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Maintaining PA Among Older Adults 24mo Outcomes
of the Keep Active Minnesota RCT

• Brian C. Martinson, PhD, A. Lauren Crain, PhD,
  Nancy E. Sherwood, PhD, Marcia Hayes, MPH, RD,
  Nico P. Pronk, PhD, and Patrick J. OConnor,
  MD, MPH
• HealthPartners Research Foundation
• HealthPartners Health Behavior Group
• Supported by a grant from National Institute on
  Aging (R01 AG023410 )

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Purpose

• Evaluate the efficacy at 6, 12 and 24-month
  follow-up of a population-based intervention to
  promote PA maintenance among currently active
  older adults
• a phone and mail-based physical activity
  maintenance intervention
• designed for use with adults age 50 to 70 years
  who have increased their physical activity (PA)
  within the past year

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Background

• Well known benefits of PA in older adults
• Yet, older adults are particularly sedentary
• Those just starting a PA routine have particular
  difficulty sustaining it.
• Flux over time in PA levels is common

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Background

• Issues of population reach
• Most PA promotion efforts focus on PA initiation
• Complementary strategies needed
• increase PA initiation among sedentary
• help active individuals maintain PA

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Specific Aim

• Did our phone- and mail-based intervention help
  participants maintain their physical activity
  level over two-years of follow-up relative to
  usual care?
• We present the primary outcomes at the 6, 12 and
  24-month follow-up points

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Participants

• N1,049 health plan members ages 50-70
• Currently accumulating 30 mins of MVPA/d at
  least 2 d/wk in average week
• Current PA level increased within past 12 months
• Recruitment occurred from July 2004 through July
  2005
• Randomized (11) to either the treatment
  condition (KAM) or a usual care control group
  (UC)

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Participants

• Health Plan administrative data used to
  screen/recruit
• Sufficiently healthy to participate in the
  intervention
• Exclusions
• Dx of CHD, CHF, or Charlson (comorbidity) score
  gt3 in prior year
• Selected heart rhythm disturbances or a cardiac
  arrest in prior year

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Intervention

• Based primarily on Banduras Social Cognitive
  Theory (SCT) and relapse prevention theory
• Intervention self-management strategies
• cognitive
• behavioral and
• environmental

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Keep Active Minnesota Intervention Elements

• In-person orientation
• Workbook, PA logbook, pedometer
• 7 session phone course
• Monthly phone contact through 1st year
• Bi-monthly phone contact for 2nd year
• Motivational challenges

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Primary Outcome Measures

• Community Healthy Activities Model Program for
  Seniors (CHAMPS) questionnaire (Stewart, King, et
  al) to calculate primary outcomes
• Revised by dropping 2 question items appearing
  suspicious for over-reporting heavy work around
  house, heavy gardening
• Weekly kilocalorie expenditures at baseline, 6,
  12 and 24 months from moderate or vigorous
  intensity PA
• Maintenance of PA at 6, 12 and 24 months relative
  to baseline (maintenance)
• Kcal/wk 80 of baseline and 1500

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Hypotheses/Analyses

• Hypothesis 1 KAM group will maintain a higher
  absolute kcal expenditure from baseline to 6, 12
  and 24 months, relative to a drop in kcal
  expenditure among the UC control group.
• Tested using general linear mixed model
  regression
• Moderate/vigorous kcal expenditure predicted from
  time and treatment condition
• Hypothesis 2 PA maintenance at 6, 12 and 24
  months will be higher among intervention group
  participants than among those in the usual care
  group
• Tested using generalized linear mixed regression

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Results

• At baseline - typical participant was
• 57 years old
• Female
• White
• Overweight (BMI 25 kg/m2)
• Working full time
• College educated
• Good functional health status
• Only observed group difference 3 fewer in KAM
  group self-identified as White (plt.05)

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-KAM group maintains moderate PA and controls
decline (timetx p lt .001) -KAM
effect at each time point p lt .05
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-KAM group maintains moderate PA and controls
decline (timetx p lt .001) -KAM
effect at 6 24 months, p lt .05 -KAM effect at B
and 12 months, p lt .10
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-No significant time by KAM group effect (timetx
p .19) -KAM effect at 6 24
months, p lt .001 -KAM effect at 12 months, p lt
.05
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Discussion

• This relatively low intensity PA intervention for
  50 to 70 year olds may be the first to focus
  exclusively on PA maintenance
• The Keep Active Minnesota intervention appears
  successful in helping older adults maintain
  health-promoting levels of physical activity
• Preliminary SEM models suggest that KAM effect
  may be mediated by incorporating physical
  activity into the self-concept and self-efficacy

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Limitations

• Generalization to other populations should be
  pursued with caution
• We have examined and identified potential biases
  across the recruitment process
• Most notable differences were between responders
  and non-responders
• Differences were increasingly smaller as the
  recruitment and enrollment proceeded
• see our poster for more details

(Martinson, Crain, Sherwood, Hayes, Pronk,
OConnor, in press JPAH)
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Limitations

• Although this was a low-intensity intervention,
  the costs of it are not negligible
• Affordability should be considered for those
  identified as potential payers
• We have not yet conducted any cost-effectiveness
  analyses

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Conclusions

• Helping the newly active to maintain PA and
  fostering PA initiation among the sedentary
  should be pursued as complementary strategies to
  increase population activity levels
• These promising results from KAM may be an
  important contribution to overall efforts to
  increase PA in the U.S. population

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Future Directions

• PASSPORT pilot
• KAM renewal re-submission

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PASSPORT pilot progress

• Recruitment has been completed as planned
• 63 adults ages 60-80 from HP membership,
• 43 assigned to intervention
• 20 to a materials only control
• Baseline measurements included
• actigraphy monitoring
• self-reported lifestyle survey
• venipuncture blood collection
• cognitive assessment battery
• anthropometric measures (height, weight, BP)

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PASSPORT pilot progress

• Intervention process data to date
• High call completion rate
• n32 subjects completed intervention
• N9 subjects in progress
• High satisfaction with the intervention
• Evaluation progress to date
• n26 completed 6 month follow-up visits
• Anticipate completion of all six-month
  follow-ups by May 2009

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Thank you!

• Nancy Sherwood
• Nancy.E.Sherwood_at_HealthPartners.Com
• Lauren Crain
• Lauren.Crain_at_HealthPartners.Com
• Brian C. Martinson
• Brian.C.Martinson_at_HealthPartners.Com

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Discussion

• High fidelity to the intervention
• 93 of those randomized to intervention
  participated in at least one intervention phone
  call
• 82 completed the seven session phone course
• 73 completed the monthly follow-up calls and
• 60 completed the sequence of bimonthly follow-up
  calls
• Client satisfaction with the intervention was
  high at each follow up
• Excellent retention - 94 response at 6 and 12
  month follow ups and 92 at 24 month follow up
  non-differential by treatment group
• So differences observed unlikely due to
  differential drop out, and
• The intervention strategy may have wide appeal to
  eligible adults

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PASSPORT pilot progress

• Recruitment has been completed as planned
• N63 adults ages 60-80 enrolled from HP
  membership,
• N43 assigned to intervention N20 to a
  materials only control
• Baseline measurements have also been completed
  with excellent adherence to actigraphy monitoring
  and self-reported lifestyle survey completion
• Baseline clinic visits included venipuncture
  blood collection, cognitive assessment battery
  and anthropometric measures (height, weight, BP)
  also completed successfully
• Intervention is ongoing with good fidelity and is
  being well received with high satisfaction
  ratings. We have completed intervention delivery
  with N32 subjects and are currently delivering
  the intervention to N9
• High rate of course session completion
• Two subjects have quit the study
• 6mo follow-up visits completed with N26
• Anticipate completion of all six-month follow-ups
  by May 2009

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Limitations

• Generalization to other populations should be
  pursued with caution
• In prior analyses (in press see our poster
  here), we examined potential biases across the
  recruitment process
• Those responding to an initial mailed screener
  differed on demographic, behavioral, and SES
  characteristics from those not responding
• Eligible individuals were significantly younger,
  more highly educated, and more likely to report
  improved health in the prior year, compared to
  ineligibles
• Study enrollees had generally higher education
  and income than eligible individuals who did not
  enroll

(Martinson, Crain, Sherwood, Hayes, Pronk,
OConnor, in press JPAH)