Translating a community-based motivational support program to increase physical activity among older adults with diabetes at community clinics: a pilot study of Physical Activity for a Lifetime of Success (PALS)

Abstract

Background: Regular physical activity is an important goal for elders with chronic health conditions.

Context: This report describes Physical Activity for a Lifetime of Success (PALS), an attempt to translate a motivational support program for physical activity, Active Choices, for use by a group of diverse, low-income, community-dwelling elders with diabetes.

Methods: PALS linked physical activity assessment and brief counseling by primary care providers with a structured referral to a community-based motivational telephone support program delivered by older adult volunteers. People with diabetes aged 65 years or older who were receiving care at two community clinics were randomized to receive either immediate or delayed intervention. The main intended outcome measure was physical activity level; the secondary outcome measure was mean hemoglobin A1c.

Consequences: One-third of those offered referral to the PALS program in the clinic setting declined. Another 44% subsequently declined enrollment or were unreachable by the support center. Only 14 (21%) of those offered referral enrolled in the program. Among these 14, the percentage who were sufficiently active was higher at follow-up than at enrollment, though not significantly so. Using an intent-to-treat analysis, which included all randomized clinic patients, we found no significant change in mean hemoglobin A1c for the intervention group compared with controls.

Interpretation: A community-based referral and support program to increase physical activity among elderly, ethnically diverse, low-income people with diabetes, many of whom are not English-speaking, may be thwarted by unforeseen barriers. Those who enroll and participate in the PALS program appear to increase their level of physical activity.

Figure

Participant flow, PALS study, 2005 – 2006. ^a Reasons for outright refusal were lack of interest, feeling at an age for rest rather than physical activity, feeling already active enough, perceived ill health and consequent inability to be more active, depression, unfamiliarity with the senior center, and uneasiness about having a telephone call from a stranger. ^b Reasons for declining after initially agreeing to participate were lack of interest, too busy, other issues of higher priority, and difficulty comprehending English.