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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3066 — Perceptions of Exercise Adherence and Response to a Transtheoretical Model-Based Behavioral Intervention to Lower Blood Pressure

Mundy LR (NY VA Harbor Healthcare System), Lin IL (NY VA Harbor Healthcare System; NYU Wagner School of Public Service), Friedberg JP (NY VA Harbor Healthcare System; NYU School of Medicine), Sathe NA (University of Chicago Pritzker School of Medicine), Cho HE (NY VA Harbor Healthcare System), Lipsitz SR (Brigham and Women’s Hospital, Harvard Medical School), Natarajan S (NY VA Harbor Healthcare System; NYU School of Medicine)

Cardiovascular exercise is an important component of hypertension treatment, however many patients have difficulty achieving exercise adherence. Additionally, inaccurate perceptions of current exercise habits or exercise self-efficacy may hinder adherence, and limit the success of interventions targeting non-adherent patients. We evaluated whether perceptions of exercise adherence were associated with self-efficacy and if such perceptions predicted the effectiveness of tailored interventions.

We enrolled and randomized hypertensive veterans (N = 533) to one of three arms: a Transtheoretical Model (TTM)-based stage-matched intervention (SMI), a non-tailored health education intervention (HEI), and usual care (UC). SMI and HEI received 6 monthly phone calls. At baseline and 6 months, a 7-Day Physical Activity Recall (PAR) was administered; participants were also asked if they performed cardiovascular exercise at least 3 times per week for at least 20 minutes each time (adherent) or not (non-adherent). Self-efficacy, or patients’ confidence to engage in exercise when faced with several barriers, was also assessed.

Among non-adherent patients at baseline (N = 143) by PAR, 45 inaccurately believed that they were exercise adherent (Group 1) while 98 had accurate perceptions of non-adherence (Group 2). Group 1 had higher baseline self-efficacy [OR = 0.897, 95% confidence interval: 0.831, 0.969] compared to Group 2 using logistic regression. Additionally, SMI was more effective in increasing exercise in Group 2, with 79.2% of SMI patients achieving exercise adherence at 6 months, compared to 63.2% of HEI and 37.1% of UC (p < 0.005 by Fisher’s exact test). For Group 1, neither arm was significantly more effective (p = 0.686) in achieving adherence.

A large proportion of non-adherent study participants (31.5%) had inaccurate perceptions of current exercise adherence, while paradoxically they exhibited high exercise self-efficacy. These patients did not respond well to SMI or HEI, while Group 2 responded well to SMI, suggesting that behavioral interventions are more effective when aimed at individuals with an accurate perception of adherence.

Identifying subgroups most responsive to TTM-based behavioral interventions is important to cost-effectively target such interventions towards appropriate individuals. Furthermore, to ensure optimal exercise improvement, future research should address issues of falsely high self-efficacy and inaccurate exercise perceptions prior to exercise counseling.

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