A primary care pedometer-based walking intervention with and without practice nurse support: PACE-UP cluster-randomised controlled trial

Abstract

Background WHO guidelines recommend walking to increase moderate-to-vigorous physical activity. Pedometerbased interventions have focused on step-counts, not moderate-to-vigorous physical activity, and have not distinguished between pedometer and support eff ects. We assessed whether a postal pedometer-based walking intervention could increase step-counts and moderate-to-vigorous physical activity in inactive adults and whether physical activity consultations delivered by a practice nurse could add benefi t. Methods 11 015 men and women aged 45-75 years, randomly selected from seven family practices in London, UK, with no physical activity contraindications, were invited by post to participate in a parallel three-arm cluster-randomised trial. Randomisation was by household, stratifi ed by practice, using random-sized blocks. 6399 were non-responders; 548 repondents who self-reported achievement of physical activity guidelines were excluded. 1023 people (922 households) were randomised after consent to usual care (338), postal pedometer intervention (339), or nursesupported pedometer intervention (346). Intervention groups received pedometers, 12 week walking programmes, and physical activity diaries. The nurse group was off ered three physical activity consultations. Assessors were unmasked to group for pragmatic reasons. The primary and main secondary outcomes were, respectively, changes from baseline to 12 months in average daily step-counts and time in moderate-to-vigorous physical activity in bouts (≥10 min), measured over 7 days objectively by accelerometry. Analysis accounted for clustering, was by intention to treat, and was masked to group for main outcomes. Ethics approval was granted by the London Research Ethics Committee (Hampstead). This trial is registered with Current Controlled Trials, ISRCTN98538934.

“It’s not just about walking.....it’s the practice nurse that makes it work”: a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care

“…The complex interventions were well accepted by participants with 86% (129/150) attending all four nurse consultations in PACE-Lift and 74% (255/346) attending all three sessions in PACE-UP with the practice nurses delivering approximately 1400 PA consultations across the two trials. Both trials were successful and showed that the interventions were effective in increasing both average daily step-counts and time in moderate-to-vigorous physical activity at both 3 and 12 months, in 60–75 year olds in PACE-Lift [ 15 ] and 45–75 year olds in PACE-UP [ 16 ]. The trial protocols provide full details of each trial, the BCTs undertaken and procedures to ensure trial fidelity [ 17 , 18 ].…”

“…Qualitative explorations from the perspectives of those delivering and receiving the intervention are recommended to provide a more in-depth understanding of complex interventions [ 24 , 25 ], enabling the intervention to be reproduced or adapted for the purposes of further research or for larger scale implementation [ 26 , 27 ]. To date we have reported the main results of both PACE-Lift and PACE-UP trials [ 15 , 16 ], the reasons for non-participation in both trials [ 28 , 29 ] and the views of intervention participants from the PACE-UP trial [ 30 ]. The aim of this paper is to provide an additional layer of evaluation by exploring the views of the practice nurses, focusing upon the perceived enablers and barriers to delivering the complex PA interventions, identifying the benefits they gained as practitioners from participating in the trial and their evaluation of the acceptability of the intervention for use within routine PA consultations in a GP setting.…”

Promoting physical activity: the general practice agenda

“…There is huge potential to use mobile phone apps and wearable devices that track patient physical activity to encourage further physical activity. The PACE-UP trial has successfully used pedometer and accelerometers with individual nurse support within general practice to increase patient physical activity 18 and the use of competitions such as the community physical activity challenges like Beat The Street are promising (https:// www.beatthestreet.me/UserPortal/Default).…”