The Veterans Learning to Improve Fitness and Function in Elders Study: A Randomized Trial of Primary Care–Based Physical Activity Counseling For Older Men

Abstract

BACKGROUND Slow gait is predictive of adverse health outcomes and increased health service utilization. Physical activity counseling (PAC) may enhance mobility among elders. Primary care settings are appropriate for PAC because most older adults see their primary care physician annually. Innovative use of automated telephone messaging facilitates physician counseling. OBJECTIVE To determine the effects of multi-component PAC promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial of 398 male veterans, ages 70 and over receiving primary care at the Veterans’ Affairs Medical Center of Durham, N.C. INTERVENTION Twelve months of usual care (UC) or multi-component PAC consisting of baseline in-person and biweekly then monthly telephone counseling by a lifestyle counselor, one-time clinical endorsement of PA and monthly automated telephone messaging by primary care provider, and quarterly tailored mailings of progress in PA. MEASUREMENTS Gait speed (usual and rapid), self-reported PA, function and disability at baseline, 3, 6 and 12 months. RESULTS Although no between-group differences were noted for usual gait speed, rapid gait speed improved significantly more for the PAC group (1.56 (0.41) m/s to 1.68 (0.44) m/s) compared to UC (1.57 (0.40) m/sec to 1.59 (0.42) m/sec, p = 0.04). Minutes of moderate/vigorous PA increased significantly in the PAC group (from a mean (SD) 57.1 (99.3) min/wk to 126.6 (142.9) min/week) compared to the UC group (from 60.2 (116.1) to 69.6 (116.1) min/wk, p < 0.001). Changes in other functional/disability outcomes were small. CONCLUSIONS In this group of older male veterans, multi-component PA significantly improved rapid gait and PA. Translation from increased PA to overall functioning was not observed. Integration with primary care was successful.

Motivational technologies to promote weight loss—From Internet to gadgets

“…In addition, dietary habits were notably improved [37]. Similar results have been confirmed in other studies, improving diet and exercise habits among older, overweight, long-term cancer survivors [38] as well as among older veterans [39]. Interestingly, written materials have been found to be ineffective in terms of improving infant diets, compared to the positive effects achieved by telephone counseling [40].…”

Effectiveness of Health and Wellness Initiatives for Seniors

“…Behavioral clinical trials found the program to be effective over a 1-year period. 24,[26][27][28] Participants demonstrated a greater increase in rapid gait speed, the primary outcome metric, over the course of the intervention compared to a usual care control group (P ¼ 0.04). 27 This outcome is particularly noteworthy given that improvement in gait speed has been shown to predict a substantial reduction in mortality.…”

Changes in Physical Functioning in the Active Living Every Day Program of the Active for Life Initiative®

“…Finally, there is concern that randomized controlled trials recruit non-representative samples of community adults. Although some studies include diverse populations [3,8,11,12,15], few report differences across racial/ethnic groups [3,8,15]. We need more information on the effects of physical activity in less advantaged and more ethnically diverse subgroups [3,18].…”

“…Studies in this area have typically been multicomponent (i.e., aerobic, strength, balance, and flexibility) [2,3,[9][10][11][12][13][14][15], have been conducted in a supervised, center-based setting [3,9,[12][13][14][15][16][17], and included exercise goals of three to five times per week, for 20-60 min [3,9,11,12,14,16,17]. There is a need to examine whether these benefits can occur through less structured, community-based programs.…”

“…A number of studies have shown that exercise interventions can improve physical functioning [2,3,[7][8][9][10][11][12][13][14][15][16][17]. Studies in this area have typically been multicomponent (i.e., aerobic, strength, balance, and flexibility) [2,3,[9][10][11][12][13][14][15], have been conducted in a supervised, center-based setting [3,9,[12][13][14][15][16][17], and included exercise goals of three to five times per week, for 20-60 min [3,9,11,12,14,16,17].…”