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Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence.

Purpose

We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes.

Methods

Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms.

Results

Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms.

Conclusions

We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.

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Acknowledgments

The research was supported by a Public Health Service Grant R01AG021010 from the National Institute on Aging (King) and a Public Health Service Training Grant 5T32HL007034 from the National Heart, Lung, and Blood Institute. The authors thank Carolyn Prosak, Catharine Cassayre, Julia Wu, Arturo Fernandez, Susannah Belding, and Sarah French for implementing the interventions; Dr. Leslie Pruitt and Stephanie Koltiska for their work with respect to study evaluations; and Dr. Judith Prochaska for comments on the manuscript.

Conflict of Interest

The authors have no conflicts of interest to disclose.

Author information

Author notes

  1. Matthew P. Buman PhD & Eric B. Hekler PhD

    Present address: Arizona State University, Phoenix, AZ, USA

  2. Guido G. Urizar Jr PhD

    Present address: California State University, Long Beach, CA, USA

Authors and Affiliations

  1. Department of Health Research & Policy and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Abby C. King PhD

  2. Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Cynthia M. Castro PhD, Matthew P. Buman PhD, Eric B. Hekler PhD, Guido G. Urizar Jr PhD & David K. Ahn PhD

  3. Stanford Prevention Research Center, 1070 Arastradero Road Suite 100, Palo Alto, CA, 94304-1334, USA

    Abby C. King PhD

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Correspondence to Abby C. King PhD.

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King, A.C., Castro, C.M., Buman, M.P. et al. Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial. ann. behav. med. 46, 157–168 (2013). https://doi.org/10.1007/s12160-013-9501-y

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