The National Exercise Referral Framework
The World Health Organisation published a European Physical Activity for Health Strategy in 2015; its purpose is to inspire governments and stakeholders to work towards increasing levels of physical activity among all citizens of the European region. The vision of Ireland's first National Physical Activity Plan, published in early 2016, is to make Ireland a more active place to live. Both documents provide a timely context for the development and publication of Ireland's National Exercise Referral Framework (NERF) NERF's vision is that those living with NCDs or mental illness will enjoy more active and healthier lives. Both documents emphasize the importance of embedding physical activity promotion within the healthcare setting and each identifies this action as a priority area particularly in addressing the prevention and control on non communicable diseases (NCDs) This emphasis is underpinned by high quality evidence supporting the use of physical activity for health promotion and primary and secondary prevention of several chronic conditions. A summary of this evidence is provided in section 2. This demonstrates that increased levels of physical activity play an important role in attaining a 20 40% relative reduction in risk of all cause mortality and premature mortality from cardiovascular diseases, colon cancer, breast cancer, depression and dementia. It also plays an essential role in halting the rise in diabetes and obesity. Doctors and other healthcare professionals are important influencers of patient behaviour and key initiators of NCD prevention actions within the healthcare system. As such, they can influence large proportions of the population. The NERF recognises this role, and advocates for the inclusion of physical activity as an explicit element of regular behavioural risk factor screening for NCD prevention, patient education and referral. Evidence supports the effectiveness of brief advice and brief intervention by healthcare professionals to increase physical activity levels among the general population, and in particular inactive adults 1. Evidence suggests that exercise referral is an effective targeted health intervention for specific patients 2, but it has limited evidence as an effective intervention for the general population 3. In order to outline the architecture for the adoption of the exercise referral approach, the NERF adopts Physical Activity Pathways in Healthcare Model (Figure 1) adpated from the physical activity care pathway model 4,5. A detailed description of this model and its application within the Irish healthcare system, along with evidence of factors that are associated with effective exercise referral schemes are explained in section 2.