Long-term objective physical activity data from two primary care pedometer-based RCTs in middle-aged and older adults– are trial effects still positive at 3 and 4 years?

Conference:

SAPC ASM 2017 - Warwick

Talk Code:

1A.5

Presenter:

Derek Cook

Co-authors:

Sally kerry, Elizabeth Limb, Christina Victor, Steve Iliffe, Michael ussher, Peter Whincup, Ulf ekelund, Julia Fox-Rushby, Chery Furness, Jusith Ibison, Stephen DeWilde, Charlotte Wahlich, Derek Cook.

Author institutions:

St George's University of London, Queen mary's University of London, University College London, Brunel University of London, Oslo University,

Problem

The PACE-UP 3-armed primary care trial recruited 45-75 year olds into a 12-week pedometer-based intervention, with one postal intervention arm and one nurse support. The PACE-Lift 2-armed primary care trial recruited 60-75 year olds into a 12-week nurse-supported pedometer-based intervention. Both trials increased step-counts by around a tenth and time in moderate-to-vigorous physical activity (MVPA) in bouts by around a third at 12 months, with no difference between nurse and postal arms in PACE-UP. Long-term physical activity (PA) maintenance, particularly MVPA in bouts, is important for a wide range of health benefits, but few trials provide objective PA measures beyond 12 months. We followed up PACE-UP and PACE-Lift cohorts at 3 and 4 years respectively, to investigate whether intervention effects persisted.

Approach

3-year (PACE-UP) and 4-year (PACE-Lift) accelerometer outcomes were regressed on baseline accelerometry to estimate change in average daily step-counts and average weekly time in MVPA in ≥10 minute bouts in the treatment compared to control groups. Missing data effects were assessed using imputation analyses.

Findings

PACE-UP 3-year follow-up rate was 67% (681/1023). Both intervention groups were still doing more steps/day than the control group: postal 627 (95% CI 198, 1056); nurse 670 (95% CI 237, 1102); nurse plus postal 648 (95% CI 272, 1024). The pattern was similar for total weekly MVPA in bouts: postal 28 (95% CI 7, 49); nurse 24 (95% CI 24 (3, 45); nurse plus postal 26 (95% CI 8, 44). PACE-Lift 4-year follow-up rate was 76% (225/298). In PACE-Lift the intervention v control comparisons were 407 (95% CI -177, 992) for steps and 32 (95% CI 5, 60) for MVPA in bouts; though the steps comparison is not statistically significant, both the steps and MVPA estimates are consistent with the PACE-UP findings. Imputation analyses did not change results’ interpretation.

Consequences

Over two thirds of both trial cohorts provided long-term data. Both trials showed persistent effects on time in MVPA in bouts at 3 or 4 years. PACE-UP showed a significant persistent effect on step-counts and no difference between nurse and postal group outcomes. In PACE-Lift the step count effect, while not statistically significant was consistent with both the PACE-UP findings and with the persistent significant effect for MVPA in bouts in PACE-Lift. These findings suggest that primary care pedometer interventions, delivered by post or with minimal contact, can make an important long-term contribution to addressing the public health physical inactivity challenge.

Submitted by:

Teresa J. Harris

Funding acknowledgement:

This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number HTA 10/32/02) and will be published in full in Health Technology Assessment. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, National Health Service, or the Department of Health.