Walking intervention tied to long-term health benefits
Short-term walking interventions using pedometers resulted in fewer cardiovascular events and fractures after 4 years as well as sustained increases in physical activity in participants, according to study results published in PLOS Medicine.
“Strong evidence exists that physical activity is protective for a wide range of health conditions, and inactivity is claimed to be the fourth leading risk factor for global mortality,” Tess Harris, MD, MSc, of the Population Health Research Institute at St. George’s University of London, and colleagues wrote.
Study authors noted that most previous studies of physical activity only provided short-term results. To evaluate long-term effects of physical activity in adults, researchers conducted two pedometer-based walking trials, PACE-UP for adults aged 45 to 75 years and PACE-Lift for adults aged 60 to 75 years. Study participants were recruited from 10 primary care practices in London.
In the PACE-UP trial, participants were randomly assigned to a control arm and received usual care, to an intervention group that received materials and instructions through the mail, or to an intervention group that received the program materials and instructions during the first of three primary care nurse physical activity consultations. The PACE-Lift trial included a control arm and a nurse-supported intervention arm.
Participants in intervention groups were asked wear a pedometer and increase their step count over a 12-week period based on mailed materials or nurse recommendations after consultations.
Follow-up primary care data were evaluated at 3 and 12 months for both trials, and again at 3 years for PACE-UP and 4 years for PACE-Lift. Due to the similarity of the trials, researchers combined analysis of all three intervention groups at 4 years.
Researchers evaluated primary care data from 1,297 (98%) of 1,321 participants from both trials, 1,001 from PACE-UP and 296 from PACE-Lift. After 4 years, patients in intervention groups achieved sustained increases in physical activity of approximately 30 minutes per week of moderate-to-vigorous physical activity.
Compared with controls, the portion of nonfatal (HR = 0.24; 95% CI, 0.07-0.77) and total HR = 0.34; 95% CI, 0.12-0.91) cardiovascular events was lower in patients in intervention groups. Researchers found that to prevent one cardiovascular event, 61 individuals would need to receive walking intervention.
The risk for fracture during follow-up was significantly reduced in intervention groups (HR = 0.56; 95% CI, 0.35-0.9) compared with control groups. To prevent one fracture, 28 people would need to receive walking intervention.
There was no significant difference in new depression or diabetes diagnoses between the intervention and control groups of both trials.
“An important implication for both future clinical practice and policy is that primary care short-term pedometer-based walking interventions incorporating behavior-change techniques can lead not only to long-term changes in physical activity levels but also to long-term beneficial health effects for adults and older adults,” Harris and colleagues wrote. “They could thus help to address the public health physical inactivity challenge and be part of the ‘call to activity’ for clinicians and patients.” – by Erin Michael
Disclosures: Harris reports grants from the NIHR Health Technology Assessment Program, grants from NIHR Research for Patient Benefit Programme and NIHR Collaboration for Leadership in Applied Healthcare Research, South London. Please see study for all other authors’ relevant financial disclosures.