The increasing proportion of adults older than 65 years of age in developed countries is not only reflected in the US but also in Hong Kong where the proportion of this age group is expected to reach 28% by 2039. There is a high burden of associated physical and mental problems with this age group which have major social and economic impact. Furthermore, high levels of inactivity (30-40%) in the Hong Kong older population contribute to their burden of disease. In 1995, 25% had type 2 diabetes, 53%% had hypertension, and 64% had hyperlipidemia (elevated cholesterol or fat in the blood).
Even fewer in the U.S. population, only 25%, meet the public health recommendations for physical activity (30 minutes, 5 days per week, of moderate intensity) based on self-reported non-occupational physical activity, a level that has not changed for the past decade. We also have a similar burden of disease as the Hong Kong older population.
Epidemiological and clinical studies have clearly shown the benefits of exercise on health including a reduction in cardiovascular disease and type 2 diabetes. Therefore a 12-month physical activity intervention aimed at increasing cardiovascular health was launched in Hong Kong. The subjects were selected from 24 Community Centers for older persons where social and recreational day services were provided. Several interventions were studied. Centers were randomly allocated to 1) pedometry and buddy, 2) pedometry and no buddy, 3) no pedometry and buddy, and 4) no pedometry and no buddy. Many previous studies have validated the use of a monitoring system like pedometer use for behavior change as well as the enlistment of peer support or a “buddy” for behavior change. These intervention tools were considered easy to implement and easy for subjects to use.
Subjects were measured for physical activity using the International Physical Activity Questionnaire (IPAQ) and fitness levels. The study also investigated the effects on cardiovascular risk factors including BMI, waist circumference, percentage body fat, and blood pressure.
Getting started: At the” baseline” meeting, all participants received face-to-face counseling and advice on how to increase energy expenditure via integration of physical activities into their daily routines. Also basic strategies for starting slowly and how to work the exercise into the daily routine were given. If they were randomized to the buddy peer support system, they received instructions on how to enlist support and walking partners from the same center.
Goals: The participants receiving the pedometers were asked to increase the number of steps they take during a normal day by an extra 3500 steps a day (3-5 times per week). The buddy peer support subjects were asked to reach the daily ACSM/CDC recommendations of 30 minutes of moderate physical activity (3-5 times per week) with a partner.
Other supports: During the first 6 months participants received monthly telephone calls of 15 minutes in duration so that they could report the frequency, time, and distance they had walked and to receive feedback that was supportive. The calls also informed participants of organized events promoting physical activity such as organized walks that were rotated to the different Community Centers.
Results: Of the 399 participants, 356 (89.2%) completed the 12 month study. The centers randomized to the pedometry group significantly increased their levels of physical activity relative to the control group. However, only a limited number of participants (7.9%) reached their target of increasing their daily steps by 3500 (3-5 times per week). Furthermore, despite the improvements in activity levels, there was only a tendency for improved cardiovascular fitness as measured by increased oxygen uptake. No other improvements were observed in other cardiovascular risk such as body fat or blood pressure.
The buddy peer support group also significantly increased their levels of physical activity. Similarly only a small proportion (6.6%) of participants reached their target goal of increasing physical activity by 30 minutes (3-5 times per week). There were positive changes in physical fitness and a small reduction in percentage body fat (-0.6%).
Interestingly, the group that received both interventions did not fare any better than those that received only one intervention.
Discussion: These results suggest that both motivational interventions are appropriate tools to help support increased physical activity in older populations. Even though participants didn’t increase their activity by the proposed amount, they still had significant increases. “Moving more” is a big focus in trying to improve health. It is also possible that in this study participants were unable to reach the “goal” amount of activity because of a “ceiling effect.” Participants were already achieving daily steps higher than what is average for individuals in the same age group.
Suggestions: For more substantial improvements to occur this group may need to be challenged to participate in more strenuous activity provided that they are cleared medically to do so. Furthermore, because resistance training has been shown to benefit the elderly, for those who are already active, adding resistance exercises may also yield additional results.
Conclusion: This study is encouraging because of its 12 month length and feasibility of integrating it into a health care system. Remember that physically fit individuals are at lower mortality risk than unfit individuals with a similar cardiovascular risk profile, so the increases seen with these two interventions, if maintained, could have a significant long-term benefit on both all-cause and cardiovascular disease mortality.
Take Home Message: Strap on a pedometer or grab a buddy and get moving today!!
1 Thomas, G. N. (2012). Health promotion in older chinese: a 12-month cluster randomized controlled trial of pedometry and “peer support”. MSSE, 44(6), 1157-1166.