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Home » Research » Programmes » Healthy Public Policy » Long-Term Implementation And Effects Of The National Exercise Referral Scheme (NERS) In Wales

Long-Term Implementation And Effects Of The National Exercise Referral Scheme (NERS) In Wales

Lead Investigator

Dr Kelly Morgan


 Professor Graham Moore


The proposed project will evaluate the post-trial implementation and long-term clinical effectiveness of the Welsh National Exercise Referral Scheme [NERS] across all 22 Local Authorities [LAs] in Wales.

Physical inactivity is a major cause of preventable illness and significant cost to the NHS. In Wales, 71% of adults are not sufficiently active. Increasing physical activity at the population level, and among at risk groups, is a public health priority. While an earlier evaluation of NERS revealing promising impacts upon self-reported physical activity and mental health outcome at 12-month follow-up, the ongoing fidelity of implementation and long-term effectiveness on health outcomes is unknown; understanding the longer-term maintenance of implementation and effects of evidence-based interventions is a major empirical gap in the public health literature. What evidence there is to date suggests that evidence-based interventions are often not widely adopted or are adopted with insufficient quality and fidelity following trials of their effectiveness. Furthermore, use of self-reported outcomes may have subjected data to inaccuracies and the follow-up of participants in the longer-term may be necessary to demonstrate significant improvements in a variety of health outcomes.

This proposal aligns with Welsh government strategy which identifies physical activity as a priority area. It addresses NICE research recommendations, as well as service delivery recommendations of Public Health Wales’ Health Improvement Review, focused on furthering the impact of NERS through innovation and research.

Aims and Objectives

The overarching aim of this study is to evaluate the long-term implementation of NERS across Wales and to examine the long-term clinical effectiveness of the scheme, in order to quantify the sustainability and effectiveness of the national scheme. The objectives are:

1: To explore experiences of programme implementation since the programme evaluation and national roll-out (investigating the acceptability, adherence, fidelity and dose at which the programmes core components are delivered).

2: To examine the long-term effectiveness of NERS participation on patient health outcomes and health service usage at 3 follow-up time points.

Study Design

Research plan

This research will consist of two phases; 1) structured/ semi-structured interviews will be conducted to explore experiences and views of programme implementation with a wide range of stakeholders; 2) secondary data analysis of routine NERS data and record linkage to anonymised routine health records. The use of propensity-score matching will enable long-term health outcomes to be compared between NERS patients and non-NERS patients.


NERS is delivered in a variety of settings across the 22 local authorities in Wales, including council owned leisure centres and private gyms. For this project, data will be gathered from scheme implementers (i.e. NERS national coordinator and area coordinators) across all 22 local authorities and a sub-sample of scheme referrers, scheme instructors and leisure managers. Routinely collected data will be analysed for all NERS participants who were referred via the NERS generic pathway.


Morgan, K.; Rahman, M.; Moore, G. Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales From 2008 to 2017: A Data Linkage StudyInt. J. Environ. Res. Public Health 2020

Morgan, K; Lewis, J;  Hawkins, J; Moore, G. From a research trial to routine practice: stakeholders’ perceptions and experiences of referrals to the National Exercise Referral Scheme (NERS) in Wales. BMC Health Services Research 2021

Start date

October 2016

End date

June 2020


Health and Care Research Wales – Health Fellowship