Randomised controlled trial of a complex intervention by primary care nurses to increase walking in patients aged 60–74 years: protocol of the PACE-Lift (Pedometer Accelerometer Consultation Evaluation - Lift) trial

Abstract

BackgroundPhysical activity is essential for older peoples’ physical and mental health and for maintaining independence. Guidelines recommend at least 150 minutes weekly, of at least moderate intensity physical activity, with activity on most days. Older people’s most common physical activity is walking, light intensity if strolling, moderate if brisker. Less than 20% of United Kingdom 65–74 year olds report achieving the guidelines, despite most being able to. Effective behaviour change techniques include strategies such as goal setting, self-monitoring, building self-efficacy and relapse prevention. Primary care physical activity consultations allow individual tailoring of advice. Pedometers measure step-counts and accelerometers measure physical activity intensity. This protocol describes an innovative intervention to increase walking in older people, incorporating pedometer and accelerometer feedback within a primary care nurse physical activity consultation, using behaviour change techniques.Methods/DesignDesign: Randomised controlled trial with intervention and control (usual care) arms plus process and qualitative evaluations.Participants: 300 people aged 60–74 years registered with 3 general practices within Oxfordshire and Berkshire West primary care trusts, able to walk outside and with no restrictions to increasing their physical activity.Intervention: 3 month pedometer and accelerometer based intervention supported by practice nurse physical activity consultations. Four consultations based on behaviour change techniques, physical activity diary, pedometer average daily steps and accelerometer feedback on physical activity intensity. Individual physical activity plans based on increasing walking and other existing physical activity will be produced.Outcomes: Change in average daily steps (primary outcome) and average time spent in at least moderate intensity physical activity weekly (secondary outcome) at 3 months and 12 months, assessed by accelerometry. Other outcomes include quality of life, mood, exercise self-efficacy, injuries. Qualitative evaluations will explore reasons for trial non-participation, the intervention’s acceptability to patients and nurses and factors enhancing or acting as barriers for older people in increasing their physical activity levels.DiscussionThe PACE-Lift trial will determine the feasibility and efficacy of an intervention for increasing physical activity among older primary care patients. Steps taken to minimise bias and the challenges anticipated will be discussed. Word count 341.Trial registration numberISRCTN42122561

A Primary Care Nurse-Delivered Walking Intervention in Older Adults: PACE (Pedometer Accelerometer Consultation Evaluation)-Lift Cluster Randomised Controlled Trial

“…The trial protocol has been published ( S1 Text ) [ 13 ]. A two-arm parallel cluster randomised trial, randomised by household, compared a complex intervention to increase walking carried out over a 3 month period with a usual care control group.…”

Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention

“…Those selected for telephone interview were reminded of their initial consent to be interviewed and if they were happy to go ahead, their consent was also sought to be audio-recorded. The interview schedule was modelled on that used during a preceding PA trial [ 30 ] and refined by discussion between authors and piloting prior to recruitment. The schedule was adapted slightly after the first 15 interviews, following discussion between co-authors, to ensure better understanding of the questions and also to probe participants’ memories further with regard to meeting with the practice nurse, as we found that few participants were spontaneously volunteering specific details.…”

Recruiting Hard-to-Reach Subjects for Exercise Interventions: A Multi-Centre and Multi-Stage Approach Targeting General Practitioners and Their Community-Dwelling and Mobility-Limited Patients

“…In fact, our data correspond to a recently published study protocol for a walking intervention [39]. The authors plan to conduct the same recruitment steps as we did in our study, with the exception that they cooperate with three much larger (list size of at least 10,000 patients) GP practices.…”