MacMillan et al. BMC Public Health 2011, 11:120 http://www.biomedcentral.com/1471-2458/11/120 activity [47] by a general practitioner. Computer random sequence generation was used to determine the order of screening. Recruitment was via letter sent from a gen- eral practitioner. Individuals were asked to indicate on a reply slip whether they would be interested in taking part. Positive responders indicated their preferred method of contact (email, post or telephone). A researcher contacted those wishing to take part to assess current physical activity participation and to sche- dule the first appointment. An open-ended question for negative responders to provide a reason why they did not want to take part was included in the recruitment letter. Reminder letters were sent out at least two weeks after initial study invitations to individuals that did not respond to the initial recruitment letter. Negative responders who did not give a reason for declining par- ticipation in their first reply were sent a further letter asking for help in trying to understand why the study did not appeal to them to assist the research team with future study recruitment. Study population Inclusion criteria were as follows: aged ≥65 years; able to understand the study rationale; living independently; English speaking and not meeting the current physical activity recommendations (defined as being in the pre- contemplation, contemplation or preparation stages of change from the Transtheoretical Model of behaviour change in relation to meeting the current physical activ- ity recommendations [48] (see table 1 for descriptions)). After discussion with a researcher on the telephone, individuals who were already regularly physically active (e.g. in stage 4 or 5) were excluded from the study. Two participants recruited into the study were from the same household (the second member of the household was not invited into the study until the first member had completed participation in the study). The intervention Glasziou and colleagues [49] highlight the importance of fully describing intervention protocols in enough detail for others to replicate the intervention. The authors acknowledge that full reporting may not be feasible in scientific journals where space is limited and thus recommend providing links to websites where full Page 5 of 12 details are available [49]. Intervention pro formas for this study are detailed in the intervention manual which can be accessed at http://www.strath.ac.uk/humanities/ courses/physicalactivityforhealth/staff/mutrienanetteprof/ or by contacting the chief investigator. A 30 minute physical activity consultation was delivered individually to each participant by a practice nurse who had been trained in consultation procedures. To examine delivery of the intervention by a practice nurse and to assess consultation fidelity, audio recordings of consultations were made. NHS Health Scotland has provided physical activity consultation training which can be undertaken by anyone with an interest and basic knowledge in health and physical activity (i.e. college or university level knowledge is not required) and is delivered over 1-2 days. The lead trainer for these courses conducted a one-to-one training session with the study practice nurse over 1 day and was available for clarification and guidance as the nurse practiced these skills before deli- vering a consultation with participants. The consulta- tions followed recommended guidelines [24], were based on the social cognitive model of behaviour change as a theoretical framework, and have previously been shown to successfully increase physical activity participation in adults [17,50,51]. Details of the behaviour change pro- cesses targeted in the consultations are provided in Table 2. The intervention involved two consultations. The aim of the initial consultation was to increase walk- ing participation. A second consultation focussed on relapse prevention (12 weeks after the first consultation) and aimed to maintain walking behaviour. A 12-week individualised walking programme and ped- ometer were also given to participants. Details of the walk- ing programme are given in Table 3. A cadence of 100 steps/minute has become a widely-accepted population guideline for an adult walking at a moderate pace, and has been confirmed in two recent controlled studies of over- ground walking [52,53]. Thus increasing step count by 3,000 steps/day equates to approximately 30 minutes of moderate intensity physical activity. It is important to note however that limited research has examined step rate spe- cifically in older adults with only one of these studies including adults aged 50-65 years [53]. A local walking group was set up and led by a trained walk leader to help participants increase walking Table 1 Description of the stages of change in relation to meeting the current physical activity recommendations Stage 1 2 3 4 5 Stage name Pre-contemplation Contemplation Preparation Action Maintenance Description of individual in terms of physical activity participation Not regularly physically active and do not intend to be in the next 6 months Not regularly physically active but are thinking about becoming more active in the next 6 months Do some physical activity but do not participate in regular physical activity Regularly active but for less than 6 months Regularly active for over 6 months