Promoting physical activity in older people in general practice: ProAct65+cluster randomised controlled trial

Background Regular physical activity reduces falls, hip fractures, and all-cause mortality, but physical activity levels are low in older age groups. Aim To evaluate two exercise programmes promoting physical activity among older people. Design and setting Pragmatic three-arm, parallel-design cluster randomised controlled trial involving 1256 people aged >= 65 years (of 20 507 invited) recruited from 43 general practices in London, Nottingham, and Derby. Method Practices were randomised to the class-based Falls Management Exercise programme (FaME), the home-based Otago Exercise Program (OEP), or usual care. The primary outcome was the proportion reaching the recommended physical activity target 12 months post-intervention. Secondary outcomes included falls, quality of life, balance confidence, and costs. Results In total, 49% of FaME participants reached the physical activity target compared with 38% for usual care (adjusted odds ratio 1.78, 95% confidence interval [CI] = 1.11 to 2.87, P = 0.02). Differences between FaME and usual care persisted 24 months after intervention. There was no significant difference comparing those in the OEP (43% reaching target at 12 months) and usual-care arms. Participants in the FaME arm added around 15 minutes of moderate-to-vigorous physical activity per day to their baseline level; this group also had a significantly lower rate of falls (incident rate ratio 0.74, 95% CI = 0.55 to 0.99, P = 0.042). Balance confidence was significantly improved in both intervention arms. The mean cost per extra person achieving the physical activity target was 1740 pound. Attrition and rates of adverse reactions were similar. Conclusion The FaME programme increases self-reported physical activity for at least 12 months post-intervention and reduces falls in people aged >= 65 years, but uptake is low. There was no statistically significant difference in reaching the target, or in falls, between the OEP and usual-care arms.