Primary Care Research

Simple, effective methods to promote increased physical activity introduced to older American Indians in a primary care setting yield positive results

Studies of geographically diverse American Indian tribes consistently show low levels of leisure-time physical activity, less frequent exercise, and a higher proportion being classified as sedentary. Researchers led by Craig N. Sawchuk, Ph.D., of the University of Washington found that physical activity among American Indian elders (aged 50-74) can be promoted in a brief, inexpensive manner in primary care. The study randomly divided 125 American Indians into 2 groups, with the first group receiving basic instruction in daily physical activity monitoring and the second group receiving instruction in daily physical activity monitoring augmented with a pedometer to track and record their total daily step counts. At the end of the 6-week study, participant fitness was measured by performance in a 6-minute walk test. Both groups showed increases in walking frequency.

Contrary to the researchers' initial hypothesis, adding a pedometer to daily physical activity monitoring did not produce an increase in self-reported physical activity scores. The finding that a pedometer did not confer an advantage over basic self-monitoring suggests that self-monitoring alone may be sufficient. This conclusion may be premature, however, given that participants using pedometers were not offered any instruction in daily step-count goal setting. The researchers further suggest that the act of self-monitoring can raise awareness of modifiable health habits, create an external environmental reminder to increase personal responsibility, improve self-efficacy, and provide ongoing feedback on progress.

The study included two face-to-face 60-90 minute clinic sessions with the research assistant at the beginning and end of the study period. There were also two 10-minute phone calls during weeks two and four to reinforce participation in the study. During the initial session, the research assistant reviewed different types of physical activity and distributed an educational handout on the health benefits of increased physical activity. The study was supported by the Agency for Healthcare Quality and Research (HS10854).

See "A randomized trial to increase physical activity among native elders" by Dr. Sawchuk, Steve Charles, Yang Wen, M.S., and others in Preventive Medicine 47, pp. 89-94, 2008.

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