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Promoting physical activity in older people in general practice: ProAct65+ cluster randomised controlled trial [with consumer summary]
Iliffe S, Kendrick D, Morris R, Griffin M, Haworth D, Carpenter H, Masud T, Skelton DA, Dinan-Young S, Bowling A, Gage H, ProAct65+ Research Team
British Journal of General Practice 2015 Nov;65(640):e731-e738
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; 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*

BACKGROUND: Regular physical activity reduces falls, hip fractures, and all-cause mortality, but physical activity levels are low in older age groups. AIM: To evaluate two exercise programmes promoting physical activity among older people. DESIGN AND SETTING: Pragmatic three-arm, parallel-design cluster randomised controlled trial involving 1,256 people aged > 65 years (of 20,507 invited) recruited from 43 general practices in London, Nottingham, and Derby. METHOD: Practices were randomised to the class-based Falls Management Exercise programme (FaME), the home-based Otago Exercise Program (OEP), or usual care. The primary outcome was the proportion reaching the recommended physical activity target 12 months post-intervention. Secondary outcomes included falls, quality of life, balance confidence, and costs. RESULTS: In total, 49% of FaME participants reached the physical activity target compared with 38% for usual care (adjusted odds ratio 1.78, 95% confidence interval (CI) 1.11 to 2.87, p = 0.02). Differences between FaME and usual care persisted 24 months after intervention. There was no significant difference comparing those in the OEP (43% reaching target at 12 months) and usual-care arms. Participants in the FaME arm added around 15 minutes of moderate-to-vigorous physical activity per day to their baseline level; this group also had a significantly lower rate of falls (incident rate ratio 0.74, 95% CI 0.55 to 0.99, p = 0.042). Balance confidence was significantly improved in both intervention arms. The mean cost per extra person achieving the physical activity target was 1,740. Attrition and rates of adverse reactions were similar. CONCLUSION: The FaME programme increases self-reported physical activity for at least 12 months post-intervention and reduces falls in people aged > 65 years, but uptake is low. There was no statistically significant difference in reaching the target, or in falls, between the OEP and usual-care arms.

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