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Exercise on referral: evidence and complexity at the nexus of public health and sport policy

ABSTRACT Exercise on referral schemes (ERS) are recommended by the National Institute of Clinical Excellence for increasing physical activity in inactive patients with long-term health conditions. The current paper critiques a recent extension to ERS provision, specifically, schemes using sport as the primary delivery mechanism (sport-based ERS). We suggest attention should be given to how such schemes that operate across sport and public health sectors may have mismatched approaches to evidence and policy implementation. Specifically, we highlight two current issues concerning ERS and consider the addition of sport-based schemes in respect to these. First, we argue that ERS-related public health policy and guidance is drawn from a limited evidence base, and is consequently vague. While this leads to opportunities for local innovation, the subsequent design, implementation and evaluation of ERS is diverse. ‘Scaling-up’ of effective interventions, desired by Public Health England, is therefore problematic, and likely to be further exacerbated by introducing sport-based ERS. Second, we contend that sport-based schemes are unlikely to overcome existing challenges concerning untargeted provision of ERS, and that funding would be better directed towards services for those who have complex barriers to successful engagement.