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Table 3 Components of the complex intervention for the PACE-UP trial

From: PACE-UP (Pedometer and consultation evaluation - UP) – a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45–75 years: study protocol for a randomised controlled trial

Components

What was provided

Group receipt of components

Additional detail on components

Pedometer

Yamax Digi-Walker (Tokyo, Japan) SW-200 model

Pedometer by post group (sent by post with instructions).

Yamax Digi-Walker is the criterion pedometer with best accuracy[7274]. The CW200 model is used for baseline target setting, because of 7-day memory of consecutive daily steps, but is bulky to wear and complicated to use. For the intervention groups we are using the SW-200 model, which is compact, cheaper and simpler. It provides direct step-count to participants and requires daily manual recording and re-setting.

Pedometer plus support group (given by nurse to patients with instructions).

Patient handbook, walking plan and diary

Patient handbook to support 12-week walking programme. Suggested individualised walking plan (Figure 2). Diary to record weekly PA for 12 weeks (step-count and walks) and whether walking targets have been met each week.

Pedometer by post group (sent by post).

Participants’ baseline average daily step-count (from blinded pedometer assessment) is recorded in the individual’s handbook and diary. Participants have been informed that adding in 3,000 steps/day (approximately equivalent to a 30-minute brisk walk) on 5 or more days weekly to their baseline would help them achieve the recommended PA guidelines, but that this can be built up gradually. The handbook provides advice on the health benefits of at least moderate intensity PA and states that moderate intensity PA makes you warm and a bit breathless and increases your heart rate, but that you should still be able to talk. The handbook and diary provide written advice on maintaining activity, and anticipating and managing setbacks. Table 1 lists the BCTs[58] included in the PACE-UP patient handbook and diary, respectively.

Pedometer plus support group (given by nurse to patients).

Practice nurse PA consultations

Three individually tailored PA consultations with the practice nurse. Participants can be seen individually or as a couple.

Pedometer plus support group only.

Session timings, content and planned BCTs[58] (Table 2). Most BCTs overlap with those in the patient handbook and diary to reinforce consultations. The face-to-face nurse consultation allows some additional BCTs to be used; e.g., communication strategies to overcome resistance and promote patient-led change using motivational interviewing techniques and a scale to check confidence levels and build confidence to make change. In the first consultation, the nurse provides the pedometer, patient handbook and diary. The patient’s baseline blinded pedometer average daily step-count is reviewed alongside health and anthropometric data, so that an individual PA plan, tailored to baseline step-count, abilities, health and goals and based on increasing walking and walking speed and other existing PA, can be produced. The nurse shows participants how to use the pedometer and how to record step-counts. Individual tailoring of step-count increase and how fast to increase this is possible. Participants are asked to wear a pedometer and keep daily step-count diary for 4 weeks, until their next appointment. If goals have been achieved new goals can be set, if not, then problems and barriers can be discussed. For couples, both individual goals and opportunities to increase their PA together will be discussed.