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Table 4 PARS components and PA effectiveness data

From: A systematic review and narrative synthesis of physical activity referral schemes’ components

PARS model

Person-centered approach

Individualized content

Behavior change theory

Behavior change techniques

Screening

Brief advice

Written materials

Written prescription

Referral

Baseline consultation

Exit consultation

PARS vs usual care

 Prex, Finland [39]

I

I

I

I

I

I

 

I

   

 PAP, Sweden [41]

I

I

I

I

I

  

I

 

I

 

 PAP, Sweden [58]

I

I

 

I

   

I

 

I

 

 Enhanced GRx, NZ

[47] ([93]‡)

I

I

 

I

I

I

 

I

   

 GRx, NZ [48]

([94, 95]‡)

I

I

 

I

I

I

I

I

   

 HLC model, Norway [61]

I

I

I

I

    

I

I

I

 NERS, UK [46] ([96, 97]‡)

I

I

 

I

I

   

I

I

I

 Exercise referral programme, UK [63]

        

I

I

I

 EoP, Netherlands

[67]

   

I

   

I

I

I

I

 Referral to AEP, Australia [52] ([98]‡)

I

I

I

I

I

  

I

I

I

 

 ENGAGE, Australia [56]

 

I

I

I

    

I

I

 

 Active Practice, Australia [99]

  

I

   

I

I

   

 ERS, Spain

[57]

   

I

    

I

  

 PAP+referral, Canada [100]

  

I

  

I

 

I

I

  

PARS vs advice

 Enhanced PAP, Sweden [40]

IC

IC

 

IC

IC

 

IC

I

 

IC

 

 ERS, Mexico [49] ([101, 102]‡)

 

I

I

I

IC

IC

 

I

I

I

 

 Fitness for Life, UK [51]

  

I

  

C

C

 

I

I

I

 ‘Walking Partners’ scheme, UK [51]

     

C

C

 

IC

  

 GRx, USA [59]

   

IC

 

IC

 

I

   

 GRx, New Zealand [62]

   

IC

 

IC

 

I

   

PARS vs. prescription

 PAP+referral, Canada [100]

     

IC

 

IC

I

  

 Majorca model, Spain [60]

I

I

I

I

  

I

IC

 

I

I

 ERS, UK

[50]

 

I

    

IC

 

IC

I

I

Enhanced vs. standard / High-dose vs low-dose PARS

 Co-PARS, UK [73]

I

I

I

I

    

IC

IC

IC

 Enhanced PAP, Sweden [42] ([90, 103]‡)

IC

IC

I

I

IC

IC

 

IC

   

 IPAC, Canada [55]

IC

I

IC

IC

IC

IC

 

IC

 

I

I

 ERS + e-coachER¹, UK [64] ([104, 105]‡)

  

I

I

    

IC

  

 STEPS, Canada [65]

 

IC

I

    

IC

 

I

 

 PAP enhanced, Sweden

[43] ([91]‡)

IC

IC

I

I

IC

 

C

IC

I

I

I

 EoP, Denmark [44]

IC

IC

IC

IC

IC

  

IC

IC

IC

IC

 EoP, Denmark

[85] ([106]‡)

IC

IC

IC

IC

IC

IC

 

IC

I

IC

IC

 Birmingham EoP scheme, UK [45]

IC

IC

I

IC

  

I

IC

 

IC

IC

 PAP with CS, Sweden [70]

IC

IC

   

IC

 

IC

   

 Pedometer step-based GRx, New Zealand

[53] ([107]‡)

IC

IC

IC

IC

IC

IC

 

IC

   

Other comparison

 GRx, New Zealand [92]

 

IC

 

IC

   

IC

   

 GRx, New Zealand [54]

IC

IC

 

IC

IC

 

IC

IC

   

 EoP, USA [66]

 

IC

 

IC

IC

  

IC

IC

IC

 

 Active Lifestyle ERS [88]

 

IC

 

IC

   

IC

IC

IC

IC

No comparison group

 PAP, Sweden

[35, 36]

I

I

I

I

I

I

 

I

   

 Östergötland PARS, Sweden

[37, 38] ([89])

I

I

  

I

I

 

I

   

 PAP, Sweden [71]

I

I

 

I

I

 

I

I

 

I

I

 EoP, Denmark [84]

I

I

I

I

I

  

I

 

I

I

 Northumberland ERS, UK [75]

 

I

I

I

    

I

I

I

 Northumberland ERS, UK [76]

 

I

I

I

    

I

I

I

 Scottish PARS, UK [77]

        

I

  

 PAFES PARS, Spain [86]

    

I

   

I

  

 ERS Tameside, UK [78]

 

I

      

I

I

I

 PAP, Sweden [72]

I

I

 

I

I

  

I

 

I

 

 Active Living for Life, UK [79]

 

I

      

I

I

I

 Heartlinks, UK [80]

I

I

I

I

  

I

 

I

I

I

 NERS – exercise referral only, UK [68]

 

I

      

I

  

 Proactive scheme, UK [81] ([108]‡)

        

I

  

 Birmingham EoP scheme, UK [74]

I

I

I

I

  

I

I

 

I

I

 ERS, UK

[69]

 

I

    

I

 

I

I

I

 Stockport

EoP scheme, UK [82]

 

I

  

I

  

I

 

I

 

 ERS, UK [83]

 

I

  

I

   

I

  

 Referral to peer coach PA, The Netherlands [87]

        

I

  

PARS model

Counseling support session(s)

PA sessions

Education session(s)

Action for non-attendance

Structured follow-up

PA network

Feedback to referrer

Exit strategies/routes

PA effect direction

PARS uptake

Adherence

PARS vs usual care

 Prex, Finland [39]

    

I

   

+

n/a

n/a

 PAP, Sweden [41]

I

 

I

 

I

I

  

+

n/a

n/a

 PAP, Sweden [58]

    

I

   

ND

n/a

n/a

 Enhanced GRx, NZ

[47] ([93]‡)

I

   

I

 

I

 

+

98.0%†

95.0% received full intervention†

 GRx, NZ [48]

([94, 95]‡)

    

I

   

+

65.5 %

85.0%

 HLC model, Norway [61]

 

I

      

ND

n/a

73.7 %

 NERS, UK [46] ([96, 97]‡)

I

I

 

I

I

  

I

+

85.1 %

85% (43.8 % fully,

41.33 % partly)

 Exercise referral programme, UK [63]

 

I

      

ND/+

87.6%

28.0% (at least 15/20 sessions), 41.0% (at least 10/20),

68.0% (at least 5/20)

 EoP, Netherlands

[67]

I

I

 

I

   

I

+

99.0%†

86.0%

 Referral to AEP, Australia [52] ([98]‡)

I

       

+

91.7%†

76.0% fully adhered

85.0% attended at least 4/5 sessions

 ENGAGE, Australia [56]

 

I

     

I

ND/+

n/a

85.0%

 Active Practice, Australia [99]

        

+

n/a

n/a

 ERS, Spain

[57]

 

I

     

I

+

n/a

71%

 PAP+referral, Canada [100]

I

       

+

n/a

n/a

PARS vs advice

 Enhanced PAP, Sweden [40]

I

 

I

 

I

   

ND

n/a

n/a

 ERS, Mexico [49] ([101, 102]‡)

 

I

     

I

ND

78.6%

78.0% attended ≥ 50.0% of the sessions

 Fitness for Life, UK [51]

 

I

     

I

ND/+

92.0%

82.0% attended at least 25.0% of sessions, 42.0% high-adherence

 ‘Walking Partners’ scheme, UK [51]

 

I

     

I

+

76.5%

56.0% attended at least 25.0% of sessions, 21.5% high-adherence

 GRx, USA [59]

        

ND

n/a

n/a

 GRx, New Zealand [62]

        

+

n/a

n/a

PARS vs. prescription

 PAP+referral, Canada [100]

        

ND

n/a

n/a

 Majorca model, Spain [60]

I

    

I

  

ND/+

n/a

n/a

 ERS, UK

[50]

       

I

+

n/a

n/a

Enhanced vs. standard / High-dose vs low-dose PARS

 Co-PARS, UK [73]

I

      

I

ND

85.0%†

71.4%, 60.7% and 32.1% attended 3rd, 4th and 5th consultation session out of 5 respectively

 Enhanced PAP, Sweden [42] ([90, 103]‡)

I

   

IC

IC

  

ND

n/a

57.0%

 IPAC, Canada [55]

I

      

I

+/ND

88.0% for I&C

87.0%

 ERS + e-coachER¹, UK [64] ([104, 105]‡)

I

       

+

75.0% I,

78.0% C

n/a

 STEPS, Canada [65]

        

+

n/a

n/a

 PAP enhanced, Sweden

[43] ([91]‡)

 

I

     

I

ND

48.0%†

46.6%

 EoP, Denmark [44]

IC

I

I

    

I = 1

C = 0

ND

100%†

Exercise sessions attendance (I): 18/24 (q1, 14.8; q2, 21.3)

Counseling attendance: I=76.0%, C=91.0%

 EoP, Denmark

[85] ([106]‡)

IC

I

     

I

ND

n/a

n/a

 Birmingham EoP scheme, UK [45]

   

IC

I

  

IC

ND

n/a

n/a

 PAP with CS, Sweden [70]

I

       

+

37.0%

n/a

 Pedometer step-based GRx, New Zealand

[53] ([107]‡)

IC

   

IC

   

ND/+

n/a

84.0%

Other comparison

 GRx, New Zealand [92]

I

I

  

C

   

+

31.9%

I=8.5%, C=24.4%

 GRx, New Zealand [54]

IC

       

n/a

100%

n/a

 EoP, USA [66]

 

IC

      

n/a

n/a

26.35 (SD = 10.85) sessions

 Active Lifestyle ERS [88]

IC

IC

     

IC

n/a

88.0% I, 68.9% C

Weekly adherence: I = 48% ± 35, C = 39% ± 36

No comparison group

 PAP, Sweden

[35, 36]

     

I

  

+ [32]

n/a

65.0% adhered to PAP, 19.0% partly adhered, 16.0% non-adherence

[33]

 Östergötland PARS, Sweden

[37, 38] ([89])

   

I

I

I

  

+[34]

n/a

56.0% at 3 months, 50.0% at 12 months [35]

 PAP, Sweden [71]

I

       

+

n/a

n/a

 EoP, Denmark [84]

I

I

     

I

+

n/a

n/a

 Northumberland ERS, UK [75]

I

I

    

I

I

+

75.7%

40.0%†

 Northumberland ERS, UK [76]

I

I

 

I

    

+

81.0%

53.5% attended mid-scheme, 42.9% completed the scheme

 Scottish PARS, UK [77]

 

I

      

+/ND

83.8%

43.0%

 PAFES PARS, Spain [86]

 

I

      

+

n/a

75.0% completed, 84.1% average attendance

 ERS Tameside, UK [78]

I

I

      

+

76.5%

38.7% completed

 PAP, Sweden [72]

    

I

I

  

+

n/a

n/a

 Active Living for Life, UK [79]

        

+

64.5%

47.4% completed

 Heartlinks, UK [80]

I

I

    

I

 

+

n/a

45.5% completed

 NERS – exercise referral only, UK [68]

 

I

      

+

n/a

78.6%

 Proactive scheme, UK [81] ([108]‡)

 

I

   

I

  

n/a

68.8%

48.3%

 Birmingham EoP scheme, UK [74]

   

I

I

 

I

I

n/a

n/a

51.0%

 ERS, UK

[69]

       

I

n/a

79.0%

n/a

 Stockport

EoP scheme, UK [82]

 

I

      

n/a

60.0%

30.6%

 ERS, UK [83]

 

I

  

I

  

I

n/a

89.3%

82.4% completed stage one

51.8% continued stage two

 Referral to peer coach PA, The Netherlands [87]

 

I

      

n/a

5.7%

66.7%

  1. Abbreviations: n/a Not available, SC Counseling support, Prex Prescription-based PA counseling, PAP Physical Activity on Prescription, GRx Green Prescription, HLC Healthy Lifestyle Centers, NERS The Welsh National Exercise Referral, Co-PARS Coproduced PA Referral Scheme, EoP Exercise on Prescription, AEP Accredited Exercise Physiologists, ERS Exercise Referral Scheme, IPAC Intensive Physical Activity Counseling, STEPS Step Test Exercise Prescription Stage of Change Counseling, PARS Physical Activity Referral Scheme
  2. I, The component is present only in the intervention group
  3. C, The component is present only in the comparison group
  4. IC, The component is present in both the intervention and comparison group
  5.  + , PA level increased regardless of statistical significance
  6. ND No difference between groups or pre-post for studies without a comparison group
  7. †, Our calculation/interpretation of data
  8. ‡, Report of the same study, but no data extracted. Reports from the same study, merged with the included study that represents the main data source
  9. 1, Web-based behavioral support is classified under the component “counseling support session(s).” The participants in both groups receive one of three typical ERS models that differ from one another. The only difference between groups is the web-based behavioral support intervention added to the intervention group. Thus, the components rating provided here are made based only on this added intervention
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International Journal of Behavioral Nutrition and Physical Activity

ISSN: 1479-5868

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