Older patients receptive to exercise counseling

Medical Tribune Malaysia July 2008 P26
David Brill

Counseling can be an effective way of encouraging older primary care patients to engage in physical activity at home, according to a study of American veterans.

Participants who attended brief individually-tailored counseling sessions with a nurse later reported spending more time walking and performing strength exercises than those who received non-specific advice based on educational brochures.

The performance of strength exercises was also associated with improvements in general health, vitality and physical function.

Dr. Sitoh Yih Yiow, a consultant physician and geriatrician at Mount Elizabeth Medical Centre, Singapore, said: “Interventions that help to promote appropriate physical activity that is targeted and safe have been consistently shown to be beneficial in terms of improving general health, reduction of falls risk and improvement in physical and cognitive function.”

Sitoh said he would advise primary care doctors who deal with elderly patients to adopt similar counseling strategies, but added that it is important to consider factors such as arthritis and balance or visual problems that may be present in some individuals.

The study, led by Dr. Patricia Dubbert from the Veterans Affairs Medical Center in Jackson, Mississippi, lasted for 10 months and involved 224 males aged from 60 to 85. [Arch Intern Med
2008;168(9):979-86]

After five months, those randomized to receive counseling reported walking for an average of
64.5 min over the preceding week compared to 19.2 min when questioned at baseline. They also reported spending an average of 44.6 min/week on strength exercises, compared to 9.2 min at baseline. At 10 months these activity times had decreased to 60.6 and 41.2 min/week, respectively – still significantly higher than when the study began.

All patients in the study had met with a nurse at baseline, one month and five months – with these sessions differing according to the two study protocols. Those in the intervention group
were given specific exercises and equipment based on a US National Institute on Aging workbook, negotiated new goals and targets at each session, and received a short phone call a week later to discuss any problems. Non-intervention patients selected educational topics to discuss with the nurse, but did not receive specific instructions or phone calls.