Improving aerobic fitness in older adults: Effects of a physician-based exercise counseling and prescription program

Robert J. Petrella; Chastity N. Lattanzio; Sheree Shapiro; Tom Overend

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Figure 1.
Flow of patients through the study

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Table 1.

Patient demographic and clinical characteristics at baseline: Comparisons of continuous means were performed using ANOVA; comparisons of categorical variables were performed using χ² analysis.

CHARACTERISTICS	STEPS (N= 193)	CONTROL (N = 167)	PVALUE
Mean (SD) age, y	64.2 (7.4)	65.8 (6.7)	.040
• Men	65.3 (7.5)	66.5 (7.0)	.314
• Women	63.4 (7.3)	65.2 (6.4)	.068
Sex, n (%)			.750
• Male	81 (42.0)	73 (43.7)
• Female	112 (58.0)	94 (56.3)
Dwelling, n (%)			.536
• Alone	33 (17.1)	33 (19.8)
• With spouse	146 (75.6)	124 (74.3)
• With other relative	12 (6.2)	6 (3.6)
• With friend	0 (0)	1 (0.6)
• With other person	2 (1.0)	3 (1.8)
Marital status, n (%)			.945
• Single	6 (3.1)	5 (3.0)
• Married	147 (76.2)	129 (77.2)
• Divorced	15 (7.8)	10 (6.0)
• Widowed	23 (11.9)	22 (13.2)
• Long-term companion	2 (1.0)	1 (0.6)
Education, n (%)			.400
• Elementary	8 (4.1)	30 (18.0)
• Secondary	90 (46.6)	76 (45.5)
• College	35 (18.1)	27 (16.2)
• University	38 (19.7)	21 (12.6)
• Postgraduate	22 (11.4)	13 (7.8)
Employment status, n (%)			.062
• Full-time	52 (26.9)	34 (20.4)
• Part-time	26 (13.5)	14 (8.4)
• Retired	108 (56.0)	106 (63.5)
• Unemployed	7 (3.6)	13 (7.8)
Smoking behaviour, n (%)			.607
• Never	84 (43.5)	64 (38.3)
• Former	18 (9.3)	17 (10.2)
• Current	91 (47.2)	86 (51.5)
Mean (SD) BMI, kg/m²	26.62 (5.01)	29.07 (5.60)	.414
Mean (SD) HR_rest, beats/min	71.9 (10.3)	72.9 (9.9)	.356
Mean (SD) SBP_rest, mm Hg	133.2 (16.3)	133.6 (14.9)	.800
Mean (SD) DBP_rest, mm Hg	77.5 (8.9)	78.6 (9.3)	.254
Mean (SD) EE, kcal/kg/d	32.91 (1.02)	33.08 (1.01)	.106
Step test
• Mean (SD) pVO_2max, mL/kg/min	30.50 (7.82)	31.02 (8.21)	.550
• Mean (SD) HR_max, beats/min	107.2 (18.7)	109.1 (20.3)	.591
• Mean (SD) stepping time, s	94.68 (23.54)	92.03 (23.32)	.300
• Mean (SD) RPE, Borg score	3.5 (1.5)	3.5 (1.8)	.815

ANOVA—analysis of variance, BMI—body mass index, DBP_rest—resting diastolic blood pressure, EE—energy expenditure, HR_max—maximum heart rate, HR_rest—resting heart rate, pVO_2max—predicted maximal oxygen consumption, RPE—rate of perceived exertion, SBP_rest—resting systolic blood pressure.

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Table 2.

Mean changes in primary and secondary outcome variables in the STEPS and control groups at 12 months

VARIABLES	*STEPS (N = 169^) MEAN CHANGE (95% CI)**	CONTROL (N = 160^†) MEAN CHANGE (95% CI)	DIFFERENCE BETWEEN GROUPS IN MEAN CHANGE (95% CI)	PVALUE FOR THE DIFFERENCE BETWEEN GROUPS
pVO_2max, mL/kg/min	3.02 (2.40 to 3.65)	2.21 (1.27 to 3.15)	0.81 (−0.29 to 1.91)	.147
HR_max, beats/min	8.27 (5.70 to 10.84)	4.22 (0.91 to 7.54)	4.05 (−0.09 to 8.18)	.055
Stepping time, s	−19.05 (−21.35 to −16.74)	−10.77 (−14.20 to −7.35)	−8.28 (−12.32 to −4.24)	< .001
RPE, Borg score	0.93 (0.61 to 1.25)	0.50 (0.18 to 0.82)	0.43 (−0.02 to 0.88)	.061
BMI, kg/m²	0.13 (−0.08 to 0.35)	−0.17 (−0.46 to 0.12)	0.30 (−0.05 to 0.66)	.095
HR_rest, beats/min	1.23 (−0.15 to 2.61)	1.70 (0.18 to 3.23)	−0.47 (−2.52 to 1.57)	.648
SBP_rest, mm Hg	−4.13 (−6.39 to −1.86)	−0.38 (−2.98 to 2.22)	−3.75 (−7.17 to −0.32)	.032
DBP_rest, mm Hg	−1.93 (−3.22 to −0.63)	−1.67 (−3.23 to −0.10)	−0.26 (−2.27 to 1.76)	.801
EE, kcal/kg/d	0.67 (0.43 to 0.91)	0.25 (0.07 to 0.42)	0.42 (0.12 to 0.72)	.006

BMI—body mass index, CI—confidence interval, DBP_rest—resting diastolic blood pressure, EE—energy expenditure, HR_max—maximum heart rate, HR_rest—resting heart rate, pVO_2max—predicted maximal oxygen consumption, RPE—rate of perceived exertion, SBP_rest—resting systolic blood pressure.
↵* In the STEPS group, 23 of the original 193 patients withdrew, and 1 died of causes not related to the study.
↵† In the control group, 6 of the original 167 patients withdrew, and 1 died of causes not related to the study.

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Table 3.

Mean changes in the STEPS and control groups at 12 months

	MEAN CHANGE IN PVO_2MAX, ML/KG/MIN (95% CI)
CHARACTERISTICS	*STEPS (N = 169^)**	CONTROL (N = 160^†)
Sex
• Men (n = 155)	2.81 (1.80 to 3.82)	3.38 (1.95 to 4.80)
• Women (n = 174)	3.20 (2.41 to 4.00)	1.23 (0.00 to 2.46)
Age, y
• < 65 (n = 179)	2.98 (2.17 to 3.79)	2.31 (0.77 to 3.87)
• ≥ 65 (n = 139)	3.10 (2.09 to 4.10)	2.11 (1.00 to 3.22)
BMI, kg/m²
• ≤ 24.9 (n = 90)	3.62 (2.03 to 5.21)	0.57 (−1.25 to 2.39)
• 25.0–29.9 (n = 129)	2.99 (2.11 to 3.87)	2.82 (1.02 to 4.61)
• ≥ 30.0 (n = 108)	2.60 (1.57 to 3.63)	3.03 (1.69 to 4.37)
Setting
• Urban (n = 166)	2.74 (1.91 to 3.58)	2.03 (0.81 to 3.24)
• Rural (n = 163)	3.34 (2.39 to 4.29)	2.35 (0.96 to 3.74)
Region
• British Columbia (n = 101)	5.36 (4.02 to 6.69)	1.67 (0.27 to 3.06)
• Alberta (n = 47)	3.17 (1.33 to 5.02)	2.14 (−0.72 to 5.00)
• Ontario (n = 118)	2.16 (1.15 to 3.18)	2.68 (1.14 to 4.23)
• Nova Scotia and New Brunswick (n = 62)	2.22 (1.22 to 3.22)	2.55 (−1.12 to 6.22)

BMI —body mass index, pVO_2max—predicted maximal oxygen consumption.
↵* In the STEPS group, 23 of the original 193 patients withdrew, and 1 died of causes not related to the study.
↵† In the control group, 6 of the original 167 patients withdrew, and 1 died of causes not related to the study.