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Physical activity counseling inexpensive, effective in older men

Older men who enrolled in a primary care-based physical activity counseling group saw improvements in physical activity and rapid gait speed at a small fraction of their annual health care costs, according to recent findings.

“Successfully engaging adults of any age in regular, consistent physical activity can be challenging, and older individuals may face obstacles that make participation even less likely,” Patricia A. Cowper, PhD, from the department of medicine at Duke University Medical Center and Duke Clinical Research Institute, and colleagues wrote. “Physical activity programs that are initiated in the primary care setting and offer expertise and support at regular intervals by phone and other media may provide a necessary bridge for successful home-based exercise.”

Researchers enrolled 398 men aged 70 years or older  from the Veterans Affairs Medical Center in Durham, North Carolina, to evaluate the economic impact of a primary care-based physical activity counseling intervention. In this randomized trial, known as the VA-LIFE Trial, they assessed the effect of exercise counseling compared with usual care on physical performance, physical activity, function, disability, and medical resource use and cost. Each participant received baseline in-person exercise counseling, followed by telephone counseling at weeks 2, 4 and 6, and then monthly after that through 1 year. Cowper and colleagues calculated intervention costs and the incremental cost of achieving clinically significant changes in major trial endpoints.

Per participant, direct cost of the intervention totaled $459, with 85% attributed to counselor effort, and program cost plus overhead totaled $696. During follow-up, investigators found that medical costs with intervention reached $10,418, compared with $12,052 in usual care (difference = –$1,634; 95% CI –4,683 to 1,416). Between baseline and 1-year follow-up, they observed a 16% increase in combined endurance and strength activities among patients enrolled in the intervention, compared with a 2% increase in patients enrolled in usual care. The intervention cost an extra $4,971 per additional patient reaching target exercise levels. After calculating cost per unit improvement in rapid gait speed, the results showed that it cost $4,640 per patient to reach a clinically significant change.

“Although home-based programs are less intensive and less effective than center-based initiatives in improving health-related quality of life and functional status, they have the potential to reach a broader segment of the population at considerably lower cost,” Cowper and colleagues wrote. “Larger multi-site studies with longer follow-up are needed to determine the net financial impact and value of implementing a tailored home-based physical activity counseling program for older adults in a primary care setting.” – by Savannah Demko

Disclosure: Cowper reports no relevant financial disclosures.