Patients who enrolled in a physical activity trial enjoyed a long-term benefit of fewer cardiovascular events and bone fractures up to four years after the intervention was completed.
According to a new review of these patients’ routine primary care records published in PLoS Medicine, the data support further rollout of pedometer-based walking programs among older adults, even if the intervention itself doesn’t last more than a few months.
Of the 1,297 participants of the PACE-UP and PACE-Lift trials who consented to sharing their data, a full four years of primary care data was available for 1,077.
Among both control patients and those who received the 12-week intervention, the four-year incidence of diabetes or depression diagnoses were low and did not significantly vary. However, fractions, fatal cardiovascular events and non-fatal cardiovascular events occurred significantly less frequently among those who received the walking interventions, an effect that the researchers noted was apparent even within the first year of follow-up.
HOW IT WAS DONE
The PACE-UP (n = 1,001) and PACE-Lift (n = 297) studies recruited older patients receiving care from UK practices. The ages of participants in PACE-UP ranged from 45 to 75 years, while PACE-Lift patients were 60 to 75 years. Both trials assigned participants to receive a 12-week pedometer-based walking intervention that incorporated behavior change strategies, or to a control group receiving usual care.
For the current analysis, the researchers downloaded these patients’ primary care data and reported outcomes at one year and four years after the intervention. Participant deaths that were not the result of a cardiovascular event were censored from the analysis.
THE LARGER TREND
Wearable-tracked activity initiatives are a key component of numerous employer and payer wellness programs, which bank on long-term health improvements to offset the cost of devices and incentive rewards. Fitbit has been shifting a larger portion of its business in this direction, especially with the release of specialized fitness trackers, although some data has highlighted the Apple Watch as a particularly enticing, and effective, reward for program participants.
While the data offer merit to short-term pedometer-based walking interventions — as well as to the use of routine primary care records for identifying long-term trends — the team noted that more data would still be necessary to gauge the full impact of physical activity interventions.
“Our data, based on RCT [randomized controlled trial] evidence, are important for silencing the sceptics who argue that the new guidelines lack high-quality evidence from RCTs,” the researchers wrote. “It is too soon to conclude with any confidence that relatively modest changes in [physical activity] can achieve greater health benefits than predicted from cohort studies, but that is the hope. Observational studies, even those using objective [physical activity] measures, cannot provide direct evidence of what happens when individuals change their [physical activity] levels by modest amounts; what is needed is for more [physical activity] trials that have successfully increased [physical activity] levels to provide long-term follow-up of clinical outcomes.”