Is Behavior Change Sustainable for Diet, Exercise, and Medication Adherence?

Abstract

Treatment for hypertension involves following a healthy diet, exercising regularly, and taking medications. This study aimed to assess whether participants in a monthly stage of change (SOC) matched telephone intervention for 6 months would have continuing improvement in long-term (12 months) adherence to diet, exercise and medications, and systolic blood pressure (SBP) compared to two other groups. Secondary analyses sought to predict if participants who lowered their SBP more quickly and progressed more rapidly through the SOC in the first 3 months of the intervention would be more likely to have lower SBP and better adherence to diet, medication and exercise at the 12-month follow-up.;The researchers enrolled and randomized 533 veterans from the Brooklyn and Manhattan campuses of the Veteran's Administration New York Harbor Healthcare System to: i) a telephone behavioral intervention based on the transtheoretical model (the stage-matched intervention, SMI), ii) a telephone health education intervention (HEI), or iii) a usual care group (UC). SBP and measures of adherence were collected at baseline, 6-months, and 12-months.;While the SMI group improved from baseline to 6 months and it remained steady after that, it did not show significant improvement (or deterioration) between 6 and 12 months. There was a trend whereby the SMI group had slightly better outcomes at 12 months on all measures except for exercise. For the secondary hypotheses, change in SOC from baseline to 3 months predicted 12-month diet and exercise adherence, but not medication adherence. Patients with a positive change in stage of change consistently had a lower mean intake of sodium, fat, and fat in calories compared to those who had no change in stage of change. Similarly, those who had no change in stage of change had a lower mean intake of sodium, fat and fat in calories than those who had a negative change in stage of change. Change in SBP from baseline to 3 months did not predict 12 month SBP. Future studies should evaluate if booster sessions improve long-term adherence.