Promoting physical activity: issues in primary health care.

In the past few years, alliances between primary care and leisure services have become a popular strategy for exercise promotion in the England. 'GP Referral Schemes' typically involve referral to a local leisure centre by a General Practitioner (GP), whereupon patients are inducted into a 10-12 week exercise programme at a reduced fee. Referred patients are usually white, middle aged and apparently healthy women, with the main reason for referral being overweight. The schemes are characterised by their lack of formal evaluation, making conclusions about effectiveness impossible. In the US, physicians advice to exercise has been the focus of interventions to date. Two controlled trials, one randomised, have provided some evidence that exercise behaviour can be changed, at least in the short term. The ability to recruit sufficient numbers of patients, who have potentially the most to gain from increased physical activity, is the biggest barrier to primary care based interventions. One contributing factor to this problem, may be doctors and nurses' knowledge about the benefits of physical activity.