Why social support, belonging and shared experiences matter in physical activity programmes for people living with long-term conditions.
Think about a physical activity referral class that you've delivered or maybe been part of. Some participants arrive early to have a chat. Someone notices that a regular member hasn't been for a couple of weeks. Another participant encourages a newcomer who's unsure about an exercise. Perhaps a conversation develops about managing fatigue, living with a health condition or finding time to be active.
None of these things are part of the exercise prescription. But they might be important to what participants gain from the programme, and to whether they keep attending.
We know that social support can influence physical activity. What I find particularly interesting is how group-based programmes can create opportunities for that support to develop, and how being active alongside other people can offer benefits beyond the exercise itself. These questions seem particularly relevant to physical activity and exercise referral programmes, where participants may be managing long-term health conditions alongside the challenge of becoming more active.
There's an important distinction between several people exercising at the same time and people beginning to experience themselves as part of a group.
When someone joins an exercise referral programme, there's understandably a strong focus on their individual circumstances. Their health conditions, exercise history, goals, confidence and need for adaptations all influence what we prescribe. But delivering exercise in a group introduces another possibility: participants can influence one another.
In a qualitative study of group physical activity programmes for older adults, Zimmer and colleagues (2022) explored how social support helped people begin, maintain and develop their participation. The researchers identified several ways in which participants supported one another. They encouraged people to try new activities, helped others maintain attendance, recognised achievements and offered comfort during difficult experiences.
Sometimes the support was practical, such as helping with equipment or offering transport. Sometimes it involved sharing experiences or advice. At other times, it was simply knowing that somebody would notice if you weren't there. What I particularly like about this study is that it takes the broad idea of social support and shows us what it can look like in an ordinary exercise class. Importantly, the instructor wasn't the only person providing it.
Another interesting feature of group exercise is the opportunity to learn from others. Someone who is unsure about their physical capabilities might see another participant managing an activity they previously thought was beyond them. Hearing how someone else has dealt with a setback, adapted an exercise or gradually developed their confidence could make being active feel more achievable. In Zimmer and colleagues' research, participants described being encouraged by seeing others overcome difficulties and succeed. But the researchers also found that social comparison wasn't always helpful. For some, watching a more capable participant was intimidating or discouraging.
Think about two people attending the same class. One sees someone completing a challenging exercise and thinks, "They're managing it, perhaps I could too." Another sees exactly the same thing and thinks, "I'm nowhere near as capable as everyone else here." The same experience can have very different consequences.
This matters in physical activity referral programmes, where participants may differ considerably in their health conditions, previous experiences, confidence and capabilities.
Being around other people can provide encouragement, reassurance and opportunities to learn. But these benefits aren't automatic.
Group exercise can also offer something that is more difficult to capture through the usual measures of physical activity or fitness. A sense of belonging.
People don't necessarily begin an exercise programme thinking of themselves as physically active people. Some may have had negative experiences of exercise in the past. Others might feel that their age, health condition or physical capability means that exercise isn't really for people like them. Being part of a group can sometimes challenge those assumptions.
Londoño-Martínez and colleagues (2026) explored the experiences of women receiving treatment for breast cancer who participated in supervised group exercise. Their findings described how participants developed a positive identity through their exercise group, alongside their experiences of being cancer patients. Friendships, shared experiences and a sense of belonging became important aspects of participation. This connects with the social identity approach, which helps us understand how the groups we belong to can influence how we think about ourselves and what we believe is possible.
Someone who initially sees themselves as a person who doesn't exercise might gradually begin to feel that they belong among physically active people. Perhaps they start referring to our class, look forward to seeing familiar faces or begin encouraging newer members themselves. These changes might not show up in an exercise assessment, but they can be meaningful parts of someone's experience.
Of course, one of the challenges for physical activity referral programmes is helping participants continue being active. Starting an exercise programme is one thing. Maintaining physical activity over months and years, particularly while living with a long-term health condition, can be much more difficult.
A systematic review by Morgan and colleagues (2016) identified social support among the factors influencing adherence to exercise referral schemes. Support could come from providers, fellow participants, family members and others in people's lives. Similar experiences emerged in the SITLESS study, where Blackburn and colleagues (2021) explored older adults' experiences of a physical activity and sedentary behaviour intervention. Participants described the enjoyment and social connections associated with taking part, alongside the challenges of maintaining activity once structured support was removed.
These findings help explain why someone might attend a class even on a day when they aren't particularly enthusiastic about exercising. They might want to see their friends. They might enjoy feeling part of something. Someone might be expecting them. And sometimes, those reasons may be just as important as the exercises themselves.
There is also evidence from programmes that have deliberately incorporated social support into their delivery. For example, Martín-Borràs and colleagues (2018) evaluated an exercise referral programme that included mechanisms to encourage social participation and support, examining physical activity adherence over a 15-month period. This is an important direction for research because it treats social experiences as something worth considering within behaviour-change interventions, rather than merely an incidental benefit of group delivery.
It would be easy to paint an entirely positive picture of group exercise, but that wouldn't reflect everyone's experience. People can feel excluded from established friendships. Group conversations may be unwelcoming. Differences in abilities can produce uncomfortable comparisons. Some participants may simply prefer to exercise independently. Zimmer and colleagues (2022) found examples of negative interactions and social exclusion that affected people's enjoyment and willingness to continue attending.
We also need to remember that participants living with long-term conditions bring different circumstances, needs and preferences.
Mesbah and colleagues (2024), for example, explored experiences of an exercise programme for older adults living with dementia. Their findings illustrated the value participants placed on companionship and peer support, while also highlighting the importance of accessible activities, individual adaptations, clear communication and appropriate support.
The group experience can be valuable, but it must coexist with the needs of the individuals within it. This is why we shouldn't assume that delivering an activity to several people automatically creates a supportive group, or that group delivery is necessarily the best choice for everyone.
There's one further consideration that I think deserves more attention, particularly within time-limited referral programmes. If someone has developed friendships, confidence and a sense of belonging through their exercise group, what happens when their referral period finishes? They may have improved their fitness and developed new skills. But they may also be losing the regular contact, encouragement and companionship that helped them become active.
Research into maintaining physical activity following referral programmes has highlighted the importance of ongoing support and the difficulties people can experience when moving beyond a structured scheme. More recently, Gavin and colleagues (2025) explored the barriers, enablers and support needs of people with long-term conditions following physical activity referral schemes. Their findings reinforce the need to consider how people are supported beyond the initial referral period.
For some, the answer might be an independent exercise programme. For others, joining another class, activity group or community organisation may provide continuity. The point is that we should consider not only what physical activity someone will do next, but also what social support and connections might help them continue.
None of this diminishes the importance of good exercise prescription, clinical knowledge, individualisation or safe supervision. Those remain fundamental when supporting people living with long-term conditions. But research into group-based physical activity suggests that we should also pay attention to what people gain from exercising alongside others.
The reassurance of meeting someone with similar experiences. The encouragement that comes from watching others succeed. The friendships that make attendance something to look forward to. Or the growing feeling that physical activity is something people like them can do. These experiences won't happen in every group, and they won't matter equally to everyone. Nevertheless, they remind us that the value of a physical activity programme isn't necessarily limited to the physical activity being delivered.
When we assess programmes, we often consider attendance, fitness, physical activity levels and health outcomes. Perhaps we should also pay more attention to the relationships, shared experiences and sense of belonging that can develop along the way.
We spend a lot of time thinking about the exercise we deliver. Perhaps we should spend a little more time considering what being part of the group makes possible.
Blackburn, N. E., et al. (2021). Older adults' experiences of a physical activity and sedentary behaviour intervention: A nested qualitative study in the SITLESS multi-country randomised clinical trial. International Journal of Environmental Research and Public Health, 18(9), 4730. https://doi.org/10.3390/ijerph18094730
Gavin, J. P., Holt, L. C., Muckelt, P. E., Sadler, E., McDonough, S., & Barker, M. (2025). Maintaining physical activity in people with long-term conditions following engagement in physical activity referral schemes: Barriers, enablers, and intervention strategies. International Journal of Behavioral Nutrition and Physical Activity, 22, Article 102. https://doi.org/10.1186/s12966-025-01802-y
Londoño-Martínez, M., Agut-Nieto, S., & Collado-Boira, E. J. (2026). From breast cancer patient to teammate: The role of exercise group identity in enhancing well-being. European Journal of Oncology Nursing, 83, 103237. https://doi.org/10.1016/j.ejon.2026.103237
Martín-Borràs, C., Giné-Garriga, M., Puig-Ribera, A., Martín, C., Solà, M., & Cuesta-Vargas, A. (2018). A new model of exercise referral scheme in primary care: Is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial. BMJ Open, 8(3), e017211. https://doi.org/10.1136/bmjopen-2017-017211
Mesbah, N., Perry, M., Hill, K. D., Manlapaz, D., & Hale, L. (2024). The experiences of older adults with dementia of “Balance Wise”, an individual or group-delivered exercise programme: A qualitative study. Disabilities, 4(1), 11–26. https://doi.org/10.3390/disabilities4010002
Morgan, F., Battersby, A., Weightman, A. L., Searchfield, L., Turley, R., Morgan, H. E., Jagroo, J., & Ellis, S. (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, Article 227. https://pmc.ncbi.nlm.nih.gov/articles/PMC4779205/
Zimmer, C., McDonough, M. H., Hewson, J., Toohey, A. M., Din, C., Crocker, P. R. E., & Bennett, E. V. (2022). Social support among older adults in group physical activity programs. Journal of Applied Sport Psychology. https://doi.org/10.1080/10413200.2022.2055223
For those interested in exploring the research on group participation, behaviour change and exercise referral in more detail:
Social identity and exercise referral
Portman, R. M., Levy, A. R., Mooney, K. M., Whittaker, E. M., & Fairclough, S. J. (2019). Towards an understanding of the social identity approach in exercise referral schemes: A brief commentary. Sport & Exercise Psychology Review, 15(1), 25–30.
A discussion of how social identity ideas might help us understand participation and adherence within exercise referral programmes.
Psychological factors influencing exercise referral adherence
Eynon, M., Foad, J., Downey, J., Bowmer, Y., & Mills, H. (2019). Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review. Scandinavian Journal of Medicine & Science in Sports, 29, 638–650. https://doi.org/10.1111/sms.13403
A review of factors such as motivation, social support and self-efficacy in relation to exercise referral adherence.
Understanding how group-based interventions work
Borek, A. J., Abraham, C., Greaves, C. J., Gillison, F., Tarrant, M., Morgan-Trimmer, S., McCabe, R., & Smith, J. R. (2019). Identifying change processes in group-based health behaviour-change interventions: Development of the mechanisms of action in group-based interventions (MAGI) framework. Health Psychology Review, 13(3), 227–247. https://doi.org/10.1080/17437199.2019.1625282
The MAGI framework provides a comprehensive account of the many processes that may operate within group-based behaviour-change interventions. Particularly useful for readers interested in exploring group processes in greater depth.
Identity leadership in exercise groups
Steffens, N. K., Slade, E. L., Stevens, M., Haslam, S. A., & Rees, T. (2019). Putting the 'we' into workout: The association of identity leadership with exercise class attendance and effort, and the mediating role of group identification and comfort. Psychology of Sport and Exercise, 45, 101544. https://doi.org/10.1016/j.psychsport.2019.101544
Research exploring the relationships between instructor identity leadership, group identification and exercise participation.