Title: RCT of a complex intervention by primary care nurses to increase walking in patients aged 60-74 years. (PACE-Lift Pedometer Accelerometer Consultation Evaluation - Lift).
Funder: Department of Health (England)

Abstract: Background Physical activity is important for older peoples’ physical and mental health and for maintaining independence. Guidelines recommend at least 30 minutes daily, 5 days weekly, of at least moderate intensity PA. Less than 20% of UK 60-74 year olds report achieving this. Effective PA behaviour change interventions include cognitive behavioural strategies eg. goal setting, self-monitoring, relapse prevention and the ability for interventions to be incorporated into daily routine, eg. increasing walking. Primary care PA consultations allow individual tailoring of such advice. Pedometers measure step-counts and accelerometers measure PA intensity, feedback on both of these measures could help to increase PA, but no studies have assessed this combination in older people or in primary care. Aims Efficacy of intervention: i) To determine whether or not a pedometer & accelerometer based intervention plus primary care nurse PA consultations, can help 60-74 year olds to increase their PA over 3 months (primary outcome); ii) To determine whether any increases are maintained over 12 months. Components of the intervention & acceptability to population: iii) To assess the fidelity & quality of intervention implementation over time; iv) To explore the reasons for non-participation in the trial; v) To explore the intervention’s acceptability to practice nurses & older people and what intervention components were most & least helpful; vi) To explore the factors enhancing or acting as barriers for older people in increasing their PA. Plan of Investigation Design: RCT with intervention & control arms plus process & qualitative evaluations. Target population: 300 people aged 60-74 registered with 3 Oxfordshire PCT practices, who can walk outside and have no contraindications to PA. Intervention: 3 month pedometer & accelerometer based intervention with practice nurse PA consultations. Four consultations based on cognitive behavioural strategies, PA diary, pedometer average daily steps & accelerometer feedback on PA intensity & timing of activities. Individual PA plans based on increasing walking and other existing PA will be produced. Outcomes: change in average daily steps (primary outcome) and average time spent in at least moderate intensity PA weekly (secondary outcome) at 3 months (main outcome) and 12 months (to assess maintenance). Potential Impact If the desired outcome of increased PA levels (both daily steps and time spent at moderate intensity PA) occurs and is maintained, there should be direct participant benefits, as increased PA is associated with numerous physical and mental health benefits for older people. Additionally, participants and nurses will master a behaviour change technique that is transferrable to other health behaviours. If this study’s intervention is acceptable and effective, this will justify funding for a larger trial in a representative primary care population, to test the different components separately and to assess cost-effectiveness. The long term aim is to develop an effective primary care PA intervention for older people, which will reduce the huge NHS costs of physical inactivity in this age group.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL