Question 1

Who actually provides physical activity services in the UK?

Accepted Answer

Provision spans 4 sectors. The health service provides brief advice, exercise referral, cardiac and pulmonary rehabilitation, physiotherapy and social prescribing. Local authorities in England hold statutory public health responsibility and run leisure centres, parks and active travel infrastructure. The voluntary and community sector delivers much of what people use, and commercial providers are funded directly by the user.

Question 2

Why does provision vary so much between areas?

Accepted Answer

Health and local government are devolved, and major levers sit with local authorities, funded in England through the ring-fenced public health grant and council budgets, both under sustained pressure. Commissioning decisions are made locally against local priorities, delivery may be by grant, contract, partnership or in-house, and budgets face annual uncertainty. Neighbouring areas can therefore offer very different provision.

Question 3

When should I refer someone to an exercise referral scheme?

Accepted Answer

When they are sedentary or inactive and also have an existing health condition or other risk factors, and only if the scheme uses behaviour change techniques and collects baseline, follow-up and process data. People who are inactive but otherwise apparently healthy should not be referred; give brief advice instead.

Question 4

Why is brief advice preferred to a referral scheme for most people?

Accepted Answer

Economic analysis found that referral schemes add only a very small effect over brief advice while costing considerably more, so they are less cost-effective for the general inactive population. That is not a judgement that schemes never help, but a referral should not be the automatic response to inactivity.

UK Physical Activity Services

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