Research and analysis

Co-location of health and leisure services and their impact on physical activity: rapid scoping review

Published 12 June 2026

Report authors:

• Jovita Leung
• Larissa Stolar
• Benji Horwell
• Filippo Bianchi

Acknowledgements:

We would like to acknowledge the contributions of the DCMS Sport Policy and Analysis Teams, as well as those who took part in the scoping workshops at the early stage of the project from DHSC and Sport England.

Disclaimer:

The conclusions and recommendations presented in this report are those of the authors and do not necessarily reflect the views or policies of the Department for Culture, Media and Sport (DCMS).

Executive summary

Introduction

One of the three ‘big shifts’ for the UK government’s Health Mission is to move the emphasis of the UK’s health system from ‘sickness to prevention’ and address the underlying causes of ill-health.

To aid this work, DCMS commissioned the Behavioural Insights Team (BIT) to explore evidence on physical activity interventions that could help to prevent ill-health. This scoping review focuses on the co-location of healthcare services with leisure facilities to promote physical activity.

Co-location interventions integrate healthcare services (e.g. GP practices, physiotherapy clinics) with leisure or fitness facilities (e.g. gyms, pools, community sports centres) in the same physical location. These interventions aim to reduce practical and psychological barriers to being active, particularly for people with long-term health conditions, by embedding access to physical activity within healthcare settings. While most co-location interventions are targeted at people with health conditions, some examples such as the Sheffield Move Together programme, also aim to engage under-represented groups more broadly.

Achieving population-level change in physical activity requires systemic approaches, with a range of complementary interventions operating across multiple levels. This review is intended to inform where attention and resources might be prioritised to improve health outcomes through physical activity, both in the short and long term.

Aims and research questions

BIT conducted a scoping review to summarise the evidence on the following research questions:

1. What are some existing case studies where co-located leisure and healthcare services have been trialled? Specifically, what are the features, partnership structures, and delivery models?

2. What evidence exists on a) the impact of co-located leisure and healthcare services on physical activity and b) the impact on physical activity inequalities for priority groups?

This review was not designed to be a comprehensive or exhaustive search; instead, it aims to provide a rapid synthesis of publicly available evidence to support decision-making within the current policy context.

Key findings

Existing case studies of co-location interventions

We have identified three main examples of co-location interventions that have been implemented in the UK and Italy.

Move Together (Sheffield, UK)

A cross-sector partnership led by the National Centre for Sport and Exercise Medicine (NCSEM) Sheffield, co-locating NHS clinical services within three community leisure centres: Concord, Graves, and Thorncliffe. The programme aimed to support people with long-term conditions through personalised physical activity plans delivered alongside routine care. Findings suggested that the intervention created a supportive environment for physical activity, with increased leisure centre use, although direct impacts on physical activity remains unclear.  

MSK Physical Activity Hubs (UK-wide)

A national initiative delivered by a consortium including ukactive, Good Boost, and NHS partners, transforming leisure centres into hubs offering tailored exercise programmes for musculoskeletal conditions. Participants are referred or self-enrol into structured support combining AI-based and evidence-based rehabilitation programmes. Findings suggested that the MSK hubs generally engaged the inactive population and were accessible to people with MSK conditions, but data gaps on follow-up activity measures limit conclusions on physical activity impact.

Movement in Health (Sicily, Italy)

A non-profit-led initiative integrating a multidisciplinary medical team within a gym-based setting to support diabetes prevention and management. Patients engage in supervised, personalised exercise sessions with ongoing clinical monitoring and staff participation to encourage behaviour change. The interventions reported health improvements (e.g. reduced glycated hemoglobin [HbA1c] and insulin use) but causal impact remains unclear due to the pre-post study design.

Impact of co-location intervention on physical activity

The majority of the co-location interventions reviewed were designed mainly for people with long-term conditions, meaning the evidence base primarily reflects impacts on individuals already engaged with healthcare services rather than the general public or those who are not in contact with healthcare services.

However, none of the reviewed studies directly measured changes in physical activity level as the outcome measure. Despite this, a small number of studies offered some signals that co-location may support physical activity or related outcomes among clinical populations;

• Some descriptive and qualitative evidence suggested co-location can create supportive environments and facilitate engagement in physical activity among those with health conditions;

• Attendance and gym membership rose in some co-located centres (e.g. Graves Leisure Centre, Sheffield), but these trends mirrored wider national increases and may not be attributable to co-location alone;

• The only study with health outcome data (Movement in Health) reported reduced HbA1c and insulin use, but lacked a control group and thus could not infer causality.

Impact of co-location intervention on health inequalities

Socioeconomic status (SES)

No study directly measured the impact on inequalities by socioeconomic group. However, most initiatives deliberately targeted underserved areas or offered cost flexibility, indicating potential to reduce access barriers to patients from lower socioeconomic backgrounds.

Gender and ethnicity

Data from the MSK Physical Activity Hubs showed that men and ethnic minorities were underrepresented in these programmes. This highlighted the need for targeted strategies to engage these populations, e.g. tailored outreach and programme design, partnership with community organisations.

Baseline physical activity level

Data from the MSK Physical Activity Hubs suggested programmes tended to reach individuals with low baseline activity levels, though long-term engagement was not tracked.

Conclusions and recommendations

Overall, there was very limited evidence on whether co-location interventions increase physical activity. None of the reviewed interventions provided robust, causal evidence demonstrating changes in physical activity levels among participants. Notably, all of the case studies identified focused on supporting service provision to clinical populations with long-term health conditions, rather than the general population. To date, co-location interventions have primarily been used to support individuals with specific health needs, often through referral-based models that offer tailored support in accessible settings. While there is no clear evidence that these interventions drive increases in physical activity at the population level, they may play a useful role in improving access, engagement, and health outcomes among targeted groups. For DCMS, this suggests that co-location may be a promising delivery model to support physical activity within specific groups, particularly those with long-term health conditions. As a result, we recommend the following:

• 1. Clarify the role of co-location within the wider strategy for population-wide physical activity promotion. We recommend further investigation and evaluation on the theory of change underpinning co-location interventions. If the primary aim of the Health Mission is to promote population-level behaviour change, co-location intervention may be better positioned as a complementary strategy to support at-risk groups, rather than a core mechanism for population-wide physical activity promotion.

• 2. Strengthen the evidence base through targeted, robust evaluation, using:  

  • experimental or quasi-experimental designs incorporating theory-based methods  
  • objective measures of physical activity (e.g. via accelerometers)  
  • longitudinal data  
  • equity-focused analysis  
  • cost-effectiveness assessments

Given that several co-location interventions are already operating at scale (e.g. MSK hubs in 100+ centres), there are also valuable opportunities to embed evaluation into existing delivery infrastructure.

Introduction

One of the three ‘big shifts’ for the UK government’s Health Mission is to move the emphasis of the UK’s health system from ‘sickness to prevention’ and address the underlying causes of ill-health. While the mission is led by the Department of Health and Social Care (DHSC), the Department of Culture, Media and Sport (DCMS) will support the mission through a focus on improving health outcomes through physical activity.

To aid this work, DCMS commissioned BIT to help identify and review existing evidence for promising physical activity interventions and policies. BIT created an initial list of 28 interventions and policies based on interventions identified in existing reports (e.g. International Society for Physical Activity and Health’s ‘Eight Investments’; ISPAH, 2020), examples of physical activity initiatives from around the world, and idea generation grounded in the behaviour change wheel (Michie et al. 2011). Considering factors such as the impact on healthy life expectancy, implementation feasibility, and the value-add for DCMS, BIT then worked with DCMS to identify four priority interventions/policies for a series of rapid evidence reviews. This included:

1. school-based interventions/policies  

2. community-based and peer-led interventions/policies  

3. active travel interventions/policies; and  

4. interventions involving the co-location of healthcare services and leisure facilities (co-location interventions)

Focus for this scoping review

The aim of the current review is to better understand the amount and quality of evidence available on the impact of co-location interventions on physical activity levels.

Co-location interventions involve integrating healthcare services (e.g. GP clinics, therapy services) and leisure facilities (e.g. gyms, community sports centres) within the same location to promote physical activity. These interventions are often designed for people with health conditions that could benefit from increased activity, such as chronic back pain, cardiovascular diseases, or mental health difficulties, with the aim of making it easier for individuals to engage in exercise as part of their treatment or recovery plan (Grinvalds et al., 2019; Grinvalds, 2025). The rationale is that by aligning the point of diagnosis or referral with access to physical activity facilities, co-location can reduce logistical barriers and support behaviour change (Grinvalds et al., 2019). However, it is less clear how co-location intervention can promote physical activity beyond individuals who are already engaged with healthcare services.

This review, along with another rapid evidence review ‘What works to improve physical activity and reduce physical activity inequalities? A rapid literature review for DCMS covering school-based, community-based and active travel interventions’ explore the impact of a range of interventions on physical activity. Findings from these two reviews will be used to highlight priority areas in which the government could intervene to improve health outcomes through physical activity.

Aims and research questions

Despite the health benefits of physical activity, there is limited evidence on the effectiveness of co-location interventions promoting physical activity. This scoping review summarises the evidence on the impact of co-locating health and leisure services, addressing following research questions:

1. What are some existing case studies where co-located leisure and healthcare services have been trialled previously? Specifically, what are the features, partnership structures, and delivery models?

2. What evidence exists regarding a) the impact of co-located leisure and healthcare services on physical activity and b) the impact on physical activity inequalities regarding socioeconomic status, gender and ethnicity, and baseline physical activity?

Methods

We conducted a rapid evidence review to summarise insights from relevant systematic reviews and meta-analyses, experimental studies, quasi-experimental studies, and the grey literature (e.g. policy and industry reports).

We searched relevant databases using pre-agreed search strategies. Studies were identified using academic databases, web searches, evidence provided by the DCMS, and AI tools.

We reviewed the evidence based on a title and abstract screening. A full-text review was then conducted to compile a final list of relevant evidence to be included in the review. The quality of studies were also assessed using Nesta Standards of Evidence (see Figure 1). This evidence framework was chosen due to its greater relevance to interventions with limited evidence.

We summarised the findings narratively. Data from the included studies were recorded in a spreadsheet and were summarised narratively.

Full details of our methodology can be found in Appendix 1.

Figure 1: The Nesta Standards of Evidence (Puttick & Ludlow, 2013)

Level	Our Expectation	How the evidence can be generated
At Level 1	You can give an account of impact. This means providing a logical reason (or set of reasons) for why your intervention could have an impact and why that would be an improvement on the current situation.	You should be able to do this yourself, and draw upon existing data and research from other sources.
At Level 2	You are gathering data that shows some change amongst those receiving or using your intervention.	Data can begin to show effect but will not evidence direct causality. Consider methods such as: pre and post-survey evaluation; cohort/panel study; regular interval surveying.
At Level 3	You can demonstrate that your intervention is causing the impact by showing less impact amongst those who don’t receive the product/service.	We consider robust methods using a control group (or another well-justified method) to isolate the impact. Random selection and a sufficiently large sample size are important at this level.
At Level 4	You can explain why and how your intervention is having the impact. An independent evaluation validates the impact. The intervention can deliver impact at a reasonable cost, suggesting it could be replicated and purchased in multiple locations.	We look for robust independent evaluation (e.g., commercial standards, industry Kitemarks). You need documented standardisation of delivery/processes and data on costs and acceptable price points for customers.
At Level 5	You can show that your intervention could be operated by someone else, somewhere else and scaled up, while continuing to have positive impact and remaining a financially viable proposition.	We expect to see use of methods like multiple replication evaluations, future scenario analysis, and fidelity evaluation.

Findings

Overview of included studies

We reviewed a total of 16 academic papers and reports, of which 6 were considered relevant and included in the review. Overall, the evidence consisted of a mix of realist reviews (n=3, of which one included qualitative research), pre-post studies (n=1), and grey literature (i.e. findings report; n=2,) indicating varied methodological rigor. There was an absence of high-quality evidence, with no studies using experimental or quasi-experimental methods to assess the impact of co-location interventions on physical activity and health inequalities.

See Table 1 below for an overview of the included evidence.

Table 1. Overview of the included studies

Co-location intervention	Study title	Location	Evidence standard[footnote 1]	Publication type	Description
Move Together Sheffield	Grinvalds (2025). The co-location of healthcare and leisure as part of a whole-system approach to physical activity promotion	Sheffield, UK	Level 1	Realist review	This review discussed co-location interventions as part of a whole-system approach to promote physical activity, with a description on the design and implementation of the Move Together Sheffield programme.
Move Together Sheffield	Grinvalds et al. (2019). What works to facilitate the promotion of physical activity in co-located healthcare and leisure settings: a realist review	Sheffield, UK	Level 1	Realist review	This review discussed the theoretical basis for how co-location interventions could increase physical activity.
Move Together Sheffield	Grinvalds (2022). Co-location of health and leisure to promote physical activity: A realist synthesis	Sheffield, UK	Level 1	Realist review and Qualitative interviews	This paper explored how co-locating healthcare services within leisure centres in Sheffield supports physical activity, qualitative findings suggested co-location improves patient perceptions of accessibility and creates opportunities for integrated care, though direct evidence of increased physical activity remains limited.
Musculoskeletal (MSK) Physical Activity Hubs	ukactive. (2024). Transforming gyms into community musculoskeletal (MSK) hubs: Executive summary report	UK	Level 2	Grey literature (report)	This report found that co-locating MSK services in leisure centres successfully engaged inactive people with MSK conditions and improved access to tailored exercise programmes, though follow-up data on changes in physical activity were not captured due to technical issues.
Musculoskeletal (MSK) Physical Activity Hubs	ukactive. (2024). Transforming gyms into community musculoskeletal (MSK) hubs: May 2024 Evaluation report	UK	Level 2	Grey literature (report)	This report found that co-locating MSK services in leisure centres successfully engaged inactive people with MSK conditions and improved access to tailored exercise programmes, though follow-up data on changes in physical activity were not captured due to technical issues.
Movement in Health initiative	Leotta et al. (2011). Movement in health: Housing a diabetes centre within a gym (and vice versa)	Sicily, Italy	Level 2	Pre-post study	This study found improvements in clinical outcomes (e.g. reduced HbA1c and insulin use) among participants with diabetes, though the impact of co-location on physical activity levels remains unclear due to the study design.

Existing case studies of co-location intervention

We have identified three main examples of co-location interventions that have been implemented within the UK and Italy.

Move Together, Sheffield UK

As part of the Olympic legacy-funded National Centre for Sport and Exercise Medicine (NCSEM), Sheffield launched the ‘Move Together’ programme -  a model co-locating multi-specialty clinical services (e.g. musculoskeletal care, diabetes management, long COVID support, podiatry, psychotherapy, and rheumatology) with three leisure centres: Concord, Graves, and Thorncliffe. The programme is one component of Sheffield’s wider Move More whole-system physical activity strategy, which was developed through a cross-sector partnership supported by NCSEM Sheffield (Grinvalds, 2025).

Move Together aims to help people with long-term conditions become more active by embedding tailored physical activity support within leisure centres. Healthcare professionals (e.g. GPs, physiotherapists) refer patients into the programme, where they receive personalised plans and ongoing support from physical activity specialists based on-site. The leisure centres are equipped with gyms, pools, and clinical spaces to facilitate integrated care. It also includes 37 clinical rooms that are used by over 20 clinical services from Sheffield Teaching Hospitals, Sheffield Children’s Hospital, and Sheffield Health and Social Care Trust.

The programme was funded by a capital investment of £10 million from DHSC to deliver the vision and co-locate researchers, clinicians, and other stakeholders. The Sheffield sites opened over a period of 2 years in 2013, with a mix of new-build and refurbished centres. All of the centres were strategically situated in areas with higher-than-average deprivation, elevated incidences of non-communicable diseases, low physical activity participation, and proximity to green spaces. This strategic placement ensured that the services reach communities with the greatest need, addressing health inequalities and promoting wellness.

Key learnings from the Move Together Sheffield model:

• Integrated workforce boosts service delivery: The co-location of NHS and leisure staff increased service capacity, enabled joint delivery (e.g. MSK and mental health teams), and supported the development of integrated patient pathways. It also created opportunities for cross-sector collaboration and shared learning, but this required active effort to align organisational objectives, IT systems, governance, and workflows.

• Environment and design matter: Building design influenced success; sites with open, shared spaces (e.g. Graves) promoted visibility, interaction, and referrals, whereas separated designs (e.g. Concord) inhibited them.

• Promotion of physical activity needs organisational support: Regular physical activity conversations and modelling by staff occurred most when supported by leadership, incentives, and access for staff to be active themselves.

Musculoskeletal (MSK) Physical Activity Hubs, UK

The MSK Physical Activity Hubs are a UK-wide initiative launched as part of the government’s Healthy Ageing Challenge, with the aim to support people with MSK conditions through accessible, community-based physical activity (UK Research and Innovation, 2024). The hubs were developed and delivered by a consortium including ukactive, Good Boost, Orthopaedic Research UK, ESCAPE-pain, and Arthritis Action.

The MSK hubs transform leisure centres and swimming pools into integrated health and wellbeing centres for managing MSK conditions, including knee, hip, and back issues, through tailored exercise programmes. Through these hubs, individuals are referred or self-enrol into tailored, evidence-based exercise programmes to support mobility, reduce pain, and build strength and confidence. Programmes include Good Boost’s AI-personalised exercise plans, ESCAPE-pain’s structured rehabilitation sessions, and broader well-being support from partner organisations.

The pilot phase launched in 2022, involving 15 leisure centres across England, Scotland and Wales. It was then expanded in March 2023 to include an additional 85 facilities across the same geographies, with ongoing evaluations to assess its impact (ukactive, 2024b).

Key learnings from the MSK Physical Activity Hubs

• Clear operational framework is essential: Delivery was supported by the development of an operational blueprint outlining timelines, branding, referral pathways, and engagement strategies for underserved populations. A unified MSK Hubs brand and shared marketing materials were also important for promoting the model and engaging target populations across different sites.

• Dedicated project management improves coordination: Appointing a central project manager helped streamline delivery and maintain consistency across multiple sites and stakeholders.

• Upskilling the workforce is critical: Ongoing investment in training fitness and leisure professionals was necessary to ensure they had the competencies to deliver MSK support as part of the wider public health workforce.

Box 1. Guy’s and St Thomas’ MSK pilot project  

The Guy’s and St Thomas’ MSK project is one the the pilots for the MSK Physical Activity Hubs in the UK, The project was funded by the Guy’s and St Thomas’s Charity, in partnership with ukactive. It combines the expertise of the Trust’s specialist staff with high-quality gym equipment at Castle Leisure Centre in Elephant and Castle, Brixton Recreation Centre and Streatham Ice and Leisure Centre (Guy’s and St Thomas’ NHS Foundation Trust, 2024). Across the 18-month pilot, around 25,000 patients were able to benefit from more space and a much wider range of equipment than at the hospital gym sites. These include mats, benches, steppers and cross trainers that can better support specific rehabilitation as well as general fitness, confidence and mental well-being. Additionally, patients were able to use the wider gym facilities - including pool, sauna and steam room facilities – for free on the days that they are attending physio services. The initiative also lowers transport costs for patients and reduces travel time to and from appointments as they tend to be closer to their home or work, making it easier for patients to attend.

Movement in Health initiative, Italy

Established in 2005 in Sicily, Italy, the “Movement in Health” initiative was led by a non-profit organisation named MOV.I.S and focused on diabetes prevention and treatment (Leotta et al., 2011).

This initiative integrated healthcare services with physical activity by operating a gym-based medical facility where patients received comprehensive care. A multidisciplinary team, including diabetes specialists, geriatricians, pulmonologists, pediatricians, dieticians, podiatrists, psychologists and exercise specialists, collaborated to provide personalised exercise programs.

A key highlight of the initiative was the active participation of medical staff in the same physical activities as their patients, reinforcing behavioural changes and fostering a supportive environment. Patients went through medical assessments, including evaluations by specialists before embarking on a personalised exercise plan. Training sessions were held three times per week in a supervised gym setting, with continuous monitoring of glucose levels, blood pressure, and weight before and after each session. The programme also offered ongoing support, allowing patients to engage in the programme for as long as they choose, without a predetermined end date.​

Box 2. Recent and upcoming co-location interventions  

In addition to the above case studies, we have also identified two recent / upcoming co-location interventions - Health Hub in North Hykeham and Clay Cross Active in North East Derbyshire. It is worth noting that both examples are located in relatively rural areas, highlighting how co-location models are also being explored as a means of improving service access in less urbanised communities.

• Health Hub: In North Hykeham, Lincolnshire, the Better’s One NK leisure centre launched a pioneering Health Hub in late 2023, which brings a variety of health resources and services into the local leisure centre, making services such as blood pressure checks, physiotherapy, and pulmonary rehabilitation more accessible to the public. The project is a collaborative effort among several organisations, including Better Leisure, Lincolnshire NHS Community Pulmonary Rehab, Lincolnshire NHS Community Cardiac Rehab, One You Lincolnshire, and Great Northern Physiotherapy.  

• Clay Cross Active: North East Derbyshire District Council is currently developing Clay Cross Active, a forthcoming community hub that will integrate leisure, health provision, and support services. This project aims to replace the existing Sharley Park Leisure Centre with a state-of-the-art facility, anticipated to open in 2025. The new centre will feature amenities such as a modern fitness suite, swimming pools, sports halls, health clinic, and a community café. Additionally, Citizens Advice North East Derbyshire will offer daily drop-in sessions and appointments within the hub, enhancing access to essential support services.  Additional co-location examples highlighted by stakeholders – such as the Portway Lifestyle Centre and Portway Family Practice in Sandwell, and the redeveloped Sands Leisure Centre in Carlisle – further illustrate the growing use of this model across England. However, due to limited publicly available evaluation data, these examples were not included in the formal evidence review.

Impact on physical activity and health inequalities

The following section synthesises the evidence on the impact of co-location interventions on physical activity and health inequalities. While the findings suggested potential benefits, it is important to approach these findings with caution due to the limited robustness of the available evidence. For instance, given the lack of Level 3+ evidence, we are unable to make confident casual claims between the findings and the intervention.

Impact on physical activity or health related outcomes

None of the reviewed studies directly measured changes in physical activity level as the outcome measure. Additionally, the majority of the co-location interventions reviewed were designed mainly for people with long-term conditions, meaning the evidence base primarily reflects impacts on individuals already engaged with healthcare services rather than the general public. Despite this, a small number of studies offered signals that co-location may support physical activity or related outcomes.

For example, interviews with patients and healthcare professionals from the Move Together Sheffield programme suggested that co-locating NHS clinics inside community leisure centers created a health-promoting environment that actively facilitated physical activity participation (Grinvalds, 2022). Healthcare professionals also noted that some patients with long-term conditions were more likely to become active when their routine care happened adjacent to a gym (Grinvalds, 2022).

Co-location has also been associated with increased use of physical activity facilities - data from the Move Together Sheffield programme at Graves leisure centre showed that monthly attendance has more than doubled from 21,009 in March 2013 (before co-location) to 48,992 in March 2024 (after co-location). Over the same period, fitness membership also increased by 186% (Grinvalds, 2022).

While this growth is notable, it broadly aligns with wider national statistics - industry data suggested that the overall UK gym membership rose from around 4.8 million in 2013 to approximately 12 million in 2024, representing a 150% increase (Statista, 2024; PureGym, 2024). Data from ukactive and Deloitte also noted UK health and fitness club membership rose to 11.5 million in 2024, with total sector revenue increasing from £5.2 billion in 2023 to £5.7 billion in 2024 (ukactive, 2025). This suggests that the growth in fitness membership at the Graves leisure centre may reflect general sector-wide increases. It is also unclear to what extent the co-location intervention helped accelerate or sustain participation for people with health conditions specifically. Finally, while increased membership figures are encouraging, they do not necessarily equate to sustained increase in physical activity level among individuals. For example, studies have shown that attendance at health and fitness venues often declines dramatically during the first year of membership (e.g. Rand et al., 2020).

Despite the lack of physical activity measurement, the Movement in Health initiative in Italy offered insights into the potential value of co-location by combining structured exercise with integrated medical and health services in a single setting. In their pre-post study, participants who engaged in a 12-week, thrice-weekly exercise programme showed a significant reduction in HbA1c levels, from an average of 8.2% at baseline to 7.1% after three months (Leotta et al., 2011). Among insulin-dependent participants, daily insulin requirements decreased from a mean of 41 IU/day to 29 IU/day. Although these improvements may have been driven primarily by the intensive, multi-component programme, the co-location model could have played a supporting role by enabling coordinated care, therapeutic consistency, and sustained patient engagement. For example, as part of the programme, medical specialists often spent time in the gym alongside their patients. However, given the study design, findings should be interpreted with caution and no firm causal conclusions can be drawn.

Impact on health inequalities

Socioeconomic status (SES)

By situating health and leisure services within the community, the co-location intervention aims to mitigate logistical and financial obstacles, such as transportation costs, thereby facilitating greater engagement among disadvantaged populations. Many of the programmes reviewed were intentionally designed to serve underserved areas or offer financial flexibility for those on low incomes. While none of the studies directly measured the impact of co-location on health inequalities or physical activity levels by socioeconomic group, some descriptive data suggest that these models may successfully reach disadvantaged communities.

For example, in the Move Together Sheffield programme, all of the centres were deliberately placed in neighbourhoods with higher deprivation, more chronic disease, and low baseline activity levels (Grinvalds et al. 2025). This geographic targeting means services are ‘on the doorstep’ for communities that might otherwise face distance and transport barriers.

Similarly, the Movement in Health initiative in Italy was designed to be financially accessible so that lower-income patients could participate (Leotta et al, 2011). The programme received no funding from local authorities or the Italian Health Service, and instead operated on a flat-fee model where patients paid €50 per month to cover access to exercise sessions and all associated clinical examinations, with no additional registration costs. Patients who are unable to pay were not charged, and those on limited incomes could contribute as and when they were able.

This suggests that co-location interventions, when combined with deliberate placement and inclusive design, could help address participation gaps. Nonetheless, further research is needed to assess whether these interventions translate into meaningful reductions in health inequalities.

Gender and ethnicity

Data from the MSK Physical Activity Hubs shows that 81.2% of the programme participants were female, while only 16.7% were male (ukactive, 2024b). In terms of ethnicity, 90.5% identified as White, with lower representation from Asian (3.8%), Black (2.7%), and mixed ethnic backgrounds (1.3%). Compared to the national census, this suggests the programme is under-engaging men and individuals from ethnic minority communities, particularly Asian and Black groups, who are more proportionately represented in the general population (UK government, 2022; ukactive, 2024b).

Baseline physical activity level

Given the intervention design and mechanisms - centred on clinical referral pathways and tailored support for individuals with specific health needs - co-location interventions are unlikely to be effective or appropriate for physical activity promotion at a population level.

Baseline data from the MSK Physical Activity Hubs, collected using the International Physical Activity Questionnaire – Short Form (IPAQ-S), indicated the programme successfully engaged participants who were inactive or insufficiently active (ukactive, 2024b). Among 1,205 participants, 42.1% were classified as ‘moderately active’ and 39.8% as ‘low active’, with only 18.2% reporting high levels of activity. Most participants also had at least one musculoskeletal condition (68.8%), and many presented with additional health conditions, including cardiovascular (28.4%), respiratory (20.0%), and neurological (11.8%) issues.

This supports the idea that co-location interventions, when combined with clinical targeting (e.g. referrals for MSK conditions), can engage individuals from clinical populations with lower activity levels who may benefit most from tailored support. By reaching individuals with the lowest baseline activity levels, who are often underserved by mainstream physical activity initiatives, these models may help to narrow the physical activity gap and reduce health inequalities.

However, due to a technical error in the data collection, follow-up IPAQ data were not captured. As a result, it was not possible to determine whether physical activity levels changed over time. Additionally, as the intervention is largely targeted at individuals with existing health conditions, it remains unclear whether co-location models are effective at promoting physical activity among the broader population. To date, there is no evidence that co-location interventions have been used as a tool to drive population-wide increase in physical activity.

Discussion and recommendations

Summary of key findings

In summary, while this review found no strong evidence that co-location intervention  drives sustained behaviour change or reduces inequalities in physical activity at the population level, they may play a useful complementary role in improving access, engagement, and health outcomes among groups that regularly access health services.

There is some qualitative evidence suggesting that co-location can create a health-promoting environment that facilitates discussions about physical activity and encourages participation among those who are already in contact with healthcare services. For example, healthcare professionals reported that patients were more likely to engage in activity when care was delivered adjacent to a gym.

Descriptive data from Move Together Sheffield showed an increase in facility attendance and fitness membership following co-location, suggesting stronger community engagement. Similarly, the Movement in Health initiative in Italy reported positive health-related outcomes, such as reductions in HbA1c and insulin requirements following a 12-week exercise programme. However, these findings come from pre–post designs or anecdotal feedback, so it is not possible to draw causal conclusions about the effectiveness of co-location models in increasing physical activity.

Gaps in the literature and limitations

We identified the following gaps and limitations in the evidence reviewed:

• Lack of robust impact evaluations:Many studies lack rigorous evaluations of the impact of co-location interventions on physical activity and health outcomes. The lack of experimental and quasi-experimental studies mean we are unable to establish causality between the intervention and observed outcomes.​ There is also a heavy reliance on self-reported data and service delivery metrics, with limited use of objective physical activity or behaviour change measures.

• Limited data on long-term engagement and sustainability: Very few studies assessed whether participants maintained increased physical activity level or engagement over time or evaluated the long-term sustainability of co-location models within varying policy and funding contexts.​

• Underexplored equality and demographic insights: There is a paucity of evidence on how co-location impacts different demographic groups, such as variations by socioeconomic status, age, gender, and ethnicity Understanding who benefits most and the underlying reasons remains an area requiring further research.​

It is also worth noting some caveats and limitations relevant to this review:

• Scope of outcomes assessed: This review focused specifically on physical activity outcomes, but we acknowledge that co-location initiatives often have other goals in mind such as improving adherence to physiotherapy schedules or reductions in pain and therefore other benefits of co-location interventions were not fully captured by this review.

• Search methodology: Given the scope of the current review, we were only able to review a limited number of papers and had to adapt the search strategy flexibly throughout the review. This means we focused on publicly available evidence and thus additional evidence on co-location interventions that might have been identified (by contacting those involved in  individual co-location initiatives) were not included. We acknowledge that the findings may not capture the full extent of co-location activity or its potential impacts, and a more comprehensive review would further increase robustness of the findings.

• Potential overlap with other interventions: It is worth noting that participants in the reviewed case studies may have been involved in other programmes or received concurrent support outside of the co-location intervention. This limits our ability to isolate the specific impact of co-location and further constrains causal inference.

Recommendations

This scoping review set out to examine the evidence on co-locating healthcare and leisure services as a model to promote physical activity at a population level and reduce health inequalities. While co-location interventions show some signs of promise to support people with long-term conditions, the current evidence base is limited and the effect on population level physical activity remains unclear. As a result, we recommend the following:

Clarify the role of co-location within the wider strategy for population-wide physical activity promotion

Current co-location interventions are almost exclusively targeted at individuals who are already engaged with healthcare services, with limited evidence or rationale to suggest that they are effective for general population-wide physical activity promotion or for tackling broader physical activity inequalities.

We recommend further investigation and evaluation of the theory of change underpinning co-location intervention. If one of the central aims of the Health Mission is to promote population-level disease prevention, co-location intervention may be better positioned as a complementary strategy to support at-risk groups, rather than a core mechanism for population-wide physical activity promotion.

Strengthen the evidence base through targeted, robust evaluations

We recommend working closely with other departments (e.g. DHSC) and delivery partners (e.g. the consortium for the MSK Hubs and Move Together Sheffield) to co-fund and co-design high-quality evaluations of existing co-location interventions. This would help determine whether these models meaningfully increase physical activity and health outcomes, particularly within underserved groups, and whether they deliver value for money. The evaluations should:

• use robust study designs to help establish causal claims about impact, such as randomised encouragement trials (e.g. comparing referrals randomised to either co-located or business-as-usual facilities);  

• incorporate formal theory-based evaluation methods such as contribution analysis to help understand how co-location interventions achieve impact and the relative contribution of each element;  

• include objective measurement of physical activity, ideally using accelerometers or validated digital tools;  

• collect longitudinal data to assess both behaviour change and longer-term health outcomes;  

• incorporate equity-focused analysis, examining how impacts vary by age, disability, gender, ethnicity, socioeconomic status and baseline physical activity; and  

• include cost-effectiveness assessments to inform decisions on scaling or replication.

Given that several co-location interventions are already operating at scale (e.g. MSK hubs in 100+ centres), there is a valuable opportunity to embed evaluation into existing delivery infrastructure.

References

Grinvalds, N., Shearn, K., Copeland, R. J., & Speake, H. (2019). What works to facilitate the promotion of physical activity in co-located healthcare and leisure settings: a realist review. SportRχiv.

Grinvalds, N. (2022). Co-location of health and leisure to promote physical activity: A realist synthesis. Sheffield Hallam University Research Archive.

Grinvalds, N. (2025). The co-location of healthcare and leisure as part of a whole-system approach to physical activity promotion. Sheffield Hallam University Research Archive.

Guy’s and St Thomas’ NHS Foundation Trust. (2024). Pilot offers physiotherapy at local gyms.

International Society for Physical Activity and Health. (2020). Eight investments that work for physical activity. ISPAH.

Leotta, C., Fedele, V., Schifilliti, C., Ingegnosi, C., Savoca, G., Cucinotta, L., & Strauss, K. (2011). Movement in health: Housing a diabetes centre within a gym (and vice versa). Journal of Diabetes, 3(4), 273-277. (Note: No URL provided for this entry).

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6, 1-12. (Note: No URL provided for this entry).

PureGym. (2024). The UK fitness report – 2024/25 gym statistics.

Puttick, R. & Ludlow, J. (2013). Standards of evidence: An approach that balances the need for evidence with innovation. Nesta.

Rand, M., Goyder, E., Norman, P., & Womack, R. (2020). Why do new members stop attending health and fitness venues? The importance of developing frequent and stable attendance behaviour. Psychology of Sport and Exercise, 51, 101771. (Note: No URL provided for this entry).

Statista. (2022). Number of private gym members in the United Kingdom (UK) from 2011 to 2019, by type of gym.

ukactive. (2024a). Transforming gyms into community musculoskeletal (MSK) hubs: Mobilising the UK leisure sector to deliver inclusive, accessible, personalised and gamified health services for older adults with MSK conditions. Executive summary report.

ukactive. (2024b). Transforming gyms into community Musculoskeletal (MSK) Hubs: Mobilising the UK leisure sector to deliver inclusive, accessible, personalised and gamified health services for older adults with MSK conditions. Technical evaluation report.

ukactive. (2025). UK Health and Fitness Market report reveals exponential growth as penetration rate hits 16.9% and revenue grows 8.8%.

UK government. (2022). Population of England and Wales. Ethnicity facts and figures.

UK Research and Innovation. (2024). Healthy ageing challenge.

Appendix 1: Review methodology

Literature search

We conducted a rapid evidence review to summarise the current state of evidence on co-location interventions. The initial focus was on identifying the most recent and relevant systematic reviews and meta-analyses. Given the limited availability of such reviews in this area, we iteratively expanded our search to include any experimental and quasi-experimental studies, as well as relevant grey literature (e.g. policy and industry reports).

We searched relevant evidence databases using pre-agreed search strategies. Studies were identified through the following methods:

• systematic searches of academic databases (primarily Pubmed, Google Scholar) and journals for academic literature based on key search terms

• web searches of grey literature, including policy reports, working papers, academic and research blogs, and other reports

• relevant input, reports and resources provided by DCMS and/or other UK government departments

• AI tools (e.g. ChatGPT, Claude, Consensus, Elicit) to assist evidence identification and review process

Screening

Studies were first selected based on a title and abstract screening. A full-text review was then conducted to compile a final list of relevant evidence to be included in the review. The screening process follows the pre-agreed inclusion and exclusion criteria:

The following sets out some principles for what is eligible for inclusion in this scoping review.

Category	Criteria
Population	The review will prioritise evidence among the population who are least active, either defined through their baseline physical activity levels (e.g. <30mins moderate physical activity, MPA, per week for adults) or through their association with less active demographics in the population, including: - those with disabilities - those with long-term health conditions - lower socio-economic groups - women and girls, and - ethnic minorities
Policies and interventions	Policies and interventions that are designed to co-locate healthcare services with leisure centres.
Outcomes	The main outcome of interest is physical activity. Where available, the review will prioritise studies which use a range of physical activity-related measurements (e.g. steps, moderate to vigorous physical activity). Other health-related outcomes (e.g. obesity, cardiovascular diseases) and/or wider outcomes (e.g. education, employment, crime) will be out of scope for this review.
Settings	The review will prioritise evidence focused on the UK, or studies in the whole or parts of England, Scotland, Wales and/or Northern Ireland. Evidence from comparable developed countries will also be included, especially in cases where UK evidence is not available.
Study design	We will prioritise the most recent and relevant systematic reviews and meta-analyses. If no systematic reviews/meta-analyses are available, we will look for the next best available evidence (e.g. narrative reviews, experimental or quasi-experimental evidence, robust theory-based evaluations), followed by observation studies and grey literature.
Others	Include: - Literature that are available in full text - Literature must be published in English - Literature published in the last 10 years will be prioritised. We may extend this to include studies up to last 20 years if no evidence is available within this timeframe. Policies and interventions implemented between March 2020 and late 2021 will be reviewed with caution due to the impact of the COVID-19 pandemic and the limited generalisability of findings from this period.

Data extraction, assessment, and synthesis

Data were recorded in a spreadsheet and included the following list of variables (where available):

• Title and authors  

• Year of publication  

• Type of publication (e.g. systematic review, RCT, grey literature)  

• Evidence standard assessment (see Figure 1 for the Nesta Standard of Evidence framework)    

• Country of research  

• Brief description of the intervention (e.g. format, target audience, duration)  

• outcome measure  

• Key findings on intervention effectiveness, impact on health inequalities, and other relevant findings

1.  As defined by Nesta’s Standard of Evidence. ↩