Brisk walking in older people can increase step-counts and moderate to vigorous intensity physical activity (MVPA) in ≥10-minute bouts, as advised in World Health Organization guidelines. Previous interventions have reported step-count increases, but not change in objectively measured MVPA in older people. We assessed whether a primary care nurse-delivered complex intervention increased objectively measured step-counts and MVPA.
Methods and Findings
A total of 988 60–75 year olds, able to increase walking and randomly selected from three UK family practices, were invited to participate in a parallel two-arm cluster randomised trial; randomisation was by household. Two-hundred-ninety-eight people from 250 households were randomised between 2011 and 2012; 150 individuals to the intervention group, 148 to the usual care control group. Intervention participants received four primary care nurse physical activity (PA) consultations over 3 months, incorporating behaviour change techniques, pedometer step-count and accelerometer PA intensity feedback, and an individual PA diary and plan. Assessors were not blinded to group status, but statistical analyses were conducted blind. The primary outcome was change in accelerometry assessed average daily step-counts between baseline and 3 months, with change at 12 months a secondary outcome. Other secondary outcomes were change from baseline in time in MVPA weekly in ≥10-minute bouts, accelerometer counts, and counts/minute at 3 months and 12 months. Other outcomes were adverse events, anthropometric measures, mood, and pain. Qualitative evaluations of intervention participants and practice nurses assessed the intervention’s acceptability. At 3 months, eight participants had withdrawn or were lost to follow-up, 280 (94%) individuals provided primary outcome data. At 3 months changes in both average daily step-counts and weekly MVPA in ≥10-minute bouts were significantly higher in the intervention than control group: by 1,037 (95% CI 513–1,560) steps/day and 63 (95% CI 40–87) minutes/week, respectively. At 12 months corresponding differences were 609 (95% CI 104–1,115) steps/day and 40 (95% CI 17–63) minutes/week. Counts and counts/minute showed similar effects to steps and MVPA. Adverse events, anthropometry, mood, and pain were similar in the two groups. Participants and practice nurses found the intervention acceptable and enjoyable.
The PACE-Lift trial increased both step-counts and objectively measured MVPA in ≥10-minute bouts in 60–75 year olds at 3 and 12 months, with no effect on adverse events. To our knowledge, this is the first trial in this age group to demonstrate objective MVPA increases and highlights the value of individualised support incorporating objective PA assessment in a primary care setting.
In this cluster randomized controlled trial, Tess Harris and colleagues investigate whether a program delivered by primary care nurses to older adults can increase bouts of moderate to vigorous physical activity.
Worldwide, people are becoming increasingly sedentary. They are sitting at desks instead of doing manual labor; they are driving to work instead of walking; and they are participating in fewer leisure time physical activities. But the human body needs regular exercise to stay healthy. Physical activity helps to maintain a healthy weight and prevents or delays heart disease, type 2 diabetes, and some cancers. Moreover, physically active people feel better and live longer than physically inactive people. The World Health Organization recommends that adults should be active daily and should do at least 150 minutes of moderate- to vigorous-intensity physical activity (MVPA) every week in bouts that each last at least 10 minutes. Moderate-intensity physical activities (for example, brisk walking) require a moderate amount of effort and noticeably increase the heart rate; vigorous-intensity physical activities (for example, running) require a large amount of effort and cause rapid breathing and a substantial heart rate increase.
Why Was This Study Done?
When physical activity is objectively measured using an accelerometer (a movement monitor that is usually worn on the waist; unlike pedometers, which simply count the number of steps a person takes, accelerometers record both step-counts and the intensity of physical activity), fewer than 5% of older people achieve the recommended weekly levels of MVPA. These levels could be reached by taking regular brisk walks but how can older people be persuaded to make such walks part of their daily lives? In this cluster randomized controlled trial—the PACE (Pedometer Accelerometer Consultation Evaluation)-Lift trial—the researchers assess whether an intervention to increase walking comprising pedometer and accelerometer feedback combined with physical activity consultations provided by practice nurses can lead to sustained increases in physical activity in 60–75 year olds. Cluster randomized trials compare outcomes in groups of people (here, husbands and wives living in one household) assigned through the play of chance to receive a test or a control intervention.
What Did the Researchers Do and Find?
The researchers assigned 298 people from 250 households to receive the intervention or usual care and determined the participants’ physical activity at baseline, 3 months, and 12 months by asking them to wear an accelerometer for 7 days. Intervention group participants received four physical activity consultations with a primary care nurse over 3 months. At the first consultation, the nurse gave each participant a pedometer to measure step-counts, a physical activity diary in which to record their goals and progress, and the PACE-Lift patient handbook. At each consultation, the nurse used behavior change techniques (for example, goal setting) to encourage the participant to walk regularly, gave the participant visual feedback from their accelerometer readings, and devised a personal walking plan. Control group participants received normal care only from the practice. At 3 months and 12 months, both the average daily step-count and the weekly MVPA level had decreased from baseline in the control group but increased in the intervention group. At 3 months, compared to the control group, the average step-count in the intervention group was 1,037 steps/day higher and the MVPA in bouts of more than 10 minutes in the intervention group was 63 minutes/week higher. At 12 months, the corresponding differences were 609 steps/day and 40 minutes/week. There were no significant differences in adverse events (for example, pain), body fat, or other measured health-related outcomes between the groups.
What Do These Findings Mean?
These findings show that the complex intervention tested in the PACE-Lift trial increased both step-counts and objectively measured MPVA among 60–75 year olds for at least 12 months. Importantly, all the participants and practice nurses were positive and enthusiastic about the intervention. Moreover, the observed increase in physical activity is estimated to reduce the participants’ risk of heart disease and type 2 diabetes by an estimated 5.5% and 9.1%, respectively. Further trials are needed to determine which aspects of the intervention were responsible for increasing physical activity, to determine whether the intervention’s effects will persist for longer than 12 months, and to test the intervention in socio-economically diverse populations (all the PACE-Lift participants came from an affluent, non-ethnically diverse area). However, these findings highlight the value of family practices providing older individuals with individualized support that incorporates objective assessment of physical activity to help them become more physically active.
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001783.
The US Centers for Disease Control and Prevention provides information on all aspects of healthy living; its Physical Activity for Everyone web pages include guidelines for older people, instructional videos, and personal success stories (some information in English and Spanish)
The World Health Organization provides information about physical activity and health (in several languages); its Global Recommendations on Physical Activity for Health are available in several languages
The UK National Health Service information source Choices explains the benefits of regular physical activity, provides recommendations for older people, and includes tips for exercising and some personal stories
MedlinePlus has links to other resources about exercise and physical fitness (in English and Spanish)
More information about the PACE-Lift trial protocol is available