869. Physical activity levels in adults and older adults 3–4 years after pedometer-based walking interventions: Long-term follow-up of participants from two randomised controlled trials in UK primary care
Commentary by Kylie Ball, Institute for Physical Activity and Nutrition, Deakin University
Source: PLoS Med
Physical activity researchers often lament the lack of long-term follow-up studies of physical activity intervention effects. The dearth of evidence of the most effective approaches for bringing about sustained increases in physical activity remains one of the most significant problems in the field. This new study by Harris and colleagues (2018) followed up participants from two pedometer-based walking trials, to establish whether the positive short-term effects on physical activity were sustained over time.
Both the Pedometer And Consultation Evaluation-UP (PACE-UP) and the Pedometer Accelerometer Consultation Evaluation-Lift (PACE-Lift) trial were 12-week interventions delivered via primary care practices in the UK. PACE-UP involved participants aged 45-75 years, randomised to one of three intervention arms: postal, nurse support, and control. In PACE-Lift participants aged 60-75 years were randomised to one of two arms, nurse support or control. Intervention participants received pedometers and 12-week walking programs incorporating behaviour change techniques, including handbooks and physical activity diaries, delivered either via post (PACE-UP) or with nurse support over three or four consultations (PACE-UP, PACE-Lift).
Both trials previously showed increases in step counts and time spent in moderate-to-vigorous physical activity (MVPA) at 12- months post-baseline. This paper reported on an examination of the maintenance of these effects at 3 years (PACE-UP) or 4 years (PACE-Lift) post-baseline. Results showed that intervention participants in both trials remained significantly more active than control participants at three or four years follow-up. These effects were noted for both accelerometer-assessed steps-day and MVPA minutes/week, and whether the intervention was delivered postally only or with nurse support. For example, participants receiving the PACE-UP post-delivered intervention demonstrated on average an additional 627 steps/day relative to controls at three-year follow up, and an additional 28 minutes/week MVPA.
The 3-4 year follow-up observation period and the use of objective assessments of physical activity are key strengths. The study population was restricted to those aged 45-75, and generalizability to other age groups requires future investigation. Follow-up retention was relatively good in both trials (n=681 or 67% of participants in PACE-UP; 225 or 76% of participants in PACE-Lift), and the authors found results to be robust to missing data sensitivity analyses.
These findings are important in that they are the first to demonstrate the potential for population-based pedometer-based interventions to effect long-term increases in physical activity in a middle-aged and older population. Particularly encouraging is the fact that the interventions were relatively low-intensity in terms of delivery, with one intervention arm involving only postal contact, and the other two involving either three or four nurse consultations. These results are promising in terms of potential cost-effectiveness and scalability, and in suggesting approaches that could help address the public health challenge of physical inactivity over the longer-term.
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