Exercise Referral Schemes (ERS) are programmes commonly implemented in the United Kingdom to increase physical activity levels and ‘treat’ ‘sedentary’ individuals and those diagnosed with non-communicable chronic disease. The views and interpretations of stakeholders are currently under-researched, however. This paper addresses sociologically this research lacuna, presenting data from interviews with 17 ERS stakeholders (seven exercise professionals, five health professionals and five strategic managers) in a case study English county. A figurational sociological lens was adopted to provide novel insights into the meanings attached to ERS, and their contestation through service delivery models. Thematic analysis generated salient themes regarding divergent interpretations of ERS goals, and conflict within both service delivery pathways and perceptions of programme impact. Data highlighted conflicting and inconsistent stakeholder accounts within and across groups, suggesting participants attached specific, interdependent and sometimes contradictory meanings to ERS. This created conflict and generated interesting unintended consequences. Perceived divisions between strategic and local levels, and between professional groups emerged strongly. The consequences of such divisions are discussed, together with implications for future analyses of exercise as medicine programmes. Results suggest that an excessive focus upon programme impact and end-user experiences may overlook the influence of stakeholder interpretation on how and why exercise is employed as medicine, by whom, for whom and in which circumstances.