For fitness professionals who aim to make a tangible difference in people’s lives, exercise referral schemes (ERS) have proven to be a promising route, especially when considering mental health improvements. With the advancements in technology, integrating web-based support can potentially amplify the benefits of ERS. Let’s delve into a study that showcases this potential.

The e-coachER Study

Exercise referral schemes have been shown to help reduce depression, but the impact of adding web-based behavioural support was not previously well-understood. The e-coachER trial investigated the effects of coupling standard ERS with a theory-driven web-based behavioural support system. This analysis focused on participants who had elevated depressive symptoms.

Out of the 450 adults in the e-coachER trial, 205 had at least mild depression and were the subject of this study. Various data collection methods were employed, including the Hospital Anxiety and Depression Scale (HADS) and accelerometer measurements for physical activity.

Key Findings

  1. At the four-month mark, participants in the e-coachER group reported improved depression levels when compared with controls. However, there were no significant differences noted for anxiety or moderate to vigorous physical activity (MVPA).
  2. By the 12-month follow-up, no differences were observed in depression, anxiety, or MVPA between the groups.
  3. Interestingly, it was not increased physical activity that mediated the improvements in depression. Instead, the intervention’s influence on participants’ confidence, competence, and self-monitoring was the significant mediator for the reduction in depression scores at four months. Additionally, competence and self-monitoring mediated the improvements in anxiety scores at four months.

Incorporating web-based support into traditional ERS resulted in a noticeable reduction in depression at the four-month interval. The key takeaway is that the improvements in mental health stemmed more from enhancing the participants’ motivational regulations towards physical activity rather than just increasing the activity itself. This highlights the importance of building confidence, competence, and self-monitoring skills.


These findings have several implications for fitness professionals who aim to help their clients improve their nutrition and overall health:

  1. Embrace Digital Tools: Consider adding web-based support to your ERS to provide constant, easily accessible motivation and guidance for your clients.
  2. Shift the Focus: While it’s essential to aim for increased physical activity, the emotional and psychological journey of your clients is equally crucial. Focus on building their confidence, competence, and self-monitoring skills to achieve sustainable benefits.
  3. Continuous Feedback: Offer continuous feedback and support to clients. The integration of self-monitoring tools, which can be web-based, can empower them to track their progress and stay motivated.
  4. Personalise the Journey: Recognise that every individual has unique motivations and challenges. Customise the ERS journey to cater to individual needs, focusing more on strengthening their motivational regulations than merely pushing them to exercise more.
  5. Stay Updated: As technology and methodologies evolve, continue to educate yourself on the latest findings and incorporate them into your practice for improved outcomes.

Become and Exercise Referral Specialist with TRAINFITNESS

For fitness professionals, understanding the profound impact of an integrated approach, combining exercise with psychological support, is vital. The e-coachER study underscores the power of building internal motivations and self-monitoring skills in enhancing mental wellbeing. In our digital age, leveraging web-based tools can significantly elevate the effectiveness of Exercise Referral Schemes, making them a potent weapon in the fight against mental health issues.


  1. 1. Jeffrey Lambert, Adrian Taylor, Adam Streeter, Colin Greaves, Wendy M. Ingram, Sarah Dean, Kate Jolly, Nanette Mutrie, Lisa Price, John Campbell. Adding web-based support to exercise referral schemes improves symptoms of depression in people with elevated depressive symptoms: A secondary analysis of the e-coachER randomised controlled trial. Mental Health and Physical Activity, Volume 25, 2023. Click here to review the full research article

Start Your Exercise Referral Scheme Today

Unlock the next level of your fitness career with our Diploma in Exercise Referral. Designed specifically for forward-thinking fitness professionals, this course delves deep into the transformative power of exercise on mental wellbeing. As recent studies like the e-coachER trial have revealed, combining traditional exercise referral schemes with web-based support can significantly reduce depression in clients, emphasising the importance of motivational regulations towards physical activity. Learn how to harness these insights and integrate them into your practice, empowering you to provide holistic, tech-enhanced, and evidence-based solutions for your clients. Elevate your impact and become a pioneer in the evolving world of fitness and mental health.

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