Does a complex intervention by primary care nurses increase walking in older people? Outcomes at 3 and 12 months in the PACE-Lift (Pedometer Accelerometer Consultation Evaluation-Lift) cluster-randomised controlled trial

Abstract

BackgroundWalking is the commonest physical activity done by older people. Intensity can be light if strolling, and moderate if brisker. We assessed whether a primary care nurse-delivered complex intervention increased walking. MethodsOur study was a parallel two-arm cluster-randomised trial, randomised by household, by researcher using an internet randomisation service. 988 people aged 60–75 years, with no contraindications to increasing their walking, randomly selected from three UK general practices, were invited to participate. 298 people from 250 households were randomised to intervention (150 individuals) or usual care control group (148 individuals). During 3 months, intervention participants received four consultations from their own practice nurse about their physical activity, incorporating behaviour change techniques, feedback on step-counts as measured by pedometer and intensity of physical activity as measured by accelerometer, and an individual physical activity diary and plan. Outcomes were accelerometer-assessed change in average daily step counts over 7 days (primary outcome) and average time spent in physical activity of moderate-to-vigorous intensity weekly (secondary outcome) between baseline, 3 months, and 12 months. Adverse events were recorded by self-administered questionnaire. Assessors were not masked to group allocation. Analysis was by intention to treat, controlling for household clustering (intraclass correlation coefficient=0·004 at 3 months, 0·16 at 12 months). This trial is registered with Current Controlled Trials, ISRCTN42122561. FindingsOutcome data were available for 280 (94%) individuals. Mean baseline average daily step-count was 7388 (SD 2218) in the intervention group and 7453 (2463) in the control group. At 3 months both average daily step-counts and average weekly moderate-to-vigorous physical activity increased significantly more in the intervention than in the control group by 1037 steps per day (95% CI 513–1560) and 66 min per week (36–96), respectively. At 12 months the corresponding differences were 609 (104–1115) and 40 (10–70). Differences in adverse events between intervention and control groups were not significant at either 3 months or 12 months (−4% [95% CI −15 to 7] vs −1% [–13 to 11], respectively). InterpretationIn the PACE-Lift trial, both step-counts and moderate-to-vigorous physical activity increased in people aged 60–75 years at 3 and 12 months. To our knowledge, this is the first trial in older people to show objective increases in moderate-to-vigorous physical activity, and it highlights the value of both accelerometry physical activity assessment and primary care as a setting for phyisical activity interventions. If these differences in physical activity are sustained they should lead to important differences in health outcomes. FundingNational Institute for Health Research Research for Patient Benefit Programme.