Promoting physical activity in older people in general practice: ProAct65+ cluster randomised controlled trial.
BACKGROUND
Regular physical activity reduces falls, hip fractures, and all-cause mortality, but physical activity levels are low in older age groups.


OBJECTIVE
To evaluate two exercise programmes promoting physical activity among older people.


METHODS
Pragmatic three-arm, parallel-design cluster randomised controlled trial involving 1256 people aged ≥65 years (of 20 507 invited) recruited from 43 general practices in London, Nottingham, and Derby.


METHODS
Practices were randomised to the class-based Falls Management Exercise programme (FaME), the home-based Otago Exercise Program (OEP), or usual care. The primary outcome was the proportion reaching the recommended physical activity target 12 months post-intervention. Secondary outcomes included falls, quality of life, balance confidence, and costs.


RESULTS
In total, 49% of FaME participants reached the physical activity target compared with 38% for usual care (adjusted odds ratio 1.78, 95% confidence interval [CI] =1.11 to 2.87, P = 0.02). Differences between FaME and usual care persisted 24 months after intervention. There was no significant difference comparing those in the OEP (43% reaching target at 12 months) and usual-care arms. Participants in the FaME arm added around 15 minutes of moderate-to-vigorous physical activity per day to their baseline level; this group also had a significantly lower rate of falls (incident rate ratio 0.74, 95% CI = 0.55 to 0.99, P = 0.042). Balance confidence was significantly improved in both intervention arms. The mean cost per extra person achieving the physical activity target was £1740. Attrition and rates of adverse reactions were similar.


CONCLUSIONS
The FaME programme increases self-reported physical activity for at least 12 months post-intervention and reduces falls in people aged ≥65 years, but uptake is low. There was no statistically significant difference in reaching the target, or in falls, between the OEP and usual-care arms.
University College London, London.
Steve
S
Iliffe
University of Nottingham, Nottingham.
Denise
D
Kendrick
University of Bristol, Bristol.
Richard
R
Morris
University College London, London.
Mark
M
Griffin
University College London, London.
Deborah
D
Haworth
University of Nottingham, Nottingham.
Hannah
H
Carpenter
Nottingham University Hospitals NHS Trust, Nottingham.
Tahir
T
Masud
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow.
Dawn A
DA
Skelton
University College London, London.
Susie
S
Dinan-Young
University of Southampton.
Ann
A
Bowling
Heather
H
Gage
D000368:Aged; D004739:England; D015444:Exercise; D005240:Feasibility Studies; D006293:Health Promotion / Q000379:methods* / Q000592:standards / Q000639:trends; D006801:Humans; D008131:London; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends; D011788:Quality of Life; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
aged people; exercise promotion; falls; general practice; physical activity