Promoting Adult Physical Activity in West Lancashire through Exercise Referral


Student thesis: Doctoral Thesis


Background: Exercise referral schemes (ERSs) are widely adopted physical activity (PA) interventions for insufficiently active individuals with existing health conditions. Despite the prevalence of ERSs across the UK, completion rates are poor and there remains modest and variable evidence for the ability of ERSs to confer meaningful health-related improvements. This thesis documents the exploration and intervention development of a social-identity-informed peer support intervention to promote participant completion of a West Lancashire-based ERS: Active West Lancs (AWL).
Methods: This thesis adopted a two-phase, mixed-methods approach across five empirical studies. Phase One comprised of a mixed-methods evaluation and needs analysis of AWL. Study one investigated rates of scheme uptake and completion according to participant demographic and referral characteristics. Study two identified pre-post changes in physical (body mass index, blood pressure), behavioural (PA volume, sedentary time), and well-being outcomes. Study three employed semi-structured interviews to elicit in-depth contextual understanding of perceived facilitators and barriers to scheme completion. Phase Two documented the development and acceptability of the social-identity-informed peer support intervention. Study four identified desirable characteristics and roles of AWL peers perceived by existing scheme clients and providers. Study five explored multi-stakeholder perspectives on the intervention’s retrospective acceptability.
Results: Study one found AWL uptake and completion rates, as well as socio-demographic patterning of uptake and completion rates, to be comparable with previous ERS evaluations. Older participants, and those referred due to cardiovascular disease or musculoskeletal health
conditions were most likely to uptake and complete, whilst those referred due to mental health were least likely. Study two demonstrated AWL completion to be associated with reductions in BMI, blood pressure and sitting time, as well as increased PA volume and improved well-being. However, the magnitude of change for all outcomes varied according to participants’ primary reasons for referral. Study three highlighted perceived facilitators and barriers to AWL completion. Notably, the extent of participants’ other commitments and previous PA experiences permeated perceptions of individual-level facilitators and barriers. AWL clients’ expectations, experiences, and preferred forms of social support varied, ranging from disinterest in social engagement to the development of strong social support networks. In study four, AWL clients reported no preference for peers of certain ages, sex or physical appearance, though highlighted empathy, positivity and affability as salient personal characteristics. Clients and providers welcomed the prospect of introducing AWL peers in the capacity of providing supplementary emotional, motivational and informational support. Lastly, study five documented details of actual AWL peer behaviour in terms of how scheme providers and clients utilised peers. AWL stakeholders reported high acceptability of peers, though acceptability varied as a function of demographic and personal peer characteristics, with some clients preferring age and/or same sex peers.
Conclusions: Findings provide positive evidence for the contextual appropriateness and acceptability of the AWL peer support intervention. Subsequently, this thesis provides a template to inform the adoption of peer support interventions across a heterogenous range of ERSs. Future work is necessary to investigate the potential for peer support interventions to positively enhance rates of ERS completion.
Date of Award12 Feb 2021
Original languageEnglish
Awarding Institution
  • Edge Hill University
SponsorsWest Lancashire Borough Council & Lancashire County Council
SupervisorSTUART FAIRCLOUGH (Director of Studies), ANDREW LEVY (Supervisor) & ANTHONY MAHER (Supervisor)


  • Exercise referral
  • Social support
  • peer support
  • social identity
  • physical activity

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