Randomised controlled trial of a complex intervention by primary care nurses to increase walking in patients aged 60–74 years: protocol of the PACE-Lift (Pedometer Accelerometer Consultation Evaluation - Lift) trial

Tess Harris,Alison Woodcock,Derek Cook,Fredrika Adams,Carole Beighton,Steve Iliffe,Michael Ussher,Sally Kerry,Christina Victor,Ulf Ekelund,Lee David,Annabelle Rogers,Debbie Brewin,Peter Whincup

doi:10.1186/1471-2458-13-5

Abstract

BackgroundPhysical activity is essential for older peoples’ physical and mental health and for maintaining independence. Guidelines recommend at least 150 minutes weekly, of at least moderate intensity physical activity, with activity on most days. Older people’s most common physical activity is walking, light intensity if strolling, moderate if brisker. Less than 20% of United Kingdom 65–74 year olds report achieving the guidelines, despite most being able to. Effective behaviour change techniques include strategies such as goal setting, self-monitoring, building self-efficacy and relapse prevention. Primary care physical activity consultations allow individual tailoring of advice. Pedometers measure step-counts and accelerometers measure physical activity intensity. This protocol describes an innovative intervention to increase walking in older people, incorporating pedometer and accelerometer feedback within a primary care nurse physical activity consultation, using behaviour change techniques.Methods/DesignDesign: Randomised controlled trial with intervention and control (usual care) arms plus process and qualitative evaluations.Participants: 300 people aged 60–74 years registered with 3 general practices within Oxfordshire and Berkshire West primary care trusts, able to walk outside and with no restrictions to increasing their physical activity.Intervention: 3 month pedometer and accelerometer based intervention supported by practice nurse physical activity consultations. Four consultations based on behaviour change techniques, physical activity diary, pedometer average daily steps and accelerometer feedback on physical activity intensity. Individual physical activity plans based on increasing walking and other existing physical activity will be produced.Outcomes: Change in average daily steps (primary outcome) and average time spent in at least moderate intensity physical activity weekly (secondary outcome) at 3 months and 12 months, assessed by accelerometry. Other outcomes include quality of life, mood, exercise self-efficacy, injuries. Qualitative evaluations will explore reasons for trial non-participation, the intervention’s acceptability to patients and nurses and factors enhancing or acting as barriers for older people in increasing their physical activity levels.DiscussionThe PACE-Lift trial will determine the feasibility and efficacy of an intervention for increasing physical activity among older primary care patients. Steps taken to minimise bias and the challenges anticipated will be discussed. Word count 341.Trial registration numberISRCTN42122561

Highlights

Physical activity is essential for older peoples’ physical and mental health and for maintaining independence
Steps taken to minimise bias and the challenges anticipated will be discussed
Why is physical activity important for older people? The United Kingdom (UK) Chief Medical Officers recently published a report on physical activity (PA) for health, which has drawn upon recent international large scale reviews of the evidence of the impact of physical activity on health and included a specific chapter on older adults [1]

Summary

Introduction

Physical activity is essential for older peoples’ physical and mental health and for maintaining independence. Pedometers measure step-counts and accelerometers measure physical activity intensity This protocol describes an innovative intervention to increase walking in older people, incorporating pedometer and accelerometer feedback within a primary care nurse physical activity consultation, using behaviour change techniques. The following benefits for older adults are described: reduced mortality; a reduced risk of over 20 diseases and conditions (including cardiovascular disease, diabetes, obesity, osteoporosis, several cancers, depression, dementia); reduced falls risk; and improved function, quality of life and emotional well-being [1] These effects are of major importance to both older people and society, with the annual direct cost of physical inactivity to the National Health Service (NHS) across the UK recently estimated at £ 1.06 billion [1].

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