Counseling for home-based walking and strength exercise in older primary care patients.

BACKGROUND: We evaluated the effects of counseling linked with primary care visits on walking and "strength exercise" (the combination of strength-building and flexibility exercise) in aging veterans. METHODS: Male veterans aged 60 to 85 years (N = 224) with physical function limitations were randomized to either counseling for home-based walking and strength exercise (EXC) or discussion of their choice of health education topics (EDUC) with a nurse at baseline, 1 month, and 5 months. The EXC participants recorded exercise on monthly calendars and received brief follow-up calls from the nurse; all participants received bimonthly newsletters throughout the 10-month trial. RESULTS: Retention was 83% in the EXC group and 97% in the EDUC group (P < .001). With analyses using the last observation carried forward approach, the EXC participants reported more walking time per week at 5 and 10 months (64.5 and 60.6 min/wk, respectively, for the EXC group vs 50.5 and 45.7 min/wk, respectively, for the EDUC group; 2.4 d/wk and 2.3 d/wk, respectively, for the EXC group vs 1.8 and 1.7 d/wk, respectively, for the EDUC group) (P < .001). The EXC participants also reported more strength exercise at 5 and 10 months (44.6 and 41.2 min/wk, respectively, for the EXC group vs 19.8 and 14.7 min/wk, respectively, for the EDUC group; 2.1 and 2.0 d/wk, respectively, for the EXC group vs 0.8 and 0.8 d/wk, respectively, for the EDUC group) (P < .001). The EXC participants reported more frequent moderate- or higher-intensity physical activity (7.1 vs 5.1 sessions/wk) (P < .001). Findings from accelerometer-measured physical activity indicated more EXC than EDUC participants (64% vs 46%), who averaged 30 min/d or more of moderate- or higher-intensity physical activity (P = .03). Participants engaging in strength exercise improved physical performance and reported positive changes in quality of life. CONCLUSION: Relatively brief counseling linked with primary care visits can increase home-based walking and strength exercise in aging male veterans. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00013195.

Effects of nurse counseling on walking for exercise in elderly primary care patients.

Background. Counseling sedentary primary care patients can increase physical activity, but whether this approach will increase exercise and fitness in elderly adults with chronic diseases remains to be determined. Methods. After receiving individualized nurse counseling to begin a program of walking for health, 60- to 80-year-old primary care patients were randomized to one of three levels of telephone contacts over 10 months: (i) 20 nurse-initiated calls, (ii) 10 nurse-initiated calls plus 10 motivational calls programmed through an automated phone calling system, or (iii) no program-initiated phone contacts. Self-reported (diary) walking adherence was the primary outcome; other activity, social support, health quality of life, and measured walking performance, mobility, and body mass index and girths were also assessed during the initiation (months 1-6) and maintenance (months 7-10) phases of the trial. Results. Average adherence for the 181 participants to the goal of walking at least 20 minutes on 3 or more days per week was 44% for initiation and 42% for maintenance. Participants receiving the combination of nurse-initiated personal and automated phone calls walked significantly more frequently than those with no phone contacts. Fitness improved in all three groups; changes were generally correlated with self-reported walking. Having a companion was associated with more frequent walking. Perceived quality of physical and mental health did not change. Conclusions. Simple and relatively inexpensive nurse contacts can motivate elderly primary care patients to walk for exercise, and this activity is associated with measurable health benefits.

The Influence of Sodium Intake on Physiological Responses to Angiotensin II in Conscious Dogs.

The renin-angiotensin system (RAS) is suppressed either by high sodium intake or by high levels of angiotensin II (A II). Therefore in prior studies it has been difficult to sort out the influence on the cardiovascular homeostases of different levels of A II and different levels of sodium in the diet respectively. The present study examines the quantitative effects of A II on mean arterial blood pressure (MABP), electrolyte excretion and hormone secretion in conscious dogs on low, normal and high sodium intake with the endogenous RAS blocked with continous intravenous infusion of enalapril (MK-421). Fourteen dogs on three different Na diets, low, normal and high (5, 30 and 250 mmol/day), were infused continously with enalapril, 4 mg/kg/day and studied with superinfused A II at rates of 0, 1, 3, 6 and 12 ng/kg/min., each period lasting one week. Convening enzyme inhibitor (CEI) decreased MABP equally in dogs on low and normal sodium intake to about 80% of control, but did not have a significant effect in dogs on high sodium intake. The initial infusion of angiotensin II at the lowest rate had a pronounced effect on MABP in the normal and high sodium states, but had no effect on MABP in the sodium depleted dogs. However, at the higher rates of infusion, the angiotensin II increased the pressure to a similar degree at all levels of sodium intake. All four dogs in the high sodium group developed circulatory difficulties at the 6 or 12 ng level of A II infusion: One hemorrhaged in the feces, one developed congestive failure, and in the other two the arterial pressure remained elevated an average of 23 mm Hg after removal of all drugs. Plasma renin activity increased in all groups after CEI; however, renin secretion was suppressed by much smaller rates of angiotensin II infusion in the normal and sodium loaded dogs than in the sodium depleted dogs. CEI suppressed plasma aldosterone 30% in the low sodium dogs but by a lesser percentage in the normal sodium dogs; plasma aldosterone increased in all groups after A II. The present study indicates that when the endogenous RAS is blocked with CEI, small increments in angiotensin II infusion rate can cause almost linear increments in the chronic level of mean arterial pressure at varying levels of sodium intake. Also A II infusion and high dietary sodium can have independent effects on both plasma renin activity and plasma aldosterone concentration.