibben","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie","family":"Petherick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Wills","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"key":"19392_CR1","volume-title":"WHO Global action plan on physical activity and health 2018\u20132030: more active people for a healthier world","author":"World Health Organization","year":"2018","unstructured":"World Health Organization. WHO Global action plan on physical activity and health 2018\u20132030: more active people for a healthier world. 2018."},{"key":"19392_CR2","unstructured":"World Health Organization. Physical activity fact sheet. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/physical-activity. Accessed 11 Sep 2022."},{"key":"19392_CR3","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1136\/bjsports-2017-097563","volume":"53","author":"SFM Chastin","year":"2019","unstructured":"Chastin SFM, De Craemer M, De Cocker K, Powell L, Van Cauwenberg J, Dall P, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med. 2019;53:370\u20136.","journal-title":"Br J Sports Med"},{"key":"19392_CR4","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1249\/MSS.0000000000001943","volume":"51","author":"LS Pescatello","year":"2019","unstructured":"Pescatello LS, Buchner DM, Jakicic JM, Powell KE, Kraus WE, Bloodgood B, et al. Physical activity to prevent and treat hypertension: a systematic review. Med Sci Sports Exerc. 2019;51:1314\u201323.","journal-title":"Med Sci Sports Exerc"},{"key":"19392_CR5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.ctim.2019.03.013","volume":"44","author":"D Lugo","year":"2019","unstructured":"Lugo D, Pulido AL, Mihos CG, Issa O, Cusnir M, Horvath SA, et al. The effects of physical activity on cancer prevention, treatment and prognosis: a review of the literature. Complement Ther Med. 2019;44:9\u201313.","journal-title":"Complement Ther Med"},{"key":"19392_CR6","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1080\/08870446.2017.1325486","volume":"32","author":"RE Rhodes","year":"2017","unstructured":"Rhodes RE, Janssen I, Bredin SSD, Warburton DER, Bauman A. Physical activity: Health impact, prevalence, correlates and interventions. Psychol Health. 2017;32:942\u201375.","journal-title":"Psychol Health"},{"key":"19392_CR7","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/j.neubiorev.2019.09.040","volume":"107","author":"A Kandola","year":"2019","unstructured":"Kandola A, Ashdown-Franks G, Hendrikse J, Sabiston CM, Stubbs B. Physical activity and depression: towards understanding the antidepressant mechanisms of physical activity. Neurosci Biobehav Rev. 2019;107:525\u201339.","journal-title":"Neurosci Biobehav Rev"},{"key":"19392_CR8","doi-asserted-by":"publisher","first-page":"e1077","DOI":"10.1016\/S2214-109X(18)30357-7","volume":"6","author":"R Guthold","year":"2018","unstructured":"Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1\u00b79 million participants. Lancet Glob Health. 2018;6:e1077\u201386.","journal-title":"Lancet Glob Health"},{"key":"19392_CR9","unstructured":"Sport England. Active Lives Adult Survey November 2022-23 Report. Loughborough: Sport England; 2024. p. 45. [cited 2024 July 4]. Available from: https:\/\/www.sportengland.org\/research-and-data\/data\/active-lives."},{"key":"19392_CR10","doi-asserted-by":"publisher","first-page":"i","DOI":"10.3310\/hta15440","volume":"15","author":"TG Pavey","year":"2011","unstructured":"Pavey TG, Anokye N, Taylor AH, Trueman P, Moxham T, Fox KR, et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess. 2011;15:i\u2013xii. 1\u2013254.","journal-title":"Health Technol Assess"},{"key":"19392_CR11","doi-asserted-by":"publisher","first-page":"d6462","DOI":"10.1136\/bmj.d6462","volume":"343","author":"TG Pavey","year":"2011","unstructured":"Pavey TG, Taylor AH, Fox KR, Hillsdon M, Anokye N, Campbell JL, et al. Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. BMJ. 2011;343:d6462.","journal-title":"BMJ"},{"key":"19392_CR12","doi-asserted-by":"publisher","first-page":"979","DOI":"10.3399\/096016407782604866","volume":"57","author":"NH Williams","year":"2007","unstructured":"Williams NH, Hendry M, France B, Lewis R, Wilkinson C. Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review. Br J Gen Pract. 2007;57:979\u201386.","journal-title":"Br J Gen Pract"},{"key":"19392_CR13","volume-title":"A rapid review of the effectiveness of ERS to promote physical activity in adults.","author":"National Institute of Health and Clinical Excellence (NICE)","year":"2006","unstructured":"National Institute of Health and Clinical Excellence (NICE). A rapid review of the effectiveness of ERS to promote physical activity in adults. London: NICE; 2006."},{"key":"19392_CR14","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1080\/02813430600700027","volume":"24","author":"JB S\u00f8rensen","year":"2006","unstructured":"S\u00f8rensen JB, Skovgaard T, Puggaard L. Exercise on prescription in general practice: a systematic review. Scand J Prim Health Care. 2006;24:69\u201374.","journal-title":"Scand J Prim Health Care"},{"key":"19392_CR15","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.puhe.2004.06.008","volume":"119","author":"O Morgan","year":"2005","unstructured":"Morgan O. Approaches to increase physical activity: reviewing the evidence for exercise-referral schemes. Public Health. 2005;119:361\u201370.","journal-title":"Public Health"},{"key":"19392_CR16","doi-asserted-by":"publisher","DOI":"10.3310\/hta19600","volume-title":"A systematic review and economic evaluation of exercise referral schemes in primary care: a short report","author":"F Campbell","year":"2015","unstructured":"Campbell F, Holmes M, Everson-Hock E, Davis S, Buckley Wood H, Anokye N, et al. A systematic review and economic evaluation of exercise referral schemes in primary care: a short report. 2015."},{"key":"19392_CR17","doi-asserted-by":"publisher","unstructured":"Anokye AK, Trueman P, Green C, Pavey TG, Hillsdon M, Taylor RS. The cost-effectiveness of exercise referral schemes. BMC Public Health. 2011;11(954):1471-2458. Available from: https:\/\/doi.org\/10.1186\/1471-2458-11-954.","DOI":"10.1186\/1471-2458-11-954"},{"key":"19392_CR18","volume-title":"Process and Methods [PMG37]","author":"NICE","year":"2022","unstructured":"NICE. NICE health technology evaluations: the manual. In: Process and Methods [PMG37]. 2022."},{"key":"19392_CR19","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1186\/1471-2458-11-954","volume":"11","author":"NK Anokye","year":"2011","unstructured":"Anokye NK, Trueman P, Green C, Pavey TG, Hillsdon M, Taylor RS. The cost-effectiveness of exercise referral schemes. BMC Public Health. 2011;11:954.","journal-title":"BMC Public Health"},{"key":"19392_CR20","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.pmedr.2017.08.006","volume":"8","author":"K Abu-Omar","year":"2017","unstructured":"Abu-Omar K, R\u00fctten A, Burlacu I, Sch\u00e4tzlein V, Messing S, Suhrcke M. The cost-effectiveness of physical activity interventions: a systematic review of reviews. Prev Med Rep. 2017;8:72\u20138.","journal-title":"Prev Med Rep"},{"key":"19392_CR21","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1136\/jech-2011-200689","volume":"66","author":"SM Murphy","year":"2012","unstructured":"Murphy SM, Edwards RT, Williams N, Raisanen L, Moore G, Linck P, et al. An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative. J Epidemiol Community Health. 2012;66:745\u201353.","journal-title":"J Epidemiol Community Health"},{"key":"19392_CR22","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1136\/jech-2011-200354","volume":"66","author":"T Pavey","year":"2012","unstructured":"Pavey T, Taylor A, Hillsdon M, Fox K, Campbell J, Foster C, et al. Levels and predictors of exercise referral scheme uptake and adherence: a systematic review. J Epidemiol Community Health. 2012;66:737\u201344.","journal-title":"J Epidemiol Community Health"},{"key":"19392_CR23","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1186\/1471-2458-12-347","volume":"12","author":"P Tobi","year":"2012","unstructured":"Tobi P, Estacio EV, Yu G, Renton A, Foster N. Who stays, who drops out? Biosocial predictors of longer-term adherence in participants attending an exercise referral scheme in the UK. BMC Public Health. 2012;12:347\u2013347.","journal-title":"BMC Public Health"},{"key":"19392_CR24","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1016\/j.puhe.2007.11.006","volume":"122","author":"KL Morton","year":"2007","unstructured":"Morton KL, Biddle SJH, Beauchamp MR. Changes in self-determination during an exercise referral scheme. Public Health. 2007;122:1257\u201360.","journal-title":"Public Health"},{"key":"19392_CR25","doi-asserted-by":"publisher","first-page":"3942","DOI":"10.3390\/ijerph17113942","volume":"17","author":"K Morgan","year":"2020","unstructured":"Morgan K, Rahman M, Moore G. Patterning in patient referral to and uptake of a national exercise referral scheme (NERS) in Wales from 2008 to 2017: a data linkage study. Int J Environ Res Public Health. 2020;17:3942.","journal-title":"Int J Environ Res Public Health"},{"key":"19392_CR26","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.3399\/bjgp08X342237","volume":"58","author":"SL Sowden","year":"2008","unstructured":"Sowden SL, Breeze E, Barber J, Raine R. Do general practices provide equitable access to physical activity interventions? Br J Gen Pract. 2008;58:e1-8.","journal-title":"Br J Gen Pract"},{"key":"19392_CR27","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1177\/001789699505400408","volume":"54","author":"JC Lord","year":"1995","unstructured":"Lord JC, Green F. Exercise on prescription: does it work? Health Educ J. 1995;54:453\u201364.","journal-title":"Health Educ J"},{"key":"19392_CR28","doi-asserted-by":"publisher","first-page":"e002849","DOI":"10.1136\/bmjopen-2013-002849","volume":"3","author":"CL Hanson","year":"2013","unstructured":"Hanson CL, Allin LJ, Ellis JG, Dodd-Reynolds CJ. An evaluation of the efficacy of the exercise on referral scheme in Northumberland, UK: association with physical activity and predictors of engagement. A naturalistic observation stud. BMJ Open. 2013;3:e002849.","journal-title":"BMJ Open"},{"key":"19392_CR29","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1093\/pubmed\/fdi048","volume":"27","author":"RA Harrison","year":"2005","unstructured":"Harrison RA, McNair F, Dugdill L. Access to exercise referral schemes \u2013 a population based analysis. J Public Health (Oxf). 2005;27:326\u201330.","journal-title":"J Public Health (Oxf)"},{"key":"19392_CR30","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1016\/j.psychsport.2006.07.006","volume":"8","author":"J Edmunds","year":"2007","unstructured":"Edmunds J, Ntoumanis N, Duda JL. Adherence and well-being in overweight and obese patients referred to an exercise on prescription scheme: a self-determination theory perspective. Psychol Sport Exerc. 2007;8:722\u201340.","journal-title":"Psychol Sport Exerc"},{"key":"19392_CR31","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1080\/02640410701468863","volume":"26","author":"DVB James","year":"2008","unstructured":"James DVB, Johnston LH, Crone D, Sidford AH, Gidlow C, Morris C, et al. Factors associated with physical activity referral uptake and participation. J Sports Sci. 2008;26:217\u201324.","journal-title":"J Sports Sci"},{"key":"19392_CR32","doi-asserted-by":"crossref","unstructured":"Leijon ME, Faskunger J, Bendtsen P, Festin K, Nilsen P. Who is not adhering to physical activity referrals, and why? Scand J Prim Health Care. 2011;29:234\u201340.","DOI":"10.3109\/02813432.2011.628238"},{"key":"19392_CR33","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1093\/pubmed\/fdm002","volume":"29","author":"C Gidlow","year":"2007","unstructured":"Gidlow C, Johnston LH, Crone D, Morris C, Smith A, Foster C, et al. Socio-demographic patterning of referral, uptake and attendance in physical activity referral schemes. J Public Health (Oxf). 2007;29:107\u201313.","journal-title":"J Public Health (Oxf)"},{"key":"19392_CR34","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1080\/00140130500101544","volume":"48","author":"L Dugdill","year":"2005","unstructured":"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\u2013410.","journal-title":"Ergonomics"},{"key":"19392_CR35","volume-title":"Prepared for Greenwich Teaching Primary Care Trust and Greenwich Leisure Liited","author":"P Tobi","year":"2009","unstructured":"Tobi P, Estacio E, Seesaghur A, Nabingi S, Cawley J. Evaluation of Healthwise Exercise Referral Scheme (Final Report). In: Prepared for Greenwich Teaching Primary Care Trust and Greenwich Leisure Liited. London: University of East London, Institute for Health and Human Development; 2009."},{"key":"19392_CR36","first-page":"1","volume":"11","author":"AJ Isaacs","year":"2007","unstructured":"Isaacs AJ, Critchley JA, Tai SS, Buckingham K, Westley D, Harridge SDR, et al. Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only. Health technology assessment (Winchester, England). 2007;11:1\u2013165.","journal-title":"Health technology assessment (Winchester, England)"},{"key":"19392_CR37","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1006\/pmed.2001.0919","volume":"33","author":"TM Damush","year":"2001","unstructured":"Damush TM, Stump TE, Saporito A, Clark DO. Predictors of older primary care patients\u2019 participation in a submaximal exercise test and a supervised, low-impact exercise class. Prev Med. 2001;33:485\u201394.","journal-title":"Prev Med"},{"key":"19392_CR38","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1080\/02701367.2020.1788699","volume":"93","author":"S Calonge Pascual","year":"2022","unstructured":"Calonge Pascual S, Casaj\u00fas Mall\u00e9n JA, Gonz\u00e1lez-Gross M. Adherence factors related to exercise prescriptions in healthcare settings: a review of the scientific literature. Res Q Exerc Sport. 2022;93:16\u201325.","journal-title":"Res Q Exerc Sport"},{"key":"19392_CR39","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/s12889-016-2882-7","volume":"16","author":"F Morgan","year":"2016","unstructured":"Morgan F, Battersby A, Weightman AL, Searchfield L, Turley R, Morgan H, et al. Adherence to exercise referral schemes by participants \u2013 what do providers and commissioners need to know? A systematic review of barriers and facilitators. BMC Public Health. 2016;16:227.","journal-title":"BMC Public Health"},{"key":"19392_CR40","doi-asserted-by":"publisher","first-page":"e12374","DOI":"10.2196\/12374","volume":"21","author":"J Hawkins","year":"2019","unstructured":"Hawkins J, Charles JM, Edwards M, Hallingberg B, McConnon L, Edwards RT, et al. Acceptability and feasibility of implementing accelorometry-based activity monitors and a linked web portal in an exercise referral scheme: feasibility randomized controlled trial. J Med Internet Res. 2019;21:e12374.","journal-title":"J Med Internet Res"},{"key":"19392_CR41","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s12966-021-01218-4","volume":"18","author":"MJ Western","year":"2021","unstructured":"Western MJ, Armstrong MEG, Islam I, Morgan K, Jones UF, Kelson MJ. The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2021;18:148.","journal-title":"Int J Behav Nutr Phys Act"},{"key":"19392_CR42","unstructured":"Welsh Government. Adult lifestyle (National Survey for Wales): April 2019 to March 2020. GOV.WALES. https:\/\/gov.wales\/adult-lifestyle-national-survey-wales-april-2019-march-2020. Accessed 18 Jul 2022."},{"key":"19392_CR43","unstructured":"Welsh Index of Multiple Deprivation: index guidance. GOV.WALES. https:\/\/gov.wales\/welsh-index-multiple-deprivation-index-guidance. Accessed 21 Jul 2022."},{"key":"19392_CR44","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-34801-4","volume-title":"Multilevel modelling for public health and health services research","author":"AH Leyland","year":"2020","unstructured":"Leyland AH, Groenewegen PP. Multilevel modelling for public health and health services research. New York: SpringerOpen; 2020."},{"key":"19392_CR45","doi-asserted-by":"publisher","first-page":"e044984","DOI":"10.1136\/bmjopen-2020-044984","volume":"11","author":"J Hawkins","year":"2021","unstructured":"Hawkins J, Smeeton N, Busby A, Wellsted D, Rider B, Jones J, et al. Contributions of treatment centre and patient characteristics to patient-reported experience of haemodialysis: a national cross-sectional study. BMJ Open. 2021;11:e044984.","journal-title":"BMJ Open"},{"key":"19392_CR46","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1207\/S15327965PLI1104_01","volume":"11","author":"EL Deci","year":"2000","unstructured":"Deci EL, Ryan RM. The \u201cWhat\u201d and \u201cWhy\u201d of goal pursuits: human needs and the self-determination of behavior. Psychol Inq. 2000;11:227\u201368.","journal-title":"Psychol Inq"},{"key":"19392_CR47","volume-title":"Understanding the impact of Covid-19","author":"Sport England","year":"2021","unstructured":"Sport England. Understanding the impact of Covid-19. 2021."},{"key":"19392_CR48","doi-asserted-by":"publisher","first-page":"233372141882360","DOI":"10.1177\/2333721418823604","volume":"5","author":"S Rivera-Torres","year":"2019","unstructured":"Rivera-Torres S, Fahey TD, Rivera MA. Adherence to exercise programs in older adults: informative report. Gerontol Geriatr Med. 2019;5:2333721418823604.","journal-title":"Gerontol Geriatr Med"},{"key":"19392_CR49","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jphys.2014.06.012","volume":"60","author":"AMA Picorelli","year":"2014","unstructured":"Picorelli AMA, Pereira LSM, Pereira DS, Fel\u00edcio D, Sherrington C. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Physiother. 2014;60:151\u20136.","journal-title":"J Physiother"},{"key":"19392_CR50","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1123\/jpah.9.6.857","volume":"9","author":"KS Courneya","year":"2012","unstructured":"Courneya KS, Karvinen KH, McNeely ML, Campbell KL, Brar S, Woolcott CG, et al. Predictors of adherence to supervised and unsupervised exercise in the alberta physical activity and breast cancer prevention trial. J Phys Act Health. 2012;9:857\u201366.","journal-title":"J Phys Act Health"},{"key":"19392_CR51","first-page":"275","volume":"62","author":"A Lacroix","year":"2016","unstructured":"Lacroix A, Kressig RW, Muehlbauer T, Gschwind YJ, Pfenninger B, Bruegger O, et al. Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: a randomized controlled trial. GER. 2016;62:275\u201388.","journal-title":"GER"},{"key":"19392_CR52","unstructured":"Welsh Government. Equality and diversity statistics: 2018 to 2020. GOV.WALES. https:\/\/www.gov.wales\/equality-and-diversity-statistics-2018-2020. Accessed 13 Sept 2022."},{"key":"19392_CR53","unstructured":"United Kingdom. Cabinet Office. Government Digital Inclusion Strategy [Internet]. London: Her Majesty\u2019s Stationery Office; 2014. [cited 2024 August 2]. Available from: https:\/\/www.gov.uk\/government\/publications\/government-digital-inclusion-strategy\/government-digital-inclusion-strategy#annex-3-digital-inclusion-landscape-review."},{"key":"19392_CR54","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1093\/pubmed\/fdh208","volume":"27","author":"J Keene","year":"2005","unstructured":"Keene J, Li X. Age and gender differences in health service utilization. J Public Health. 2005;27:74\u20139.","journal-title":"J Public Health"},{"key":"19392_CR55","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1016\/S0277-9536(00)00415-9","volume":"53","author":"M Goddard","year":"2001","unstructured":"Goddard M, Smith P. Equity of access to health care services: theory and evidence from the UK. Soc Sci Med. 2001;53:1149\u201362.","journal-title":"Soc Sci Med"},{"key":"19392_CR56","volume-title":"Social determinants of health","author":"MWR Marmot","year":"2006","unstructured":"Marmot MWR. Social determinants of health. 2nd ed. Oxford: Oxford University Press; 2006.","edition":"2"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-19392-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-024-19392-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-19392-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T17:02:34Z","timestamp":1724778154000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-024-19392-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,27]]},"references-count":56,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["19392"],"URL":"https:\/\/doi.org\/10.1186\/s12889-024-19392-y","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-2670997\/v1","asserted-by":"object"}]},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,27]]},"assertion":[{"value":"8 March 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was granted by the University of Hertfordshire\u2019s Health Science Technology and Engineering Ethics Committee with Delegated Authority (ECDA; Protocol number: aLMS\/SF\/UH\/04546(3)). Informed consent was waived by the ECDA Ethics Committee given that NERS service users had provided consent at scheme registration for their data to be used for the purposes of evaluation and service improvement. This study was conducted according to the principles expressed in the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"This PHIRST evaluation was initiated following submission of an expression of interest to the funder by Public Health Wales, with partnership working between this initiator and the research team encouraged by the funder. MAM and AP are employed by Public Health Wales and have strategic oversight of NERS. They are included as co-authors to fairly reflect their involvement in conceiving the research and supporting preparation of the manuscript. There was no undue influence by MAM or AP in any aspect of the research and all study conclusions were reached independently. Other authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2324"}}