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NRM 95-022 – HSR&D Study

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NRM 95-022
Nurse Counseling for Physical Activity in Primary Care Patients
Patricia M. Dubbert PhD
G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS
Jackson, MS
Funding Period: January 1997 - June 2000

BACKGROUND/RATIONALE:
Many elderly primary care patients are at high risk for health complications and functional impairment due to low levels of physical activity. Previous trials of counseling of elderly patients in primary care clinics have not demonstrated lasting physical activity change and have not evaluated fitness changes associated with any increased activity.

OBJECTIVE(S):
The primary objective was to determine if nurse telephone counseling could assist 60 to 80 year old VA primary care patients to establish and maintain a regular walking program.

METHODS:
In this randomized clinical trial, 60-80 year old patients were referred to a walking program by primary care providers. All participants received individualized counseling by the nurse and, over the next year, one of three follow-up interventions: 1) 20 calls initiated by the nurse; 2) ten calls initiated by the nurse and ten initiated by an automated telephone message delivery system; or 3) no follow-up calls. All kept walking diaries and mailed these in to a data collector blinded to intervention group. Follow-up research visits were scheduled at six and 12 months. Self-reported walking, the primary outcome measure, was assessed from the walking diaries and validated by reports of significant others and accelerometer data. Improvement in fitness was assessed at 12 months with a standardized six minute walking test. Tinetti mobility scores, body mass index, and body girths were also assessed. Several quality of life measures were also administered.

FINDINGS/RESULTS:
Eighty-five percent of the 212 randomized patients completed the 12-month follow-up with no differences, baseline characteristics, or attrition between groups. Participants were: mean age 69 yr, 29 percent African-American, 80 percent married, 50 percent rural, 48 percent less than high school/GED, 13 percent current smokers. More than half the participants began a walking program, and overall adherence to the three days/week walking goal averaged 44 percent for the first six months and 38 percent during months 7-10. During the initiation phase (months 1-6), participants receiving the combination of personal and automated calls walked more than controls (p<.05), with those receiving personal calls intermediate in performance. During the maintenance phase (months 7-10), both phone contact groups walked more than controls without phone contacts (p<.05). At 12 months, all three groups showed significant improvements in fitness (p=.0001), and change in walking performance was significantly associated with self-reported walking (p<.01). Improvement in walking performance was also associated with improvement in BMI, girths, mobility scores, and anxiety symptoms. Injuries were rare, distributed across groups, and unrelated to walking adherence. Post-hoc analyses indicated that social support (walking with a partner) was a significant predictor of walking adherence across intervention groups.

IMPACT:
Our results suggest nurse counseling can increase walking and produce significant improvements in measures associated with disease/disability risk. Continuing phone contacts improve maintenance of a newly established home-based walking program, and automated calling can substitute for at least half the personal calls without loss of efficacy. Encouraging patients to walk with a partner may also be helpful to successful initiation of a home-based physical activity program.

PUBLICATIONS:

Journal Articles

  1. Cooper TV, Resor MR, Stoever CJ, Dubbert PM. Physical activity and physical activity adherence in the elderly based on smoking status. Addictive Behaviors. 2007 Oct 1; 32(10):2268-73.
  2. Rhudy JL, Dubbert PM, Kirchner KA, Williams AE. Efficacy of a program to encourage walking in VA elderly primary care patients: the role of pain. Psychology, health & medicine. 2007 May 1; 12(3):289-98.
  3. Dubbert PM, Vander Weg MW, Kirchner KA, Shaw B. Evaluation of the 7-day physical activity recall in urban and rural men. Medicine and science in sports and exercise. 2004 Sep 1; 36(9):1646-54.
  4. Dubbert PM, Cooper KM, Kirchner KA, Meydrech EF, Bilbrew D. Effects of nurse counseling on walking for exercise in elderly primary care patients. The journals of gerontology. Series A, Biological sciences and medical sciences. 2002 Nov 1; 57(11):M733-40.
  5. Cooper KM, Bilbrew D, Dubbert PM, Kerr K, Kirchner K. Health barriers to walking for exercise in elderly primary care. Geriatric nursing (New York, N.Y.). 2001 Sep 1; 22(5):258-62.
  6. Dubbert PM, Meydrech EF, Kirchner KA, Cooper KM, Bilbrew DE. Encouraging elders to exercise. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2001 Jul 1; 18(7):39-59.
Book Chapters

  1. Dubbert PM. Blood Pressure and Hypertension: Physical Activity. In: Encyclopedia of Health and Behavior. Volume 1 ed. New York, NY: Sage; 2004. 104-106 p.
  2. Dubbert PM, King AC, Marcus BH, Sallis JF. Promotion of Physical Activity Through the Life Span. In: Handbook of Health Psychology (Volume 2: Disroders of Behavior and Health). Washington, DC: American Psychological Association; 2004. 147-181 p.
Conference Presentations

  1. Dubbert P, Mulkana S. Validity of a 12-Month Physical Activity History in Elderly Primary Care Patients. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2004 Mar 1; Baltimore, MD.
  2. White J, Dubbert P, Karekla M, Lyons J. Physical Activity in Veterans with Post Traumatic Stress Disorder Symptoms. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2004 Mar 1; Baltimore, MD.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Prevention
Keywords: Behavior (patient), Behavior (provider), Primary care, Telemedicine
MeSH Terms: none

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