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Primary-care referral to community-based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed-method process evaluation exploring how outcomes were achieved.

Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semi-structured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme.

NERS offered patients a programme of supervised, group-based discounted exercise. However, motivational interviewing, goal-setting and patient follow-up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient-only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non-car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS.

In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed-method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS.

The use of exercise as an intervention to improve health in the general population is well documented. The purpose of this paper is to explore whether an exercise referral scheme can be an effective health promotion tool for male prisoners in Ireland, presenting with mental health symptoms.

This mixed methods study with a pre- and post-intervention design was conducted in Mountjoy Prison, Dublin, which has a capacity for approximately 790 prisoners. Reliable and validated symptom assessment scales were used to assess levels of depression, anxiety, stress, self-esteem and anger amongst a sample of 40 prisoners pre- and post-intervention. The scales used were the Depression, Anxiety and Stress scale or DASS-42 (Lovibond and Lovibond, 1995), the Novaco Anger Scale (Novaco, 1994), the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the Zung Self-Rated Anxiety Scale (Zung, 1971). Semi-structured interviews were also conducted with a subset of the participants post-intervention to further test and contextualise the symptom ratings. The data gathered from the self-rating scales were imported into SPSS 22 for statistical testing for significance. Wilcoxon’s signed-rank test was then used to measure significance of changes. Thematic analysis was performed on the qualitative data.

In the post-intervention, significant levels of improvement were achieved in the levels of depression, anxiety (DASS), anxiety (Zung), stress, anger, and self-esteem for 29 of the 30 prisoners who completed the study. The incidence of normal mood scores rose from 33 to 90 per cent after the intervention; the incidence of extremely severe scores for anxiety changed from 40 to 7 per cent, severe stress scores changed from 27 to 3 per cent, normal stress levels rose from 17 to 73 per cent, marked anger ratings reduced from 40 to 3 per cent and low self-esteem levels reduced from 20 per cent of participants pre-intervention to 7 per cent post-intervention. In the main, participants perceived the experiences and outcomes of the intervention positively.

There are some limitations to the design of this study. Operational circumstances within the prison at the start of this study prevented the authors from accessing a larger sample. A control group would add greatly to the study but this was not possible within a single prison setting. The possible influence of extraneous variables such as increased attention and social contact, and more time out of one’s cell may have contributed to improved symptom scores as much as the exercise intervention in this study. This possibility was recognised from the outset but the authors proceeded because the aim was to test if an exercise referral package (and all that inevitably goes with that) would make a difference for symptomatic prisoners.

The organisation and smooth running of the intervention and the positive results therein underpinned the practicality of this project. The significantly positive results contribute new knowledge to the profile of Irish male prisoners’ mental health.

This study could be the foundation for a larger study or set of studies which should include a control group and one or more female prisoner cohorts. The impact of positive changes in prisoners’ mental health on the prison staff and environment could also be researched. This type of study could lead to important social implications in relation to its impact on prisoner rehabilitation.

This study was the first of its kind to explore the effectiveness of exercise referral as a health promotion intervention for Irish male prisoners presenting with mental health symptoms.

Diane Crone at the University of Gloucestershire has been involved for over a decade in the design, delivery, evaluation and research both of exercise referral schemes and the use of physical activity for people with mental health problems. In this network page, she welcomes the Mental Health Foundation's new Up and Running? campaign that aims to promote exercise as an alternative to medication for treatment for mild and moderate mental health problems, and challenges the leisure industry to open its doors to people with mental health problems.

The purpose of this paper is to examine the influence of exercise on the mental health problems of older women.

The paper is based on information from academic literature, government publications and publications from other relevant bodies. It is a scoping study and is not a systematic review because of the constraints of the resources.

There is growing evidence about the value of exercise for the mental health of older women but few evaluated examples of how this can be achieved.

There is a gap in the literature about this topic with few evaluated examples of how more older women can be encouraged to take more exercise.

Policy makers, practitioners and older people themselves would gain from a greater emphasis on exercise as a means of improving quality of life and for reducing healthcare budgets through fewer referrals to services.

Greater emphasis on exercise for older women would increase their quality of life through a reduction in mental health problems.

There is limited research which links mental health, exercise and older women, especially regarding the barriers to exercise that older women with diagnosed mental health problems may face.

The Falls Exercise Prevention Programme for older people was introduced as a new project for North Bradford Primary Care Trust in 2002. The introduction of this new service was in response to an identified need to help reduce the incidence of falls, reduce serious injuries as a result of falling, and help improve and maintain the quality of life for those older people who had been identified as having had a fall or being at high risk of falling. The service was not established to be a front line service but to be incorporated into the falls referral pathway. The exercises undertaken are all evidence based and proven to be effective with this population. However, the Group promotes other aspects of quality of life for older people and promotes a holistic approach including health promotion and education. The group has now expanded to incorporate a ‘Walking for Health’ project; a ‘Walk From Home’ project and a ‘Buddy‐Up’ system. The Group is continually growing and future plans are to incorporate ‘Walks for Fallers’. Evaluation of the service provides information to continually improve and extend the services on offer.

The power of the executive to refer cases involving criminal conviction back to an appellate court is a mechanism for guarding against miscarriages of justice and regulating the inherent fallibility of the criminal justice system. These cases typically come before the executive by way of a petition that claims a person has been wrongfully convicted. In Australia, however, there are few guidelines and little information as to the criteria and standards by which the executive decides whether to refer a petitioned case. The test the petitioner must meet is not clear. This chapter therefore has two purposes. The first is to examine the types of petitions most likely to be referred to the appellate court by the executive. These cases are shown to fall into particular categories. The second is to argue that, from these categories, inferences may be drawn about the test the executive uses in deciding whether to refer a petition. These inferences follow from the common principles and links between the cases in each category. The chapter identifies the test the petition should meet to have optimal chance of referral.

In Scotland, individuals referred for NHS psychological therapies are expected to commence “treatment” within 18 weeks of receipt of referral. With high demand, high non-attendance rates and limited capacity, this can be a challenging goal. The service discussed here was keen to develop a way of seeing individuals referred sooner and improving the efficiency of the assessment process. The purpose of this paper is to look at the impact of introducing assessment (“Signpost”) appointments on waiting times, attendance, and treatment planning.

Signpost appointments were offered to all existing, and any new referrals, to an adult psychological therapies team (PTT) in NHS Lanarkshire. Clinicians kept a record of the outcomes of these appointments over a six month period. Waiting times and attendance figures were compared before and after the introduction of the Signpost system.

Following the introduction of Signpost appointments, individuals were seen sooner for both assessment and therapy. Attendance at first appointments improved and Signpost appointments helped inform treatment planning. Although alternatives were discussed, the majority of clients were still offered individual therapy. Service user and staff satisfaction was high.

The results from this study led to assessment (“Signpost”) appointments being rolled out across other adult PTTs in NHS Lanarkshire.

There is little research looking at the impact of assessment/signpost appointments on adult mental health services in the UK. In the current climate of public service cuts, this study provides an innovative way of reducing waiting times and maintaining service user satisfaction, without requiring more resources.

Historically, provision of orthopaedic services has been hospital based with GPs referring patients for specialist opinion. Growing demands on the service have led to new initiatives to reduce waiting times. One such initiative has been the introduction of orthopaedic assistants, usually physiotherapists, working with an extended scope of practice who see patients after referral to secondary care and determine the patients on‐going management. Studies to date have examined the effect of an orthopaedic assistant working alongside a consultant in the hospital environment. This study describes the impact on the management of the orthopaedic caseload in one general practice resulting from “screening” prior to referral to secondary care by a physiotherapist with an extended scope of practice. It demonstrates the successful management of the majority of patients within primary care.