Research report: Community exercise programmes for chronic disease and the emerging role of physical activity for health officers in Ireland: a narrative review

A narrative review finds that community-based exercise programmes can improve physical activity, functional capacity and health-related quality of life among people living with chronic disease, while finding that Ireland’s Physical Activity for Health Officer (PAfHO) pilot remains largely unevaluated. The role links healthcare services with community physical activity provision and is conceptually consistent with international evidence favouring personalised support, behavioural assistance and coordinated pathways, but direct evidence that it improves participant outcomes, reduces healthcare demand or saves money is limited. The review, published in Frontiers in Sports and Active Living, synthesised contemporary evidence rather than conducting a new trial or formal meta-analysis.

The author searched PubMed, Scopus and Web of Science for material published from January 2020 to 2026, supplementing the search with policy, government, health-service, Sport Ireland, Local Sports Partnership and programme documents relevant to the Irish initiative. The final database search was conducted on 30 June 2026. Of 1,116 primary and secondary records identified, 135 passed title-and-abstract screening and 35 entered the final narrative synthesis; five additional grey-literature sources were included.

The evidence base also included systematic and scoping reviews, primary research, policy and strategy documents, and implementation or service reports. Because populations, interventions, settings and outcomes varied substantially, findings were synthesised narratively rather than combined quantitatively. Across the reviewed evidence, structured community exercise was associated with gains in physical function, physical activity participation, health-related quality of life and psychological wellbeing among people with cardiovascular disease, musculoskeletal disorders, multimorbidity and other long-term conditions.

Functional outcomes included mobility, balance, lower-limb strength, walking ability and sit-to-stand performance. An umbrella review of 55 reviews identified 14 factors linked with exercise adherence, including supervision, social support, self-efficacy, education, goal setting, technology, feedback and programme design. Other systematic reviews reported benefits from aquatic exercise and nature-based programmes, including green exercise and gardening, showing that community provision can take different forms.

These findings describe reported associations and intervention results across heterogeneous studies, not the expected effect of every programme. Benefits did not emerge uniformly. The review identified variability in exercise intensity, supervision, programme duration, behavioural support and participant characteristics.

Common barriers included pain, poor health, time constraints and limited access to suitable local programmes. Social support, confidence in one’s ability to exercise, perceived health benefits and positive previous experiences were recurring facilitators. A systematic review and meta-analysis of 38 randomised controlled trials involving adults with chronic conditions found that physical activity interventions produced moderate reductions in fatigue, with resistance exercise, aerobic cycling and combined programmes showing the greatest effects.

A pragmatic assessor-blinded randomised controlled trial in adults with multimorbidity found that personalised exercise combined with self-management improved health-related quality of life at 12 months without compromising safety. These studies support exercise as part of chronic disease management, but they do not establish that every community programme will reproduce the same outcomes. Referral alone emerged as an incomplete strategy.

A 2024 systematic review, meta-analysis and meta-regression of 52 physical activity referral studies found that referral schemes increased physical activity compared with usual care, while person-centred approaches, screening and brief advice improved adherence rates. An umbrella review reported low-to-moderate improvements in physical activity, fitness and selected health outcomes, with mixed evidence on cost-effectiveness. A 2026 retrospective cohort study from an exercise referral scheme in Manchester found that early engagement was the strongest predictor of programme completion, while age, deprivation and referral pathway also influenced participation.

The review therefore treats sustained engagement as a property of the pathway rather than merely of the exercise session, and it distinguishes the average effects found in studies from the uncertain results that individual participants may experience. Personalisation, goal setting, self-monitoring, feedback, social support and structured follow-up repeatedly appeared as ingredients of successful engagement. A realist review of social prescribing found that these pathways can help people with long-term conditions when local infrastructure and personalised support are available, while an English realist evaluation emphasised trust, participant readiness and strong relationships with link workers.

Reviews of exercise referral schemes found that they work best as collaborative networks linking healthcare professionals, exercise providers, community organisations and programme coordinators, with feedback loops and shared responsibility. The review also distinguished formal referral, in which responsibility passes between services, from signposting, in which an intermediary helps a person identify and reach an appropriate community opportunity. Both require suitable local programmes, trained personnel, communication between sectors and a route for participants to progress towards more independent activity.

Ireland’s PAfHO pilot is designed around these functions. Positioned at the interface among the Health Service Executive, Sport Ireland, local authorities and Local Sports Partnerships, the role supports signposting, coordination, programme development and stakeholder engagement. The review describes a cross-sector initiative operating across six counties and focused particularly on people with chronic conditions who are least active.

The officer is not positioned as a substitute for clinical diagnosis, treatment or rehabilitation. Instead, the role is intended to help people move from healthcare services into structured community physical activity and to make that transition easier to navigate. Its conceptual similarity to international navigation and referral roles is relevant to service design, but similarity alone is not evidence of effectiveness.

Current evidence for PAfHO is much weaker than the evidence for community exercise in general. Information about the role comes mainly from policy documents, service descriptions, implementation experience and local evaluations, rather than controlled or comparative evaluations of participant outcomes. These sources can document how the service is intended to work and what practitioners report, but they cannot establish that the model itself causes better health outcomes or lower healthcare use.

An Irish pilot mixed-methods study of a hospital-to-community exercise referral pathway found that the approach was feasible, participants were highly satisfied and 78% intended to maintain membership. That study did not directly evaluate the wider PAfHO model. International examples offer relevant context: social prescribing link workers in England support navigation to community resources, while New Zealand’s Green Prescription combines written advice, counselling and follow-up for physical activity.

Their outcomes are variable and depend on local infrastructure, workforce capacity, implementation fidelity and service integration. The review identifies several priorities for converting policy promise into measurable evidence. Prospective studies would need to test whether PAfHO-supported pathways increase referral uptake, access, retention, physical activity and longer-term participation compared with existing arrangements.

They should also measure clinical and functional outcomes, participant experience, equity of access and progression towards independent activity. At service level, researchers should examine waiting lists, repeat referrals, demand for healthcare-led exercise, healthcare utilisation and workforce capacity. Standardised outcome measures across participating areas, shared referral criteria, digital pathways, workforce training and continuous implementation evaluation would allow different delivery models to be compared.

Economic evaluation is needed to determine whether any gains in continuity or service flow justify the cost of the model. Because the initiative is recent, prospective data are more informative than policy descriptions alone for judging whether its proposed benefits translate into measurable results. The review has important limitations.

Its narrative method offered less protection against selection bias and was less reproducible than a formal systematic review, so relevant studies may have been omitted. Restricting the contemporary search to English-language publications may also have excluded international evidence, while marked differences among populations, interventions and outcomes limited direct comparisons. Grey literature was necessary because the PAfHO initiative is recent, but policy and service reports have not necessarily undergone peer review and are not equivalent to controlled effectiveness studies.

The defensible conclusion is therefore that community exercise is an evidence-supported component of chronic disease management, whereas the Irish PAfHO model is a policy-aligned service design whose effects on health, access, service efficiency and cost-effectiveness remain to be demonstrated.

Subject of Research: Evaluation of community exercise programmes and Ireland’s Physical Activity for Health Officer model for chronic disease management

Article Title: Community exercise programmes for chronic disease and the emerging role of physical activity for health officers in Ireland: a narrative review

Article References: McNally, S. (2026). Community exercise programmes for chronic disease and the emerging role of physical activity for health officers in Ireland: a narrative review. Frontiers in Sports and Active Living, 8, Article 1960508. https://doi.org/10.3389/fspor.2026.1960508

Image Credits: AI Generated

DOI: 10.3389/fspor.2026.1960508

Keywords: community exercise, chronic disease, physical activity, exercise referral, integrated care, Ireland, PAfHO, health systems, behaviour change, health economics, Community, exercise