Simon Moyes

Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial.

Objective To assess the effectiveness of a primary care based programme of exercise on prescription among relatively inactive women over a two year period. Design Randomised controlled trial. Setting 17 primary care practices in Wellington, New Zealand Participants 1089 women aged 40-74 not undertaking 30 minutes of moderate intensity physical activity on at least five days of the week Intervention Brief physical activity intervention led by nurse with six month follow-up visit and monthly telephone support over nine months. Main outcome measure Physical activity assessed at baseline and 12 and 24 months. Secondary outcomes were quality of life (SF-36), weight, waist circumference, blood pressure, concentrations of fasting serum lipids, glycated haemoglobin (HbA1c), glucose, insulin, and physical fitness. Results Mean age was 58.9 (SD 7) years. Trial retention rates were 93% and 89% at 12 and 24 months, respectively. At baseline, 10% of intervention participants and 11% of control participants were achieving 150 minutes of at least moderate intensity physical activity a week. At 12 months rates increased to 43% and 30% and at 24 months to 39.3% and 32.8% (P<0.001), respectively. SF-36 physical functioning (P=0.03) and mental health (P<0.05) scores improved more in intervention compared with control participants, but role physical scores were significantly lower (P<0.01). There were no significant differences in clinical outcomes. More falls (P<0.001) and injuries (P=0.03) were recorded in the intervention group. Conclusions This programme of exercise on prescription increased physical activity and quality of life over two years, although falls and injuries also increased. This finding supports the use of exercise on prescription programmes as part of population strategies to reduce physical inactivity. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ANZCTRN012605000490673.

Effectiveness of a Falls‐and‐Fracture Nurse Coordinator to Reduce Falls: A Randomized, Controlled Trial of At‐Risk Older Adults

OBJECTIVES: To assess the effectiveness of a community‐based falls‐and‐fracture nurse coordinator and multifactorial intervention in reducing falls in older people.

Home-based activity program for older people with depressive symptoms: DeLLITE--a randomized controlled trial.

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODS We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months’ follow-up. RESULTS The mean age of the participants was 81 years, and 59% were women. All participants scored in the at–risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSION The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.

Life and Living in Advanced Age: A Cohort Study in New Zealand -Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

BackgroundThe number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand.Methods/designA total population cohort study of those of advanced age. Two cohorts of equal size, Māori aged 80–90 and non-Māori aged 85, oversampling to enable sufficient power, were enrolled. A defined geographic region, living in the Bay of Plenty and Lakes District Health Board areas of New Zealand, defined the sampling frame. Rūnanga (Māori tribal organisations) and Primary Health Organisations were subcontracted to recruit on behalf of the University. Measures - a comprehensive interview schedule was piloted and administered by a trained interviewer using standardised techniques. Socio-demographic and personal history included tribal affiliation for Māori and participation in cultural practices; physical and psychological health status used standardised validated research tools; health behaviours included smoking, alcohol use and nutrition risk; and environmental data included local amenities, type of housing and neighbourhood. Social network structures and social support exchanges are recorded. Measures of physical function; gait speed, leg strength and balance, were completed. Everyday interests and activities, views on ageing and financial interests complete the interview. A physical assessment by a trained nurse included electrocardiograph, blood pressure, hearing and vision, anthropometric measures, respiratory function testing and blood samples.DiscussionA longitudinal study of people of advanced age is underway in New Zealand. The health status of a population based sample of older people will be established and predictors of successful ageing determined.

Normative values of hip strength in adult male association football players assessed by handheld dynamometry

Chronic groin pain is a common problem in association football players. Normative values for the strength of hip muscles, measured in an accurate and accessible manner, are needed to gauge strength and inform return to play decisions in this group. The purpose of this study was to define normative values of hip muscle strength using handheld dynamometry. A series of reliable clinical tests that are commonly used when making return to sport decisions in athletes with chronic adductor related groin pain have been selected. One hundred and twenty adult male association football players, free from injury, were recruited. Isometric strength of the hip flexors and adductor muscles was measured using a handheld dynamometer. Mean age was 24.9 years (SD 5.9). Eighty participants (67%) had experienced groin pain in the past. Mean strength for dominant leg hip flexion was 47.3 kg (95% confidence interval 45.6-49.0), non-dominant leg hip flexion was 42.5 kg (41.1-43.9), adduction at 0 degrees hip flexion was 35.6 kg (34.1-37.1), adduction at 45 degrees was 32.0 kg (30.9-33.1), and adduction at 90 degrees was 25.5 kg (24.4-26.5). This study establishes reference ranges and predictive equations for maximal isometric contraction strength of the hip muscles in non-injured adult male association football players. This information will assist assessment and management of an athletes return to play following injury.

DeLLITE Depression in late life: an intervention trial of exercise. Design and recruitment of a randomised controlled trial

BackgroundPhysical activity shows potential in combating the poor outcomes associated with depression in older people. Meta-analyses show gaps in the research with poor trial design compromising certainty in conclusions and few programmes showing sustained effects.Methods/designThe Depression in Late Life: an Intervention Trial of Exercise (DeLLITE) is a 12 month randomised controlled trial of a physical activity intervention to increase functional status in people aged 75 years and older with depressive symptoms. The intervention involves an individualised activity programme based on goal setting and progression of difficulty of activities delivered by a trained nurse during 8 home visits over 6 months. The control group received time matched home visits to discuss social contacts and networks. Baseline, 6 and 12 months measures were assessed in face to face visits with the primary outcome being functional status (SPPB, NEADL). Secondary outcomes include depressive symptoms (Geriatric Depression Scale), quality of life (SF-36), physical activity (AHS Physical Activity Questionnaire) and falls (self report).DiscussionDue to report in 2008 the DeLLITE study has recruited 70% of those eligible and tests the efficacy of a home based, goal setting physical activity programme in improving function, mood and quality of life in older people with depressive symptomatology. If successful in improving function and mood this trial could prove for the first time that there are long term health benefit of physical activity, independent of social activity, in this high risk group who consume excess health related costs.Trial registrationAustralian and New Zealand Clinical Trials Register ACTRN12605000475640

Cost-effectiveness of exercise on prescription with telephone support among women in general practice over 2 years

Aim To assess the cost-effectiveness of exercise on prescription with ongoing support in general practice. Methods Prospective cost-effectiveness study undertaken as part of the 2-year Womens lifestyle study randomised controlled trial involving 1089 ‘less-active’ women aged 40–74. The ‘enhanced Green Prescription’ intervention included written exercise prescription and brief advice from a primary care nurse, face-to-face follow-up at 6 months, and 9 months of telephone support. The primary outcome was incremental cost of moving one ‘less-active’ person into the ‘active’ category over 24 months. Direct costs of programme delivery were recorded. Other (indirect) costs covered in the analyses included participant costs of exercise, costs of primary and secondary healthcare utilisation, allied health therapies and time off work (lost productivity). Cost–effectiveness ratios were calculated with and without including indirect costs. Results Follow-up rates were 93% at 12 months and 89% at 24 months. Significant improvements in physical activity were found at 12 and 24 months (p<0.01). The exercise programme cost was New Zealand dollars (NZ

Engagement and recruitment of Māori and non-Māori people of advanced age to LiLACS NZ

) 93.68 (€45.90) per participant. There was no significant difference in indirect costs over the course of the trial between the two groups (rate ratios: 0.99 (95% CI 0.81 to 1.2) at 12 months and 1.01 (95% CI 0.83 to 1.23) at 24 months, p=0.9). Cost–effectiveness ratios using programme costs were NZ

An association between ethnicity and cardiovascular outcomes for people with Type 2 diabetes in New Zealand

687 (€331) per person made ‘active’ and sustained at 12 months and NZ

Derivation and Validation of a Renal Risk Score for People With Type 2 Diabetes

1407 (€678) per person made ‘active’ and sustained at 24 months. Conclusions This nurse-delivered programme with ongoing support is very cost-effective and compares favourably with other primary care and community-based physical activity interventions internationally.