Newby K, and others. Moving an exercise referral scheme to remote delivery during the Covid-19pandemic: an observational study examining the impact on uptake, adherence, and costs. BMC Public Health 2024; 24. Available from https://doi.org/10.1186/s12889-024-19392-y

Newby K, and others. Adaptations to the welsh national exercise referral scheme during the COVID-19 pandemic: a qualitative study exploring the experiences of service users and providers and supplementary out-of-pocket cost analysis. BMC Public Health 2025; 25. Available from https://doi.org/10.1186/s12889-025-21502-3

What does the evaluation mean for Local Government?

The knowledge from this research has provided an understanding of whether and how NERS could be delivered virtually in the future (in addition to core face-to-face delivery) and the implications of this in terms of service user uptake, engagement, outcomes and programme costs. This has taken into consideration the learning gained from delivering the programme virtually in response to the Covid-19 pandemic. More widely, the findings will also be of interest to others responsible for developing or managing health improvement programmes who are considering introducing virtual delivery.

What does the evaluation mean for the Public?

Adding virtual delivery to NERS has increased programme accessibility and improved health outcomes e.g. there were groups of people whose circumstances make face-to-face attendance challenging. This research has helped to identify who these groups of people are and how they can be best supported to engage in this way. These findings have informed NERS programme managers, and those responsible for other types of health improvement programmes to deliver public services that are increasingly person-centred and flexible.

How are the public involved in the evaluation?

The public were involved throughout the project in several different ways. This includes a local service user consultation group who developed research questions important to them, assisted with data analysis, provided insight when discussing findings and produced outputs. Additionally, throughout all PHIRST Connect projects the Public Involvement in Research group acted as a critical friend on key elements of the research process, and in some situations acted as co-researchers.   

Lay summary of research

The National Exercise Referral Scheme (NERS) is a Welsh Government programme that operates across the whole of Wales. It aims to help members of the public to improve their physical and mental health and wellbeing by providing access to personalised and supervised physical activity.

NERS is aimed at people aged 16 years and over, who are not used to taking part in physical activity or who are at risk of, or currently experiencing, a long-term health condition. People are referred onto the Welsh NERS by a health professional such as a doctor, nurse or physiotherapist, and then take part in a 16-week programme of exercise sessions while being supported by a trained ‘exercise professional’. The sessions were designed to be fun and easy to fit into everyday life.

The Covid-19 pandemic meant that in March 2020 the Welsh NERS programme had to change the way it delivered its services. One of the main changes was that it moved from running exercise sessions face-to-face to running them virtually (for example, with people joining in with live sessions from their own homes while watching their instructor on a smartphone, tablet or computer).

The aims of the study were to understand whether this change in the way that the Welsh NERS was run affected:

whether people joined the Welsh NERS in the first place

whether people took part in the sessions

whether people stayed involved for the full 16 weeks of the programme

people’s physical and mental health and wellbeing

The study answered the following, broad research questions: 

Did delivering the Welsh NERS virtually affect whether people joined the project, took part in exercise sessions, and completed all 16 weeks of the programme?

Were there things that increased or decreased the chances of people joining and taking part in the Welsh NERS, and what were these for different groups of people?

How did the outcomes for service users who experienced a virtual version of the Welsh NERS compare to those who experienced it face-to-face?

How did the costs of running the Welsh NERS virtually compare to the costs of running it face-to-face?

What was the best way to deliver the Welsh NERS in the future and what were the benefits and downsides of these different options?

The research design included

1. Asking staff who helped deliver the Welsh NERS to take part in group discussions 

2. One-to-one interviews with the Welsh NERS service users and people referred on to the Welsh NERS but who never took it up 

3. Looking at information on health and wellbeing outcomes to see what changed for those who took part in the Welsh NERS and if this varied for different groups of  service users (for example, those who experienced the Welsh NERS virtually compared to those who experienced it face-to-face, and those with different health conditions)  

4. Looking at how much virtual delivery costs compared to face-to-face delivery 

5. Running a workshop to work together with those involved in the Welsh NERS to explore the best way for the Welsh NERS to be run in the future 

(Photo credit iStock)

Local Government / Partner(s)

Welsh Local Government Association

Public Health Wales

PHIRST Connect Research Team

Dr Katie Newby, Dr Neil Howlett, Charis Bontoft, Dr Olujoke Fakoya, Imogen Freethy, Nigel Lloyd, Nigel Smeeton, Dr Adam P Wagner, Amander Wellings, Professor Wendy Wills, Professor Katherine Brown
*All PHIRST Connect members input into every project

NIHR Funding Award: NIHR134153

Image credit: iStock