{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:37:26Z","timestamp":1787956646501,"version":"build-2784847793"},"reference-count":89,"publisher":"National Institute for Health and Care Research","issue":"63","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["13\/25\/20"],"award-info":[{"award-number":["13\/25\/20"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1\u2009:\u20091 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control).<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n There were 450 participants aged 16\u201374 years, with a body mass index of 30\u201340 kg\/m2<\/jats:sup>, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current\/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven \u2018steps to health\u2019. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme.<\/jats:p>\n <\/jats:sec>\n \n Primary outcome measure<\/jats:title>\n Minutes of moderate and vigorous physical activity in \u2265\u200910-minute bouts measured by an accelerometer over 1 week at 12 months, worn \u2265\u200916 hours per day for \u2265\u20094 days including \u2265\u20091 weekend day.<\/jats:p>\n <\/jats:sec>\n \n Secondary outcomes<\/jats:title>\n Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Participants had a mean body mass index of 32.6 (standard deviation) 4.4\u2009kg\/m2<\/jats:sup>, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n<\/jats:italic>\u2009=\u2009108) compared with the control group (n<\/jats:italic>\u2009=\u2009124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval \u20132.1 to 26.0 minutes; p<\/jats:italic>\u2009=\u20090.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of \u00a3439 (95% confidence interval \u2013\u00a3182 to \u00a31060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional \u00a316,885 per quality-adjusted life-year.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142\/243 (58%)] who recorded no instances of \u2265\u200910-minute bouts of moderate and vigorous physical activity at 12 months post randomisation.<\/jats:p>\n <\/jats:sec>\n \n Future work<\/jats:title>\n The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of \u00a330,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n Current Controlled Trials ISRCTN15644451.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment<\/jats:italic>; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/hta24630","type":"journal-article","created":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T09:37:24Z","timestamp":1606469844000},"page":"1-106","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT"],"prefix":"10.3310","volume":"24","clinical-trial-number":[{"clinical-trial-number":"isrctn15644451","registry":"10.18810\/isrctn","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2701-9468","authenticated-orcid":true,"given":"Adrian H","family":"Taylor","sequence":"first","affiliation":[{"name":"Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, 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