Project LIFE Modules:  Changing the PACE for Seniors

Project LIFE Protocols for Physical Activity Counseling for Seniors

Physical activity is critically important in the maintenance of optimal health. This is particularly true for older adults who often have chronic diseases that can be prevented or improved by being regularly active. Primary care providers can favorably influence lifestyle choices made by their patients and should assume the role of positive advocates of physical activity.

The PACE protocols (Patient centered Assessment and Counseling) were developed in the 1990's to help primary care physicians counsel their patients to become more physically active. Designed initially as a guide for brief counseling for use in busy clinic setting, the PACE Project has grown to encompass ongoing research aimed at developing tools that health care providers, health care systems and individuals can use to make initial and sustained improvements in physical activity, diet and other lifestyle behaviors.

Researchers at the Durham VA Medical Center worked closely with PACE investigators to modify the PACE protocols to meet the special needs of the older adult. Participants in Project LIFE (Leisure time activity counseling to Improve Fitness in Elders) used these protocols with demonstrable short-term improvements in physical activity, in particular if supplemented with telephone follow-up.

These protocols are designed to help providers deliver the right message to the right patient in an efficient and structured manner. Using state of the art behavioral theory, the PACE/LIFE protocols walk you through a simple and effective way to deliver standardized, yet individualized physical activity counseling. They will assist the provider in overcoming common barriers to physical activity counseling such as lack of knowledge about exercise, lack of training in health promotion and counseling, and lack of time in a clinic setting to adequately counsel patients.¹

The protocols consist of three basic protocols organized around different stages of readiness to become more physically active. All of the forms are to be filled out by the client with a small section at the end for provider endorsement. The provider is charged with reviewing the information given, determining its suitability, and encouraging and endorsing the selected activities.

¹Project PACE, Centers for Disease Control, Cardiovascular Health Branch, Atlanta, Georgia, 1992

Modules:

• Physical Activity Assessment Form (25 KB, MS Word)
  This initial physical activity assessment form determines a patient's current desire to adopt or maintain physical activity. Each client selects a statement that best describes his/her current level of physical activity and is given a corresponding score. The score identifies the most appropriate counseling protocol, which are categorized into three different stages of readiness to be physically active.
• Getting Out of Your Chair (36 KB, MS Word)
  Score = 1: "Getting Out of Your Chair" is aimed at the individual not currently active who has no plans to become active in the near future (precontemplator). Counseling is brief and focuses on potential benefits of becoming more physically active.
• Planning the First Step (37 KB, MS Word)
  Scores = 2-4: "Planning the First Step" is aimed at individuals who are not active or are irregularly active who are interested in starting a program (contemplators). This protocol is more detailed and designed to help a client specify an initial exercise program. Specific details are incorporated into a realistic program, barriers are addressed, and social support is encouraged.
• Planning the First Step Plus (35 KB, MS Word)
  Planning the First Step Plus" is similar to "Planning the First Step" but specifically cues the patient to incorporate elements of strength exercises into the physical activity routine; something we consider critical to maintenance of physical function among the frailer patients.
• Keeping the Pace (33 KB, MS Word)
  Score = 5-6: "Keeping the PACE" is aimed at encouraging patients who are already regularly active (maintenance).