Randomised controlled trial of a very brief pedometer intervention to promote physical activity in preventative health checks.

Problem

Physical inactivity is the 4th leading cause of premature mortality worldwide and costs the NHS £1.6 billion each year. Very brief interventions (VBIs) (<5mins) for physical activity (PA) may have substantial public health and economic impact when delivered as part of preventative health checks. However, most physical activity interventions, designed to improve public health outcomes, are either too long or complex and not scalable to the general population.

Approach

We have developed, piloted and evaluated a number of VBIs and a pilot randomised controlled trial of three promising VBIs has been undertaken to determine which intervention to take forward here for further testing. Consistent with systematic reviews and meta-analysis of pedometer interventions the pedometer-plus VBI was considered to be the most practical and feasible, and had the greatest potential to promote change in PA. We therefore aim to estimate the effectiveness and cost-effectiveness of a very brief pedometer-plus intervention (Step-It-Up), which includes action planning, goal-setting, self-monitoring and feedback to encourage adults to increase physical activity through a face to face discussion, pedometer use and written materials. A randomised controlled trial with 1:1 individual allocation evaluates Step-It-Up (delivered in a health check) against the health check alone among adults aged 40-74 years. Follow-up is at 3-months by accelerometers and questionnaires; outcomes are objectively-measured (Actigraph accelerometers) and self-reported PA. Process measures include recall of the consultation and self-reported use of behaviour change techniques. Analysis of covariance will be used to test for intervention effects using an intention to treat approach, supported by a per protocol analysis for the primary outcome.

Findings

23 GP practices in the East of England (mean deprivation score of 17.05 (SD10.72)) recruited 1008 participants. The cohort is predominantly white British, male to female ratio is 2:3, mean age 58 (SD9.0) and 58% of the cohort is in work. Retention rates at 3-month follow-up are 80%. Follow-up will be complete by the end of March 2016. We will present the outcome at the conference.

Consequences

We have recruited a cohort which is representative of the wider population attending health checks (i.e. older adults, females and from less deprived areas). Use of various approaches including text reminders have helped to achieve good retention at three months. The VBI trial will provide evidence on the effectiveness and cost-effectiveness of the Step It Up intervention when it is delivered during NHS Health Checks and will inform policy decisions about introducing very brief interventions into routine primary care practice.