Please, let’s walk before we can run!

Last week marked Social Prescribing Day. For those who tuned into BBC Radio 5 Live on the day, you will have heard Professor Isabel Oliver espousing the health and wider system-related benefits of social prescribing.

She noted that around a fifth of GP appointments are for social rather than medical problems and that GPs, through signposting to social prescribing interventions, can link individuals with organisations and charities that provide advice and support for loneliness, bereavement, or financial worries. Professor Oliver highlighted that this engagement could lead to fewer patient/GP appointments and reductions in medication use. These will not only lessen the burden on struggling GP practices but also help service users to experience improved health and wellbeing outcomes and re-engage with their communities.

To mark the day, all Health Boards in Wales are referring people and staff to parkrun (or are planning to do so). parkrun (yes, small p) is an international organisation which, through its network of volunteers, organises local 5km events. Participants can walk or run the distance and children can take part in a 2km event called Junior parkrun. Evidence conducted by parkrun suggests that participants who take part regularly experience improvements in physical health and mental wellbeing.

While Professor Oliver clearly outlines the potential benefits of social prescribing, it is important that claims regarding its effectiveness are made with caution. Our understanding of how physical activity–based interventions operate within this context remains incomplete. Greater confidence in their effectiveness should be grounded in high-quality, robustly conducted studies (currently these are lacking). This caution is relevant not only to the interpretation of the existing evidence base, but also to decisions around widespread initiatives, such as referring all patients and staff to parkrun.

My DPhil research aims to deepen understanding of how to optimise the uptake of activity-based interventions within social prescribing. Findings from my work with link workers indicate that engaging service users in physical activity is a complex process, underpinned by relational and conversational mechanisms that help to build trust, motivation, and engagement. Without this connection and emotional support, there is a risk of replicating the challenges observed in Exercise Referral Schemes. These include barriers to attendance and engagement [1,2], concerns regarding cost-effectiveness and evaluation quality [3], only modest short-term improvements in physical activity, and limited evidence of sustained long-term impact [4].

Successful engagement with activity-based interventions is not achieved simply by referring individuals to a specific activity. Rather, it depends on providing the emotional and relational support needed to help service users take the first, often daunting, steps towards becoming more active. Without this support from link workers and other healthcare professionals, confidence and motivation can diminish, while fear of judgement and uncertainty about trying something new can increase. These factors interact, reducing the likelihood of both initial and sustained engagement with activity-based interventions [5]. Developing a deeper understanding of these relational and conversational mechanisms is therefore critical to avoiding these pitfalls and addressing what is now called the pandemic of physical inactivity [6].

Finally, we need to reframe how physical activity is discussed and promoted. Link workers consistently report that the concepts of "exercise" and achieving the 150 minutes of exercise per week can feel overwhelming and disengaging. A broader framing that emphasises the wider benefits of physical activity could be more effective. For some individuals, traditional images of exercise such as sweating, being in some degree of discomfort, and wearing tight-fitting clothing can act as deterrents. In contrast, the social aspects of activity, such as camaraderie and shared experience, can be used as a tool to motivate service users. The concept of social connection provides a much less intimidating entry point and enables individuals to visualise themselves in that environment with others with similar backgrounds and experiences. This creates a more positive relationship with physical activity and service users experiences the s almost indirectly through just being there with friends.

I love being active. It has brought me great friends, adventures, and memories that I'll never forget. But accessing these benefits is such a fragile process, it can go either way. It was only because I received some support from a great teacher that I found the confidence to try being more active. If we don't support service users in the right way during the early stages of engaging with activity, we might blow our chances of helping them to realise those benefits. We must give link workers the time, support, and resources to have meaningful conversations that give the most vulnerable individuals in society the confidence to try too. In short, let's walk before we can run.

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1. Birtwistle, S.B. et al. (2018) ‘Factors influencing patient uptake of an exercise referral scheme: A qualitative study’, Health Education Research, 34(1), pp. 113–127.doi:10.1093/her/cyy038.
2. Morgan, F. et al. (2016) ‘Adherence to exercise referral schemes by participants – what do providers and commissioners need to know? A systematic review of barriers and facilitators’, BMC Public Health, 16(1). doi:10.1186/s12889-016-2882-7.
3. Pavey, T.G. et al. (2011) ‘Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis’, BMJ, 343(nov04 2), pp. d6462–d6462. doi:10.1136/bmj.d6462.
4. Booth, G. et al. (2022) ‘The effectiveness of interventions and intervention components for increasing physical activity and reducing sedentary behaviour in people with persistent musculoskeletal pain: A systematic review and meta-analysis’, The Journal of Pain, 23(6), pp. 929–957. doi:10.1016/j.jpain.2021.11.004.
5. Broom, A. et al. (2025) ‘Physical activity in context: The systems and inequalities of Metabolic Harm’, The Lancet Planetary Health, 9(11), p. 101323. doi:10.1016/j.lanplh.2025.101323.
6. Pratt, M. et al. (2020) ‘Attacking the pandemic of physical inactivity: What is holding us back?’, British Journal of Sports Medicine, 54(13), pp. 760–762. doi:10.1136/bjsports-2019-101392.