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Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial

Joan L Duda1, Geoffrey C Williams2, Nikos Ntoumanis1, Amanda Daley3, Frank F Eves1, Nanette Mutrie4, Peter C Rouse1, Rekha Lodhia1, Ruth V Blamey3 and Kate Jolly3*

Author Affiliations

1 School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK

2 Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, New York 14627, USA

3 School of Health & Population Sciences, University of Birmingham, Birmingham B15 2TT, UK

4 School of Education, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh EH8 8AQ, UK

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:10  doi:10.1186/1479-5868-11-10

Published: 29 January 2014



The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation.


An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (Nā€‰=ā€‰347) referred to an exercise referral scheme were recruited into the trial from 13 centres.

Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.

Blood pressure and weight were assessed at baseline and 6 months.


Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported.


Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed.

Trial registration

The trial is registered as Current Controlled trials ISRCTN07682833.

Exercise on referral; Physical activity promotion; Self determination theory; Autonomy support; Autonomous motivation; Need satisfaction; Subjective vitality; Dartmouth CO-OP charts