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Randomized Controlled Trial
. 2012 Sep;60(9):1655-62.
doi: 10.1111/j.1532-5415.2012.04119.x.

Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus

Miriam C Morey  1 , Carl F Pieper, David E Edelman, William S Yancy Jr, Jennifer B Green, Helen Lum, Matthew J Peterson, Richard Sloane, Patricia A Cowper, Hayden B Bosworth, Kim M Huffman, James T Cavanaugh, Katherine S Hall, Megan P Pearson, Gregory A Taylor
Affiliations
Randomized Controlled Trial

Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus

Miriam C Morey et al. J Am Geriatr Soc. 2012 Sep.

Abstract

Objectives: To determine whether a home-based multicomponent physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus.

Design: Controlled clinical trial.

Setting: Primary care clinics of the Durham Veterans Affairs (VA) Medical Center between September 29, 2008, and March 25, 2010.

Participants: Three hundred two overweight (body mass index 25-45 kg/m(2) ), older (60-89) outpatients with impaired glucose tolerance (fasting blood glucose 100-125 mg/dL, glycosylated hemoglobin (HbA1c) <7%) randomly assigned to a PAC intervention group (n = 180) or a usual care control group (n = 122).

Intervention: A 12-month, home-based multicomponent PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and customized mailed materials. All study participants, including controls, received a consultation in a VA weight management program.

Measurements: The primary outcome was a homeostasis model assessment of insulin resistance (HOMA-IR), calculated from fasting insulin and glucose levels at baseline and 3 and 12 months. HbA1c was the secondary indicator of glycemic control. Other secondary outcomes were anthropometric measures and self-reported physical activity, health-related quality of life, and physical function.

Results: There were no significant differences between the PAC and control groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose (P < .001), and other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in the PAC group (P < .001) and not in the usual care group.

Conclusion: Home-based telephone counseling increased physical activity levels but was insufficient to improve glycemic indicators in older outpatients with prediabetes mellitus.

Trial registration: ClinicalTrials.gov NCT00594399.

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Conflict of interest statement

Conflict of Interest: This study was funded by a VA Health Services Research and Development grant IIR-06-252-3 (Morey PI) and National Institute on Aging grant AG028716. Intervention materials have been developed with prior support from VA Rehabilitation Research Service grants (RRD-E2756R, RRD-E3386R) and National Cancer Institute grant CA106919. Miriam Morey is supported by the Durham VA Geriatric Research Education and Clinical Center and Hayden Bosworth is supported by a Department of Veterans Affairs Health Services Research and Development Career Scientist Award (RCS 08-027). The authors have no conflict of interest to disclose. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Figures

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Figure 1
CONSORT diagram for clinical trial
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References

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