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141. Effects of Nurse Phone Contacts on Maintenance of Exercise in Elderly Primary Care Patients

PG Dubbert, VAMC Jackson, MS & Univ Mississippi School of Medicine; KM Cooper, VAMC Jackson, MS; KA Kirchner, VAMC Jackson, MS & Univ Mississippi School of Medicine; EF Meydrech, Univ Mississippi School of Medicine

Objectives: To determine the effects of phone contacts by a nurse on maintenance of home-based walking in elderly primary care patients with chronic disease.

Methods: After individualized clinic counseling by a nurse to increase walking for health, 60-80 year old veterans in VA primary care clinics were randomized to one of 3 conditions during a 1-year follow-up: (1) 20 phone calls initiated by the nurse; (2) 10 calls initiated by the nurse and 10 initiated by an automated telephone message delivery system; or (3) no follow-up calls. The 5 minute personal calls faded in frequency to about 1/month during the maintenance phase; automated (brief recorded message) calls were randomly interspersed with personal calls for the group receiving both types of contacts. Adherence to the goal of walking at least 20 minutes 3 days per week was evaluated from weekly walking diaries mailed in to a data collector blinded to intervention assignment. Missing data was considered not walking. Self-reported walking, the primary outcome measure, was assessed from walking diaries and validated by reports of significant others, accelerometer data, and improvements in 6 minute walk test performance.

Results: 181 (85%) of 212 participants completed the trial; attrition was distributed across groups. Participants were referred by primary care providers. Baseline characteristics were: mean age 69 yr, 29% minority, 80% married, 50% rural, 48% less than high school/GED, average BMI 29.3, 13% current smokers. More than half the participants began a walking program, and overall adherence to the 3 days/week walking goal averaged across all groups was 44% for the first 6 months (initiation) and 38% during months 7-10 (maintenance). Participants receiving the combination of personal and automated calls walked more than those with no phone contacts (p<.05) with those receiving personal calls intermediate in adherence during the initiation phase. Reports of significant others and accelerometer data were consistent with the diary walking records. During the maintenance phase, both phone contact groups walked more than those without phone contacts (p<.05). Improvement in performance on the 6 minute walk was significantly associated with self-reported walking adherence (p<.01).

Conclusions: Phone contacts from a nurse, including automated delivery of recorded messages, can help maintain a home-based walking program in elderly primary care patients with chronic illness. Our sample was older, with greater disease burden and less favorable socioeconomic status than previous studies, yet physical adherence compared favorably with other community exercise studies.

Impact: Few studies have examined methods to maintain physical activity in older adults with chronic disease. Our results suggest low-cost phone contacts delivered by a nurse in a primary care setting are effective and well-accepted by patients.