One recent approach to increasing exercise uptake is the exercise prescription scheme
whereby GPs refer targeted patients for exercise. Therefore, in the same way that an
overweight or depressed patient would be referred to see a counsellor, or a patient with a
suspected skin cancer would be referred to a hospital specialist, a GP can now also refer
a patient for exercise. This could take the form of vouchers for free access to the local
leisure centre, an exercise routine with a health and fitness advisor at the leisure centre,
or recommendations from the health and fitness advisor to follow a home-based exercise
programme, such as walking.
An alternative and more simple approach involves the promotion of stair rather
than escalator or lift use. Interventions to promote stair use are cheap and can target
a large population. In addition, they can target the most sedentary members of the
population who are least likely to adopt more structured forms of exercise. This is in
line with calls to promote changes in exercise behaviour which can be incorporated
into everyday life (Dunn et al. 1998). Research also indicates that stair climbing can
lead to weight loss, improved fitness and energy expenditure and reduced risk of
osteoporosis in women (e.g. Brownell et al. 1980; Boreham et al. 2000). Some
research has therefore attempted to increase stair use. For example, some research
has explored the impact of motivational posters between stairs and escalators or lifts
and has shown that such a simple intervention can increase stair walking (e.g.
Anderson et al. 1998; Russell et al. 1999; Kerr et al. 2001). In a more detailed study,
Kerr et al. (2001) explored what characteristics of poster prompts was most effective
and explored whether this varied according to message, gender and setting. The
results showed that larger posters were more effective at promoting stair use, that
effectiveness was not related overall to whether the message emphasized time and
health (i.e. ‘stay healthy, save time, use the stairs’) or just health (i.e. ‘stay healthy
use the stairs’), but that whereas the message including time was more effective
for women in the train station it was more effective for men when presented at a
shopping centre.
Therefore, these initiatives have aimed to develop a suitable climate for promoting
exercise. In addition, as a result of government emphasis on exercise, specific exercise
programmes have been established in an attempt to assess the best means of
encouraging participation. In particular it is possible to differentiate between individual
and supervised exercise programmes.
Individual versus supervised exercise programmes
King et al. (1991) carried out a study in the USA to examine the relative value of
individual versus supervised exercise programmes. Using random telephone numbers
they identified 357 adults, aged 50–65, who led relatively sedentary lifestyles. These
subjects were then randomly allocated to one of four groups:
Group 1: the subjects were encouraged to attend a one-hour vigorous exercise session
at a local community centre at least three times a week.
Group 2: the subjects were instructed to do some intensive exercise on their own and
were encouraged and monitored with periodic phone calls.
EXERCISE 175