PACE-UP primary care walking programme

Older couple walking

08 November 2019

Dr Brian Johnson, RCGP Physical Activity and Lifestyle Project Team

The RCGP Physical Activity and Lifestyle toolkit, launched earlier this year, gives GPs the tools and knowledge to promote physical activity and lifestyle in their consultations. This is an important step to help reduce the burden of chronic disease in the UK population.

There is a global target for all countries to reduce inactivity by 10% in 2025 to stem the rise in non-communicable diseases. But how practically can we do this when many people have an increasingly sedentary lifestyle? This is where PACE UP, an evidence-based programme designed to increase walking in adults, provides an exciting intervention. It is entirely suitable for implementing into primary care and is included in the Physical Activity and Lifestyle toolkit – you can find it under ‘Resources and guidance for patients’.

How will this help?

PACE-UP was a randomised controlled trial of a 12-week pedometer intervention to increase walking in adults and older adults aged 45-75 years. Conducted in seven general practices, patients were given a pedometer, a physical activity diary and a handbook for a 12-week programme based on effective behaviour change techniques, to increase their walking.

Although many trials demonstrate short-term success in increasing physical activity, effects are rarely maintained. PACE-UP demonstrated sustained, long-term effects.

The intervention aimed to gradually increase both the frequency and intensity of walking, starting from the patient’s own baseline. There were two intervention groups, with materials either being posted out, or provided by practice nurses, as part of three nurse-supported physical activity consultations. Whilst the nurse-supported group did better in the short-term (three months), by 12 months both intervention groups were doing significantly better than controls, with no difference between postal and nurse groups.

Both intervention groups had similar sustained effects at three-year follow-up, with participants still doing around an extra 30 minutes of objectively measured moderate-to-vigorous physical activity weekly (up around a third on their baseline). Qualitative evaluation showed the intervention was acceptable and enjoyable for participants, with many talking about how they had changed long-term habits.

This programme can increase physical activity levels over the long term and lead to real health gains

The increase in physical activity levels was large enough to affect important health outcomes. Intervention groups had significantly fewer cardiovascular events and fractures at four years, with approximate ‘numbers-needed-to-treat’ to prevent one cardiovascular event, 60, and one fracture, 28. If the three-year physical activity increases were sustained long-term, both heart disease and overall deaths would be reduced by about 4%.

This trial’s success in maintaining physical activity levels long-term is thought to be due to the individual goal-setting, walking diary and daily step-count recording. This self-monitoring focuses people to realise what they have or have not achieved, making them think of their next day and plan how to move more. Spread over twelve weeks, this created a habit, which results confirm that many kept.

If implemented in your practice correctly this programme can increase physical activity levels over the long term and lead to real health gains.

Trial details, interventions, research publications and full trial report can be found on the publications section of the PACE UP website. 

The diary, handbook and walking planner can be found on materials section - see 'for use by adults and older adults wanting to increase their walking'.  

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