title: Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial.
abstract: BACKGROUND
  Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations.
  
  
  RESULTS
  A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45-75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012-2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329-955) and 677 for nurse support (95% CI 365-989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17-49) and 35 for nurse support (95% CI 19-51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation.
  
  
  CONCLUSIONS
  A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.
  
  
  BACKGROUND
  isrctn.com ISRCTN98538934.
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.identifier: http://orcid.org/0000-0002-7181-9107
authors.initials: SM
authors.lastname: Kerry
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Elizabeth S
authors.identifier: http://orcid.org/0000-0003-0830-7376
authors.initials: ES
authors.lastname: Limb
authors.affiliation: Gerontology and Health Services Research Unit, Brunel University, London, United Kingdom.
authors.forename: Christina R
authors.identifier: http://orcid.org/0000-0002-4213-3974
authors.initials: CR
authors.lastname: Victor
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: Michael
authors.identifier: http://orcid.org/0000-0002-0995-7955
authors.initials: M
authors.lastname: Ussher
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: 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: Health Economics Research Group, Brunel, University of London, London, United Kingdom.
authors.forename: Julia
authors.identifier: http://orcid.org/0000-0003-0748-0871
authors.initials: J
authors.lastname: Fox-Rushby
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Furness
authors.affiliation: Health Economics Research Group, Brunel, University of London, London, United Kingdom.
authors.forename: Nana
authors.initials: N
authors.lastname: Anokye
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Judith
authors.initials: J
authors.lastname: Ibison
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Steve
authors.initials: S
authors.lastname: DeWilde
authors.affiliation: 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, United Kingdom.
authors.forename: Lee
authors.initials: L
authors.lastname: David
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Emma
authors.identifier: http://orcid.org/0000-0002-4947-4595
authors.initials: E
authors.lastname: Howard
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dale
authors.affiliation: Population Health Research Institute, St George's University of London, London, United Kingdom.
authors.forename: Jaime
authors.identifier: http://orcid.org/0000-0002-5510-8831
authors.initials: J
authors.lastname: Smith
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 / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009726:Nurses; D011320:Primary Health Care; D016138:Walking