A Primary Care Nurse-Delivered Walking Intervention in Older Adults: PACE (Pedometer Accelerometer Consultation Evaluation)-Lift Cluster Randomised Controlled Trial

Abstract

BackgroundBrisk 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 FindingsA 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 At 3 months, eight participants had withdrawn or were lost to follow-up, 280 (94%) individuals provided primary outcome data.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.ConclusionsThe 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.Trial RegistrationControlled-Trials.com ISRCTN42122561

Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial

“…To our knowledge, this is the largest population-based trial of a pedometer-based walking intervention with 12-mo follow-up and is consistent with our findings in 60- to 75-y-olds in the smaller PACE-Lift trial [21]. Whilst the PACE-Lift intervention also included pedometer feedback, step-count diary, and practice nurse PA consultations based around BCTs, it comprised four longer consultations, which also included accelerometer feedback on PA intensity.…”

“…PA guidelines focus on time in MVPA, not step-counts; the reviews presented no data on this important outcome [10, 16, 17]. PACE-UP results confirm PACE-Lift findings [21], with significant 12-mo increases in MVPA in bouts. Based on the “3,000-in-30” formula, 35 extra min of MVPA/wk in bouts corresponds to 500 extra steps/day.…”

“…Most pedometer-based interventions have not separated pedometer and support effects [14, 16, 21]. The Healthy Steps trial showed pedometers achieved an additional effect compared with a primary care PA prescription, but PA outcomes were self-reported [31].…”

“…However, to date, primary care has had little success in playing its part in the challenge of increasing population PA levels. Some small primary care pedometer-based walking interventions in older adults have increased PA levels at 3 [19], 6 [20], and 12 mo [21], but the effects of exercise referral schemes have been disappointing [22]. We therefore conducted a trial of a pedometer-based walking intervention in 45- to 75-y-olds, predominantly inactive, primary care patients, with novel separate evaluation of pedometer and nurse-support effects on objective PA outcomes, including MVPA in bouts.…”

Measuring the implementation of a group-based Lifestyle-integrated Functional Exercise (Mi-LiFE) intervention delivered in primary care for older adults aged 75 years or older: a pilot feasibility study protocol

“…Thus, a sample size calculation was performed using G Power 3.1.2 (Universitat Kiel, Germany, 2009) to determine the number of participants needed to observe a statistically significant change from pre- to post-intervention in moderate-to-vigorous PA (minutes/day) (a secondary outcome in the current study). Based on evidence from primary care-based exercise interventions [63, 10, 15, 64, 65] and surveillance data in older adults [66, 67, 7], we need 26 participants (allowing for 20 % attrition) to detect a minimum difference (alpha = 0.05, 90 % power, effect size = 0.75) from pre- to post-intervention of a mean 15 min/day of accelerometer-measured moderate-to-vigorous PA with a standard deviation of 20 min/day.…”