Cohort differences in exercise adherence among primary care patients referred for mental health versus physical health conditions

Aim: To compare the characteristics of mental health and physical health participants attending an exercise
referral scheme (ERS) and investigate associations with their adherence to exercise.
Background: While people referred to an ERS with a mental health diagnosis have similar initial rates of
uptake as physical health participants, they are more likely to drop out. Comparisons of the groups to
understand their differences and how these might impact on their adherence have been limited by the
typically low numbers of mental health referrals in many schemes.
Methods: Retrospective analysis of a participant cohort. Data were extracted on all participants enrolled
over a 12- month period (n = 701) and included measurements at baseline, mid-point (13 weeks) and end of
programme (20-26 weeks). Differences were explored between the mental health (n=141) and physical
health (n=560) sub-cohorts, and between adherers and non-adherers in each group. Binomial logistic
regression estimated the effect of group-level factors associated with adherence.
Findings: Mental health referrals were more likely to be younger, White and unemployed, and had a lower
mean body mass index and lower proportion of participants with high blood pressure. They were also more
likely to drop out. While occupation was associated with exercise adherence among the physical health
group, no predictive factors were identified in the mental health group.
Conclusion: Participants referred for mental health disorders are more likely to drop out of exercise referral
schemes than those with physical health problems. While no factors were found to be predictive of their
exercise adherence, an understanding of their distinguishing characteristics and attendance behaviour can
guide in making better referral decisions concerning them and planning more appropriately tailored
support.