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Does adding ‘e-coachER support’ to exercise referral schemes improve participants’ physical activity level in the long term (and is this good value for money)?

450 people referred to an exercise referral scheme took part in a study to answer this question. Participants were randomly assigned to receive the usual exercise referral scheme as offered in Plymouth, Birmingham or Glasgow,or the usual plus some additional support.

The e-coachER support was a package that included: access to an interactive website that guided participants over several weeks through seven steps to increase physical activity; a pedometer to record step counts; and a weekly notepad to help with self-monitoring and goal-setting.

All participants filled out surveys and wore a motion sensor (accelerometer) to measure physical activity level for one week at the start of the study, and then at four and twelve months later. This information was compared for the two groups.

We found that participants with access to e-coachER support were only slightly more active at twelve months compared to those who did not have access. We found that e-coachER support can be provided at a relatively low cost to the NHS.

Some participants agreed to be interviewed about the study and from this we have identified a number of ways in which the e-coachER support could be improved.

We are very grateful to all the participants that contributed to the e-coachER study which has helped us to better understand what the challenges are in supporting people with chronic conditions such as being overweight, having osteoarthritis, type 2 diabetes, high blood pressure and low mood to improve their health by becoming more physically active.

We welcome your comments on the findings and if you would like to get in touch, please email: PenCTU@plymouth.ac.uk.

Thank you.

Introduction to the e-coachER study

When health-care professionals refer patients with chronic conditions such as obesity, type 2 diabetes, high blood pressure, lower limb osteoarthritis and poor mental health to an exercise referral scheme, the effects on long-term increases in physical activity, which may help to manage these conditions, are limited as far as we know. We therefore developed the e-coachER support package to add to usual exercise referral schemes and to prompt the use of personal skills such as self-monitoring of amount of physical activity and setting goals to be more physically active. 

This package was also intended to empower people to increase their levels of physical activity as a way of improving their health over 9 months and more. The seven-step programme was delivered online (via an interactive website). As part of the package, we mailed participants a guide for accessing the online support, a pedometer to monitor daily steps, and a fridge magnet with a notepad to record physical activity.

We aimed to determine whether or not adding the e-coachER support to usual exercise referral schemes resulted in lasting changes in moderate and vigorous physical activity and whether or not it offers good value for money compared with exercise referral schemes alone.

Methods and Results


A total of 450 inactive individuals were recruited across Plymouth,Birmingham and Glasgow. 

Using random assignment procedures, half of the participants were given access to the e-coachER support and the other half were not. 

All individuals were mailed a wrist-worn movement sensor (accelerometer) to wear for 1 week and a survey to assess other outcomes at the start of the study as well as at 4 and 12 months post randomisation. 

All information was captured before 2019, long before COVID restrictions.


Those recruited had been referred to an exercise referral scheme for the following self-reported main reasons: weight loss (50%), low mood (19%),osteoarthritis (12%), type 2 diabetes (10%) and high blood pressure (8%).Participants often had multiple conditions; 74.2% had two conditions,30.7% had three conditions and 11.8% had four or more conditions. The participants had an average age of 50 years and an average body mass index of 33 kg/m2. (A BMI of 30 and higher is considered obese). Most (83%) described themselves as white, and 63% were female.

Participants with access to e-coachER support were only slightly more active (about 12 minutes per week of moderate and vigorous physical activity) at 12 months than those who did not have access, but we cannot be confident in the findings because we had data from fewer participants than planned. The lack of a clear effect may have been as a result of around one-third of participants not accessing the website, but otherwise there was reasonable engagement. Participants in both groups tended to increase their physical activity up to 4 months but this was reduced by the time participants reached the 12 month point, particularly among those who didn’t receive the e-coachER support.

The e-coachER support also aimed to encourage participants to make contact with an exercise professional after being referred by a health practitioner. Again, the findings showed no difference in the proportion who did meet the exercise professional between those who had access to the additional e-coachER support (75%) and those who didn’t (78%).  

We calculated that, if e-coachER support was to be made available as part of our healthcare, it would cost the provider £439 per participant over a 12-month period. This is a relatively low cost to the overall healthcare budget.


Implications for healthcare

Our findings suggest that overall clinically meaningful increases in physical activity may not be derived from the e-coachER intervention, when added to a usual exercise referral scheme. Nevertheless, given its relatively low additional cost such additional support could still be a cost-effective addition to a usual referral scheme (offered in different ways) for increasing physical activity for up to 12 months. In other words, sending patients a pedometer and fridge magnet with tear-off activity self-monitoring strips, and access to a website which requires virtually no human support, could be a cost-effective way to improve quality of life in inactive patients with certain chronic conditions.

Interviews with some participants identified a number of ways in which e-coachER could be improved, such as giving patients more information about their specific health conditions. Improvements could also be made by providing more structured guidance in the User Guide on the overall aim and content of web-based e-coachER support, including where to find links to more information about exercise and medical conditions.

Recommendations for research

Further research could examine the effects of a modified e-coachER intervention for participants with similar chronic conditions to those involved in the present study and also for different populations such as patients with cancer, back pain and in cardiac rehabilitation.

Since the design of the study new technologies such as smart phones and watches are more widely used and data from these could be shared with exercise practitioners and health professionals to help provide appropriate patient-centred support.

Links to publications:

This study was funded by the National Institute for Health and Care Research (NIHR), Health Technology Assessment Programme (grant reference: 13/25/20). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.