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PLoS Med. 2017 Jan 3;14(1):e1002210. doi: 10.1371/journal.pmed.1002210. eCollection 2017 Jan.

Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial.

Author information

Population Health Research Institute, St George's University of London, London, United Kingdom.
Pragmatic Clinical Trials Unit, Queen Mary's University of London, London, United Kingdom.
Gerontology and Health Services Research Unit, Brunel University, London, United Kingdom.
Research Department of Primary Care & Population Health, University College, London, United Kingdom.
Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
Health Economics Research Group, Brunel, University of London, London, United Kingdom.
10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, United Kingdom.



Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations.


A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45-75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012-2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329-955) and 677 for nurse support (95% CI 365-989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17-49) and 35 for nurse support (95% CI 19-51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation.


A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.


[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: (1) LD reports personal fees from 10-minute CBT (a commercial organisation providing behaviour change training) during the conduct of this study and outside the submitted work; (2) NA reports grants from Department of Health, Sports England, NIHR, Sheffield University, and NICE, outside the submitted work. He is/has been involved as a researcher on the following projects: Age- and lifestyle-related chronic disease and causes of death among adults with cerebral palsy in the United Kingdom. Brunel University, Research Interdisciplinary Award. An examination of the feasibility of an economic evaluation of resistance training for adolescents with cerebral palsy. Brunel University. Research idea Award. (3) JFR reports grants from NIHR, Department of Health, Sports England, MacMillan, and NICE, outside the submitted work. The other authors declare no conflicts of interest. All authors have completed the ICMJE Unified Competing Interest form (available on request from the corresponding author).

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