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.

Tess Harris,Derek G Cook,Ulf Ekelund,Jaime Smith,Emma Howard,Julia Fox-Rushby,Steve Dewilde,Rebecca Dale,Judith Ibison,Steve Iliffe,Peter H Whincup,Elizabeth S Limb,Christina R Victor,Michael Ussher,Cheryl Furness,Nana Anokye,Sally M Kerry,Lee David

doi:10.1371/journal.pmed.1002210

Abstract

BackgroundPedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations.Methods and FindingsA parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45–75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012–2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329–955) and 677 for nurse support (95% CI 365–989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17–49) and 35 for nurse support (95% CI 19–51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation.ConclusionsA primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.Clinical Trial Registrationisrctn.com ISRCTN98538934.

Highlights

Physical activity (PA) helps adults remain healthy and improves physical function, quality of life, and emotional well-being [1]
A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge
Whilst the PACE-Lift intervention included pedometer feedback, step-count diary, and practice nurse physical activity (PA) consultations based around behaviour change techniques (BCTs), it comprised four longer consultations, which included accelerometer feedback on PA intensity

Summary

Introduction

Physical activity (PA) helps adults remain healthy and improves physical function, quality of life, and emotional well-being [1]. One way to achieve this is by 30 min of MVPA on at least 5 d weekly [1] Setting such goals is helpful, a graded dose–-response relationship exists for PA and health, so for inactive people any PA increase is valuable [6]. Adding “3,000 steps in 30 min” onto habitual activity can increase step-counts [9] and reduce fasting glucose [9] in people with impaired glucose tolerance, but evidence for a change in MVPA in bouts is lacking. Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations

Methods

Results

Conclusion