Article Text

Randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial
  1. Adrian Taylor1,
  2. Rod S Taylor2,3,
  3. Wendy Ingram4,
  4. Sarah Gerard Dean5,
  5. Kate Jolly6,
  6. Nanette Mutrie7,
  7. Jeff Lambert8,
  8. Lucy Yardley6,9,
  9. Adam Streeter10,
  10. Colin Greaves11,12,
  11. Chloe McAdam7,
  12. Lisa Price13,
  13. Nana Kwame Anokye14,
  14. John Campbell5
  1. 1Peninsula School of Medicine, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
  2. 2Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  3. 3Health Statistics, University of Exeter Medical School, Exeter, UK
  4. 4Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, Devon, UK
  5. 5University of Exeter Medical School, Exeter, Devon, UK
  6. 6Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
  7. 7Physical Activity for Health Research Centre, The University of Edinburgh, Edinburgh, UK
  8. 8Department of Health, University of Bath, Bath, Somerset, UK
  9. 9School of Psychological Sciences, University of Bristol, Bristol, UK
  10. 10Medical Statistics, University of Plymouth, Plymouth, Devon, UK
  11. 11School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  12. 12University of Exeter Medical School, Exeter, UK
  13. 13School of Sport and Health Sciences, University of Exeter, Exeter, Devon, UK
  14. 14Department of Clinical Sciences, Brunel University, Uxbridge, Middlesex, UK
  1. Correspondence to Professor Adrian Taylor, Peninsula Medical School, Faculty of Health, Plymouth Science Park, University of Plymouth, Plymouth, Devon, UK; adrian.taylor{at}


Objective To determine whether adding web-based support (e-coachER) to an exercise referral scheme (ERS) increases objectively assessed physical activity (PA).

Design Multicentre trial with participants randomised to usual ERS alone (control) or usual ERS plus e-coachER (intervention).

Setting Primary care and ERS in three UK sites from 2015 to 2018.

Participants 450 inactive ERS referees with chronic health conditions.

Interventions Participants received a pedometer, PA recording sheets and a user guide for the web-based support. e-coachER interactively encouraged the use of the ERS and other PA options.

Main outcome measures Primary and key secondary outcomes were: objective moderate-to-vigorous PA (MVPA) minutes (in ≥10 min bouts and without bouts), respectively, after 12 months. Secondary outcomes were: other accelerometer-derived and self-reported PA measures, ERS attendance, EQ-5D-5L, Hospital Anxiety and Depression Scale and beliefs about PA. All outcomes were collected at baseline, 4 and 12 months. Primary analysis was an intention to treat comparison between intervention and control arms at 12-month follow-up.

Results There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: −2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: −26.8 to 54.2; p=0.51) for 232 participants with usable data. There was no difference in the primary or secondary PA outcomes at 4 or 12 months.

Conclusion Augmenting ERS referrals with web-based behavioural support had only a weak, non-significant effect on MVPA.

Trial registration number ISRCTN15644451.

  • accelerometer
  • physical activity
  • behaviour
  • chronic
  • primary care

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  • Contributors AT conceived the idea for the study with co-applicants: RST, NM, KJ, LY, NKA, JC, CG and SGD. AT, all co-applicants listed above, and WI contributed to the final study design and development of the protocol. AT, JL and LY developed the web support using LifeGuide. SGD led the qualitative work and developed the process evaluation plan with JL, CG, JC and AT. RST provided the statistical analysis plan, and conducted and reported the statistical analysis in accordance with the Plan. AS provided additional support to the statistical analysis. LP was responsible for accelerometer data processing, advising and reporting on accelerometer-derived measures. AT, KJ and NM were principal investigators, assisted by CM at the Glasgow site. WI was the trial manager.All authors critically revised successive drafts of the manuscript and approved the final version. AT is the guarantor.

  • Funding This study was funded by the National Institute for Health Research (NIHR), Health Technology Assessment Programme (grant reference: 13/25/20). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests All authors have completed the ICMJE uniform disclosure forms at and declare support from National Institute for Health Research (NIHR), Health Technology Assessment grant 13/20/25 for the submitted work. CM declares that she is an employee of the Public Health Team in NHS Greater Glasgow and Clyde, a Health Board which funds and manages one of the exercise referral scheme included in the study. KJ declares that she is partly funded by NIHR ARC West Midlands and is a subpanel chair of the NIHR Programme Grants for Applied Health Research. NM declares grants from NIHR during the conduct of the study and personal fees for work in relation to UK physical guidelines revision outside the submitted work. LP reports: grants from Living Streets Charity, personal fees from NIHR, personal fees from NIHR PHR, personal fees from NIHR PHR rapid response, grants from Wellcome Trust seed corn (internal funding) outside the submitted work; the physical activity group in Sport and Health Sciences at the University of Exeter has a collaboration with Activinsights (the manufacturer of the physical activity monitor) to provide study design advice and data analysis—the analysis of the physical activity data in the present study was not undertaken as part of this service. SGD is partly funded by the South West Peninsula Applied Research Collaboration. LY is partly supported by the NIHR Southampton Biomedical Research Centre. All other authors have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and have no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the National Research Ethics Committee North West—Preston (15/NW/0347).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The guarantor (AT) is willing to examine all requests for the deidentified dataset after a period of three years from the date of this publication.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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