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The PACE-UP trial

A pedometer-based walking intervention in 45- to 75-year olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT

Principal Investigator: Tess Harris, Population Health Research Institute, St George’s University of London (Funding: NIHR Health Technology Assessment Programme – 10/32/02)

This randomised controlled trial based in UK primary care assessed the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention which incorporated behaviour change techniques. The trial included 1,023 inactive adults (10% of those approached), aged 45 to 75, from seven London general practices. They were assigned, by household, to usual care, postal intervention, or nurse-supported intervention. The postal group received a pedometer, step-count diary and 12-week walking programme, advising them to gradually add ‘3000 steps in 30 minutes’ at least five days weekly. The nurse support group received the same materials, but additionally were offered three practice nurse physical activity consultations over the 12 weeks. The main outcomes, measured with accelerometers, were changes between baseline and 12 months in average daily step-counts, and time spent in moderate to vigorous physical activity levels. Ninety three percent of participants provided outcome data at 12 months. On average, both interventions increased 12-month step-counts by around one-tenth from baseline (660 extra steps per day), and time in moderate to vigorous physical activity by around one-third (34 extra minutes per week). The benefits persisted for at least three years. Interestingly, there were no differences in physical activity outcomes between the postal and nurse-supported groups at 12 months or 3 years, but the postal route was more cost-effective in both the short and long-term. Qualitative evaluations indicated that participants and nurses found the interventions acceptable and enjoyable and many talked about the pedometers or the PACE-UP programme kickstarting a long-term walking habit.

PACE-UP participants were asked consent to access their routine primary care records for long-term data on health outcomes and 98% gave consent. A similar trial called PACE-Lift conducted by the same research group, compared a 12-week pedometer-based walking intervention with nurse support to a control group in 60-75 years olds recruited from three Berkshire and Oxfordshire general practices. PACE-Lift showed similar positive effects on increased step-count and time in moderate to vigorous physical activity at 12 months and a persistent effect at four years and 99% of PACE-lift trial participants gave consent for their primary care data to be accessed. Both trials were therefore combined to examine long-term health benefits. At 4-year follow-up there was a significant 66% reduction in cardiovascular event (heart attacks, strokes etc) and a 46% reduction in fractures in the intervention compared to control groups. No significant reductions were seen in falls, new cases of diabetes or depression. The approximate numbers needed to treat to prevent one cardiovascular event was 61 and to prevent one fracture was 28.

These trials combined show that short-term pedometer-based walking interventions can produce long-term effects, not just on increased physical activity levels, but also on important health outcomes like cardiovascular events and fractures.

Full details of the PACE-UP trial, including all the patient facing materials and all the peer reviewed publications are available online

https://www.paceup.sgul.ac.uk/