Determinants of high and low attendance to diet and exercise interventions among overweight and obese older adults - Results from the arthritis, diet, and activity promotion trial

Maastricht University, Maestricht, Limburg, Netherlands
Contemporary Clinical Trials (Impact Factor: 1.99). 06/2006; 27(3):227-37. DOI: 10.1016/j.cct.2005.11.002
Source: PubMed

ABSTRACT Determinants of adherence to lifestyle regimens are ill understood. Attendance to intervention sessions is crucial for patients to acquire knowledge and skills regarding the core elements of an intervention. Therefore, we explored demographic, health-related, and social determinants of high and low attendance to diet and exercise sessions among overweight and obese patients with knee osteoarthritis (> or = 60 years; N = 206).
The Arthritis, Diet, and Activity Promotion Trial was an 18-month randomized controlled trial on the effectiveness of dietary weight loss and exercise interventions. We conducted chi-square and t-tests, and logistic regression analyses on categories of short- and long-term attendance to intervention sessions.
Over the 18-month duration of the study, 60.7% (+/- 28.5) of diet sessions, and 53.2% (+/- 29.0) of exercise sessions were attended. Not being married, low social participation, and single intervention randomization predicted high attendance to diet sessions during months 1-4. Exercising at home, and single intervention randomization predicted high attendance to exercise sessions during months 5-18. High attendance to sessions early in the intervention was a significant determinant of high session attendance thereafter.
Offering people a choice where to exercise, and stimulating early intervention session attendance can be effective in improving long-term attendance to both interventions. Several determinants we found may be amenable to change to enhance intervention adherence of future randomized controlled trials involving dietary weight loss and/or physical exercise.

  • Source
    • "Baseline behaviour ' Brenes et al . ( 1998 ) , Litt et al . ( 2002 ) , McAuley et al . ( 2003 ) , Oman and King ( 1998 ) , Rejeski et al . ( 1997 ) , Sharpe and Connell ( 1992 ) , van Gool et al . ( 2006 ) Smoking behaviour 0 Dubbert et al . ( 2002 ) , Garcia and King ( 1991 ) , van Gool et al . ( 2006 ) ( King et al . ( 1991 , 1997 ) , Leung et al . ( 2007 ) Drinking behaviour 0 van Gool et al . ( 2006 ) Psychological determinants Pre - motivational Exercise knowledge ' Hopman - Rock et al . ( 2005 ) Motivational Self - efficacy 0 Brenes et al . ( 1998 ) , Burke et al . ( 2007 ) , Damush et al . ( 2001 ) , Hopman - Rock et al . ( 200"
    [Show abstract] [Hide abstract]
    ABSTRACT: Understanding the determinants of changing physical activity among older adults is crucial for effective intervention development. The aim of this study was to review and update the evidence relating to the determinants of physical activity initiation and maintenance among older adults, and to explore the main similarities and dissimilarities in determinants between the two phases. Only longitudinal and experimental studies were used to assess the level of evidence. Fifty-nine longitudinal observational and experimental studies were identified. Recent studies were identified that focused on some recently developed concepts, especially in the field of the post-motivational concepts and several environmental determinants in predicting physical activity initiation and maintenance. Furthermore, dissimilarities were found in determinants between physical activity initiation and maintenance. It can be concluded that determinants are to a large degree phase-specific, which should be taken into account during further investigation, theory development and intervention development. Further investigation is needed to study the importance of promising concepts, such as post-motivational and environmental determinants. Recommendations for further empirical research, theory development and intervention development are outlined in this review.
    Health Psychology Review 09/2009; 3(2):147-207. DOI:10.1080/17437190903229462 · 2.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Osteoarthritis (OA) is a chronic disease that disables many aging adults. People with OA are often asked to adhere to prescribed exercise regimens that must be undertaken in the presence of pain and other disease-related symptoms. We conducted a review of literature that focused on what is known about exercise adherence and the factors that influence exercise adherence among people with OA. Results revealed multiple determinants of exercise adherence; however, these determinants have not been carefully studied in the context of exercise adherence and OA. Almost all studies of exercise adherence among people with OA are short-term and do not use validated measures of adherence. Moreover, poor adherence is the most compelling explanation for the declining impact of the benefits of exercise over time. We conclude that interventions to enhance self-efficacy, social support, and skills in long-term monitoring of progress are necessary to foster exercise adherence among people with OA.
    Journal of aging and physical activity 11/2005; 13(4):434-60. · 1.41 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This review aims to assess by meta-analysis of randomised controlled trials (RCTs) changes in pain and function when overweight patients with knee osteoarthritis (OA) achieve a weight loss. Systematic searches were performed and reference lists from the retrieved trials were searched. RCTs were enclosed in the systematic review if they explicitly stated diagnosis of knee OA and reported a weight change as the only difference in intervention from the control group. Outcome Measures for Arthritis Clinical Trials III outcome variables were considered for analysis. Effect size (ES) was calculated using RevMan, and meta-regression analyses were performed using weighted estimates from the random effects analyses. Among 35 potential trials identified, four RCTs including five intervention/control groups met our inclusion criteria and provided data from 454 patients. Pooled ES for pain and physical disability were 0.20 (95% CI 0 to 0.39) and 0.23 (0.04 to 0.42) at a weight reduction of 6.1 kg (4.7 to 7.6 kg). Meta-regression analysis showed that disability could be significantly improved when weight was reduced over 5.1%, or at the rate of >0.24% reduction per week. Clinical efficacy on pain reduction was present, although not predictable after weight loss. Meta-regression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime. The analysis supported that a weight loss of >5% should be achieved within a 20-week period--that is, 0.25% per week.
    Annals of the Rheumatic Diseases 05/2007; 66(4):433-9. DOI:10.1136/ard.2006.065904 · 10.38 Impact Factor
Show more