Evidence map›Paper›PMID 39938960›Full record

ArticleBMJ open2025

Exploring the levels of variation, inequality and use of physical activity intervention referrals in England primary care from 2017-2020: a retrospective cohort study.

Anant Jani, Harshana Liyanage, Cecilia Okusi, Julian Sherlock, Uy Hoang, Dylan McGagh, John Williams, Filipa Ferreira, Ivelina Yonova, Simon de Lusignan

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Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Anant JaniHeidelberg Institute for Global Health, Heidelberg University, Heidelberg, Baden-Württemberg, Germany.ORCID http://orcid.org/0000-0002-7046-6768
Harshana LiyanageDepartment of Health and Social Care, UK Health Security Agency, London, UK.
Cecilia OkusiNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, University of Oxford, Oxford, Oxfordshire, UK.
Julian SherlockNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, University of Oxford, Oxford, Oxfordshire, UK.
Uy HoangNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, University of Oxford, Oxford, Oxfordshire, UK.ORCID http://orcid.org/0000-0002-8428-5140
Dylan McGaghNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, University of Oxford, Oxford, Oxfordshire, UK.
John WilliamsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, University of Oxford, Oxford, Oxfordshire, UK.
Filipa FerreiraNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, University of Oxford, Oxford, Oxfordshire, UK.
Ivelina YonovaResearch and Surveillance Centre, Royal College of General Practitioners, London, UK.
Simon de LusignanNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK, University of Oxford, Oxford, Oxfordshire, UK simon.delusignan@phc.ox.ac.uk.ORCID http://orcid.org/0000-0001-5613-6810

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesIn this study, we explore the use of physical activity intervention referrals in primary care in England and compare their use with the rate of cardiovascular disease (CVD) risk factors in England from 2017 to 2020. We also explore variation and inequalities in referrals to these interventions in England across the study period.

designRetrospective cohort study.

settingEngland primary care via the Royal College of General Practitioners Research Surveillance Centre.

participantsThe Royal College of General Practitioners Research Surveillance Centre, a sentinel network across England covering a population of over 15 000 000 registered patients, was used for data analyses covering the 2017-2020 financial years and including patients with long-term conditions indicating CVD risk factors. OUTCOME MEASURES: An existing ontology of primary care codes was used to capture physical activity interventions and a new ontology was designed to cover long-term conditions indicating CVD risk factors. Single factor analysis of variance, paired samples t-test and two-tailed, one proportion z-tests were used to determine the significance of our findings.

resultsWe observed statistically significant variation in physical activity intervention referrals for people with CVD risk factors from different ethnic groups and age groups across different regions of England as well as a marked decrease during the COVID-19 pandemic. Interestingly, a significant difference was not seen for different socioeconomic groups or sexes. Across all attributes and time periods (with the exception of the 18-39 group, 2017-2019), we observed a statistically significant underuse of physical activity intervention referrals.

conclusionsOur findings identified statistically significant variation and underuse of physical activity referrals in primary care in England for individuals at risk of CVD for different population subgroups, especially different ethnicities and age groups, across different regions of England and across time, with the COVID-19 pandemic exerting a significant negative impact on referral rates.

Indexed as

Cardiovascular DiseasesCOVID-19ExerciseHealthcare DisparitiesPrimary Health CareReferral and ConsultationAdolescentAdultAgedEnglandFemaleHumansMaleMiddle AgedRetrospective StudiesRisk FactorsCardiovascular DiseaseDIABETES & ENDOCRINOLOGYHealth EquityHealth informaticsPREVENTIVE MEDICINEPrimary Care

Identifiers

PMID39938960
PMCPMC11822388

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.