An e-health lifestyle walking intervention partially supported by remote coaching led to significant improvement in BP in older adults as well as a desire to keep walking.
In a group of sedentary older adults with hypertension, an e-health walking intervention to increase lifestyle walking by 3000 steps per day significantly reduced both systolic and diastolic blood pressure (SBP, DBP) at 20 weeks, according to results of a small pilot study. The investigators reported decreases of 7 mm and 4 mm Hg in systolic and diastolic readings, respectively, without significant changes in diet or body weight over the course of the study.
Importantly, participants maintained their increased step count above baseline values and BP declined an additional 2 mm Hg despite minimal interaction with researchers during the second 10-week phase of the study.
The findings were published in the Journal of Cardiovascular Development and Disease.
“The increase in steps/day and the reductions in blood pressure in the present study both have the potential for substantial benefits regarding risk reduction in sedentary older adults, in addition to the overall health benefits acquired from simply meeting the physical activity guidelines,” lead author Linda Pescatello, PhD, distinguished professor of kinesiology, Neag School of Education at the University of Connecticut in Storrs, CT, and colleagues wrote.
Estimates are that 8 out of 10 adults aged 65 years and older have hypertension, placing them at significantly increased risk of cardiovascular morbidity and mortality, said the authors. Increasing physical activity is an essential component of the lifestyle modification measures typically employed first for hypertension management but participation in structured physical activity, eg, gym-based, is often impractical or impossible for older adults.
Previous research, according to Pescatello’s group, supports the benefits of “lifestyle physical activity,” in the older population, the most common being walking. Steps/day is a simple metric for older adults to understand, making it an ideal goal.
Older adults typically log an average of 4200 steps/day, investigators wrote, quite a few less than the popular public health goal of 10 000 steps/day, which may be unrealistic and difficult for the population. Further, achieving an absolute step goal may be less critical to improved health vs increasing step activity above a baseline, they added.
With the knowledge that increased activity is associated with reducing BP, Pescatello and colleagues set out to test the feasibility and effectiveness of an e-health lifestyle walking intervention for BP control in adults aged ≥65 years with hypertension (SBP, 130–159 mm Hg and/or DBP 80–99 mm Hg) or currently taking antihypertensive medication who were overweight or obese.
The study had 2 aims: First, to assess whether an extra 3000 steps/day on 5 days/week for 10 weeks effectively reduced BP. Second, to determine whether participants could maintain the extra steps and frequency during weeks 11-20. Behavior change assistance was provided during the active phase (weeks 1–10) to help reach step goals and minimal assistance was provided during the second self-maintenance phase (weeks 11–20).
The authors recruited participants via email during September and October 2020 from the Physical Activity and Aging Study (PAAS), an ongoing prospective cohort study of more than 900 older adults in central Iowa, investigating associations of physical activity and fitness with chronic disease prevention and longevity in older adults. Among the exclusion criteria was the ability to walk >8000 steps/day, a level considered active enough to reap CV benefits.
The pilot study’s single arm, within-participant design included assessments at baseline, 10 weeks, and 20 weeks during the intervention period, each lasting 8 days.
Participants received a pedometer and were asked to increase daily steps to 3000 on 3 out of 5 days during the first week and then on 5 days/week from week 2 to week 20. Steps could be accumulated throughout the day in any manner that fit their lifestyle and all other lifestyle habits were to be maintained.
A health coach was assigned to each participant and during the first 10 weeks of the intervention each received scheduled weekly video or telephone call from the coach to answer questions, collect step counts, and assist with suggestions to help meet their goals.
The final cohort numbered 21 (13 women, 8 men) with mean age of 73 years. Nineteen participants (91%) completed both the 10- and 20-week assessments. Investigators reported that participants wore the study pedometer for more than 10 hours on nearly all (97%) of the days over the full 20-week study period.
Overall, the group significantly increased average steps/day from 3899 at baseline to 6512 at the 10-week point and 5567 at 20 weeks. At 20 weeks, there were significant improvements in both SBP (137 ± 10 to 130 ± 11 mm Hg; P < .001) and DBP (81 ± 6 to 77 ± 6 mm Hg, P = .01), according to the study, the majority of the improvement occurring during weeks 1-10. Pescatello and colleagues reported the response was consistent among those taking (n = 8) and not taking (n = 13) antihypertensive medication. On average, the participants met their step goals on 43 days (86%) and 40 days (80%) during weeks 1–10 and 11–20, respectively. In addition, the participants reported going for a walk becoming more of a habit, researchers wrote.
“These results could have important implications for healthcare professionals looking for a simple yet effective strategy that can be delivered broadly via e-health technology to reduce blood pressure,” they concluded. “However, future large-scale and sufficiently powered randomized, controlled trials are warranted and necessary to verify these results.”