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Improving aerobic fitness in older adults: effects of a physician-based exercise counseling and prescription program [with consumer summary]
Petrella RJ, Lattanzio CN, Shapiro S, Overend T
Canadian Family Physician 2010 May;56(5):e191-e200
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine the effects of adding stages of change-based counseling to an exercise prescription for older, sedentary adults in family practice. DESIGN: The step test exercise prescription stages of change counseling study was a 12-month cluster randomized trial. SETTING: Forty family practices in 4 regions of Canada. PARTICIPANTS: Healthy, community-dwelling men (48%) and women (52%) with a mean (SD) age of 64.9 (7.1) years (range 55 to 85 years). There were a total of 193 participants in the intervention group and 167 in the control group. INTERVENTION: Intervention physicians were trained to deliver a tailored exercise prescription and a transtheoretical behaviour change counseling program. Control physicians were trained to deliver the exercise prescription alone. MAIN OUTCOME MEASURES: Predicted cardiorespiratory fitness, measured by predicted maximal oxygen consumption (pVO2max), and energy expenditure, measured by 7-day physical activity recall. RESULTS: Mean increase in pVO2max was significant for both the intervention (3.02 (95% confidence interval 2.40 to 3.65) mL/kg/min) and control (2.21 (95% confidence interval 1.27 to 3.15) mL/kg/min) groups at 12 months (p < 0.001); however, there was no difference between groups. Women in the intervention group improved their fitness significantly more than women in the control group did (3.20 versus 1.23 mL/kg/min). The intervention group had a 4-mmHg reduction in systolic blood pressure, while the control group's mean reduction was 0.4 mmHg (p < 0.001). The mean (SD) energy expended significantly increased and was higher in the intervention group than in the control group (69.06 (169.87) kcal/d versus -6.96 (157.06) kcal/d, p < 0.006). Practice setting characteristics did not significantly affect the primary outcomes. CONCLUSION: The step test exercise prescription stages of change exercise and behavioural intervention improved fitness and activity and lowered systolic blood pressure across a range of Canadian practices, but this was not significantly different from the control group, which received only the exercise prescription. Women in the intervention group showed higher levels of fitness than women in the control group did; men in both groups showed similar improvement.

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