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BACKGROUND/RATIONALE:
Many older individuals are at high risk for health complications and functional impairment due to low levels of physical activity. Walking is an acceptable and safe activity associated with many health benefits. Strength and flexibility exercises are also important components of the exercise prescription for optimal health and function in the elderly. Developing interventions to promote healthy physical activity is a current public health priority, and counseling by providers in health care settings is a promising approach.
OBJECTIVE(S):
The primary objective is to evaluate the effects of nurse counseling on total weekly minutes and frequency of home-based walking and strength/flexibility exercises. Secondary objectives include evaluating effects on physical function and accelerometer physical activity. A sub-study initiated in April 2004 examines the association between exercise and cognitive functioning.
METHODS:
The design is a randomized clinical trial. Outcomes were assessed at 5 months (end of initiation phase) and 10 months (maintenance). Clinic-based exercise counseling was delivered by a nurse and physical therapy assistant at baseline and a 1-month follow-up. VA primary care patients aged 60 to 85 referred by their primary care provider were assigned to one of 2 conditions: a) exercise counseling or b) health education contact control. All participants received preventive health counseling emphasizing safety and falls prevention. The exercise counseling group also received follow-up phone contacts, including automated motivational messages, from the nurse. All participants had continuing contact with research staff but were exposed to different specific intervention components.
FINDINGS/RESULTS:
As of March 2006, data collection is complete and final analyses are in progress, with preliminary results as follows. 566 patients were referred and screened, 224 (all male) were randomized. Attrition was less than anticipated (<15%), but greater in the exercise counseling than education group. 152 participants entered the cognitive sub-study and repeated measures were obtained for 84. For the primary outcomes at 5 months, participants randomized to exercise counseling reported more frequent (days/week) and more time (minutes/week) brisk walking and doing strength/flexibility exercise (p’s< .05). For secondary outcomes, analyses with observed values showed exercise counseling participants were also more likely to increase 6 minute walking distance and arm curls (p’s=.05). Combining both groups, participants reporting more physical activity scored better on several of the cognitive function tests relative to those who were less active (p’s < or = .05). Analyses in progress include examining outcomes at 10 month follow-up, intent-to-treat analyses for primary and secondary outcomes using imputed values for missing data, and relationships among the multi-modal measures of physical activity with outcome measures and adherence, quality of life, and participant characteristics. Personnel time and materials costs for the interventions will also be reported.
IMPACT:
This study will help inform health care providers and public health experts about the effects of low-cost counseling interventions that may help elderly patients without access to facility-based exercise to achieve recommended physical activity goals and prevent or reduce the progression of functional impairments and disability.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Epidemiology, Etiology, Prevention
Keywords:
Education (patient), Frail elderly, Long-term care, Nursing, Primary care, Risk factors
MeSH Terms:
none
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