MacMillan et al. BMC Public Health 2011, 11:120 http://www.biomedcentral.com/1471-2458/11/120 50% of adults meeting the physical activity recommen- dation by 2022 [4]. Older adults are a key segment of the population for physical activity intervention if Scot- land is to reach the 2022 target, because of the low pro- portion of older adults meeting the physical activity guideline [5] and an ageing population structure [6]. In addition, older adults may have the most to gain from physical activity intervention as a consequence of physi- cal [7-9] and cognitive [10,11] functions deteriorating with age. Being regularly physically active has physiolo- gical (e.g. reduced risk of overall mortality, cardiovascu- lar disease, obesity, Type 2 diabetes, osteoporosis and breast and colo-rectal cancer), psychological (e.g. reduced anxiety and depression risk and reduced risk or decreased rate of dementia and memory loss develop- ment), social (e.g. interaction) and overall well-being benefits (e.g. increased energy, vitality and improved mood and sleep pattern) [2,12]. Regular physical activity has a number of benefits that are particularly important for older adults. It can: a) slow the age-related decline in functional capacity; b) improve mobility and indepen- dence thus making activities of daily living easier; c) slow age-related declines in cognition or even improve cognitive functioning; d) reduce the risk of falling; and e) benefit areas of mental health such as social interac- tion and overall well-being [2,12-14]. Walking is an ideal mode of physical activity for older adults and has been described as ‘the nearest activity to perfect exercise’ [15] (p. 328) as it is a cheap and safe way of increasing physical activity participation with minimal adverse effects [15]. For previously sedentary adults, walking can result in physiological health bene- fits including decreases in body weight, body mass index, percentage body fat and resting diastolic blood pressure [16] as well as psychological health benefits such as positive effects on mood [17]. In a systematic review by Ogilvie et al. [18] of the evidence for success- ful walking interventions, the authors identified a lack of peer reviewed literature on how best to support older people. The authors also concluded that walking inter- ventions tailored to the individual and delivered on a one-to-one, household or group basis are the most suc- cessful at encouraging increases in walking participation in those that are most sedentary and/or most motivated to change [18]. The review found evidence that ped- ometers are effective tools to increase walking participa- tion in adults but there is a need for research to examine who can benefit the most from pedometer- based walking programmes and which elements of the interventions are most important to their success. In addition, the review called for studies to be conducted outside of the USA and Australia where most of the current literature was generated and also to focus on longer term effects. Page 2 of 12 There is growing interest around the world in the health implications of sedentary behaviour (time spent sitting and lying), independent of physical activity levels. A number of recent policy documents have highlighted concern about the high levels of sedentary behaviours in the Scottish population [4,19]. Recent evidence suggests a dose-response association between sitting times and mortality from all causes and cardiovascular disease, independent of leisure time physical activity [20]. If an individual achieves the recommended amount of physi- cal activity, his/her health may still be at risk if seden- tary for many hours. Recent research from Australia suggests that those who spend more time in sedentary behaviour but are sufficiently active (at least 2.5 hrs of activity/week) and those who are insufficiently active but spend less time in sedentary behaviours have a simi- lar risk of being overweight or obese [21]. A study using the activPAL™ to assess activity patterns in 20 older Scottish adults (mean age 74.0 ± 5.3 years) found that on average 18 hours/day were spent in sedentary beha- viours [22]. Previous research conducted by our group found a 12-week individualised pedometer-based graduated walking programme (‘Walking for Well-being in the West’(WWW)), delivered with a series of physical activ- ity consultations, significantly increased walking beha- viour, improved mood and decreased self reported sitting time in Scottish adults aged 18-65 years [17,23] over a 3 month period. The WWW intervention was based on the recommendations from Ogilvie and collea- gues’ review [18], consisting of a one-to-one, theory- driven, individualised programme. The consultation was based on established guidelines [24] and adapted for walking behaviour. Specific behaviour change techniques that were used included information provision on the link between walking and health, setting graded tasks (pedometer step counts), identifying barriers and ways to overcome them, prompting self-monitoring by use of the pedometer, identifying social support and relapse prevention. All of these techniques have been recognised as having evidence for behaviour change and are used as described by Abraham et al. [25]. The methods of the present study will determine if the same intervention that was used in WWW could be used to increase walk- ing behaviour in adults aged ≥65 years who do not cur- rently meet the physical activity recommendations. WWW was based in a community setting but deliv- ered by a research team. Little is known regarding the feasibility of delivering such walking interventions by professionals (not researchers) through primary care. Therefore this study was based in a primary care setting, specifically in a general practice (family practice) and delivered by a practice nurse. Recruitment was via a general practice in this study for two main reasons.