Gool CH, Penninx BWJH, Kempen GIJM, et al. 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: 1.94). 06/2006; 27(3):227-37. DOI: 10.1016/j.cct.2005.11.002
Source: PubMed


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.

Download full-text


Available from: Coen H van Gool, Oct 13, 2015
53 Reads
  • Source
    • "In the 'Arthritis, Diet and Activity Promotion Trial', 206 patients were randomised into diet and exercise interventions over 18 months [30]. Early compliance to dietary intervention occurred in isolated cases, following one advice session. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Osteoarthritis prevalence is increasing, placing greater demands on healthcare and future socioeconomic costing models. Exercise and non-pharmacological methods should be employed to manage this common and disabling disease. Expectations at all stages of disease are increasing with a desire to remain active and independent. Three key areas have been reviewed; the evidence for physical activity, lifestyle changes and motivational techniques concerning knee osteoarthritis and the barriers to instituting such changes. Promotion of activity in primary care is discussed and evidence for compliance has been reviewed. This article reviews a subject that is integral to all professionals involved with osteoarthritis care.
    Journal of Orthopaedic Surgery and Research 03/2012; 7(1):15. DOI:10.1186/1749-799X-7-15 · 1.39 Impact Factor
  • 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
    • "This results in an interaction between the allocated treatment and extraneous variables (see Figure 4) and violates the assumptions of ITT. In non-blinded randomized trials, opportunities for extraneous variables to interact with ITT increase with the length of the trial [28]. Similar to this finding in RCTs, in Mendelian randomization studies specific genotypes may interact with a range of extraneous factors and establish epigenetic changes that are inherited by subsequent generations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Instrumental variable (IV) methods have been used in econometrics for several decades now, but have only recently been introduced into the epidemiologic research frameworks. Similarly, Mendelian randomization studies, which use the IV methodology for analysis and inference in epidemiology, were introduced into the epidemiologist's toolbox only in the last decade. Mendelian randomization studies using instrumental variables (IVs) have the potential to avoid some of the limitations of observational epidemiology (confounding, reverse causality, regression dilution bias) for making causal inferences. Certain limitations of randomized controlled trials, such as problems with generalizability, feasibility and ethics for some exposures, and high costs, also make the use of Mendelian randomization in observational studies attractive. Unlike conventional randomized controlled trials (RCTs), Mendelian randomization studies can be conducted in a representative sample without imposing any exclusion criteria or requiring volunteers to be amenable to random treatment allocation.Within the last decade, epigenetics has gained recognition as an independent field of study, and appears to be the new direction for future research into the genetics of complex diseases. Although previous articles have addressed some of the limitations of Mendelian randomization (such as the lack of suitable genetic variants, unreliable associations, population stratification, linkage disequilibrium (LD), pleiotropy, developmental canalization, the need for large sample sizes and some potential problems with binary outcomes), none has directly characterized the impact of epigenetics on Mendelian randomization. The possibility of epigenetic effects (non-Mendelian, heritable changes in gene expression not accompanied by alterations in DNA sequence) could alter the core instrumental variable assumptions of Mendelian randomization.This paper applies conceptual considerations, algebraic derivations and data simulations to question the appropriateness of Mendelian randomization methods when epigenetic modifications are present. Given an inheritance of gene expression from parents, Mendelian randomization studies not only need to assume a random distribution of alleles in the offspring, but also a random distribution of epigenetic changes (e.g. gene expression) at conception, in order for the core assumptions of the Mendelian randomization methodology to remain valid. As an increasing number of epidemiologists employ Mendelian randomization methods in their research, caution is therefore needed in drawing conclusions from these studies if these assumptions are not met.
    Emerging Themes in Epidemiology 06/2009; 6(1):3. DOI:10.1186/1742-7622-6-3 · 2.59 Impact Factor
Show more