Is physical activity counseling effective for older people? A cluster randomized, controlled trial in primary care

Abstract

Objectives: To establish the effectiveness of the Green Prescription physical activity counseling program in increasing activity and quality of life in older community-dwelling people.

Design: Post hoc subgroup analysis of a large cluster randomized, controlled trial.

Setting: One hundred seventeen doctors in 42 primary care practices (74% participation rate) in the Waikato region of New Zealand.

Participants: Two hundred seventy sedentary primary healthcare patients aged 65 and older (67% participation rate).

Intervention: Patients in intervention practices prompted their primary care doctors or practice nurse to deliver brief activity counseling. A "Green Prescription" was written involving the negotiation of activity goals. Trained exercise specialists from a regional sports foundation gave follow-up telephone support over 3 months.

Measurements: Leisure moderate and vigorous physical activity, total energy expenditure, systolic and diastolic blood pressure, health-related quality of life, musculoskeletal injuries, falls, and hospitalizations.

Results: After 12 months of follow-up, leisure time moderate activity increased by 0.67 h/wk more in the intervention group than the control group (95% confidence interval (CI)=0.17-1.17) and energy expenditure increased by 2.67 kcal/kg per week (95% CI=0.87-4.47) more. For intervention group participants, vitality and general health scales of the 36-item Short Form showed statistically and clinically relevant improvements, and there was a decrease in hospitalizations (P<.03). There were no observable changes in blood pressure, injuries, or falls as a result of the Green Prescription program.

Conclusion: This physical activity intervention improved activity, energy expenditure, health-related quality of life, and hospitalizations for older primary care patients. Systematic inclusion of the Green Prescription in routine primary health care will probably lead to health gain for older people.