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NRI 99-334 – HSR&D Study

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NRI 99-334
Nurse Physical Activity Counseling in Primary Care
Patricia M. Dubbert PhD
G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS
Jackson, MS
Funding Period: April 2002 - March 2006

BACKGROUND/RATIONALE:
Many older individuals are at high risk for health complications and functional impairment due to low levels of physical activity. Walking is an acceptable and safe activity associated with many health benefits. Strength and flexibility exercises are also important components of the exercise prescription for optimal health and function in the elderly. Developing interventions to promote healthy physical activity is a current public health priority, and counseling by providers in health care settings is a promising approach.

OBJECTIVE(S):
The primary objective was to evaluate the effects of nurse counseling on total weekly minutes and frequency of home-based walking and strength/flexibility exercises. Secondary objectives included evaluating effects on physical function and accelerometer physical activity. A sub-study examined the association between exercise and cognitive functioning.

METHODS:
The design was a randomized clinical trial. Outcomes were assessed at 5 months (end of initiation phase) and 10 months (maintenance). Clinic-based exercise counseling was delivered by a nurse and physical therapy assistant at baseline and a 1-month follow-up. VA primary care patients aged 60 to 85 referred by their primary care provider were assigned to one of 2 conditions: a) exercise counseling (EXC) or b) health education contact control (EDUC). All participants received preventive health counseling emphasizing safety and falls prevention. The exercise counseling group also received follow-up phone contacts, including automated motivational messages, from the nurse. All participants had continuing contact with research staff but were exposed to different specific intervention components.

FINDINGS/RESULTS:
Of 566 patients referred and screened, 224 (all male) were randomized. Retention was 83% in EXC and 97% in EDUC. With last observation carried forward, the EXC participants reported more walking (64.5 and 60.6 min/wk) than EDUC (50.5 and 45.7 min/wk) and more strength training time (2.4 and 2.3 d/wk versus 1.8 and 1.7 d/wk) at 5 and 10 months, respectively. The EXC participants also reported more frequent moderate or higher intensity physical activity (p<.001). More EXC than EDUC participants (64% vs 46%) averaged 30 min/day or more of moderate or higher intensity physical activity. Participants engaging in strength exercise improved physical performance and reported postitive changes in quality of life. Personnel time and materials costs for the interventions were described. 152 participants entered the cognitive sub-study and repeated measures were obtained for 84. Combining both groups, participants reporting more physical activity scored better on several of the cognitive function tests relative to those who were less active (p's < .001). After controlling for potential confounding variables, physical activity energy expenditure 5-6 months prior to testing was related to verbal memory, word fluency, and attention.

IMPACT:
This study results suggest low-cost counseling interventions can may help elderly patients without access to facility-based exercise to achieve recommended physical activity goals and prevent or reduce the progression of functional impairments and disability.

PUBLICATIONS:

Journal Articles

  1. Dubbert PM, Morey MC, Kirchner KA, Meydrech EF, Grothe K. Counseling for home-based walking and strength exercise in older primary care patients. Archives of internal medicine. 2008 May 12; 168(9):979-86.
Conference Presentations

  1. Akylbekova E, Dubbert PM, Wyatt S, Mosley T, Sims M, Taylor H, Payne T. Cardiovascular Disease and Depression in African Americans of the Jackson Heart Study. Paper presented at: American Heart Association Nutrition, Physical Activity and Metabolism / Cardiovascular Disease Epidemiology and Prevention Annual Scientific Sessions; 2009 Mar 11; Palm Harbor, FL.
  2. Dubbert PM, Akylbekova E, Payne T, Wyatt S, Mosley T, Sims M, Taylor H. Association of Low Physical Activity and Depressive Symptoms in the Jackson Heart Study. Paper presented at: American Heart Association Nutrition, Physical Activity and Metabolism / Cardiovascular Disease Epidemiology and Prevention Annual Scientific Sessions; 2009 Mar 10; Palm Harbor, FL.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Epidemiology, Etiology, Prevention
Keywords: Education (patient), Frail elderly, Long-term care, Nursing, Primary care, Risk factors
MeSH Terms: none

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