title: A primary care nurse-delivered walking intervention in older adults: PACE (pedometer accelerometer consultation evaluation)-Lift cluster randomised controlled trial.
abstract: BACKGROUND
  Brisk walking in older people can increase step-counts and moderate to vigorous intensity physical activity (MVPA) in ≥10-minute bouts, as advised in World Health Organization guidelines. Previous interventions have reported step-count increases, but not change in objectively measured MVPA in older people. We assessed whether a primary care nurse-delivered complex intervention increased objectively measured step-counts and MVPA.
  
  
  RESULTS
  A total of 988 60-75 year olds, able to increase walking and randomly selected from three UK family practices, were invited to participate in a parallel two-arm cluster randomised trial; randomisation was by household. Two-hundred-ninety-eight people from 250 households were randomised between 2011 and 2012; 150 individuals to the intervention group, 148 to the usual care control group. Intervention participants received four primary care nurse physical activity (PA) consultations over 3 months, incorporating behaviour change techniques, pedometer step-count and accelerometer PA intensity feedback, and an individual PA diary and plan. Assessors were not blinded to group status, but statistical analyses were conducted blind. The primary outcome was change in accelerometry assessed average daily step-counts between baseline and 3 months, with change at 12 months a secondary outcome. Other secondary outcomes were change from baseline in time in MVPA weekly in ≥10-minute bouts, accelerometer counts, and counts/minute at 3 months and 12 months. Other outcomes were adverse events, anthropometric measures, mood, and pain. Qualitative evaluations of intervention participants and practice nurses assessed the intervention's acceptability. At 3 months, eight participants had withdrawn or were lost to follow-up, 280 (94%) individuals provided primary outcome data. At 3 months changes in both average daily step-counts and weekly MVPA in ≥10-minute bouts were significantly higher in the intervention than control group: by 1,037 (95% CI 513-1,560) steps/day and 63 (95% CI 40-87) minutes/week, respectively. At 12 months corresponding differences were 609 (95% CI 104-1,115) steps/day and 40 (95% CI 17-63) minutes/week. Counts and counts/minute showed similar effects to steps and MVPA. Adverse events, anthropometry, mood, and pain were similar in the two groups. Participants and practice nurses found the intervention acceptable and enjoyable.
  
  
  CONCLUSIONS
  The PACE-Lift trial increased both step-counts and objectively measured MVPA in ≥10-minute bouts in 60-75 year olds at 3 and 12 months, with no effect on adverse events. To our knowledge, this is the first trial in this age group to demonstrate objective MVPA increases and highlights the value of individualised support incorporating objective PA assessment in a primary care setting.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN42122561.
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Tess
authors.initials: T
authors.lastname: Harris
authors.affiliation: Pragmatic Clinical Trials Unit, Queen Mary's University of London, London, United Kingdom.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Kerry
authors.affiliation: College of Health and Life Sciences, Brunel University London, London, United Kingdom.
authors.forename: Christina R
authors.initials: CR
authors.lastname: Victor
authors.affiliation: Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Ulf
authors.initials: U
authors.lastname: Ekelund
authors.affiliation: Independent Psychology Research Consultant, Southampton, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Woodcock
authors.affiliation: Research Department of Primary Care & Population Health, University College, London, United Kingdom.
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Whincup
authors.affiliation: Faculty of Health Social Care and Education, Kingston University and St George's University of London, London, United Kingdom.
authors.forename: Carole
authors.initials: C
authors.lastname: Beighton
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Limb
authors.affiliation: 10 Minute CBT, Letchworth Garden City, Hertfordshire, United Kingdom.
authors.forename: Lee
authors.initials: L
authors.lastname: David
authors.affiliation: 10 Minute CBT, Letchworth Garden City, Hertfordshire, United Kingdom.
authors.forename: Debbie
authors.initials: D
authors.lastname: Brewin
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Fredrika
authors.initials: F
authors.lastname: Adams
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
mesh_terms: D056044:Actigraphy; D000368:Aged; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009726:Nurses; D005082:Physical Exertion; D011320:Primary Health Care; D012017:Referral and Consultation; D016138:Walking