The Healthy Steps Study: A randomized controlled trial of a pedometer-based Green Prescription for older adults. Trial protocol

Kolt, Gregory S., Schofield, Grant M., Kerse, Ngaire, Garrett, Nicholas, Schluter, Philip J., Ashton,Toni and Patel, Asmita (2009) The Healthy Steps Study: A randomized controlled trial of a pedometer-based Green Prescription for older adults. Trial protocol. BMC Public Health, 9 404: 1-6. doi:10.1186/1471-2458-9-404

Author Kolt, Gregory S.
Schofield, Grant M.
Kerse, Ngaire
Garrett, Nicholas
Schluter, Philip J.
Patel, Asmita
Title The Healthy Steps Study: A randomized controlled trial of a pedometer-based Green Prescription for older adults. Trial protocol
Journal name BMC Public Health   Check publisher's open access policy
ISSN 1471-2458
Publication date 2009-11
Year available 2009
Sub-type Article (original research)
DOI 10.1186/1471-2458-9-404
Open Access Status DOI
Volume 9
Issue 404
Start page 1
End page 6
Total pages 6
Editor Melissa Norton
Place of publication London, U.K.
Publisher BioMed Central
Collection year 2010
Language eng
Subject C1
920104 Diabetes
920102 Cancer and Related Disorders
920502 Health Related to Ageing
920103 Cardiovascular System and Diseases
111099 Nursing not elsewhere classified
Formatted abstract
Background. Graded health benefits of physical activity have been demonstrated for the reduction of coronary heart disease, some cancers, and type-2 diabetes, and for injury reduction and improvements in mental health. Older adults are particularly at risk of physical inactivity, and would greatly benefit from successful targeted physical activity interventions.

Methods/Design. The Healthy Steps study is a 12-month randomized controlled trial comparing the efficacy of a pedometer-based Green Prescription with the conventional time-based Green Prescription in increasing and maintaining physical activity levels in low-active adults over 65 years of age. The Green Prescription interventions involve a primary care physical activity prescription with 3 follow-up telephone counselling sessions delivered by trained physical activity counsellors over 3 months. Those in the pedometer group received a pedometer and counselling based around increasing steps that can be monitored on the pedometer, while those in the standard Green Prescription group received counselling using time-based goals. Baseline, 3 month (end of intervention), and 12 month measures were assessed in face-to-face home visits with outcomes measures being physical activity (Auckland Heart Study Physical Activity Questionnaire), quality of life (SF-36 and EQ-5D), depressive symptoms (Geriatric Depression Scale), blood pressure, weight status, functional status (gait speed, chair stands, and tandem balance test) and falls and adverse events (self-report). Utilisation of health services was assessed for the economic evaluation carried out alongside this trial. As well, a process evaluation of the interventions and an examination of barriers and motives for physical activity in the sample were conducted. The perceptions of primary care physicians in relation to delivering physical activity counselling were also assessed.

Discussion. The findings from the Healthy Steps trial are due in late 2009. If successful in improving physical activity in older adults, the pedometer-based Green Prescription could assist in reducing utilisation of health services and improve cardiovascular health and reduction of risk for a range of non-communicable lifestyles diseases.
© 2009 Kolt et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keyword Lower-extremity function
References 1. Centers for Disease Control: Physical activity and health. A report of the Surgeon General Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion; 1996. 2. Singh NA, Clements KM, Singh MA: The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized controlled trial. J Gerontol 2001, 56:M2349-2356. 3. Mazzeo RS, Cavanagh P, Evans WJ, Fiatarone M, Hagberg J, McAuley E, et al.: ACSM position stand: Exercise and physical activity for older adults. Med Sci Sports Exerc 1998, 30:992-1008. 4. Simons LA, Simons J, McCallum J, Friedlander Y: Lifestyle factors and risk of dementia: Dubbo study of the elderly. Med J Aust 2006, 184:68-70. 5. Spirduso WW, Cronin DL: Exercise dose-response effects on quality of life and independent living in older adults. Med Sci Sports Exerc 2001, 33:S598-S608. 6. Arent SM, Landers DM, Etnier JL: The effects of exercise on mood in older adults: A meta-analytic review. J Aging Phys Act 2000, 8:407-430. 7. Taylor AH, Cable NT, Faulkner G, Hillsdon M, Narici M, Bij AK Van Der: Physical activity and older adults: a review of health benefits and the effectiveness of interventions. J Sport Sci 2004, 22:703-725. 8. Ministry of Social Policy: The New Zealand Positive Ageing Strategy. Wellington, New Zealand 2001. 9. Elley C, Kerse N, Arroll B, Robinson E: Effectiveness of counselling patients on physical activity in general practice: Cluster randomised controlled trial. BMJ 2003, 326:793-796. 10. Kerse N, Elley CR, Robinson E, Arroll B: Is physical activity counseling effective for older people? A cluster randomized, controlled trial in primary care. J Am Geriatr Soc 2005, 153:1951-1956. 11. Dalziel K, Segal L, Elley CR: Cost utility analysis of physical activity counselling in general practice. Aust N Z J Public Health 2006, 30:57-63. 12. Elley R, Kerse N, Arroll B, Swinburn B, Ashton T, Robinson E: Costeffectiveness of physical activity counselling in general practice. N Z Med J 2004, 117(1207):1-15. 13. Aoyagi Y, Shephard RJ: Steps per day: The road to senior health? Sports Med 2009, 39:423-438. 14. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis M, et al.: Using pedometers to increase physical activity and improve health: A systematic review. JAMA 2007, 298:2296-2304. 15. Kerse N, Falloon K, Moyes SA, Hayman KJ, Dowell T, Kolt GS, et al.: DeLLITE Depression in late life: an intervention trial of exercise. Design and recruitment of a randomised controlled trial. BMC Geriatr 2008, 8:12. 16. Kolt GS, Schofield GM, Kerse N, Garrett N, Oliver M: Effect of telephone counseling on physical activity for low-active older people in primary care: a randomized controlled trial. J Am Geriatr Soc 2007, 55:986-992. 17. Thomas S, Reading J, Shephard RJ: Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can J Sports Sci 17:338-345. 18. Prochaska JO, DiClemente CC, Norcross JC: In search of how people change. Applications to addictive behaviours. Am Psychol 1992, 47:1102-1114. 19. Rollnick S, Heather N, Bell A: Negotiating behavior change in medical settings: The development of brief motivational interviewing. J Ment Health 1992, 1:25-27. 20. Arroll B, Jackson R, Beaglehole R: Validation of a three-month physical activity recall questionnaire with a seven-day food intake and physical activity diary. Epidemiol 1991, 2:296-299. 21. Elley C, Kerse N, Swinburn B, Arroll B, Robinson E: Measuring physical activity in primary health care research: Validity and reliability of two questionnaires. N Z Fam Phys 2003, 30:171-180. 22. Ainsworth BE, Haskell WL, Leon AS, Jacobs DRJr, Montoye HJ, Sallis JF, et al.: Compendium of physical activities: Classification of energy costs of human physical activities. Med Sci Sports Exerc 1993, 25:71-80. 23. Anderson B, Elley CR: Energy expenditure and cardiovascular risk estimation Auckland: University of Auckland and Pinnacle Independent Practitioners' Association; 2002. 24. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, et al.: Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992, 305:160-164. 25. Scott KM, Tobias MI, Sarfati D, Haslett SJ: SF-36 health survey reliability, validity and norms for New Zealand. Aust N Z J Public Health 23:401-406. 26. McHorney CA: Measuring and monitoring general health status in elderly persons: Practical and methodological issues in using the SF-36 Health Survey. Gerontol 1996, 36:571-583. 27. Laforge RG, Rossi JS, Prochaska JO, Velicer WF, Levesque DA, McHorney CA: Stage of regular exercise and health-related quality of life. Prev Med 1999, 28:349-360. 28. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al.: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49:M85-94. 29. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Eng J Med 1995, 332:556-561. 30. Studinski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, et al.: Physical performance measures in the clinical setting. J Am Geriatr Soc 2003, 51:314-322. 31. Sheikh JJY: Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol 1986, 5:165-173. 32. The Euro Qol Group: EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990, 16:199-208. 33. Brazier JE, Walters SJ, Nicholl JP, Kohler B: Using the SF-36 and EuroQol on an elderly population. Qual Life Res 1996, 5:195-204. 34. Tidermark J, Bergstrom G, Svensson O, Tornkvist H, Ponzer S: Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fractures. Qual Life Res 2003, 12:1069-1079. 35. Schofield G, Mummery K, Brown W, Eakin L: Pedometer use in the context of the 10,000 Steps Rockhampton project: Results from a population project. J Sci Med Sport 2004, 7(Suppl 4):44. 36. Twisk JWR: Applied Longitudinal Data Analysis for Epidemiology Cambridge: Cambridge University Press; 2003. 37. Twisk J, de Vente W: Attrition in longitudinal studies. How to deal with missing data. J Clin Epidemiol 2002, 55:329-337. 38. Dupont WD: Statistical Modelling for Biomedical Researchers: A Simple Introduction to the Analysis of Complex Data. Cambridge: Cambridge University Press; 2002.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Trial registration.: Australian and New Zealand Clinical Trials Registry ACTRN012606000023550

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
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Created: Thu, 21 Jan 2010, 14:39:44 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work