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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1026 — Enhancing Fitness in Older Overweight Veterans with Impaired Fasting Glucose: A Partnership with Primary Care

Morey MC, VAMC & DUMC; Pieper CF, DUMC; Edelman DEYancy WSGreen JB, and Peterson MJ, VAMC & DUMC; Sloane R, and Cowper PA, DUMC; Bosworth HB, and Huffman KM, VAMC & DUMC

Rates of diabetes and obesity continue to increase and are responsible for disproportionate utilization of healthcare expenditures. Physical activity (PA) initiatives vary widely throughout VA. The Enhanced Fitness primary aim was to improve glycemic control in older Veterans with impaired fasting glucose receiving VA primary care. Hypothesis: Relative to Usual Care (UC), individuals receiving physical activity counseling (PAC) would have significantly improved fasting insulin, fasting glucose, and homeostasis model assessment of insulin resistance (HOMA-IR).

A randomized clinical trial with an adaptive randomization design. Sedentary Veterans ages 60+, with a body mass index between 25-45, and fasting glucose between 100 and 125 mg/dl were enrolled (n = 302) and randomized to receive PAC or UC. At 3 months, individuals in the PAC arm were randomly reassigned to higher or lower doses of PAC for the remainder of the study for future comparisons of costs relative to counseling dose and outcomes.

PA increased significantly for the PAC group from an average of 73 minutes/week at baseline to an average of 133 minutes/week at 12 months (+82%) in comparison to the UC group whose PA remained constant at an average of 112 minutes/week, p <0.0001 for between group difference controlling for baseline PA. There were no significant differences between PAC and UC over time for any of the glycemic indicators. Both groups had 6% declines over 12 months in fasting blood glucose, p <0.001. Fasting insulin and HOMA-IR fluctuated at 3 and 12 months, thus no overall changes were observed for these measures.

Veterans successfully achieved a two-fold increase in PA but this was not sufficient to impact our primary outcome (HOMA-IR). Our study confirms in a VA population a recent finding of low efficacy of telephone-based PAC to improve insulin resistance and points towards the higher chronic disease burden that Veterans possess as a possible impediment to achieving evidence-based levels of PA necessary to obtain certain health benefits. Further research is needed to optimize health-promoting PA strategies for Veterans.

Results differed significantly at 3 months relative to 1 year. As VA embarks on increasing implementation of telephone-delivered healthcare delivery it is imperative to evaluate the long-term impact of these initiatives.

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