Randomised controlled trial of a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45-74 years
A pedometer and three sessions with a practice nurse are being tested against a pedometer alone to see which gets inactive 45-to-74-year-olds walking more. Most adults in the UK do not meet the recommended 30 minutes of moderate activity five times a week, and walking is their most common form of exercise. Previous trials have been short, have not separated the effect of the pedometer from the effect of personal support, and have measured only step counts rather than time spent at different walking intensities. This trial recruits 993 inactive patients from six GP practices in South West London, randomises them into three groups—pedometer alone, pedometer plus nurse support, or usual care—and tracks them for 12 months using accelerometers that give no feedback. The main outcome is change in average daily step count; secondary outcomes include changes in sedentary time, time spent in moderate activity, cost-effectiveness, and acceptability. If the nurse-supported group shows significantly greater and sustained increases in walking, the NHS could adopt a cheap, scalable intervention—a pedometer and a few short nurse appointments—to reduce inactivity-related disease in primary care.
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Background Physical activity (PA) is vital for health, yet most adults are inactive and do not achieve the recommended 30 minutes of moderate intensity activity on 5 or more days weekly. Adults' most common PA is walking, light intensity if strolling, moderate if brisker. Pedometers measure step-count and can increase walking, but most trials have had short-term outcomes, have not separated out pedometer effects from other support and have reported only step-counts, not time spent at different PA intensities. Design: Primary care based 3-arm randomized controlled trial with 12 month follow-up and health economic & qualitative evaluations. Participants: 993 inactive patients aged 45-74 years with no contraindications to increasing their moderate intensity PA will be recruited by postal invitation from 6 South West London general practices and randomly allocated into three groups. All participants will have their PA assessed objectively (step-count & time spent at different PA intensities) for 7 days at baseline, 3 months and 12 months by wearing an accelerometer which gives no patient feedback. They will also complete questionnaires and have anthropometric assessments. Intervention: One intervention group (pedometer alone) will be posted out a pedometer diary and written instructions for a 12-week pedometer-based walking programme, based on their own baseline accelerometer step-count. The second intervention group (pedometer plus support) will receive a pedometer and diary and three individually tailored PA consultations with a practice nurse. They will be supported to follow a 12-week pedometer-based walking programme, using strategies such as self-monitoring, goal-setting, boosting motivation and anticipation of set-backs. The control group will continue usual PA. Main outcome measures in all groups after 12 months: 1. Change in average daily step-count (primary outcome) 2. Change in sedentary time and time spent in at least moderate intensity PA weekly 3. Cost-effectiveness. 4. Acceptability of the interventions.
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