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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)

Objectives:
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.

Methods:
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.

Results:
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.

Implications:
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.

Impacts:
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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