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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1071 — Effects of Nurse Counseling on Walking and Strength Exercise in Aging Veterans

Author List:
Dubbert PM (G.V. (Sonny) Montgomery VA Medical Center)
Kirchner KA (G.V. (Sonny) Montgomery VA Medical Center)
Morey M (Durham NC GRECC)

Objectives:
Counseling can increase home-based walking for health, but the addition of age-appropriate strength training increases complexity and patient burden and has not been evaluated. We evaluated effects of nurse-managed counseling for home-based walking in combination with strength exercises tailored to elderly patients’ functional impairments. Results are reported for the 5-month follow-up (initiation phase).

Methods:
Veterans aged 60-85 with functional impairments and no regular exercise were randomized to nurse counseling on 1) patient-selected health education topics (EDUC) or 2) walking plus strength training based on the NIA exercise program for people over 50 (EXC). Intervention included baseline and 1-mo clinic counseling by nurse and physical therapy assistant and phone contacts by the nurse. Functional fitness and self-reported physical activity were assessed by study staff blinded to treatment assignment.

Results:
Participants were male, average age=72 +6 years, 17% minority, and average BMI = 29.3+4.9; groups were not different in demographics, physical activity, or functional fitness at baseline. 206 of 212 (97%) completed the 5-mo follow-up. Analyses using SAS CATMOD revealed significantly greater increases for EXC in weekly time and frequency (days/week) of walking and doing strength exercises (p<.001). T-tests on changes at 5 months showed the EXC group improved more on arm curls (p=.04); chi-square analyses also found a larger percent of EXC participants increased walking distance >= 150 feet on the 6MW (p=.05). Weekly energy expenditure in physical activity increased by 695 kcal in EXC and 50 kcal in EDUC (p=.05). There were no adverse events associated with the interventions.

Implications:
2 sessions of nurse and physical therapist counseling plus nurse telephone follow-up resulted in significant increases in home-based walking and strength exercises and improved functional fitness for at-risk elderly veterans.

Impacts:
Exercise reduces pain, disability, and falls in the elderly, but many patients do not have access to supervised center-based programs. Nurse-managed counseling for home-based exercise can help to safely extend access to effective exercise programs for at-risk aging patients.


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