The Veterans Learning to Improve Fitness and Function in Elders Study: a randomized trial of primary care-based physical activity counseling for older men

Abstract

Objectives: To determine the effects of primary care-based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans.

Design: Randomized controlled trial.

Setting: Veterans Affairs Medical Center of Durham, North Carolina.

Participants: Three hundred ninety-eight male veterans aged 70 and older.

Intervention: Twelve months of usual care (UC) or multicomponent PAC consisting of baseline in-person and every other week and then monthly telephone counseling by a lifestyle counselor, one-time clinical endorsement of PA, monthly automated telephone messaging from the primary care provider, and quarterly tailored mailings of progress in PA.

Measurements: Gait speed (usual and rapid), self-reported PA, function, and disability at baseline and 3, 6, and 12 months.

Results: Although no between-group differences were noted for usual gait speed, rapid gait speed improved significantly more for the PAC group (1.56 +/- 0.41 m/s to 1.68 +/- 0.44 m/s) than with UC (1.57 +/- 0.40 m/sec to 1.59 +/- 0.42 m/sec, P=.04). Minutes of moderate/vigorous PA increased significantly in the PAC group (from 57.1 +/- 99.3 to 126.6 +/- 142.9 min/wk) but not in the UC group (from 60.2 +/- 116.1 to 69.6 +/- 116.1 min/wk, P<.001). Changes in other functional/disability outcomes were small.

Conclusion: In this group of older male veterans, multicomponent PA significantly improved rapid gait and PA. Translation from increased PA to overall functioning was not observed. Integration with primary care was successful.

Trial registration: ClinicalTrials.gov NCT00435188.

Figure 1

Participant Flow Chart

Figure 2. Gait Speed, Change Over Time Usual and Rapid Speed

Omnibus P value provides the overall differences between groups at the end of the study for group and group by time interaction assessed by the change in log-likelihood on two degrees of freedom controlling for baseline gait speed, age, race, education, and number of diseases.

Figure 3. Change in Combined Moderate/Vigorous Endurance and Strength Minutes over Time

Omnibus P value provides the overall differences between groups at the end of the study for group and group by time interaction assessed by the change in log-likelihood on two degrees of freedom controlling for baseline exercise minutes, age, race, education and number of diseases.